Patient Preparation

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Author:
tsbatiste
ID:
260884
Filename:
Patient Preparation
Updated:
2014-02-08 19:00:46
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VTHT Anesthesia Surgery
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Description:
adjunct information for the P.G.E.
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  1. VIC
    Veterinarian In Charge
  2. Veterinary Technician Pre-anesthetic responsibilities
    • Preliminary General Examination (history,clinical examination, bloodwork)
    • Animal is fasted for 8-12 hours and walked immediately prior to surgery
    • Intravenous catherization
    • Initiation of fluids
    • Preparation of basal anesthetics
    • Patient stabilization
  3. This is considered the best way to convey caring that the client expects and deserves.
    exceptional communication
  4. This is a brief outline of what is essential to proceed with surgery
    Minimum Patient Database
  5. What comprises the Minimum Patient Database?
    • 1. Preliminary General Examination
    • 2. Results of CBC and serology
    • 3. Appropriate radiographs as necessary
  6. When should the minimum patient database be completed for an elective surgery?
    several days in advance
  7. What percentage of accredited veterinary technology programs in the US and Canada have an outpatient clinic?
    Less than 2%
  8. What type of questions are emphasized during the history phase of the minimal patient database?
    open ended questions
  9. Regardless of sign or owner's complaint, these points should be answered:
    • 1. duration
    • 2. severity
    • 3. frequency
    • 4. character or appearance
  10. Feline specific responses to anesthetics and adjunts
    • 1. more sensitive to opioids vs. cattle/dogs
    • 2. require lower doses of lidocaine
    • 3. more resistant to phenothiazines vs. dogs
    • 4. more tolerant to dissociatives vs. dogs
    • 5. prone to hypercabia/hypoxemia d/t increased dead space
    • 6. prone to airway blockage d/t increased secretions
  11. Canine specific responses to anesthetics and adjunts
    • 1. prone to seizure-like activity with dissociatives unless combined with another agent
    • 2. small dogs: prone to hypoxemia/hypercarbia d/t increased dead space
  12. Ruminant specific responses to anesthetics and adjunts
    • 1. avoid anticolinergics d/t increase saliva viscosity and roping
    • 2. extra care should be taken to prevent aspiration - can regurgitate at any time
    • 3. prone to bloat
    • 4. prone to airway blockage d/t increased secretions
    • 5. sensitive to Xylazine (req. 1/10 the amt)
  13. Breed specific responses to anesthetics and adjunts
    • Sighthounds - sensitive to barbiturates
    • Boxers/Giant breeds/Draft HorsesĀ  - sensitive to acetylpromazine
    • Terriers - more resistent to acetylpromazine
  14. Common concurrent problems often listed on check in sheets:
    • anorexia
    • vomiting
    • diarrhea
    • coughing
    • sneezing
    • change in behavior
    • seizures (syncope)
    • exercise intolerance
    • weakness
    • unexplained bleeding problems
  15. It is illegal in most jurisdictions in the US to undertake surgery or anesthesia without this.
    The owner's written or oral consent (usually taken on a consent form upon check in)
  16. This is one of the most important parts of the External Body Surfaces portion of the Preliminary General Exam
    determination of dehydration
  17. What percentage of dehydration does loss of skin turgidity indicate?
    4%
  18. What percentage of dehydration does sunken eye globes accompany loss of skin turgidity?
    7%
  19. What percentage of dehydration does lateral recumbency accompany loss of skin turgidity and sunken eye globes?
    10%
  20. Describe a normal sinus arrhythmia
    The heart rate increases during inspiration and decreases during expiration
  21. There is no notable change in heart sounds with which degree of heart block
    1st degree
  22. There is a notable change in heart sounds with which degree of heart block
    2nd degree
  23. This type of reflex is produced by a light shone into the left eye but dilation only occurs in the right eye
    Consensual but no direct
  24. This type of reflex is produced by a light shone into the left eye, dilation occurs in the left eye but not the right eye.
    Direct but no consensual
  25. What instrument are we to use for the pupillary light reflexes
    The otoscope without the ear speculum
  26. This refers to normal gut sounds in a ruminant or equine
    Borborygmus
  27. ASA
    American Society of Anesthesiologists
  28. Patients who are normal/healthy undergoing elective surgeries are classified as what type of anesthetic risk?
    Minimal (P1)
  29. What is considered an elective surgery?
    Ovariohysterectomy, onychectomy, orchiectomy
  30. Patients with mild systemic diseases are considered what type of anesthetic risk?
    Low (P2)
  31. What conditions are considered mild systemic?
    • neonatal/geriatric/obesity
    • mild dehydration
    • skin tumor removal
  32. Patients with severe systemic disease are considered what type of anesthetic risk?
    Moderate (P3)
  33. What conditions are considered severe systemic?
    • Anemia
    • Moderate dehydration
    • Compensated major organ disease
  34. Patients with severe systemic disease that is a constant threat to life are considered what type of anesthetic risk?
    High (P4)
  35. What conditions are considered a severe systemic disease that is a constant threat to life?
    • Ruptured bladder
    • Internal hemorrhage
    • Pneumothorax
    • Pyometra
  36. Patients that are moribund and/or not expected to survive without operation are considered what type of anesthetic risk?
    Extreme (P5)
  37. Conditions that are potentially fatal if surgery is not performed are?
    • Severe head trauma
    • Pulmonary embolus
    • Gastric torsion/dilation complex
    • End-stage major organ failure
  38. This is a musical, high pitched breathing sound often associated with upper airway infection or obstruction.
    Stridor
  39. LOC
    Level of Consciousness
  40. This is a LOC where the animal can be aroused with minimal difficulty
    lethargic
  41. This is the LOC where the animal is very depressed and cannot be fully aroused.
    obtunded
  42. This is a LOC where the animal is in a sleep-like state and can be aroused only by painful stimuli
    stuporous
  43. This is the LOC where the animal cannot be aroused and is unresponsive to all stimuli
    comatose
  44. Female patient considerations during taking of the minimal patient database
    • 1. Surgery on a female in heat should be avoided due to reduced clotting because of high estrogen levels
    • 2. Blood vessels are enlarged in gravid females
    • 3. Xylazine should be avoided in pregnant cattle in 3rd trimester d/t increased uterine contractions
  45. Why is acetylpromazine maleate contraindicated in stallions?
    It can cause penile prolapse
  46. Epinephrine increases the risk of cardiac arrhythmias when given with these anesthetic drugs or drug types:
    • Cyclohexamines
    • Xylazine
    • Barbiturates
    • Halothane
  47. What 3 things may occur if mixed with a tricyclic antidepressant?
    • 1. predisposure to cardiac arrythmias
    • 2. excessive response to anticholinergics
    • 3. excessive response to CNS depressants
  48. What combination of antibiotic and anesthetic prolong recovery significantly and may prolong the action of propofol and ketamine?
    • Chloramphenicol - antibiotic
    • Barbiturates - anesthetic
  49. If given within 14 days of each other which 2 MAOIs increase the effects of morphine and other opioids?
    Amitraz (Mitaban) and Selegiline Chloride (Anipryl)
  50. Which class of drugs when given with opiods and other agents that depress body systems, can increase CNS and respiratory depression?
    Antihistamines
  51. Name 3 things on the skin and/or the mucous membranes that can be indicative of a bleeding disorder
    • Purpura
    • Eccymoses
    • petechiae
  52. A coagulation panel checks which two things?
    • PT - prothrombin time
    • APTT - activated parital thromboplastin time
  53. Coagulation disorders commonly affect which breeds of dogs?
    • Doberman pinscher
    • Rottweiler
    • Scottish terrier

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