Podcast
Questions and Answers
What is the recommended intravenous fluid (IVF) bolus rate for a hypotensive dog?
What is the recommended intravenous fluid (IVF) bolus rate for a hypotensive dog?
- 3 mL/kg STAT
- 10 mL/kg STAT (correct)
- 5 mL/kg STAT
- 15 mL/kg STAT
It is acceptable to only check the IV fluid pump setting without reading the fluid bag label to monitor fluid administration.
It is acceptable to only check the IV fluid pump setting without reading the fluid bag label to monitor fluid administration.
False (B)
Name the '4 H's' that represent common patient problems during anesthesia.
Name the '4 H's' that represent common patient problems during anesthesia.
Hypoventilation, Hypotension, Hypothermia, Hemorrhage
In cats, besides regurgitation and aspiration, a species-specific anesthetic complication is often __________.
In cats, besides regurgitation and aspiration, a species-specific anesthetic complication is often __________.
An anesthetized patient exhibits a high heart rate. Assuming adequate anesthetic depth, which of the following should be considered as potential causes?
An anesthetized patient exhibits a high heart rate. Assuming adequate anesthetic depth, which of the following should be considered as potential causes?
It is acceptable to turn on the isoflurane vaporizer before confirming a proper seal with the endotracheal tube (ETT) cuff.
It is acceptable to turn on the isoflurane vaporizer before confirming a proper seal with the endotracheal tube (ETT) cuff.
Which of the following is a critical step to take before moving an animal with an inflated ETT cuff?
Which of the following is a critical step to take before moving an animal with an inflated ETT cuff?
What is a common cause of tracheal tears associated with endotracheal intubation, particularly in cats?
What is a common cause of tracheal tears associated with endotracheal intubation, particularly in cats?
Overzealous or forceful intubation can lead to laryngeal damage, including inflammation, _____, and hemorrhage.
Overzealous or forceful intubation can lead to laryngeal damage, including inflammation, _____, and hemorrhage.
During jaw tone checks, what anatomical structure should be stabilized to avoid complications?
During jaw tone checks, what anatomical structure should be stabilized to avoid complications?
An ETT has been inserted too far into the airways. What is the most likely consequence for the patient?
An ETT has been inserted too far into the airways. What is the most likely consequence for the patient?
Why must the use of soda lime in an anesthesia machine be based on tracking mechanisms rather than color change indicators alone, and what could happen if this is not followed?
Why must the use of soda lime in an anesthesia machine be based on tracking mechanisms rather than color change indicators alone, and what could happen if this is not followed?
What is the primary risk associated with pressing the oxygen flush valve during anesthesia?
What is the primary risk associated with pressing the oxygen flush valve during anesthesia?
It is acceptable to step over a breathing circuit during a surgical procedure if you are careful.
It is acceptable to step over a breathing circuit during a surgical procedure if you are careful.
If a patient under anesthesia is in Stage II, what action should be taken?
If a patient under anesthesia is in Stage II, what action should be taken?
Closing the APL valve will always increase ______ in the breathing system as fresh gas flow continues into the circuit.
Closing the APL valve will always increase ______ in the breathing system as fresh gas flow continues into the circuit.
Inhalant anesthetics quickly achieve the desired concentration and effects, eliminating the need for high oxygen flow rates during administration.
Inhalant anesthetics quickly achieve the desired concentration and effects, eliminating the need for high oxygen flow rates during administration.
Match the following clinical signs with the corresponding plane of anesthesia best suited for surgery:
Match the following clinical signs with the corresponding plane of anesthesia best suited for surgery:
What is the minimum alveolar concentration (MAC) defined as?
What is the minimum alveolar concentration (MAC) defined as?
Which of the following best describes the ideal depth of anesthesia for surgery involving noxious stimuli?
Which of the following best describes the ideal depth of anesthesia for surgery involving noxious stimuli?
A patient under anesthesia exhibits exaggerated reflexes and irregular breathing. Which stage of anesthesia is the patient most likely in?
A patient under anesthesia exhibits exaggerated reflexes and irregular breathing. Which stage of anesthesia is the patient most likely in?
Why is it crucial to continuously assess a patient's depth and vitals instead of solely relying on the vaporizer percentage setting during anesthesia?
Why is it crucial to continuously assess a patient's depth and vitals instead of solely relying on the vaporizer percentage setting during anesthesia?
For dogs anesthetized with Isoflurane, what vaporizer setting is recommended to achieve surgical anesthesia (1.5 x MAC)?
For dogs anesthetized with Isoflurane, what vaporizer setting is recommended to achieve surgical anesthesia (1.5 x MAC)?
When moving a patient, it is acceptable to disconnect the breathing circuit to prevent accidental pulling of the endotracheal tube, although caution should be taken due to the WAG.
When moving a patient, it is acceptable to disconnect the breathing circuit to prevent accidental pulling of the endotracheal tube, although caution should be taken due to the WAG.
What should you do if tempted to press the oxygen flush valve if the bag is flat?
What should you do if tempted to press the oxygen flush valve if the bag is flat?
During induction, if a patient is in stage III plane I, using _____ x MAC (2%) is indicated.
During induction, if a patient is in stage III plane I, using _____ x MAC (2%) is indicated.
Hypothermia increases MAC requirements in anesthetized patients.
Hypothermia increases MAC requirements in anesthetized patients.
An anesthetized patient suddenly develops severe hypotension and bradycardia, progressing to cardiac arrest. Which error is MOST likely the cause?
An anesthetized patient suddenly develops severe hypotension and bradycardia, progressing to cardiac arrest. Which error is MOST likely the cause?
Which of the following is NOT a recommended safety practice when handling controlled drugs?
Which of the following is NOT a recommended safety practice when handling controlled drugs?
Explain why frequently checking the drug label and dosage is essential when drawing up medications for animal anesthesia.
Explain why frequently checking the drug label and dosage is essential when drawing up medications for animal anesthesia.
Match the following stages of anesthesia with the appropriate action regarding Isoflurane administration:
Match the following stages of anesthesia with the appropriate action regarding Isoflurane administration:
What is the first action to take when a patient begins the recovery and extubation process?
What is the first action to take when a patient begins the recovery and extubation process?
It is acceptable to detach the breathing circuit and remove the patient from 100% oxygen before extubation to conserve oxygen supply.
It is acceptable to detach the breathing circuit and remove the patient from 100% oxygen before extubation to conserve oxygen supply.
When should the cuff of the endotracheal tube be deflated?
When should the cuff of the endotracheal tube be deflated?
After removing the ETT, it is essential to promptly check for adequate airflow through the mouth or nares and turn off the ______.
After removing the ETT, it is essential to promptly check for adequate airflow through the mouth or nares and turn off the ______.
Why is it important to keep the patient on 100% oxygen until extubated?
Why is it important to keep the patient on 100% oxygen until extubated?
Holding the connectors of the endotracheal tube firmly during removal is recommended to ensure a steady motion.
Holding the connectors of the endotracheal tube firmly during removal is recommended to ensure a steady motion.
What should a team member be prepared for during gentle restraint in the recovery process?
What should a team member be prepared for during gentle restraint in the recovery process?
Why is an 'Ear Flick' potentially unreliable as a sign for extubation readiness?
Why is an 'Ear Flick' potentially unreliable as a sign for extubation readiness?
After extubation and checking airflow, place a ______, and provide flowby O2 if needed for at least 5 min post extubating.
After extubation and checking airflow, place a ______, and provide flowby O2 if needed for at least 5 min post extubating.
What does a CRT of less than 1 second, accompanied by bright red mucous membranes, typically indicate in a patient?
What does a CRT of less than 1 second, accompanied by bright red mucous membranes, typically indicate in a patient?
If a patient is breathing room air (FiO2 = 0.21), what SpO2 value would be considered normal?
If a patient is breathing room air (FiO2 = 0.21), what SpO2 value would be considered normal?
What is the MOST reliable method for confirming correct endotracheal tube (ETT) placement?
What is the MOST reliable method for confirming correct endotracheal tube (ETT) placement?
What should you suspect if you observe a 'shark fin' waveform on the capnograph?
What should you suspect if you observe a 'shark fin' waveform on the capnograph?
When using an esophageal stethoscope, at approximately which rib space should it be placed to obtain the point of maximal intensity (PMI)?
When using an esophageal stethoscope, at approximately which rib space should it be placed to obtain the point of maximal intensity (PMI)?
What is the MOST important reason for labeling all syringes during anesthetic procedures?
What is the MOST important reason for labeling all syringes during anesthetic procedures?
If a syringe containing a controlled drug is accidentally contaminated during preparation, what is the CORRECT course of action?
If a syringe containing a controlled drug is accidentally contaminated during preparation, what is the CORRECT course of action?
Why is meticulous logging of controlled drug splits or wastage necessary?
Why is meticulous logging of controlled drug splits or wastage necessary?
Which of the following reversal agents is specifically used to reverse the effects of dexmedetomidine?
Which of the following reversal agents is specifically used to reverse the effects of dexmedetomidine?
A patient has received hydromorphone as part of its anesthetic protocol. Which reversal agent is MOST appropriate to use?
A patient has received hydromorphone as part of its anesthetic protocol. Which reversal agent is MOST appropriate to use?
Which equipment is specifically used to measure the concentration of carbon dioxide in the patient's respiratory gases during anesthesia?
Which equipment is specifically used to measure the concentration of carbon dioxide in the patient's respiratory gases during anesthesia?
During anesthetic preparation, why is it crucial to review the pre-operative notes BEFORE administering any medications?
During anesthetic preparation, why is it crucial to review the pre-operative notes BEFORE administering any medications?
What is the primary reason for pre-oxygenating a patient before anesthetic induction?
What is the primary reason for pre-oxygenating a patient before anesthetic induction?
An anesthetized patient develops unexpected, severe hypotension shortly after induction, despite adequate fluid administration and anesthetic depth. Auscultation reveals muffled heart sounds. What MOST likely went wrong?
An anesthetized patient develops unexpected, severe hypotension shortly after induction, despite adequate fluid administration and anesthetic depth. Auscultation reveals muffled heart sounds. What MOST likely went wrong?
What is a potential consequence of inadequate monitoring of intravenous fluid (IVF) administration?
What is a potential consequence of inadequate monitoring of intravenous fluid (IVF) administration?
If a hypotensive cat requires an intravenous fluid bolus, what is the recommended dose?
If a hypotensive cat requires an intravenous fluid bolus, what is the recommended dose?
What initial action should be taken to manage hypotension in an anesthetized patient, assuming it's one of the '4 H's'?
What initial action should be taken to manage hypotension in an anesthetized patient, assuming it's one of the '4 H's'?
Why is it important to check that the Anesthetic Gas Scavenging (AGS) ADS leak test is performed correctly after refilling the carbon dioxide absorber canister?
Why is it important to check that the Anesthetic Gas Scavenging (AGS) ADS leak test is performed correctly after refilling the carbon dioxide absorber canister?
What is the maximum recommended duration for using a carbon dioxide absorber canister in small animal anesthesia, assuming typical usage, according to the provided guidelines?
What is the maximum recommended duration for using a carbon dioxide absorber canister in small animal anesthesia, assuming typical usage, according to the provided guidelines?
Besides bradycardia, which of the following is NOT one of the '4 H's' representing common patient problems during anesthesia?
Besides bradycardia, which of the following is NOT one of the '4 H's' representing common patient problems during anesthesia?
Identify the earliest indicator of carbon dioxide absorbent exhaustion as detected by a capnograph.
Identify the earliest indicator of carbon dioxide absorbent exhaustion as detected by a capnograph.
During anesthesia, other than regurgitation and aspiration, what is a species-specific anesthetic complication commonly observed in cats?
During anesthesia, other than regurgitation and aspiration, what is a species-specific anesthetic complication commonly observed in cats?
What is the primary danger associated with disconnecting the breathing circuit or deflating the endotracheal tube (ETT) cuff before confirming the animal's readiness for extubation?
What is the primary danger associated with disconnecting the breathing circuit or deflating the endotracheal tube (ETT) cuff before confirming the animal's readiness for extubation?
To accurately track IV fluid administration, what is the MOST reliable method?
To accurately track IV fluid administration, what is the MOST reliable method?
What is the primary reason to communicate with the team and instructor during a perceived 'panic' or 'brown out' moment during a procedure?
What is the primary reason to communicate with the team and instructor during a perceived 'panic' or 'brown out' moment during a procedure?
The Threshold Limit Value – Time Weighted Average (TLV-TWA) for inhalant anesthetics in the operating room is < 2 parts per million (ppm). Why might personnel still be at risk even if they cannot smell the inhalant?
The Threshold Limit Value – Time Weighted Average (TLV-TWA) for inhalant anesthetics in the operating room is < 2 parts per million (ppm). Why might personnel still be at risk even if they cannot smell the inhalant?
Oxygen is an oxidizing gas and supports combustion. Which of the following statements BEST describes the safety implications of this property in the OR?
Oxygen is an oxidizing gas and supports combustion. Which of the following statements BEST describes the safety implications of this property in the OR?
Which of these interventions should be considered LAST when addressing hypoventilation in an anesthetized patient?
Which of these interventions should be considered LAST when addressing hypoventilation in an anesthetized patient?
Consider a scenario in which a patient exhibits clinical signs of hypercapnia during anesthesia, but the capnograph readings appear within normal limits. What is the MOST plausible explanation for this discrepancy?
Consider a scenario in which a patient exhibits clinical signs of hypercapnia during anesthesia, but the capnograph readings appear within normal limits. What is the MOST plausible explanation for this discrepancy?
A patient under anesthesia begins to show signs of hypothermia. After actively warming the patient, what additional step can be taken to address this complication?
A patient under anesthesia begins to show signs of hypothermia. After actively warming the patient, what additional step can be taken to address this complication?
What is the primary danger associated with inappropriately using the oxygen flush valve during anesthesia?
What is the primary danger associated with inappropriately using the oxygen flush valve during anesthesia?
In an emergency where rapid removal of inhalant anesthetic is required, what is the recommended procedure when using the oxygen flush valve?
In an emergency where rapid removal of inhalant anesthetic is required, what is the recommended procedure when using the oxygen flush valve?
If, during anesthesia, you're tempted to use the oxygen flush valve to inflate a flat reservoir bag, what is a safer alternative?
If, during anesthesia, you're tempted to use the oxygen flush valve to inflate a flat reservoir bag, what is a safer alternative?
What physiological consequence is MOST likely to occur if the pop-off valve (APL) is inadvertently left in the closed or partially closed position during mechanical ventilation?
What physiological consequence is MOST likely to occur if the pop-off valve (APL) is inadvertently left in the closed or partially closed position during mechanical ventilation?
What is the MOST appropriate immediate action to take if an anesthetized patient exhibits signs of being in Stage II anesthesia?
What is the MOST appropriate immediate action to take if an anesthetized patient exhibits signs of being in Stage II anesthesia?
During patient repositioning, what is the MOST critical step in ensuring patient safety related to the endotracheal tube (ETT) and breathing circuit?
During patient repositioning, what is the MOST critical step in ensuring patient safety related to the endotracheal tube (ETT) and breathing circuit?
What is the primary risk associated with stepping over or under the breathing circuit during an anesthetic procedure?
What is the primary risk associated with stepping over or under the breathing circuit during an anesthetic procedure?
Which combination of clinical signs BEST indicates that a patient is at an appropriate anesthetic depth (Stage III Plane 2) for surgery?
Which combination of clinical signs BEST indicates that a patient is at an appropriate anesthetic depth (Stage III Plane 2) for surgery?
During anesthesia, a dog begins to exhibit a purposeful struggling motion, increased heart rate and is now swallowing. How should you adjust the anesthesia machine?
During anesthesia, a dog begins to exhibit a purposeful struggling motion, increased heart rate and is now swallowing. How should you adjust the anesthesia machine?
A 2kg cat, anesthetized for a spay, reaches stage IV of anesthesia. After turning off the vaporizer and administering a reversal agent, the patient is still in stage IV after 30 seconds. What is the most appropriate next step?
A 2kg cat, anesthetized for a spay, reaches stage IV of anesthesia. After turning off the vaporizer and administering a reversal agent, the patient is still in stage IV after 30 seconds. What is the most appropriate next step?
When shpuld you extubate a canine patient, select all that apply
When shpuld you extubate a canine patient, select all that apply
When should you extubate a feline patient, select all that apply
When should you extubate a feline patient, select all that apply
Flashcards
ETT Cuff Inflation Timing
ETT Cuff Inflation Timing
Inflate the ETT cuff only after confirming a seal with a cuff inflation device to prevent leaks.
Moving Patient on ETT
Moving Patient on ETT
Always disconnect the patient from the circuit and occlude the circuit opening to avoid additional waste anesthetic gas exposure and turn off O2.
Stabilizing During Jaw Checks
Stabilizing During Jaw Checks
Stabilize the head/maxilla when checking jaw tone to prevent accidental extubation or injury.
Tracheal Tears in Cats
Tracheal Tears in Cats
Signup and view all the flashcards
Causes of Tracheal Damage
Causes of Tracheal Damage
Signup and view all the flashcards
ETT Obstruction Cause: Mucus & Over-inflation
ETT Obstruction Cause: Mucus & Over-inflation
Signup and view all the flashcards
Endobronchial Intubation
Endobronchial Intubation
Signup and view all the flashcards
Poor IVF Monitoring Consequence
Poor IVF Monitoring Consequence
Signup and view all the flashcards
IV Fluid Rates (Dog vs. Cat)
IV Fluid Rates (Dog vs. Cat)
Signup and view all the flashcards
Common Anesthetic Complications (4 H's and 1 P)
Common Anesthetic Complications (4 H's and 1 P)
Signup and view all the flashcards
Treating Hypotension
Treating Hypotension
Signup and view all the flashcards
Causes of High Heart Rate During Anesthesia
Causes of High Heart Rate During Anesthesia
Signup and view all the flashcards
MAC (Minimum Alveolar Concentration)
MAC (Minimum Alveolar Concentration)
Signup and view all the flashcards
Isoflurane MAC Values
Isoflurane MAC Values
Signup and view all the flashcards
1.5 x MAC
1.5 x MAC
Signup and view all the flashcards
2 x MAC
2 x MAC
Signup and view all the flashcards
Factors affecting MAC
Factors affecting MAC
Signup and view all the flashcards
Stage II Excitement Phase
Stage II Excitement Phase
Signup and view all the flashcards
Hypothermia & Anesthesia
Hypothermia & Anesthesia
Signup and view all the flashcards
Drug Safety Checks
Drug Safety Checks
Signup and view all the flashcards
Inhalant Anesthetics
Inhalant Anesthetics
Signup and view all the flashcards
Monitoring During Recovery
Monitoring During Recovery
Signup and view all the flashcards
Patent Airway
Patent Airway
Signup and view all the flashcards
Positioning for Regurgitation
Positioning for Regurgitation
Signup and view all the flashcards
Oxygen Before Extubation
Oxygen Before Extubation
Signup and view all the flashcards
Timing of Extubation
Timing of Extubation
Signup and view all the flashcards
Restraint During Extubation
Restraint During Extubation
Signup and view all the flashcards
Deflate the Cuff
Deflate the Cuff
Signup and view all the flashcards
ETT Removal Technique
ETT Removal Technique
Signup and view all the flashcards
Check Airflow Post-Extubation
Check Airflow Post-Extubation
Signup and view all the flashcards
Post-Extubation Oxygen
Post-Extubation Oxygen
Signup and view all the flashcards
Oxygen Flush Valve Danger
Oxygen Flush Valve Danger
Signup and view all the flashcards
Emergency Oxygen Flush
Emergency Oxygen Flush
Signup and view all the flashcards
Closed APL Valve Effect
Closed APL Valve Effect
Signup and view all the flashcards
Breathing Circuit Movement Risks
Breathing Circuit Movement Risks
Signup and view all the flashcards
Transferring Patient Safety
Transferring Patient Safety
Signup and view all the flashcards
Dangers of Incorrect Anesthetic Depth
Dangers of Incorrect Anesthetic Depth
Signup and view all the flashcards
Ideal Anesthetic Surgical Plane
Ideal Anesthetic Surgical Plane
Signup and view all the flashcards
Stage 2 Voluntarily Avoided
Stage 2 Voluntarily Avoided
Signup and view all the flashcards
Signs of Ideal Anesthetic Depth
Signs of Ideal Anesthetic Depth
Signup and view all the flashcards
Stages of Anesthesia
Stages of Anesthesia
Signup and view all the flashcards
Study Notes
- This is an ANES I Recap
- A VETC2012 review for VETC2015
- The following information covers ADS flow, functions, and leak tests
Fundamental ADS Parts
- Gas supply with gauge & pressure reducer (+/- line pressure gauge)
- Flow Meter
- Flush Valve bypasses the Flow Meter and Vaporizer, at 50psi & 35-75mL/min
- Anesthetic Precision Vaporizer
- Common Fresh Gas Outlet
- Scavenge interface to wall Evacuation System
Gas Pressures
- Compressed O2 or carrier gas has a high pressure of 2200 psi.
- Regulators reduce this to an intermediate pressure of 50 psi at the wall.
- The flow meter sets the appropriate rate of carrier gas, reducing the pressure further to a low 15 psi, which is safe for both the vaporizer and the patient.
- The O2 flush provides fresh O2 at an intermediate pressure of 50 psi.
- O2 flush bypass the flowmeter and vaporizer and does not deliver anesthetic agent.
- Use for machine leak tests, to flush the system clear of anesthetic gas, and in emergencies.
Non-Rebreathing Oxygen Flow Rates
- Require high flow rates per unit body weight during all periods
- The appropriate rate is ≈300 mL/kg/min
- Always used on patients that are less than 3kg
- OK on patients 3-7 kg too
- If rebreathing CO2, increase O2 flow and assess the depth of anesthesia, may be too light or hypoxic if tachypneic.
Rebreathing Oxygen Flow Rates
- Small Animal Rates, these must be memorized
- Induction/Changes/Recovery rate is 50-100 mL/kg/min
- Maintenance rate is 20-50 mL/kg/min
- You can increase O2 flow when changing the inhalant percentage to reach patient plane quickly.
- If less than 0.5 L/min O2, set flowmeter to 0.5L/min for optimal vaporizer performance.
- Use a pediatric rebreathing circuit on 3-7kg patients, or a non-rebreathing Bain system.
- For patients over 7kg use an adult RB circuit
- COAXIAL Rebreathing systems are advantageous for K9/Fe
Reservoir Bag Size Calculation
- Functions; Inspiratory reserve for patient, administering positive pressure ventilation, and allows anesthetist to monitor ventilation
- Formula; [ (patient tidal volume 15 mL/kg) x 6 ]
- For example, a 10 kg animal, with 15 mL/kg tidal volume is calculated as; [10 kg animal x (15 mL/kg)] x 6 = 900 mL
- Convert 900mL to Litres by dividing by 1000 = 0.9L
- Round UP to equal a 1 Liter bag
ADS Leak Test Protocol
- How to perform it?
- What if there is a leak?
- What do you do?
- Order of check points?
- When & why measure leak rate?
- What part of the ADS does it not test?
- Why?
- How can we know these parts are ok?
Common Leak Locations
- Connections
- Breathing Bag
- Breathing circuits hoses, connections
- FRESH GAS O-Ring, adaptor or hose
- Rebreathing: Soda Lime canister cracked, or o- rings not sealing
- Unidirectional Valve Domes
- Leak test done with a capnograph adaptor on
- Breathing Circuit Pressure Alarm
- Use a soapy solution to locate leak and ensure it is fixed
- Acceptable leak rate can be up to 200mL/min (0.2 L/min)
Common Errors With ADS
- Incorrect Evacuation systems; scavenge from RB to NRB = closes system
- Any set up that contributes to WAG
- Connecting circuit directly to wall without use of interface
- Too strong a suction will create negative pressure
- Sidestream capnograph not scavenged
- Quick connect at wall not secure
- You must hear a click, button should not be jamn
- Must ensure it is snug by gently pulling
ETT Length
- An Incorrect ETT Length Choice will cause:
- Excessive dead space will cause rebreathing of CO2 and adds resistance
- TOO SHORT (adaptor will be in mouth) = DISCONNECTS EASILY, POOR ACCESS, & INJURY TO GUM
- Placing the tube PAST the THORACIC INLET/TOO FAR will cause OCCLUSION AT CURVE OF TRACHEA/BLOCKAGE, CAN CAUSE INADEQUATE DELIVERY
- OR AN INAPPROPRIATE BREATHTUBE CHOICE
Complications of Intubation
- Complications during induction include;
- Esophageal intubation (airway will not be secure and could aspirate regurg, or air can occlude causing hypoxia)
- Laryngospasm in cats and sheep
- Apnea will cause hypercapnia and hypoxia
- Hypoxia can be caused by hypoventilation on room air
- Vagus nerve stimulation (drop in HR)
- Brachycephalic dogs or other breed deformities are difficult intubations and take prolonged time
- Overzealous & harmful intubation efforts
- Overinflation of cuff – tare or pressure necrosis
- Obstructed endotracheal tube
- Waiting too long to remove the tube
- Improper cleaning and sanitizing between uses
- Tracheal and/or laryngeal irritation leading to postsurgical cough
ETT Cuff Inflation Recap
- Two people are required to perform a safe minimal occlusive volume (MOV) inflation.
- In quick overview, do the following;
- Close APL Valve & watch gauge – inducer role
- Ensure O2 Flow is on at high end of induction rate
- Be ready @ patient end with syringe connected to pilot balloon value – monitor role
- Squeeze bag to 20 cmH2O dogs, 15 cmH2O cats (inducer) AND Listen for leak (monitor)
- ONLY inflate the cuff UNTIL the leak stops
- May take a few times - max 3 ideally
- If there is no Leak, Then don't add AIR!
- Instructor will confirm with a cuff inflation device
- Turn on ISO only after there is a confirmed seal
- Watch depth of patient during inflation because the patient is at risk of movement
Cuff Tips & Complication Prevention!
- Do not inflate cuff without first checking to see if there is a leak around it - some bulky cuffs create their own seal.
- Caution when moving or rotating an animal with an inflated ETT cuff
- DISCONNECT from circuit before moving (& occlude circuit to avoid additional WAG & turn off O2)
- Stabilize head/maxilla during jaw tone checks
- Ensure the tongue is not entrapped in tube tie or between teeth (swelling will occur)
- Tracheal tears are not uncommon in cats due to moving animals with cuff inflated and breathing tubes
- Be aware to prevent; Laryngeal damage from overzealous or forceful intubation causing inflammation, edema, & hemorrhage and Laryngospasm in cats and sheep
Common ETT Complications
- Tracheal damage can occur from;
- Tracheal tears due to an Over-inflated cuff & moving or twisting the patient with an inflated cuff
- May lead to mucosal damage, tracheal rupture (SQ emphysema, pneumomediastinum, etc.)
- ETT obstruction - Secretions (mucus most common), & Cuff over inflation
- Endobronchial intubation from;
- Introducing the ETT too far into the airways
- Tube must be measured at time of intubation, it should not extend past the thoracic inlet
- Leads to hypoxemia +/-hypercapnia
- ETT inhalation or ingestion can occur from;
- Tube being chewed (usually upon recovery)
- Do not wait too long to extubate while being Ready to evaluate depth and knowing signs of extubation
- Risk of bronchospasm in some species: pigs and cats
Soda Use
- Ensure there is LINE USE & granule consistency
- The substance is Very caustic so wear gloves & mask
- Ensure ADS leak test is done correctly, or they could enter breathing system
- Leak test AFTER refilling
- Small Animal - 8-12 hours of use and then needs changed
- Lab Rules - Use only for 8 hours max, then replace with new
- Record anesthesia time on canister during or post anes
Clinical Signs of CO2 Absorbent Exhaustion
- Bad thing
- Monitor exhaustion with capnography for the following occurrences;
- InCO2 is >2 mmHg
- Capnogram does not return to baseline
- ETCO2 high/hypercapnia Consider NBR dilution so capnometer not always precise
- Patient Signs of Hypercapnia from exhaustions = VERY BAD
- Increased RR to compensate for increased inspired CO2
OHS Hazards
- Inhaled volatile anesthetic agents must be less than < 2 parts per million (ppm) for OHS SAFETY
- But, it must be greater than >125 ppm to identify isoflurane by SMELL
- Too much exposure can risk OHS, and may be occurring even if there is no perceived odour
- Accept no ADS leaks, turn off oxygen flow if disconnecting (keep hand on flow meter until it is turned back on), do not disconnect circuit or deflate ETT cuff before extubation, and keep active scavenge wall connection loose ISOFLURANE is Toxic - causes reproductive issues and is an eye/skin irritant, may cause fatigue, dizziness or cause nausea Improper Handling of COMPRESSED GASES - OXYGEN IS AN IGNITOR & FUELS FIRES (an oxidizing gas) & High compressed pressure makes it a missile
Halogenated Organic Compounds
- The following points explain why/advantages to using inhalants
- Provide a state general anesthesia with hypnosis, unconsciousness, amnesia, muscle relaxation, and immobility
- Both sevoflurane & isoflurane liquid at room temp, vaporized with carrier gas (100% oxygen most common) where it travels to lungs at alveoli, then diffuses into bloodstream
- Rate of this diffusion controlled by the concentration gradient between alveolar & blood stream, & the lipid solubility of the agent.
- It Takes sometime for the concentration needed to plateau, use a high flow oxygen rate to assist unless that concentration is reached
- Reversible CNS depression
- Eliminated by the lungs
MAC
- Minimum Alveolar Concentration is the anesthetic agent that prevents purposeful movement by 50% of observed subjects.
MAC Factors
- Factors and setting choices
- MAC ≈ Dogs Isoflurane 1.3%, Cats 1.3-1.6%
- 1.5fx x MAC = Surgical anesthesia, Dogs Isoflurane 1.5fx x 1.3% = 1.95% (2%), known as Aka Induction Rate
- Once in plane II, reduce iso to what is appropriate for your patient/procedure
- 2fx x MAC = deep anesthesia, Dogs Isoflurane 2 x 1.3 = 2.6% THEREFORE DON'T ALLOW YOUR PATIENT TO GET TOO DEEP AT INDUCTION
REMEMBER TO DO FREQ DEPTH CHECKS AND TURN DOWN usually 5-15 minutes only
MAC varies with species, age, body temperature, metabolic status...
- Use 1.5 x MAC (2%) for INDUCTION if patient is in stage III plane I
- If patient at stage II use injectable for fast action to deepen
- If patient at plane III maybe hesitate to turn on iso or turn on at lower!
- The more hypothermic, the deeper your patient can/will be! and Hypothermia reduces MAC requirements!
Safety Considerations
- Supervise all drugs
- Do not leave controlled drugs unattended or without a lab
- Drawing up drugs and CHECk OFTEN (x2-3 times) drug, concentration, dosage, dose, & route before injecting and CHECK AGAIN
- EVERYTHING MUST BE LABELLED
- Or you will be asked to discard and redraw it up
- Try using coloured pre printed syringe labels found in the binder
- Confirm again with instructor before ANY administrations -Prepare syringes and labels during evening set-up
- Discard & get new if accidently contaminated, DO NOT continue to use it
- Log Controlled Drugs, log what is splits or wasting of unused drugs to ensure accuracy is witnessed.
Reversal Agents
- ATIPAMAZOLE reverses Alpha-2 Agonists (Dexmedetomidine)
- NALOXONE reverses Mu Agonist Opioids (Hydromorphone and Partially reverses use of Butorphanol)
- FLUMAZENIL reverses Benzodiazepines(Diazepam or Midazolam)
Monitor Checks
- The following checks need to be tested during setup;
- Capnograph (ensure it is scavenged)
- Pulse OX
- Oscillometric & Doppler
- Temp probe & thermometers
- Stethoscope and Esophageal Stethoscope
- Patient Warming Device
- and IVF Pump
- ALL EQUIPMENT MUST BE PLUGGED IN
Lab Flow
- Review pre operative notes, prepare plan
- Admit & PE notes including; behaviour, CV & Resp functions, pre-op blood work, confirm consent, weight (kg) & fasting & requests
- Premedicate intramuscularly
- Begin Patient warming and apply blanket
- Insert IVC
- Assess Patient Premed Effect with Pre-Oxygenation
- surgical shave should occur before this - Except when preformed on cat neuters Induction;
- Intubation, Confirm Placement and connect to O2
- ETT cuff Inflation procedure
- Monitor placement
- Pulse Ox 2. Capno 3. Oscillometric & Doppler 4.ECG 5. Espohageal & Temp Probes 6. Warming Device Check %7 IV Drip (on ASAP).
Procedure
- Maintain & Monitor in plane II
- Perform Extubation & Recovery, Monitoring & Support
- Then transfer patient to Sx Group
- Complete postoperative checks, then round to Clinic RVT and DVM
- Complete discharge
Recovery & Extubation Steps:
- Maintain a patent airway while monitoring depth & vitals continuously
- If regurgitation occurs, arrange position appropriately incase silent regurgitation presents
- Do not detach breathing circuit, continue to to keep on 100% Oxygen during extubation (helps prevent hypoxemia)
- Be ready to extubate once medial palpebrals become strong
- have a team member continues gentle restraint while being prepare to catch and move
- DEFLATE CUFF immediately as a sign of extubation
- Untie the tube, pull ties forward to avoid getting stuck on teeth
- Extend head, & remove the tube in one slow and held firmly as one move
- Prevent animal from biting with proper technique
- Once ETT is removed, confirm adequate airflow
- Provide face pulse oximeter for flowly 02 if required
- Allow patient to sit as preferred or require assistance with sitting
- Patient at full recovery contains 5 considerations; Must see patient still with patient until each is met. 1 optimal mentations 2 Holding head on sternum 3 vital is normal 4 pain is controlled 5 environment
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This lesson covers key considerations for managing anesthesia in veterinary patients. It addresses intravenous fluid administration, common patient problems like the '4 H's', and species-specific complications in cats. Additionally, it covers endotracheal intubation best practices for safety.
