Final Flashcards
Waste anesthetic gas includes what vapours
Includes all anesthetic vapors……
breathed out by a patient (in recovery)
that escape (leak) from the anesthetic machine
during filling or emptying of anesthetic vaporizers
due to accidental spill of liquid anesthetic.
what unit are waste gas concentrations expressed in
ppm
33ppm = level at which average person can smell the odor of halothane which is how many times the recommended max concentration
= 15X the recommended max concentration!
What are the short term effects of breathing in waste anesthetic gasses
direct effect on brain neurons causing fatigue, headache, drowsiness, nausea, depression and irritability
if occur frequently, may be indicator of excessive waste gas levels with a potential for long-term toxicity effects
What are the long term effects of breathing in waste anesthetic gasses
Long-term inhalation of waste gas may be associated with several health problems
Mechanism? Not fully understood. Probably due to toxic metabolites produced by the breakdown if anesthetic gases within the liver and their subsequent excretion by the kidney
The more an anesthetic agent is retained by the body and then metabolized (versus those quickly eliminated through the lungs), the more likelihood toxic metabolites will be produced.
How do you assess risk for waste anesthetic gas exposure
It is difficult to determine a clear-cut assessment of risk because many studies are contradictory within themselves or across studies
It is not established in the majority of studies that the waste anesthetic gases are the causative factor in some of the increased health risks
Many studies did not measure the level of waste gas present which makes interpretation of the validity of the study difficult
In general, avoid exposure to high levels of waste anesthetic gas and reduce exposure as much as possible
What does waste anesthetic gas levels depend on
Iso levels vary between 1 to 20ppm (if presence of scavengers) Highest level immediate to anesthetic machines but depends on: Duration of anesthesia Flow rate of carrier gas Anesthetic maintenance Use of an effective scavenging system Anesthetic techniques used Room ventilation Anesthetic spills
How do you reduce exposure to waste anesthetic gas
Use of a scavenging system
equipment leak testing
anesthetic techniques and procedures
What is the definition of a scavenging system
tubing attached to the anesthetic pop-off valve (or in case of a non-rebreathing system, to the outlet port or tail of the reservoir bag)
What is the function of a scavenging system
to collect waste gas from the machine and conduct it to a disposal point outside the building
what is the employers responsibility involving a scavenging system
install adequate engineering controls to ensure that occupational exposure to any chemical never exceeds the permissible exposure limit
what are the two types of scavenging system
active system
passive system
What is the active scavenging system
Active system (fig. 13.2 p.357) uses suction created by vacuum pump or fan to draw gas into the scavenger most efficient system but more expensive more maintenance ..and must turn on system each day!!
What is the passive scavenging system
Passive system (fig. 13.1 p. 357) uses gravity and positive pressure of gas in the anesthetic machine to push gas into the scavenger
most commonly, passive systems discharge through a hole in the wall
suitable for rooms adjacent to the exterior of the building
distance to the outlet should be less than 20 feet
Another type of passive system: may place end of transfer hose adjacent to room ventilation exhaust or nonrecirculating air conditioning system.
waste gas should be totally confined within scavenger hose until discharge and must not be recirculated within the building
transfer hose may not be more than 10 feet in length
What is an activated charcoal canister and filter mask used for
Activated charcoal canister: system used of no scavenging into the room
Activated charcoal filter mask: for personnel at special risk
What is the negative pressure system
Negative pressure: if using an active scavenging system, you should prevent negative pressure (vacuum) from the scavenger from being excessively applied to the breathing circuit,
particularly if machine is not equipped with a negative pressure relief valve
If occurs, reservoir bag will collapse!!
ensure that reservoir bag is at least partially inflated with air at all times (if no neg. P relief valve present)
What is the disadvantage to using a scavenging system
Potential for blockage of the entry of waste gas into the system which is analogous to a closed pop-off valve
Why is equipment leak testing so important
Leakage is a significant source of operating room pollution and is not reduced by scavenging
Where can leakage occur from
Leakage may occur from any part of the machine in which N2O or anesthetic is present including:
Connections for N2O lines
rings, washers, seals etc.
Connections between flowmeter and vaporizer
Unidirectional valves
CO2 absorber canisters
Holes in the reservoir bags/ hoses
Pop-off valve and scavenger is not airtight
Connection sites of the hoses, reservoir bag or endotracheal tube
Vaporizer cap not replaced after the filling
What is a high pressure leak test
High pressure tests for N2O or O2 leakage arising between the tanks and the flowmeter (to do only if use N2O)
What is a low pressure leak test
Low pressure tests for escape of anesthetic gas from the anesthetic machine
To do every day!
Why are good anesthetic techniques so important
Faulty work practices were found to account for 94% to 99% of waste anesthetic gas released in scavenged operating rooms in one survey of human hospitals
How many air changes per hour are needed
at least 15.
how often should anesthetic machines be serviced
1/2x per year
How can you monitor waste gas levels
If required, done by an occupational hygienist with samples collected from multiple areas of the hospital and analyzed by infrared spectrometer at a cost of $250 - $700. Detector badges (passive dosimeters) or tubes may also be worn or placed in a specific area that are specific to a single chemical or to multiple chemicals. Results are given as a time-weighted average at $50 to $70 per badge.
What is the fire and safety precaution you have to take with compressed gas cylinders
Oxygen and N2O are not flammable but both support combustion and cause fuels to burn more readily. No sources of ignition should be in same room
describe use and storage of compressed gas cylinders
Ideally, wear protective goggles when connecting a gas cylinder to an anesthetic machine, and/or keep your head and face away from the valve outlet
Always turn the valve slowly to the full open position
If a cylinder leak occurs, never use your hand to try to stop the leak!!!
Sudden release of gas from cylinder (e.g. damage or regulator detaches) may cause the tank to become a rocket like projectile!!!
Thus, cylinders should always be upright and chained or belted to a wall etc.
Valve caps should be used on large cylinders that are not connected to gas line (to protect the valve from damage
They should also be out of emergency exits or heavy traffic areas
Use a handcart to move a cylinder to another location
Keep in order (first in, first out) and clearly labeled as to type and status
Use tear-off labels system
what are potential accidental methods of exposure
skin exposure, eye splash, oral ingestion of injectable drugs or inhalation agents, oral ingestion
Most concerns drugs are opiods used for restraint and capture of wildlife (10000X the potency of morphine!)
Why do we do paediatric spay and neuter
advantages for shelters
benefits for pet owner
advantages for breeders
faster/easier for vets
what are the advantages for shelters with paediatric spay and neuter
Tool for controlling pet overpopulation.
decrease return rate, decrease euthanasia
what are the benefits for owners with paediatric spay and neuter
more commitment, more socialized pets, better health care and persistent juvenile behaviour
what are the advantages for the breeders with paediatric spay and neutering
it is a real non breeding contract.
what are the advantages for vets with paediatric spay and neuters
faster, easier, less stress to the vet and to the animal, less expensive.
What are the medical advantages to doing paediatric spay and neuters
:decreased risk of pyometra, mammary neoplasia, behavioural changes, testicular neoplasia, perineal neoplasia, hernia.
:shorter surgery time
:shorter anesthesia episode
:shorter anesthetic recovery and healing
Does paediatric spay/neuter result in stunted growth
No, false.
Does paediatric spay/neuter result in obesity
No, obesity is multifactorial.
Does paediatric spay/neuter result in lethargy/inactivity
No, animals are naturally active. The dominant behaviour is unaffected.
Does paediatric spay/neuter result in reduced vaccine response
False.
How does paediatric spay/neuter affect the secondary sex characteristics
infantile vulva is more prone to medical problems, infantile prepuce and penis are present with prepubertal neutering.
Is estrogen linked to incontinence in cats
yes, it is estrogen responsive and easily treatable
what age is considered a neonate
birth to 2 weeks
what age is considered an infat
2-6 weeks
what age is considered pediatric
6-12 weeks avg. (8-16 wk)
what are some general characteristics about pediatrics
hypoAlb
increased permiability of blood brain barrier
low % body fat
What are the effects of anesthesia for neonates
makes them more sensitive to standard drug dosage
decrease tolerance to fluid load
what are the good strategies for dealing with neonates
decrease drug dosage
dont overhydrate
Describe neonates immature thermoregulatory system
large body surface area compared to body mass - leads to heat loss
have small fat reserve
decreased shivering reflex
what are the effects of anesthesia on neonates thermoregulatory system
hypothermia = delayed recovery hypothermia = increased O2 consumption
what are the thermoregulatory strategies to employ with neonates
keep them warm
describe neonates renal-urinary system
immature
what are the effects of anesthesia on neonates renal-urinary system
prolonged recovery time
decreased tolerance to fluid load
describe a neonates hepatic system
immature
what are the effects of anesthesia on neonates hepatic system
prolonged recovery time
**reduce drug dosage, or avoid drugs metabolized by the liver
describe a neonates respiratory system
high metabolic rate
limited pulmonary reserve
pliable rib cage
what are the effects of anesthesia on a neonates respiratory system
decreased respiratory reserve
what are the strategies to employ when working with neonates respiratory system
O2 and ventilation support
supervise induction
describe a neonates cardiovascular system
heart contraction not as efficient
limited cardiac reserve
what are the effects of anesthesia on neonates cardiovascular system
decrease cardiac reserve
what are the strategies to employ when working with neonates cardiovascular system
IV fluid (monitor closely) drugs that help contract the heart
What are two pieces of anesthetic equipment suited for pediatrics
temperature control device
pediatric bain system could be used
do we fast paediatrics?
no (max 2-4hr) due to risk of hypoglycaemia
What is part of the preanesthetic preparation for pediatriacs
weight gpe blood test \+/- vaccines/deworm \+/- pre-oxygenate
when does the fear imprint stage occur
at 7-8 weeks of age, reaction to painful stimulus is marked.
what is a necessary precaution to take when dealing with the fear imprint stage
smooth, gentle induction into anesthesia in mandatory or catecholamines are released that increase the liklihood of dysrhythmias.
What is the max fluid rate for pediatrics
3ml/kg/hour
why do we give pediatrics fluid
adapt poorly to hypovolemia
What do you need to do to ensure the patients stay warm
decrease contact with cold surface minimal shaving use warm pre-op solution use warm fluid use warming device limit body cavity exposure decrease surgery time use reversal agent.
What can you premedicate paediatrics with
opiods
acepromazine
alpha-2-agonist
what drug do you use to induce pediatrics
ketval or propofol
what analgesia do you give pediatrics
nsaid
describe recovery period for pediatrics
risky preventable continue fluid + active warming monitor glucose feed immediately upon anesthetic recovery
What is assisted ventilation
Assisted ventilation: anesthetist ensures that an increased volume of air is delivered to the patient…
◦ although the patient initiates each inspiration
what is controlled ventilation
Controlled ventilation: anesthetist forcefully delivers all of the air that is required by the patient…
◦ and the patient does not make any spontaneous respiratory efforts.
how do you administer controlled ventilation
any method by which anesthetist assists or controls the delivery of O2 + anesthetic gas to the patient’s lung
what is the goal of controlled ventilation
GOAL: ensure that patient receives adequate O2 and is able to exhale adequate amounts of CO2
describe ventilation when awake
Inhalation is initiated by the respiratory center (RC) of the brain
triggered by increasing levels of CO2 in arterial blood.
Above 40mmHg of CO2, RC initiate inspiration by:
stimulating intercostal muscles and diaphragm to move…
which results in expansion of the chest.
This create a negative P in the chest, pulling air into the lungs as they expand
When the lungs are adequately expanded….
…nerve impulses feed back to the RC to stop expansion.
Passive phase can begin as the diaphragm and intercostal muscles relax.
Normally, expiration lasts twice as long as inspiration
Why is ventilation in the anesthetized animal different
Tranquilizers and GA the responsiveness of the RC in the brain to CO2.
◦ Thus, inspiration does not occur as often despite significant elevations in CO2
Tranquilizers and GA relax the intercostal muscles and the diaphragm
◦ resulting in a decreased Tv
◦ With decreased RR and TV, Respiratory minute volume is decreased .
what are 3 potential problems with ventilation in the anesthetized animal
Hypercarbia
Hypoxemia
Atelectasis
what is hypercarbia
Hypercarbia:
◦ CO2 is not eliminated as rapidly (so PaCO2 increase)
◦ CO2 + H2O molecules in blood = HCO3 ˉ + H+
◦ Too much H+ = blood ph decrease
◦ Blood pH is decrease to as low as 7.2 relative to normal (7.38 to 7.42) = respiratory acidosis
how do you overcome hypercarbia
may have to assist or control ventilation
What is hypoxemia and how is it overcome
Hypoxemia: PaO2 may be if breathing room air as a result of respiratory minute volume
This is overcome by 100% O2 supply
What is atelectasis and how do you overcome it
may occur due to Tv
How to overcome?
◦ May have to assist or control ventilation
which patients are more at risk
Procedures that last greater than 30-60 minutes Obeses patients Preexisting lung disease Recent head trama Species differences
what are the two types of controlled ventilation
manual (bagging)
mechanical ventilation
How do you manually bag
◦ Periodic; 1-2 breaths ev. 2-5 minutes
◦ Intermittent mandatory: bagging throughout anesthetic period
How do you do mechanical ventilation
use a ventilator
what are the risks of controlled ventilation
Rupture alveoli if overinflated.
CO may be decreased with PPV throughout entire respiratory cycle
Excessive ventilation rate may result in excessive exhalation of CO2, resulting in a respiratory alkalosis
CONCLUSION: needs close anesthetic monitoring to ensure anesthetic depth and vital signs are maintained
what is laser surgery
L.A.S.E.R =
◦ Light amplification stimulated
emission radiation
What are the types of lasers in vet medicine
Types in med.vet:
◦ CO2 laser, diode laser in vet med
How does the laser work in laser surgery
How it works? Creates light absorbed transmitted into heat within tissue
Different T causes different changes
what happens at 42-45*c with the laser
42-45C: destroys blood vessels = necrosis
What happens at 50-100*c with the laser
50-100C: denature Pt, coagulation = irreversible
tissue damage
If you get too much heat with the laser you get a carbon deposit called:
charring
what are the advantages to laser surgery
rapid healing cauterize (less bleeding) sterilize (less risk of post-op infection) less need for suturing less pain less swelling, faster sx time
what are the disadvantages to laser surgery
it costs more than 50,000. add in all the time spent talking to people about it.
what are the hazards with laser use
Eye Hazards: Laser light and scaterred Wear protective glasses: patient and
personnel
Skin Hazards
Wear gloves, gowns
Fire Hazards:Sx drapes, anesthetic
agents, O2, fur, alcohol products
With CO2 laser: put wet sponges around sx area: absorb the Co2
Smoke plume Hazards
Contain toxic and carcinogenic
chemicals, bacterial, viral particle Must have an evacuator
what is a laparoscopy
Miminal invasive abdominal procedure
Allows you to visualize the inside of the abdominal cavity.
A type of endoscope is placed through a small midline incision into the abdominal wall
what is the indication for using laparoscopy
Perform specific procedures within the abdominal cavity
◦ Perform biopsy
what do you require doing when you’re going to do a laparoscopy
require insufflation with co2 so that you can look around the abdominal area
what are the advantages to laparoscopy
Improved patient recovery Smaller sx incision post-op morbidity post op pain hospitalization
what is an endoscopy
Noninvasiave or minimally invasive procedure
Use to visualize internal body structures using optical instruments
Body is entered through:
an orifice (mouth, anus)
Or small incision (laparoscopy, arthroscopy)
what are the endoscopy procedures
Cystocopy GI endoscopy Esophagoscopy Gastrocopy Colonoscopy Rhinoscopy Tracheobronchoscopy They have limitations because may not obtain diagnosis, but if they do, saves on surgical incisions and healing....
what are the preoperative duties of the surgical tech
+/- GPE, Dx wu, setting up and prepare the OR, administrating premed, induction, ET intubation, maintenance, hair clipping, prepping (surgical scrub)
what are the intraoperative duties of the surgical tech
“Circulating nurse” (non-sterile)
Anesthetic monitoring / flush urinary catheter, abdomen..etc “Scrub nurse” (sterile)
what are the postoperative responsibilities of the surgical tech
Post-op monitoring, patient care, tx, cleaning/sterilization of instruments, cleaning of the OR
what are the characteristics of a competent scrub nurse
1) proficient knowledge of:
(a) the surgical procedure
(b) the surgical instruments
(c) aseptic and sterile technique
2) anticipation of the surgeon’s needs
what are the responsibilities of the scrub nurse
Maintain strict sterile technique!!
Organize instrument table and
instruments
Pass instruments and other supplies
Proper tissue handling, retraction, bone reduction, hemostasis, suture cutting, fluid evacuation, and wound sponging
Keep tissues moist
Save, dispose and label collected specimens
What are the specific procedures a scrub nurse should know
Abdominal procedures Canine and feline castration Gastro-intestinal tract surgeries Cystotomy Pharyngostomy tube placement Tegumentary surgeries Auditory system surgeries Ophthalmic procedures Minimally invasive procedures Biopsy and mass removal Orthopedics 
what are the indications for ovariohysterectomy
Sterilization (avoid reproduction)
Abolition of heat cycle
Treatment of pyometra
Adjunctive treatment of mammary tumors Adjunctive treatment of dystocia
Stabilized other systemic disease epilepsy, diabetes
Treat or prevent urine marking (esp. cats)
Uterine torsion
Congenital abnormalities
what are the basic preoperative duties of the tech
Dorsal recumbency
Hair clipping: xiphoid process to pubis + 1-2 fingers on either side of nipples
Basic prepping
what are the intraoperative duties of the tech
Circulating nurse: anesthetic monitoring / respond to surgeon needs
In regular clinic, a scrub nurse is rarely needed
May be for mature female, especially if obese
If so, follow RESPONSABILITIES OF SCRUB NURSE
what are the postoperative responsibilities of the tech
Post-op care: post-op monitoring, patient comfort, cleaning of wound, pain assessment, discharge
describe the procedure for ovaryhysterectomy
Ventral midline incision continued through the linea alba.
Uterine horn is brought up and out of incision…
…exposing the ovary and ovarian pedicle.
This is then clamped, ligated (absorbable suture) and
transected
Ligatures are tied into the clamped area.
The opposite horn is treated the same way
Then both horns are pulled cranially and then caudally to exposed the uterine body which is also clamped, ligated and transected proximal to the cervix.
Sometimes, uterine blood vessels are ligated separately from the body.
Closure is usually 2 or 3 layer (may go to 4)
Linea alba
Absorbable suture PDS , Monocryl
Cat: 3-0, Dog: 2-0, 0
Simple continuous, or simple interrupted
+/- SQ (absorbable)
+/- subcuticular (absorbable)
Skin
Nonabsorbable Supramid 3-0
Absorbable (feral cats, Vanier) Tissue glue
What is the cause of pyometra
Start after a dog goes through a heat cycle
usually within about 3-5 wks
Stimulation of the uterus with abnormal levels of hormones (estrogen and progesterone)
Cause the lining (endometrium) of the uterus to become thickened (hyperplasia)
This lower its resitance to 2 bacterial invaders
Fluid accumulation + bacteria =
Inflammation then infection develops in
the uterus
As the infection progresses, the uterus fills with pus
What is the treatment for pyometra
OVH,
stabilize first with IV fluid, antibiotics
what is the increased anesthetic risk for animals with pyometra
rupture of the uterus, peritonitis, abcess, sepsis, DIC
what is the basic preoperative duty of the tech
Like for C-section, put dorsal recumbency at the last minute
Hair clipping: same as OVH but usually larger
what is the intraoperative duties of the tech
Circulating nurse: anesthetic monitoring / respond to surgeon needs
In regular clinic, a scrub nurse is rarely needed
May be for mature large breed female, especially if obese
If so, follow RESPONSABILITIES OF SCRUB NURSE
what are the other main responsibilities of the tech
Basic post-op care + IV fluid maintenance / tx (ATB) / pain management
What is C-section
delivery of a fetus or fetuses by incision through the
abdominal wall and uterus
what are the preoperative duties of the tech
Know the strategies to decrease anesthetic risk
Anesthetic drugs, patient positioning…etc
what are the intraoperative duties of the tech
Circulating nurse OR scrub nurse
Follow RESPONSABILITIES of the scrub nurse
Care to prevent leakage of uterus fluid into abdomen
what are the 3 ways to do a c-section
w/o OVH
C-section then OVH
EN BLOC
what is the procedure for c-section
Ventral midline incision continued through the linea alba
Exteriorization of gravid uterus
Each fetus are gently squeezed toward the hysterotomy incision
Removal of fetus/
placentas from uterus
OVH performed or suturing of the uterus
What materials are needed for neonatal care after a c-section
Warm, dry area prepared before surgery (eg. basket with heating devices. towels)
why would you need clean warm towels
to clean them off and warm them up and rub them vigorously
why do you need suture material and clean scissors
to suture their umbilical cord
why do you need a suction bulb
to remove fluid from their mouth, pharynx and nose
what drugs do you need to have prepared
epinepherine
doxapram
naloxone
how many cm do you leave on the umbilical cord
1 cm
why do you need naloxone for the neonate
if you used opiods to pre-medicate the mom
what do you do if there is still a respiratory issue after administering doxapram
do tactile stimulation, o2 by mask.
why do we do feline castration
Sterilization to prevent reproduction
Prevention: roaming, aggressive behavior, fighting, urine spraying/marking, scrotal neoplasia/abcess/infection/trauma / endocrine abnormalities (eg. stud tail)
what are the preoperative duties of a tech for feline castration
Always Ck if really a male + IF CRYPTORCHID!
Dorsal or lateral recumbency, legs tied up cranially
Hair clipping or plucked hair scrotal area
Basic prepping
what are the intraoperative duties of a tech
Circulating nurse: anesthetic monitoring
No need of a scrub nurse
Some vets allow tech to perform feline castration = “acte délégué” ? No.
what is the procedure for castration
Scrotal incision
Incision of parietal vaginal tunic
Ductus deferens and the spermatic vessels are separated and used to tie square knots.
what is the indication for canine castration
Tx of prostatic disease, perineal hernia
what are the basic preoperative duties for a tech
CK IF CRYPTORCHID!
Dorsal recumbency
Hair clipping: tip of the prepuce to just above the scrotum, inguinal areas
Basic prepping
what are the intraoperative duties for a tech
Circulating nurse: anesthetic monitoring
May need to pass on electrocautery (provide appropriate hemostasis /mature male dog)
what is the closed technique to canine castration
vas deferens And entire spermatic cord is
ligated with a double or triple clamp technique Usually done on small dog or
what is the open technique for canine castration
exposing the spermatic vessels and spermatic cord
are ligated with a double or triple clamp technique
followed by ligature of the outer tunic
Usually done on large dog or > 7 kg`
what are the indications for doing an abdominal exploratory surgery
Diagnostic (eg. biopsy, looking for a
mass, FB…etc)
Curative purposes: acute abdomen (trauma, bleeding, bladder rupture..)
what are the special instruments used in an abdominal exploratory surgery
balfour abdominal retractor
gelpi
self retaining retractors
what is the preoperative duties of the tech for a laparotomy
May involved extensive dx tests, stabilizing critical patients
Preholding food ideally but frequently an emergency
Dorsal recumbency
Extensive and adequate hair clipping : ABOVE xiphoid process to the pubis
Thorough surgical scrub
What are the intraoperative duties of a tech
If circulating nurse : anesthetic monitoring
If scrub nurse: follow basic RESPONSABILITIES of the scrub nurse + additional ones (next slide)
What are the additional responsibilities of a scrub nurse in a laparotomy
The g.i. tract is not sterile so contamination is a real possibility!!
Surgeons and technicians assisting need to minimize contamination by:
Packing off area (keep tissues moist with sterile saline) Rotate tissues properly
Irrigate abdomen with prewarmed saline +/- antibiotics
Switch packs when appropriate
Tissue can be very fragile and must be handled gently
Often very ill patient therefore close monitoring of patient is essential
What are the indications of doing a gastrotomy
Removal of FB
Gastric biopsy
Neoplasia removal
What is the diagnosis testing for a gastrotomy
standard rads, +/- barium study, +/- US, +/- endoscopy
What is the indication for an enterotomy
Removal of FB
Intestinal biopsy Neoplasia removal
What is the diagnosis testing for an enterotomy
standard rads, bw, +/- barium study, +/- US, +/- endoscopy
What is the special instrument used for enterotomy
doyen clamps
what is the function of the
to clamp the intestines on either side of the incision site
what is the indication for doing an intestinal resection and anastamosis
removal of dead or diseased
bowel
foreign bodies, neoplasia, intussusception, necrosis, and ischemia
What is dilatation:
Swelling
What is volvulus
rotating on its axis
what is GDV
GDV: swelling and rotation of stomach in its mesenteric axis
what are the preoperative duties for gastric dilatation volvulus
Decompress the stomach (orogastric intubation)
Fluid of shock (2 IV catheters often necessary!)
Dorsal recumbency
Extensive and adequate hair clipping : ABOVE xiphoid process to the pubis
Thorough surgical scrub
what are the intraoperative duties of the tech
If circulating nurse: anesthetic monitoring
Follow basic RESPONSABILITIES of the scrub
nurse
what is part of basic post-op care for GDV
Basic post-op care + :correct fluid and electrolytes imbalance, control V+, arrhythmia monitoring, pain management
what is GDV usually caused by
deep chested breeds, eating and then exercising without waiting
how do you diagnose gdv
rads
what is involved with the surgery for gdv
Repositioning of the stomach
+/- partial gastrectomy (devitalized tissue) gastropexy
what are the indications for doing a cystotomy
Remove cystic calculi
Neoplasia
Congenital abnormalities
what are the special instruments used in a cystotomy
bladder spoon, suction pump
what is the technician role during a cystotomy
care to avoid the leakage of urine into the abdomen
what is pharyngostomy tube placement also referred to as
feeding tube placement
what is the definition of feeding tube placement
Opening of the pharynx Often via esophagostomy
what is the indication for feeding tube placement
Anorexia (eg. hepatic lipidosis)
caloric intact (trauma patients) Jaw trauma
what are the basic preoperative duties of the tech
Prepare required materials:
blade #10, scalpel handle, Orange urinary catheter 10-12F, curved hemostatic forcep (Crile, Kelly, Rochester Carmalt), plastic teat canula, PRN, bandage kit
Hair clipping: left neck region
Basic prepping
what are the intraoperative duties of a tech
Circulating nurse
Anesthetic monitoting
Hold hemostatic forcep into the mouth
Post- op rads (lateral view of neck) / Neck bandage
what is the post-op care for feeding tube placement
: bandage care/wound site, tube feeding, tube medications, discharge
what causes an abscess
bite wound
but may be due to anything resulting in deposition of an infectious agent within the body
what is the treatment for an abscess
Medical: +/- sedation or GA, stab and drain abscess, e-colar, ATB PO or Convenia inj
Surgical (next slide), e-colar, ATB PO or Convenia inj
what are the preoperative duties for a tech
Prepare materials: hair clipper, prep solutions
If minor abscess: scalpel handle, blade #11, bowl, large cc syringe catheter-tip, warm saline or chlorexidine 0.02%, +/- iodine, e-collar
If more extensive: the above + general sx pack or wound pack, Drain (Penrose drain), suture materials
what are the intraoperative duties of a tech
Circulating nurse
Anesthetic monitoring if GA / assist the vet
+/- Stab the abscess, drain, flush
what is the procedure for a minor abscess
Area is clipped and prepped
Stab the abscess, drain and flush with
with the chosen soln
Discharge with e-collar, ATB, +/- analgesia
what is the procedure for a major abscess
If extensive, and/ or a lot of empty spaces, may required drain
Done by vet
what is a laceration
a sliced opening which varies in length, may be smooth or jagged, clean or contaminated, fresh or old.
what is the definition of declaw
Surgical removal of the entire nail and third phalanx of the paws
what are the indications for declawing
Some owners wants their cats to be declawed without valid reason
Prevent/eliminate scratching
what are the alternatives for declawing
Surgical: tenectomy
Non-surgical: refer to N &Radiology
What are the basic preoperative duties when doing a declaw
Materials and prepping: depend of the technique used (next slide)
Lateral recumbency
Three-Point nerve bloc (refer to Lecture + textbook on Special Techniques)
what are the basic intraoperative duties for a tech
Circulating nurse: anesthetic monitoring
what is an aural hematoma
Formation of an hematoma within the auricular cartilage on the concave surface of the ear
what is the cause of an aural hematoma
Fx of ear pinna cartilage, usually from violent head shacking or scratching
Ear otitis, FB, Atopy, Ear mites
what are the basic preoperative duties with an aural hematoma
Materials: hair clipper, prep soln, bowl, flush materials, suture materials, +/- piece of x-ray film. E-collar
Lateral recumbency (eg. right ear = left lat. Recumbency)
Shave and prep pinna: both concave and convex side
what are the intraoperative duties of a tech
Circulating nurse: anesthetic monitoring
Assist vet by holding pinna and required materials
what is the post op care required
Basic post-op care +: +/- post-op bandage, e-collar placement
what is a lateral ear canal resection
Resection of the lateral ear canal involves lateralization of
the horizontal ear canal.
what are the indications for a lateral ear canal resection
Chronic ear otitis / easier removal of polyp
Allow drainage and ventilation of ear canal reducing risk of infection
what are the reasons that anesthetic problems and emergencies occur
human error
equipment failure
adverse effects of anesthetic gas
patient variation factors
what happens if f excess CO2 is not removed, patient will develop
hypercapnia
what are the clinical signs of hypercapnia
increase RR
increase HR
dysrhythmia
what do you do if o2 meter is turned off or reads zero
disconnect the patient, always assume theres 0 o2
How do you avoid an empty o2 tank
extremely serious but easily prevented mistake
check O2 pressure and flowmeter
if O2 flowmeter reads zero, always assume there is no O2 going to the patient
occasionally, O2 flowmeter indicates O2 flow but tank pressure reads zero; this is an indication the tank is virtually empty and needs changing
how do you avoid missassembly of the anesthetic machine
be familiar with every connection, etc. on the machine
trace these connections every time a connection or new patient is added to the machine
trace the connections from the O2 tank to the ET tube and then to the scavenger
how do you prevent endotracheal tube problems
blockages due to twisting, kinking of tube or accumulations of material
if complete blockage, signs of dyspnea occur leading to arrest
check by trying to bag patient and observing for chest movements
if blocked, no movement of chest and resistance to air passage
disconnect animal and feel for air coming out of tube
if none present, but dyspnea is obvious, remove tube and place a mask or second ET tube
what are the clinical signs of respiratory difficulty
exaggerated breathing pattern, lack of movement in rebreathing bag
what are some vaporizer problems that are possible
potential disaster is wrong anesthetic put into vaporizer
rarely, dial may stick in which case patient should be transferred to another machine
what are some possible pop off valve problems
closed valve leads to rapidly rising pressure
results in respiratory difficulty, decreased venous return, decreased CO with rapid drop in BP, followed by death quickly
how do you prevent pop off valve problems
monitor rebreathing bag, maintain at no more than 2/3 full
what are the adverse effects of anesthetic agents
all anesthetic agents have potentially harmful side effects
one should minimize this potential by:
choosing an anesthetic protocol based on the needs of the patient
be familiar with the adverse side effects and contraindications associated with each agent used
balanced anesthesia using multiple drugs is safer than single drug use
what is the effect of age on perioperative morbidity (step before dying) and mortality related to
reduced functional physiological reserve capacity of various organ systems and
poor response to stress
what is a geriatric patient
an animal who has reached 75% of his life expectancy
what are the components of increased anesthetic risk with geriatrics
Increased anesthetic risk associated with geriatric dogs/cats is multifactorial and involves the following: 2
Age-related pathophysiological changes to organ function that are not necessarily related to a specific disease(s)
Presence of concurrent disease processes which tend to emerge in older patients (eg. mitral valve insufficiency, DM, cancer, CRF)
Examples of key physiological changes associated with aging that may impact anesthetic management of geriatric patients:
CV system: ↓ arterial + myocardial compliance, ↓ maximal HR, ↓CO
Body composition: ↓ skeletal muscle mass
Respiratory system: ↓ gas exchange efficiency, ↓ lung elasticity…etc
Renal/hepatic systems: ↓ drug clearance, ↓ GFR, ↓ capacity to handle water and Na loads (↓ [urine] ability), ↓ perfusion and organ blood flow
Strategies used to decrease risk in geriatric anesthesia
Compete history and GPE is essential
preoperative work up should be recommended to clients: CBC, biochemistry profil, UA, chest rads, EKG
If possible, correct or stabilize pre-existing abnormalities prior anesthesia
Unrecognized or untreated abnormalities will almost always be exacerbated by anesthesia, regardless of the drug protocol used!
What are the general drug guidelines to follow with geriatric patients
Allow longer time for response to drugs (eg. SC injection : 30 minutes)
Doses may be reduced by ½ to 1/3 of normal
Recovery may be slower due to decreased ability to excrete drugs
what are the general preanesthetic drug guidelines
Anticholinergics: not required in all patients. May induce reflex tachycardia which is not well-tolerated in geriatric patients
Instead, monitor HR closely, and treat bradycardia if needed
Extreme of HR (bradycardia or tachycardia) should be avoided
why do you Avoid potent sedatives such as medetomidine, ace in geriatrics
causes cardiovascular depression
what opioid do you give for mild, moderate pain
butorphanol
what opioid do you give for moderate to severe pain
hydromorphone
what benzodiazepine do you combine with opioids for geriatrics
midazolam
why do we combine opioids with benzodiazepines
calm stressed or anxious geriatric cats/dogs
This combination may not produce “heavy sedation” but it will minimize anxiety without causing significant CP depression
what is necessary with pre oxygenation for geriatrics
Pre-oxygenation: (as in neonates, debilitated, brachycephalic animals) with a face mask 5 minutes prior to induction is optimal
why do we use propofol in geriatrics
smooth induction, recovery is rapid and quickly eliminated from body. it is a dose-dependent CV depression so must be titrated and carefully to effect in these patients
If only opiod as pre-medication, may give IV bolus of benzodiazepine immediately prior a decreased dose of propofol (minimize CP depression)
what do you do when you use ketamine/valium for induction
Ketamine-diazepam or ketamine-midazolam
Always titrated to effect
Should use a reduced dose (
why is vigilant cardiopulmonary monitoring mandatory in anesthetized patients
Vigilant CP monitoring is mandatory in all anesthetized patients but even more critical for geriatrics. because of limited organ reserve to respond to depressant effects of the anesthetic agents!
why do we give iv fluids to geriatrics
Hypovolemia not well tolerated = will result in hypotension and compromise tissue perfusion (so fluids counteract renal disease)
But remember, IV fluids must be given carefully because geriatric patients may have difficulty excreting salt and/or water load (esp. with compromised kidneys), so at risk for being over hydrated.
Normovolemic patients: 10ml/kg/hour and adjusted as needed.
why do we add in local anesthesia for geriatrics
May incorporate local (eg. dental block), regional anesthetic and analgesic techniques where applicable:
Contribute to balanced anesthesia
↓ dose of inhalants
Improve patient comfort post-op
NSAIDS Ok if patient is hemodynamicallys stable, and has normal GI, renal and Pl function
what are the main concerns with brachycephalic dogs
Increase anesthetic risk due to anatomic characteristics that can impede air exchange
small nasal openings (stenotic nares)
elongated soft palate
small diameter trachea (hypoplastic trachea)
redundant tissue in pharynx
eversion of laryngeal saccules
anesthetic agents that depress laryngeal muscle tone may cause increased respiratory difficulties, particularly if animal is not intubated
what are the strategies employed to decrease risk
Successful anesthesia revolves entirely around airway management throughout the pre-anesthetic, anesthetic, and post-anesthetic periods.
what are the preanesthetic strategies to reduce risk for brachycephalics
Pre-anesthetics: goal: provide enough sedation to calm and minimize anxiety during restraint, handling, while avoiding excessive relaxation which may predispose to airway management
what are the special concerns about vagal tone with brachycephalics
Vagal tone (parasympathetic tone) is frequently high in these breeds. Stimulation (Et intubation, administration of vagotonic drugs) may lead to bradycardia. So which drug is recommended to decrease vagol tone stimulation? glyco in the pre-medication.
what analgesia do you use for brachycephalics
Use opiods for painful procedures (despite respiratory depression effect)
Butorphanol: less respiratory depressant that pure agonist
Hydromorphone, morphine for moderate to severe pain: but use low dose
what is the goal of giving sedatives for brachycephalics
Sedatives: goal: provide adequate sedation without inducing excessive muscle relaxation.
if very calm, not needed (glyco + opiod sufficient)
midly agitated: benzodiazepine (eg. midazolam) + opiods
agitated: low dose of ace + opiod
Avoid α-2 agonists such as medetomidine: cause profound sedation, muscle relaxation, may predispose to upper airway obstruction
