Anaesthesia for airway dental and occular procedures

Question 1

What must be considered when completing an anaesthetic for a patient undergoing rhinoscopy trache-broncoscopy

Answer 1

Very stimulating procedure
Adequate depth anaesthesia (deep plane)
Antisussive drugs (butorphanol)

Question 2

Why may the ET tube be removed in a rhinoscopy patient and what steps should be taken if the
Is takes place?

Answer 2

To observe further down the larynx
Preoxygenate
Laryngeal mask
Total infused Voltaire anaesthetic (propofol CRI) unable to use volatile

Question 3

What condition associated with cats may be of concern when completing a rhinoscopy and what can be done to prevent it?

Answer 3

Laryngeal spasm
(Bronchoconstriction)
Pre-treat glycopyrrolate(anti-cholinergenic)
Beta 2 agonists inhaler for acute asthmatic crisis (salbutamol terbutaline)
Monitor recovery until breathing fully

Question 4

Why should a BOAS case not be left alone after their pre med?

Answer 4

Soft tissues may block the airways

Upper airway obstruction due to muscle relaxation

Question 5

What difficulties at a BOAS dog provide you with during induction?

Answer 5

Difficult intubation (soft tissues surrounding larynx)
Narrow trachea
Laryngeal collapse
Pre-oxygenate!!!
Have hands ready consider urinary catheter as guide

Question 6

What problems may occur during surgery in a BOAS dog?

Answer 6

Risk of regurgitation
(Keep in sternal, extubate late, cuff tube, extubate mildly cuffed tube)
Manipulation of the surgical field may kink et tube or increase soft tissue swelling

Question 7

Why should BOAS dogs be monitored closely in recovery?

Answer 7

Upper airway obstruction due to muscle relaxation 
Hang from canines 
Monitor SpO2 
Check breathing pattern 
Extubate late 
Corticosteroids 
Tracheostomy 
Use sedatives

Question 8

Why may laryngeal surgery be required?

Answer 8

Laryngeal paralysis horses and dogs

Question 9

What may dogs with laryngeal paralysis present with?

Answer 9

Obstructive breathing
Tracheostomy
Sedatives to calm

Question 10

What complications may arise during laryngeal paralysis surgery?

Answer 10

Tube may be in surgical field(make surgeon aware) have spare tube
may need to extubate
Pre-oxygenate TIVA
Blood in upper airway extubate mildly inflated cuff

Question 11

Why may dental surgery cause problems with the ET tube?

Answer 11

Awkward positioning may kink or block the tube (reinforced tube)
Traction of the tube when moving over (disconnect patient)

Question 12

Why is it important to consider the side effects of a mouth gag in dental procedures?

Answer 12

Cats of mouth opened too wide can cause blindness

Question 13

What must be considered during the dental procedure?

Answer 13

Hypothermia

Question 14

What must be considered when recovering a dental patient?

Answer 14

Tartar and water in the oropharynx
Extubate mildly inflated cuff
Pack with gauzes (count at the end of the procedure)

Question 15

What loco-regional techniques can be used in the dental patient?

Answer 15

Maxillary
Inferior alveolar nerve
Infraortibal nerve
Mental

Question 16

Why is positioning a problem when monitoring ocular procedure anaesthetics?

Answer 16

Kinking of the ET tube (reinforced tube)
Torsion from movement of the ET tube
Accessibility to the patient is difficult (can’t rely on palpebral reflexes, avoid cephalon vein IV)

Question 17

What is used in ocular procedures to make the eye stay central?

Answer 17

Stay sutures
Sub tendons injection with local anaesthetic
Use of NMBA (atracurium, vecruronium)

Question 18

What should be avoided during ocular surgery?

Answer 18

High intraocular pressure 
Avoid hypercalcemia
Ventilate 
Avoid jugular vein obstruction 
Optimise positioning of the patient(elevated head)

Question 19

What must be considered during recovery of the ocular patient?

Answer 19

Slow recovery sedation to avoid damage to the eye
Quiet recovery
Empty bladder
Elizabethan collar( get used to before surgery)

Question 20

What loco-region techniques can be used to block the eye?

Answer 20

Enucleation
Retrobulbar block
Sub tendons block
Four point block 
Super-orbital nerve 
Lacrimal nerve 
Infratrochlear nerve 
Zygomatic nerve
(Loss of sensation to eye and adnexa) 
Local infiltration of eye lids

Question 21

What loco-regional blocks can be used in the ocular surgery for the standing horse?

Answer 21

Auriculo-palpebral nerve

Only blocks motor no block sensation