Patient Evaluation Flashcards
Pre-anesthetic patient evaluation
- Signalment/general appearance
- History
- Physical exam and accurate weight
- Risk assessment
- Pre-anesthetic workup (blood work, radiology, etc)
- Preparation
What weight should you use for obese patients to calculate drug dosages?
Estimated ideal weight
IV drugs should always be given to….
Effect
Anesthetic concerns for overweight/obese animals
- Increased CO
- Decreased lung and chest wall compliance
- Decreased functional residual capacity- respiratory depression, mechanical ventilation often necessary
Evaluation of thin/cachectic animals
Evaluate and treat any underlying disease prior to anesthetic induction
Concerns of IV anesthetics in underweight animals
Drugs stay in VRG longer (titrate to effect)
Prone to severe hypothermia
Concerns with very small animals
- Severe hypothermia
- Must get accurate weight to avoid overdose of drugs and fluids
- Difficult to access under drapes
- Prone to hypoglycemia
Concerns with giant breeds
- Profound response to sedatives (lower MBR)
- Smaller body surface area to body weight ratio (BSA dosages should be reduced)
- Senescence occurs earlier and have lower life expectancy
Concerns with neonates
- Increased sensitivity to drug effects
- Hypothermia
- Hypoglycemia
Concerns with geriatrics
- Decreased organ reserves
2. Sub-clinical organ function
T/F: Hyper or aggressive animals typically take higher dosages of drugs to achieve the same effect.
True
Concerns with brachiocephalic animals
- Elongated soft palate
- Everted saccules
- Obstructed nares
- High vagal tone- predisposes to bradycardia
Concerns with greyhouds
- Susceptible to stress hyperthermia
- Low body fat
- Avoid thiobarbituates (decreased ability to metabolize)
- Sensitive to propofol
Concerns with herding breeds (collies)
MDRI mutation- increased sensitivity to invermectins, acepromazine, butorphenol
Breeds with predisposition to Cardiomyopathies
Boxers, doberman pincher, giant breeds, maine coons
Cardiac/renal disease medications
Potentiate anesthesia related C/V depression
Angiotensin converting enzyme inhibitors, Beta or Ca channel blockers
What drug should you avoid with angiotensin converting enzyme inhibitors?
Acepromazine
What drug interacts with SSRIs Tricyclics and MAO inhibitors
Tramadol, some opiods
What drug increases metabolism of other similar drugs?
Phenobarbital- increases P450 metabolism
Why is it important to review anesthesia records?
To find any previous potentially drug related problems and avoid those drugs or try to alleviate
Should a physical exam always be performed the day of the anesthetic procedure?
Yes- helps determine ASA physical status and if any changes have occurred
Is the ASA risk assessment scale subjective or objective?
Somewhat subjective but based on set standards
ASA category I
Normal healthy patient
Likely will not require any invasive monitoring, extra IV catheters, different/special drug protocols/contradindications
ASA category II
Mild systemic disease but well compensated or uncomplicated injury
Likely will not require any invasive monitoring, extra IV catheters, different/special drug protocols/contradindications
ASA category III
Moderate systemic disease requiring medical management but stable physiologically
Likely not be managed with the same protocol or dosages and management
ASA category IV
Severe systemic disease that is a constant threat to life
Likely not be managed with the same protocol or dosages and management
ASA category V
Moribund; not expected to survive with or without surgery
ASA category E
Emergency
Patients usually otherwise classified as III, IV, or V
Is pre-anesthetic bloodwork a good predictor of risk?
No, it rarely alters anesthetic protocols
Fasting time
12hr fast, free access to water
May be longer for endoscopy or GI surgery
What patients should receive supplemental glucose?
Neonates and pediatrics Up to 4-6hr prior
Diabetic pre-anesthetic protocols
Adjustment of insulin dose (usually half) and early morning procedures
Should exotics/pocket pets be fasted?
No
Why should patients be fasted?
Reduce risk for vomiting/regurgitation- aspiration pneumonia
Does fasting decrease incidence regurgitation or reflux?
NO- just reduces material
