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Questions and Answers
What is a critical factor to consider in fluid therapy for neonates during anesthesia?
What is a critical factor to consider in fluid therapy for neonates during anesthesia?
- Delivering dextrose-containing fluids to prevent hypoglycemia (correct)
- Using larger doses of anesthetics to manage fluid levels
- Intravenous isotonic solutions without dextrose
- Prolonged fasting to prevent aspiration
In managing dyspnea during anesthesia, what is an effective strategy?
In managing dyspnea during anesthesia, what is an effective strategy?
- Minimize oxygen supplementation
- Constantly increase the anesthetic depth
- Monitor blood pressure only and ignore respiratory rates
- Sigh the patient every 5 to 10 minutes (correct)
Which of the following is a common cardiac rate and rhythm abnormality to expect in a patient with cardiovascular disease during anesthesia?
Which of the following is a common cardiac rate and rhythm abnormality to expect in a patient with cardiovascular disease during anesthesia?
- Tachycardia as the primary response
- Bradycardia as the most common issue (correct)
- Irregular heart rates without any cause
- Normal heart rate without any changes
What should be closely monitored to evaluate the effectiveness of anesthesia?
What should be closely monitored to evaluate the effectiveness of anesthesia?
During management of respiratory arrest, which intervention is considered essential?
During management of respiratory arrest, which intervention is considered essential?
What is an indication of hypoxemia during anesthesia that must be monitored?
What is an indication of hypoxemia during anesthesia that must be monitored?
Which of the following choices is involved in the careful monitoring process during anesthesia?
Which of the following choices is involved in the careful monitoring process during anesthesia?
The use of which monitoring device is essential for assessing oxygenation during anesthesia?
The use of which monitoring device is essential for assessing oxygenation during anesthesia?
Which is a crucial consideration when treating a patient with respiratory disease during anesthesia?
Which is a crucial consideration when treating a patient with respiratory disease during anesthesia?
In cases of trauma patients, what is the critical preparation step before anesthesia?
In cases of trauma patients, what is the critical preparation step before anesthesia?
Which factor is NOT associated with dyspnea in brachycephalic dogs?
Which factor is NOT associated with dyspnea in brachycephalic dogs?
What is the ideal respiratory rate when ventilating an animal during basic life support?
What is the ideal respiratory rate when ventilating an animal during basic life support?
Which treatment option is least appropriate for managing respiratory arrest?
Which treatment option is least appropriate for managing respiratory arrest?
Which statement about advanced life support monitoring is incorrect?
Which statement about advanced life support monitoring is incorrect?
In a patient requiring oxygen therapy, which method is NOT typically used for delivering oxygen?
In a patient requiring oxygen therapy, which method is NOT typically used for delivering oxygen?
What is the primary concern when dying or unconscious patients are experiencing dyspnea?
What is the primary concern when dying or unconscious patients are experiencing dyspnea?
Which of these is NOT a component of assessing cardiac rate and rhythm abnormalities during anesthesia?
Which of these is NOT a component of assessing cardiac rate and rhythm abnormalities during anesthesia?
Which criteria about cardiac arrest statements is true?
Which criteria about cardiac arrest statements is true?
In regards to fluid therapy during anesthesia, which statement is inaccurate?
In regards to fluid therapy during anesthesia, which statement is inaccurate?
Which is NOT a common cause of prolonged recovery from anesthesia?
Which is NOT a common cause of prolonged recovery from anesthesia?
What fluid administration rate is recommended for maintaining blood pressure during anesthesia in large animals?
What fluid administration rate is recommended for maintaining blood pressure during anesthesia in large animals?
Which action is NOT recommended when treating a patient in dyspnea and/or cyanosis caused by excessive anesthetic depth?
Which action is NOT recommended when treating a patient in dyspnea and/or cyanosis caused by excessive anesthetic depth?
What is a common cause of bradycardia during anesthesia?
What is a common cause of bradycardia during anesthesia?
What is the primary monitoring parameter for assessing the adequate depth of anesthesia?
What is the primary monitoring parameter for assessing the adequate depth of anesthesia?
In case of respiratory arrest during anesthesia, what is the first recommended action?
In case of respiratory arrest during anesthesia, what is the first recommended action?
Which of the following is a sign of excessive anesthetic depth?
Which of the following is a sign of excessive anesthetic depth?
What is the most appropriate immediate response to a patient exhibiting tachypnea during anesthesia?
What is the most appropriate immediate response to a patient exhibiting tachypnea during anesthesia?
Which condition is most likely to cause prolonged capillary refill time during anesthesia?
Which condition is most likely to cause prolonged capillary refill time during anesthesia?
Which of the following interventions is not part of basic life support as per RECOVER Guidelines?
Which of the following interventions is not part of basic life support as per RECOVER Guidelines?
What should be done if an anesthetized animal presents with pale mucous membranes?
What should be done if an anesthetized animal presents with pale mucous membranes?
What should be done if the anesthetic depth, body temperature, and vital signs are acceptable?
What should be done if the anesthetic depth, body temperature, and vital signs are acceptable?
What is the primary initial response to suspected respiratory arrest in an anesthetized patient?
What is the primary initial response to suspected respiratory arrest in an anesthetized patient?
Which medication is NOT typically used for treating cardiac arrhythmias?
Which medication is NOT typically used for treating cardiac arrhythmias?
What should be monitored continuously to track arrhythmia status?
What should be monitored continuously to track arrhythmia status?
During respiratory arrest, what is an important step if the patient is not intubated?
During respiratory arrest, what is an important step if the patient is not intubated?
What is a potential cause of respiratory arrest?
What is a potential cause of respiratory arrest?
What is the primary observation to ensure during manual ventilation?
What is the primary observation to ensure during manual ventilation?
In cases of apnea, what is the appropriate initial monitoring parameter?
In cases of apnea, what is the appropriate initial monitoring parameter?
What should be done regarding the anesthetic vaporizer if respiratory arrest occurs?
What should be done regarding the anesthetic vaporizer if respiratory arrest occurs?
What is the recommended frequency for bagging a patient during respiratory support?
What is the recommended frequency for bagging a patient during respiratory support?
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Study Notes
Anesthetic Emergencies - Causes
- Human error is a common cause of anesthetic emergencies, including inadequate training, lack of familiarity with equipment, and drug calculation errors.
- Equipment issues include carbon dioxide absorbent exhaustion, failure of oxygen supply, and vaporizer problems like overfilling or tipping.
- Adverse effects of anesthetic agents can also lead to emergencies; it's important to choose a protocol suitable for the patient and be familiar with side effects.
- Increased patient risk factors include neonates, geriatric animals, obese animals, brachycephalic dogs, sighthounds, trauma victims, and patients with cardiovascular, respiratory, hepatic, or renal disease.
Anesthetic Problems and High-Risk Patients
- Neonates: Susceptible to hypoglycemia and dehydration due to fasting, require intravenous isotonic crystalloid solution with 5% dextrose during anesthesia.
- Geriatric animals: Exhibit decreased heart, lung, and liver function, leading to reduced anesthetic requirements and prolonged recovery.
- Obese animals: Anesthetics are not efficiently distributed to fat stores, requiring lower doses.
- Brachycephalic dogs: Prone to airway obstruction and bradycardia, requiring careful monitoring.
- Sighthounds: Increased sensitivity to some anesthetic agents.
- Cardiovascular disease: Preanesthetic evaluation crucial, with bradycardia being a common problem.
- Respiratory disease: Avoid nitrous oxide, monitor for dyspnea and cyanosis, and assess oxygen-carrying capabilities.
- Hepatic disease: Avoid ketamine and diazepam due to the liver's role in drug metabolism.
- Renal disease: Correct dehydration before anesthesia, watch for prolonged recovery.
- Cesarean delivery: High-risk due to advanced pregnancy, patient's compromised condition, anesthetic agents crossing the placenta, and risk of shock. Anesthetic protocols may include epidurals, general anesthesia, and opioid agents.
Anesthetic Emergencies - Veterinary Technician's Role
- The veterinary technician plays a crucial role in responding to anesthetic emergencies.
- They should be familiar with emergency procedures and actively participate in resuscitation.
- They may be authorized to provide emergency and after-hour care in the absence of the veterinarian.
Common Anesthetic Problems and Responses
- Inadequate anesthetic depth: Check equipment, vaporizer setting, and oxygen flow.
- Excessive anesthetic depth: Decrease vaporizer setting, ventilate with oxygen, and consider reversal agents.
- Pale mucous membranes: Rule out hypothermia, hypotension, drug reactions, blood loss, and pain.
- Prolonged capillary refill time: Check pulse and blood pressure, monitor for other signs of shock.
- Hypotension: Reduce anesthetic depth, optimize pain control, administer fluids, and consider medication.
- Dyspnea and/or cyanosis: Ensure oxygen delivery, ventilate with oxygen, and monitor vital signs.
- Tachypnea: Assess anesthetic depth, check for hypercapnia.
- Apnea: Monitor heart rate, mucous membrane color, and oxygen saturation.
- Respiratory arrest: Ensure oxygen delivery, intubate if necessary, ventilate with oxygen, and consider medications.
- Abnormalities in cardiac rate and rhythm: Monitor with EKG, assess oxygen levels, and consider medications.
Cardiopulmonary Resuscitation (CPR)
- Basic Life Support (BLS): Begin immediate CPR to establish airway, breathing, and circulation.
- Advanced Life Support (ALS): Includes drug administration, intravenous fluids, and monitoring vital signs.
Post-Anesthetic Recovery
- The veterinary technician is responsible for monitoring the patient during the recovery period.
- Common problems include hypothermia, respiratory distress, vomiting, and restlessness.
- Treat hypothermia with external heat, monitor respiratory function, and provide appropriate pain management.
Cardiac Arrest
- Cessation of blood circulation due to heart's inability to pump effectively
- Follows abnormal electrical activity in the heart
- Can occur at any time during general anesthesia
- May be preceded or followed by respiratory arrest
- Signs are usually noticeable before the event
Cardiopulmonary Arrest
- Cardiac and respiratory arrest often occur together
- Permanent brain damage can occur within 5 minutes if oxygen is not restored
- Requires coordinated action from all hospital staff to reverse
Cardiopulmonary Resuscitation (CPR)
- RECOVER initiative (Reassess Campaign on Veterinary Resuscitation)
- Guidelines differ from traditional CPR
- All personnel must be competent in CPR procedures
- Ideally, 3 to 5 staff members are needed for CPR
CPR Terminology
- BLS: Basic Life Support
- ALS: Advanced Life Support
- ROSC: Return of Spontaneous Circulation
- PAC: Post-Arrest Care
Basic Life Support (BLS) - Step 1: Chest Compressions
- High-quality chest compressions are vital
- Patient positioned on right or left side, feet away from caregiver
- Two-handed technique over widest part of the chest
- Compressions at 100 to 120 bpm
- Compress 1/2 to 1/3 of chest width, allowing for full re-expansion
- Alternative: Interposed abdominal compressions
Basic Life Support (BLS) - Step 2: Intubation and Ventilation
- Ventilation support must be provided alongside chest compressions
- Endotracheal intubation:
- Lateral recumbency
- Ventilate with 100% oxygen
- 10 breaths per minute
- Tidal volume of 10 mL/kg
- Mouth-to-mouth:
- After 30 chest compressions
- Two quick breaths
- Chest compressions DO NOT stop when breaths are given
Advanced Life Support (ALS) - Step 3: ECG and End-Tidal CO2 Monitoring
- Place ECG leads (do not stop compressions)
- Do not use alcohol (use physiological saline solution)
- Monitor compression quality with a capnograph
Advanced Life Support (ALS) - Step 4: Obtaining Vascular Access
- Place an IV catheter in a peripheral vein
- Intraosseous route is an alternative
- If not possible, drugs can be administered intratracheally
- Intracardiac injections should be avoided if possible
Advanced Life Support (ALS) - Step 5: Administration of Reversal Agents
- Administer appropriate reversal agents if sedatives or anesthetics were given before arrest
- Dosage according to CPR Emergency Drugs and Doses
Advanced Life Support (ALS) - Additional Steps
- Briefly pause compressions after every 2-minute BLS cycle
- Change compressors
- Evaluate for ROSC
- Evaluate ECG tracing for rhythm diagnosis
Advanced Life Support (ALS) - Normalizing Heart Rhythm
- Therapy tailored to ECG diagnosis
- Treatment of asystole or pulseless electrical activity (PEA):
- Low-dose epinephrine or vasopressin may be used
Advanced Life Support (ALS) - Open-Chest CPR
- Performed when external compressions are ineffective
- Clip and rinse lateral thorax with alcohol
- Apply self-adhering drape
- Skin incision between 7th and 8th rib
- Incise through muscle into the chest cavity
- Manually pump the heart at 100 times/min
Aftercare
- Monitoring is crucial
- High risk of another cardiac arrest within 24 hours
- Complex care depending on many factors
- Many patients cannot be successfully revived
Regurgitation During Anesthesia
- Passive process under anesthesia, no retching
- Stomach contents may be aspirated into the respiratory tract
- Most common in head-down surgical positions and ruminants
- Treatment:
- Immediate placement of cuffed ET tube
- Suction out regurgitated material
Vomiting During or After Anesthesia
- Common in brachycephalic dogs or non-fasted animals
- Active process usually accompanied by retching
- Often occurs during loss or regaining of consciousness
- Signs:
- Airway obstruction causing dyspnea/cyanosis, bronchospasm
- Treatment:
- Intubation and suction if unconscious
- Lower head and clean oral cavity if conscious
Seizures After Anesthesia
- Seen with ketamine administration, after diagnostic procedures, or preexisting conditions
- Signs:
- Spontaneous twitching, uncontrolled head/neck/limb movements, opisthotonus, triggered by stimuli
- Treatment:
- Reduce stimuli
- Postoperative analgesia
- Diazepam or propofol
- Monitor for hyperthermia
Emergence Delirium After Anesthesia
- Seen after barbiturate anesthesia or high opioid doses
- Signs:
- Spontaneous paddling and vocalization
- Treatment may not be necessary
- Sedatives may help
- Naloxone reverses opioids
- Differentiate from seizures
Dyspnea in Dogs
- Breed-related:
- Brachycephalic dogs
- Airway obstruction:
- Anatomy, foreign objects, postoperative tissue swelling
- Humidified oxygen can be delivered to an awake animal:
- Facemask, nasal cannula, E-collar, oxygen cage/tent
Dyspnea in Cats
- Caused by laryngospasm, sometimes triggered by ET tube removal
- Laryngeal edema may result from repeated intubation attempts
- May breathe with an audible stertor (wheeze)
- May resolve or require oxygen via facemask, intubation, or tracheotomy
- Easier to prevent than treat
Causes of Prolonged Recovery
- Impaired renal or hepatic function
- Hypothermia
- Patient susceptibility to anesthetic agent
- Breed variation
- Coexisting disorder
- Prolonged or deep anesthesia
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