C09979344 / invoice 10000

Nurse GA report: TD
Induction & Recovery: did x-rays under alfax so a bit twitchy on induction, did have to top up once induced which then caused him to stop breathing and so manual breathes were given for 5-10mins. No other concerns.
Nice quick recovery, no concerns.
During GA: Very low temp - due to being on x-ray table for so long before induction. Good HR and good RR once started breathing by himself. BP also good. No other concerns.

Dental S&P, Dental Xrays, Forelimb xrays

Pre-GA examination:
- Confirmed patient was fasted overnight 
- 1 week course of Rimadyl completed 16 Feb for L forelimb lameness, no lameness since. No pain on palpation today. Visible bilateral valgus of forelimbs. 
- HR 140
- RR Panting
- MM/CRT Pink, <2s
- Temp 38.2

Pre-anesthetic bloodwork: 
Borderline high BGC
Borderline low globulin 
Low platelet - clumping visualised on blood smear
Borderline low RBC/HCT - No concerns on blood smear
Ok to proceed

Premedication:
-The patient was premedicated with acepromazine 0.03mg/kg and methadone 0.3mg/kg IM.
- A 22G catheter was placed in the R cephalic vein and placed on peri-operative fluid therapy.

FL xrays
IV sedation was achieved using alfaxan to effect. 4.2ml Alfax used total for forelimb xrays. 
6 views taken: RFL antebrachium/elbow DP, RFL Elbow Flexed lateral, Elbow resting lateral, LFL Antebrachium/elbow DP, LFL Elbow Flexed lateral, LFL elbow resting lateral
No obvious evidence of elbow dysplasia bilaterally 
Evidence of angular limb deformity: Elongated/bowed Radius relative to ulna bilaterally

-The patient was induced with 1ml alfaxalone and maintained on isoflurane gaseous anesthesia via size 7.5mm ET tube. 

Dental:
- The teeth were charted for calculus, gingivitis & pocketing around each individual tooth (dental chart attached)
   - Missing teeth:  None
- The teeth were scaled and polished & the oral cavity was flushed

Dental radiographs: No concerns

- Extractions: None

Routine anesthesia and recovery. See nurse notes for details

Post-operative:
1) Home care instructions provided, can return to regular diet/routine tonight. Routine dental checks and at-home dental care. 
Monitor for return of lameness of forelimbs
Will email forelimb xrays to MARS for comment on any other intervention/recommendations

Pre-approval outcome arrived via email
'The expected gap amount to be paid by the client (based on the estimate submitted) is: $933.63'
Tried calling O to let him know and to book this in if O would like to
No answer, left message 10/2
EN