Anesthetic Problems 2
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Anesthetic Problems 2
Who is in charge of anesthesia?
the veterinarian but the vet may not be fully available
When is the LVT in charge of anesthesia?
vet should ideally preauthroize LVT to perform certain emergency procedures
vet should provide written instructions and written drug protocol to avoid legal liability issues
Who gets emergency care during an anesthetic procedure?
not all patients get "the works" in an emergency situation
certain patients may be under "no heroics" order or they are too sick or its too expensive
What are the things you need to think about before doing an anesthetic procedure?
What kind of list should be kept in the crash kit?
emergency drugs, doses, indications for use
What should you not do in an emergency?
do not perform chest compressions if the heart is still beating
do not bag the patient with the vaporizer on 5%
What should you do after an emergency?
discuss any probelms with the veterinary team had with the emergency.
discuss ways to prevent or solve these problems before the next emergency
How do you prepare for an emergency?
delegate emergency tasks to specific people
What are some potential emergency situations during anesthesia?
pale mucous membranes
dyspnea and/or cyanosis
What do you check if the patient is too light?
What in the patient do we check if they are too light?
depth of anesthesia
When you're checking the depth of anesthesia to see if the patient is too light, what question should you ask yourself?
is he really too light or is he excessively deep, agonal, moving due to that?
If the patient is really too light after checking depth of anesthesia, what should you do?
turn up the vaporizer
When checking a patients respirations to see if they are too light, what questions do you need to ask yourself?
is the patient hold his breath?
are the respirations too shallow to take in enough anesthetic gas?
Which types of animals tend to take shallow breaths?
obese animals and toy dogs
What equipment do we need to check?
What do we need to check about the trach tube?
is it in the esophagus?
is it endobronchial?
is air leaking aroung the tube? - is the cuff inflated?, is the tube too small?
What about the anesthesia machine do we need to check?
is it assmebled correctly?
are the hoses attached?
What should the flowmeter not be under?
What are the clinical signs of a patient who is too deep?
respiration is very slow (under 8 bpm)
mucous membranes are pale or cyanotic
CRT over 2 seconds
bradycardia (dog - under 60 - 70, cat - under 100)
pulse weak (under 80 mm Hg)
no reflexes (no pupillary light reflex)
no muscle tone
What would cause a patient to have an increased sensitivity to the anesthetic drug?
prolonged anesthetic episode (hypothermia)
What should you do if the depth of anesthesia is too deep?
turn off the vaporizer
bag the patient
drugs (reversing agents)
lighten the patient
What could cause the mucous membranes to become pale?
What should you do if a patient's mucous membranes are too pale?
may need to lighten
give IV fluids
give blood transfusion
Hypotension can progress to _____.
If a patient has a prolonged CRT, what should you check?
check for other signs of shock - rapid HR, rapid RR, cold extremities
What are some causes of a prolonged CRT?
What should you do if a patient has a prolonged CRT?
treat shock - IV fluids, warm up patient, drugs
decrease anesthetic depth - give 100% O2
reversers if appropriate
What is dyspnea?
What is cyanosis?
bluish discoloration of mucous membranes
What are some causes of respiratory distress?
What are some problems with the equipment that could cause respiratory distress?
no O2 delivered to patient - O2 tank off or empty, flowmeter off, blockage of breathing circuit or trach tube
What are some patient problems that could cause respiratory distress?
surgeon leaning on patient's chest
What are things that could obstruct a patient's airway?
trach tube blockage
excessive flexion of head
What are some respiratory pathologies that could cause respiratory distress?
How should you respond to a patient in respiratory distress?
is patient getting enough oxygen?
bag with 100% O2
may need tracheotomy is airway is completely obstructed
drugs - doxapram, IV fluids, O2
What is tachypnea?
What could cause tachypnea?
How should you respond to tachypnea?
check anesthetic depth
check soda lime
may give analgesic
What are some cardiac abnormalities?
What is considered tachycardia in large dogs? small dog/cat?
: over 120 bpm
: over 160 bpm
What are some causes of tachycardia?
What are some drugs that could cause tachycardia?
What are some pre-existing conditions that could cause tachycardia?
What should your response be to tachycardia?
may need to adjust depth of anesthesia
What is considered bradycardia for a medium/large dog? small dog? cat?
: under 60 bpm
: under 70 bpm
: under 100 bpm
What are some causes of bradycardia?
very deep anesthesia
What are some drugs that could cause bradycardia?
What parasympathetic stimulation could cause bradycardia?
What is hyperkalemia?
increase of potassium in the blood
How should we respond to bradycardia?
may need to adjust anesthetic depth
may need to give atropine
What are the different types of arrhythmias?
spurts of tachycardia
PVC's - premature ventricular contractions
How do we detect arrhythmias?
palpation of pulse or chest
What are the causes of arrhythmias?
What are some drugs that could cause arrhythmias?
What types of respiratory depression could cause arrhythmias?
What pre-exisiting conditions could cause arrhythmias?
What anesthetic conditions could cause arrhythmias?
How do we respond to arrhythmias?
correct hypercapnia, hypoxia
What are some potential problems in the recovery period?
regurgitation and vomiting
What is regurgitation?
passive, no stomach contractions
What can regurgiation occur?
at any time
What predisposed position could cause regurgitation?
head-down position because it puts pressure on the stomach
How should we respond to regurgitation?
suction through trach tube
What is vomiting?
active stomach contractions
When does a patient usually vomit?
during induction and recovery
How do we respond to vomiting?
if not intubated with cuff, hold head lower than lungs
may need suction
clean out mouth
What are the clinical signs of aspiration?
When do we see clinical signs for aspiration?
What is aspiration pneumonia?
occurs when there is a small amount, not totally blocked
What are the clinical signs of aspiration pneumonia?
increase lung sounds
When do we see clinical signs for aspiration pneumonia?
over next 24 - 48 hours
How do we prevent aspiration?
place endotracheal tube, inflate cuff
leave trach tube in until swallowing reflex returns
if inductin an unfasted animal - induce quickly by injection, place trach tube quickly, inflate cuff quickly
do not put pressure on stomach or abdomen
antiemetic drug if unfasted
What are some causes of post-anesthetic seizures?
drugs - ketamine
What is myelography?
injecting dyes in epidural space to see spinal cord
How do we respond to post-anesthetic seizures?
differentiate between seizures and stage II excitement
eliminate stimuli - light, sound, touch
watch for hyperthermia and cyanosis
What kind of drugs do we give for post-anesthetic seizures?
if still having seizure, mask down with sevoflurane or isoflurane or give pentobarbital
What is the most common cause of post-anesthetic death?
dyspnea due to upper airway obstruction
What could cause dyspnea in cats during recovery?
How do we determine if the cat is having a laryngospasm or if its just growling?
: makes growling noise in inspiration
: makes growling noise on expiration
How do we prevent laryngospasms in cats?
lidocaine spray or lube
remove early, before laryngeal reflex returns
What could cause dyspnea in dogs during recovery?
What are some causes of a prolonged recovery?
kidney or liver disease
excessive anesthetic depth
sighthounds and greyhounds
What drugs could cause a prolonged recovery?
repeated doses of ketamine or barbiturates
How do we speed up recovery?
give IV fluids
Why does giving IV fluids speed up recovery?
increases renal elimination of drugs
maintains blood pressure
What are ways we can give oxygen to speed up recovery?
What kind of nursing care can we give to speed up recovery?
turn frequently to prevent hypostatic congestion
What kind of drugs can speed up recovery?
What is hypostatic congestion?
blood pooling in the down side lung
What should you do if recovery is a chronic problem in your practice?
re-evaluate anesthetic and recovery protocols and techniques