Plus-Hex CLINICAL
Antibiotics
Bourguignon et al. [ 12 ] suggest that in cases of traumatic dental injuries, antibiotics can be used at the VS ' s discretion based on the accompanying soft tissue injuries. Therefore, in this case, based on the time frame and the scale of the soft tissue injuries, antibiotics were considered justified. iatrogenic fluid overload. NIBP monitoring will help reduce the risk of fluid overload [ 2, 13 ].
In this case, either the patient could have been started on a lower rate of fluids for the whole procedure, or the rate could have been periodically lowered based on increasing NIBP readings throughout the procedure.
Pain management and fluid therapy
It is understood that animals are capable of feeling pain, with the World Small Animal Veterinary Association( WSAVA) Global Dental Guidelines [ 13 ] suggesting that this is similar to pain felt by humans. However, understanding of dental pain, in particular, in animals is weaker, with animals thought to express dental pain differently, most notably given their absence of speech [ 13 ]. Signs of dental pain can include pawing at the face, hypersalivation and hyporexia.
Appropriate use of analgesia can improve patient safety under anaesthesia [ 14 ] by lowering the risk of dose-dependent adverse effects of anaesthetic agents as well as reducing the likelihood of pain-related responses during the procedure. Both the WSAVA [ 13 ] and American Animal Hospital Association( AAHA) [ 14 ] guidelines concur that although it is not always possible to accurately assess pain in animal patients, it is important to pre-emptively treat for pain using current evidence-based methods rather than on the basis of signs of pain or absence thereof.
Using a multimodal approach to analgesia in the dental patient is recommended, especially when dental nerve blocks are harder to achieve, for example, in maxillary surgeries such as this case [ 2, 13, 14 ]. Multimodal approaches commonly include a combination of opioid analgesia and non-steroidal anti-inflammatory drugs( NSAIDs), with additional use of anxiolytics being common in neuroleptanalgesia, which is the most effective method of premedication for anaesthesia [ 13 ].
This is reflected in this case through the use of an opioid and anxiolytic combination premedication, as well as incremental use of further opioid and NSAID analgesia throughout the peri- and postoperative periods. Brock and Kruse-Elliott [ 2 ] state that the use of systemic opioids can contribute to postoperative dysphoria; however, this was not noted in this case.
Throughout both surgical procedures, the patient was maintained on IV crystalloid fluids at a rate of 5 ml / kg / hour. It is thought that dental surgical procedures rarely require such a high fluid rate and these patients could be managed appropriately on a maintenance rate of 2 – 3 ml / kg / hour due to less significant fluid losses compared with larger surgeries [ 13 ]. There may be benefit from tapering fluid rates during longer surgeries to minimise the risk of
Nutrition
Malnutrition can have a negative influence on patient outcomes in practice, including prolonged wound healing and weight loss [ 15 ]. Hyporexia or anorexia of more than 3 days ' duration is a known risk factor for malnutrition [ 15 ]. Allard et al. [ 16 ] found that hospital malnutrition is reported in up to 70 % of human patients experiencing prolonged hospital stays, with malnutrition being linked to more negative outcomes for patients. Varying hospital factors were found to play a role in this, including polypharmacy, lack of monitoring and procedures affecting food intake.
In patients with maxillofacial fractures, the monitoring of appropriate nutrition and intervention when needed is of utmost importance. Internal fixation of these fractures can lead to better postoperative nutrition and mandibular mobilisation than orthodontic methods of fracture stabilisation [ 17 ]. Enteral nutrition is preferable post-surgery, in order to maintain as much gastrointestinal function as possible and minimise enterocyte atrophy [ 18 ].
In patients with significant facial trauma, the use of oesophagostomy tubes is widely accepted as an alternative to oral nutrition due to the potential inability to prehend food and limited access to the nasopharynx for naso-oesophageal or nasogastric tube placement [ 18 ].
This patient was able to mobilise her jaw post-surgery, so oral nutrition was attempted throughout hospitalisation. According to the RER calculations, the patient should have consumed 919 kcal daily, corresponding to five meals each consisting of 168 g of Royal Canin Gastrointestinal wet food( 840 g in total per day). It is important to note that periods of hyporexia longer than 3 days have been associated with the potential for refeeding syndrome and secondary comorbidities including electrolyte and fluid abnormalities [ 19 ]. Acknowledging this, the RER for this patient on day 1 of refeeding should have been 306 kcal( one-third of the full RER), corresponding to five meals of 56 g of Gastrointestinal wet food( 281 g total on day 1).
On the first 2 days of hospitalisation the patient ' s intake fell significantly below this amount, with on average only 150 g of food in total being consumed on each of these days and intake not increasing with the accepted one-third increase per day after starting refeeding [ 20 ].
Volume 41( 4) • August 2026
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