Recovery Flashcards
patient should be positioned in __________ recumbency
sternal recumbency
what should you do if the patient has reguritated before extubation
postural drainage (nose low)
swab posterior pharynx with gauze (or suction)
remove ET tube with cuff inflated (may need to deflate slightly)
how long should patients be monitored closely post anesthesia
until able to hold head upright and maintain sternal recumbency
T/F brachycephalics commonly develop upper airway obstruction in recovery
True
have an extra ET tube ready for re-intubation in an emergency
how can you stimulate patients to increase level of consciousness
change position (roll legs under when switching laterals)
auditory and tactile stimulation
what are some recovery complications
pain
dyphoria
hypo/hyperthermia
hypoventilation
hypoxemia
prolonged recovery
how can you recognize pain
TPR changes
vocalization
posture/gait
interaction with caregivers
gaurding of [ainful site
behavior change
cadiovasular consequences of pain
increased cardiac workload
respiratory consequences of pain
hypoventilation or hyperventilation
hypoxemia
GI consequences of pain
ileus
renal consequence of pain
oliguria
hematologic consequence of pain
risk of thromboembolism
examples of mild to moderately painful surgical procedures
tracheostomy
aural hematoma
castration
caudal abdominal procedure
examples of molderately painful surgical procedures
mastecomy
mandibulectomy
fracture stabilization
crania abdominal procedure
OHE
enucleation
most painful surgical pain procedures
thoracotomy
ambutation
ear resection
cervical disc
that are the keys to analgesia
multi-modal
pre-emptive
anticipate pain based on….
procedure: surgical site, tissue trauma
what is opioid dysphoria
uncontrollable/unpleasant thoughts, difficulty with concentration, unpleasant bodily sensations, nervousness, anxiety
how can you distinguish opioid dysphoria from pain
painful patient will quite with additional opioids
dysphoric patient will become more distressed with additional opiods
T/F some breeds are more susceptible to dysphoria
True
huskies, malamutes
one strategie for pain vs dysphoria would be to administer ….
alpha 2 agonist - will treat dysphora and pain
T/F an opioid antagonist may be used when dysphoria is suspected
True
butorphenol - mu antagonist, will maintain some analgesia (kappa receptor)
naloxone - titrate carefully to avoid severe pain caused by removal of opioid analgesia
short term effects of hypothermia
increased O2 demand
prolonged recovery
discomfort
long term effects of hypothermia
delayed healing
infection
most effective treatment of hypothermia
forced hot air device (BAIR hugger)
radiant heat device
“hot dog”
T/F heating pads are an effective way to treat hypothermia
False
can be dangerous - can cause burns
common causes of hyperthermia
opioid treament in cats
MRI in obese furry dogs
routine cooling procedures
remove bedding from cage
fan
wet towels
how can hypoventilation be diagnosed
arterial blood gas
EtCO2 monitor
clinical signs
common causes of hypoventilation
drugs
airway obstruction - brachycephalics, collapsing trachea, laryngeal/tracheal Sx, debris
pain
treatment of hypoventilation
delay extubation and continue IPPV PRN
clear away
reverse drugs
how can hypoxemia be diagosed
pulse oximetry
arterial blood gas
most common cause of hypoxemia
airway obstruction (hypoventilation)
pulmonary pathology (V/Q mismatch)
treatment of hypoxemia
address underlying cause
position properly - sternal or good lung up
warming - shivering increases O2 demand
O2 support - increase FiO2
length of recovery depends on…
patient
specific procedure and duration
drugs administered
prolonged recovery rule outs
hypothermia
hypotension
hyoglycemia
electrolyte derangements
anemia
hypoventilation and/or hypoexmia
drugs
neurologic conditions
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
what is the most dangerous part of equine anesthesia
recovery
try to stand before physically capable
potential for catastrophic injuries, minor injuries common
complication in equine recovery
pain
hypothermia
hypoventilation → hypoxemia
airway obstruction (obligate nasal breathers)
anemia, electrlyte disturbances
myopathy / neuropathy
what are the 2 types of equine recovery
free recovery
assisted recovery
when is free recovery used
generally healthy horses without orthopaedic disese
short anesthesia event (1-2hours)
dangerous or unhandled horses
when assisted recovery indicated
ol, weak, systemically ill patients
orthopaedic disease
when airway obstruction is a concern - sinus or dental sx
ophtho surgery
what is “hand” recovery
foals and other small equines (<100kg)
one person on head (with halter and lead) and one on tail
when is sling recovery used
extremely debilitated patients
fracture repair
pool recovery
fragile orthopaedic repairs
not commonly avaible
T/F recovery from tripple drip is usually rapid and smooth
true
why is a sedative needed
smooth recovery from gas anesthesia
which alpha 2 agonist are preferred sedatives in horses
xylazine or romifidine
when should acepromazine be used
healthy, anxious or high strung patients needing additional sedation
low dose
give while on table to allow BP monitoring
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
T/F there is no evidence that hypoxemia is common during equine recovery
False
ample evidence
supplemental O2 is required for …
sick patients or those with respiratory compromise
demand valve O2 while intubated
Nasal O2 once extudated
how can nasal edema be treated
IN phenylephrine
nasopharyngeal tube
why should bloodwork be checked before recovery in equines
hypocalcemia, hypokalemia, hypoglycemia, and anemia can lead to muscle weakness
can contribute to fatal injury
rhabdomyolysis
muscle injury secondary to hypoprofusion
- hard muscles, sweating, trembling, myoglobinuria, pain
Tx: fluids and analgesics
what are some common nerves seen in horses with neuopathies post anesthesia
radial - padding and positioning
facial - remove halter during procedure
ruminant recovery
do not attempt to stand until physically able
complications similar to small animal - reguritiation (common), bloat
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)
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
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
