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42 Cards in this Set
- Front
- Back
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Pre-anesthetic patient Eval |
ID individual risk factors underlying physiological abnormalities develop individul anesthetic plan |
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Dogs and cat fasting |
6-12 hours no food; free choice water until procedure decreaes risk of regurge/aspiration |
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<4 months pre anesthetic fasting |
fast ~ 4 hours; risk of hypoglycemia |
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Prevention of peri-anesthetic nausea and vomiting |
cerenia for dogs!= results in faster return to feeding as well |
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equine fasting |
6-12 hours; access to water |
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importance of fasting in equines |
horses do not vomit weight of GI contents increases pressure on diaphragm and limits lung expansion= decrease ventilation = decrease arterial oxygen= increase arterial CO2= ventilation--perfusion mismatch |
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Ruminant fasting |
24-48 hours food fasting; 12-24 hours water restriction |
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Importance of fasting Ruminant |
regurgitation and aspiration BLOAT= incrased pressure on diaphragm, limits lung expansion= decreased ventilation= decrease O2 and increased CO@ in arterial blood= ventilation-- perfusion mismatch |
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Small Ruminant fasting |
12-24 hours food, +/- water |
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Ruminants <4 weeks |
fast only 2-4 hours, nursing, monogastrics are less prone to regugitation |
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patient prep success begins.... |
signalment, history, P.E>, lab tests and diagnostic tests |
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Signalment breed concerns for SX |
bracycephalic= upper airway obstruction greyhounds and drug metabolism, collies and MDR1 cardiac DQ prone cats malignant hyperthermia - some swine QH and hyperkalcemic periodic paralysis draft horses and laryngeal hemiplegia |
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Age and surgery concerns |
geriatric= less organ reserve pediatric= risk for hypothermia, hypoglycemia and low drug metabolism |
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sex/neuter status and SX |
related to temperament and metabolic differences |
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all body systems should be evaluated but... which 3 should be our focus? |
cardiovascular, respiratory and CNS |
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lab data <5 years old |
big 4= BG, PCV, TP, azostrip |
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LAb data >5-7 years |
CBC, Chem, U/A |
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Radiographs and SX |
check for metastasis- thoracic heart DZ/ murmuer- echocardiogram or thoracic rads trauma= thoracic and abd. rads |
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physical status 1 |
healthy no disease |
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physical status 2 |
healthy, localized or mild systemic Dz (i.e. patellar lux, cruciate) |
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physical status 3 |
moderate systemic DZ (i.e. murmur, anemia) |
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Physical status 4 |
severe systemic disease, life threatening ( heart or liver failure) |
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physical status 5 |
moribund, not expected to live >24 hours |
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proper pre-operative patient prep |
rehydration= correction acid/base, electrolyte abnormalities, anemia, hypoproteinemia correct co-morbidities= pneumothorax will help patient better compensate during anesthetia and surgery |
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some procedures that may result in immediate anesthesia and surgery |
-elective outpatient procedure (excellent prognosis and PS 1-2 -Continued blood loss- splenic tumor rupture, gutteral pouch mycosis -acute abdomen- colon torsion colic or gastric dilation/volvulus |
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a complete anesthetic plan addresses: |
pre &post operative sedation/tranquilization perioperative analgesia induction and maintenance drugs ongoing physiological support monitoring plan anticipation and response plan to adverse events or complications |
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premed sedation and analgesia: Advantages |
decreased patient and staff stress Ease of handling decreased induction and inhalant anesthetic doses pre-emptive analgesia |
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premed sedation and analgesia: Disadvantages |
bradycardia hypotension excitement/dysphoria *disadvantages mitigated by selecting most appropriate drug or combo of drugs |
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Dog premed sedative |
acepromazine dexmedetomidine midazolam/diazepam |
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Dog premed opioid |
butorphanol buprenorphine hydromorphone morphine methadone fentanyl |
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Cat premed sedative/analgesic |
dexmedetomidine and an opioid (butorphanol,buprenorphine, methadone, hydromorphone) ketamine or telazol |
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equine premed sedative + opioid |
alpha 2 agonist (xylazine, detomidine, romifidine) butorphanol non-steroidal anti-inflammatory drugs (NSAID) -phenylbutazone, flunixin |
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Benzodiazepines and pure mu agonist opioids can cause excitement in... |
HORSES |
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Cattle PRemed |
may or may not be needed xylazine (1/10 equine dose) butorphanol- behavior changes such as restlessness and bellowing |
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Goats and sheep premed |
butorphanol +/- benzodiazepine +/- xylazine (only healthy patients, can cause hypoxemia in sheep) |
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anesthetic induction- dog |
propofol, ketamine/benzodiazepine, alfaxalone |
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anesthetic induction- cats |
propofol, ketamine/benzodiazepine, alfaxalone |
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anesthetic induction- horses |
ketamine/benzodiazepine, +/- guafenasin |
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anesthetic induction- cattle |
triple drip: guafenasin, xylazine, ketamine double drip: GG, ketamine |
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Anesthetic induction- sheep/goats |
ketamine/benzodiazepine |
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post-op plan recovery |
sedation, analgesia, airway protection, hypoxemia |
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anesthetic related complications |
hypotension, cardia arrhythmia, cardiac arrest, respiratory insufficiency=> hypoventilation and hypoxemia hypothermia > hyperthermia myopaty/neuopathy - equine/cattle |
