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Applied Clinical Veterinary Nursing > Anaesthesia for Pre-existing Conditions > Flashcards

Anaesthesia for Pre-existing Conditions Flashcards

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1
Q

How is ICP increased in patients?

A

Increases in CSF or intracranial blood volume

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2
Q

What are our 2 main aims when anaesthetising animals with neurological/brain trauma?

A

Maintain cerebral blood flow
Reduce increases in ICP

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3
Q

What is normal ICP?

A

5-12mmHg

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4
Q

What clinical signs indicate increased ICP?

A

Papilledema
Abnormal pulsing of retinal vessels
Depression
Stupor
Coma

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5
Q

Why does the Cushings reflex occur?

A

Due to reduction in cerebral blood flow
To decrease intracranial volume/pressure

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6
Q

Describe the Cushings reflex.

A

Reduction in cerebral blood flow causes accumulation of CO2 as a result of poor perfusion
Detected by brainstem and sympathetic NS responds by increasing MAP (HYPERTENSION), which alerts baroreceptors and causes reflex BRADYCARDIA

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7
Q

How can we avoid increasing ICP?

A

Avoid coughing (anti-tussive?)
Harnesses to avoid pulling on leads
Careful intubation (adequate depth prior to attempt)
Avoid pressure on neck during restraint
Avoid jugular sampling
Avoid straining to defecate/urinate

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8
Q

What pre-op considerations should we have for neurological cases?

A

Pre-op assessment (may include bloods, electrolytes, glucose, PCV)
Modified Glasgow Coma Scale
Stabilisation if possible
Drug choice - not increase ICP or cause dramatic changes to MAP

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9
Q

What intra-op considerations should we have for anaesthetised neurological cases?

A

Pre-oxygenation
Adequate depth for intubation
Lateral intubation if neck instabilities
Isoflurane may slightly increase ICP - Sevo will not!
Maintain normocapnia
Fluid therapy
Mild head elevation to assist venous drainage
Monitor for seizure activity

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10
Q

Why might neurological cases be anaesthetised?

A

Imaging (MRI/myelography)
CSF tap
Spinal surgery (hemilaminectomy/ventral slot etc.)
Treatment of concurrent disease
Pre-existing neurological disease (e.g. epilepsy)

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11
Q

What considerations should we have for carrying out MRIs?

A

Careful positioning - lots of padding, patient must be straight
NO METAL - patient/staff/equipment
Temperature - can be cold, difficult to maintain
Remote monitoring

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12
Q

Describe CSF taps.

A

Common sites = cisterna magna or lumbar
Positioning - may need neck bent to chest (consider armoured ET tube)

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13
Q

How can we care for possible seizure patients?

A

Often unknown cause
IV catheter essential
Treat as if potential for increased ICP
On any current medication/anti-convulsant?
Close monitoring before/after anaesthesia
Capnography, BP
Risky post-op phase

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14
Q

What complications might we see in patients with neuromuscular disorders?

A

May be predisposed to regurgitation/aspiration - check gag reflex
Weakness may affect respiratory muscles
May require IPPV - capnography essential
Myasthenia gravis - exaggerated response to NMBs

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15
Q

What pre-op considerations should we have for a planned GI surgery e.g. oesophageal/GI FB?

A

Stabilise patient
May be dehydrated/anorexic
Acid-base disturbances
Potential for gastro-oesophageal reflux/aspiration pneumonia
Pain!
Limited access to head?

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16
Q

What intra-op considerations should we have for planned GI surgery patients?

A

Avoid drugs that may induce vomiting e.g. morphine
Pre-oxygenate
Suction available
Head elevated until ET tube inserted and cuff inflated
Removal per os or via thoracotomy
Rupture of oesophagus possible
Analgesia!
Care with heat preservation

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17
Q

What pre-op considerations should we have for emergency GI patients e.g. GDV?

A

IV access vital
Large volume fluid therapy
Stabilise but not much time!
Decompress stomach if possible
Arrhythmias common - monitor CVS
AIM - improved cardiovascular and pulmonary function prior to GA

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18
Q

What complications can we see with GDV patients?

A

Electrolyte and acid-base abnormalities
Clotting abnormalities
Potential pneumothorax
Blood pressure often okay BUT perfusion poor (reduced CO and increased systemic vascular resistance)

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19
Q

What arrhythmias are commonly seen in GDV patients?

A

Up to 40% of dogs will have arrhythmia
Commonly ventricular in origin
May last into post-op period

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20
Q

What pre-op considerations should we have for patients with pre-existing GI disease?

A

May require sedation/GA for diagnostics/surgery
Gastro-oesophageal reflux risk - starvation times crucial
May be on medication already
May need special diet
May have electrolyte/acid-base disturbances

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21
Q

What are the functions of the liver?

A

Substance production - urea/clotting factors/albumin
Bilirubin excretion
Biotransformation of drugs/toxins
Metabolism of carbs/proteins/fats
Glucose homeostasis - glycogen storage/gluconeogenesis
Major metabolic organ (heat!)

22
Q

What are the possible dysfunctions of the liver?

A

Porto-systemic shunt
Biliary obstruction/trauma
Chronic disease
Acute failure
Neoplasia

23
Q

What clinical signs of hepatic dysfunction can we see?

A

Ascites/oedema/pulmonary oedema
PUPD
Anaemia
Hypocalcaemia/hypoglycaemia
Hypothermia
Reduced clotting times
Acid-base disturbances
Jaundice
Encephalopathy

24
Q

Why does hepatic encephalopathy occur?

A

Increased levels of toxins (inc. ammonia) in blood as liver cannot process properly
Toxins enter the CNS and result in encephalopathic signs

25
Q

How do we treat hepatic encephalopathy?

A

Aim to reduce ammonia levels in the blood (via absorption or reduction)
Lactulose - transformed by colonic bacteria to organic acids, which trap ammonia ions and decreases ammonia absorption

26
Q

What affects of liver dysfunction can we see on anaesthesia?

A

Prone to hypothermia/hypoglycaemia
Hypoalbuminaemia (reduced protein binding of drugs, harder to retain fluid in circulation)
Slower biotransformation of drugs?
Increased risk of surgical haemorrhage - coagulopathy risk
Electrolyte imbalances - sodium retention and decreased potassium

27
Q

How can we manage hepatic patients before anaesthesia?

A

Stabilise (treat encephalopathy/seizures)
Minimal premed/cautious dosing/consider short-acting and antagonisable?
Induction - slow and use lowest possible dose
Analgesia
Avoid NSAIDs
Maintain body temp.
Monitor BG
Beware of coagulopathies!

28
Q

How can we manage patients with coagulopathies?

A

Care with venepuncture - use peripheral veins!
Pressure after samples/IV catheters
Avoid rough handling/pulling leads
Avoid trauma e.g. excitable recoveries

29
Q

What pre-anaesthetic lab tests can we do for hepatic patients?

A

Liver enzymes
Bile acids
Clotting function
Urea
Plasma proteins
Glucose

30
Q

What is an insulinoma and what are the clinical signs?

A

Pancreatic islet cell tumour
Hypoglycaemia

31
Q

What post-op complications may we see with insulinoma removal (laparotomy, partial pancreatectomy)?

A

Pancreatitis
Pain
Hyperglycaemia

32
Q

What anaesthetic considerations should we have for patients having insulinoma surgery?

A

Monitor blood glucose
Avoid hyperglycaemia (stimulate insulin release) and hypoglycaemia
Consider neuromuscular blocking agents

33
Q

What are the possible complications associated with diabetes mellitus patients?

A

Hyperglycaemia
Dehydration
Weight loss
Fatty liver
Ketosis

34
Q

How can we manage diabetes mellitus patients prior to surgery?

A

Stabilise if elective
Find out routine from owner inc. favourite foods
First patient of the day
Monitor BG
Half dose insulin?

35
Q

What anaesthetic considerations should we have for diabetes mellitus patients?

A

Short-acting drugs
Good analgesia
Avoid medetomidine (hyperglycaemia)
Fluids inc. glucose
Monitor BG!
Possibly second IV catheter?

36
Q

Describe hyperthyroidism and its clinical signs.

A

Multi-organ dysfunction
Usually elderly cats
Thin
PUPD
Muscle weakness
Hypertrophic cardiomyopathy

37
Q

What anaesthetic considerations should we have for hyperthyroid patients?

A

Avoid stress!
Consider sedating with opioid +/- ACP
?Avoid ketamine (increases myocardial workload and increases HR) and medetomidine (drops CO)
IV induction if possible
Monitor ECG
IV fluids

38
Q

What considerations should we have for thyroidectomy surgery for hyperthyroid patients?

A

Monitor BP
Location of surgery!
Potential for laryngeal paralysis/hypocalcaemia post-op
Keep IV in and patent

39
Q

What are the clinical signs of canine hypothyroidism?

A

May have megaoesophagus
Decreased GI motility
Obesity
Lethargy
Bradycardia and hypotension
Slow biotransformation of drugs

40
Q

What causes hyperadrenocorticism (Cushing’s disease)?

A

Pituitary / adrenal tumour - glucocorticoid excess
May be iatrogenic

41
Q

What are the clinical signs of hyperadrenocorticism (Cushing’s)?

A

Poor muscle tone
May be overweight and lethargic
Poor thermoregulation
Bruising
Risk of pulmonary thromboembolism - hypercoagulability
PUPD, Na retention/K excretion
Risk of wound infection

42
Q

What are the clinical signs of hypoadrenocorticism (Addison’s disease)?

A

Unable to mount normal stress response - avoid stress!
Hyperkalaemia
Bradycardia
Dehydration
Weight loss
Weakness/lethargy
Non-specific clinical signs

43
Q

What possible renal diseases can we see?

A

Acute kidney disease
Chronic kidney disease
Urinary tract obstruction/rupture - bladder/urethra/ureter

44
Q

What complications can we see with renal disease?

A

Hypoproteinaemia
Uraemia
Metabolic acidosis
Hyperkalaemia
Anaemia

45
Q

How can renal hypoproteinaemia affect anaesthesia?

A

Increased free fraction of drug
Decreased oncotic pressure

46
Q

How can renal uraemia affect anaesthesia?

A

CNS depression

47
Q

How can renal metabolic acidosis affect anaesthesia?

A

Decreased renal excretion of drugs
Myocardial dysfunction

48
Q

How can renal hyperkalaemia affect anaesthesia?

A

Potentially life-threatening - acute vs chronic!
Measure potassium!

49
Q

How can renal anaemia affect anaesthesia?

A

Oxygen-carrying capacity may be compromised

50
Q

What considerations should we have for renal patients?

A

Pre-op bloods to ascertain current function of kidneys
Pre-op fluids? (maintain circulating volume and hydration)
Full clinical exam, avoid stress
Drugs with minimal effect of CVS and renal function/BP
Feed before going home!

51
Q
A

Applied Clinical Veterinary Nursing (40 decks)

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