Patient Evaluation and Preparation Flashcards
who should preform the preanesthetic evaluation?
the clinician who refers the patient - comunicate results with anesthetist
what should the anesthetist do?
read all patient related documentation
personally examone the patient
request/perfomr additional tests if necessary
make anesthetic plan
it is misconduct not to….
examine the patient yourself before anesthesia
ALWAYS: see, touch, and auscultate
parts of preanesthetic examination
signalment
history
physical exam
laboratory examinations
advanced diagnostics
Species and breed specific conditions: Doberman Pinschers
Von Willebrands Dz
DCM
Species and breed specific conditions: Miniature Schnauzers
Sick Sinus Syndrome
Species and breed specific conditions: Pugs
Brachycephalic Syndrome
Species and breed specific conditions: Quarter Horses
Hyperkalemic Periodic Paralysis (HYPP)
Species and breed specific conditions: Rabbits
have atropine estherase
(used Glycopyrrolate instead)
the history can provide information about:
previous - trauma, Dz, Sx, anesthetic events/ complications, vax
current (or recent) - symptoms, medications, feeding
current medications that can interfere with anesthesia
liver microsomal enzyme activity - inducers (phenobarb, phenytoin); inhibitors (cimetidine)
NSAIDS - nephrotoxicity
ACE inhibitors - hypotension
chemotherapeutics - toxicitiy
what should you be checking to assess ventilation
rate, regularity, effort, thoracic auscultation
palpate the larynx and trachea (intubation) - this also helps to estimate ET tube size
what do you check to asses oxygenation
mucous membrane color
whats the difference between oxygenation and ventillation
ventillation - act of moving air in an out and the removal of CO2
oxygenation - refers to gas exchange, amount of O2 in the arterial blood
Breathing does not mean they are oxygenating!
what is CRT an indicator of
peripheral perfusion
normal CRT
1-2 sec
increased CRT
<1 sec
may indicate hyperdynamic state and vasodilation (also bright red mm)
associated with sepsis, distributed shock, hyperthermia
prolonged CRT
may indicate decreased peripheral perfusion
associated with shock and dehydration
T/F CRT is important to examine but it is not considered to be a very specific test
True
other influential factors: vasodilation, strength of compression, site tested
normal mucous membranes are:
pink and moist (may be pigmented)
pale mucous membranes can indicate
anemia, vasoconstriction, hypovolemia
brick red mucous membranes can indicate:
hyperdynamic status (e.g. sepsis)
petechial bleeding can indicate
thrombocytopenia, thrombocytopathy
yellow mucous membranes can indicate
icterus, hyperbilirubinemia
clinical signs: <5 % dehydration
not detectable
clinical signs: 5-6 % dehydration
subtle loss of skin elasticity
clinical signs: 6-8% dehydration
definite delay in return of skin to normal position
slightly prolonged CRT
eyes possibly sunken
possible dry mucous membranes
clinical signs: 10-12 % dehydration
tented skin stands in place
definite prolonged CRT
eyes sunken in orbits
dry mm.
possible signs of shock
clinical signs: 12-15% dehydration
definite signs of shock - tachycardia, cool extremities, rapid and weak pulses
death imminent
T/F preanesthetic laboratoary examinations should be less than 1 week old
True
general recommendations for healthy <2year old small animals
PCV, TP, glucose, BUN
canine: CBC becuase of the platelet related tick born diseases
general recommendations for sick and old patients
CBC
Chem
U/A
tests for specific cases: BMT, coag, etc
advanced diagnostics
ECG, Radiography, U/S, BP
T/F: a physical status classification should be done aafter patient evaluation is complete
True
proposed by the ASA (American Society of Anesthesiologist)
ASA - I
healthy animal, no systemic disease
age is not a disease!
ASA - II
mild systemic disease (no functional impact)
mild anemia or fever, pregnancy, obesity, diabetes mullitus controlled by insulin
ASA - III
Moderate or severe systemic disease
morbid obesity, heart disease (moderate), some colic horses
ASA - IV
severe systemic disease that is a constant threat to life (can die at any moment)
emergency colic Sx, GDV, congestive heart failure, sepsis, shock, actively hemorrhaging splenic tumor
ASA - V
Moribund patient that is not expected to survive 24 hours with or without surgery (these animals are normally euthanized- more for human med)
- end stage of shock, multiple organ/system dysfunction
massive trauma
emergency patients are give a physical status classification of:
E
Low risk
ASA - I and II
no limitations in organ function
moderate risk
ASA - III
some limitation in organ function
high risk
ASA - IV and V
severe limitations in organ function
the risk of the procedure depends on:
risk of anesthesia
risk of surgery
risks of anesthesia include:
physical staus of patient
skills of anesthestist
anesthestic techniques
duration of anesthesia
peri-operative care
risks of surgery include
type of surgery
skills of the surgeon
blood loss
indications for pre-anesthetic fasting
decreased food and fluid in stomach
decreased risk of aspiration
distended stomach (rumen) impairs ventilation and gas exchange
horses - full stomach may rupture at induction
reflux
open lower esophageal sphincter, gastric content enters the esophagus - invisible, silent reflux is very common during anesthesia
regurgutation
passive discharge of gastric content from the mouth
vomitting
active process (projectile)
T/F feeding small amounts of wet food prior to anestheia could decrease the occurrence of reflux and increase gastric pH
True
how long should healthy dogs and cats be fasted
8-12 hours
except: very young, diabetes mellitus, other severe disease
who should not be fasted
rabbits and rats - don’t vomit, no need to fast
small birds
suckling youngsters!!
T/F pre-anesthetic water deprivation is normally not needed
True
may be needed in ruminants to decrease ruminal content
dont forget to obtain…
Signed owner consent form!!
