10. Anesthetic Complications Flashcards
Anesthetic overdose. absolute v. relative
absolute - gave incorrect dose.
relative - right dose, but there was an underlying patient condition
signs of overdose
bradycardia, hypotension…. cardiac arrest, no pulse.
What do you do if theres an anesthetic overdose?
- get oxygen in, intubate
2. reverse any drugs
What drugs can you reverse? with what?
xylazine - yohimbine (can use atipamazole in theory)
opioids - naloxone
benzos - flumenazil (1/10 dose of dose of benzo)
dexmedetomadine - atipazole (equal volume)
NaBicarb (barbituates) overdose, what do you do?
balanced fluids! without dextrose (will swell brain) - support CV function (dopamine/dobutamine for BP, atropine/glyco for brady)
Nalve question -
phenobarbital overdose
ventilate
isoflurane put in sevoflurane vaporizor
reverse?
iso is more volatile, higher iso concentration will be delivered
Sevo has higher MAC also can go deep/into cardiac arrest quickly.
reverse? sevo in iso - pt will be light than expected
if using a rebreathing circuit you must ______ oxygen flow to reduce the amount of anesthetic being inhaled.
increase.
not necessary in nonrebreathing circuit
Tachypnea can be caused by
- **hyperthermia - opioids/other
- Equipment Malfunction (unidirectional valve stuck, soda exhausted)
- Light plane
PaCO2 is ______ when tachypnic
unpredictable
how to manage tachypnea
IPPV in just hypoventilating
check temp/equipment
Animals hyperthermic what do you do?
> 102.5
- Turn off warming devices
- COLD IV fluids
- iced gastric lavage or cold water enema
- electric fan and water spray (cats)
- increase O2 flow
- steroids if brain trauma
- NSAID if contaminated pyrogen
signs of hyperthermia
- tachypnea
2. tachycardia
causes of hyperthermia
- obese/dense hair coat - fialure to lose heat
- low flow circuit
- bair hugger/hot dog too hot/lamp OR temp
- drugs contaminated with pyrogens
- CNS injury
- hypermetabolic state (MALIGNANT HYPERTHERMIA, or bacteremia, or high T4)
signs of malignant hyperthermia
- genetic
- accumulation of Ca in muscles in hypermetabolic state.
- tachypnic, tachycardic
- acidemia high CO2 in spite of tachypnea (RESPIRATORY ACIDOSIS)
treatment of malignant hyperthermia
- stop inhalants (most common cause) maintain anesthesia with injectable - inc. O2 flow - change anesthetic machine - ***DANTRIUM reduces Ca in sarcoplasmic reticulum - ice packs/spray down - Na bicarb for acidosis - dobutamine for hypotension
hyperthermia post anesthesia is common in ____. Associated with which drugs?
cats
ketamine and hydromorphone. (But all opioids can cause hyperthermia in cats)
What to do in cat with post-op anesthesia?
- give ace
- fan and spray with water
anaphylaxis vs. anaphylactoid reaction?
anaphylaxis - Prior sensitization (IgG prod first time, second time -> anaphylaxis)
anaphylactoid - no prior sensitization (give drug -> histamine release)
common anaphylactic anesthetic drugs
- thiopental, propofol, atropine, xylazine
- opioids: morphine, meperidine
- cremophor EL (used to be used as preparation for propofol/alfaxolone)
- NMBAs: allamine/Atracurium (give slowly), procaine, ketamine,
- blood products
- abx
signs of anaphylaxis
CV: disrhythmias, HYPOTENSION
respiratory: cyanosis, labored breathing, bronchospasm
Cutaneous: hives, swollen paws
anaphylaxis:
if hypotensive, ______ the inhalant and ___drugs?___.
If bronchospasm and normotensive, _______ the inhalant.
hypotensive - turn off inhalant, give fluids and epinephrine .01mg/kg IV (IM/DC if less severe) or give diphenhydramine
keep on inhalant - its a bronchodilator
how to prevent anaphylactic reactions
- give drugs slowly (ex/ abx)
2. prophylactic diphenhydramine, corticosteroids
hypoxemia signs/numbers?
SpO2 <90% PaO2 < 60 mmHg MM: normal OR CYANOTIC bradycardia or VPCs if chronic dog may open mouth if severely hypoxemic, bc brain overrides, needs O2