Exam 1 - Post-op Complications Flashcards
What are the normal recovery period activities?
Turn off anesthetic gas Patient regains gag or swallow reflex Extubation Regains consciousness Sits sternal Walks
What should be monitored during recovery?
Cardiovascular status Ventilation Oxygenation Pain Body temperature Tolerance of the ET tube Signs of abnormal behavior
What are some recovery related complications?
Emergence delirium, Mu agonist opioid dysphoria, pain, laryngeal trauma, regurgitation, aspiration +/- pneumonia, upper airway obstruction, hypoventilation and hypercapnea, and hypothermia
What three problems have the same clinical signs?
emergence delirium, Mu agonist opioid dysphoria, and pain
What clinical signs are associated with recovery related complications?
Vocalization in dogs, uncontrolled or controlled muscle movements, anxiety, dysphoria, and hyperthermia in cats associated with opioid dysphoria
What is emergence delirium?
post-anesthetic excitement
What can be done to mitigate emergence delirium?
administer a tranquilizer (acepromazine/dexmedetomidine)
What does dysphoria mean?
you cannot interupt the behavior
What condition is associated with Mu agonist opioid dysphoria in cats?
hyperthermia
What can be done to mitigate Mu agonist opioid dysphoria?
Naloxone or butorphenol
If pain is an issue, what can be administered to mitigate it?
a mu agonist
What can regurgitation lead to?
esophagitis, pneumonitis, or pneumonia
How do you mitigate regurgitation?
maintain appropriate ET cuff pressures
If a patient is hypoventilating or hypercapneic with an elevated ETCO2, what may you need to do?
assist ventilation with an ambu-bag or O2
If there is an upper airway obstruction, what should be done?
reintubate the patient
What are common complications in our feline patients?
pain, respiratory distress, hyperthermia, and hyperactivity
What are common complications in our canine patients?
pain and hypothermia
What are the causes for post-operative pain?
deficiency of pain medication, tissue trauma, surgical complication, and is often associated with hypothermia
How is post operative pain managed?
assess pain scores regularly, multimodal pain management, and work up potential surgical complications
What are the pain management drugs used for cats?
Meloxicam (NSAID) - 24 hour duration
Buprenorphine (opioid) - 4-8 hour duration, causes hyperthermia
Bupivicaine - local block - 3-5 hours
What are the pain management drugs used for dogs?
Carprofen - NSAID- 12-24 hour duration
Hydromorphone - opioid - 4-6 hour duration, causes sedation and hypothermia
Bupivicaine - local block - 3-5 hours
Tilly is a Junior female, now spayed, DSH who presented from NW IA HS. Her pre-op PE revealed she was an overall healthy cat, however her BCS was 3 and she was obviously pregnant. Her pre-op BW was PCV 30%, TS 6.5 mg/dL, Glucose 122 mg/dl, and Azostick 5-15. She was spayed yesterday. Her incision was approximately 100% longer due to her pregnancy status. This am she is QAR and reluctant to come to the front of the cage. She ate ~ 40% of her evening meal. She did not defecate and had a small amount of urine in her litterbox
Vital parameters – Temp 102.8, HR 200, RR 40. color pink, crt 1 sec, hydration – possibly mildly dehydrated – slow skin tent and tacky mm
PE - painful on incisional palpation. Abdomen markedly tense and cannot palpate thoroughly. No obvious fluid.
What is Tilly’s Pain score?
a. 1
b. 2
c. 3
d. 4
b. 2
Tilly is a Junior female, now spayed, DSH who presented from NW IA HS. Her pre-op PE revealed she was an overall healthy cat, however her BCS was 3 and she was obviously pregnant. Her pre-op BW was PCV 30%, TS 6.5 mg/dL, Glucose 122 mg/dl, and Azostick 5-15. She was spayed yesterday. Her incision was approximately 100% longer due to her pregnancy status. This am she is QAR and reluctant to come to the front of the cage. She ate ~ 40% of her evening meal. She did not defecate and had a small amount of urine in her litterbox
Vital parameters – Temp 102.8, HR 200, RR 40. color pink, crt 1 sec, hydration – possibly mildly dehydrated – slow skin tent and tacky mm
PE - painful on incisional palpation. Abdomen markedly tense and cannot palpate thoroughly. No obvious fluid.
Her analgesia plan was buprenorphine given as a pre-med, buprivacaine line block, Meloxicam in recovery. What medications are currently controlling her pain?
a. Buprenorphine
b. Bupivicaine
c. Meloxicam
c. Meloxicam
Tilly is a Junior female, now spayed, DSH who presented from NW IA HS. Her pre-op PE revealed she was an overall healthy cat, however her BCS was 3 and she was obviously pregnant. Her pre-op BW was PCV 30%, TS 6.5 mg/dL, Glucose 122 mg/dl, and Azostick 5-15. She was spayed yesterday. Her incision was approximately 100% longer due to her pregnancy status. This am she is QAR and reluctant to come to the front of the cage. She ate ~ 40% of her evening meal. She did not defecate and had a small amount of urine in her litterbox
Vital parameters – Temp 102.8, HR 200, RR 40. color pink, crt 1 sec, hydration – possibly mildly dehydrated – slow skin tent and tacky mm
PE - painful on incisional palpation. Abdomen markedly tense and cannot palpate thoroughly. No obvious fluid.
What do you want to do to manage her pain?
a. Give second dose of Meloxicam early
b. Give a dose of buprenorphine at 0.02 mg/kg IM
c. Prescribe an oral medication such as gabapentin
b. Give a dose of buprenorphine at 0.02 mg/kg IM
Bailey is a 6 month, FS, Pitty-mix, who presented 5 days ago for an elective ovariohysterectomy from Boone AHS. Her pre-operative evaluation revealed a healthy patient. Her surgery today went well with a minor complication of bleeding from the broad ligament that required ligation. Her recovery initially was slow. She was hypothermic, but with heat support increased to 99.o F and she was able to walk around the treatment room. She was returned to her cage at 5:00 pm.
At 7:00 pm SOAP – QAR – will lift head, but does not want to stand and walk. No interest in food or water. CSU pain score = 2-3. Temp = 98F, CRT = 2 sec, mm pale pink, feet are cold, pulses feel weak and deep.
What are Bailey’s problems? (multiple answers)
a. Post-operative pain
b. Post-operative hypothermia
c. Possible anemia
d. Lethargy
All of them
Bailey is a 6 month, FS, Pitty-mix, who presented 5 days ago for an elective ovariohysterectomy from Boone AHS. Her pre-operative evaluation revealed a healthy patient. Her surgery today went well with a minor complication of bleeding from the broad ligament that required ligation. Her recovery initially was slow. She was hypothermic, but with heat support increased to 99.o F and she was able to walk around the treatment room. She was returned to her cage at 5:00 pm.
At 7:00 pm SOAP – QAR – will lift head, but does not want to stand and walk. No interest in food or water. CSU pain score = 2-3. Temp = 98F, CRT = 2 sec, mm pale pink, feet are cold, pulses feel weak and deep
What are the likely differential diagnoses?
a. Hypothermia and sedation secondary to hydromorphone
b. Internal bleeding
c. Pain
d. Addison’s disease
e. Liver disease
a. Hypothermia and sedation secondary to hydromorphone
b. Internal bleeding
c. Pain
Bailey is a 6 month, FS, Pitty-mix, who presented 5 days ago for an elective ovariohysterectomy from Boone AHS. Her pre-operative evaluation revealed a healthy patient. Her surgery today went well with a minor complication of bleeding from the broad ligament that required ligation. Her recovery initially was slow. She was hypothermic, but with heat support increased to 99.o F and she was able to walk around the treatment room. She was returned to her cage at 5:00 pm.
At 7:00 pm SOAP – QAR – will lift head, but does not want to stand and walk. No interest in food or water. CSU pain score = 2-3. Temp = 98F, CRT = 2 sec, mm pale pink, feet are cold, pulses feel weak and deep
What is a reasonable diagnostic plan?
a. PCV/TS
b. Blood Pressure
c. Response to treatment
d. Clotting profile
e. Abdominal imaging
a. PCV/TS
b. Blood Pressure
c. Response to treatment
Bailey is a 6 month, FS, Pitty-mix, who presented 5 days ago for an elective ovariohysterectomy from Boone AHS. Her pre-operative evaluation revealed a healthy patient. Her surgery today went well with a minor complication of bleeding from the broad ligament that required ligation. Her recovery initially was slow. She was hypothermic, but with heat support increased to 99.o F and she was able to walk around the treatment room. She was returned to her cage at 5:00 pm.
At 7:00 pm SOAP – QAR – will lift head, but does not want to stand and walk. No interest in food or water. CSU pain score = 2-3. Temp = 98F, CRT = 2 sec, mm pale pink, feet are cold, pulses feel weak and deep
What treatment should you do immediately?
a. heat support
b. IV fluid
c. Administer another dose of hydromorphone for the pain
a. heat support
At what post-op temperature is there no concern for hypothermia in a dog?
temp >99F
What should you do if a dog’s post-op temp is between 98-99 F?
Provide heat support until temp is >99 and the patient is stable
What should you do if a dog’s post-op temp is less than or equal to 98F and/or unstable?
provide heat support and follow after-hours non-emergency SOP
What are clinical signs associated with upper airway complications?
Sneezing, nasal discharge, gagging and discomfort, coughing and subcutaneous emphysema
What are differential diagnoses should you have for upper airway complications?
Nasal passage irritation or infection, laryngeal trauma, tracheitis, and ruptured trachea
What are diagnostics are used for upper airway complications?
PE, radiographs, pulse ox
What is the plan for upper airway complications?
Monitor, pain meds, subcutaneous emphysema
What are clinical signs associated with lower airway complications?
Febrile +/- tachypnea, dyspnea, increased respiratory effort, coughing, extended neck and wide stance in the front limbs, anxiety, depression, recumbency, cyanosis
What are differential diagnoses should you have for lower airway complications?
Barotrauma, aspiration pneumonia, pneumonia, pulmonary edema
What are diagnostics are used for lower airway complications?
PE, CBC, pulse oximetry, rads, FAST scan
What is the plan for lower airway complications?
Take to ICU, O2, IV fluids, antibiotics, bronchodilators
Marla is a 4 month, FS, DSH who was spayed yesterday. No previous problems.
On PE she is BAR, interested in food, spontaneously gagging and coughing.
Temp = 102.6, HR 200, RR 36 and purring. Pain on palpation of the larynx and trachea. Referred lung sounds throughout lung fields
What are Marla’s problems? (multiple)
a. Coughing
b. Fever
c. Pain
d. Tachypnea
a. Coughing
b. Fever
c. Pain
Marla is a 4 month, FS, DSH who was spayed yesterday. No previous problems.
On PE she is BAR, interested in food, spontaneously gagging and coughing.
Temp = 102.6, HR 200, RR 36 and purring. Pain on palpation of the larynx and trachea. Referred lung sounds throughout lung fields
What are the LIKELY differential diagnoses? (multiple)
a. Aspiration pneumonia
b. Laryngeal and/or tracheal trauma
c. Barotrauma
d. Pain
e. Upper respiratory tract infection
b. Laryngeal and/or tracheal trauma
d. Pain
Marla is a 4 month, FS, DSH who was spayed yesterday. No previous problems.
On PE she is BAR, interested in food, spontaneously gagging and coughing.
Temp = 102.6, HR 200, RR 36 and purring. Pain on palpation of the larynx and trachea. Referred lung sounds throughout lung fields
What is a reasonable plan? (multiple)
a. Buprenorphine
b. Soft food
c. Oxygen
a. Buprenorphine
b. Soft food
Ducky is a 4 month, FS, DSH who was spayed yesterday. She was dysphoric and ate ravenously after surgery
On PE she is QAR and easily agitated, no interest in food, dyspnea and tachypnea. Head and neck extended.
Temp 103.4, HR 200, RR 65. Cough on tracheal palpation. Lung sounds dull cranioventrally, crackles (adventicial sounds) bilaterally
What are Ducky’s problem? (multiple)
a. Respiratory disease - dyspnea, tachypnea, struggling to breath, and adventicial sounds
b. fever
c. coughing and sneezing
d. Difficult anesthetic recovery
a. Respiratory disease - dyspnea, tachypnea, struggling to breath, and adventicial sounds
b. fever
Ducky is a 4 month, FS, DSH who was spayed yesterday. She was dysphoric and ate ravenously after surgery
On PE she is QAR and easily agitated, no interest in food, dyspnea and tachypnea. Head and neck extended.
Temp 103.4, HR 200, RR 65. Cough on tracheal palpation. Lung sounds dull cranioventrally, crackles (adventicial sounds) bilaterally
What are the LIKELY differential diagnoses?
a. Aspiration pneumonia
b. Barotrauma
c. Laryngeal trauma
d. Airway obstruction
e. Upper respiratory infection
a. Aspiration pneumonia
Ducky is a 4 month, FS, DSH who was spayed yesterday. She was dysphoric and ate ravenously after surgery
On PE she is QAR and easily agitated, no interest in food, dyspnea and tachypnea. Head and neck extended.
Temp 103.4, HR 200, RR 65. Cough on tracheal palpation. Lung sounds dull cranioventrally, crackles (adventicial sounds) bilaterally
What is a reasonable plan?
a. Take immediately to ICU and text Dr. Carnevale or Dr. VW
b. Text Dr. Carnevale or Dr. VW for instructions
c. Recheck in 30 minutes after offering warmed canned food
a. Take immediately to ICU and text Dr. Carnevale or Dr. VW
