Recovery Flashcards by Corinne Perra

Who do you extubate earlier, cats or dogs?

Cats

-avoid laryngospasm

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When recovering small animals, what should you do if there was regurgitation?

Postural drainage(nose low)
Suction
Swab posterior pharynx with gauze before awakening
Remove ET tube with cuff inflated

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What are you monitoring in small animals during recovery?

TPR in all patients

Pulse ox in brachycephalic —> upper or lower airway disease, pulmonary pathology

BP in patients with hemorrhage, sepsis, and hypovolemia

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You should be cautious about bandages around the head during recovery because??

Can lead to upper airway obstruction in sedate animlas

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How can you stimulate your patient to increase level of consciousness ?

Change position- roll legs under when switching lateral —> more natural

Auditory and tactile stimulation

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What are complications with recovery?

Pain 
Dysphoria 
Hypo- or hyperthermia 
Hypoventilation 
Hypoxemia 
Prolonged recover

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What affect does pain have on the CV and respiratory system?

CV: increased cardiac work load

Respiratory: hypoventilation/hyperventilation, hypoxemia

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What affect does pain have on GI and Renal function?

GI: ileus

Renal: oliguria

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T/F: pain can impair immune function and increase risk of thromboembolism

True

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Which of these surgeries will cause the most amount of pain?

Tracheostomy
Thoracotomy
Ovariohysterectomy

Thoracotomy > ovariohysterectomy > tracheostomy

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Which of these surgeries causes the most pain?

Cranial abdominal procedure
Aural hematoma
Pelvic repair

Pelvic repair > cranial abdomen repair > aural hematoma

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What is opioid dysphoria?

In humans..”uncontrollable/pleasant thoughts, difficulty concentrating, unpleasant bodily sensations, nervousness, and anxiety”

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T/F: a painful patient will quiet with additional opioids, a dysphoria patient will become more distressed with additional opioids

True

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How can you differentiate pain vs dysphoria??

What analgesics have been administered? - dose and duration?

Pain? -level expected?

Temperament? -anxious?

Surgical site?- palpate site, reaction suggests behavior is pain related, not dysphoria

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What opioid can you administer to a patient that is vocalizing and distressed, and you are unsure if its due to pain or dysphoria?

Fentanyl
-short acting opioid

Pain—> improve
Dysphoria —> worsen

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What drug will treat both dysphoria AND pain?

A-2 agonists

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What drugs can treat dysphoria?

Acepromazine
Benzodiazepines
Opioid antagonist

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What opioid antagonist can you use if you want to maintain some analgesia?

Butorphanol (mu antagonist)

Kappa agonsit -> some analgesia

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How should you administer naloxone when treating opioid dysphoria?

Last resort

Titrate carefully to avoid severe pain caused by removal of opioid analgesia

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Why do we want to avoid hypothermia during recovery?

Short term causes..

increased O2 demand
prolonged recovery
discomfort

Long term causes..

delayed healing
infection

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What is the treatment for hypothermia?

Most effective

force hot air device (BLAIR hugger)
radiant heat device
hot dog

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T/F: a heating pad is a good method to warm patients when treating for hypothermia on recovery

False

—heating pads can cause burns!!

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When can you see hyperthermia in recover?

Opioid treated cats

MRI in obese furry dogs

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What can you do to treat hyperthermia?

Remove bedding from cage
Fan
Wet towels

Can reverse opioids if severe (cats)

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What are some causes of hypoventilation?

Drugs Airway obstruction - brachycephalic - collapsing trachea - laryngeal/tracheal surgery - debris in airway Pain - thoracotomy - rib fractures

How can you treat hypoventilation ?

Delay extubation and continue IPPV as needed Clear airway Reverse drugs

What is the most common cause of hypoxemia?

``` Airway obstruction (hypoventilation) Pulmonary pathology (V/Q mistmatch) ```

Hwo can you treat hypoxemia?

Address underlying cause Position properly-sternal recumbency or good lung up Warming O2 support - O2 by mask - flow by O2 - O2 cage - nasal O2 - PPV

What are causes of prolonged recovery??

``` Hypothermia Hypotension Hypoglycemia Electrolyte derangement Anemia Hypoventilation/hypoxemia Drugs Neurological disease ```

What anesthetic related neurological diseases can be seen in cats especially?

Blindness Stupor Coma —>due to cerebral hypoxia

Hypoglycemia is causing a prolonged recovery in your patient. How do you treat?

Dextrose

Hypotension is causing prolonged recovery in you patient. How could you treat this?

Maintain BP with inotropes or vasopressors

What is the most dangerous part of equine anesthesia?

Recovery!! —> potential for catastrophic injury- fracture, luxation, airway obstruction Minor injuries are common - contusions/lacerations

T/F: equines can generally be extuabed earlier than other species

True - horses don’t regurgitate - reflux is possible after colic surgery but not common

What are complications to recovery of equine patients?

``` Pain Hypothermia Hypoventilation —> hypoxemia Airway obstruction Anemia, electrolyte disturbances Myopathy/neuropathy ```

Why are airway obstructions more common in horses?

Horses are obligate nasal breathers

What are the methods of recovery used in equine anesthesia?

Free recovery Assisted recover

What type of recovery is most appropriate for dangerous/unhandled horses?

Free recovery

What type of recovery is most appropriate for old/weak/systemically ill patients?

Assisted recovery

What type of recovery is most appropriate in horses undergoing ophthalmic surgery?

Assisted —> some of the most dangerous recoveries

What are methods of assisted recovery?

Hand -foals or small equines Ropes inside recovery stall - attached to head and tail for leverage Ropes outside recovery stall - fed through wall openings, held by personnel on outside of stall Sling recovery Pool recover

T/F: recovery from triple drip is usually rapid and smooth for equine patients

True

T/F: recovery from gas anesthesia is usually smooth from gas anesthesia in equine patients

False | -> need sedative to smooth recovery

What sedative is most preferred in equine patients to help them recover smoothly from gas anesthesia? What about for anxious or high-strung patients ?

A2 agonsit -xylazine or romifidine For anxious —> acepromazine (low dose )

What additional methods can be used to ensure safe recovery of equines?

Place elasticon over shoes or rough feet to increase traction Bandages to protect surgical sites Eye mask after ophthalmic procedures Quiet environment —> decrease auditory stimuli to prevent early rising Dark stall

What drugs are commonly used for visceral pain in equine?

A2 agonists | Butorphanol

What is a good drug choice in equines for somatic pain?

Morphine | NSAIDS

T/F: hypoxemia is common during equine recovery

True

What can you do to reduce hypoxemia in equines?

Supplemental O2 for healthy recommended, REQUIRED for sick patients Demand valve O2 while intubate Nasal O2 once extubated

What should you do if you have nasal edema in your horse?

Intranasal phenylephrine Nasopharyngeal tube

What should you do if you are concerned about airway patency/aspiration in equine recovery?

Tape ETT in and extubate once standing

What abnormalities can lead to muscle weakness? How can you prevent this?

Hypocalcemia Hypokalemia Hypoglycemia Anemia Check bloodwork before recovery and correct disturbances while still on the table

What is rhabdomyolysis ?

Muscle injury secondary to hypoperfusion

What are clinical signs of rhabdomyolysis ?

``` Hard muscles Sweating Trembling Myoglobinuria Pain ```

How do you treat rhabdomyolysis ?

Fluids and analgesics

What are common neuropathies due to equine anesthesia ?

Radial nerve | Facial nerve

How can you prevent neuropathies in your equine patients?

Padding on bony prominences Bring down forelimb forward Remove halter during procedure

What can you do if you have radial nerve neuropathy in the horse?

Splint forelimb to prevent knuckling

What do you do in the case of facial nerve neuropathy?

Keep corneas lubricated

What are common complications to ruminant recovery?

Regurgitation and bloat In addition to complications of other small animals

What is the best way to recover a ruminant?

Maintain sternal recumbency Postural drainage(nose down), pharyngeal swabbing, and suction Delayed extubation with cuff inflated Pass stomach tube to relieve bloat if needed

If your total ear canal abalation patient woke up vocalizing and struggling, what would be an appropriate response? - give naloxone - give hydromorphone - give Buprenorphine - give dexmedetomidine

Giving hydromorphone (treat pain) or dexmedetomidine (treats pain and dysphoria) Painful surgery —> do NOT give naloxone with would reverse opioid analgesia —> do NOT give buprenophine, can worsen severe pain and is long acting

What are the 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

What re the differentials for prolonged recovery in a horse? ``` A. Hypothermia B. Anemia C. Myopathy D. Hypocalcemia E. All of the above ```

E. All of the above