4. Pre- and postoperative Care Flashcards
- Anesthesia related mortality in different species (also possible reasons and prevention)
-Cat greater risk to DIE in ASA 1-2 (50% higher risk)
> dog 0,05%, cat 0,11% = 50% higher
-maintanence of (medications) anesthesia greater risk are dogs 46%, compared to cats 30%
-risk 2x higher for cats than dogs are related mortality
>dog 1:600, cat 1:400
-POSSIBLE REASONS:
>smaller animal (hypothermia, over hydrating)
>uncooperative behaviour
>prone to laryngospasm (intubation)
>sensitivity to local anesthesia drug toxicity
>reduced glucuronidation (slower drug metabolism)
-PREVENTION:
>after procedure well look after patient (post-operative care)-waking up, drugs needed
>O2
>clock
>blanket > to avoid hypothermia
-greater mortality the smaller the animal ex. rabbits and exotics
> ASA 3 has 5x greater risk than ASA 1-2
POST-OPERATIVE PERIOD>highest risk! have to monitor and look animal until wakes up and leaves station
- Preoperative care
+GOOD:
+check-list, SURGICAL SAFETY CHECKLIST (separate from anesthesia protocol)
+planning and anticipating complications
+ANAMNESIS=anamnesis vitae(full history of animal): breed (brachycephalic breeds=incr.tonus of n.vagus, toy breeds=hypothermia, giant breeds=lower drug dosage, herding breeds=mutation in MDR-1 gene, boxers=drug sensitivity to acepromazine), lifestyle - anamnesis morbid(when in procedure): reasons for surgery, CS&duration, past meds
+MOST important: PHYSICAL/CLINICAL EXAMINATION=1. cardiovascular system (heart, MM, pulse), 2. respiratory system (breathing pattern and noises, lung auscultation, MM, palpation of trachea), 3. hydration status (MM, skin turgor, eyes), 4. GIT and urinary system (abdominal palpation), 5. integumentary system (skin, abnormal signs inflammation/infection), 6. CNS (mentation, neurological examination), 7. BCS, 8. temperature
+LAB data
+communication with owner
+determination of surgical risk
+pre-meds
+prepare drugs + prepare and prevent risks
+OVERALL stabilization of all vital functions (thermoregulation, hemodynamics, resp., hydration, preoperative fasting, analgesia and sedation (MULTIMODAL anesthesia and analgesia are preferred, both NSAIDs and opioids used often), positioning)
+diagnostic tests (PCV, total protein, glucose, urea), hematology, biochemistry, urinalysis, diagnostic imaging (X-R, MRI, CT), further testing (ECG, blood typing)
+PREOPERATIVE FASTING: 2-4h water, 6-8h food
+oxygenation; pre-oxygenation 100% O2, start before induction and intubation, lasts 3-5min and stopped before intubation, O2 continued after intubation
+intraoperative fluid management (maintenance of hemodynamics, catheter, reduce fluid and blood loss) Ri-Lac or Hartmann’s solution (in case hypotension ; crystalloid bolus or colloid bolus)
+Positioning of patient; intubation, catheterization, procedure, monitoring, well-being of patient
-BAD:
-to look 2 patients at same time
-rush
-not to do good stuff^(previously listed)
> immediate postoperative concerns: pain, anxiety, cardioresp.function:blood pressure, oxygen saturation, temperature, wound protection, pleasant as possible!!
- Postoperative care
-HIGHEST DEATH RATES 3 HOURS AFTER EXTUBATION
-patient must be closely monitored until:
1. extubation 2. laying on sternum, head elevated 3. able to swallow, normal ocular reflex 4. strong and regular peripheral pulse 5. O2 saturation more than 94% 6. no sus of upper airway obstruction 7. effective analgesia 8. no evident bleeding
-pain management:in clinic analgesia optimal, analgesia at home: NSAIDs, Tramadol, Fentanyl, calcium channel blockers
-nutritional management
-wound care (protection, ABs): for protection=west, collar > wound care=daily up to 14d., exudate removal, cleaning, wound gels, suture materials removed after 7-14 d. OWNER INSTRUCTED in DETAIL!!!!
-care related to surgical procedure: exercise restriction, immobilization, feeding tubes, depends on surgical procedure and condition of patient
-other care possibilities
-home care-instructions necessary
