Canine/Feline Anesthesia And Anesthetic Monitoring/Problems Flashcards
Describe anesthetic techniques commonly used in small animal practices.
I. Multimodal general anesthesia (premedicate, IV induction, Inhalant maintenance)
II. Sedation/Neurolept analgesia – procedures, aggressive patients
III. Local/regional anesthesia – part of multimodal aneshtesia
List strategies used to minimize adverse effects when selecting an anesthetic protocol.
I. Minimum patient database
II. ASA status (PS1 – healthy; tailor proctol based on individual patient)
III. Procedure – correct dehydration, hypotension, anemia
IV. DVM drug preference (multimodal, double check dose, label syringes, administer ‘to effect’ – smallest dose possible generating desired effect)
Describe how different methods of anesthetic induction and maintenance influence the dynamics of an anesthetic event.
- IM induction – peak effect by 30 min, metabolized 60min; little control depth & peak
- IV (profol) – peak 5 min, metabolized 10-20min
Control peak effect (repeat bolus), not duration - Total intravenous anesthesia TIVA (intermittent bolus) – rapid induction & maintainable; depth increase as more bolus given
- Inhalant – peak 5 to 8 min, better control depth but can be delayed (RD, agent, flow rate)
- IV & inhalant – induction <5min, control depth, rapid recovery
Describe the process of induction
- Gather equipment – machine, ETT, mask, monitoring devices, warming device, drugs, crash cart
- Premedicate – ease stress, IV catheter placement, reduce induction agent & prevent windup
- Conscious – excitement (prevent with preanesthetic) – general – surgical anesthesia
Describe induction of general anesthesia by IV injection of an ultrashort-acting agent, by mask or chamber induction, or by IM injection.
Explain cautions and risks associated with each method of anesthetic induction and strategies to maximize patient safety.
IV induction (Ketamine&Midazolam, Propofol): Give initial bolus (1/2); check HR, RR, jaw tone, pedal, palpebral reflex; titrate (give more bolus until effect)
Inhalation: Iso (3-5%), Sevo (4-6%) by mask/chamber
- Patient may struggle, vitals hard to obtain
- Exposure to WAG, no airway control
- Vomit/regurgitate, epinephrine release
IM (neuroleptanalgesia): aggressive, give entire dose, slow onset, longer recovery
List reasons for, advantages of, and potential complications of endotracheal intubation.
Advantages: open airway, deliver fresh gas efficiently (low WAG, flow rate), reduce aspiration & dead space (more gas in alveoli), ventilation, CPR
Disadvantage: irritation, trauma, stimulate vagus nerve (bradycardia, hypotension), overzealous (damage trachea), overinflate, obstruction, chew tube
Steps of Endotracheal Intubation
- Supplies – ETT (3-4.5mm cats, 7.5-8 10kg dog), syringe, gauze, lidocaine, IV tubing, larygoscope
- Induce into light stage III – sternal recumbency
- Assistant grasp maxilla, raise head, extend the neck
- Grasp tongue with sponge, visualize larynx
- Displace epiglottis ventrally, insert ETT in rotating motion – do not force, exchange tube
- Place patient laterally, check tube is trachea, secure
- Turn on flowmeter, connect ET to breathing circuit, inflate cuff, turn on vaporizr & monitor
Explain the process of intubation
How to check tube in trachea – moving RB, air moving/fogging in tubing, valves, palpate ETT, capgnograph
Tie gauze using surgeon knot, loose end over head/behind head (brachycephalic, cats)
Inflate cuff until pressure at 20cm H2O (close pop off valve, compress bag watching pressure manometer)
Cats (laryngospasm) – inject 0.1mL Lidocaine in glottis
Describe maintenance of general anesthesia by administration of an inhalant agent, injection of repeat IV boluses of an ultrashort-acting agent, or constant rate infusion (CRI).
Inhalant: Iso (1.5-2.5%), Sevo (2.5-4%), change increments 0.5-1% or add opioid/injectable
TIVA: 0.10 to 0.25 induction volume q 3-5min
CRI: Propofol & Alfaxalone, adjust rate
IM – not to be used with propofol (short duration procedure)
List principles of providing for patient positioning, comfort, and safety during anesthetic maintenance.
Position: lateral recumbency
Needle is not left in Tport, double check IV access
ETT maintenance – disconnect first when repositioning, do not drag, watch RB
Heat support, eye lubrication q 1-3hr
List factors that affect patient recovery from anesthesia, the signs of recovery, appropriate monitoring during recovery, and oxygen therapy during recovery.
Recovery = time when anesthesia discontinued, able to walk/stand. Based on procedure time, condition, anesthesia used, temperature, breed
Signs ↑ HR, RR, RV; central eyeball; return of reflex, shivering, voluntarily head movement, delirium
Monitor: hypoxemia, cardiac arrhythmia, delayed conciousness, hypothermia/abnormal vitals
Administer reversal/analgesia, O2 (50-100mL/kg/min), extubate, general nursing care
Describe the process of extubation.
Extubate – once swallowing reflex, chewing, head movement
- Deflate cuff until balloon empty, untie tube
- Remove ETT when patient can lift head (brachycephalic), do not delay on cats
Dentals – keep cuff partially inflated, remove fluids, keep patient lateral/sternal, extend head
Describe general nursing care during the postanesthetic period.
Remove any ties, probe, cuff, ECC electrode
Keep IV catheter – fluid maintenance
Gently stimulate – turn, rub chest, turn q 10-15 (hypostatic congestion)
Gradual warming (Bair hugger), padded bedding
NPO 1-2 hours, gradual introduction of water (except neonates)
Explain the principles of anesthetic monitoring, including the reasons for and goals of monitoring.
Monitor vital signs – proper circulation, oxygenation, ventilation (patient safe)
Monitor anesthetic depth – adequate CNS depth, analgesia, muscle relaxation/immobility
List and describe each of the stages and planes of anesthesia.
Stage 1 (voluntarily movement)
Induction agent given → Stage I (signs pronounced mask/chamber induction, less premedicated)
Dysphoria/disoriented
Normal vitals ↓ awareness of pain
Recumbent
Patient begin to loose conciousness
List and describe each of the stages and planes of anesthesia.
Stage 2 (involuntary movement)
Stage II → loss of spontaneous muscle movement
(Signs pronounced mask/chamber induction, less premedicated)
Involuntarily movement, vocalization
Struggle, ‘paddle’ (causes epinephrine release)
Normal reflex
Dysphoria
↑ HR, RR, dilated pupils, marked muscle tone, apnea/irregular respiration
List and describe each of the stages and planes of anesthesia.
Stage 3 (light)
Best time to intubate, minor procedures
Muscle relaxation, patient calm/non-vocal
↓ HR, ↓↑ RR, normal respiratory pattern
Eyeball center, pupil constricted, ↓ PLR
Pedal & palpebral present; reduce gagging, laryngeal, swallowing
List and describe each of the stages and planes of anesthesia.
Stage 3 (surgical)
Completely unconciousness & immobile
Slight ↓ HR, RR, BP in absence of pain, HR/RR mildly ↑ for painful stimuli
Moderate pupil size, ventromedial eye rotation
Reflexes sluggish - PLR, lacrimation; absent - pedal, swallowing; lost - laryngeal & palpebral
List and describe each of the stages and planes of anesthesia.
Stage 3 (deep)
Depth too deep progressing into cardiac/respiratory depression
↓ HR, RR, VT , BP unchanged to surgical stimulation
↓ pulse strength, pale MM, prolonged CRT
Loss of all reflex
Abdominal breathing/contraction
Central eyeball, widely dilate, unresponsive pupil
Flaccid jaw tone (very relaxed muscle tone)
List the monitoring parameters used primarily to determine whether or not the patient is safe and group them according to whether they primarily assess circulation, oxygenation, or ventilation.
Circulation/Perfusion
- Parameter: HR/rhythm, pulse, CRT, MM, BP
Oxygenation
- Parameter: MM, SPO2, Blood gas
Ventilation
- Parameter: RR/RD, Breath sounds, ETCO2, PACO2, Blood pH
ACVAA Guideline - Circulation
- Always: palpate peripheral pulse, awareness of heart rate, rhythm, quality
- Always: evaluate CRT & MM color
- Intermittent: Auscultate heartbeat stetoscope
- Continuous: Esophageal statoscope (audible monitor)
- Periodic: SPO2
- Periodic: ECG to detect arrhythmias
- Periodic: Blood pressure
Vital Sign
Heart Rate (HR)
HR ↓ bradycardia: dex, opioids; excessive anesthetic depth/adverse reaction
HR ↑ tachycardia atropine, acepromazine; inadequate depth, pain, blood loss/shock, hypoxemia, hypercapnia
Palpate apical pulse (femoral artery), ausculate heart
Explain setup, operation, care, maintenance, and troubleshooting.
Esophageal Stethoscope
Catheter instered into esophagus (5th rib) connected to audio monitor amplifying heart sound (adjust volume)
Clean catheter with chlorhex, change batteries
Explain setup, operation, care, maintenance, and troubleshooting.
Heart Rhythm/ECG
Abnormal rhythm is only visualized through ECG – attach color coded electrod to pt, recorded into leads/views (Lead I/II GA); artificats – moving, exagerrate breathing
Pt is placed on towel (nonconductive), record 1-2 min
Normal baseline, P wave (atria contract - ventricle), PR interval (SA node – purkinje fiber), QRS complex (ventricle contract – pulmonary artery & aorta), ST segment (flat), T wave (repolarization/filling ventricles)
Be familiar with certain rhythms on an electrocardiographic tracing (I)
- NSR: normal HR, equal distance between QRS complex
- SA: ↓ HR expiration (short QRS), ↑ HR inspiration (long QRS), normal in healthy dog
- Sinus bradycardia: slow HR (excessive depth)
- Sinus tachycardia: fast HR (inadequate depth)
- AV hear block: delay in conduction of AV ndoe (Dex, high vagal tone, hyperkalemia)
• 1st degree: prolong PR interval
• 2nd degree: occasional missing QRS, prolong PR
• 3rd: No P/QRS relationship (↓ cardiac output, tx)
Be familiar with certain rhythms on an electrocardiographic tracing (II)
- Supraventricular complex (SPC): QRS close, +/- P wave
- Supraventricular tachycardia: >3 SPC
- Ventricular Premature Complex (VPC): ≥1 wide & bizarre QRS closely follow previous (common in anesthesia, treatment based on frequency)
- Ventricular tachycardia: >3 VPC (tx with Lidocaine)
- Atrial fibrillation (chaotic contraction): absent P waves, normal QRS irregular interval
- Ventricular fibrillation: unrecognizable QRS complex (CPA) → PEA (no pulse/heart contraction)
Vital Sign:
Capillary Refill Time (CRT)
Rate of return of color to (oral) mucous membranes after applying gentle digital pressure; >2 sec = reduced tissue perfusion & temperature
Epinephrine release, hypotension, hypothermia, excess depth, shock
Vital Sign:
Blood Pressure (BP)
Force exerted of flowing blood on arterial walls = indicator of perfusion for anesthetized patients (interaction of HR, stroke volume = amount ejected, vascular diameter, arterial elasticity, blood volume
PSYS: contraction of L ventricle – aorta/arteries
PDIA: pressure remaining in arteries (RA & LA filling blood
MAP: average pressure throughout cardiac cycle (diastole, atrial systole, ventricular systole); best indicator of tissue perfusion
Hypotension: dehydration, shock, sepsis, GDV, tachycardia
Hypertension: pain, light plane, disease, drugs
Vital Sign:
Pulse Strength
Palpate peripheral artery (femoral/thigh) ~ BP
GA: strength ↓ but palpable ouccring after S1 ‘lub’ (ventricular systole)
Based on PSYS - PDIA, vessel diameter – not always correlated with MAP/tissue perfusion
Explain setup, operation, care, maintenance, and troubleshooting.
Doppler (non-invasive)
Doppler – probe (crystal) emits frequency to pulsating artery received back as echos (pitch = velocity of RBC). Place on clipped area peripheral (leg/tail) artery, held/taped in place use ultrasound gel
Cuff (30-50% circumference of leg) attached to sphygmonamoeter inflated until ‘heartbeat’ not heard, PSYS = signal returns (underestimated in cats)
Values affected by positioning, movement, cuff size
Explain setup, operation, care, maintenance, and troubleshooting.
Oscillometric Blood Pressure Monitor (non-invasive)
Oscillometeric BP Monitor – cuff (inflates & deflates) with sensor (measures oscillation) connected to monitor = PSYS (10-15mmHg lower), PDIA, MAP, HR
Accurate for >7kg (small, superficial arteries), underestimate hypotension & over estimate hypertension, may not work if shivering/moving/tight/loose cuff
Vital Sign:
Central Venous Pressure
BP in large central vein – monitor critical patients heart function, fluid overload, return of blood to heart
Place jugular catheter to R atrium attached to pressure manometer, meniscus of fluid rise & fall with each breath (<8cm H2O dogs & cats)
ACVAA Guideline - Oxygenation
Periodic SPO2 or PAO2 (ill patients)
Oxygen – required for metabolic process
Free/unbound (PaO2/PvO2) – based on O2 alveoli/lung
Bound to hemoglobin (SaO2/SvO2) – based on PO2
• SO2 100% (anesthesia) = PO2 500mmHg
• SO2 98% (room air) = PO2 100mmHg
• < SO2 95% = PO2 80mmHg (hypoxemia)
Vital Sign:
Mucous Membrane Color (MM)
‘Pink’ MM. tongue, prepuce/vulva = proper oxygenation, tissue perfusion
Pale: blood loss/anemia
Cyanosis (blue/purple): hypoxemia if PCV normal
Vital Sign:
Hemoglobin Saturation
SPO2 = oxygenated – deoxygenated hemoglobin
• 95-100% (normal)
• 90-94% (hypoxemia)
Explain setup, operation, care, maintenance, and troubleshooting.
Pulse Oximeter (SPO2)
Transmission (clothespin)/reflective probe with light source & sensor
- Place on tongue/pinna (no pigment, hairless) transmission; rectum/ventral tail - reflective
- Temperamental, can lose signal (motion)
- Drugs, tissue perfusion can affect
- Clean with alcohol (do not immerse)
Sensory analyzing frequency & HR by pulsation in arterioles
Diagnostic:
Blood Gas Analysis
Measurement of blood pH, dissolved O2 & CO2 in arteriers (PaO2, PvO2, PaCO2, PvCO2), ~RR/RD/RC
Usually performed in specialty/LA – arterial blood
- Blood pH: 7.35-7.45 (normal awake), 7.2-7.3 (GA)
- PaCO2: <45mmHg (normal), 45-55Hg (GA), >55 (hypoventilation)
- PaO2 <80mmHg (hypoxemia), <60mmHg (severe)
ACVAA Guideline - Ventilation
Ventilation: movement of gases in & out alveoli
Respiration: oxygen is supplied & used by tissue, CO2 eliminated by tissue
- Always - observe thoracic wall movement/breathing bag movement
- Always - auscultate breath sounds with statoscope/esophageal stethoscope/audible respiratory monitor
- Recommended - capnograph (end-expired CO2)
- Arterial blood gas analysis (PACO2)
- Respirometry - measure tidal volume
Vital Sign:
Respiratory Rate (RR)
Respiratory Character
RR/RC – from chest movement/RB
Bradypnea common for anesthetics
Tachypnea – surgical → light stage III (arousal), hypercapnia, surgical stimulus
Panting: rapid shallow breaths only seen in conscious animals
Vital Sign:
Tidal Volume (VT)
VT = amount of air inhaled (decreased in GA)
Atelectasis: partially collapsed alveoli (bag pt)
Hyperventilation: ↑ VT hypercapnia, surgical stimulation
Measured by respirometer placed between expiratory hose & exhalation valve
Explain setup, operation, care, maintenance, and troubleshooting.
Apnea Monitor
Monitor ventilation/patient breating
Sensor between ETT connector & breathing circuit detecting Δ temperature from cool inspired & warm expired air (beep – breath, alarm – no breaths)
Can increase mechanical dead space, difficult to measure ↓ VT & hypothermia
Explain setup, operation, care, maintenance, and troubleshooting.
Capnograph (ETCO2)
ETCO2 measures COS inspired (0mmHg) & expired (35-55mmHg)
Mainstream (immediate, ↑ dead space)/side stream (delay, little dead space) monitor CO2 in venous blood/lungs
Vital Sign:
Core Body Temperature
Best to have intermittent rectal measurement/continuous rectal or esophageal temp probe
Thermoregulation in hypothalamus regulate temp (depressed during GA)
Hypthermia – excess heat support, drug (seen during recovery, apply cooling methods, reversal/acepromazine)
Explain adverse consequences of hypothermia and identify strategies to prevent hypothermia.
Hypothermia (89.6-93.2F) = prolong recovery, depress CNS & heart
Shaved skin w/ alcohol – cools, GA = cannot shiver, vasodilation (agents) cause heat loss
Best to warm IV fluids, non-rebreathing machine warm air, circulating warm blanket, keep room warm
List and explain monitoring parameters to determine anesthetic depth.
Swallowing: material into pharynx (LS-maybe, SA/DA-no)
Laryngeal: closure of epiglottis/vocal cords (LS-yes)
Palpebral (blink): when tap/stroking eyelids (LS– maybe, SA/DA – no)
Pedal: withdrawal of libm (LS-yes, SA/DA – no)
Corneal: retraction of eyeball (for assessing LA)
PLR: constriction of pupil w/ light (LS- yes. SA-maybe, DA-absent)
Dazzle: blink in response to bright light, similar to PLR
List the most common reasons that anesthetic emergencies occur.
Inadequate training/unfamiliar with agent
Failure to prepare patient (History, PE)
Drug administration error (weight/math, ‘6 rights’)
Fatigie. Haste
Misassembled machine, O2 supply, vaporizer, POV
CO2 absorbent exhausted
ETT blockage, positioning
Explain how anesthesia of pediatric patients differs from anesthesia of healthy adult dogs and cats.
Neonatal – unable to respond to physiological stress Δ fluid balance, blood glucose; immature kidney, liver, heart, ↑ surface area:volume (hypothermia)
Do not withhold food, use gram scale
IV fluid with burette, D5W additive
Shorten ETT, induce & maintain inhalant
Dilute injectable
Predisposed to ↓ HR, RR, BP (add anticholinergics)
Heat support (heating pad, Bair hugger)
Explain how anesthesia of geriatric patients differs from anesthesia of healthy adult dogs and cats.
Geriatic - ↓ organ function & reserve, poor response to stress, hypothermia, less tolerable hypotension, preexisting conditions
Premedicate with sedation & analgesia, regional block, injectable induction, maintain inhalant
IV fluid, heat support
Describe the problems involved in anesthetizing:
Obese animals
Poor blood supply (calculate based on lean body weight)
Respiratory difficulties – shallow respirations (O2 facemask in induction, ventilator, hydromorphone)
Describe the problems involved in anesthetizing:
Bracycephalic Dogs
Skull & airway pathology – stenotic nares, everted saccules, elongated soft palette, hypoplastic trachea, swelling of laryx, high parasympathetic tone
Preoxygenate, rapid IV induction & intubation, maintain inhalants, monitoring (dyspnea, cyanosis), prolong recovery (keep ETT, extend head & neck), minimize excitement & stress (analgesia/sedative)
Describe the problems involved in anesthetizing:
Sighthounds
Lack of body fat for drug redistribution, inefficient metabolism of propofol & alfaxalone
Describe the problems involved in anesthetizing:
Pre-exisiting Cardiovascular Disease
Δ HR, rhythm, ↓ cardiac output, fluid buildup, altered blood flow (congential injury/disease)
Preanesthetic labs, pre-O2, IV fluid (overhydrate) hydromorphone/fentanyl, midazolam, anticholinergic, acepromazine (no dex, ketamine)
Induction & maintain: alfaxalone, propofol, +/- opioid (slow IV, CRI), titrated inhalation
Describe the problems involved in anesthetizing:
Pre-existing Respiratory Disease
Airway obstruction, laryngeal paralysis, pleural effusion, diaphragmatic hernia, pulmonary contusion
PE, labs, rads, blood gas; minimal restraint, pre O2, Buprenorphine, midazolam, low dose ace (no dex)
Rapid ETT, ventilator, monitor ETCO2/SPO2, induce propofol/alfaxal, best to maintain with inhalant
Suction, swallowing reflex back, post O2
Describe the problems involved in anesthetizing:
Pre-existing Hepatic Disease
Liver - metabolize drugs, synthesize clotting factors & proteins, carbohydrate metabolism (hypoproteinemic, liver failure – icteric, anemic, thin)
Avoid (ace, midazolam, ketamine)
Induce/maintain inhalants
Describe the problems involved in anesthetizing:
Pre-existing Renal Disease
Kidneys – maintain fluid volume, electrolyte/acid-base
Diagnostics – USG, BUN, CREA, SDMA (pretreat hyperkalemia sodium bicarbonate & D5W)
Offer water 1hr premedication = reduced acepromazine, midazolam, ketamine dose
Induce/maintain inhalants, reduced propofol, ketamine/diazepam
Describe the problems involved in anesthetizing:
Cesarean Section
Aspirate vomiting, decreased lung capacity (pressure on diaphgram), cardiac workload, physiologic anemia, poor regulation BP (IV fluids, clip clean before induction, left lateral)
Epidural, tranquilizer, neuroleptanalgesia, anticholinergic (most cross placentra depressing newborn respiration)
40% inhalant, propofol/ketamine induction, extubate when swallowing
Describe the problems involved in anesthetizing:
Parturition
Distend uterus ↓ lung capacity, functional residual volume
PreO2, IV catheter (add 2nd catheter rapid infusion), butorphanol/buprenorphine post op
Neonates – O2 facemask, intubate 16-18g catheter, suction, doxapram base of tongue, dilute atropine, allow to nurse
Describe the problems involved in anesthetizing:
Trauma
Low Tv (hypoxia, arrhythmia, acid-base imbalance), hypercarbia (acid-base imbalance, arrhythmia), shock
Very few trauma case require surgery – stabilize, diagnostics, monitor dyspnea, cardiac arrhythmia, radiographs, cage rest (thoracic injury)
Describe the problems involved in anesthetizing:
Diaphragmatic Hernia
Hole in diaphragm pushing abdominal organs into thoracic cavity = respiratory distress, apnea
PreO2, avoid head down position, emergency abdominal exploratory
IV induction & rapid ETTI, ventilator, monitor respiratory (SPO2, ETCO2, blood gas)
PostO2, risk of pneumothorax
Describe the role of the vet tech in responding to anesthetic emergencies.
- Notify DVM & plan with for potential emergency
- Check/monitor equipment (functional), patient apperance/depth, current events
- Get supplies & crash cart ready (ask another staff)
- Brief with team after – why emergency occur, prevention steps
List common causes of and responses to the following anesthetic problems:
Light Anesthesia Plane
Vaporizer – setting, filled, calibrated, malfunction
ETT – blocked, disconnected, too small, leaks
Patient (apnea, low VT) - ventilator
Anesthesia machine – leaking (switch machine)
Flow rate – minimum 250mL/min, high flow dilutes
List common causes of and responses to the following anesthetic problems:
Deep Anesthesia Plane
Consider all parameters when evaluating (<6 bpm, shallow, pale/cyanotic MM, bradycardia, weak pulse, arrhythmia, hypothermia, absent corneal, palpebral, PLR, dilated pupils)
High vaporizer setting/overdose on injectable, Preexisting condition – shock, anemic
Notify DVM/always assume too deep = discontinue anesthesia, ventilate, IV fluid, heating, reversal
List common causes of and responses to the following anesthetic problems:
Pale Mucous Membrane
Monitor depth, vitals, rule out anemia, hemorrhage, anesthetic (vasodilators)
Notify DVM – drugs, IV fluid/blood transfuion
List common causes of and responses to the following anesthetic problems:
Prolong CRT
Check pulse, BP (<60 mmHg MAP, <80mmHg PSYS)
Observe shock, hypothermia, tachycardia & bradycardia (late stage)
Notify DVM
List common causes of and responses to the following anesthetic problems:
Dyspnea, cyanosis
Anesthesia machine – O2 supply, flowmeter on, blocked (circuit/ETT)
Airway obstruction – excess flexion of head & neck
Pathology – pneumothorax, pulmonary edema
Surgical drapes, constricting bandage, deep anesthesia
Turn off vaporizer, O2 support, IV fluid, doxapram, observe to avoid cardiac arrest
List common causes of and responses to the following anesthetic problems:
Tachypnea
↑ RR that can arise anytime during anesthesia
Assess anesthetic depth (delay 1-2 min changing setting), check CO2 canister, administer analgesia (surgical stimulation), assist ventilation (obese)
List common causes of and responses to the following anesthetic problems:
Tachycardia, bradycardia, cardiac arrhythmia
Tachycardia (>140-200 BPM) – from atropine, ketamine, epinephrine preexisting (hyperthoid, shock, CHF), surgical stimulation = notify DVM, adjust vaporizer
Bradycardia (<60-100 BPM) – from alpha2 agonist, opioid, stimulate vagus nerve/viscera, deeply anesthetized = notify DVM, anticholinergics
Cardiac arrhythmia – anticholinergic, alpha2 agonist, seen in induction/light anesthesia, respiration depression, dz = consult DVM
List common causes of and responses to the following anesthetic problems:
Apnea
Temporary cessation of breathing secondary from anesthesia (propofol), hyperventilation
Monitor vitals, ventilate, alert DVM if spontaneous respiration doesn’t resume in 1-2min
List common causes of and responses to the following anesthetic problems:
Respiratory and Cardiac Arrest
Respiratory arrest - prolong apnea, anesthetic overdose, respiratory dz = monitor RR, dyspnea, HR, CRT, pulse, pupils (dilated), SPO2 <90%; ventilator (avoid overbagging)
Cardiac arrest - anesthesia/drug reaction, precede by cyanosis, dypsnea, RA, prolong CRT, arrhythmia = no palpable heartbeat/QRS complex/pulse, BP <25mmHg, cyanotic, CRT >2sec, dilated pupil, no PLR/corneal reflex, agonal breath
Permanent brain damage if CPA is not treated within 5 minutes
Explain the principles of cardiopulmonary resuscitation as recommended in the RECOVER Guideline
Basic Life Support
- Confirm CPA (ausculate heart beat)
- Chest compression
- Cardiac pump: compress ventricles between ribs & spine
Cats/small dogs (lateral, over heart), bulldog (sternal, sternum)
- Thoracic pump: compress aorta, blood flow to thorax in recoil
Giant breed (lateral, wide portion of chest)
- Two hands, 100-120 compression, 1/3 to 1/2 chest, allow reexpansion, switch after 2 minutes & listen - Intubate/ventilate – 1 breath q 6 sec, watch for rise, VT >10/kg, room air/O2
RECOVER on CPR
Advanced Life Support and Additional Treatment
- Monitoring: ECG leads (saline, gel), ETCO2 >15mmHg, ROSC – pulse, QRS complex, heartbeat
- IV access – emergency drugs can be given intratracheal, IV fluids
- Give reversals, epineprhine/atropine, lidocaine (VT); additionally potassium (hypokalemia), calcium (hypocalcemia)
Recurrent CPA common – monitor BP, bloog gas, SPO2, ECG, capgnopgraph, constant IV fluid
List the most common problems that may arise in the recovery period and the appropriate action that can be taken to prevent or treat these problems.
- Regurgitation (passive expulsion of stomach content), vomiting (active expulsion, retching) = aspiration in trachea
- Intubate (cuff), extend & lower head, suction, antiemetics
- Most occur after animal concious & able to swallow
- Pts that are fed higher risk - Excitement – paddling, vocalization = self limiting, reversals, monitor; seizure – twitch, uncontrolled neck/head movement (ketamine, epiletic) = dark room, diazepam/propofol, monitor
- Dyspnea – seen after ETT (laryngeal edema, bracycephalic) = check MM, SPO2; O2 support, extend head, tongue forward; drugs, reintubate
Prolong recovery – notify DVM
