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Surgery I > Pre- and postoperative care > Flashcards

Pre- and postoperative care Flashcards

1
Q

ASA I description and examples.

A

Apparently healthy

e.g. Ovariohysterectomy, mild
periodontal disease, patellar luxation

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2
Q

ASA II description and examples.

A

Mild systemic disease

e.g. Neonatal or geriatric animals,
compensated cardiac disease, small
tumors

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3
Q

ASA III description and examples.

A

Severe systemic disease

e.g. Chronic cardiac disease, fever,
dehydration, cachexia, anemia

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4
Q

ASA IV description and examples.

A

Severe systemic disease that is life
threatening

e.g. Heart failure, renal failure, hepatic
failure, severe hypovolemia, severe
hemorrhage

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5
Q

ASA V description and examples.

A

Moribund; patient not expected to
live longer than 24 hours without
surgery

e.g. Endotoxic shock, multiorgan failure,
severe trauma

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6
Q

Anesthesia-related mortality dogs vs cats

A

data as of 2002, dogs had a 1:600 chance of surgery related mortality

cats had a 1:400 chance of surgery related mortality

Risk is pretty much ~2 times higher for cats in comparison to dogs.

The postoperative period is riskiest for both species.

Next is the anesthetic maintenance period (intraoperative).

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7
Q

Possible reasons for Anesthesia-related mortality: (5)

A
  • Smaller animal (hypothermia, overhydrating)
  • Uncooperative behavior
  • Prone to laryngospasm
  • Sensitivity to local anesthesia drug toxicity
  • Reduced glucuronidation (slower drug
    metabolism)
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8
Q

Anesthesia-related mortality:
Rabbits
Horses
Humans

A

Rabbits: 1:70
* Most other small animal species have higher mortality risks.

Horses: 1:100
Humans: 1:100,000

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9
Q

ASA III patients have how much of a higher anesthesia related mortality risk?

And ASA IV-V?

And ASA E (emergency)?

A

ASA III – risk 4,8x greater
ASA IV-V – risk 19x greater
ASA E (emergency) – risk 13,6x greater

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10
Q

What is necessary in order to minimize the chance of adverse events related to surgery

A

Planning for and anticipating complications.

These details require special attention:
* Thorough anamnesis
* Full clinical examination
* Laboratory data
* Patient stabilization
* Determination of surgical risk (ASA class)
* Client communication

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11
Q

Anamnesis morbi =

A

History of present disease

E.g.
* Reason for surgery (chief complaint)
* Clinical signs and duration
* Past medical problems and treatments
* Current medical problems and treatments
* Prior anesthesia
* Used drugs, complications, recovery

(vs Anamnesis vitae = previous/past history)

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12
Q

Careful attention to breed must be paid due to..? (2)

A

Anatomical differences and other possible genetic predispositions.

Some examples:
* Brachycephalic breeds
* Toy breeds
* Giant breeds
* Boxers, greyhounds, herding breeds,
dobermen, miniature schnauzers etc.

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13
Q

Brachycephalic breeds are predisposed to the following surgical complications: (5)

A
  • Brachycephalic Obstructive Airway Syndrome (BOAS): Small hypoplastic trachea; elongated soft palate; stenotic nares.
  • Laryngeal mucous membranes prone to swelling/edema.
  • Increased tonus of n. vagus
  • Predisposition to gastroesophageal reflux
  • Higher risk of hypoxia
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14
Q

Toy breeds are predisposed to the following surgical complications: (5)

A
  • Hypothermia
  • Catheter placement may be more difficult.
  • Questionable accuracy of monitoring equipment due to tiny size.
  • Accuracy of drug dosages
  • Hands-on assessment is limited during anesthesia due to tiny size.
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15
Q

Giant breeds are predisposed to the following surgical complications: (3)

A
  • Lower drug dosages required relative to large size.
  • Considered geriatric at a much younger age.
  • Ease of patient handling more difficult.
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16
Q

Herding breeds predisposed to the following medical intervention related complications

A

prolonged effect of some drugs due to mutations in the MDR-1 gene

(ivermectin among others)

17
Q

Boxers are predisposed to the following medical intervention related complications

A

drug sensitivity (acepromazine)

18
Q

Greyhounds (+ other sighthounds?) are predisposed to the following medical intervention related complications

A

drug sensitivity,
prolonged recovery from some drugs (propofol, barbiturates)

Other similarly lean-muscled breeds may also appear more sensitive to lipophilic drugs (most anesthetic drugs).

19
Q

Miniature schnauzers are predisposed to the following medical intervention related complications

A

sick sinus syndrome (SSS)

is an acquired disease of the conduction (electrical) system which is typically diagnosed in geriatric dogs.

with SSS, the sinus node has lapses in which it discharges (beats much too slowly, or not at all). As a result, there are long pauses in between heartbeats. Sometimes, an electrical impulse originating from another part of the heart will come to the rescue, particularly if the heart has stopped for several seconds. Such rescue beats can be very rapid.

In most cases, the sinus node will eventually resume its job in which case there will be periods of normal heart rate (60-100 beats per minute). Other dogs with SSS have a constant bradycardia (heart rate is too slow). Even with exercise or excitement, the heart rate remains at less than 40 beats per minute.

20
Q

Dobermans are predisposed to the following medical intervention related complications

A

high prevalence of Von Willebrand disease

“Of 15,000 Dobermans screened in a research study, more than 70% were found to be carriers of the disease.”

(vWD) is the most common inherited bleeding disorder of both humans and dogs. It is caused by a deficiency in the amount of a specific protein needed to help platelets (the blood cells used in clotting) stick together and form clots to seal broken blood vessels. The deficient protein is called von Willebrand factor (vWF).

  • Buccal mucosal bleeding time may be measured if access to coagulation factor labs unavail.
21
Q

How does age affect surgery related mortality?

A

Pediatric and geriatric patients at a higher risk than average adult patients – smaller drug dosages are required.

22
Q

Pediatric-patient surgery related risk is exacerbated due to? (3)

A
  • Immature organs and defense mechanisms
  • Prone to hypothermia, hypoglycemia,
    regurgitation
  • Blood loss is more dangerous due to lower blood volume and large body surface area vs body mass.
23
Q

Geriatric-patient surgery related risk is exacerbated due to? (3)

A
  • Reduced response to hypercapnia, hypoxemia.
  • Slower metabolism and healing, decreased organ function.
  • Prone to hypothermia, regurgitation.
24
Q

Preoperative care includes: (3)

A

Clinical examination
↓
Diagnostic tests
↓
Stabilization:
See image for what is included.

25
Q

Clinical examination in the preoperative period.

A

Benefits of evaluating veterinary patients before general anesthesia are often underestimated.

Includes evaluation of risks and the necessity of further diagnostic tests.

Full clinical examination always warranted, but sometimes not possible.

Exam includes:
Cardiovascular system
Respiratory system
Hydration status
Gastrointestinal and urinary system
Integumentary system
Central nervous system
Temperature

26
Q

Recommended minimum labs to run before anesthetics (4)

A

packed cell volume,
total protein,
glucose,
urea

27
Q

Preoperative fasting should be especially carefully considered in what types of patients? (4)

A
  • Pediatric patients
  • Cachectic patients
  • Concurrent diseases (fever, diabetes, etc. [polyuria])
  • Different species (e.g. rabbits should not be fasted at all)

Fasting of 2-4 hours for water and 6-8 hours for food should be enough in most cases (this doesnt apply to puppies who’s fasting period is shorter and variable).

28
Q

the most common complication of anesthesia

A

Hypothermia

29
Q

Hypothermia may in turn cause (4)

A

hypoxia,
prolonged recovery from anesthesia,
an increased infection risk,
worse cardiovascular parameters.

Warming should be started as soon as possible.

30
Q

Purposes of Intraoperative fluid management: (3)

A
  • Maintenance of hemodynamics
  • Maintenance of the catheter
  • Replacement (amortization) of fluid and blood loss

amortization = to replace a deficit over time

31
Q

American Animal Hospital Association guidelines for Intraoperative fluid management, starting dose IVFT:

A
  • Starting dose of 5 ml/kg/h for dogs and 3 ml/kg/h for cats
  • Can be reduced 25% each hour (unless fluid/blood loss ongoing)
31
Q

Most often used IVFT crystalloids (2)

A

Ringer’s-Lactate or Hartmann’s solution
(not NaCl 0,9%)

32
Q

In case of hypotension, intraoperative crystalloid bolus at what dose and rate?
and Colloid bolus?

A

10-30 ml/kg for 10-15 min
(depending on mean arterial pressure)

Colloid bolus 2-10 ml/kg for 5-10 mins (depending on mean arterial pressure)

33
Q

Intraoperative Positioning of the patient is

A

Often underestimated, but extremely important.

34
Q

Immediate postoperative concerns (6)

A
  • Pain
  • Anxiety
  • Cardiorespiratory function
  • Temperature

Procedure-related factors
* Wound protection

Postoperative period should be made as pleasant as possible.

35
Q

Patient has to be closely monitored until it: (8)

A
  • Has been extubated
  • Is laying on sternum, head elevated
  • Is able to swallow, has normal ocular reflex
  • Has a strong and regular peripheral pulse
  • Has an oxygen saturation of >94%
  • Has no suspicion of upper airway obstruction
  • Has effective analgesia
  • Has no evident bleeding
36
Q

Postoperative care, non-immediate: (6)

A
  • Pain management
  • Nutritional management
  • Wound care (protection, antibacterials)
  • Care related to surgical procedure
    (ie. Exercise restriction, Immobilization)
  • Other care possibilities
  • Home care – instructions necessary!
37
Q

Options for analgesia at home (4)

A
  • NSAIDs
  • Tramadol
  • Fentanyl/lidocaine patch
  • Ca++ channel blockers (e.g. gabapentin)
  • Etc.

Surgery I (9 decks)

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