Small Animal Emergencies Flashcards
What are the 5 major anesthetic concerns in patients with hemoabdomen?
- hypovolemia and hypotension due to hemorrhage
- anemia = poor oxygen delivery
- tachycardia and tachyarrhythmias
- pain
- regurgitation and aspiration
What are the 4 major concerns in patients with GDV?
- decreased ventilation - gas distending abdomen
- decreased CV function - obstructed venous return
- metabolic alkalosis or acidosis
- cardiac arrhythmias
What ASA status would a patient undergoing hemoabdomen be? What blood work should be done?
ASA 3-4 E
- CBC/chem
- repeat PCV and TS immediately before induction
- blood type and cross match
- coagulation profile
- lactate
What imaging is important for hemoabdomen cases?
abdominal U/S and thoracic rads
- site of hemorrhage
- metastatic disease
Why is lactate an important component of pre-anesthesia blood work in emergency cases?
- INCREASED = worsening perfusion
- DECREASED = improving function
Why are ECGs and BP measurements important monitoring for patients with hemoandomen?
ventricular arrhythmias are very common
gives an idea if the impact of blood loss is being managed
How should catheters be placed in patients with hemoabdomen? What else is done at induction?
two catheters placed - one for induction agents and the other available for additional CRIs and transfusions
- ECG, BP, pulse ox placed
- preoxygenation with facemask
What drugs are avoided in premedications in patients with hemoabdomen? What is used?
- Acepromazine = vasodilation
- Dexmedetomidine
neruoleptic anesthesia/analgesia
- pure mu opioid (Fentanyl, Methadone) + BZD (Midazolam) IV
What induction agents are commonly used in patients with hemoabdomen? CRIs?
ketamine +/- propofol or alfaxalone —> slow and careful, likely to need less than in a healthy patient
REDUCE/ELIMINATE inhalant usage
- fentanyl, hydromorphone, morphine
- ketamine
- lidocaine: anti-septic and analgesic
What should be prepared before anesthesia in patients with hemoabdomen? What is done if an arrhythmia is noticed prior? What should be done before using inotropes and vasopressors?
pre-calculate dopamine and/or norepinephrine CRI
bolus lidocaine, start CRI
restore blood volume
What are the 4 expected complications seen in hemoabdomen cases under anesthesia? How are they treated?
- hypotension - crystalloid, hypertonic saline, blood products, inotropes, minimization of inhalants
- hypoventilation - ventilator, assist to 45-55 mmHg with some permissive hypercapnia (CO2 = resp stimulant)
- hypothermia - aggressively prevent and warm patient
- tachyarrhthymia - lidocaine
What analgesia is commonly provided during hemoabdomen correction?
- CRIs
- line block infiltration with local
- TAP block
- Nocita at closure
continue/wean off post-op with regular pain scoring
When are Acepromazine and Dexmedetomidine able to be used in hemoabdomen patients? What is indicated for ongoing arrhythmias?
at low doses for agitation or euphoria
lidocaine and continousu ECG monitoring
What are 4 important aspects to GDV pre-anesthesia workup?
- electrolyte and blood gas analysis
- CBC/chem, at minimum PCV, TS, glucose, BUN
- lactate (trend)
- ECG and BP monitoring pre-anesthesia and during induction
How is the placement of IV catheters different in patients with GDV?
use forelimbs —> compromised perfusion in back legs due to enlarged stomach
What should be done before beginning induction in patients with GDV?
- decompress stomach with a trochar or stomach tube
- preoxygenate with face mask
- correct electrolyte and acid-base abnormalities
What is commonly part of premedications in patients with GDV?
- Fentanyl CRI (decreases inhalant need)
- Midazolam
- Lidocaine bolus (to be maintained with CRI)
AVOID ACE AND DEX
How induction agents are recommended in patients with GDV? How can regurgitation be avoided?
propofol or alfaxalone carefully titrated
keep patient sternal with head up until the ET tube and stomach tube are placed
What monitoring is especially important post-anesthesia in patients that just had GDV?
monitor for ongoing arrhythmias —> lidocaine!
(also want to recheck electrolytes, lactate, and other biochem parameters as indicated by patient status)
What are the 4 most common anesthetic concerns in patients with septic abdomens?
- decreased ventilation
- peripheral vasodilation
- metabolic acidosis and electrolyte imbalances
- cardiac arrhythmias
What work up is recommended in patients with septic abdomen?
- CBC/chen
- lactate
- coagulation status
- blood glucose trends
- blood pressure
- ECG
What additional catheter can be placed in patients with sepsis if time allows?
multi-lumen central (jugular) catheter —> quick reaction in patients that are prone to quick decompensation
What is important to anesthesia planning in patients with sepsis?
- correct electrolyte and acid-base abnormalities
- lidocaine CRI for arrhythmias and anti-septic action
- vasopressor (NE) for hypotension
How are CRIs used in septic patients?
multiple with a PIVA protocol to minimize inhalants
- fentanyl
- lidocaine
- ketamine
What cardiovascular support CRIs should be ready for use in patients with sepsis?
- norepinephrine**
- dopamine
What are the 2 phases of sepsis?
- vasodilation
- hypotension, hypoglycemia
What are the 3 specific anesthetic concerns in dystocia cases?
- decreased ventilation due to oxygen delivery to fetus
- fetal perfusion will be reduced by the anesthetic-induced hypotension
- higher potential for regurgitation or aspiration since patients are not typically fasted
What are the 2 major parts of a dystocia pre-anesthetic workup?
- abdominal U/S or thoracic radiograph to confirm number of puppies or kittens
- basic labs - tend to be healthy, young animals
What is the goal of anesthesia planning in dystocia cases?
selective analgesia, muscle relaxation, and sedation/narcosis that doesn’t endanger the mother or fetus
What are 5 important physiologic parameters that are unique in pregnant mothers?
- increased HR, CO, blood volume, and plasma volume with decreased PCV/TS
- increased minute volume and oxygen consumption
- decreased functional residual capacity
- increased gastric emptying time and decreased pH and motility = increased chances of regurgitation
- increased RBF
What are 3 causes of fetal depression?
- prolonged labor
- decreased placental perfusion
- fetal hypoxemia, acidosis, and stress
What anesthetics should be avoided in dystocia cases? What is commonly found in the mothers?
those that cause cardiac depression —> already have increased cardiac work with a decreased reserve due to increased CO and decreased SVF for fetus
hypoxemia and hypercapnia —> abdominal contents are pressinge on diaphragm = decreased FRC and atelectasis
What gastroprectants are recommended in patients undergoing dystocia? How else is this treated?
increased gastric acidity —> Metoclopramide, Famotidine +/- Maropitant
protect the airway —> pre-oxygenate, sternal, proper ET tube placement
What neonate resuscitation supplies should be prepared in dystocia cases?
- suction bulb
- warming device/incubator
- suture material and hemostats for umbilical cord
- sublingual Naloxone to reverse opioids used on mother
- Atropine for slow fetal HR
- intubation materials
What drugs are avoided in the fetus in dystocia cases? What is used?
Acepromazine, Dexmedetomidine, Midazolam, Ketamine
- short-acting and reversible opioids
- alfaxalone or propofol
- epidural at L-S space
(decreased necessary inhalants until feti are out)
Why is uteroplacental circulation maintenance especially important?
- maintained fetal and maternal homeostasis
- keeps uterine bloodflow proportional to systemic BP
What post-anesthesia monitoring is used for mothers that underwent dystocia? What is especially important for the neonates?
- NSAIDs
- small dose of Ace for sedation
- additional opioids
- Nocita incisionally or Bupivacaine at closure
nursing ASAP - consider sublingual dextrose if it becomes prolonged
