1 / 32

MAINTAINING ANESTHESIA

MAINTAINING ANESTHESIA. MONITORING. Involves both vital signs and reflexes Can be done with or without machines. VITAL SIGNS. Tell us how well a patient is maintaining homeostasis through respiration & circulation

ismet
Download Presentation

MAINTAINING ANESTHESIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MAINTAINING ANESTHESIA

  2. MONITORING • Involves both vital signs and reflexes • Can be done with or without machines

  3. VITAL SIGNS • Tell us how well a patient is maintaining homeostasis through respiration & circulation • Often grouped according to whether they reflect circulation, oxygenation, or ventilation • For example, values that reflect _____________are: HR, heart rhythm, pulse strength, CRT, mucous membrane color, and blood pressure • Values that reflect _______________ are:mucous membrane color, hemoglobin saturation with oxygen, measurement of arterial blood oxygen • Values that reflect ______________are:RR, respiratory depth, breath sounds, expired CO2 levels, measurement of arterial CO2

  4. MONITORING WITHOUT INSTRUMENTATION THE MOST IMPORTANT MONITORING TOOLS ARE YOUR HANDS, EYES, & EARS! MACHINES WILL FAIL! ONLY RELY ON MACHINES FOR VALUES THAT YOU CANNOT GET ON YOUR OWN(blood pressure, ECG, SPO2)

  5. HEART RATE AND RHYTHM • Anesthetic agents are expected to lower the heart rates of patients • While under anesthesia, the following heart rates are appropriate for dogs: • Large dogs: ____________beats per minute • Small dogs: _____________per minute • Notify the vet if heart rates are outside these ranges • While under anesthesia, the following heart rates are appropriate for cats: • _____________ beats per minute

  6. OPTIONS FOR CARDIAC MONITORING ___________________ ______________ _______________________________

  7. ESOPHAGEAL STETHOSCOPE An esophageal stethoscope is a thin, flexible tube that is attached to a regular stethoscope. Lubrication is applied to the end of the tube which is placed in the oral cavity and down the esophagus until a heartbeat is heard. This allows a person to listen to the heart on an animal that is draped in for a surgical procedure

  8. CAPILLARY REFILL TIME • Provides information about ___________________ • A normal CRT does not guarantee that the patient is normal, however a prolonged CRT (longer than 2 seconds) means that tissue perfusion is not adequate • Possibly due to vasoconstriction, hypotension, hypothermia, heart failure, shock, or increased anesthetic depth

  9. MUCOUS MEMBRANE COLOR • IDEALLY, COLOR SHOULD BE PINK! • If gums are pigmented, look at the conjunctiva, or the inner prepuce or vulva • If pale, there may be blood loss, anemia, or poor perfusion • _______________: purple or blue discoloration= EMERGENCY! • _______________: yellow discoloration, may indicate severe liver disease or hemolysis

  10. PULSE STRENGTH • Can be done at the lingual, femoral, metacarpal/metatarsal, and dorsal pedal arteries • Should be strong and match the heart beat • Weak pulses may indicate hypotension • CAUSES: ______________________, ________________, & _______________________________

  11. EVALUATING BLOOD LOSS • Excessive blood loss can cause complications such as shock • One soaked3x3 gauze = ~_________mLofblood • One soaked 4x4 gauze= ~_______mLblood • The actual amount lost may be more due to clotting or pooling of blood • Healthy animal can tolerate ~ _______mL/kg blood loss during surgery

  12. Intra-abdominal blood clot Intra-abdominal blood pooling

  13. RESPIRATORY RATE AND DEPTH • Normal breaths are smooth and regular, not gasping or labored • DO NOT FORGET TO USE YOUR STETHOSCOPE TO EVALUATE BREATH SOUNDS! • Should not hear crackles or wheezes

  14. RESPIRATION RATE AND DEPTH • Anesthetic agents are expected to reduce the _______________________, which is the amount of air inhaled with each breath. • Can be evaluated by watching the patient’s chest or the reservoir bag on the anesthetic machine • Normal values while under anesthesia for dogs & cats: _________ bpm

  15. RESPIRATORY RATE & DEPTH • Hyperventilation: Increase in respiratory depth • Tachypnea: increase in respiratory rate • Causes of hyperventilation and/or tachypnea: • ___________________________________ • ___________________________________ • ___________________________________ • ____________________________________

  16. RESPIRATION RATE AND DEPTH • __________________________refers to the process of manual ventilation. • Gentle squeezing of the reservoir bag causes oxygen and/or anesthetic gas to be forced into the patient’s lungs

  17. RESPIRATION RATE AND DEPTH • Reasons to manually ventilate (“bag the patient”): • _________________________________. If an animal is waking up, manually forcing anesthetic gas into the lungs will cause it to fall asleep more rapidly • _________________________________If the respiratory rate is low, we can provide manual breaths ~q20 seconds to increase the rate • _________________________________. Atelectasis refers to the collapse of alveoli

  18. THERMOREGULATION • _____________________is the most common anesthetic problem • Begin prevention from the moment the animal is induced. • The greatest decrease in body temperature is within the first _________ minutes of anesthesia.

  19. THERMOREGULATION • The following event related to anesthesia can decrease body temperature: • Check the patient’s temperature at least every 30 minutes if there is not an esophageal probe available. In between temp checks, feel the animal’s extremities

  20. THERMOREGULATION • Several methods to avoid hypothermia:

  21. Circulating warm water heating pad Fluid line warmer Self-warming surgery table

  22. Bair Huggers

  23. THERMOREGULATION • Excessive efforts to warm a patient could cause thermal injuries. • Always place towels between the patient and the heat source!

  24. THERMOREGULATION • Some patients, usually cats, will become hyperthermic post-operatively. This is due to the effects of some drugs such as ketamine and opioids. • If the temp reaches 103.5˚ or higher, we should begin cooling methods. • Taking all blankets/towels out of the cage • Putting a fan in front of the cage • Wiping the patient down with a wet washcloth • Applying alcohol to the footpads.

  25. REFLEXES Reflexes are involuntary reactions to a stimulus It is also important to monitor reflexes, which will help you determine the stages and planes of anesthesia.

  26. __________________ Reflex Touch the corner of the eyelids and the animal blinks. The palpebral reflex is stimulated by tapping the skin at the medial canthus of the eye or by running the finger along the eyelashes. This disappears in light to medium plane of surgical anesthesia in small animals.

  27. ____________________ (Swallowing) Reflex • Simulation of the larynx will cause the animal to swallow. This is a mechanism to prevent accidental aspiration of fluids into the lungs. • passing an endotracheal tube should be possible without this reflex

  28. __________________ Reflex Pull a limb gently, pinch the toe and the animal will pull back the limb. The reflex is obtained by firm pressure of the interdigital skin in the dog and cat, squeezing the claws together in cattle and swine and firm pressure on the pastern of horses. The reflex disappears late in phase III and indicates deep anesthesia. When checking the reflex, the legs should be held in extension. Probably more useful in monitoring laboratory animal patients and birds.

  29. __________________________Reflex Shine a light in the eye and the pupil constricts. The pupillary responses under anesthesia are heavily influenced by pre-medication. Species variations exist. There is also variability in response to different anesthetics. In general, in un-premedicated patients, the pupil is dilated in the early excitement phase and then becomes progressively constricted as surgical anesthesia occurs. With very deep surgical anesthesia the pupil begins to dilate again and with entry into phase IV, with respiratory and cardiac arrest, the pupil is maximally dilated.

  30. ____________________Reflex Touch the cornea and the animal blinks. Be careful not to damage the cornea if this reflex is tested. The corneal reflex is obtained by gentle palpation of the lateral aspect of the cornea. This causes reflex closure of the eyelids. The reflex disappears in the deeper levels of phase III, plane II. This reflex is not always reliable in the dog, particularly if the eyeball is markedly rotated.

  31. _________________________REFLEX Pinnal reflex used in cats. Gently touch the hair on the inner surface of the ear and watch the pinna twitch. Don’t test too frequently or the reflex will be inaccurately lost.

More Related