Anaesthetic Emergency Flashcards
What can reduce the risk of an anaesthetic emergency?
- adequate pre-anaesthetic assessment
- appropriate use of anaesthetic drugs
- careful monitoring
What are the 4 general causes of an anaesthetic emergency?
- 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.
Why are neonates at more risk of anaesthetic emergency?
- don’t possess much plasma protein to bind drugs
- don’t have great ability in kidney and liver to metabolise and excrete the drugs.
Why are geriatric animals more at risk?
- more likely to have underlying disease
- reduced liver and kidney function so diminished ability to metabolise and excrete drugs
Why are brachycephalic breeds and obese patients more at risk?
May struggle to breathe
Why do thinner dogs such as sighthounds have more risk of an anaesthetic emergency?
- less body fat so affects the distribution of lipophilic anaesthetic drugs and can slow recovery
What is the first thing you need to do in ANY anaesthetic emergency
Alert the operating VS
What is Atropine used for in an emergency?
Used to treat cardiac arrest in conjunction with adrenaline
- reverses bradycardia by reducing vagal tone
What is Adrenaline/Epinephrine used for in an emergency?
Used to treat cardiac arrest - in conjunction with Atropine
- It increases heart rate and force of contraction
What is Frusemide used for in an emergency?
Used for cerebral or pulmonary oedema, congestive heart failure and oliguria
What is Lidocaine (w/o epinephrine) used for in an emergency?
It decreases the rate of contractions of the heart by blocking sodium channels.
Used to treat arrhythmias (should use an ECG)
What is Diazepam used for in an emergency?
Used to treat seizures
What is Naloxone used for in an emergency?
Opioid antagonist - used to reverse opioids if causing unwanted effects e.g. respiratory depression
What is Dopamine used for in an emergency?
Increases the force of myocardial contraction ( to maintain blood pressure)
What is Doxapram used for in an emergency?
Used to stimulate respiration in neonates.
An analeptic drug (respiratory and CNS stimulant)
What is Atipamezole used for in an emergency?
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)
What is Sodium bicarbonate used for in an emergency?
Used to treat severe metabolic acidosis or hyperkalaemia (often used in conjunction with CPR)
What signs would indicate that a patient is too light?
Patient movement
Tachycardia
Elevated BP
Muscle twitching in response to stimulation
Why could a patient be too light?
- Vaporiser problems - off, empty..
- ET tube problems - misplaced, blocked, too small, cuff not inflated
- Breath-holding - may be due to Propofol
- Shallow respiration
- Inadequate O2 flow
- Anaesthetic machine malfunction
What should you do if a patient is shallow breathing or breath-holding and therefore too light?
Give them a few breaths via IPPV to allow anaesthetic gas to reach the lungs
What are the signs that a patient is too deep?
- Slow, shallow respiration
- Pale/ cyanotic MMs
- CRT >2s
- Bradycardia with weak pulse
- Absence of reflexes
- Cold extremities
What can cause the patient to be too deep?
- Vaporiser set too high
2. Presence of pre-existing problems e.g. shock or anaemia
What should you do if the patient is too deep?
Tell VS
Turn down or Turn off the vaporiser!
Initiate IPPV if respiration is shallow
Supportive treatment - fluids, Reversal drugs
What does IPPV stand for?
Intermittent Positive Pressure Ventilation
