Читать книгу Pet-Specific Care for the Veterinary Team - Группа авторов - Страница 189

Example 1: Ovariohysterectomy (OHE) in a 5‐month‐old mixed‐breed dog. Client administers trazodone at home prior to transport to hospital. Patient admitted with fear‐free and low‐stress handling techniques, premedicated with buprenorphine, midazolam intramuscularly (IM), and NSAID of choice orally (PO). Induction of anesthesia, placed on intravenous (IV) fluids, incisional block with bupivacaine. OHE proceeds with lidocaine mesovarium block. Patient discharged with three days of NSAID.

Example 2: Comminuted femoral fracture resulting in hindlimb amputation of 7‐year‐old cat. Client administers gabapentin and NSAID at home prior to transport to hospital. Patient admitted with fear‐free and low‐stress handling techniques, premedicated with combination of buprenorphine, dexmedetomidine, and ketamine IM. Induction of anesthesia, placed on IV fluids with ketamine constant rate infusion (CRI), epidural with bupivacaine via lumbosacral or sacral‐coccygeal approach. Post‐op administered long‐acting buprenorphine and discharged with NSAID and gabapentin PO.

Example 3: Cruciate repair surgery in a 6‐year‐old lab mix. Client administers NSAID and high‐dose gabapentin at home prior to transport to hospital. Patient admitted with fear‐free and low‐stress handling techniques, premedicated with hydromorphone and midazolam IM. Induction of anesthesia includes loading dose of ketamine IV, placed on IV fluids with ketamine CRI. Femoral and sciatic regional nerve block performed with bupivacaine, and IA hydromorphone. Patient prepped and surgery performed. Long‐acting (liposome‐encapsulated) bupivacaine infused into several layers of closure. Post‐op cold compression, continue ketamine ± opioid CRI for 4–6 hours. Patient discharged with NSAID, gabapentin PO, and physical rehabilitation instructions (or referral), to include therapeutic laser if available.

Example 4 : 12‐year‐old golden retriever with a BCS of 7/9 stiff in the mornings and after exercise; owner has to help up onto the couch. Physical exam reveals straight‐legged conformation and atrophy rear quarters, discomfort, physical examination, and radiographic signs consistent with hip dysplasia and advancing OA. Priority is to place patient on NSAID or PRA of choice and switched to an EPA‐rich diet formulation that also promotes weight loss to BCS of 6 and ultimately a lean 5. If owners agreeable, patient is also placed on polysulfated glycosaminoglycan, or alternatively, a high‐quality and reputable nutraceutical; exercise program implemented that includes vigorous walks and inclines but unrestricted activity is limited. If and when eventually deemed appropriate and available, choice (and/or combination of) pain‐modifying analgesic medication (e.g., amantadine, gabapentin) is prescribed as adjunct to the NSAID or PRA, IA biologic injections, and anti‐NGF mAb treatments are implemented. Acupuncture, therapeutic laser, pulsed electromagnetic field, myofascial trigger point, referral for aggressive physical rehabilitation, and other nonpharmacological modalities can be utilized at any time.