Anaesthesia A&Es

Question 1

What patient factors may increase anaesthetic risk according to a 2022 paper?

Answer 1

Poorer health (higher ASA grade)
Urgent procedures
Older age
Long nose (dolichocephalic)

Question 2

What other factors may lead to anaesthetic accidents?

Answer 2

Equipment failure
Inadequate preparation
Inadequate monitoring

Question 3

Define complication vs error.

Answer 3

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

Question 4

What human errors can occur?

Answer 4

Drug admin errors
Incomplete clinical assessment
Inadequate knowledge of machine/protocols
Failure to appropriately monitor animal
Closed APL valve

Question 5

Why might an inadequate oxygen supply be provided to a patient?

Answer 5

Lack of oxygen in cylinder/source
Disconnection of piped O2
Stuck or missing one-way valve
Leaks in machine/breathing system
Ventilator failure

Question 6

What risks are associated with IV catheterisation?

Answer 6

Trauma during insertion
Lack of placement i.e. outside vessel
Infection/inflammation
Phlebitis
Air embolism
Pain/discomfort

Question 7

How can we prevent IV catheter complications?

Answer 7

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

Question 8

What drug admin errors can occur?

Answer 8

Death by decimal
Wrong drug given
Wrong dose/concentration
Incorrect route
Miscommunication

Question 9

How can we avoid drug admin errors?

Answer 9

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

Question 10

What should we do if we notice a drug error?

Answer 10

Tell vet!
If not all given, stop
Carefully monitor animal
Check drug bottle/data sheet for info
Contact VPIS if concerned
Inform owner?

Question 11

What are the risk factors for gastro-oesophageal reflux?

Answer 11

Excessive/inadequate pre-op fasting
Drugs e.g. ACP, diazepam, opioids
Abdo pressure
Abdo surgery/long surgery
Orthopaedics

Question 12

How can we reduce the risk of gastro-oesophageal reflux?

Answer 12

Appropriate pre-op fasting times
Identify at-risk patients
Pre-op GI protectants
Head-up/swift induction
Cuffed ET tube
Have suction available

Question 13

What should we do if we notice regurgitation?

Answer 13

Head down, suction/swab out pharynx
Consider omeprazole IV for at-risk patients (at direction of vet)
Record on anaesthetic record
Inform vet

Question 14

What are some causes of corneal ulceration?

Answer 14

Anaesthesia/sedation/opioids reducing tear formation
Trauma from external sources e.g. heat/masks/liquids
Very painful!!

Question 15

How can we prevent corneal ulcers?

Answer 15

Care with warming devices, positioning, face mask placement
Avoid droplets/liquids around face
Avoid trauma
Regular use of ophthalmic ointment
Be aware of environment

Question 16

What should we do if we notice corneal ulcers during/following anaesthesia?

Answer 16

Prevent rubbing/scratching
Inform vet
Start eye ointments/continue at home
Identify reason if possible
Inform owner

Question 17

What issues can hypothermia cause?

Answer 17

Cardiac arrhythmias - atrial fibrillation, ventricular fibrillation
Bradycardia
Impaired coagulation and wound healing
Shivering - increased oxygen demand

Question 18

What impact does hypothermia have on anaesthesia?

Answer 18

Prolonged duration of action of drugs
Decreased renal plasma flow
Decreased oxygen delivery to tissues
Lower anaesthetic requirement

Question 19

How can we prevent hypothermia?

Answer 19

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

Question 20

What are the consequences of hyperthermia?

Answer 20

Increased basal metabolic rate
Increased oxygen requirement
Parenchymal cell damage
Irreversible brain damage, death

Question 21

How can we avoid hyperthermia?

Answer 21

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

Question 22

What can cause respiratory failure?

Answer 22

Depression of respiratory centres in brain
Impaired movement of thoracic case
Impaired lung movement
Airway obstruction

Question 23

What are the clinical signs of respiratory tract obstruction?

Answer 23

Increased respiratory effort
Paradoxical ventilation
No air movement at nose/mouth
Possible cyanotic MMs
Capnography changes

Question 24

Why might a patient be apnoeic/cyanotic?

Answer 24

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

Question 25

What do we do if we notice a respiratory tract obstruction?

Answer 25

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

Question 26

What should we do if we notice a patient is apnoeic/cyanotic?

Answer 26

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

Question 27

What are some causes of cardiac arrest?

Answer 27

Pre-existing cardiovascular disease
Anaesthetic overdose
Hypovolaemia
Electrolyte/acid-base abnormalities
Vagal reflex
Respiratory arrest

Question 28

What should we do if we suspect cardiac arrest?

Answer 28

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