Anaesthesia A&Es Flashcards
What patient factors may increase anaesthetic risk according to a 2022 paper?
Poorer health (higher ASA grade)
Urgent procedures
Older age
Long nose (dolichocephalic)
What other factors may lead to anaesthetic accidents?
Equipment failure
Inadequate preparation
Inadequate monitoring
Define complication vs error.
Complication = an event that develops but is not due to human error (i.e. it would happen regardless) e.g. hypotension, haemorrhage, drug reaction
Error = an avoidable event e.g. APL valve left shut, wrong drug dose given
What human errors can occur?
Drug admin errors
Incomplete clinical assessment
Inadequate knowledge of machine/protocols
Failure to appropriately monitor animal
Closed APL valve
Why might an inadequate oxygen supply be provided to a patient?
Lack of oxygen in cylinder/source
Disconnection of piped O2
Stuck or missing one-way valve
Leaks in machine/breathing system
Ventilator failure
What risks are associated with IV catheterisation?
Trauma during insertion
Lack of placement i.e. outside vessel
Infection/inflammation
Phlebitis
Air embolism
Pain/discomfort
How can we prevent IV catheter complications?
Aseptic technique
Start low down on limb
Correct catheter type
Good technique/adequate restraint
Prevent patient interference
Daily/twice daily observation and dressing change
Regular flushing
What drug admin errors can occur?
Death by decimal
Wrong drug given
Wrong dose/concentration
Incorrect route
Miscommunication
How can we avoid drug admin errors?
Double check calculations
Have an accurate bodyweight
Label syringes
Understand pharmacology
Check medication form before admin
Record all drugs given
Careful prep - ensure correct drug
Confirm route of admin
What should we do if we notice a drug error?
Tell vet!
If not all given, stop
Carefully monitor animal
Check drug bottle/data sheet for info
Contact VPIS if concerned
Inform owner?
What are the risk factors for gastro-oesophageal reflux?
Excessive/inadequate pre-op fasting
Drugs e.g. ACP, diazepam, opioids
Abdo pressure
Abdo surgery/long surgery
Orthopaedics
How can we reduce the risk of gastro-oesophageal reflux?
Appropriate pre-op fasting times
Identify at-risk patients
Pre-op GI protectants
Head-up/swift induction
Cuffed ET tube
Have suction available
What should we do if we notice regurgitation?
Head down, suction/swab out pharynx
Consider omeprazole IV for at-risk patients (at direction of vet)
Record on anaesthetic record
Inform vet
What are some causes of corneal ulceration?
Anaesthesia/sedation/opioids reducing tear formation
Trauma from external sources e.g. heat/masks/liquids
Very painful!!
How can we prevent corneal ulcers?
Care with warming devices, positioning, face mask placement
Avoid droplets/liquids around face
Avoid trauma
Regular use of ophthalmic ointment
Be aware of environment
What should we do if we notice corneal ulcers during/following anaesthesia?
Prevent rubbing/scratching
Inform vet
Start eye ointments/continue at home
Identify reason if possible
Inform owner
What issues can hypothermia cause?
Cardiac arrhythmias - atrial fibrillation, ventricular fibrillation
Bradycardia
Impaired coagulation and wound healing
Shivering - increased oxygen demand
What impact does hypothermia have on anaesthesia?
Prolonged duration of action of drugs
Decreased renal plasma flow
Decreased oxygen delivery to tissues
Lower anaesthetic requirement
How can we prevent hypothermia?
Insulation
Warm from point of premed, avoid leaving unsupervised
Heat moisture exchange breathing system
Care with clip and prep
External heat sources
Warm environmental temperature
Avoid excessive lengths of anaesthesia
What are the consequences of hyperthermia?
Increased basal metabolic rate
Increased oxygen requirement
Parenchymal cell damage
Irreversible brain damage, death
How can we avoid hyperthermia?
Close observation of patient warming
Never leave animal on heat source when unable to move away
Avoid microwave heat sources - do not distribute heat evenly, can cause burns
Identify at-risk animals (brachy, overweight)
Provide cooling if needed
What can cause respiratory failure?
Depression of respiratory centres in brain
Impaired movement of thoracic case
Impaired lung movement
Airway obstruction
What are the clinical signs of respiratory tract obstruction?
Increased respiratory effort
Paradoxical ventilation
No air movement at nose/mouth
Possible cyanotic MMs
Capnography changes
Why might a patient be apnoeic/cyanotic?
Inappropriate depth e.g. too light/too deep
Unnoticed resp. tract obstruction
Drug-related e.g. post-induction apnoea
Cyanosis may be due to inadequate O2 supply/very low cardiac output
What do we do if we notice a respiratory tract obstruction?
Inform vet!
Straighten neck, pull tongue forward, check mouth/pharynx - suction if needed
Check O2 source
If intubated - check ET tube not kinked/obstructed
If not intubated, do so
Corticosteroids if indicated
Pre-oxygenate at-risk patients and have equipment prepared
What should we do if we notice a patient is apnoeic/cyanotic?
Confirm heartbeat
Check depth of anaesthesia
Check for obstruction/obvious reason for apnoea
Ensure 100% oxygen given
Manually ventilate lungs, check breathing system/tube, check chest wall movement
Specific antagonist if required
Turn off volatile agent
What are some causes of cardiac arrest?
Pre-existing cardiovascular disease
Anaesthetic overdose
Hypovolaemia
Electrolyte/acid-base abnormalities
Vagal reflex
Respiratory arrest
What should we do if we suspect cardiac arrest?
Call for help - establish team, note time
Check pulse/HR - begin cardiac compressions
Check ventilation
Check depth of anaesthesia
Turn off volatile agent, ensure 100% oxygen given
Manually ventilate lungs, check breathing system/tube/chest wall movement
