Patient Prep/Preoperative Flashcards
Problems associated with intubation.
Stimulation of vagus nerve, brachycephalic breeds, laryngospasm, bronchi intubation, pressure necrosis, tracheal tears
Common intubation problem in cats.
Laryngospasm
Caused by over inflation of the ET tube cuff.
Pressure necrosis
Caused by pushing the ET tube too far down.
Bronchi intubation
Caused by too large of an ET tube and forceful intubation.
Tracheal tears
Problems associated with post intubation.
ET tube obstruction, ET tube removal, not disinfected tubes
Supplies needed for intubation?
Trach tube (3 sizes), Insufflation syringe, laryngoscope, lube, gauze, stylet and tie
What do you do before intubation?
Measure the tube length, inspect the equipment, insert stylet (if applicable), administer induction agent
Where do you secure the ET tube?
Behind the ears (cats), over the muzzle
How do you confirm ET tube placement?
Bag inflation, coughing, fogging of the tube, visualization
Alternative methods to intubation?
Mask induction, chamber induction
Risk of using an anesthetic mask?
Risk of aspiration, according nostrils, gas leak
Why do we Intubate?
Reduce exposure to waste gas, provide delivery of gas, rapid deliver of oxygen, assist in ventilation, decrease risk of aspiration
What should be included on a consent form?
Patient name and signalment, owner name, procedure, doctor name, emergency contact, anesthesia disclaimer/complications
Factors that affect minimum database of patients?
Age, species, medical hx
Minimum tests before surgery?
PCV, TS, blood glucose, BUN, ALT
How much blood glucose do you loose each hour?
7-10%
What does blood glucose tell us?
Indicates carbohydrate metabolism in the body and can measure endocrine function of the pancreas
What does BUN tell us about the patient?
Evaluates kidney function and the ability for the kidney to remove urea from the blood
What does ALT tell us about a patient?
Liver
Surgery able to do at any point on a healthy animal.
Elective
Required procedure.
Non elective
Why do we pre med?
Relaxes patient, preemptive pain management, eases surgical transition
Four phases of the pain pathway.
Transduction, transmission, modulation, perception
The pain phase which the patient knows the pain is present.
- Perception
The pain phase where Impulses spread to the spinal cord
- Transmission
The pain phase which the event is converted to a signal that is sent tomCNS for processing.
- Transduction
The pain phase of which pain signals are being sorted out.
- Modulation
Four classes of analgesic drugs?
Opioids, NSAIDs, local anesthetic, alpha-2 agonists
Possible side effects of opioids.
Bradycardia, emesis, panting
Used for acute pain management.
Opioids
Used to treat inflammation and pain of surgery.
NSAIDs
When is the best time to give NSAIDs for surgical use.
1-2 hours before surgery
Possible side effects of NSAIDs.
Renal toxicity, liver toxicity, GI upset
Short acting sedative, muscle relaxant that can be reversed.
Alpha-2 agonist
Most common alpha-2 agonists.
Metatomidine, xylazine
Two concentrations of xylazine?
20mg/ml, 100mg/ml
Blocks pain at the source.
Local anesthetic
What do we use intraoperative antibiotic for?
Contaminated wounds, possible break in sterility, prophylaxis
Possible side effects of alpha-2 agonists?
Bradycardia, vomiting, hypertension, heart block, respiratory depression
Only use in healthy, young patients.
Alpha-2 agonists
Risk of: Normal, health animals with no disease.
Class 1
Risk of: Animal with slight to moderate systematic disturbance (geriatrics, fractures, mild diabetes, obesity, estrus)
Class 2
Risk of: animal with moderate systematic disturbances (anorexia, anemia, murmur, fever, dehydration).
Class 3
Risk of: preexsisting disease or disturbance. (High fever, anemia, shock, pulmonary disease, heart failure, severe dehydration).
Class 4
Risk of: life threatening disease or incorrect able disturbance (head trauma, severe trauma, advanced endocrine disease, pulmonary embolus).
Class 5
Standard surgical blade clippers size?
40 or 50
Where do you clip for abdominal surgery?
Xiohoid, outside the nipples and to the mid pubis
Skin prep using sterile gauze and sterily scrubbed in.
Sterile skin prep
Scrub that acts faster and lasts longer.
Chlorexadine
Scrub that ha longer contact time.
Betadine
Potential risks of clipping.
Clipper burn, chemical reactions
How can you maintain body temperature during operation?
Warm water blanket, warm air blanket, microwaved heating discs and lads, warm bottles, heated table
