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Anaesthesia > Anaesthetic Emergency > Flashcards

Anaesthetic Emergency Flashcards

1
Q

What can reduce the risk of an anaesthetic emergency?

A
  • adequate pre-anaesthetic assessment
  • appropriate use of anaesthetic drugs
  • careful monitoring
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2
Q

What are the 4 general causes of an anaesthetic emergency?

A
  • Human error - fatigue, distracted, incompetent
  • Equipment failure - ET tube, gas, APL valve, circuit
  • Anaesthetic agents - incorrect for patient e.g. ACP for a hypovolaemic patient
  • Patient variation factors - underlying disease, breed risks, age… etc.
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3
Q

Why are neonates at more risk of anaesthetic emergency?

A
  • don’t possess much plasma protein to bind drugs

- don’t have great ability in kidney and liver to metabolise and excrete the drugs.

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4
Q

Why are geriatric animals more at risk?

A
  • more likely to have underlying disease

- reduced liver and kidney function so diminished ability to metabolise and excrete drugs

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5
Q

Why are brachycephalic breeds and obese patients more at risk?

A

May struggle to breathe

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6
Q

Why do thinner dogs such as sighthounds have more risk of an anaesthetic emergency?

A
  • less body fat so affects the distribution of lipophilic anaesthetic drugs and can slow recovery
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7
Q

What is the first thing you need to do in ANY anaesthetic emergency

A

Alert the operating VS

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8
Q

What is Atropine used for in an emergency?

A

Used to treat cardiac arrest in conjunction with adrenaline

- reverses bradycardia by reducing vagal tone

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9
Q

What is Adrenaline/Epinephrine used for in an emergency?

A

Used to treat cardiac arrest - in conjunction with Atropine

- It increases heart rate and force of contraction

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10
Q

What is Frusemide used for in an emergency?

A

Used for cerebral or pulmonary oedema, congestive heart failure and oliguria

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11
Q

What is Lidocaine (w/o epinephrine) used for in an emergency?

A

It decreases the rate of contractions of the heart by blocking sodium channels.
Used to treat arrhythmias (should use an ECG)

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12
Q

What is Diazepam used for in an emergency?

A

Used to treat seizures

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13
Q

What is Naloxone used for in an emergency?

A

Opioid antagonist - used to reverse opioids if causing unwanted effects e.g. respiratory depression

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14
Q

What is Dopamine used for in an emergency?

A

Increases the force of myocardial contraction ( to maintain blood pressure)

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15
Q

What is Doxapram used for in an emergency?

A

Used to stimulate respiration in neonates.

An analeptic drug (respiratory and CNS stimulant)

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16
Q

What is Atipamezole used for in an emergency?

A

Its an alpha-2-adrenoreceptor antagonist
May be used to reverse or partially reverse the effects of medetomidine (which can cause respiratory depression, vasoconstriction etc)

17
Q

What is Sodium bicarbonate used for in an emergency?

A

Used to treat severe metabolic acidosis or hyperkalaemia (often used in conjunction with CPR)

18
Q

What signs would indicate that a patient is too light?

A

Patient movement
Tachycardia
Elevated BP
Muscle twitching in response to stimulation

19
Q

Why could a patient be too light?

A
  1. Vaporiser problems - off, empty..
  2. ET tube problems - misplaced, blocked, too small, cuff not inflated
  3. Breath-holding - may be due to Propofol
  4. Shallow respiration
  5. Inadequate O2 flow
  6. Anaesthetic machine malfunction
20
Q

What should you do if a patient is shallow breathing or breath-holding and therefore too light?

A

Give them a few breaths via IPPV to allow anaesthetic gas to reach the lungs

21
Q

What are the signs that a patient is too deep?

A
  • Slow, shallow respiration
  • Pale/ cyanotic MMs
  • CRT >2s
  • Bradycardia with weak pulse
  • Absence of reflexes
  • Cold extremities
22
Q

What can cause the patient to be too deep?

A
  1. Vaporiser set too high

2. Presence of pre-existing problems e.g. shock or anaemia

23
Q

What should you do if the patient is too deep?

A

Tell VS
Turn down or Turn off the vaporiser!
Initiate IPPV if respiration is shallow
Supportive treatment - fluids, Reversal drugs

24
Q

What does IPPV stand for?

A

Intermittent Positive Pressure Ventilation

25
Q

Describe how you would administer IPPV

A
  • Patient must be intubated and on an O2 supply
  • Close (or partially lose for Bain and Ayres T) the APL valve
  • Fill the reservoir bag with O2
  • Gently squeeze the reservoir bag until the patients chest rises slightly
  • Open the valve and allow the patient to expire (2-3 times the length of time it took to inhale)
  • Repeat every 6 seconds until signs of recovery noted (approx. 10 times per minute)
26
Q

What would the signs be in a patient that was too deep, receiving IPPV that it was working?

A

Increasing HR
Stronger pulse
Improved MM colour
Improved CRT

27
Q

What are the 2 types of respiratory arrest?

A
  1. Temporary - Induction apnoea is quite common

2. True respiratory arrest - Requires attention - precursor to cardiac arrest!

28
Q

Why does true respiratory arrest happen?

A
  • anaesthetic overdose
  • lack of oxygen - equipment
  • Pre-existing respiratory disease
  • side effects of pre-meds or induction agents
29
Q

What do you do if a patient has induction apnoea?

A

Check first if they are holding their breath!

  • Look at their eye position and palpebral reflex (if eyes are central and there is no PR then they are very deep!)
  • Will need IPPV for a short time ( assess depth and decide if vaporiser should be on or off) if eyes central and no PR then switch off vaporiser!!
30
Q

What are signs of true respiratory arrest?

A
  • dyspnoea before arrest
  • cyanosis
  • abnormal HR, CRT, pulse , pupil dilation
31
Q

What is the appropriate response to respiratory arrest?

A
  • Tell VS
  • place ET tube if not intubated. Give 100% o2
  • Check heart to ensure no cardiac arrest
  • Commence IPPV:
    • Deliver one breathe every 6s until vital signs improve. Once vital signs are normal, cease IPPV for 30s to see if patient can breathe on own. If not, continue IPPV
  • IV fluids and drugs may be administered
  • Keep patient warm
32
Q

What are the signs of cardiac arrest?

A
  • No heartbeat can be auscultated, palpated or seen on ECG/ultrasound
  • No arterial pulse can be palpated
  • MMs grey or cyanotic
  • Prolonged CRT
  • Pupils widely dilated with no pupillary light reflex
  • Respiration absent or Cheyne-Stokes respiration (indicated imminent death)
33
Q

What can cause cardiac arrest?

A

Underlying CV disease (esp in cats)
Anaesthetic overdose
Other systemic disease

34
Q

What is the appropriate response to cardiac arrest?

A

Inform Vs

  • START COMPRESSIONS!
  • Deliver compressions at 100-120bpm in 2m cycles
  • Intubate patient if not already
  • IPPV at 1 breath every 6s (assistant)
  • If on own, deliver 30 cardiac compressions then 2 breaths*
  • Check pulse after each 2 minute cycle and continue until spontaneous return of pulse and breathing
  • VS may advise drug administration e.g. adrenaline and IV fluids
  • Keep patient warm
  • Can use defibrillator

After 15 minutes, outcome poor

35
Q

Describe the technique for cardiac compressions

A

R lateral recumbency
Heel of hand at fifth intercostal space
Compress chest by 1/3-1/2 width of chest

  • In small dogs and cats, use thumb and fingers to compress chest
36
Q

What is a defibrillator used for?

A

Uses electricity to stimulate cardiac muscle contraction

37
Q

What is an Ambu bag?

A

Self-inflating resuscitator bag - good if don’t have an o2 supply

38
Q

What is a urinary catheter used for in arrest?

A

Used to administer drugs down the ET tube

Anaesthesia (15 decks)

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