Post-Anesthesia Care Flashcards
4 signs of airway obstruction after extubation
- increased inspiratory effort
- stridor
- thorax doesn’t expand
you cannot feel air passing through the nose
Which patients are more to catastrophic injury during recovery?
- horses
- large animals
- wild animals
(hypoxemia/hypoxia) leads to organ damage
hypoxia
Dysphoric patients can be treated with ___________ and __________/_______
- opiod antagonists
- careful, you will reverse analgesia too!
- sedatives/tranquilizers
- Acepromazine
- Dexmedetomidine
Problems with brachycephalics that make them prone to airway issues
- stenotic nostrils
- elongated soft palate
- everted saccules and tonsils
- hypoplastic trachea
- laryngeal collapse
(plus edema and irritation)
Risk factors for airway obstruction (4)
- obligate nasal breathers
- horses
- camelids
- rabbits
- brachycephalics
- pre-existing respiratory conditions
- tracheal collapse
- bronchial disease
- tight bandage around the neck
Predicting airway obstruction prior to extubation (5)
- increased respiratory effort
- thorax does not expand
- high PIP alarm on ventilator
- capnography
- try to ventilate (feels like trying to ventilate a brick)
causes of hypoxemia (4)
- low FiO2
- hypoventilation
- ventilation to perfusion mismatch
- AV shunt (anatomical)
4 things that can cause prolonged recovery
- residual drug effect
- acid base/electrolyte abnormalities
- hypoxemia, hypercapnea
- hypothermia
Airway obstructions are usually due to _________ or __________
- tube kinking
- mucus plug obstructing the lumen of the ET tube
3 causes of atelectasis
- absorption (high FiO2)
- compression
- mm relaxation
- external compression
- decreased surfactant
- more relevant for long term ventilation
in ______ the alveolus is ventilated but not perfused (caused by _______)
- High V/Q
- hypotension
_______ and/or ____ are the only way to rule it out hypoxia
- Pulse-oxymetry
- ABG
3 signs of a painful patient (vs. dysphoric)
- responds to palpation of surgical site
- seems to be aware
- responds to administration of an opiod
_____________: profound state of unease or dissatisfaction accompanied by anxiety or agitation
dysphoria
__________ during anesthesia can result i a pneumothorax hours after anesthesia is over
closed APL (pop-off valve)
What to do when an animal is taking too long to recover
- check the temperature
- treat hypothermia
- evaluate the ventilation status
- capnography (if still intubated)
- venous or arterial blood gas
- evaluate oxygenation
- pulse-ox
- arterial blood gas
- evaluate acid base/electrolyte status
- all normal? can any of the anesthetic drugs be reversed?
___________ is the drug given to treat malignant hyperthermia
Dantrolene
3 causes of myopathy/neuropathy
- malpositioning during anesthesia
- compression of nerves
- hypoperfusion of muscles
cyanosis becomes visible when the concentration of deoxyHb rises above ____ g/dL
5 g/dL
in ______ the alveolus is perfused but not ventilated (commonly caused by _______)
- low V/Q
- atelectasis
Cautions for airway obstruction in alpacas (often silent) (5)
- watch for movements of the thorax
- use IN phenylephrine prior to recovery
- nasopharyngeal tubes can be used
- extubate only when they are reactive and don’t tolerate the tube
- have drugs for induction and airway equipment available
3 signs of dysphoria
- whining
- screaming
- uncoordinated movements
Aspiration/regurgitation risk factors (7)
- GI surgery (FB, GDV)
- septic abdomen
- hx of vomiting
- megaesophagus
- laryngeal paralysis
- airway surgery requiring unprotected airway
- ruminants
3 signs of a dysphoric patient (vs painful)
- does not respond to anything in particular
- seems to be “out of it”
- is often caused by opiod administration
Can you be hypoxic without being hypoxemic?
yes
Why does regurgitation/aspiration occur under anesthesia?
- many anesthetic drugs cause nausea, vomiting, and delayed gastric emptying
- most anesthetic drugs also impair swallowing reflexes
Treatment/prevention for aspiration/regurgitation (3)
- administration of gastro protectants/ antiacids
- suction
- late extubation of patients at risk
About 50% of the anesthesia related mortality happen in the _______ period
post anesthetic
Risk factors of hypoxemia (9)
- obese patients
- intra-thoracic surgery
- abdominal surgeries
- dorsal recumbency
- pre-existing respiratory disease
- long anesthetic procedures
- patients requiring higher doses of opiods/sedatives
- painful animals
- dysphoric animals
Why is it easy to become hypoxemic during the recovery period?
most of the drugs used during anesthesia or as analgesics/sedatives cause hypoventilation
- untreated pain may also cause hypoventilation
What can we do to promote a smooth recovery in a horse? (5)
- sedation
- alpha 2 adrenergic agonist
- acepromazine
- good analgesia
- they should lie down for at least 30-40 min after discontinuation of haogenate
- quiet recovery box
- limit noises
- low lighting/cover eyes
- assist recovery
- ropes/pool
- risk for personnel
________ is the cause of hypoxia
insufficient oxygen delivery
_______: deflated alveoli
atelectasis
__________= Reduction below normal levels of oxygen in blood = low PaO2
hypoxemia
How to treat hyperthermia (6)
- turn off all heating devices
- increase fresh gas flow
- check CO2 adsorbent canister (is it hot)
- is it a cat or ferret that has been given opiods?
- initiate cooling process
- do you suspect malignant hyperplasia?
Horses can generate such a substantial negative pressure when trying to breath against an obstructed airway that they can develop ________
fulminating pulmonary edema
Common post-operative complications
- Respiratory complications
- poor recovery
- prolonged recovery
- hyperthermia
- CV complications
- myopathy/neuropathy
- worsening pre-existing conditions
_______: reduction below normal levels of oxygen in the tissues
hypoxia
T/F
Dysphoria is not a reason to withold the administration of analgesics
T
Causes of peri-anesthetic hyperthermia (5)
- iatrogenic (heating pads)
- opiod-related
- capture related
- exhausted CO2 adsorbent
- malignant hyperthermia
