Lecture 2: Patient Evaluation & Prep (Exam 1) Flashcards
Who should perform the pre anesthetic eval
The vet in charge of the px
What is the parts of the pre-anesthetic eval
- Always start w/ signalment
- History
- PE (including BW & PCS)
- Blood & urine sampling
- Temperament/mentation & level of pain & stress
- Advanced diagnostics if indicated (like ECG, BP, radiographs)
What are the required components of a signalment
- Species
- Breed
- Age
- Sex
- Repro status
What should the history include
- previous anesthesia events
- If ill find out what symptoms are present, the severity, & how long it has been going on
- Vax status
- Recent & current medication
Who should have routine ECG screenings
- Patients w/ evidence of CV disease
- Geriatric disease
- Px w/ underlying disease that may lead to arrhythmias (hyperkalemia, GDV, splenomegaly, & traumatic myocarditis)
What should be in the PE findings
- Temp (know the norms)
- Pulse (rate, rhythm, & quality)
- Respiration
- mm/CRT
- Body wt in kg
Fill in the following for dehydration
What other systems should be evaluated in a PE
- Integument
- LN
- GI tract/abdominal palpation/gut sounds
- Genitourinary tract
- CNS
What lab work should be done
- Young ( < 5 YO) healthy px having an elective procedure w/ no abnorm hx: PCV/TS/Glucose/BUN
- Older px having an elective or non-elective procedure, any history of recent illness, screening for suspected infectious disease in endemic region, or all px included in a research study: CBC/chemistry profile/UA, +/- T4, ECG, BP, thoracic rads, echocardiogram, blood gas analysis, coag profile, liver fxn testing, 4Dx
Where is the pre anesthetic eval performed
- In the clinic but also done during farm calls
- A quiet area so the lungs & heart can be auscultate
When should you perform the pre anesthetic eval
- The day before or up to 1 week before a planned procedure
- Another short exam is done the day of anesthesia
- In emergencies it is done immediately prior to procedure
Why should a pre-anesthetic eval be done on all px
- Greater chance of a safe anesthetic episode &/or a more successful outcome for the px
- Formulate an assessment of the px’s overall organ function & perioperative risk
- Proved the client w/ valuable info that will help them decide if they are willing to take the risk
What is added to the ASA physical status to indicate emergency status
E
Fill out the ASA Physical status scale:
What determines the physical status
- Presence or absence of disease (determined by hx, PE, lab test, & other dx)
- Severity of pain if present
- Level of stress
- Overall efficiency & fxn of organ sys
When should the ASA PS be assigned
After the PE is complete & the lab work or dx tests have been interpreted
Give an example of an elective surgery
Spay
What are scheduled surgeries
Detromential
What are urgent cases
Can’t wait very long
Why is ASA physical status impt
- Used (along w/ skill of anesthetist & drugs chosen) to assess “anesthetic risk” of a case
- Physical status effect the PK & PD & aids in the selection of drugs &/or tech for a px
- Impt criteria used in selection of px in research studies
- Can also be used from a legal standpoint retrospectively
Sicker the px = poorer the physical status = what
Increased likelihood of cardiopulmonary emergencies
What are other considerations for dosing drugs
- SA vs. LA (wide variation in doses based on species/pharmacogenetics)
- Size of px (smaller animals will req a higher dose per unit of body weight; consider using BSA formulas)
- Obesity (vol of distribution for drugs)
- Poor condition/starvation
- Age
(increase/decrease) a dose for neonate or pediatric
Decrease
(increase/decrease) a dose for juvenile to early adulthood
Increase
(increase/decrease) a dose for geriatric
Decrease
What concurrent medications could cause problems during the peri-anesthesia episode?
What should be done for hygiene & px comfor prep
- Encourage defecation/urination prior to surgery
- Bathe excessively dirty px prior
- Clean out hooves
- Parasite control
What should be done during px prep
- Fasting
- Hygiene & px comfort
- Correct dehydration & electrolyte imbalance
- Pre op antibiotics
- Specific prep for procedure
Fill out the table for fasting & water deprivation times:
Why is a px fasted prior to general anesthesia
- Decrease food & fluid in the stomach
- Decrease risk of aspiration
- A distended stomach or rumen impairs ventilation & could lead to hypoxemia & hypercapnia
- In horses a full stomach could rupture @ induction
Why is it not necessary for neonates, small birds, and some mammals
- Prone to hypoglycemia w/in a few hours of starvation
- Increased metabolic rate in birds & small mammals
What about depriving water from px w/ increased fluid requirements
- Renal insufficiency
- Febrile
- Diabetes
- Hot environement
What are the 4 Hs of general anesthetic concerns
- Hypotension
- Hypoventilation
- Hypothermia
- Hypoxemia
What are some other concerns that are species/age/disease/ or procedure specific
- Hemorrhage
- Pain
- Delayed recovery
- Regurgitation
- Laryngeal spasms
- Difficult intubation
- Dysphoria
- Arrhythmias
- Myopathy or neuropathy
What is the most important to get before surgery
Signed consent form by owner
