Anaesthetic Procedure - Part 1 - Booking to Intubation PDF

Intro to Veterinary Anaesthetic and Surgical Procedures The Anaesthetic Procedure Part 1: Booking to intubation Part 2: Recovery, Discharge, Post op Booking the Patient in for the Procedure Either over the phone or in person Booking details Date of the surgery Animal/Client Name & Address...

Intro to Veterinary Anaesthetic and Surgical Procedures The Anaesthetic Procedure Part 1: Booking to intubation Part 2: Recovery, Discharge, Post op Booking the Patient in for the Procedure Either over the phone or in person Booking details Date of the surgery Animal/Client Name & Address Contact phone numbers - home, mobile, work, spouse Surgery - Procedure name(s) if having multiple treatments, identification of lump locations etc Email address Current medications - When was it last given & what dose was given Known allergies - Highlighted on the form so not forgotten Estimates or quotes if given - Noted on the computer Procedure details At this stage spend a little time with the client talking about the procedure & what will happen to their pet on the day. Letting the client know what’s going to happen can reassure them. Talk to them about what’s going to happen with their pet on the surgery day. Arrive/Pick up times Explain the suitable arrival time to the client & advise this process may take 15 mins on arrival & may take longer on pick up, if the Vet needs to talk for any reason, so be sure to ask them to have that time up their sleeve. (Be careful about saying “drop off” time) If you have LOTS of surgeries stagger their arrival times, so that you don’t have 5 owners & animals arriving at the same time If a specialized surgery, a go home Vet booking may be needed – Check with the Vet & book appropriately as needed Fasting Instructions These vary with species, age, disease. Healthy cats & dogs are generally fasted 6-8 hrs prior to surgery – due to owner compliance. However, this is not really optimal. Ideally cats and dogs should be fasted for 3-4hrs prior to surgery as longer times can increase the risk of reflux. Be sure to give the correct fasting instructions & if you’re not sure - ask! Can change with disease processes, species and age. Water can safely be given up until the morning of the anaesthetic. Some places give free access to water until the pre-medication is given. This is to help prevent any dehydration. Savvas, I., Rallis, T., & Raptopoulos, D. (2009). The effect of pre-anaesthetic fasting time and type of food on gastric content volume and acidity in dogs. Veterinary anaesthesia and analgesia, 36(6), 539-546. https://doi.org/10.1111/j.1467-2995.2009.00495.x Medication This is VERY important. If a patient is on any medication, it is important to advise the client about administration on the day of the surgery. – check with the vet on this Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are typically NOT be given the day prior to surgery Advise whether the client needs to bring medication with them (insulin?) Hand outs Helpful to have pre-op handouts with all info client needs. You can use a template & input the pets name & surgery date details, when booking is done. Having an online version is also a good idea. Hopefully you have now answered all the owners questions & gathered the information that you need. Many clients need a reminder phone call or text message to confirm their booking & give arrival times etc, make sure this is done the day before each surgery booking. Arrival at the clinic On the day of the procedure Arrival Greet client, watch the patient & check distance examination parameters & try to assess the owners feelings about the day. Discuss any important things the owner may want clarification on, then have consent form signed Try to keep the owner and the patient CALM Consent form Explain that “There are always risks with anaesthesia, but we take every effort to minimize those risks” Patient is constantly monitored by a Veterinary Nurse & records are made every 5 mins We tailor the anaesthetic protocol to your pet, depending on the history, & clinical examination findings We offer a pre anaesthetic blood testing service - Your pets anaesthetic protocol can be tailored depending on these results also We have a variety of monitoring machines that are used during the procedure to enhance the safety of their pet & these machines are regularly serviced & maintained. Consent form Ask pre-anaesthesia questions, which include: Check phone numbers note the best number for the day/time of surgery Pre-anaesthetic blood test – Yes or No. Explain the cost, benefits, what it entails? When did their pet last have access to food/water? And did they eat/drink at this time? Confirm the procedure/surgery being done & confirm which limb,lumps etc (pre clip lumps if necessary) Are there any Medications - Have they been taken or not, & when last given. Are they behaving as usual, note any other behaviour. Arrange pick up time to suit you both Urination/Defaecation if appropriate Consent form On the day of surgery added notes should include: If an ovariohysterectomy - note when last season was. Take note of gait, demeanor , attitude, respiratory rate as soon as you lay eyes on your patient. Note down any items the owner has left with the patient - Include collar/lead, cage, blankets, toys, food bowls etc. Some clients may want to see where their pet will be staying for the day - make the time for these clients if your clinical protocol allows Make sure the consent form is completed and signed before the client leaves the building Weigh in Weigh patient at scales & note weight on chart Check their body score while you are doing this (If Hosp nurse free she can take animal from you here) Take patient to appropriate ward & settle in with suitable bedding for size/procedure If a cat weigh cage & subtract from total Write patient up on whiteboard with appropriate details Check patient records to compare weights & check history for relevant info Update today’s history with current weight Pre-anaesthetic assessment Including physical examination and diagnostic testing Clinical exam Equipment you need: Stethoscope Clinical Examination Form Thermometer & lube Blood pressure monitor A FULL clinical examination is vital & should include at minimum: Temperature Heart rate & Pulse rate Respiration rate Nose to tail Blood pressure (ideally) Pre-anaesthetic testing May include: Blood testing – Packed cell volume (PCV), haematology (CBC), biochemistry, specialized tests Urine testing Radiography Ultrasound Neurological examination by the veterinarian And more! Pre-anaesthetic testing Preparation: Get in-house test ready before blood draw Clippers Alcohol /Tincture swab 20g needle & suitable size syringe Tubes – depending on tests being done Haematocrit tubes & plug When ready: Blood is drawn & tested Some in-house machines only do biochemistry, others do CBC too. Blood test may need to be done prior & sent to lab Results are recorded in computer & Vet is advised Drugs are tailored for patient & procedure from results by the Vet, once the clinical examination details are compiled  Pre-medication A combination of drugs that work synergistically to make the anaesthesia smooth Contains usually analgesic and an sedative, but not always This must be authorised by the veterinarian Premedication is given usually SC or IM and will vary clinic to clinic. It should be tailor made for each individual, although many clinics have general protocols for healthy patients. IV catheter placement This will vary clinic to clinic, may occur before or after premedication IV catheter placement Every animal that has a general anaesthetic should have and IV catheter placed. Ideally those having sedation too. IV CATHETER PLACEMENT CONSIDERATIONS Ensure IV catheter is suitable size for the animal – not you. Prepare ALL your equipment before restraining patient Know what steps your clinic uses Always use the ‘2-stick rule’ Setting up for IV catheterisation IV catheter placement You will need: Clippers Alcohol swab IV catheter (appropriate size) Tape (pre cut into strips) Catheter plug or T-port Bandaging – soffban and vetrap https://www.theveterinarynurse.com/review/article/ how-to-perform-fluid-therapy IV catheters Placing an IV catheter Clip foreleg, over the cephalic vein. Clipper’s need to be clean & charged Clean Using – Microshield 4 soap with Aqueous (Microshield 5 + Distilled water), Aqueous alone, Tincture (Microshield 5 + Alcohol)swab. One after the other, until the area is clean. Restrainer needs to ensure foreleg stays extended at the elbow, to ensure a clean area. They can also raise the cephalic vein in preparation of catheter insertion. The catheter is placed & taped in using “DURAPORE” (shiny material tape) or appropriate tape. https://www.theveterinarynurse.com/review/article/how-to-perform-fluid-therapy Placing an IV catheter I/V fluid line is attached to catheter & line is taped up the outside of the limb. Ensure NO kinks in the line. Tape is then used to secure the I/V line up the side of the limb. Soffban is then used for added comfort from the toes toward the heart. Vetrap is used in the same manner. Flush catheter with saline to ensure correct placement Ensure I/V ports are accessible at all times. Check the I/V line is running properly. Induction and Intubation The act of placing the patient under a general anaesthetic for the procedure and placing an endotracheal breathing tube Induction Patient goes from conscious to unconscious High Risk stage Ideally passing through stage 1 & 2 of anaesthesia quickly Restraint is VITAL at this point Restrainer should have hand on patients heart to palpate & be watching for respiration IS HEART BEATING? IS PATIENT BREATHING? Know what to expect from the agent you are using. Induction The FIRST TWO things you want to worry about at induction are.... Is their HEART beating? (feel it) Are they breathing? (watch for it) SAY OUT LOUD IF YOU CAN’T FEEL IT/SEE IT - TELL VET ASAP!! Intubation Endotracheal (ET) tube is placed in trachea Should be suitable size to produce a seal once cuff is blown up via pilot tube ET tube MUST be checked before EVERY USE ET tube MUST be cleaned after EVERY USE Selection of 3 sizes per patient should be available Setting up for Intubation  Intubation – cuff inflation The ETT cuff must be inflated properly once placed using the ‘listen and leak’ method Ideally done with two people To inflate the cuff, a syringe with air in it needs to be attached to the cuff inflation valve. For small tubes and cats, a 3ml syringe should be sufficient. In bigger tubes and dogs a 6 to 10 ml syringe can be used. The pop-off valve needs to be closed by the assistant holding down the pop-off button (ideal for safety reasons) or by closing the pop-off valve and the reservoir bag should be squeezed. While the bag is being squeezed (being careful not to exceed 20 cm H2O peak inspiratory pressure) the anaesthetist should place their ear by the mouth of the patient and listen for leaks. https://www.dvm360.com/view/capture-airway-everything-you-ne ed-know-about-endotracheal-tubes-and-difficult-intubations-proce edin  Intubation – cuff inflation If leaks are heard (usually a hissing sound) during the inspiratory phase of the given breath air should be injected into the cuff. Only enough air should be injected to stop the leak sound. If two people are cuff checking, it is customary for the bag squeezer to say "breathing" during the bag squeeze and "release" during relaxation of the bag If the leak is sealed, the reservoir bag will remain full and firm while being squeezed. If there is still a leak, the bag will empty as air rushes past the tube into the oral cavity Once the cuff is properly inflated the syringe must be disconnected from the valve so that the air stays in place within the cuff. The anaesthetist should note how much air was used to seal the cuff. The amount of air should not be excessive.” https://www.dvm360.com/view/capture-airway-everything-you-ne ed-know-about-endotracheal-tubes-and-difficult-intubations-proce edin Holding patients for intubation Patient needs to be in sternal recumbency and straight Hold either side of the maxilla (upper jaw) and elevate the head and neck Don’t put your fingers in the mouth… why? Tilt the nose upwards – aiming for the neck to be as straight as possible Cats: can often gently pull down on the throat to make