General post-op care

Question 1

What is the pre-operative period defined as?

Answer 1

The time before surgery

Involves any prior preparations/premeds up until induction/initiation of GA

Question 2

What is the peri-operative period defined as?

Answer 2

From the start of GA until the patient wakes up/GA is antagonised

Question 3

What is the post-operative period defined as?

Answer 3

The return to normal after GA and surgery

Question 4

When does the recovery period end?

Answer 4

When a full level of consciousness is present and physiological values have been normalised

Question 5

Where should patients be taken for recovery from anaesthesia?

Answer 5

Clean/dry/comfortable/quiet kennel

Ensure safe in case of dysphoria/thrashing/aggression

Question 6

When should ET tube be removed from dog? (non-brachy)

Answer 6

When the dog begins to swallow or move tongue

Question 7

When should cats ET tube be removed?

Answer 7

When blink reflex returns - risk of laryngeal spasm (fatal)

Question 8

How do you make sure the airway remains patent after ET tube removal?

Answer 8

Extend the neck and head and pull the tongue forward

Question 9

How long should ET tube be kept in brachycephalic breeds?

Answer 9

Until firmly in sternal recumbency/as long as tolerated - aids breathing

Question 10

What are the general parameters which should be monitored regularly in the post-op period?

Answer 10

TPR
Mucous membrane colour 
Respiratory effort 
Lung auscultation 
Blood pressure (?)
CRT

Question 11

Which patients are more likely to require IVFT in the post-op recovery period?

Answer 11

Those at risk of kidney injury/chronic kidney disease
Sick animals (pyometra, peritonitis)
Those with low BP pre/peri-operatively

Question 12

Why might pain be difficult to assess in the post-operative period?

Answer 12

Determining dysphoria vs. pain
Effects of sedation still present
Species differences (prey)
Subjective

Question 13

When should water be offered post-operatively?

Answer 13

As soon as patient is able to hold themselves in sternal recumbency unaided

Question 14

Why wouldn’t you expect an animal to defecate for a while post-operatively?

Answer 14

Will have been starved for 16+ hours

Question 15

What nursing considerations should be made specifically for rabbits post-operatively?

Answer 15

Provide fresh hay/pellets immediately
Try to get eating ASAP, monitor droppings

Ensure quiet ward away from predators
Ensure hiding places

Continue eye lubrication
Consider pro-kinetics

Question 16

What are the signs of post-surgery haemorrhage?

Answer 16

Slow CRT
Pale MM 
Low BP 
Tachycardia 
Lethargy
Dull behaviour

Question 17

What are the signs/symptoms of aspiration pneumonia?

Answer 17

Fluid from nose
Crackles on lung auscultation
Dyspnoea

Question 18

What are the 4 classes of medications most likely to be given in the post-operative period?

Answer 18

Pain relief
Anti-emetics
Antibiotics
Probiotics/kaolin

Question 19

What are the side effects of opioid administration in the post-op period?

Answer 19

Respiratory depression
Bradycardia 
Panting 
Salivation 
Vocalisation 
Urination/defecation

Question 20

Why might ant-emetics be used in the post-operative period?

Answer 20

Used if signs of nausea present (lip-licking, hypersalivation, inappetence)

Question 21

Which anti-emetics are commonly used in rabbits post-op?

Answer 21

Ranitidine

Metaclopramide

Question 22

When might antibiotics be administered post-op?

Answer 22

Orthopaedic procedures

Patients already unwell pre-op

Surgeries over 2 hours long

Dental disease/wound infections where antibiotics are part of the treatment plan

Question 23

Which antibiotics might be used in the post-op period?

Answer 23

Amoxicillin-cluvanic acid (IV/SC)
Metronidazole (IV)
Cephalosporin (IV)

Question 24

Why might probiotics/kaolin be used in the post-op period?

Answer 24

Not routine unless diarrhoea post-op

Good idea for rabbits (just in case)