Revision 2, pre- & postoperative care

Question 1

Anesthesia related mortality in different species (also possible reasons and prevention)

Answer 1

Dogs 0,17%, 1:600
* ASA I-II: 0,05%
* ASA III-IV: 1,3%

Cats 0,24%, 1:400
* ASA I-II: 0,11%
* ASA III-IV: 1,4%

Reasons:

• Small animal
  1. Hypothermia
  2. Overhydrating
• Uncooperative behaviour
• Cats prone to laryngospasm
• Sensitivity to local anesthesia drug toxicity
• Reduced glucuronidation (slower drug metabolism)
• Rabbits 1:70
• Horses 1:100
• Humans 1:100000

Question 2

Preoperative care

Answer 2

• Planning for and anticipating complications is necessary to minimize the chance of
  adverse events

Several details require attention:
* Thorough anamnesis
* Full clinical examination
* Laboratory data
* Patient stabilization
* Determination of surgical risk
* Client communication

Steps:
* Clinical examination
- Evaluating of risks and the necessity of further diagnostics tests
- Diagnostics tests:
Recommended at least:
1. Packed cell volume
2. Total protein
3. Glucose
4. Urea

• Stabilization:

1. Optimizing hemodynamics if possible
2. Optimizing respiratory function (also preoxygenation)
3. Optimizing hydration status (fluid therapy)
4. Preoperative fasting
   - Reduced possibility of vomiting, gastrointestinal reflux and
   consequently aspiration
   - Fasting of 2-4 hours for water and 6-8 hours of food should be enough in most cases
5. Analgesia and sedation
6. Thermoregulation
   - Hypothermia most common complication of anesthesia
7. Positioning

Question 3

Postoperative care

Answer 3

Concerns:
* Pain
* Anxiety
* Cardiorespiratory function
- BP
- Oxygen saturation
* Temperature
* Procedure-related factors
* Wound protection
* Postoperative periods should be made as pleasant as possible

• Highest death rate 3 hours after extubating
• Patient has to be closely monitored until it:
• Has been extubated
• Is laying on sternum, head elevated
• Is able to swallow, has normal ocular reflex
• Has a strong pulse and regular peripheral pulse
• Has an oxygen saturation of >94%
• Has no suspicion of upper airway obstruction
• Has effective analgesia
• Has no evident bleeding
• Important:
• Pain management
• Nutritional management
• Wound care
• Care related to surgical procedure
• Exercise restriction
• Immobilization
• Other care if possibilities
• Home care – instructions necessary!