post-anesthetic period

Question 1

objective during recovery

Answer 1

stabilize the patient as they transition from surgical depth of anesthesia to a conscious state

Question 2

recovery area should be

Answer 2

well ventilated

quite

minimal traffic

controlled intensity of light

person for monitoring!

Question 3

what to monitor for SA:

Answer 3

HR

BP

RR

ETCO2

mm color

SPO2

temperature

Question 4

general guidelines for LA recovery

Answer 4

• disconnect all monitoring equipment
• disconnect from IV fluid
• disconnect from anesthesia machine
• move to recovery area
• give sedative (romifidine, xylazine)
• goal for horses: decrease inhalant concentration as much as possible!!!
• restrain
• extubate (lateral recumbence or standing)
• check bilateral nasal flow!

Question 5

phenylephrine nasal spray in horses

Answer 5

causes vasoconstriction

decreases chance of nasal edema

Question 6

what to monitor for LA recovery

Answer 6

HR

RR

mm color

anesthetic depth (horizontal nystagmus)

Question 7

potential complications during recovery

Answer 7

respiratory

cardiovascular

hypo/hyperthermia

regurgitation/gastroesophageal reflux

delayed return of consciousness

emergence dysphoria

Question 8

ventilatory complications during recovery

Answer 8

apnea

airway obstruction

hypoventilation

pleural space disease

pulmonary disease

bronchospasms (cats!)

Question 9

apnea during recovery

Answer 9

potentially a sign of cardiac arrest

check for pulse

re-intubate

Question 10

airway obstruction

Answer 10

• clinical signs-intubated
  
  • high PIP to expand chest
  • absence of EtCO2 despite mechanical ventilation
  • cyanosis
• clinical signs-extubated
  
  • stridor
  • dyspnea
  • chest movement wihthout air movement
  • cyanosis

Question 11

potential causes of airway obstruction

Answer 11

• kinking of E-tube
• obstruction of E-tube (mucus, blood, aspiration)
• endobronchial intubation
• airway edema
• broncho/laryngospasm
• obstruction of airway
• collapsing trachea
• laryngeal paralysis

Question 12

pleural space and pulmonary disease during recovery

Answer 12

• ascult thorax
• supplement oxygen
• pleural space disease-thoracocentesis
• pulmonary edema-furosemid, steroids

Question 13

clinical signs of CV complications during recovery

Answer 13

• weak pulses
• tachycardia/bradycardia
• CRT> 3 sec
• cold extremities
• cyanosis/hypoxemia
• pale mucous membrances
• hypotension

Question 14

treatment of CV complications during recovery

Answer 14

supplemental O2

fluids/blood products prn

inotropic agents

drug reversal

Question 15

hypothermia during recovery

Answer 15

<98 F

prolongs recovery

increases oxygen demand

Question 16

delayed return to consciousness during recovery

Answer 16

• causes:
  
  • drug overdose/residual drug effect
  • deep plane of anesthesia
  • hypothermia
  • hypoglycemia
  • hypotension
  • decreased drug metabolism
  • CNS disease
  • hypoventilation
• run BW, electrolytes, glucose, fluid support, supplemental O2, reversal agents

Question 17

emergence dysphoria

Answer 17

hard to distinguish from true pain

treat for pain first, then treat dysphoria if no improvment

Question 18

negative effects of pain

Answer 18

• increased cardiac workload
• increased myocardial oxygen consumption
• delayed healing
• hypoventilation
• ileus
• water retention
• excitation

Question 19

pain control

Answer 19

• analgesics used pre-op and intra-op
• is your patient painful?
• perceived pain?
• analgesics available
• mentation?
• return to function?
• CV compromise?
• chronic pain/wind-up?