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Anesthesia > Anesthesia related complications > Flashcards

Anesthesia related complications Flashcards

1
Q

Anesthesia related complications

A

-hypothermia
-hypotension
-hypoventilation (hypercapnia)
-hypoxemia
-bradycardia

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2
Q

Procedure related complications

A

-pain
-hemorrhage

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3
Q

Patient specific complications

A

-upper airway obstruction
-regurgitation/vomiting= aspiration
-hyperthermia

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4
Q

Causes of hypoxemia and low SpO2

A

-low inspired O2
-hypoventilation
-diffusion problem (pulmonary disease)
-ventilation perfusion (V/Q) mismatch
-right to left shunt

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5
Q

Mild Hypoxemia

A

SpO2 >80%
-activation of sympathetic nervous system
-increased HR, mild hypertension

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6
Q

Moderate Hypoxemia

A

SpO2 60-80%

-local vasodilation leading to hypotension
-reflex increase in HR

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7
Q

Severe Hypoxemia

A

SpO2 <60%

-local depressant effects predominate
-rapid decrease in BP leading to severe hypotension
-bradycardia, leading to ventricular fibrillation or cardiac arrest

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8
Q

Consequences of hypoxemia

A

-tissue hypoxia
-lactic acidosis
-organ failure

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9
Q

High risk patients for hypoxemia

A

-brachycephalics
-diaphragmatic hernia
-pneumothorax, pulmonary contusion
-upper airway obstruction
-pneumonia
-abdominal distension (GDV, C-section)

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10
Q

Low inspired O2 causing hypoxemia

A

-Check O2 supply

-endotracheal tube: check if tube is properly placed (esophageal, endobronchial)

-check that breathing system is tightly attached to ET tube

-airway obstruction (remove or bypass)

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11
Q

Hypoventilation causing hypoxemia

A

-check anesthetic depth
-administer O2
-intermittent positive pressure ventilation (IPPV)

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12
Q

Ventilation perfusion mismatch and intrapulmonary shunting leading to hypoxemia

A

Need to improve perfusion and ventilation

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13
Q

Specific ways to help with breathing under anesthesia

A

-Provide O2
-Position= sternal
-extend head and neck, pull out tongue
-Place Iv catheter and induce anesthesia

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14
Q

Stage 3, plane 1

A

Eye position=central

Palpebral reflex present

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15
Q

Stage 3 plane 3

A

Eye position= central
Absent palpebral reflex

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16
Q

Hypotension definition

A

SAP <80mmHg

MAP < 60mmHg

DAP <40mmHg

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17
Q

Driving force of Hypotension

A

MAP

MAP <60mmHg = compromised perfusion of visceral organs

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18
Q

Treating small animals with hypotension

A

-under 6mths have a physiologically low BP
-Geriatric: sub clinical organ impairment

TREAT earlier and more aggressive

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19
Q

Treating large animals with hypotension

A

Horses: minimum acceptable MAP 70mmHg (myopathy)

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20
Q

Treating severe hypotension

A

*sudden onset, MAP 35-45 mmHg)

Requires more aggressive diagnosis and correction

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21
Q

3 basic pathophysiological mechanisms leading to hypotension

A
  1. decreased vascular tone
  2. decreased CO
  3. hypovolemia
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22
Q

Hypotension and depth of anesthesia

A

Vasodilation: vasomotor center excessively depressed
-decrease vaporizer setting
-admin anesthetic sparing drugs

23
Q

Anesthetic sparing drugs for hypotension

A

-Hydromorphone
-butorphanol
-morphine
-Continuous Rate Infusion of fentanyl, ketamine, lidocaine

24
Q

Check HR during hypotension

A

Treat Bradycardia (1/2 rest HR), which can decrease CO
**slow normal heart rates do not usually affect CO

Anticholinergics: Atropine, Glycopyrrolate

25
Q

Fluids for hypotension

A
  1. Crystalloid fluids
  2. Colloid bolus
  3. Hypertonic saline
26
Q

Crystalloid fluids

A

-isotonic balance

-fluid bolus: 3ml/kg over 15mins for cats; 5ml/kg for dogs
**over 2-10mins if MAP <40mmHg

-repeat once if needed

27
Q

Colloid bolus

A
28
Q

Hypertonic saline

A
29
Q

Ephedrine use for hypotension

A
30
Q

Positive inotrope (Dobutamine) for persistent MAP <60 mmHg

A
31
Q

Vasopressor for hypotension

A

**Last resort

-NE infusions and Vasopressin infusions

32
Q

NE infusions

A

-alpha 1 vasoconstrictor
-may dimish visceral organ perfusion (liver, kidneys)
-try to limit emergency use only
-treatment for refractory hypotension (septic patients)

33
Q

Vasopressin infusions

A

-non-catecholamines vasopressor (V1 receptors)
-used for refractory hypotension
-very sick patients or post cardiac arrest

34
Q

Causes of bradycardia

A

-Drugs: alpha 2 agonists, opioids
-deep plane of anesthesia
-hypothermia
-vagal reflexes (oculo cardiac reflex)
-electrolyte imbalance

-sinus bradycardia
-AV block

35
Q

Cardiac arrhythmias

A
36
Q

Ventricular premature complexes

A
37
Q

Sinus bradycardia with escape beat

A
38
Q

Tachycardia

A

HR >180bpm in dog, or >200 bpm in cats

39
Q

Causes of tachycardia

A
  1. Sympathetic response to:
    -pain
    -awareness
    -hypotension
    -hypoxemia
    -hypercapnia
    -hypovolemia
  2. drug induced? Anticholinergics?
40
Q

Regurgitation/Gastro-esophageal reflux (GER)

A

-Brown fluid from nose
ADD

41
Q

Predisposing factors for Regurgitation

A

-brachycephalic breeds
-drugs relaxing lower esophageal sphincters (volatiles, opioids, anticholinergics, propofol)
-increased intra-abdominal pressure (pregnancy, obesity, surgery, head down position)
-prolonged anesthetic

42
Q

Preventative measures for Regurgitation

A

-appropriate pre-anesthetic fasting
-pretreatment with omeprazole, maropitant, metoclopramide
-use of cuffed ET tube

43
Q

Treatment of Regurgitation

A

-Secure airway in unconscious patient
-place suction catheter in esophagus
-suction refluxate and lavage with tap water
-instillation of 5-30ml Na-Citrate solution
-check and suction again prior to extubation
-Pantoprazole, famotidine

44
Q

Hypercapnia

A

Normal: 35-45 mmHg

Mild: 45-60mmHg
-SNS stimulation= tachycardia, mild hypertension

Severe: >90mmHg
-severe CNS depression (narcosis)
-respiratory arrest (depression of brainstem)

45
Q

Clinical signs when CO2 >60mmHg

A
  1. bounding pulses (high systolic, low diastolic)
  2. Vasodilation (brick red colour, capillary oozing)
46
Q

Causes of hypercapnia

A
  1. hypoventilation
  2. equipment failure
  3. endobronchial intubation
  4. V/Q mismatch
  5. Apparatus dead space (overlong ET tube)
  6. increased CO2 production (hyperthermia)
47
Q

Causes of hypoventilation

A

-respiratory depressant drugs
-positioning (dorsal)
-abdominal distension
-obesity

48
Q

Equipment failure causing hypercapnia

A

-unidirectional valves (circle systems)
-CO2 absorber exhausted
-inadequate fresh gas flow (non-rebreathing systems)

49
Q

Preventing Hypothermia

A
  1. insulation (towels bubble packs)
  2. Warming mats (circulating water, electrical, hot dogs, microwave bags of fluids, bean bags, snuggle safe)
  3. Warm air blankets (bair hugger)
  4. radiant heat lamps
  5. warm IV fluids/irritation fluids
50
Q

Potential problems with warming devices

A
  1. patient cannot move away
  2. blood flow may not conduct heat away
  3. body pushed into heat source
  4. temperature must be monitored
  5. burns from direct contact to patient… use towel for insulation
51
Q

Animals susceptible to hyperthermia

A

-heavy coated dogs on circle rebreathing system

-post op hyperthermic cats- linked to mu opioids, ketamine, intra-op hypothermia

-malignant hyperthermia

52
Q

Treatment for hyperthermia

A

-turn off supplemental heat, remove blankets, ice packs
-water, alcohol to inguinal and axillary regions
-fans (but be careful of corneal ulcers)
-Acepromazine- causes vasodilation and resets hypothalamus temperature set point

53
Q

Extubation of brachycephalic breeds

A

-Late extubation to avoid airway obstruction

**be patient, keep period between extubation and full alertness as short as possible

Anesthesia (24 decks)

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