Recovery Flashcards
Who do you extubate earlier, cats or dogs?
Cats
-avoid laryngospasm
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
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
You should be cautious about bandages around the head during recovery because??
Can lead to upper airway obstruction in sedate animlas
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
What are complications with recovery?
Pain Dysphoria Hypo- or hyperthermia Hypoventilation Hypoxemia Prolonged recover
What affect does pain have on the CV and respiratory system?
CV: increased cardiac work load
Respiratory: hypoventilation/hyperventilation, hypoxemia
What affect does pain have on GI and Renal function?
GI: ileus
Renal: oliguria
T/F: pain can impair immune function and increase risk of thromboembolism
True
Which of these surgeries will cause the most amount of pain?
Tracheostomy
Thoracotomy
Ovariohysterectomy
Thoracotomy > ovariohysterectomy > tracheostomy
Which of these surgeries causes the most pain?
Cranial abdominal procedure
Aural hematoma
Pelvic repair
Pelvic repair > cranial abdomen repair > aural hematoma
What is opioid dysphoria?
In humans..”uncontrollable/pleasant thoughts, difficulty concentrating, unpleasant bodily sensations, nervousness, and anxiety”
T/F: a painful patient will quiet with additional opioids, a dysphoria patient will become more distressed with additional opioids
True
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
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
What drug will treat both dysphoria AND pain?
A-2 agonists
What drugs can treat dysphoria?
Acepromazine
Benzodiazepines
Opioid antagonist
What opioid antagonist can you use if you want to maintain some analgesia?
Butorphanol (mu antagonist)
Kappa agonsit -> some analgesia
How should you administer naloxone when treating opioid dysphoria?
Last resort
Titrate carefully to avoid severe pain caused by removal of opioid analgesia
Why do we want to avoid hypothermia during recovery?
Short term causes..
- increased O2 demand
- prolonged recovery
- discomfort
Long term causes..
- delayed healing
- infection
What is the treatment for hypothermia?
Most effective
- force hot air device (BLAIR hugger)
- radiant heat device
- hot dog
T/F: a heating pad is a good method to warm patients when treating for hypothermia on recovery
False
—heating pads can cause burns!!
When can you see hyperthermia in recover?
Opioid treated cats
MRI in obese furry dogs
What can you do to treat hyperthermia?
Remove bedding from cage
Fan
Wet towels
Can reverse opioids if severe (cats)
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
