Coping with Comorbidities Flashcards
What are some general anaesthetic consideration for patients with cardiac conditions?
- Avoid stress/pain
- Pre-oxygenation
- Avoid hypothermia/shivering
- Co-induction techniques ( e.g. midazolam)
- Decrease inhalants use:
- Minimum Alveolar Concentration (MAC) sparing effect techniques
- Loco-regional anaesthesia
- Monitoring
GOALS of Mitral valve dx?
- Maintain forward flow
- Minimise regurgitation
→ Maintain normal or (slight) ↑ HR
→ Avoid vasoconstriction
→ Avoid excess volume/rate of fluids
how can we avoid vasoconstriction in MMVD patients
☺ ACP (low dose): mild vasodilation
Alpha-2 agonists: vasoconstriction, bradycardia
DCM goals?
- Maintain forward flow
- Minimise regurgitation
→ Maintain normal or slight ↑ HR
→ Maintain myocardial contractility
→ Avoid vasoconstriction
Alpha- 2 agonists
→ Avoid excess volume/rate of fluids
HCM GOALS?
- Optimise diastolic filling
→ Avoid ↑ contractility & Tachycardia
( ketamine )
→ Avoid stress/pain
→ Maintain systemic vascular resistances
( ACP, inhalants)
→ Avoid hypovolemia
What is the problem in HCM
- Diastolic disfunction
- Concentric LV hypertrophy: poor ventricular filling
→ ↓CO
Should we use alpha 2 in HCM?
? Controversial…
* Reduction outflow obstruction in cats with LVOTO ☺
* ↓ Cardiac output
* ↓ stress ☺
* Preventing tachycardia ☺
* MAC sparing effect ☺
* Careful if echo/thoracic x rays performed
What pathophys of anaemia?
*Impaired O2 carrying capacity → ↓O2 delivery to tissues → hypoxia →metabolic acidosis
*Acute vs Chronic
*↑ Sympathetic Nervous System → ↑ CO, SV, HR to compensate
What considerations from our POV with anaemia?
*Optimise PCV, CO, tissue perfusion
*Blood products
*Careful with fluids (haemodilution)
* Heart murmur
Make a table of the risk factors & relevant anaesthetic considerations & solutions with BOAS?
WHAT DO WE WANT DO for FELINE ASTHMA
- Avoid stress/pain
- Pre-oxygenation
- Give asthma medications the day of anaesthesia
- Bronchodilators: (Terbutaline - systemic or salbutamol inhaled/ steroids)
- Abodi drugs cuaisng histamine release (morphine, pethidine)
- Ketamine & inhalands -> good for bronchodilation
- Avoid cough
- Suction, prepare to reintubate
What are the anaesthetic considerations and solutions for each risk factor of liver dx ?
Risk factors for liver dx pt 2?
Risk factors/ considerations & solutions for CKD?
What are the GOALS for anaetshesia of our kidney dx patients?
Goal : Maintain renal perfusion & GFR
* Avoid cardiovascular depression
* Maintain normotension
* Avoid stress/pain
What drugs to be careful with in kidney dx?
OPIOIDS
* Decrease CO & renal blood flow/GFR
* Hyperglycaemia
* Active metabolites Morphine & pethidine renally excreted * Diuresis
* Accumulation?
* Urinary retention
DON’T use Opioid or NSAID
What important thing to be aware of/monitor in Urethral obstruction?
Hyperkalaemia !! -> BradyC / Arrythmia
also hypovol, azotaemia, metabolic acidosis
How do we treat the hyperkalaemia ?
Should you give hyperthyroid drugs on the day of sx?
YEs continue with normal tx schedule
what does hypothyroidism cause?
- ↓ Contractility & HR : bradycardia, arrhythmias, hypotension
- Obesity
- Muscle weakness
- Possible laryngeal paralysis
- Anaemia
- Regurgitation
- ↓ metabolic rate
- ↓ hepatic metabolism
- Hypothermia
- Prolonged recovery
Should we stabilise our hypothyroid patient with levothyroxine pre-op?
yes
Considerations of Diabetes Mellitus?
How to manage diabetes patient with op time/ insulin times?
- Procedure am (ideally 1st case of the day): Fasting since 12 am night before, administer 50% of normal insulin dose am
- Fasting from 12am night before, withhold the morning insulin, assess pre-operative blood glucose
- Procedure pm: administer patient’s usual insulin dose + food am, 6 hours fasting
- Avoid long fasting times (> 12h)
How to tailor insulin dosage?
- Withhold the morning insulin, assess pre-operative blood glucose + blood tests
(PCV/TS, electrolytes, ketones, lactate, hydration status) - Insulin dose tailored to patient needs:
Intra op what to do ?
glucose monitoring q 30 mins ->
Managing intra op hyperglycaemia?
If Blood Glucose:
* >15- 20 mmol/L : administer regular insulin 0.1 IU/Kg IV, IM
* or regular insulin intravenous (IV) or intramuscular (IM) at 20% of the patient’s usual dose
Intra op hypoglycaemia?
If Blood Glucose:
* < 6 mmol/L: start glucose infusion
* 3.5-6 mmol/L : bolus 0.5-1 g/kg (diluted 1:4) + 2.5% glucose
* < 3.5 mmol/L : bolus 0.5-1 g/kg (diluted 1:4) + 5% glucose
Common complication fo diabetes patients?
hypotension
What to do with our diabetes patients anaesthetic/analgesic wise?
- Select short-acting or reversible anaesthetic drug
- Loco regional anaesthesia (careful with peripheral neuropathies)
- Alpha 2 agonists: Inhibition insulin release: transient ↑ in blood glucose
- ☺ Opioids
would u give anything else for diabetic patient?
IVFT & prokinetics/ antiemetics?
