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Applied Clinical Veterinary Nursing > Anaesthesia for Airway, Dental and Ocular Surgery > Flashcards

Anaesthesia for Airway, Dental and Ocular Surgery Flashcards

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1
Q

what are the main concerns with dental surgery?

A

access to face and mouth limited - difficult to check depth

patients commonly geriatric with underlying conditions

lots of water - aspiration risk, can become very cold

often final procedure of day when staff are tired

dentistry can be very painful

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2
Q
A
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3
Q

what are the anaesthetic considerations for dental surgery?

A

pain
haemorrhage
hypothermia
aspiration of water/fluids
length of procedure
concurrent diseases

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4
Q

why is it difficult to assess blood loss during dentals?

A

usually mixed with water - looks like more than it is

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5
Q

what are the the anaesthetic concerns for geriatric patients undergoing dental surgery?

A

reduced CV reserve
reduced FRC
reduced muscle mass, increased fat tissue
prone to hypothermia
may have reduced kidney +/- liver function

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6
Q

what does it mean if a patient has reduced CV reserve?

A

baroreceptor function may be reduced - more prone to hypotension

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7
Q

what does it mean if a patient has reduced FRC?

A

more prone to hypoxia

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8
Q

what should we consider in older patients which might have reduced liver/kidney function?

A

consider drug dosages - may have less or exacerbated effects/length of action

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9
Q
A
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10
Q

what pre-op considerations might we have for patients undergoing dental surgery?

A

full clinical exam
blood/urine testing
consider other disease processes
anorexic? (common in cats with dental disease)
any other diagnostic testing (U/S, x-ray, ECG)

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11
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A
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12
Q

what can we use for MAC sparing in dental procedures?

A

adequate analgesia
local blocks

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13
Q

what are our airway considerations when anaesthetising a patient for a dental procedure?

A

cuffed ET tube essential
mouth pack to avoid AP
care when turning patient - check for fluid in mouth
observe tube to ensure not kinking or twisting

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14
Q

what are the perioperative considerations for dental procedures?

A

protect airway - cuffed ETT, throat pack

long procedure - consider patient temperature, drug top-ups if req

look after the eyes (patient and staff)

haemorrhage

consider patient positioning

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15
Q

how can we make patients more comfortable during/after dental procedures

A

pad joints to avoid sores
consider effects of atelectasis
tube care when moving

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16
Q

what is the advantage of local blocks for dental procedures?

A

dentals are painful - blocks will reduce maintenance anaesthetic requirements

improve post-op pain management

may improve speed of recovery (eating)

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17
Q

what are the 4 main dental nerve blocks?

A

rostral maxillary (infraorbital)

caudal maxillary

caudal mandibular

mental

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18
Q

what does the infraorbital nerve block affect?

A

soft tissues, incisors, canines and premolar teeth

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19
Q

where is the infraorbital foramen located?

A

(in dogs) located on maxilla, dorsal to the third maxillary premolar

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20
Q

why should care be taken performing an infraorbital nerve block in cats/brachy dogs?

A

the foramen is located at the level of the medial canthus of the eye (needle could penetrate eyeball)

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21
Q

what does the caudal maxillary nerve block affect?

A

all bones of the maxilla

soft and hard palates

soft tissues of the nose, upper lip and dentition rostral to the maxillary second molar

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22
Q

where is the caudal maxillary foramen located?

A

just caudal and central to the last maxillary molar

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23
Q

what does the mandibular nerve block affect?

A

entire hemimandible teeth of the lower jaw

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24
Q

where is the mandibular foramen located?

A

needle inserted percutaneously at the ventral angle of the mandible

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25
Q

why are bilateral mandibular nerve blocks discouraged?

A

due to risk of damage due to lack of sensation in the recovery period

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26
Q

what type of nerve block should not be administered bilaterally?

A

bilateral mandibular block

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27
Q

what does the mental nerve block affect?

A

lower incisors, skin and tissues rostral to the foramen

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28
Q

where is the mental foramen located?

A

ventral to the rostral root of the second premolars

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29
Q

why is the mental nerve block not often carried out in small animals?

A

can be tough to locate the foramen

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30
Q

which block may be preferred over the mental block in small animals?

A

mandibular

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31
Q

what equipment should be prepared for local block placement?

A

sterile needle and syringe
local agent
scrub
alcohol wipe
method of recording doses/times
(sterile gloves)

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32
Q

what should be considered when administering local blocks to cats?

A

intubeaze - 2.27mg lidocaine per spray

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33
Q

what are the post-op considerations for dental procedures?

A

re-assess/pain score for analgesia

remove mouth pack/gag

dry off as much as possible for temperature maintenance

tempt to eat

continue fluids if necessary

thorough discharge advice for owners - expect bleeding

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34
Q

why might an animal have ocular surgery?

A

cataract sx, enucleation, eyelid mass removal, entropion, cherry eye, trauma

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35
Q

what are important pre-anaesthetic considerations for ocular surgery?

A

is the animal experiencing pain
could the eye rupture
are there any underlying diseases e.g. diabetes
are they on any medication
what procedure is being performed

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36
Q

what should be ascertained before ocular surgery?

A

full clinical exam and hx
pre-op screening if indicated

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37
Q

what should not be used for preparation for ocular surgery?

A

hibiscrub

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38
Q

what are the specific peri-operative considerations for ocular surgery?

A

preventing further trauma to eye, preserving sight

maintenance of central eye for intraocular procedures

adequate analgesia

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39
Q

what is the normal intraocular pressure?

A

15-20mmHg

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40
Q

what determines intraocular pressure?

A

a balance of aqueous humour production and absorption

other factors e.g. pupil size, corneoscleral rigidity, extra ocular muscle tone, vascularity of the globe

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41
Q

why do we want to avoid acute increases in intra-ocular pressure?

A

to avoid damage to the eye

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42
Q

how can we manage intraocular pressure during surgery?

A

maintain a normal Co2

avoid coughing on intubation/extubation

avoid drugs with emetic effects (e.g. morphine)

be aware of effects of drugs on IOP and use drugs judiciously

avoid neck restraint/jugular pressure

positioning - avoid head down position

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43
Q

what is the oculo-cardiac reflex?

A

sudden reduction in heart rate associated with traction on the eye or surrounding structures

44
Q

why does the oculo-cardiac reflex occur?

A

due to stimulation of the trigeminal and vagal nerves

45
Q

how should the oculo-cardiac reflex be managed?

A

surgical manipulation should stop and manage by administration of anticholinergics

46
Q

how can you maintain a central eye during ocular surgery?

A

most common is use of a NMBA

47
Q

why is it essential for all ocular surgery patients to wear a bustEr collar?

A

to avoid scratching eye/rubbing face along surfaces for contact

48
Q

which block might be used to provide analgesia during ocular surgery?

A

retrobulbar

49
Q

what does a retrobulbar block affect?

A

cranial nerves II III IV V and VI

50
Q

what are the important considerations post-op for ocular surgery?

A

analgesia - pre-emptive and multimodal

buster collar - avoid mutilation

fluid therapy if needed

patient warming

feed, give opportunity to defecate

prevent vomiting/coughing post-op especially if IOP increased

consider sedation if anxious/fractious

51
Q

what is important to avoid after ocular surgery?

A

coughing/vomiting especially if IOP increased

52
Q

what are the primary abnormalities in BOAS patients?

A

stenotic nares
aberrant nasal turbinates
elongated/thickened soft palate
tracheal hypoplasia

53
Q

what is primary BOAS?

A

where it is identified early on and present before significant clinical signs

54
Q

what is secondary BOAS?

A

develops as a consequence of longstanding increase in respiratory pressures

55
Q

how does boas cause secondary respiratory/digestive issues?

A

animal has to pull harder on inspiration, creating negative pressure in the throat/neck/chest

56
Q

what are the secondary abnormalities of BOAS?

A

laryngeal collapse
eversion of laryngeal saccules
GI - reflux, regurgitation

57
Q

why is IV access important in BOAS cases?

A

can rapidly proceed to induction of anaesthesia and intubation for prompt airway security

58
Q

why is it important to prevent stress in BOAS cases?

A

to prevent raising temperature, causing panting and GI signs

59
Q

why might we sedate a BOAS patient before placing an IV catheter?

A

if catheter placement is causing undue stress

60
Q

why must sedated bOAS patients be observed closely?

A

can easily obstruct and regurgitate

61
Q

why might we use sevo over iso for BOAS maintenance?

A

faster recovery of laryngeal reflexes

62
Q

what might be the disadvantage of using sevo for BOAS patients?

A

quicker recovery may increase chance of dysphoria/anxiety/stress

63
Q

what drugs are commonly used for premed for airway surgery?

A

ACP/A2 agonist combined with an opioid

acp will provide longer sedation than an a2 agonist

64
Q

how can we protect the airway in patients undergoing airway surgery?

A

pre-oxygenate

intubation stylet may be helpful

large range of ETT sizes - always cuff

always have suction available

head down until airway secured

65
Q

what are the perioperative considerations during BOAS surgery?

A

airway management vital, may require ventilation support

careful and close monitoring, watch ventilation

maintain heat but avoid overheating

eye care is crucial

66
Q

what are the post-op considerations for BOAS surgery?

A

observe closely - don’t remove ETT until swallowing and can maintain patent airway

mild sedation can be useful if patient agitated

ware with warming techniques

oxygen supplementation (+pulse ox if tolerated)

early discharge if stress + safe to do so

67
Q

what should we always be prepared for when recovering a BOAS patient?

A

re-intubation

68
Q

why might NSAIDs be avoided intra-op in BOAS patients?

A

in case steroids required for post-op obstruction

69
Q

how does laryngeal paralysis often present?

A

stridor
exercise intolerance
panting
coughing, hoarse bark

70
Q

what is stridor?

A

abnormal, harsh high-pitched sound during inspiration/expiration resulting from airflow through an obstructed airway

71
Q

what is stertor?

A

noisy breathing sound - like snoring

low pitched

72
Q

what are the non-surgical approaches to laryngeal paralysis?

A

weight loss
exercise restriction
owner education

73
Q

what is the surgical approach to laryngeal paralysis?

A

laryngeal tie-back

74
Q

how can a nurse help with a patient who presents with laryngeal paralysis?

A

put in quiet/stress free environment

use a fan - cool and blow air into airways

oxygen supplementation if not stressful

start recording esp RR

leave alone until calm (with observation)

enquire with vet about butorphanol

75
Q

what is laryngeal tie back surgery called?

A

unilateral arytenoid lateralisation

76
Q

why do animals with laryngeal paralysis present with dyspnoea?

A

due to closure of the vocal cords

77
Q

why should we assess the larynx under a light plane of anaesthesia?

A

anaesthetics affect mobility of the larynx

78
Q

what are the pre-operative considerations for laryngeal tie-back surgery?

A

pre-oxygenate

reduce stress

anti-tussive drugs

light plane of anaesthesia so that VS can assess larygngeal function

pain management

79
Q

what should be involved in post-op care after laryngeal tie-back surgery?

A

very close observation - AP high risk

assess pain

avoid things around neck

wet food made into balls, elevated feeding and water

avoid excitement - consider sedation if req

80
Q

what are some of the presentations requiring bronchoscopy?

A

variable - chronic cough, suspected lung infection, feline asthma, airway parasites, chronic aspiration pneumonia, neoplasia

81
Q

are patients requiring bronchoscopy likely to saturate well on room air?

A

no

82
Q

what can be given to bronchoscopy patient as a bronchodilator?

A

terbutaline

83
Q

why should care be taken when giving terbutaline as a bronchoconstrictor?

A

CV side effects - tachycardia

84
Q

when might terbutaline be given?

A

may be given as a bronchodilator to bronchoscopy patients

85
Q

why is bronchoscopy usually performed?

A

for sample collection (bronchial alveolar lavage)

86
Q

what are the pre-op considerations for bronchoscopy?

A

history and clinical exam, assess degree of respiratory compromise

rule out cardiac disease

further testing, blood tests depending on px

BGA, x-rays

87
Q

what may be required for stabilisation pre-bronchoscopy?

A

O2 supplementation and sedation if required

inhaled bronchodilators e.g. terbutaline

systemic steroid and anti-tussive meds

88
Q

what is the issue with the ET tube during bronchoscopy?

A

may not be able to maintain it in place - some larger tubes can fit scope inside

89
Q

what are the temperature considerations during bronchoscopy?

A

patient easily cold - coupage, usually uncovered

90
Q

which drug might be useful for bronchoscopy? why?

A

ketamine and propofol - have bronchodilatory effects

91
Q

what are the airway management options for bronchoscopy?

A

large diameter ET tube - pass scope through

small diameter tube - extubate and use TIVA

SGAD/LMA

92
Q

what is the most important piece of monitoring equipment during a bronchscopy?

A

pulse ox

93
Q

why is it sensible to consider TIVA for bronschoscopy?

A

easier access to required areas

avoids leakage of inhalant agent into surrounding air

94
Q

what are the potential peri-operative issues during bronchoscopy?

A

hypoxia

bronchoconstriction (esp after BAL)

desaturation and shark fin capnograph (obstructive)

reduced compliance

laryngeal oedema (cats)

airway/lung rupture - possible during FO removal or biopsy

95
Q

what equipment should we get ready for a bronchoscope?

A

endoscope
sterile saline
collection pots
mouth gag?
urinary catheter (if blind BAL)
syringes
emergency box/induction agent

96
Q

why is it valuable to take a pre-scope sample of the endoscope?

A

to ensure any abnormalities found (e.g. fungus) were not present in the scope before it was introduced to the patient

97
Q

why does bronchoscopy often require multiple people?

A

needs to be fast

coupage required as well as close monitoring of the patient

things can go wrong quickly

need quick access to emergency drugs/oxygen

98
Q

why should the patient be monitored closely in the recovery period from bronchoscopy?

A

risky period - can easily occlude

may have cough

99
Q

how can we lower risk of occlusion after bronchoscopy?

A

keep head elevated, use towels

monitor closely

100
Q

how can we monitor/support the patient after bronchoscopy?

A

constant observation until fully recovered

use pulse ox until no longer tolerated

supplement oxygen

101
Q

why should bronchoscopy patients be monitored regularly after the procedure?

A

tension pneumothorax can manifest clinically later in the recovery period

102
Q

what are the potential post-op complications after bronchoscopy?

A

haemorrhage in the airways

desaturation of oxygen

pneumothorax due to damaged bronchi (poss tension pneumothorax)

103
Q

when might pharyngostomy intubation be performed?

A

avoids the oral cavity - for cases where orotracheal intubation is not possible

104
Q

what are the overall main challenges for dental/ocular/airway surgery?

A

access to head/eyes is limited - depth, avoid breathing systems that require access near head

use appropriate monitoring, may have to attach pulse ox elsewhere

close eye on capnography to ensure tube isn’t kinking

remember eye/mucous membrane lubrication

105
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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