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Who is in charge of anesthesia?
the veterinarian but the vet may not be fully available
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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
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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
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What are the things you need to think about before doing an anesthetic procedure?
- airway
- breathing
- cardiac
- drugs
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What kind of list should be kept in the crash kit?
emergency drugs, doses, indications for use
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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%
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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
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How do you prepare for an emergency?
- crash kit
- staff meetings
- delegate emergency tasks to specific people
- practice sessions
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What are some potential emergency situations during anesthesia?
- too light
- too deep
- pale mucous membranes
- prolonged CRT
- dyspnea and/or cyanosis
- tachypnea
- cardiac abnormalities
- CPA
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What do you check if the patient is too light?
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What in the patient do we check if they are too light?
- depth of anesthesia
- respirations
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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?
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If the patient is really too light after checking depth of anesthesia, what should you do?
turn up the vaporizer
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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?
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Which types of animals tend to take shallow breaths?
obese animals and toy dogs
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What equipment do we need to check?
- trach tube
- anesthesia machine
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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?
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What about the anesthesia machine do we need to check?
- is it assmebled correctly?
- are the hoses attached?
- check flowmeter
- check vapoizer
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What should the flowmeter not be under?
0.5 L/min
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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)
- cardiac arrhythmias
- cold extremities
- no reflexes (no pupillary light reflex)
- no muscle tone
- dilated pupils
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What would cause a patient to have an increased sensitivity to the anesthetic drug?
- ill
- inadequate ventilation
- prolonged anesthetic episode (hypothermia)
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What should you do if the depth of anesthesia is too deep?
- turn off the vaporizer
- bag the patient
- supportive care
- drugs (reversing agents)
- monitor closely
- lighten the patient
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What could cause the mucous membranes to become pale?
- pre-existing anemia
- blood loss
- drugs
- hypothermia
- pain
- too deep
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What should you do if a patient's mucous membranes are too pale?
- may need to lighten
- give IV fluids
- give blood transfusion
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Hypotension can progress to _____.
shock
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If a patient has a prolonged CRT, what should you check?
- check BP
- check for other signs of shock - rapid HR, rapid RR, cold extremities
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What are some causes of a prolonged CRT?
- pre-exisiting trauma
- pre-exisiting dehydration
- blood loss
- too deep
- some drugs
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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
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What is dyspnea?
difficulty breathing
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What is cyanosis?
bluish discoloration of mucous membranes
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What are some causes of respiratory distress?
- equipment problems
- patient problems
- anesthetist problems
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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
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What are some patient problems that could cause respiratory distress?
- airway obstruction
- respiratory pathology
- heavy drapes
- surgeon leaning on patient's chest
- restrictive bandaging
- obesity
- heavy muscling
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What are things that could obstruct a patient's airway?
- trach tube blockage
- excessive flexion of head
- laryngospasm
- aspiration
- brachycephalic
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What are some respiratory pathologies that could cause respiratory distress?
- pneumothorax
- pulmonary edema
- diaphragmatic hernia
- pleural effusion
- pneumonia
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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
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What is tachypnea?
rapid RR
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What could cause tachypnea?
- certain drugs
- too light
- too deep
- obesity
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How should you respond to tachypnea?
- check anesthetic depth
- check soda lime
- may give analgesic
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What are some cardiac abnormalities?
- tachycardia
- bradycardia
- arrhythmias
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What is considered tachycardia in large dogs? small dog/cat?
- large dog: over 120 bpm
- small dog/cat: over 160 bpm
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What are some causes of tachycardia?
- drugs
- pre-existing condition
- surgical stimulation
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What are some drugs that could cause tachycardia?
- atropine
- ketamine
- epinephrine
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What are some pre-existing conditions that could cause tachycardia?
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What should your response be to tachycardia?
- notify vet
- may need to adjust depth of anesthesia
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What is considered bradycardia for a medium/large dog? small dog? cat?
- medium/large dog: under 60 bpm
- small dog: under 70 bpm
- cat: under 100 bpm
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What are some causes of bradycardia?
- drugs
- parasympathetic stimulation
- very deep anesthesia
- hyperkalemia
- hypothermia
- hypoxia
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What are some drugs that could cause bradycardia?
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What parasympathetic stimulation could cause bradycardia?
- endotracheal intubation
- ocular surgery
- handling viscera
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What is hyperkalemia?
increase of potassium in the blood
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How should we respond to bradycardia?
- inform vet
- may need to adjust anesthetic depth
- may need to give atropine
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What are the different types of arrhythmias?
- dropped beats
- pulse deficit
- spurts of tachycardia
- irregular heartbeat
- PVC's - premature ventricular contractions
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How do we detect arrhythmias?
- EKG
- auscultation
- palpation of pulse or chest
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What are the causes of arrhythmias?
- drugs
- respiratory depression
- pre-exisiting conditions
- anesthetic conditions
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What are some drugs that could cause arrhythmias?
- barbiturates
- halothane
- xylazine
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What types of respiratory depression could cause arrhythmias?
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What pre-exisiting conditions could cause arrhythmias?
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What anesthetic conditions could cause arrhythmias?
- thoracic surgery
- intubation
- electrolyte imbalances
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How do we respond to arrhythmias?
- inform vet
- correct hypercapnia, hypoxia
- anti-dysrhythmic drugs
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What are some potential problems in the recovery period?
- regurgitation and vomiting
- post-anesthetic seizures
- dyspnea
- prolonged recovery
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What is regurgitation?
passive, no stomach contractions
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What can regurgiation occur?
at any time
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What predisposed position could cause regurgitation?
head-down position because it puts pressure on the stomach
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How should we respond to regurgitation?
- intubate
- inflate cuff
- suction through trach tube
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What is vomiting?
active stomach contractions
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When does a patient usually vomit?
during induction and recovery
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How do we respond to vomiting?
- if not intubated with cuff, hold head lower than lungs
- may need suction
- clean out mouth
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What are the clinical signs of aspiration?
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When do we see clinical signs for aspiration?
immediately
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What is aspiration pneumonia?
occurs when there is a small amount, not totally blocked
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What are the clinical signs of aspiration pneumonia?
- fever
- increased RR
- increase lung sounds
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When do we see clinical signs for aspiration pneumonia?
over next 24 - 48 hours
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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
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What are some causes of post-anesthetic seizures?
- drugs - ketamine
- myelography
- epilepsy
- hypoglycemia
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What is myelography?
injecting dyes in epidural space to see spinal cord
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How do we respond to post-anesthetic seizures?
- differentiate between seizures and stage II excitement
- inform vet
- eliminate stimuli - light, sound, touch
- drugs
- prevent self-mutilation
- watch for hyperthermia and cyanosis
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What kind of drugs do we give for post-anesthetic seizures?
- diazepam
- if still having seizure, mask down with sevoflurane or isoflurane or give pentobarbital
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What is the most common cause of post-anesthetic death?
dyspnea due to upper airway obstruction
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What could cause dyspnea in cats during recovery?
larngospasm
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How do we determine if the cat is having a laryngospasm or if its just growling?
- laryngospasm: makes growling noise in inspiration
- growling: makes growling noise on expiration
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How do we prevent laryngospasms in cats?
- gentle intubation
- lidocaine spray or lube
- lubricate tube
- remove early, before laryngeal reflex returns
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What could cause dyspnea in dogs during recovery?
- brachycephalics
- FB
- blood clots
- vomit
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What are some causes of a prolonged recovery?
- kidney or liver disease
- hypothermia
- hypothyroid
- shock
- hemorrhage
- excessive anesthetic depth
- prolonged anesthesia
- certain drugs
- sighthounds and greyhounds
- individual variation
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What drugs could cause a prolonged recovery?
- methoxyflurane
- repeated doses of ketamine or barbiturates
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How do we speed up recovery?
- monitor closely
- give IV fluids
- give oxygen
- nursing care
- drugs
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Why does giving IV fluids speed up recovery?
- increases renal elimination of drugs
- maintains blood pressure
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What are ways we can give oxygen to speed up recovery?
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What kind of nursing care can we give to speed up recovery?
- keep warm
- turn frequently to prevent hypostatic congestion
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What kind of drugs can speed up recovery?
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What is hypostatic congestion?
blood pooling in the down side lung
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What should you do if recovery is a chronic problem in your practice?
re-evaluate anesthetic and recovery protocols and techniques
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