Week - Anaesthesia for respiratory compromised patient Flashcards
What is safer…heavy sedation or general anaesthesia?
General anaesthesia is safer as it ensures that the airway is secured.
- ET tube and oxygen
- Monitoring (nurse designated with a GA patient)
- In control mor
Why is reducing stress and anxiety important in the reparatory compromised patient?
How can stress be reduced?
Stress = increased respiratory rate = increased demand for oxygen
Stress can be decreased by:
- Quiet and calm environment
- Good handling
- Sedation (e.g butorphanol)
- Antii-anxiety (e.g gabapentin)
Which weight should be used in an overweight patient?
Lean body weight
When overweight, the liver remains the same size and can only cope with the lean weight dose of drugs.
Be careful not to overdose!
Which animals should you have a larger selection of ET tubes for?
Brachycephalic = severity depends on size of tube
Animals with bronchoconstruction = harder to guess size
When an animal ‘sighs’ -> what could this be sign on and what should you do?
Sigh could suggest the lung is starting to collapse (Atelectasis).
Collapsed lung = reducing surfactant
Give breath to prevent the lung from collapsing -> ventilatory support
Why should you be careful with IVFT in respiratory compromised patients?
Too much IVFT = can overwhelm the pulmonary circulation, causing fluid to leak into the lungs, leading to pulmonary oedema, worsened respiratory function, and potentially life-threatening complications.
Mechanisms involved:
- increased hydrostatic pressure
- decreased oncotic pressure
- weakened cardiovascular system
- impaired lymphatic drainage
What ASA state are brachycephalic and respiratory distress patients?
ASA II-III = brachycephalic
ASA III-V = respiratory distress
What are premedication options for a dog in respiratory distress?
Opiod alone
Opiod (methadone, butorphanol) and one of :
- Dexmedetomidine
- Acepromazine
- Benzodiazepines
What should you always do and give patients in respiratory distress while preparing for sedation/intuabtion/further diagnostics?
Administer oxygen (mask, flow by, oxygen cage etc)
Gain IV access
What four other types of drugs (other than premedication and induction) can be given to a dog in respiratory distress?
Gastroprotectant (e.g, brachy’s prone to regurgitation)
- Omeprazole
- Metoclopramide
- Maropitant
Decongestants
- Xylometazoline
Beta agonist - open airway
- Terbutaline
Pain relief
- NSAIDs
- Paracetamol
What are premedication options for a cat in respiratory distress?
Opiod alone
Opiod (methadone, butorphanol) and one of:
- Dexmedetomidine
- Acepromazine
- Benzodiazepines
Opiod (methadone, butorphanol) AND Alfaxalone, AND midazolam
- Given IM
- Preferred for very sick cats
Ketamine AND midazolam
- IM and IV
- Less common as ketamine increases HR
What two other types of drugs (other than premedication and induction) can be given to a cat in respiratory distress?
Beta agonist - open airway
- Terbutaline
- Salbutamol
Pain relief
- NSAIDs
- Steroid
What are induction options for a cat or dog in respiratory distress?
- Alfaxalone IV (preferred, lower risk of apnea)
- Propofol IV (risk of apnea)
- Ketamine IV (less common)
Can combine alfaxalone or propofol with a benzodiazepine to reduce doses.
What should you remember to do when intubating?
- intubate as quickly as possible (to prevent SpO2 dropping)
- Cats = lidocaine
- Asses airway (BOAS, laryngeal paralysis, collapse, masses, polyps)
- Laryngoscope = visualise
- May need swab or suction
When sedating/GA an animal in respiratory distress, what should you tell the owner?
Convey information about the risk of anaesthesia
