Recovery Flashcards
How frequently do you monitor the vitals on an unconscious or immobile patient?
Every 10 minutes until animal regains consciousness.
An unconscious patient needs to be continuously supervised until when?
Extubation
What are 2 things that shivering consumes?
Oxygen and glucose
What needs to be conserved in an unconscious patient?
Body heat
With an unconscious patient, the tongue should be pulled rostrally to prevent what?
Pharyngeal occlusion
The endotracheal tube should be maintained until upper airway reflexes and jaw movement return in what type of patient?
Brachycephalic
Food and water should not be offered until the patient is what?
Standing
What should not be placed with an anesthetized animal?
An awake animal.
Caution needs to be used with what type of bandaging?
Especially where?
- Constrictive
- Head and throat
Tight bandaging over the abdomen of a cat can lead to what?
Posterior paralysis
What are 2 possible causes that can be mistaken for anesthetic sensitivity?
- Inappropriate dosing
- Inappropriate monitoring
Is anesthetic sensitivity common or rare in dogs?
Rare
What information do you need to know with prolonged emergence?
What the cause of the animal being asleep is.
How do you systematically evaluate a patient undergoing prolonged emergence?
A - Airway: maintain & protect
B - Breathing: ventilate to maintain normal CO2
C - CV: assess HR, BP, perfusion, urine output
D - Drugs: review all combinations
E - Electrolytes
F - Failure to find cause
What are 5 possible pharmacologic factors for prolonged emergence?
- Timing
- Total dose
- Half life
- Route
- Patient bioavailability
What effect do opioids have on the respiratory system?
How does this affect the inhalant?
- Decrease ventilation
- Delay inhalant elimination
What are 2 types of drugs that can potentiate other general anesthetic agents?
- Benzodiazepines
- Ketamine
What drugs can have a prolonged affect in greyhounds?
Barbiturates
Opioid accumulation can lead to what?
Prolonged emergence
What are 2 reversal agents for alpha 2 agonists?
- Atipamezole
- Yohimbine
What effect do benzodiazepines have that can cause prolonged emergence?
Decrease hepatic blood flow may prolong hepatic metabolism.
What is a reversal agent of benzodiazepines?
Flumazenil
What do you want to be careful of when reversing drugs?
Reversing analgesic effects.
Depressed thermoregulation under anesthesia can lead to what?
Hypothermia
What are 4 ways heat is lost?
- Evaporation
- Radiation
- Conduction
- Convection
What are 3 classes of drugs that alter thermoregulation?
- Opioids
- Alpha 2 agonists
- Inhalants
Inhalants lower thermal threshold response to what temperature?
What won’t happen in the patient until this level is reached?
- 34.5 C
- Patient won’t shiver.
How do you convert from Celsius to Fahrenheit?
Multiply by 1.8 and then add 32
A patients body temperature decreases over time with what?
How much in dogs?
How much in horses?
- Inhalants
- 2 C/hr
- 0.37 C/hr
Hypothermia (body temp
Reduces hepatic metabolism.
What effect does hypothermia have on the CNS?
Depresses CNS activity (cold narcosis)
What effect does hypothermia have on the solubility of anesthetic agents?
What effect does this have on their DOA?
- Increased solubility
- Longer DOA
What are 3 options for treating hypothermia seen with prolonged recovery?
- Circulating warm water pads
- Forced warm air device
- Conductive fabric
What are 3 organs that may be affected by reduced cardiac output seen with prolonged emergence?
- Lungs
- Kidney
- Liver
How can prolonged emergence affect protein binding?
Why is this a problem?
- Decreased protein binding.
- Adequate amounts of protein are necessary to take drug to liver to be metabolized.
An altered acid base status of
Altered mental status
What are 4 effects renal failure and azotemia can have that cause prolonged emergence?
- Altered acid base status
- Decreased protein binding
- Delayed excretions of drugs & metabolites
- Electrolyte changes
What are 7 examples of endocrine imbalances that can cause prolonged emergence?
- Hypothyroidism
- Adrenal insufficiency
- Sepsis
- SIRS
- Pancreatitis
- Uremia
- Hypoglycemia
What are 4 possible causes of hypoglycemia that can cause prolonged emergence?
- Neonates
- Very small patients (increased metabolic rate)
- Fasted diabetics treated with insulin
- Glucocorticoid deficiency
What are 7 examples of neurological conditions that can lead to prolonged emergence?
- Hydrocephalus
- Cerebral hypoperfusion
- Hypoxia
- Elevated ICP
- Cerebral ischemia
- Cerebral edema
Can genetic differences cause prolonged emergence?
Yes
Can idiosyncratic reactions cause prolonged emergence?
Yes
What commonly occurs within the first 10 minutes of emergence?
Postoperative delirium
How long can postoperative delirium last?
Up to an hour.
Hyperarousal, agitation and hyperactivity can be seen with what?
Postoperative delirium
What are 6 possible causes of postoperative delirium?
- Surgery
- Infection
- Anemia
- Drugs
- Hypotension
- Hypoxia
What are 3 things can cause postoperative delirium?
- Decreased Acetylcholine
- Increased Dopamine
- Increased Cortisol
Postoperative delirium is common in what 3 breeds of dogs?
- Greyhounds
- Russian Wolfhounds
- Afghans
What are 3 possible treatments for postoperative delirium?
- Reversal agents
- Quiet, dark, padded room/cage
- Sedate
Wait to extubate and deflate the cuff until what happens?
Patient swallows or coughs.
What needs to be monitored during recovery?
Mucous membrane color and ventilation
The patient should be placed in what type of recumbency during recovery?
Sternal recumbency
What are 3 things that need to be maintained during recovery?
- CV support
- Pulmonary support
- Catheter patency
What is a concern with feline recovery?
Postoperative hyperthermia
What are 3 thing to keep available during equine recovery?
- Tranquilizers
- Ropes
- ER drugs
