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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
most effective treatment of hypothermia
forced hot air device (BAIR hugger) radiant heat device "hot dog"
26
T/F heating pads are an effective way to treat hypothermia
**False** can be dangerous - can cause burns
27
common causes of hyperthermia
opioid treament in cats MRI in obese furry dogs
28
routine cooling procedures
remove bedding from cage fan wet towels
29
how can hypoventilation be diagnosed
arterial blood gas EtCO2 monitor clinical signs
30
common causes of hypoventilation
drugs airway obstruction - brachycephalics, collapsing trachea, laryngeal/tracheal Sx, debris pain
31
treatment of hypoventilation
delay extubation and continue IPPV PRN clear away reverse drugs
32
how can hypoxemia be diagosed
pulse oximetry arterial blood gas
33
most common cause of hypoxemia
airway obstruction (hypoventilation) pulmonary pathology (V/Q mismatch)
34
treatment of hypoxemia
address underlying cause position properly - sternal or good lung up warming - shivering increases O2 demand O2 support - increase FiO2
35
length of recovery depends on...
patient specific procedure and duration drugs administered
36
prolonged recovery rule outs
hypothermia hypotension hyoglycemia electrolyte derangements anemia hypoventilation and/or hypoexmia drugs neurologic conditions
37
what should be considered before using a reversal agent as a treatment of prolonged recovery
address underlying problem first analgesia will also be reversed in cases of opioids
38
what is the most dangerous part of equine anesthesia
**recovery** try to stand before physically capable potential for catastrophic injuries, minor injuries common
39
complication in equine recovery
pain hypothermia hypoventilation → hypoxemia airway obstruction (obligate nasal breathers) anemia, electrlyte disturbances myopathy / neuropathy
40
what are the 2 types of equine recovery
free recovery assisted recovery
41
when is free recovery used
generally healthy horses without orthopaedic disese short anesthesia event (1-2hours) dangerous or unhandled horses
42
when assisted recovery indicated
ol, weak, systemically ill patients orthopaedic disease when airway obstruction is a concern - sinus or dental sx ophtho surgery
43
what is "hand" recovery
foals and other small equines (\<100kg) one person on head (with halter and lead) and one on tail
44
when is sling recovery used
extremely debilitated patients fracture repair
45
pool recovery
fragile orthopaedic repairs not commonly avaible
46
T/F recovery from tripple drip is usually rapid and smooth
**true**
47
why is a sedative needed
smooth recovery from gas anesthesia
48
which alpha 2 agonist are preferred sedatives in horses
xylazine or romifidine
49
when should acepromazine be used
healthy, anxious or high strung patients needing additional sedation low dose give while on table to allow BP monitoring
50
treatment of post-op pain (equine)
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
T/F there is no evidence that hypoxemia is common during equine recovery
**False** ample evidence
52
supplemental O2 is required for ...
sick patients or those with respiratory compromise demand valve O2 while intubated Nasal O2 once extudated
53
how can nasal edema be treated
IN phenylephrine nasopharyngeal tube
54
why should bloodwork be checked before recovery in equines
hypocalcemia, hypokalemia, hypoglycemia, and anemia can lead to muscle weakness can contribute to fatal injury
55
rhabdomyolysis
muscle injury secondary to hypoprofusion - hard muscles, sweating, trembling, myoglobinuria, pain Tx: fluids and analgesics
56
what are some common nerves seen in horses with neuopathies post anesthesia
radial - padding and positioning facial - remove halter during procedure
57
ruminant recovery
do not attempt to stand until physically able complications similar to small animal - reguritiation (common), bloat
58
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
**E. B or D** Give hydromorphone and dexmedetomidine (painful\>dysphoria)
59
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
**D. A and C** discomfort, poor healing, infection, increased O2 demand
60
What would be some differentials for prolonged recovery in a horse? A. Hypothermia B. Anemia C. Myopathy D. Hypocalcemia E. All of the above
**All of the above**

RUSVM Anesthesiology (39 decks)

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