Post Op Care COPY Flashcards
define pre-operative
before surgery
what is involved in the pre-operative period?
any prior preparation, premedication up until the point of induction of general anaesthesia
what is involved in the peri operative period?
operative period from the start of genera anaesthesia until the patient wakes up form inhaled anaesthesia or anaesthesia is antagonised
what is the post operative period?
return to normal after general anaesthesia and surgery, during which the patient must be monitored closely
when does the recovery period end?
when a full level of consciousness is present and physiological values have been normailised
why is the post op period so important?
period of greatest risk during anaesthesia
what is a major contributory factor to mortality of animals in the recovery period?
a lack of continuous monitoring
where should the patient be transferred to for recovery?
clean, dry, comfy and quiet kennel
why must the recovery area be safe?
in case of thrashing, dysphoria or aggression
when can close monitoring of the recovering patient end?
until the animal is able to remain in sternal recumbancy unaided
when should the ET tube be removed in dogs?
when the animal is starting to swallow or move the tongue
when must cats be extubated?
earlier than dogs - when blink reflex returns as they are prone to laryngeal spasm - fatal
what should you do following extubation to ensure the airway remains patent?
extend the neck and head, pull the tongue forwards
what is different about extubating brachycephallic breeds?
may benefit from tube remaining in place until in sternal recumbancy to aid breathing
what will slow a patients recovery?
low temperature
what can be placed in the kennel in order to warm the patient?
hot hands
hot water bottles
heat pads
what parameters should be monitored in the recovering patient?
TPR
MM
lung auscultation
CRT
what is monitoring of the recovering patient looking for?
signs of haemorrhage or other complicatiosn
when may blood pressure be monitored in the recovering patient?
digital pulses or using doppler in a patient who you are concerned about - should have an idea of BP and its trend from peri-operative monitoring
does IVFT always need to continue post operatively?
only if animal is at risk - most cna come off
what animals are likely to need to stay on IVFT through recovery?
animals at risk of kidney injury or CKD
sick animals (e.g. pyometra)
low perioperative BP
what makes pain assessment in the post op period difficult?
determining dysphoria vs pain
animals level of sedation (unable to respond normally)
species differences (e.g. cats and rabbits)
what can we use to assess pain?
GPS
CMPS - Feline
Rabbit grimace scale
when should water be made available to patients?
as soon as the animals is able to hold themselves in sternal
what will be fed following most routine operations?
soft bland food
when will most animals be fed following routine surgery?
soon after they have fully regained consciousness and seem capable of eating
what is different about feeding cats in hospital?
some cats will be reluctant to eat in hospital which is not necessarily a concern
why is it a priority to get rabbits eating ASAP following surgery?
to prevent gut stasis
when should rabbits be syringe fed if they are not eating by themselves?
within 2 hours of surgery
what will wounds be covered with?
mostly surgical wounds will be covered with a dressing e.g. primapore
why is a buster collar usually necessary as soon as the patient is transfurred to the kennel?
to prevenet interference
what cna be used as an alternative to the buster collar?
medical vest
when should dogs be walked following surgery?
when able to stand and move comfortably
is defecation expected soon after surgery?
no - some animals may have diarrhoea which should be monitored
when should special attention be paid to urination?
following any surgery involving the urogenital tract (e.g. bitch spay) in case of complication
why should rabbits droppings be monitored?
as an indication of gut motility / stasis
how can gut stasis in rabbits be prevented?
lowering of stress
provide fresh hay, pellets and favorite foods at all times
syringe feed if not eating
how can you lower rabbits stress while in practice?
ensure quiet ward away from predators (including smell of them if possible!)
bring the other half of their bonded pair with them
ensure hiding places available
how can you ensure that you are monitoring the recovering rabbits faeces?
set up a partition in kennel so that rabbits can see each other but you are able to see individual rabbits droppings seperately
why should eye lube be continued post operatively in rabbits?
as they are more likely to end up with eye ulcers due to mask use
what medication may be given to rabbits to reduce gut stasis risk?
pro-kinetics
how should pain be recognised?
pain scales facial expression behaviour inappaetance reluctance to move
how is pain managed?
pain relief
how is post op haemorrhage recognised?
slow CRT pale MM low BP tachycardia lethargy dull behavour
how will post op haemorrhage be managed?
likely to require surgical management and exploration
how can aspiration pneumonia be recognised?
fluid from nose (esp. cats)
crackles on lung auscultation
dyspnoea
what patients are more at risk from aspiration pneumonia?
dentals
vomiting / regurgitating
brachycephallic breeds
long surgeries
how should aspiration pneumonia be managed?
need close monitoring (TPR) and oxygen
care with IVFT so that the problem is not made worse
vet may prescribe antibiotics and diuretics to help clear the lungs of fluid
how should a patient that is taking a while to recover be managed?
ensure adequate temperature
consider antagonising any drugs still acting
monitor closely
how is gut stasis recognised?
lack of faeces production and inappetance
no borborygmi sounds (unreliable)
what patients can gut stasis be seen in?
possible in any patients post op but most likely in abdominal patients and rabbits
how should gut stasis be managed?
manage complicating factors (e.g. pain)
promotility agents
IVFT
careful monitoring
how is wound breakdown (dehiscence) recognised?
strike through dressing material
sutures may be disrupted
how can wound breakdown (dehiscence) be managed?
may require surgery
how should aggressive / dysphoric animals in recovery be managed?
anticipate before waking from GA - replace muzzle, buster collar or vest on, ensure secure IV
how can a crashing patient be recognised?
bradycardia
apnoea
non-responsive
how should a crashing in the recovery period be managed?
initiate CPR
get help
ALS
what are the 4 most common medications given in the post op period?
pain relief
anti emetics
antibiotics
probiotics/kaolin
when is opioid analgesia frequently used?
in routine surgeries
what level of pain is methadone used for?
severe
what are the routes of administration for methadone?
IV
IM
SC
what is the duration of action of methadone?
4 hrs
what level of pain is buprenorphine used for?
moderate
what are the routes of administration for buprenorphine?
IV
IM
SC
sublingual (cats
what is the duration of action of buprenorphine?
6-12 hours
what level of pain is fentanyl used for?
severe
what are the routes of administration of fentanyl?
IV or dural patch
how long can a fentanyl patch take to reach full onset?
24 hours
why must animal not lick or chew a fentanyl patch?
risk of overdose
what are the main side effects of opioids?
all should be transient - respiratory depression bradycardia panting salivation vocalisation urination defication
how long do NSAID injections usually last?
24 hours
what is the route of most NSAID injections?
SC
what must be checked if giving NSAIDs post op?
ensure adequate BP to avoid renal damage
when are NSAIDs most often given?
peri-operatively
what are 2 examples of NSAIDs?
metacam
carprofen
what are the main side effects of NSAIDs?
mostly transient GI effects (vomiting or diarrhoea)
lethargy
renal failure
vary rarely more serious e.g. gastric ulcers
are anti emetics always used?
not usually but will be used if signs of nausea present
what are the main examples of anti-emetics?
maropitant (Cerinia)
raniridine
metaclopramide
what are the routes of administration of Maropitant (Cerinia)?
SC
IV
PO
what anti emetics are also pro-mobility agents?
Ranitidine
Metaclopramide
what are the signs of nausea?
lip licking
hypersalivation
crouched positon
inappetance
what are the side effects of Cerenia?
pain on SC injection
what are the side effects of ranitidine?
hyotension
weakness
cardiac arrhythmia (IV administration)
what are the side effects of metoclopramide?
rare - behavioural changes, sedation
when are antibiotics most commonly used post operatively?
orthopedic procedures
sick patients
surgeries lasting over 2 hours
dental disease or wound infection where they form part of treatment plan (most likely PO)
what are the main IV antibiotics?
synuclav
cephalosporin
metronidazole
what are the side effects of metronidazole?
vomiting and neuro side effects (e.g. seizures)
what are the side effects of amoxy-clav?
nausea
diarrhoea
skin rashes
are probiotics/kaolin routinely used post op?
not unless diarrhoea in the post op period
what is the role of probiotics / kaolin?
binds faeces and puts good bacteria back into gut
what animals are probiotics / kaolin good for before and after surgery?
rabbits
