Misc. Anesthetic Complications Flashcards
what are some examples of anesthetic complications that dont fall into cardio or resp categories
▪ Dosing errors
▪ IV Catheter complication
▪ Intubation complications
▪ Hypothermia
▪ Hyperthermia
▪ Regurgitation/GER
▪ Hypoglycemia
▪ Seizures
▪ Awakening/moving
▪ Poor Recoveries
what are some dosing errors that you can make that could lead to overdose (5)
- Wrong drug concentration (Acepromazine, hydromorphone, xylazine…)
- Math error
- Drawing up the wrong drug
- Giving the wrong drug (syringe swapping)
- Do not wait until peak effect of the drug (re-dose too soon)
what are some precautions to take to avoid dosing errors (4)
- Always label syringes!
- Always check concentration in bottle
- Double check volume math (specially if non familiar drug)
- Have reversals available
three examples of IV catheter complications
▪ Catheter non patent = Extravasation of induction agent
-Careful with irritant agents (barbiturates)
-Animal not getting induced or rough induction (troublesome in LA)
▪ Phlebitis from long term catheter
▪ Multiple attempts when placing (leaky vein)
issues that can occur with esophageal intubation (5)
- Lack of movement of rebreathing bag
- Very low or no CO2 wave
- Inability to seal the cuff
- Animal waking up
- Hypoxemia
how can you approach a situation where you cant visualize the intubation
- Stylet or guide tube
- Look for condensation, CO2 monitor
- Scope to visualize
causes of hypothermia (9)
▪ Temperature drops with GA especially in 1st hour; Worst if: small, young, low body fat, thin hair patients, hypothyroidism…
▪ Causes: Loss of temperature regulation ability under GA
▪ Vasodilation (acepromazine, inhalants…)
▪ Large surface area:body mass ratio
▪ Cold inhaled anesthetic gases
▪ Cold fluids
▪ Cool operating room
▪ Alcohol prep
▪ Lavage during surgery
consequences of hypothermia (8)
▪ Decrease metabolism leads to less anesthetic requirements: risk of anesthetic overdose
▪ Prolonged recovery
▪ Postoperative wound infection
▪ Impairment of coagulation
▪ Increased shivering and discomfort during recovery,
▪ Increased blood viscosity
▪ Bradycardia, non responsive to anticholinergics
▪ Cardiac arrhythmias and arrest < 23C
iatrogenic causes of hyperthermia
- Warming devices
- Large heavy‐coated animals undergoing diagnostic procedures
associated with little heat loss
prevention of hypothermia; preventing heat loss
- Keep patient covered
- Avoid cold surfaces
prevention of hypothermia; active warming
▪ Forced air blankets (Bair Hugger)
▪ Water circulating heating pads
▪ Oat bags
▪ Hot Dog (Resistive polymer electric heating)
▪ Warm Lavage
▪ Warm IV fluids
metabolic derangement/disease leading to hyperthermia
- Malignant hyperthermia
- Serotonin syndrome
- Hyperthyroidism and Cushing’s
- Hyperkalemic Periodic Paralysis (HYPP)
- Seizures
- Opioids (Cats)
consequences of hyperthermia (6)
▪ Hypermetabolism (increase in anesthetic requirements)
▪ Increase HR and RR (panting)
▪ Increased end‐tidal CO2
▪ Metabolic acidosis
▪ Seizures
▪ Organ dysfunction (severe cases)
treatment of hyperthermia
Stop all warming devices, fleeces out, active cool down
what is regurgitation and why does it happen
▪ Passive process: gastric content moves up the esophagus and passes the upper esophageal sphincter (LES) to exit through mouth or nose (Do not confuse with GER)
▪ Multiple anesthetic drugs relax the LES
what can regurgitation lead to (3)
- Aspiration pneumonia
- Ulcerative esophagitis and stricture formation (1 in 1000)
- Nasal and pharyngeal irritation
prevention and treatment of regurgitation
▪ Prevention:
- Cisapride and metoclopramide
▪ Treatment
- Antiacids: omeprazole and famotidine (increase pH)
- Head down position to drain
- Suction
- Lavage of the esophagus
causes of hypoglycemia
- Pediatric patients (fasting too long)
- Very small patients (fasting too long)
- Diabetes
- Insulinoma
- Hepatic disease
consequences of hypoglycemia
- Prolonged recovery
- Seizures
treatment of hypoglycemia
- Dextrose CRI 2.5-5%
- Dextrose 50% bolus 0.5 ml/kg in severe cases
what are some causes of seizures (6)
o Idiopathic epilepsy
o Intracranial disease/trauma
o Metabolic disease: hypocalcemia, hyponatremia, hypoglycemia
o Cerebral ischemia
o Severe hyperthermia
o Post-myelogram contrast injection
what are some treatments for seizures
Benzodiazepines, Propofol, Barbiturates, Inhalant anesthetics, provide oxygen, check temperature, glucose and electrolytes
what are some things that can lead to the patient waking up/moving when during anesthesia
▪ Inadequate depth monitoring
▪ Apnea
▪ Hypoventilation
▪ Accidental extubation/Loss of IV
▪ You forget to turn the vaporizer on
some aspects that contribute to poor recovery (4)
- Pain
- Emergence delirium: quick wake up from general anesthesia accompanied by psychomotor agitation
- Anxious animals
- No sedatives
- Noises and stimulation - Dysphoria: Excitement, vocalization, lack of response to
interaction after opioid administration - Your patient is a horse
what are some things you can do when a patient is having a poor recovery?
▪ Check last dose of analgesics
▪ Palpation of the surgical site
▪ Minimize noise and light at recovery
▪ Administration of sedatives to slow down transition (Acepromazine, Alpha2s)
▪ Reverse opioids with Naloxone (titrated to effect)
▪ Sometimes animals just need some time to figure it out
