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Post operative management of brachycepahlic dogs

Talk Overview
Postoperative Management 
The animal must be closely monitored for the next 24-48 hours. At Veterinary Specialist Services / Animal Emergency Services we have a dedicated nurse cage side AT ALL TIMES. In my opinion it is negligent to leave an animal unattended in the 24 hours following BAS surgery.  
Once surgery is completed and other BAS associated problems have been treated 1-2 folded swabs are soaked in 20mld Mannitol per swap and a dose of bupivacaine which is attached to a string or tie and placed in the oropharynx.  
Extubation Our preference is to leave the dog intubated for as long as possible. We like the dog to be awake and even standing before extubation. 
Nasal Oxygen We recover all dogs on nasal oxygen. Recently however we have been using paediatric nasal prongs with great success. 
Medication Antibiotics – only used on the basis of culture and sensitivity 
Analgesia Methadone (duration of activity 4-6 hours) is used as part of the pre-med then as required based on pain scoring
Dyspnoea / increased effort As dogs recover – if they start to develop mild dyspnoea and increased effort we use some or all of the following medications:
Medetomidine – this drug has been game changer for us at VSS. We have been using micro doses of medetomidine for the past 5 years. We dilute the 1mg/ml from the bottle with saline to make it 100mg/ml – 1 in 10 dilution. 
 Adrenaline - Adrenaline is administered by nebulizer – 0.4 mg with 5mls NaCl for a 10kg animal Nebulise with saline every 4-6 hours
 Trazadone Particularly in very anxious dogs starting at 2.5-5mg/kg every 6-8 hours – not used with Tramadol 
Maropitant If nauseous – 1mg/kg once daily. 
Omeprazole 1mg/kg every 12 hours PO – for 4-6 weeks post op depending on severity of GIT signs 
Pain relief. 
Oral Bupivacaine lasts 4-5 hours. Once the animal is discharged oral opioids (Tramadol) are dispensed for 5-7 days – unless Trazadone is required in which case we use a Fentanyl patch. I avoid NSAID’s in these animals until they are eating. 
Soft food is usually offered 12 hours after recovery. Owners are advised to avoid any hard food for 2-3 weeks. 
Speakers
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Philip A Moses
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