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CPS > Recovery from anaesthesia > Flashcards

Recovery from anaesthesia Flashcards

1
Q

When do a majority of anaesthesia deaths occur?

A

60% occur in the recovery period with nearly half of these dying within 3 hours of disconnection.

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2
Q

What is the fatality rates in healthy dogs?

A

0.17%

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3
Q

What is the fatality rates for healthy cats?

A

0.24%

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4
Q

What is the fatality rates for healthy rabits?

A

1.39%

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5
Q

What is the fatality rate for horses?

A

0.9%

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6
Q

Name 7 risk factors for recovery?

A
  1. ASA category
  2. Breed
  3. Age
  4. Weight
  5. Duration of anaesthesia
  6. Drugs given
  7. Temperature
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7
Q

Which breed of horse has more problems in recovery?

A

heavy breeds and draft horses.

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8
Q

What age of animals struggle with recovery?

A

Geriatrics and paedeatrics

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9
Q

What do we mean by the ‘drugs given’?

A

These are the drugs given at pre-meds. if there is a traumatic induction, this will influence the recovery.

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10
Q

What do we have to monitor in terms of temperature and recovery?

A

If the animal is cold, it is not going to recover very well.

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11
Q

What sort of breeds will have problems with extubating?

A

Bulldogs and bracycephalic breeds.

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12
Q

When do you extubate cats in relation to dogs and why?

A

Extubate cats earlier than dogs because they have a more sensitive larynx. There is a risk of laryngospasm at extubation.

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13
Q

Name 8 things that should be present in the recovery room?

A
  1. Oxygen and delivery system
  2. anaesthesia induction drugs and analgesics
  3. fluid therapy equipment
  4. crash box/ trolley (for CPR)
  5. suction
  6. Monitoring equipment and warming devices
  7. protective clothing and gloves
  8. bedding
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14
Q

What is recommended in terms of recordning things for animals?

A

Keep all of the records on the same piece of paper.

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15
Q

If Nitrous oxide, how long do you leave the animal on pure oxygen for following surgery and why?

A

10 mins because of the dangerous of nitrous oxide. It also exacerbates hypoxia

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16
Q

What do you do to the reservoir bag at the end of surgery and why?

A

‘Dump’ the reservoir bag and fill up with fresh gas as this artificailly speeds up recovery by increasing the concentration gradient.

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17
Q

Why is it good practice to leave animals connected for a long time following surgery?

A

Because this means the more iso is scavenged so not in the air around you therefore this is good practice.

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18
Q

When might cuff not be fully deflated during recovery?

A

During dental/oral procedures so as to prevent blood, mucus/ debris (teeth) being inhaled.

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19
Q

What do you do in these cases e.g. post-dental/ oral procedures?

A

can check the oropharynx with laryngoscope..

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20
Q

When is the ET tube removed in most species?

A

When the gag reflex is returned.

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21
Q

How is the gag reflex indicated?

A

Attempts to swallow and tongue movements.

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22
Q

Is it best to extubate on inspiration or expiration?

A

expiration

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23
Q

In what situation might the palpebral reflex not return?

A

If NMBD blockers have been used.

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24
Q

In which dogs do you leave the tube in longer for?

A

Brachycephalic obstructive airway syndrome dogs.

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25
Q

What tubing to horses have to have during anaesthesia and why?

A

Nasal tubes because horses are obligate nose breathers.

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26
Q

When do you extubate cats?

A

Just before the gag reflex has returned e.g. when there is palpebral reflex is back, and tongue movement.

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27
Q

What should you do with cats following extubation?

A

Keep the head and neck extended and the tongue pulled foward.

28
Q

What are 6 signs of airway obstruction?

A
  1. increased respiratory noise and effort
  2. abdominal effort, nares flaring
  3. ‘air hunger’ posture - head and neck extended
  4. cyanosis
  5. reslessness and agitation
  6. agonal breathing
29
Q

What 4 things should you do if you suspect airway obstruction?

A
  1. call for help!
  2. Open mouth, use laryngoscope
  3. Pull tongue foward and suction blood/mucus
  4. re-intubate if possible (might need to give drugs to do this)
30
Q

At what point would you supplement an animal with oxygen in recovery?

A

SPo2 is <93%

31
Q

How could you increase oxygen delivery?

A

Oxygen cages/ incubators/ buster collar with clingfilm

32
Q

In first stage of recovery, what should be monitored and how often?

A

Rate and quality of pulse every 5 minutes.

33
Q

Name 5 other things you can monitor?

A

ECG, CRT, temp, Blood pressure, mucus membrane colour

34
Q

What temperature do we want the animal to be at following surgery?

A

normothermic

35
Q

Name a good example of warming dogs in recovery on fluids?

A

Warm the IV fluids and flushing solution

36
Q

Give 4 reasons an animal could be restless/vocal when in recovery?

A
  1. in pain
  2. Dysphoric (depression, anxiety, disorientation)
  3. Emerging from the anaesthesia
  4. uncomfortable e.g. fall bladder, needs to defecate
37
Q

If in doubt as to why the animal is restless/vocal, what should you do?

A

Give the animal an analgesic and re-assess.

38
Q

When do most issues that manifest themselves in recovery occur in the horse?

A

When something goes wrong during maintenance.

39
Q

Name 4 things in the horse which might have gone wrong in maintenance but manifest themselves in recovery?

A
  1. hypotension
  2. Hypoxaemia
  3. hypercapnia
  4. poor positioning
40
Q

What happens to lungs of horses when in surgery?

A

If horses are on their backs for a prolonged period of time, the bottom part of their lungs are being perfused, whereas the top part of their lungs are being ventilated. There is a mismatch which could lead to hypoxaemia.

41
Q

What are the two things that cause post-op myopathy?

A

It is caused by malpositioning and hypotension during surgery

42
Q

When does post-op myopathy manifest itself?

A

When the horse wakes up.

43
Q

Name 6 signs of post-op myopathy?

A
  1. mild lameness and inability to stand
  2. Hard, swollen and painful muscles
  3. extreme distress
  4. sweating
  5. difficult breathing
  6. restlessness
44
Q

What are the two causes of post-op neuropathy?

A
  1. hypotension also

2. Pressure on a nerve

45
Q

What is another sign of myopathy?

A

Weeing brown urine e.g. damage to the kidneys

46
Q

What is another onset that can come on during post-operative recovery in horses?

A

Spinal cord malacia e.g. softening of the biological tissues.

47
Q

What kind of horses does spinal cord malacia occur in?

A

Young, brassy, heavy horses

48
Q

How does spinal cord malacia occur?

A

Something happens to the blood flow to the spinal cord during surgery

49
Q

What is the outcome of spinal cord malacia in horses?

A

The only option is euthanasia as they will not recover.

50
Q

When do eye problems tend to occur in horses?

A

When the horse is in lateral recumbency - need to administer lubrication because surgery always reduces tear production.

51
Q

What are the three most common issues in horses during the recovery phase?

A
  1. myopathy
  2. neuropathy
  3. self-inflicted traumas
52
Q

How can you reduce self-inflicted trauma during post-op recovery? 4 things?

A
  1. calm recovery e.g. sedation
  2. analgesia
  3. padded box
  4. head and tail ropes
53
Q

How can you stop horses from getting up?

A

Sit on their necks and hold their heads up

54
Q

What is it called when you tie their tail to the box to guide the horse up?

A

tail gaiting

55
Q

How can you detect an upper airway obstruction in horses on recovery? 5 things

A
  1. stridor or stertor following extubation
  2. nostril flaring on inspiration
  3. abdominal respiratory effort
  4. exaggerated thoracic excursion
  5. absence of airflow at the nostrils
56
Q

Where does obstruction tend to occur in horses?

A

In the nasal passages or at the level of the pharynx

57
Q

What is common in horses in the recovery phase to do with the nares?

A

Nasal oedema - everything seems to drain and then the oedema goes - short-lived.

58
Q

what could you do to reduce the effects of nasal oedema?

A

use nasopharyngeal tubes or phenylephrine (reduces congestion)

59
Q

What other type of obstruction is common other than upper airway obstruction?

A

Laryngeal obstruction

60
Q

What two things might cause laryngeal obstruction?

A
  1. dorsal displacement of the soft palate

2. Epiglottic retroversion

61
Q

What two methods can be used to alleviate symptoms of a dorsal soft palate displacement?

A
  1. be prepared to re-intubate

2. Emergency tracheastomy

62
Q

What are the 3 signs of pulomonary oedema in horses follwing surgery?

A

pinkish, frothy discharge at the nares following re-intubation, exaggerated respiratory efforts and cyanosis.

63
Q

How do horses get pulmonary oedema?

A

Related to changes of venous return and an influx of fluid into the alveoli as a result of excessive negative pressures within the thorax.

64
Q

What are the 3 ways to treat pulmonary oedema?

A
  1. remove obstruction
  2. provide oxygen
  3. frusemide and dexamethasone.
65
Q

What other presentation can be a problem in horses post-operatively?

A

Colic

66
Q

What should you make sure on recovery -4 things?

A
  1. no pain
  2. no obstructions
  3. full bladder not a problem
  4. secure jugular catheter in palce

CPS (21 decks)

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