Anesthetic Problems & Emergencies Flashcards by Dana Dyches

Most common human errors in anesthesia

-poor planning (missed hx/PE concerns)
-inexperience (drug, machine, response, etc.)
-drug overdose (P weight error, calc. error, wrong drug/conc./route)
-distraction/inattentiveness/fatigue

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Most common equipment problems in anesthesia

1.Incomplete breathing circuits
2.CO2 absorbent exhaustion
3.Empty O2 tank
4.ET tube
5.Vaporizer problems
6.Pop-off valve left closed

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Formula for calculating how much O2 left in E tank

psi x 0.3

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Formula for calculating how much O2 left in H tank

psi x 3

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Concerns for using acepromazine in anesthesia and how to correct

lowers seizure threshold, hypotension; dopamine and fluids

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Concerns for using dexmedetomidine in anesthesia and how to correct

CVS depression (bradycardia); atropine, reverse

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Concerns for using buprenorphine in anesthesia and how to correct

Respiratory depression; naloxone, doxapram

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Concerns for using propofol and how to correct

apnea; prevent by titrating 1/3-1/4 then by 10%

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Concerns for using ketamine in anesthesia

eye position reflexes, disorientation and slow recovery in cats, contraindicated w/ head trauma

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Patient factors effecting anesthesia

-Geriatric, Pediatric
-Lean, obese patients
-Breed-linked risks
-Cardiac patients
-Renal and hepatic disease
-Endocrine disorders

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What should be done for geriatric and pediatric patients

decrease dosages of drugs by 1/2-1/3

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How should you calculate drugs for obese animals

use ideal body weight

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What should be done for brachycephalic breeds

rapid induction, pre-oxygenate, delay extubation

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What should you avoid in thin animals and sighthounds

barbiturates

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What should be done for patients with renal disease

decrease drug dosages, rehydrate prior

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The following should be done for _ patients
-Shorter fasting
-Dextrose (5ml/kg/hr)
-Decrease drug dosages

pediatric

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What is the most common anesthetic complication

Hypotension

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What systolic BP is considered hypotensive

<90mmHg

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What Mean BP is considered hypotensive

<60-70mmHg

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The following are causes of _
-Hypovolemia
-Excessive peripheral vasodilation
-Bradycardia or other arrhythmia’s
-Decrease cardiac output (contractility, cardiac failure)
-“Too deep” = overdose
-Hypothermia

Hypotension

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The following are ways to correct _
-Decrease anesthetic depth
-Warm patient
-Fluid therapy bolus
-Anticholinergics (atropine)
-Sympathomimetic (+ionotropic) drugs- Dobutamine, Ephedrine, Dopamine

Hypotension

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How to make a dopamine or dobutamine drip

kg x 6= _mg to add to 100ml fluid

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Dopamine or dobutamine drip should be infused at

1ml/hr= 1mcg/kg/min

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Signs of fluid overload

-crackles/wheezes
-serous nasal discharge
-increase RR/RE
-coughing

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Crystalloids will leave the IV space within

2 hours

The following are causes of _ -Anesthesia, drug induced (too light/deep) -Hypoventilation & Electrolyte imbalances (acidosis, hypoxia, hypercapnia) -Vagal stimulation -Heart trauma, GDV -Breed (boxers)

Cardiac rhythm abnormalities

Rates considered bradycardia

-Dog <60bpm -Cat <100bpm -LA <25bpm

The following are causes of _ -Too deep -Opioid drugs -Alpha 2 agonists -Severe hypotension -Vagal stimulation -Hypothermia

Bradycardia

Rates for tachycardia in dogs

Standard: >160bpm Giant breeds: >140bpm Toy breeds: >180bpm Puppies: >220bpm

The following are causes of _ -Light anesthesia -pain -Hypotension -Hypoxia -Shock -Hyperthermia

Tachycardia

Symptoms of arrhythmias

-irregular pulse rate or strength -irregular heart sounds and ECG -pallor, cyanosis, increased CRT

Tx of arrhythmias

prevent, correct cause

Ventilation is the correction for

Hypoxia and respiratory acidosis

Respiratory depression leads to _

hypoventilation

Hypoventilation leads to

hypoxemia

Respiratory emergencies

Inadequate ventilation and/or abnormal blood gas values (PaCO2 & PaO2)

Signs of respiratory emergencies

-apnea or dyspnea -tachypnea -cyanosis

The following is identification of _ -RR <6bpm -Decrease tidal volume -PaCO2 >45mmHg -Blood gas analysis

hypoventilation

The following are causes of _ -Drugs and anesthetic depth -Equipment -Positioning -Lung/pleural disease -CNS disease -Hypothermia

Hypoventilation

How to correct hypoventilation

-check equipment -decrease inhalant -reverse opioids -correct body temp. -initiate intermittent positive pressure ventilation (IPPV)

Examples of parenchymal exchange disease

pneumonia, pulmonary edema or contusion

Correction of parenchymal exchange diseases

-Pre-op meds -Pre-oxygenate -Intermittent Positive pressure ventilation (15-20cm H2O= MAX

Examples of pleural cavity disease

diaphragmatic hernia, pleural effusion, pneumothorax

Results of pleural cavity diseases

hypoxemia, cardiac arrest

Correction of pleural cavity diseases

thoracocentesis, thoracostomy tube

Respiratory arrest should be corrected in _-_ minutes

1-3

Indications for ventilation

-prolonged apnea -severe hypoventilation -intrathoracic surgery -others

What should you do to wean off ventilation

-Lighten anesthesia -Decrease RR to 4-6brpm -Warm and stimulate P -Provide analgesia

Consequences of hypothermia

metabolic acidosis, hypoxia, bradycardia

Signs of malignant hyperthermia

increased temp. and HR, muscle rigidity

Tx of malignant hyperthermia

D/C anesthesia, drugs, cool body

Malignant hyperthermia is common in some _

swine lines

_ _ is an acute adverse reaction to anesthesia, especially inhalants

Malignant hyperthermia

Anesthetized patients less tolerant of _ _

blood loss

A _% blood volume loss= crisis

20%

4x4 gauze can hold _ml of blood

10ml

3x3 gauze can hold _ml of blood

6ml

Blood volume formula for dogs

90ml/kg

Blood volume loss formula for cats

70ml/kg

The following are tx of _ _ 1. Replace w/ LRS @ 3x volume lost or 2.Replace w/ hetastarch @ 1x volume lost or 3.Hypertonic saline (7.5%) @ 4ml/kr (only in emergency) or 4.Whole blood, PCV monitoring

blood loss

Tx/resolution to not being able to keep P anesthetized

5P's, assess equipment, assess patient

What are the 5 P's

prior planning prevents poor performance

Tx/ resolution for P being too deep

Decrease or turn off vaporizer, ventilate patient, antagonize drugs, 5P's

Biggest anesthetic complications

-Hypotension -Hypoventilation -Hypothermia -Bradycardia

Most common occurrence of _ is in head-down surgical positions and in ruminants

regurgitation

Tx of regurgitation

-immediate placement of cuffed ET tube -clean out regurgitated material w/ suction

Vomiting during or after anesthesia is common in

brachycephalic dogs or non fasted animals

Signs of vomiting during or after anesthesia

airway obstruction leading to dyspnea/cyanosis, bronchospasm

Tx of vomiting during or after anesthesia

-intubation and suction if unconscious -lower head and clean oral cavity if conscious

Seizures are seen with

ketamine admin., after dx procedures (myelography), or preexisting conditions

Tx of seizures

reduce stimuli, postoperative analgesia, diazepam or propofol, monitor for hyperthermia

What does excitement look like and when is it seen

spontaneous paddling and vocalization; seen after barbiturate anesthesia or high opioid doses

Dyspnea in cats is usually caused by

laryngospasm sometimes triggered by removal of the ET tube

_ _ in cats may result from repeated intubation attempts

laryngeal edema

Dyspnea in cats is easier to _ than _

prevent; treat

The following are causes of _ _ -Impaired renal or hepatic function -Hypothermia -Patient susceptibility to anesthetic agent -Breed variation -Coexisting disorder -Prolonged anesthesia or deep anesthesia

prolonged recovery

Ps having a C-section are at risk for

blood loss and shock during sx

Physiologic effects of pregnancy

anemia and impaired BP regulation

Supportive measures for c-section

-IVC and fluids -Decrease anesthetic agent dosages -Preoxygenate -Monitor (SaO2, PaO2, ETCO2, BP)

If PCV normal in pregnant patients, may indicate _

dehydration

Anesthesia options for C-section

Neuroleptanalgesia + Epidural General anesthesia

What drug should not be used as a premed for C-section

ace

_ induction is not recommended for c-section because dam not intubated (aspiration), maternal excitement, length of time for induction and environmental pollution

Mask

Drugs that cross the _ will also cross the placenta

BBB

_ will not cross placenta so should not be used for bradycardia in c-section

glycopyrrolate

What should be done for apnea in neonates

intubate with 16-18g IVC and gently bag every 5 seconds

What should be done if no HR in neonate

epi via umbilical

Avoid _ in patients with seizures and include _/_

ace; valium/midazolam

Why should lower dosages be used in meningitis

BBB more permeable

What should be avoided with head trauma patients

ketamine and opioids

What must be done prior to anesthesia in trauma patient with respiratory problems

remove air/fluid

Oxygen delivery methods for trauma patient with respiratory problems

flow by (50-100ml/kg/min) nasal catheters (10ml/kg/min) oxygen collars

Head down patient positions before and during anesthesia should be avoided in patients with _ _

diaphragmatic hernia

A rebreathing circuit is a _ _ system

low flow

A non rebreathing circuit is a _ _ system

high flow