L8: Post-op Anesthesia Care (Gatson) Flashcards
objective of recovery
stabilize the patient as they transition from surgical depth of anesthesia to a conscious state
recovery area for large animal
- down leg pulled forward to avoid radial n. paralysis
- cover eyes to decrease stimulus from light source
- often don’t extubate horses until standing
what to monitor for SA in recovery
RR BP RR ETCO2 (end tidal CO2) mm color SPO2 temp
takes horses longer than SA to wake up from anesthesia
T
neo-synephrine spray
used to open up nasal passages and dec. chance of post-op obstruction (since horses obligate nasal breathers
usually give sedative in post-op period to horses to make smoother transition into consciousness
:)
monitoring horses in recover
HR
RR
mm color
anesthetic depth
horses commonly develop horizontal nystagmus when emerging from anesthesia
(when slows down, horse getting closer to standing up)
complication of pool recovery
pulmonary edema
ventilatory complications
apnea airway obstruction hypoventilation (monitor for by monitoring pulse oximeter) pleural space disease pulmonary dz
what to do if patient apneic
- first check pulse
- intubate p again, then ventilate
- may need to reverse p
CS of airway obstruction
INTUBATED: -high Peak Inspiratory Pressure (PIP) to expand chest -absence of EtCO2 despite mechanical ventilation -cyanosis EXTUBATED: -stridor -dyspnea -chest movement w/o air movement -cyanosis
EtCO2
end tidal CO2; lvl of CO2 released at end of expiration
causes of airway obstruction
- kinking of E-tube
- obstruction of E-tube (mucous, blood, aspiration)
- endobronchial intubation
- airway edema
- broncho/laryngospasm
- obstruction of airway
- collapsing trachea
- laryngeal paralysis
what to do when airway obstructed and p intubated
- intubate and ventilate again
- give drugs to stimulate breathing
what to do when airway obstructed and p extubated
1) provide oxygen
2) intubate if not enough and ventilate
3) emergency tracheostomy
tx of pleural space/pulmonary disease
- ascult thorax (will be difficult to hear airway sounds if pneumothorax, pleural effusion)
- supplement oxygen
- pleural space dz: thoracocentesis
- pulmonary edema: give furosemide, steroids
CS of CV complications
weak pulses tachycardia/bradycardia CRT >3s cold extremities cyanosis/hypoxemia pale mm hypotension
tx of CV complications
1) provide oxygen
2) fluids (crystalloids, colloids, blood)
3) +/- BP meds (ie. dopamine)
4) try to reverse p with dexmedetomidine (sp?)
hypothermia below what temp in dogs
98 F
hypothermia increases/decreases oxygen demand
increases
causes of delayed return of consciousness
- drug overdose/residual drug effect
- deep plane of anesthesia
- hypothermia
- hypoglycemia
- hypotension
- dec. drug metabolism
- CNS dz
- hypoventilation
tx of delayed return of consciousness
- PE
- check bloodwork, esp. blood glucose
- supportive fluids
- provide flow of oxygen
- give partial reversal dose
- stimulation
sedative has synergistic effect with opioid
:)
negative effects of pain
- inc. CO
- inc. myocardial oxygen consumption
- delayed healing
- hypoventilation
- ileus
- water retention
- excitation
