Test 2: 18 recovery Flashcards
when does recovery end
achievement of an ambulatory, alert, normothermic state
recovery plan should consider what aspects
Species
* Personality of the animal
* Age
* Co-morbidities
* Procedure and duration of anesthesia
* Elective vs. emergency procedure
Recovery planning begins when you prepare for a case and develop your anesthetic protocol
steps of recovery
- Discontinuation of all anesthetic drugs
- Transportation the patient to a dedicated area for monitoring
- Positioning of the animal into normal position
- Oxygen supplementation
- Drug administration
- Cardiovascular support
- Reversal agents
- Sedatives
what stage of anesthesia is most frequent for complications
recovery
overall goal of anesthetic recovery is to minimize — and create a safe and — environment
risk of complication development
quiet
patient monitoring and re-assessment
Goals of anesthetic recovery
* Overall: Minimize risk of complication development
* Maintain — function
* Restore and/or maintain normal —
* Assess pain and provide —
cardiovascular, respiratory and ventilatory
body temperature
analgesia
what equipment might you need during recovery
O2 supplementation
thermal support- bear hugger
emergency supplies: airway, CPR drugs, re-induction agents
— can be used to reduce environmental pollution and occupational exposure
scavenging (F/air canisters)
horses can’t be left attached to anesthesia machine, only O2
patient monitoring post op should include re-assessment of
- Cardiovascular system
- Respiratory system
- Temperature
- Neuro/mental
- Pain
how to re-assess CV system during recovery
Physical examination
* Mucous membrane color + CRT
* Heart rate and rhythm (EKG)
* Pulse quality
Additional monitoring devices
* Blood pressure: Doppler, NIBP
* Lactate measurements
respiratory compromise during post op can be caused by
- Pain
- Diaphragmatic/respiratory muscular dysfunction
- Muscular weakness
- Residual pharmacologic effects
- Patient position
If not recognized, conditions can be fatal
how to monitor respiratory system post op
monitoring oxygenation
- pulse ox
- arterial blood gas analysis
monitoring ventilation
- respiratory effort and pattern
- listen
- capnography
- arterial blood gas analysis
when to extubate
airway protected
* minimize aspriation/obtruction
* prevent endotracheal tube foreign body
depends on species and pt
how to flush system after procedure
- Disconnect patient from breathing circuit
- Occlude patient end of the circuit
- Empty the reservoir bag into the scavenge system
- Flush O2 through the system
- Do not press flush valve when small patient is attached to the system
- Reconnect system to the patient for continued O2 delivery
horses are provided post op O2 by
nasotracheal tube
forms of heat loss during anesthesia
- Radiation (majority)
- Convection
- Evaporation
- Respiration
Hypothermia impairs — and suppresses — function
coagulation
immune
hypothermia prolongs — and shivering increases —
recovery
oxygen consumption
panting from hyperthermia can cause
increased work of breathing
hyperthermia is associated with what drugs in cats
opioids
— is a potentially fatal condition when pts become too warm
malignant hyperthermia
digs, pigs, horses
what are some neurologic complications associated with anesthesia
- Blindness
- Thromboembolic event
- Seizures
uncommon but potentially life-threatening
If no signs of pain at surgical site but patient is still showing signs of discomfort, consider other source:
- Full bladder
- Constipation
- Orthopedic pain from positioning during surgery
- Other pre-existing source of pain (OA, pancreatitis)
acute and fluctuating alteration of mental state of reduced awareness and disturbance of attention
Postoperative delirium
profound state of unease due to extreme agitation and anxiety
Dysphoria
what are some things that might indicate pt will have dysphoria during recovery
- pt anxious or agitated preop
- some species/breeds (huskies and sighthounds)
- high doses of opioids
- older pts
what are some drugs you can give to prevent dysphoria
- Alpha-2 agonist (dex, xylazine) (small dose) → administered prophylactically
- Propofol titration (small dose)→ may need to Re-intubate
- Acepromazine
- Trazodone
you can also reverse drugs → keep in mind if you reverse opioid, you also reverse pain relief
how to reverse opioid
Small doses of naloxone or butorphanol can be titrated
how to decide pain vs dysphoria
can give analgesic
* if they get better it was pain
* if they get worse →dysphoria, can give reversal to try to fix
what are some complications of post op nausea and vomiting
- Aspiration pneumonia
- Esophagitis, esophageal
stricture - Sinusitis
what to do if pt regurgitates when intubated
maintain anesthesia:
* Ensure ETT cuff is inflated properly
* Suction mouth and esophagus
* Sinus/nares lavage with warm water
* Extubate with cuff inflated or partially inflated (not recommended for cats)
what is important during handoff of pt
communication
all medications administered
