Anesthetic Records and Monitoring Flashcards
what is the governing body for legislation and standards of practice
CVO
what falls under the following acts:
- veterinarians act
- controlled drugs and substances act
Veterinarians Act: MRs, including anesthetic records
Controlled Drugs and Substances Act: controlled drug log
what are the 3 required records related to anesthestia
1) Controlled Drug Log
2) Anesthesia and Surgery Log
3) Medical Record
where should you store the controlled drug log
away from the controlled drugs, since it can be a target of theft
what is the surgery/anesthesia log
list of all procedures done
why is the medical record part of the required records related to anesthesia
because the anesthetic log (record) is within and it is the main source of info for the V, C, P
what is the purpose of the anesthetic record in anesthesia during and in the future
DURING:
- monitor physiological variables
- indicate need for adjustments in the protocol (ex. changes in inhalant concentration)
- indicate needs for additional treatment (ex. fluids)
AFTER:
- informs future anesthetic management
what is a major purpose of the anesthetic record for the team
can see trends to inform current and future practices and helps with communication of patient status to the team
T/F anesthetic record requirements can vary depending on if you are in-hospital vs mobile
T
what is included in the individual patients medical record and anesthesia (for in-hospital anesthesia) (5 + an extra consideration if LA)
1) pre-operative assessment and rationale
2) anesthetic monitoring chart
3) post-operative assessment
4) prescribing/dispending information
5) discharge instructions (CA) or care instructions (LA)
For LA: also include drugs administered and the withdrawal time
T/F the anesthetic record should include the pre-operative assessment and baseline lab analysis if performed
T
how do we record drug information on the anesthetic record
in QUANTITY (g, ug, or mg) as well the time of administration (exception being inhalants where we put the dialed %)
especially important to include the START and END of anesthesia
how do we record fluid therapy on the anesthetic record
1) total amount administered (volume)
2) rate over time of administration
what physiological variables are recorded on the anesthetic record and what is their code
- HR (.)
- RR (x)
- BP
(systolic: v; diastolic: ^; mean: -) - temperature (at at least the beginning and end)
what is included in the post-anesthetic assessment
- pain scores
- physiological variables (includes MM colour and CRT)
- activity, concerns, etc.
what is a recommendation if giving sedation
to monitor and record physiological variables, especially if heavy sedation or compromised animal
what provides the standards for patient medical records and facility records (2)
Veterinarians Act and Accreditation Standards for Veterinary Facilities
Why do we monitor patients under anesthesia
dramatically reduces morbidity and mortality; improves the quality of anesthesia and analgesia
when do we monitor patients
immediately following sedation, during anesthesia, post-anesthesia until normal physiological variables and stable
what period is associated with the highest morbidity and mortality
a) pre-operative
b) operative
c) recovery
recovery
what do we typically measure during anesthesia (broad - 2 categories)
depth and physiological variables
in general, what is the relationship between depth and physiological variables
as you depress the CNS (get deeper), physiological variables lower
linear relationship
we monitor and record variables related to depth and physiology every ___ mins
5
How should we go about determining/assessing patient depth and physiological variables
using more than one variable to assess
what are ways to monitor patient depth using:
- physical exam
- monitors
physical exam:
- physiologic variables
- eye position and movement
- eyelid movement
- reflexes
- tear production
- jaw tone
monitors:
- EEG
in general, as patients become deeper what happens to eye position
moves ventromedially
what does eyelid movement tell us about patient depth and what is the exception
movement = too light; exception being ketamine where patient may still blink even if adequately anesthetized
what does nystagmus tell us about patient depth
too light
which palpebral is lost first
lateral lost first
how do we assess palpebral in horses
as one reflex (fan eyelids)
tearing is used to indicate light plane of anesthesia in what animal
horses
jaw tone is a very helpful indicator of depth in
cats
how do signs related to depth of anesthesia in dogs and cats differ between inhalant and injectable anesthesia
jaw tone: tight in a medium light plane of anesthesia with injectable
eye position: stays central regardless of depth with injectable
palpebral reflex: present in a medium light plane and slow in a medium deep plane with injectable
what are the components of the physical exam (manual) to monitor physiological variables in an anesthetized patient
observe:
- mm rolour
- RR
palpate:
- pulse (or auscult)
- CRT
- temperature of extremities
what types of monitors can we use to monitor HR
- stethoscope (standard or esophageal)
- EKG (standard or esophageal)
what types of monitors can we use to monitor pulse rate
- pulse oximeter
- pulse minder
- doppler BP monitors
- oscillometric BP monitors
what types of monitors can we use to monitor BP
- doppler BP monitor
- oscillometric BP monitor
- invasive (direct)
why is EKG not a heart PERFORMANCE indicator
it is just measuring electrical activity
what is the standard EKG placement (where and what colour)
3 lead: RF (white), LF (black), LH (red)
why can EKG be misleading
- may not have good contact of the leads
- it reads deflection from baseline so may get two deflections on a single beat or other artifacts making the rate inaccurate
what does a pulse minder do
detects perfusion to display pulse rate
what are the components of a doppler (4)
- piezoelectric crystal
- box to convert US waves to audible sound
- cuff (placed proximal to probe)
- sphingomanometer
pressure determined using a doppler represents _______ pressure in the dog and __________ pressure in the cat
systolic; mean
T/F Doppler gives accurate BP regardless of extremes (hypo or hypertension) in all species
F; it does give reliable pressure readings but only useful in dogs and cat
cuff size in small animals should be
35-40% of the circumference of the placement site for a Doppler and 30-40% of the circumference of the placement site for an oscillometric monitor
what information will an oscillometric bp monitor display
- systolic
- diastolic
- mean
- pulse rate
if you had a hypo/hypertensive patient or a patient with an arrhythmia is it better to use a doppler or oscillometric monitor
doppler
what can we use to measure:
- oxygenation (O2)
- ventilation (CO2)
Oxygenation:
- pulse oximeter
- arterial blood gas
Ventilation:
- arterial blood gas
- capnograph (ETCO2)
how does a pulse oximeter work and what info does it give us
uses red and infrared light to measure hemoglobin oxygen saturation
SpO2; heart rate/pulse rate
what do we want to see on a SpO2 reading
> 90% (normally 90-100 in arteries)
what is a major disadvantage of pulse oximeters
only telling you hemoglobin saturation not oxygen content so it assumes normal hemoglobin levels…
T/F vasoconstriction and skin pigmentation can interfere with pulse oximeter readings
T
what can blood gas analyzers be used to measure
CO2, O2, pH, Hb, electrolytes, glucose, lactate….
why do we measure END tidal CO2
at the end of an exhale there is less expired CO2 mixing with inspired O2, making the reading a more accurate indicator of arterial CO2 concentration…
how is capnography and pulse oximetry similar
both use infrared
