Test 1- Recovery Flashcards
Small animal recovery – extubation
Position patient in sternal recumbency
Ensure patent and clean airway
If regurgitation occurred:
Postural drainage (nose low)
Swab posterior pharynx with gauze (or suction) before awakening
Remove ET tube with cuff inflated
Do not force the tube! Deflate a small
amount if needed
If no regurgitation, deflate endotracheal tube cuff, remove after swallow or cough
Small animal recovery – monitoring
Continue specific physiologic monitoring as indicated
TPR in all patients
Pulse ox in brachycephalics, upper or lower airway
disease, pulmonary pathology, etc.
Blood pressure in patients with haemorrhage, sepsis, hypovolemia, etc.
Monitor patient closely until able to hold head upright and maintain sternal recumbency
Cautions:
Bandages around neck or head can lead to upper airway obstruction in a sedate patient – monitor closely and remove bandages if necessary
Bandages around thorax may cause breathing difficulty – cut bandage or loosen if necessary
Brachycephalics commonly develop upper airway obstruction in recovery
Monitor
Have an extra ET tube ready for re-intubation in an emergency
Small animal recovery – supportive care
Use active and passive warming to maintain or raise body temperature as needed
Stimulate patient if needed to increase level of consciousness
Change position (roll legs under when switching laterals) – more physiologic position
Auditory and tactile stimulation
Consequences of pain
CV: increased cardiac work load
Resp: hypoventilation or hyperventilation,
hypoxemia
GI: ileus
Renal: oliguria
Hematologic: risk of thromboembolism
Immunologic: impaired immune function
Psychological: anxiety, fear
Anticipating surgical pain
MOST PAINFUL
thoracotomy, amputation, ear resection, pelvic repair, cervical disc
MODERATELY PAINFUL
mastectomy, mandibulectomy, T-L disc, fracture stabilization, cranial abdominal procedure, ovariohysterectomy, enucleation, corneal transplant
MILDLY TO MODERATELY PAINFUL
tracheostomy, aural hematoma, castration, caudal abdominal procedure, phacoemulsification
Pain vs. dysphoria
What is opioid dysphoria?
In humans, described as “uncontrollable/unpleasant thoughts, difficulty with concentration, unpleasant bodily sensations, nervousness, anxiety”
Is a vocalizing, struggling, distressed patient painful or dysphoric?
A painful patient will quiet with additional opioids
A dysphoric patient will become more distressed with additional opioids
Pain vs. dysphoria – considerations
What analgesics have been administered? Dose, duration of action
Procedure?
What is the expected level of pain?
Patient temperament and breed?
Anxious patients will likely continue to be anxious post-operatively
Some breeds seem more susceptible to dysphoria (ex. Huskies, Malamutes)
Surgical site pain?
Gently palpate the surgery site, reaction suggests behavior is pain-related rather than dysphoria
Pain vs. dysphoria – strategies
Administer short-acting opioid (ex. Fentanyl) Worse?likely dysphoria
Better?likely pain
Alpha-2 agonist
Will treat dysphoria AND pain
Acepromazine
Benzodiazepine Opioid antagonist
Butorphanol (mu antagonist) – will maintain some analgesia (agonist at kappa receptor)
Naloxone
Titrate carefully to avoid severe pain caused by removal of opioid analgesia
Hypothermia short vs long term
Short-term
Increased O2 demand
Prolonged recovery
Discomfort
Long-term
Delayed healing
Infection
Treatment – active warming
Most effective
Forced hot air device (BAIR
hugger)
Radiant heat device
“Hot dog”
CAREFUL, can cause burns in certain
circumstances
Less effective
Circulating warm water blanket Heated cage
Heated objects (fluid bags, etc.)
Dangerous
Heating pads
Hyperthermia
Opioid-treated cats, MRI in obese furry dogs
Routine cooling procedures Remove bedding from cage Fan
Wet towels
Can reverse mu-agonists if severe (cats)
Hypoventilation
Diagnosis
Arterial blood gas EtCO2 monitor
Clinical signs
Causes
Drugs
Airway obstruction
Brachycephalics
Collapsing trachea
Laryngeal/tracheal surgery
Debris in airway (fluid, surgical sponge, food, blood)
Pain – esp. thoracotomy, rib fractures
Treatment
Delay extubation and
continue IPPV as needed Clear airway
Reverse drugs
Hypoxemia
Diagnosis
Pulse oximetry
Arterial blood gas
Causes
Most common: airway obstruction (hypoventilation), pulmonary pathology (V/Q mismatch)
Treatment
Address underlying cause
Position properly – sternal recumbency or good
lung up
Warming (shivering increases O2 demand) Oxygen support – increase FiO2
Flow-by O2
O2 cage
Nasal O2
Positive pressure ventilation
Short term – re-anesthetize and institute IPPV with 100% O2
Long term – ventilator
Complications – pain
NSAIDs
Mainstay of equine pain relief Long duration
Option for PO administration
α-2 agonists
Short duration
Commonly used for visceral (colic) pain
Butorphanol
Short duration
Commonly used for visceral pain
Morphine/Meperidine
Short duration, concern for ileus May be better for somatic pain
Complications – hypothermia
Large body mass = takes longer to cool and warm
Maintain body temperature throughout the procedure to avoid need to warm during recovery (will take a long time)
Cover patient with sheets, use Bair hugger (large blankets available) during surgery
Increase recovery stall temperature if possible
