T9: Post Operative Care

Question 1

Why is anaesthesia lightened towards the end of surgery?

Answer 1

• to prevent deepening once the stimulus of surgery is stopped.
• This counteracts the depressant effects of anaesthesia on the central nervous system and cardio-vascular system.

Question 2

How should you place an animal in its cage after surgery?
Enviro considerations?

Answer 2

• in a clean, warm cage with no protruberance, dishes, toys or other animals.
• surgical wound should be uppermost for observation and to avoid contamination.
• head should be placed towards the door of the cage for observation and slightly lower than the body for drainage from the mouth
• animal should be turned frequently; at least every two hours

Question 3

Things to remember when extubating:

Answer 3

• always deflate the cuff before removing the tube
• never leave an animal unattended with an endotracheal tube in place
• position animal with neck extended and tongue protruding
• always check air is moving freely; moving chest does notindicate obstruction
• always check the oropharynx for secretions, blood, etc. before and after removing the endotracheal tube

Question 4

Special ET tube removal considerations for cats?

Answer 4

• can have ER tube removed just before swallowing reflex occurs
• cats are very sensitive; early removal can result in laryngospasm and upper airway obstruction
• also consider this for brachycephalic dogs

Question 5

What aspects should a recovery area have?

Answer 5

• soft, comfy bedding
• heating
• quiet and easily accessible

Question 6

Along with vital signs, what are some surgically related considerations for recovery?

Answer 6

• hypothermia
• endotracheal tube removal
• pain associated with the specific surgical procedure
• the possibility of a prolonged recovery
• other factors such as monitoring drains and intravenous fluid

Question 7

At what temperature will cardiac arrest occur (hypothermia)?

Answer 7

28 - 30 C

Question 8

How can hypothermia impair recovery?

Answer 8

• longer recovery
• depressed ventilation
• :: prone to hypoxia

Question 9

What is CRI?

Answer 9

constant rate infusion

Question 10

Possible causes of delayed recovery include:

Answer 10

• drug related sedation due to opioid analgesics
• drug overdosage. This may be “absolute”, where too much drug is given to a healthy animal, or “relative” where the amount of drug given may not have seemed excessive but the animal has a delayed return to consciousness because of an inability to metabolise the drug
• hypothermia
• haemorrhage
• shock

Question 11

How can a violent recovery be counter-acted?

Answer 11

• small doses of tranquillisers at doses to be determined by the surgeon
• physical restraint
• re-anaesthesia

Question 12

How is inhalation of fluids controlled?

Answer 12

• can cause a serious inspiration pneumonia.
• It is controlled by aspirating through the cuffed tube with a suction catheter and prevented by keeping the cuff inflated.
• If the tube has been removed, re-anaesthetising and re-intubating is necessary

Question 13

Signs of shock?

Answer 13

• pale mucous membranes
• poor capillary return
• cold ears, feet, skin
• rapid, shallow breathing
• weak, rapid pulse
• occasional deep sighs or gasps.

treated w/ IV drips, O2 and warmth

Question 14

How long should you monitor an animals vital signs after surgery?

Answer 14

until the animal is fully conscious

Question 15

How should you position an animal in recovery?

Answer 15

• preferably in sternal recumbency
• so that the mouth is the lowest point to avoid aspiration if the animal vomits.

Question 16

If an animal has not ‘righted’ itself in half an hour post surgery, what should you do?

Answer 16

turn animal to avoid pooling of fluid in the lungs.

Question 17

How can you assist with a newborn puppy?

Answer 17

• clear mouth of secretions, use syringe to aspirate if necessary
• give oxygen via mask
• rub vigorously to stimulate breathing with a towel
• humidicrib
• clamp or tie umbilical cord

Question 18

Post operative abnormalities in wounds and surgical sites include:

Answer 18

• haemorrhage or other exudation
• swelling
• self trauma

Question 19

Other post-op abnormalities include:

Answer 19

• delayed recovery
• cold extremities
• low body temperature
• pale mucous membranes
• increased heart rate
• increased respiratory rate
• abdominal distension

Question 20

What are the three main phases of post-op pain management?

Answer 20

1. The immediate recovery period at the end of surgery, up to the time the animal returns to consciousness
2. The extended period of care up until the time the animal is discharged. This may be hours, days or weeks
3. Post-operative care at home.

Question 21

Why are drains placed into wounds?

Answer 21

• to aid the removal of infection or to prevent the accumulation of fluid under the incision.
• These need to be kept patent and may need flushing a couple of times a day.
• Most drains are removed once the wound has started to heal and there is no sign of continued fluid build up under the wound.
• In most cases, this is 4-7 days post-operatively.

Question 22

For tissue repair, animals may require what dietary changes?

Answer 22

require additional energy and high quality protein

Fats are the preferred source of energy for tissues during recovery.

Question 23

When would you use naso-eosophageal tube feeding?

Answer 23

• once other non-invasive methods of feeding have failed (offering highly palatable food and syringe feeding).

Question 24

What dietary considerations are there for patients staying in hospital long term?

Answer 24

• RER (resting energy requirement)
• documentation of food offered/food eaten
• need to consider that eg small amount of chicken every few hours is not a complete diet

Question 25

What problems can occur with animals who are in prolonged recumbency?

Answer 25

• bed sores (decubital ulcers)
• urine scalding

Question 26

Where should you place an incontinence bad in the animals cage?

Answer 26

• underneath a fluffy
• not appropriate on top
• keeps animal dry and prevents scalding
• only top layer needs changing

Question 27

Rehabilitation activities may include:

Answer 27

• massage
• swimming
• passive range-of-motion (PROM) exercises
• electrical muscle stimulation

Question 28

How is massage beneficial?

Answer 28

Stroking, kneading and compression techniques can assist in improving circulation, loosening tendons and minimising oedema

Question 29

Describe “passive range-of-motion excersises

Answer 29

• requires no voluntary muscle activity.
• The limb is slowly moved within its proper range of motion.
• Each treatment should last for 5-10 minutes and be performed two to four times a day

Question 30

What are some things that need to be communicated to the owner post-op?

also some considerations (not just info)

Answer 30

• how to administer meds (oral and topical)
• client safety is important; advise to take no risk if animal becomes aggressive
• timing and amount of meds
• adverse signs to watch out for
• nutrition of pet
• physical and psychological behaviours
• particularly bowel and bladder function