Problems And Emergencies In Anesthesia *final (Packet 3 Of 4)

Front 1

What is the KEY to preventing Emergencies?

Back 1

PROPER PREPARATION!!!!

*Recognize High Risk Patients

Front 2

Higher Risk Patients:

Back 2

All patients are at risk, but these are the HIGHEST:
-Trauma, Geriatric, Juvenile, Brachycephalic, Sight Hounds, Hepatic & Renal problems, Cardiac problems, C-Sections

Front 3

What is the first thing that should be done, if possible, before anesthetizing a TRAUMA PATIENT?

Back 3

STABILIZE!!!
-Fluids important and Radiographs to evaluate chest are essential (pneumothorax & pulmonary contusions)

Front 4

What special considerations should be taken when choosing drugs for the GERIATRIC PATIENT?

Back 4

**Use drugs that:
- don't require Excessive Metabolism
-can be Reversed

Front 5

What are 2 major problems that JUVENILES can encounter under anesthesia?

Back 5

1. Inability to maintain body temperature...Hypothermia
(remedy by using a heat source and NO alcohol in surgery prep) and maintain Blood Pressure, AVOID ACE!
2. No Blood Sugar Reserves (remedy by giving fluids containing Dextrose, and only Short Term NPO)
**At Risk for OVERHYDRATION...maintain fluid rates carefully!

Front 6

What are the potential problems with anesthesia of BRACHYCEPHALIC BREEDS?

Back 6

Problems:
-Smalll trachea
-Obesity
-Excitable
-Obstructed Airway can occur

Front 7

What can be done to prevent the potential anesthesia problems with BRACHYCEPALIC BREEDS?

Back 7

Prevent Problems:
-Smaller tubes will be necessary
-Use Cuffed tubes
-Leave the tube in as long as possible w/ recovery
-Premedicate to reduce excitement

Front 8

What are the major problems associated with anesthesia of SIGHT HOUNDS?

Back 8

-Low level of body fat
-Sensitive to:
*Phenothiazines(Acepromazine)

*Thiobarbituates

Front 9

What drugs CAN be used in SIGHT HOUNDS?

Back 9

Drugs that CAN be used:
1. Butorphanol
2. Domitor
(often recommended to routinely use anticholenergic)

**DO NOT USE:
ACE for pre-med!
NO BARBIUTRATES for induction!

Front 10

What drugs are best to use for anesthesia in patients with HEPATIC DISEASE?

Back 10

*Appropriate drug selection is essential!
-Midazolam is BEST
-Propofol Best for Induction
-Only Iso or Sevo for Maintenance
-Oxy is o.k.

DO NOT USE:
-Ace, Barbiturates, Telazol, ketamine/valium

Front 11

What drugs are best to use for anesthesia in patients with RENAL DISEASE?

Back 11

**Important to maintain hydration status (night prior)
1. Premedication: OPIOIDS
2. Induction: Propofol safest
3. Maintenance: Isoflurane or Sevoflurane

Do NOT USE: ACE or MEDETOMIDINE

Front 12

What drugs are best to use for anesthesia in patients with CARDIAC PROBLEMS?

Back 12

1. Pre-med: Midazolam is best, opioids o.k.
2. Induction: Ketamine & Valium
3. Maintenance: Isoflurane and Sevoflurane safest
4. Fluids: Minimize to prevent volume overload

Front 13

What about OBESE animals?

Back 13

Calculate drug to match Ideal body weight!

Front 14

During a C-SECTION, what could be the potential problems associated with the DAM?

Back 14

*Minimum of 2 patients!
DAM PROBLEMS:
-Hypovolemic
-Hypoglycemic
-Weak from delivery

Front 15

During a C-SECTION, what could be the potential problems associated with the OFFSPRING?

Back 15

OFFSPRING PROBLEMS:
-Prone to Respiratory Depression (need to prevent)
-Sensitive to drugs

Front 16

What drugs should be AVOIDED when anesthetizing for a C-SECTION?

Back 16

AVOID:(high neonatal deaths)
-DIAZEPAM
-PENTOBARBITAL

Instead USE: Propofol for Induction, or mask w/ Iso/Sevo
-Local Anesthetic Block (for Incision & Exteriorize Uterus)
**REVERSAL w/ NARCAN if opioid was used
-Isoflurane to Finish Procedure

Front 17

What is an Open Thoracic Procedure?

Back 17

When any incision is made into the chest. (thoracotomy, diaphragmatic, hernia repair, etc.)

Front 18

How would you take control of a patients breathing during an Open Thoracic Procedure?

Back 18

*It is necessary to breath for a patient in order to prevent damage to lung tissue and to maintain respirations....
-BAG the patient EVERY 4-5 Seconds
-When patient ceases respirations, continue to breathe for them EVERY 5-7 Seconds

Front 19

How will you Return Control whemn the Thoracic Wall is Sealed?

Back 19

1.When ready to close, give a DEEP Breathe and HOLD while Thorax is Re-Sealed.
2.Once the Seal is in place, patient can then respirate on their own. (must encourage by breathing less for them)
3.BAG the patient EVERY 12 Seconds.

Front 20

Why does returning breathing control to the patient work spontaneously?

Back 20

Build up of Carbon Dioxide (its controlled by the need to eliminate it from the body)

Front 21

Anesthetic Emergencies
What are the Risks associated with Anesthesia?
Name 6:

Back 21

1.Physical Status
2.Species
3.Breed
4.Type of Anesthesia used
5.Level of Anesthesia used
6.Age

Front 22

What are the 9 common problems you may encounter with Anesthesia?

Back 22

1.Waking UP
2.Animal is Too Deep
3.Pale MM's or Prolonged CRT
4.Respiratory Arrest
5.Cardiovascular Arrest
6.Difficult (Rough) Recovery
7.Prolonged Recovery
8.Arrhythmias
9.Malignant Hyperthermia

Front 23

WAKING UP:
Signs and Responses

Back 23

-SIGNS: kicking back legs, struggling, rigid jaw tone, return of palpebral reflex
-RESPONSES: check anesthesia & oxygen flow, turn up rates(rebreathing system), check tube is in place and cuff inflated, admin. more induction drug IV
Check if small breed:endobronchially intubated?
Is this a common problem with this machine

Front 24

ANIMAL IS TOO DEEP:
Signs and Responses

Back 24

-SIGNS: flaccid jaw tone, lack of corneal reflex, pale mm's/prolonged CRT, no tachycardia/tachypnea w/ pain
-RESPONSES: check anesthesia and oxygen flow, turn anesthetic down/off and turn up oxygen flow
*If necessary, treat shock, respiratory/cardio arrest

Front 25

PALE MM"S or PROLONGED CRT: a) SHOCK
*Note: If pale mm's but uneffected CRT= PAIN!
Signs and Responses

Back 25

SIGNS: a) SHOCK (cardio)pale mm's/prolonged CRT; indicators of excessive depth, No blood loss in surgical field
RESPONSES: Turn anesthetic down/off and turn up oxygen, administer IV fluids @ 60mL/kg/hr, treat respiratory/cardio arrest as needed

Front 26

PALE MM's or PROLONGED CRT: b) BLOOD LOSS
Signs and Responses

Back 26

SIGNS: signs of shock WITH blood loss evident in surgical field
RESPONSES: same as for shock except immediate treatment w/ IV fluids AND longer term blood component replacement (whole blood, packed RBC, plasma, hetastarch, oxyglobin)

Front 27

RESPIRATORY ARREST
(critical to know)
Signs and Responses

Back 27

SIGNS: No respirations
RESPONSES: check for HR and rhythm (if normal proceed, if not treat cardio arrest), turn off anesthetic and increase oxygen flow, bag patient every 30 seconds until respirations occur
*continue to monitor heart and other parameters for signs of increased depth

Front 28

CARDIOVASCULAR ARREST
(critical to know)
Signs and Responses

Back 28

SIGNS: No heart beat or respirations
RESPONSES: turn off anesthetic, increase oxygen flow and Initiate a "CRASH" protocol=
A airway establish
B breathing for patient (bag every 3-5 seconds)
C circulation (initiate compressions and verify catheter and IV fluids)
D drugs during crash
E ECG and evaluate for sucess of CPR

Front 29

DRUGS administered during a "CRASH" include:
Name 3

Back 29

"CRASH" Drugs:
1. Epinephrine (stimulates heart to beat; *administer intratracheally)
2. Atropine (increases HR)
3. Doxapram (respiratory stimulant)
*Reversal of all drugs possible
-medetomidine (reversal agent= atipamezole)
-narcotics

Front 30

DIFFICULT RECOVERY
Signs and Responses

Back 30

SIGNS: excitement upon recovery with excessive thrashing/vocalization
RESPONSES: restrain patient for safety, administer Medetomidine @ 0.01 mL/5lbs. IV

Front 31

PROLONGED RECOVERY:
Signs and Responses

Back 31

SIGNS: subnormal body temp, not rousing within expected time
RESPONSES: reverse any drugs possible, determine need for fluid therapy, provide heat to raise body temp, stimulate patient by rubbing and turning frequently

Front 32

ARRHYTHMIAS:
Signs and Responses

Back 32

SIGNS: ECG abnormalities
RESPONSES:
VPC-Lidocaine
AV Block-Atropine/glycopyrrolate

Front 33

MALIGNANT HYPERTHERMIA
Signs and Responses

Back 33

SIGNS: excessive body temp during recovery (often w/ drugs such as Ketamine & Halothane)
*Common in PIGS & sometimes DOGS (mostly Greyhounds)
RESPONSES: apply cooling products like cooling towels, alcohol to pads, use anti-inflammatory steroids, IV fluids, *Dantrolene administration if possible

Front 34

What are the reasons for using Endotracheal Tubes?

Back 34

-More efficient delivery of gas
-Decreases exposure to waste gases
-Reduces the amount of dead space
-Allows direct delivery of oxygen to patient (bagging)
-Insures patent airway

Front 35

What are the differences between the 5 different types of Endotracheal Tubes?

Back 35

1.RUBBER (red)-inexpensive, absorbs disinfectants causing drying and cracking, extreme flexibility increases kinking
2.VINYL (clear)-resists cracking, stiff with age
3.SILICONE-expensive, nonporous, less irritating
4.MURPHY-beveled w/ EYE near bevel to prevent complete obstruction if mucus blocked
5.MAGILL-has bevel end, but NO eye

Front 36

What are the 3 advantages of using CUFFED Endotracheal Tubes?
1 disadvantage?

Back 36

ADVANTAGES of CUFF:
1.Prevents leakage of waste gas
2.Reduces risk of aspiration
3.Prevents the breathing of room air
Disavantage:
-in small patients may cause tracheal pressure necrosis if cuff is overinflated

Front 37

Know Steps on:
HOW TO INTUBATE

Back 37

1.determine tube length/size
2.test cuff & lubricate tube
3.after induction, open mouth
4.visualize epigottis/vocal folds
5.if correct, bag will expand/contract w/ ea. breath
6.should be able to palpat tube
7.vocalization is NOT possible
8. blow into tube to ensure chest rises
9.inflate cuff
10.secure tube,tie around tube then around muzzle/head

Front 38

Problems with Intubation

Back 38

-may stimulate parasympathetic nervous sys.
-problems w/ certain breeds
-may damage larynx/pharynx
-blind intubation
-if inserted too far,
endobronchial intubation thus only ventilating 1/2 lung fields
-pressure necrosis
-fluid obstruction of tube (blood, mucus, saliva,foreign),or kinking tube
-spread of bacteria

Front 39

Specific Intubation Problems with CATS

Back 39

**-Tracheal tears are the #1 cause of problems with endotracheal tube placement in cats. To Prevent:
-dont be over aggressive, disconnect when moving cat, use Lidocaine everytime to prevent laryngospasm, dont overinflate the cuff