Final Exam - Anesthesia/Analgesia Considerations For Polytrauma Patients Flashcards
what are the goals of anesthesia & analgesia in the polytrauma patient?
- produce an adequate level of unconsciousness needed for diagnostic examination & surgical treatment
- to provide comfort & minimize the deleterious effects of pain
- to cause minimal complications that could further impair organ function
what is the risk associated with sick dogs & cats that need emergency sedation/anesthesia?
dogs - 5X risk
cats - 10X risk
what are some underlying reasons we see an increase in mortality in trauma dogs?
cardiovascular injury
SIRS/MODS
prolonged anesthetic times
what diseases/conditions decrease pre-load in a patient needing emergency sedation/anesthesia?
bleeding/hypovolemia - can be internal or external, reduces venous return to the heart & contribute to decrease in CO & MAP
mechanical ventilation
caudal vena cava compression - uroabdomen & hemoabdomen
what diseases/conditions cause vasodilation in a patient needing emergency sedation/anesthesia?
drugs
severe hypothermia
severe hypercalcemia
SIRS
neurogenic shock
disease
what are some causes of vasodilation in the polytrauma patient? why is this a concern?
neurogenic shock, SIRS, septic shock, severe hypothermia, severe hypercapnia, drugs
vasodilation decreases the SVR which can lead to hypotension
what are some causes of myocardial depression in the polytrauma patient? why is this a concern?
metabolic acidosis
severe hypothermia
severe hypercapnia
ischemic myocardial dysfunction
cardiogenic shock
decrease the stroke volume which will decrease CO & cause hypotension
how should anesthesia be induced in a patient with polytrauma?
pre-oxygenate them
lidocaine can be splashed on the larynx prior to intubation
use iv induction agents slowly to effect
monitor HR or pulse while inducing
be ready to intubate, ventilate, & provide oxygen to your patient
(midazolam + fentanyl for very sick patients)
what are the disadvantages of using inhalant anesthetics such as isoflurane, sevoflurane, or desflurane, for patients with polytrauma?
they have cardiovascular & respiratory depressant effects
what are the benefits of using a CRI alongside inhalant anesthetics in polytrauma patients?
MAC-sparing technique
rapid recovery
lessen cardiovascular & respiratory depressant effects
what components make up respiratory support provided to polytrauma patients under anesthesia?
protect the airways - intubation
ventilation - ETCO2 35-45mmHg (30-35mmHg)
oxygenation - pre-oxygenation, oxygen supplementation, & minimal effective FiO2
what drugs are used to improve SVR in a patient with polytrauma undergoing anesthesia?
vasopressors - dopamine, norepinephrine, etc
what products do you use to improve SV through affecting preload, myocardial contractility, & afterload?
iv fluids, blood products, adjust mechanical ventilationinotropic drugs - dobutamine, dopamine, & ephedrine
when would you reach for colloids for fluids in a patient with polytrauma undergoing anesthesia?
need to provide fluid resuscitation
increase COP
need to provide coagulation factors & platelets
need to provide efficient & prolonged plasma expansion
when would you reach for hypertonic saline for fluids in a patient with polytrauma undergoing anesthesia? why?
ECV depletion!!!! hemorrhage!!
provides efficient plasma expansion of high magnitude - can use for fluid resuscitation & plasma expansion
how do you avoid further increasing intracranial pressure in a traumatic brain injury patient with polytrauma undergoing anesthesia?
avoid letting them retch/cough/vomit
avoid compressing their jugular veins
maintain the head at a higher level than the heart
maintain ETCO2 at 30-35mmHg
maintain map at slightly higher levels - >75mmHg
how can you check level of consciousness in a sedated patient with polytrauma?
palpebral reflex
eye position
jaw & tongue tone
how can you check cardiovascular function & perfusion in a sedated patient with polytrauma?
ECG, HR, arterial blood pressure, mucus membrane color, & CRT
how can you check ventilation & oxygenation in a sedated patient with polytrauma?
RR & effort, ETCO2, SpO2, blood lactate, & arterial blood gas analysis
when do we see highest mortality rates in patients with polytrauma requiring sedation?
47-61% mortality occurs within the first 3 hours post-op!!!!
how should you support the polytrauma patient during anesthetic recovery?
close monitoring
oxygen, ventilation, & anesthesia ready to go if needed
cardiovascular support
re-warm the patient
consider the need for drug reversals
what is the trauma triad of death?
hypothermia, coagulopathy, & acidosis
what criteria are used to define SIRS in dogs?
must meet 2 criteria to be considered SIRS!
temp: <100 or >103
HR: > 140
RR: > 20
WBC: <6 or > 16
band cells: >3%
what criteria are used to define SIRS in cats?
must meet 3 criteria to be considered SIRS!!
temp: <100 or >103.5
HR: <140 or > 225
RR: > 40
WBC: <5 or > 19.5
band cells: > 5%
what are some signs of cardiovascular instability in a polytrauma patient? how do you correct it?
decreased systemic vascular resistance due to vasodilation (from drugs, hypercapnia, hypothermia, SIRS, disease) - vasopressors
decreased heart rate (increased vagal tone, drugs, hyperkalemia, hyperthermia, hypercapnia, or disease) - anticholinergics
decreased stroke volume (bleeding, hypovolemia, mechanical ventilation, vena cava compression, drugs, myocardial ischemic injury, SIRS) - iv fluids, blood products, change ventilation/body position, & inotropic drugs
what all is going wrong in SIRS?
increased inflammatory cytokines
vasodilation, increased vascular permeability, & coagulopathy
mitochondrial dysfunction
what is MODS?
multiple organ dysfunction syndrome - abnormalities in multiple organs that weren’t originally affected by the insult
mortality rates increase with more organ dysfunction
what is the difference in effect seen from benzodiazepines given to sick animals vs healthy animals?
in healthy animals - can cause excitement
in sick animals - can cause sedation
why do you have to be careful when using opioids for polytrauma patients? what can you do to counter this?
opioids can cause vomiting, panting, & histamine - need to use low doses!
anti-emetics - maropitant & ondansetron
why do you have to be careful when using ketamine for polytrauma patients?
causes sedation in sick animals!!! use lower doses!!
why should you give minimal inhaled oxygen to a polytrauma patient under sedation needing respiratory support?
you need to give the minimally effective FiO2 to reduce damage from free oxygen radicals
