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RUSVM Anesthesiology > Recovery > Flashcards

Recovery Flashcards

1
Q

patient should be positioned in __________ recumbency

A

sternal recumbency

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2
Q

what should you do if the patient has reguritated before extubation

A

postural drainage (nose low)

swab posterior pharynx with gauze (or suction)

remove ET tube with cuff inflated (may need to deflate slightly)

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3
Q

how long should patients be monitored closely post anesthesia

A

until able to hold head upright and maintain sternal recumbency

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4
Q

T/F brachycephalics commonly develop upper airway obstruction in recovery

A

True

have an extra ET tube ready for re-intubation in an emergency

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5
Q

how can you stimulate patients to increase level of consciousness

A

change position (roll legs under when switching laterals)

auditory and tactile stimulation

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6
Q

what are some recovery complications

A

pain

dyphoria

hypo/hyperthermia

hypoventilation

hypoxemia

prolonged recovery

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7
Q

how can you recognize pain

A

TPR changes

vocalization

posture/gait

interaction with caregivers

gaurding of [ainful site

behavior change

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8
Q

cadiovasular consequences of pain

A

increased cardiac workload

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9
Q

respiratory consequences of pain

A

hypoventilation or hyperventilation

hypoxemia

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10
Q

GI consequences of pain

A

ileus

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11
Q

renal consequence of pain

A

oliguria

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12
Q

hematologic consequence of pain

A

risk of thromboembolism

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13
Q

examples of mild to moderately painful surgical procedures

A

tracheostomy

aural hematoma

castration

caudal abdominal procedure

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14
Q

examples of molderately painful surgical procedures

A

mastecomy

mandibulectomy

fracture stabilization

crania abdominal procedure

OHE

enucleation

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15
Q

most painful surgical pain procedures

A

thoracotomy

ambutation

ear resection

cervical disc

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16
Q

that are the keys to analgesia

A

multi-modal

pre-emptive

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17
Q

anticipate pain based on….

A

procedure: surgical site, tissue trauma

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18
Q

what is opioid dysphoria

A

uncontrollable/unpleasant thoughts, difficulty with concentration, unpleasant bodily sensations, nervousness, anxiety

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19
Q

how can you distinguish opioid dysphoria from pain

A

painful patient will quite with additional opioids

dysphoric patient will become more distressed with additional opiods

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20
Q

T/F some breeds are more susceptible to dysphoria

A

True

huskies, malamutes

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21
Q

one strategie for pain vs dysphoria would be to administer ….

A

alpha 2 agonist - will treat dysphora and pain

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22
Q

T/F an opioid antagonist may be used when dysphoria is suspected

A

True

butorphenol - mu antagonist, will maintain some analgesia (kappa receptor)

naloxone - titrate carefully to avoid severe pain caused by removal of opioid analgesia

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23
Q

short term effects of hypothermia

A

increased O2 demand

prolonged recovery

discomfort

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24
Q

long term effects of hypothermia

A

delayed healing

infection

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25
Q

most effective treatment of hypothermia

A

forced hot air device (BAIR hugger)

radiant heat device

“hot dog”

26
Q

T/F heating pads are an effective way to treat hypothermia

A

False

can be dangerous - can cause burns

27
Q

common causes of hyperthermia

A

opioid treament in cats

MRI in obese furry dogs

28
Q

routine cooling procedures

A

remove bedding from cage

fan

wet towels

29
Q

how can hypoventilation be diagnosed

A

arterial blood gas

EtCO2 monitor

clinical signs

30
Q

common causes of hypoventilation

A

drugs

airway obstruction - brachycephalics, collapsing trachea, laryngeal/tracheal Sx, debris

pain

31
Q

treatment of hypoventilation

A

delay extubation and continue IPPV PRN

clear away

reverse drugs

32
Q

how can hypoxemia be diagosed

A

pulse oximetry

arterial blood gas

33
Q

most common cause of hypoxemia

A

airway obstruction (hypoventilation)

pulmonary pathology (V/Q mismatch)

34
Q

treatment of hypoxemia

A

address underlying cause

position properly - sternal or good lung up

warming - shivering increases O2 demand

O2 support - increase FiO2

35
Q

length of recovery depends on…

A

patient

specific procedure and duration

drugs administered

36
Q

prolonged recovery rule outs

A

hypothermia

hypotension

hyoglycemia

electrolyte derangements

anemia

hypoventilation and/or hypoexmia

drugs

neurologic conditions

37
Q

what should be considered before using a reversal agent as a treatment of prolonged recovery

A

address underlying problem first

analgesia will also be reversed in cases of opioids

38
Q

what is the most dangerous part of equine anesthesia

A

recovery

try to stand before physically capable

potential for catastrophic injuries, minor injuries common

39
Q

complication in equine recovery

A

pain

hypothermia

hypoventilation → hypoxemia

airway obstruction (obligate nasal breathers)

anemia, electrlyte disturbances

myopathy / neuropathy

40
Q

what are the 2 types of equine recovery

A

free recovery

assisted recovery

41
Q

when is free recovery used

A

generally healthy horses without orthopaedic disese

short anesthesia event (1-2hours)

dangerous or unhandled horses

42
Q

when assisted recovery indicated

A

ol, weak, systemically ill patients

orthopaedic disease

when airway obstruction is a concern - sinus or dental sx

ophtho surgery

43
Q

what is “hand” recovery

A

foals and other small equines (<100kg)

one person on head (with halter and lead) and one on tail

44
Q

when is sling recovery used

A

extremely debilitated patients

fracture repair

45
Q

pool recovery

A

fragile orthopaedic repairs

not commonly avaible

46
Q

T/F recovery from tripple drip is usually rapid and smooth

A

true

47
Q

why is a sedative needed

A

smooth recovery from gas anesthesia

48
Q

which alpha 2 agonist are preferred sedatives in horses

A

xylazine or romifidine

49
Q

when should acepromazine be used

A

healthy, anxious or high strung patients needing additional sedation

low dose

give while on table to allow BP monitoring

50
Q

treatment of post-op pain (equine)

A

NSAIDs - mainstay of equine pain relief

alpha 2 agonist - short duration, visceral (colic) pain

butorphanol - short duration, visceral pain

morphine - concernfor ileus, somatic pain

51
Q

T/F there is no evidence that hypoxemia is common during equine recovery

A

False

ample evidence

52
Q

supplemental O2 is required for …

A

sick patients or those with respiratory compromise

demand valve O2 while intubated

Nasal O2 once extudated

53
Q

how can nasal edema be treated

A

IN phenylephrine

nasopharyngeal tube

54
Q

why should bloodwork be checked before recovery in equines

A

hypocalcemia, hypokalemia, hypoglycemia, and anemia can lead to muscle weakness

can contribute to fatal injury

55
Q

rhabdomyolysis

A

muscle injury secondary to hypoprofusion

  • hard muscles, sweating, trembling, myoglobinuria, pain

Tx: fluids and analgesics

56
Q

what are some common nerves seen in horses with neuopathies post anesthesia

A

radial - padding and positioning

facial - remove halter during procedure

57
Q

ruminant recovery

A

do not attempt to stand until physically able

complications similar to small animal - reguritiation (common), bloat

58
Q

If your total ear canal ablation (TECA) patient woke up vocalizing and struggling, what would be an appropriate response?

A. Give naloxone

B. Give hydromorphone

C. Give buprenorphine

D. Give dexmedetomidine

E. B or D

A

E. B or D

Give hydromorphone and dexmedetomidine (painful>dysphoria)

59
Q

What are some consequences of hypothermia?

A. discomfort, poor healing, infection

B. rapid recovery

C. increased O2 demand

D. A and C

E. all of the above

A

D. A and C

discomfort, poor healing, infection, increased O2 demand

60
Q

What would be some differentials for prolonged recovery in a horse?

A. Hypothermia

B. Anemia

C. Myopathy

D. Hypocalcemia

E. All of the above

A

All of the above

RUSVM Anesthesiology (39 decks)

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