Recovery Flashcards
List the CEPSAF fatality rates in different species
- Dogs: 0.17
- Cats -0.24
- Rabbits: 1.39%
When do most anaesthetic related deaths occur?
Recovery period
Are more anaesthetic deaths linked to TIVA or inhalation anaesthesia?
Inhalation
Who records/ monitors equine deaths under anaesthesia?
CEPEF (0.9% for horses )
Describe some of the risk factors for anaesthesia
- ASA category of patient
- Breed
- Age (less resserves)
- Condition/ weight
- Duration of anaesthesia (+1.5hrs more likely to have problems)
- Drugs used
- Temperature
What should be present in the recovery area?
- Oxygen delivery system
- Anaesthesia induction drugs
- Fluid therapy equipment
- Crash box
- Monitoring equipment
- Warming devices
- Bedding
- Suction
How do you monitor the patient in recovery?
- ABC
- HR/Temp/Resp (TPR)
What must you do once the surgery has ended and the patient is still on the breathing system?
- Turn off vapouriser
- Dump reservoir bag so it is filled with fresh gas
-Increase oxygen
(If been on NO too then turn off NO and leave on 100% O2 for 10 mins)
How do you disconnect your patient?
- DISCONNECT from breathing system
- Turn off oxygen
- Scavenge breathing gases (put finger over top and dump bag again)
- Move patient to recovery area
- Loosen tube ties
- DON’T deflate cuff until ready to extubate
Why do you not deflate the cuff earlier?
Because they still cannot control their airways so they are still at risk of regurgitating and aspirating
When do you remove the tube in different species?
- Dogs: when gag reflex returns (same with horses, ruminants, pigs)
- Cats: don’t delay extubation (difficult to judge, do it when blink becomes stronger)
Do you extubate on inspiration or expiration?
Inspiration= when the arytenoids are naturally abducted causing less damage
How do you deal with Brachycephalics? (dogs with BOAS)
Leave tube in as long as possible, preferably until they are sat up just before they start fussing at it
What can happen in cats if extubated incorrectly?
Largyngospasm
What are the signs of airway obstruction?
- Increased respiratory movement/ noise/ effort
- Abdominal breathing/ nares flaring
- Air hunger posture
- Cyanosis
What does paradoxical movement mean?
As they breathe in chest compresses instead of expanding
What should you do with a patient with airway obstruction?
- Open mouth, use laryngoscope
- Pull tongue forward and use suction blood/ mucus
- Reintubate if possible
When monitoring the SP02% when would you supplement with oxygen?
When it falls below 93%
How do you monitor circulation during recovery?
-Palpate femoral pulse
-Monitor pulse rate/ quality every 5 mins to begin with
(Also can use ECG, measure BP, CRT)
What are the main problems faced by horses in anaesthesia?
- Hypotension
- Hypoxia
- Hypercapnia
- Poor positioning
What is mismatch ventilation?
- Perfusion is best at most dorsal region of lungs but ventilation is poorest here due to high pressure
- Only small central bit is matched.
Describe post op myopathy
-Caused by malposition. hypotension
-Symptoms:
mild lameness to inability to stand
hard/ painful/ swollen muscles
Sweating
Difficulty breathing
(hypotension: lack of oxygen delivery to large muscles)
How do you tell the difference between neuropathy and myopathy?
-In true neuropathy horse cannot weight bear at all but in myopathy then can for short periods.
What are the common nerves damaged for port of neuropathy in the horse?
- Facial (poor induction and horse hits head when falls)
- Radial (forelimb not extended in lat recumbency, too much pressure on radial nerve)
How can you support a horse with post op myopathy?
Strong analgesia and plenty of fluids to help support the kidneys from muscle cell lysis
What is the name of the fatal spinal problem sometimes suffered in horses after anaesthesia?
- Spinal cord malacia
- More common in heavy breed horses
How do you manage nasal oedema during recovery in horses?
It will resolve itself as they stand
-Recover the horse with ET tube in place, pull out of the diastema and wrap lots of vet wrap around it
What is pulmonary oedema/ when is it seen?
- Seen in horses during recovery
- Frothy/ pinkish fluid at the nostrils after horse has been reintubated
- Remove obstruction, reintubate if possible
(Thought to be related to changes in venous return and an influx of fluid into alveoli)
