Elective Cases Flashcards
What ASA status would an otherwise healthy patient with unilateral cryptorchidism be considered? What pre-op blood work would be recommended?
ASA 1 —> cryptorchid testicle is not affecting the health of the patient
PCV/TS, serum biochemistry
What is the recommended IV fluid rate in dogs? What kind is recommended for a healthy dog undergoing a cryptorchid neuter?
5 mL/kg/hr
crystalloids
What are important components to IV premeds in a canine elective surgery?
- Maropitant
- Dexmedetomidine
- Hydromorphone
What IV induction is recommended for canine elective surgeries? What maintenance is used?
- ketamine: less cardiovascular effects, less propofol needed
- propofol
isoflurane or sevoflurane
What analgesia plan is recommended for canine elective surgeries?
- additional 1/2 dose of opioid used in premed (hydromorphone)
- Nocita incisionally
- Bupivacaine or Lidocaine intratesticular block on descended testicles
What are 3 important aspects to the post-operative plan in canine elective procedures?
- Acepromazine (slower onset) or Dexmedetomidine (faster) if needed for dysphoria
- Hydromorphone based on pain score
- Carprofen once fully recovered and oral TGH
What type of breathing circuit would be recommended for a healthy, 28 kg Golden Retriever undergoing an elective cryptorchid neuter?
rebreathing circuit
What are the 6 expected complications associated with a healthy canine elective cryptorchid neuter?
- hypoventilation - anesthesia-induced, laparoscopy causing insufflation of abdomen
- hypotension - anesthesia-induced, bradycardia due to anesthetics, especially with Dexmedetomidine and Hydrocodone
- bradycardia - only treat if BP is low!
- hypothermia
- hypoxemia - abdominal distension due to surgery impedes ability to expand lung/chest
- excitement at recovery - young and active dog, Trazodone + E-collar!
How are testicular blocks used in canine and feline patients?
Bupivacaine for longer procedures or Lidocaine for shorter and sooner surgeries pulled up in a 3 cc syringe with a 25g needle
- CANINE = max 0.5 mL per testicle
- FELINE = max 0.25 mL per testicle
Where is the testicular block performed?
embed needle in testicular tissue, avoiding pole due to vascularity
- aspirate and, if no blood is present, inject appropriate amount —> testicle should expand, local will travel up the spermatic cord
A 6 y/o healthy and slightly obese DSH is presenting for a prophylactic dental. She has never had blood work done. A quick oral exam shows mild tartar.
What ASA status is this patient? What blood work should be done?
ASA 1 - no gingivitis, tartar is not affecting her health
full CBC (PCV/TS) and chemistry - no BW history, obese, possibility of renal disease (middle-aged cat)
What fluid rate is recommended for cats? What kind of fluid is used in a healthy feline elective procedure?
3 mL/kg/hr
crystalloids
What IV premeds are recommended for a healthy feline elective procedure?
- Maropitant
- Butorphanol - works better in cats, hydromorphone can cause post-op hypertermia
- Midazolam
What IV induction is recommended for healthy 6.5 kg feline elective procedures? What maintenance is used? Breathing circuit?
- Ketamine
- Alfaxolone/Propofol
isoflurane or sevoflurane with a pediatric circuit on rebreathing circuit
What aspect of anesthesia maintenance is of concern in an obese patient?
may require ventilation —> more challenging to expand thorax = hypoventilation
When is an analgesia plan necessary for a routine dental? What medications can be used?
if extractions are required
- dental blocks
- Buprenorphine
- NSAID: no renal disease noted
What post-operative plan is recommended in healthy feline elective dentals? What is extractions are required?
Acepromazine +/- Dexmedetomidine for excitement
- Buprenorphine
- Robenacoxib - SQ if not administered during procedure, oral TGH
What aren’t mouth gags as commonly used in dental procedures? In cats?
very uncomfortable, soreness
causes decreased cerebral blood flow and patients can wake up blind
What are 6 anticipated complications associated with healthy feline dental procedures?
- hypoventilation - anesthesia-induced, obesity
- hypotension - anesthesia-induced, especially important due to susceptibility of developing renal disease
- bradycardia - can be decreased with mixed opioids
- hypothermia - smaller patients, water used with scaler
- hypoxemia
- excitement and hyperthermia at recovery
What are the 2 most common causes of excitement and hyperthermia in feline patients following anesthesia? When is it treated?
- rebound effect due to hypothermia during procedure
- pure mu agonists, Buprenorphine, Ketamine
use benign neglect unless T > 104, then add more sedation, reverse pure mu agonist with Naloxone or Butorphanol
How should dental blocks for procedures be determined? Which local is most commonly used? What should patients go home with?
depending on the region requiring extractions
Bupivacaine - gives time to perform extractions, give 10 mins for onset
NSAIDs +/- Buprenorphine (OTM or Zorbium)
Why is it especially important to ensure a feline patient is eating 2-4 hrs post-operatively?
medications to go home are more likely to be PO, can advise owners to give favorite meals to encourage ingestion of medications
Why is the timing of the use of NSAIDs controversial?
- pre or intra-op = okay for ASA I and II and higher status if properly hydrated (RBF concerns!)
- post-op = pre-existing hypovolemia, hypotension, surgical risk, coagulopathy
POST-OP - intraoperative hypotension + NSAID use impacts renal function, multimodal approach helps lower dosage —> mostly safe in routine patients
How is hypotension, hypothermia, hypoventilation, bradycardia, and hypoxemia troubleshooted in routine cases?
HYPOTENSION - depends on HR - bradycardia should be treated first, fluid bolus
HYPOTHERMIA - want to avoid <97 degrees, warm patient
HYPOVENTILATION - ventilator, assisted breathing
BRADYCARDIA - treat with low BP!
HYPOXEMIA - common during induction
What are the 3 most common causes of perioperative hypoxemia?
- no pre-oxygenation
- too fast induction agent
- improper ET tube placement or length
How often should patients be monitored? What else is recorded?
every 5 mins
- time of surgical incision(s)
- dental radiographs
- repositioning/moving
- support drugs given
- anesthesia machine type, ETT size, circuit type, type of IVC and location
- quality of sedation and recovery
- pain scoring
