Recovery Flashcards
Small animal extubation
- Sternal recumbancy
- Ensure clean airway
- Deflate cuff and remove after cough or swallow
What should be done if regurge has occurred?
- Position the head lower
- Swab the pharynx
- Remove ET tube with cuff inflated (deflate a small amount if needed)
Small animal recovery monitor
Continue physiologic monitoring until sternal and upright
Small animal supportive care
Continue to use warming to maintain body temp and stimulate as needed to increase level of consciousness
Common recovery complications
- Pain
- Dysphoria
- Hypo-hyperthermia
- Hypoventilation
- Hypoxemia
- Prolonged recovery
Recognizing pain
1 TPR changes
- Vocalization
- Posture/gait
- Interaction with caregivers
- Guarding of painful site
- behavior change
Consequences of pain
- Increased cardiac work load
- Hypo or hyper ventilation, hypoxemia
- Ileus
- Oliguria
- Risk of thromboembolism
- Impaired immune function
- Anxiety or fear
Should pain level be anticipated and treated based on procedure?
Yes
What will a dysphoric patient become with additional opioids?
More distressed
What will a painful patient become with additional opioids?
Quiet
What are some considerations when differentiating pain from dysphoria?
- What analgesics have been administered?
- What kind of procedure??
- Patient temperament and breed
- Surgical site pain
Strategies to differentiate pain from dysphoria?
- Short acting opioids (worse or better?)
- Alpha-2 agonists
- Acepromazine
- Benzodiazepine
- Opioid antagonist (butorphenol good)
Consequences of short term hypothermia
Increased O2 demand
Prolonged recovery
Discomfort
Consequences of long term hypothermia
Delayed healing
Infections
Hyperthermia causes
Opioid use in cats, MRI with obese furry dogs
Can reverse if severe
Treatment of hypoventilation
delay extubation and continue IPPV as needed
Clear airway
Reverse drugs
Treatment of hypoxemia
- Address underlying cause
- Position properly
- Warming
- O2 support (increased FiO2)
Causes of prolonged recovery
- Hypothermia
- Hypotension
- Hypoglycemia
- Electrolyte derangement
- Anemia
- Hypoventilation.hypoxemia
- Drugs
- Neurologic disease
Treatments of prolonged recovery
Address underlying cause before reversing analgesic drugs
Equine recovery
Most dangerous time for equine anesthesia
Potential for injury of horse or personnel
Types of recovery
Free recovery- short procedures or dangerous horses
Assisted recovery- long procedures or unstable patients, orthopedic disease
Types of assisted recovery
Personnel on hand, ropes inside/outside recovery stall, Sling recovery, pool recovery
Equine sedatives
Recovery from triple drip usually uneventful
Need sedative to recovery from gas anesthesia- Alpha-2 agonist +/- acepromazine
What should be used to control pain in equines?
NSAIDS
Alpha-2 agonists
Butorphanol (visceral)
Morphine/meperidine (somatic pain)
Equine hypothermia
Maintain body temp through procedure so that there is no nead to warm during recovery
Is hypoxemia common during equine recovery?
Yes, supplemental O2 recommended to required for all equine patients via tube or nasal flow by
Airway obstruction in equine recovery
Check for nasal edema before recovery, apply intranasal phenylephrine
Equine weakness recovery
Hypocalcemia, hypokalemia, hypoglycemia, anemia- can lead to fatal injury
Check bloodwork prior to recovery and correct disturbances
Rhabdomyolysis myopathy
Horses muscle injury secondary to hypoperfusion- hard muscles, sweating, tembling, myoglobinuria, pain
Tx: fluids analgesics
Ruminant recovery
Do not try to stand prior to ready
Regurg +/- aspiration and bloat are common complications
Maintain sternal recumbency
Delayed extubation and keep cuff inflated
Pass stomach tube to relieve gas bloat
