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ANESTHESIA - 2 > 26 – Small Animal Review > Flashcards

26 – Small Animal Review Flashcards

1
Q

Overview: Steps of Anesthesia

A
  1. Pre-anesthetic evaluation and patient preparation
  2. Pre-anesthetic medication
  3. Anesthetic induction
  4. Maintenance and monitoring
  5. Recovery
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2
Q

Pre-anesthetic evaluation and patient preparation

A
  • Fully examination: age, temperament, breed
  • Medical history
  • Basic hematology
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3
Q

What to look at or do for older and sick patients in a pre-anesthetic evaluation?

A
  • Complete blood count, serum chemistry, urinalysis
    o On basis of physical exam and history
  • Radiograph thorax (trauma or respiratory problems)
  • ECG, echocardiography
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4
Q

If you need to delay anesthesia, you will do that until

A
  • Further assessment is performed
  • Patient is stabilized
  • Anesthetic risk is established
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5
Q

What do you need to communicate with you client prior to anesthesia?

A
  • Anesthetic risk
  • Set expectations
  • Patient preparation starts at home!
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6
Q

What are some prehospital anxiety drugs (2 hours prior to drop off)?

A
  • Trazadone
  • Gabapentin
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7
Q

Patient preparation: food and water

A
  • Allow free access to water
    o Care with old animals and animals with increased fluid requirements
  • Recommend fasting before anesthesia
    o Young animals: require SHORTER fasting times
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8
Q

What is the recommending fast time for 6-16 weeks and older than 16 weeks?

A

o 6-16 weeks: 4 hours
o Older than 16 weeks: 6-8 hrs

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9
Q

Anesthesia protocol: 5 things to consider

A
  • Physical exam
  • Age
  • Temperament
  • Surgical procedure
  • Clinical setting
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10
Q

Anesthesia protocol: premedication, induction, maintenance, post operative pain management

A
  • Premedication: Sedative + opioid
  • Induction
  • Maintenance: inhalant +/- opioid +/- local anesthetic
  • Post operative pain management: NSAID, opioid
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11
Q

What are the aims of premedication?

A
  • Sedation and anxiolysis (fear free)
  • Facilitate animal handling
  • Balanced anesthetic technique
  • Analgesia
  • Smooth and quiet recovery
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12
Q

Opioids for premedication:

A
  • Hydromorphone
  • Methadone
  • Butorphanol
  • Buprenorphine: slower onset time
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13
Q

What are the 3 sedatives you may combine with your opioids for premedication?

A
  • Acepromazine
  • Dexmedetomidine
    o *Don’t co-administer with an anticholinergic (goes against the reflex bradycardia)
  • Midazolam
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14
Q

What are the 2 anticholinergics you may use for premedication?

A
  • Atropine
  • Glycopyrrolate
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15
Q

What is the standard premedication protocol for calm dogs?

A
  • Acepromazine OR dexmedetomidine
  • Hydromorphone
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16
Q

What is the standard premedication protocol for excited, agitated dogs?

A
  • Acepromazine
  • Dexmedetomidine
  • Hydromorphone
  • *if aggressive=add ketamine
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17
Q

What is the standard protocol for premedication in cats?

A
  • Dexmedetomidine
    o Range based on age and temperament of cat
  • Hydromorphone
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18
Q

Heavy sedation of cats: “kitty magic”

A
  • Dexmedetomidine
  • Ketamine
  • Butorphanol
19
Q

‘kitty magic’

A
  • For more reliable sedation=use ketamine based protocol
  • Provides general anesthesia for invasice short procedures
  • Monitor paient!
  • Provide life support!
20
Q

What should you not use in young and healthy patients as a premedication?

A
  • Midazolam
    o Causes excitement!
    o Could use flumazenil to reverse excitement but will NOT provide sedation
  • *use in animals with hypertrophic cardiomegaly
21
Q

Which drugs would help you to achieve sedation in a young and healthy cat for a neuter if given midazolam and is excited?

A
  • Dexmedetomidine (IM): may use a higher dose to override excitement
  • Alfaxalone (IM): would need a higher dose
  • Ketamine (IM): would need a very HIGH dose and it would last longer
    o Can use for cat neuters but at lower doses (combination)
22
Q

Equipment check for anesthetic induction

A
  • Ensure ET tubes (3 sizes) and intubation aids are readily available
  • Monitoring equipment
  • Anesthesia machine
    o Select appropriate breathing system
    o Perform leak test
    o Check: O2, inhalant, CO2 absorbent, waste scavenging
23
Q

Patient preparation for anesthetic induction

A
  • Venous access: catheter placement
  • Stabilize hemodynamically instable patients
  • Check HR, pulse quality and RR
  • Connect monitoring equipment
  • Pre-oxygenation (reduce risk of hypoxemia)
  • Quiet environment
24
Q

What can you use for induction of anesthesia in dogs and cats?

A
  • Propofol
  • Alfaxalone
  • Diazepam or ketamine
  • Mask/chamber induction: isoflurane or sevoflurane=MOVE AWAY FROM IT
  • *administer toe effect
25
Q

What are the ABCs of anesthesia induction?

A
  • Airway
  • Breathing
  • Circulation
  • Depth
  • Equipment
  • Fluids
26
Q

A-airway establishment (intubation)

A
  • Endotracheal intubation
  • Securing the ETT
  • Inflation of ETT cuff
  • Confirmation of ET intubation
27
Q

Endotracheal intubation

A
  • Check prior to use
  • ET for patency and cuff for leaks
  • ‘Murphy Eye’
  • Have multiple sizes available
  • Laryngoscope, kling, cuff syring
  • *Pre-measure ET tube length (incisor teeth to thoracic inlet!)
28
Q

What is the intubation technique for a dog?

A
  • Can be performed in STERNAL, lateral or dorsal
  • Apply slight coating of lube (improves cuff’s ability to seal)
  • Open dog’s mouth, pull tongue forward gently
  • Straighten head and neck, extend tongue
  • Put tip of laryngoscope blade on base of tongue (lower the epiglottis), NOT on epiglottis
  • Insert ET tube under visualization (with dominant hand)
  • Inflate cuff and check for leaks
    o *avoid over inflation of ET-tube cuff
  • Secure tube
29
Q

Intubation of cat

A
  • More difficult than dog
    o Small oropharynx=prone to laryngospasm
  • Local anesthetic (lidocaine) useful to prevent laryngospasm
    o Lidocaine spray: metered dose 12mg
    o Lidocaine neat 2% (for smaller patients, 2mg per 0.1ml)
  • Size 3-4 should work
30
Q

How can you confirm ET intubation?

A
  • Direct visualization (use laryngoscope)
  • Rebreathing bag
  • Chest excursions
  • Palpation of ONE trachea below the larynx (if in esophagus=feel 2)
  • Capnograph
  • *GOLD STANDARD: auscultation of both sides of animal’s chest during manual ventilation
31
Q

B – breathing

A
  • Auscultation for bilateral lung sounds while manually ventilating
  • Check for spontaneous ventilation
    o If not=assist
32
Q

C – circulation

A
  • Stethoscope over heart for heart beat
  • BOTH SIDES
33
Q

D – depth and drugs

A
  • Check depth of anesthesia
    o Eye position
    o Palpebral reflex
    o Jaw tone
  • *based on patient’s depth=turn on vaporizer
34
Q

E – equipment

A
  • Apply monitoring equipment
  • Doppler first: audible signal
  • Monitor BP
  • Assess patient
  • Adjust vaporizer setting
35
Q

F – fluids

A
  • Correction of normal ongoing fluid losses
  • Support of CV function
  • Countering of potential negative physiologic effects
  • Maintaining patent IV catheter
36
Q

What are the new fluid guidelines during anesthesia for dogs and cats?

A
  • Cats: 3ml/kg/hr
  • Dogs: 5ml/kg/hr
37
Q

Recovery: Postoperative period

A
  • *Critical phase of anesthesia
  • 47% (dogs) and 60% (cats) of all anesthetic related deaths within first 3 hrs of recovery
  • Continue monitoring and patient support
  • *still have the effects, but no more O2
38
Q

Exudation in small animals

A
  • After dental surgery: check oral cavity for fluid
  • Don’t untie tube until patient has reached final recovery spot!
  • ET-tube cuff should NOT be deflated until just before extubation
39
Q

Dogs extubation

A
  • On return of swallowing reflex
40
Q

Cats extubation

A
  • Need to be extubated sooner
    o On return of good palpebral reflex and ear flick reflex
  • Prone to laryngospasm or laryngeal edema
41
Q

What is the optimal recovery time?

A
  • Within 10-30mins of end of anesthesia
  • *patients should be CLOSELY observed until they are:
    o ALERT
    o NORMOTHERMIC
    o AMBULATORY
42
Q

What are some common complications of recovery?

A
  • Emergence delirium
  • Dysphoria
  • Pain
  • Delayed recovery
43
Q

Recovery: ensure patients comfort

A
  • Environmental stress (noise, bright lights)
  • Hypothermia
  • Urinary bladder distension
  • Pain assessment and adequate pain management
44
Q

What is some supportive care during recovery?

A
  • Oxygen
  • Fluids
  • Heating
  • Eye ointment

ANESTHESIA - 2 (15 decks)

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