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ANESTHESIA > 23 – Complications > Flashcards

23 – Complications Flashcards

(51 cards)

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1
Q

3 broad categories of complications?

A
  1. Anesthesia related
  2. Procedure related
  3. Patient specific
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2
Q

What are the anesthesia related complications?

A
  • Hypothermia
  • Hypotension
  • Hypoventilation (hypercapnia)
  • Hypoxemia
  • Bradycardia
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3
Q

What are some procedure related complications?

A
  • Pain
  • Hemmorrhage
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4
Q

What are some specific patient complications for a brachycephalic breed?

A
  • Upper airway obstruction
  • Regurgitation/vomiting ->aspiration
  • Hyperthermia
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5
Q

What is the normal PaO2 and FiO2?

A
  • PaO2= 80-11mmHg
  • FIO2=21%
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6
Q

What is the normal saturation of hemoglobin (SpO2)?

A
  • 97-100%
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7
Q

What values for PaO2 and SpO2 indicate hypoxemia?

A
  • PaO2<60mmHg
  • SpO2<90%
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8
Q

What are some causes of hypoxemia and low SpO2?

A
  • Low inspired O2 (FiO2)
  • Hypoventilation
  • Diffusion problem (pulmonary disease)
  • Ventilation perfusion (V/Q) mismatch
  • Right to left shunt
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9
Q

What are the clinical effects of mild hypoxemia (SpO2>80%)?

A
  • Activation of SNS
  • Increase HR
  • Mild hypertension
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10
Q

What are the clinical effects of moderate hypoxemia (SpO2: 60-80%)?

A
  • Local vasodilation ->hypotension
  • Reflex increase in HR
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11
Q

What are the clinical effects with severe hypoxemia (SpO2<60%)?

A
  • Local depressant effects predominate
  • Rapid decrease in BP ->severe hypotension
  • Bradycardia -> ventricular fibrillation or cardiac arrest
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12
Q

What are the consequences of hypoxemia?

A
  • Tissue hypoxia
  • Lactic acidosis
  • Organ failure
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13
Q

What are the high risk patients for hypoxemia?

A
  • Brachycephalic
  • Diaphragmatic hernia
  • Pneumothorax, pulmonary contusion
  • Upper airway obstruction
  • Pneumonia
  • Abdominal distance (C-section)
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14
Q

What can you do for high risk patients to hypoxemia prior to anesthisa?

A
  • Pre-oxygenation!
  • NO contra-indication to oxygen
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15
Q

What are some causes of hypoxemia?

A
  • Low inspired O2 (FiO2)
  • Hypoventilation
  • Ventilation perfusion mismatch and intrapulmonary shunting
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16
Q

Low inspired O2 (FiO2)

A
  • Check O2 supply
  • Check endotracheal tube
  • Check that breathing system is tight to ET-tube
  • Airway obstruction: remove or bypass
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17
Q

What is the definition of hypotension (SAP, MAP, DAP)?

A
  • SAP<80mmHg
  • MAP<60mmHg
  • DAP<40mmHg
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18
Q

What is the minimal acceptable MAP for large animals?

A
  • MAP=70mmHg (myopathy)
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19
Q

What are 3 basic pathophysiological mechanism that lead to hypotension?

A
  • Decreased vascular tone
  • Decreased CO
  • hypovolemia
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20
Q

What do you do if patient is hypotensive?

A
  1. Check depth of anesthesia
  2. Check HR
  3. Fluid bolus
  4. Ephedrine
  5. Add positive inotrope – dobutamine
  6. *last resort: add a vasopressor
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21
Q

Check depth of anesthesia

Study These Flashcards
A
  • Decrease vaporizer setting
  • Maybe need to administer anesthetic sparing drugs
    o Opioid: no CV side effects
22
Q

Check HR

Study These Flashcards
A
  • Treat bradycardia (1/2 resting HR)
    o Can decrease CO
  • Slow normal HRs do not usually affect CO
  • *treatment: atropine, glycopyrrolate
23
Q

Fluid bolus in hypotension recommendations for cats and dogs

Study These Flashcards
A
  • Cats: 3ml/kg over 15 mins
  • Dogs: 5ml/kg over 15 mins
24
Q

Why give a fluid bolus (crystalloid fluids: isotonic balanced)?

Study These Flashcards
A
  • Increase intravascular volume and improves venous return
  • Repeated once if needed
25
When would you give a colloid bolus?
- If response to crystalloid fluids is inadequate - Maximum dose 20ml/kg/day - Pentaspan 6%
26
When would you give a hypertonic saline (7.5%)?
- 4mL/kg over 10 min (duration 30-120min) - Blood loss - Need of rapid volume expansion
27
Ephedrine
- Synthetic noncatecholamine=stimulates alpha1 and beta1 receptors - Indirect acting: release of endogenous NE - Vasoconstrictor/venoconstrictor - *effects last up to 15mins
28
Add positive inotrope – dobutamine
- Beta1 agonist=increases myocardial contractility - Useful for low CO stages in patients with ADEQUATE intravascular volume - Used as an infustion (short half life) - Less risk of cardiac arrhythmias
29
What are 2 options for the last resort of adding a vasopressor
- NE infusions - Vasopression infustions
30
NE infusions as a last resort
- Alpha1 constictor - May dimmish visceral organ perfusion (liver, kidneys) - Try to limit to emergency use only - Treatment for refractory hyptension (septic patients)
31
Vasopressin infusions
- Non-catecholamine vasopressor - Used for refractory hypotension - Very sick patents of post cardiac arrest
32
What are some causes of bradycardia?
- Drugs: alpha2 agonists, opioids - Deep plane anesthesia - Hypothermia - Vagal reflexs (oculo-cardiac reflex) - Electrolyte imbalance
33
What are the different forms of bradycardia?
- Sinus bradycardia - AV block - Sinus arrest - Ventricular escape beats - Asystole (NO P waves)
34
Tachycardia rates in dogs and cats
- Dog >180bpm - Cat >200bpm - *correct the underlying problem
35
Tachycardia is a sympathetic response to
- Pain - Awareness - Hypotension - Hypoxemia - Hypercapnia - Hypovolemia
36
What do you treat a ventricular premature complex with?
- Lidocaine bolus
37
What do you treat sinus bradycardia with escape beats?
- Atropine or glycopyrrolate - *goal is to increase HR as the escape beat is due to slow sinus rate
38
What are some predisposing factors to regurgitation?
- Brachycephalic breeds - Drugs relaxing LES (volatiles, opioids, anticholinergics, propofol) - Increased intra-abdominal pressure: pregnancy, obestity , surger, head-down position - Prolonged anesthesia
39
What are some preventative measures for regurgitation?
- Appropriate pre-anesthetic fasting - Pretreatment with OMEPRAZOLE, maropitant, metoclopramide - Use of cuffed ET-tube
40
How do you treat regurgitation?
- Secure airway in unconscious patient: check cuff - Place suction catheter in esophagus - Suction refluxate and lavage with tap water - Instillation of 5-10ml Na-citrate solution - Check and suction again prior to extubation - *pantoprazole, famotidine
41
What does mild hypercapnia (45-60mmHg) cause?
- SNS: tachycardia, mild hypertension
42
What are the clinical signs that are usually seen when PaCO2>60mmHg?
- Bounding pulses (high systolic, low diastolic) - Vasodilation: brick red colour, capillary oozing
43
What are the clinical signs that are seen with sever hypercapnia (PaCO2>90mmHg)
- Severe CNS depression (narcosis) - Respiratory arrest (depression of brainstem)
44
What are some causes of hypercapnia?
- Hypoventilation - Equipment failure - Endobronchial intubation - V/Q mismatch - Apparatus dead-space (overlong ET-tube) - Increased CO2 production (hyperthermia)
45
When does hypoventilation occur?
- Respiratory depressant drugs - Position (dorsal) - Abdominal distension - Obesity
46
What are some equipment failures that can occur that cause hypercapnia?
- Uni-directional (one-way) valves (circle systems) - CO2 absorber exhausted - Inadequate fresh gas flow (non-rebreathing system)
47
What are some way to prevent heat loss?
- Insulation - Warming mats - Warm air blankets - Radiant heat lamps - Warm IV fluids/irrigation fluids
48
What are some potential problems with warming devices?
- Patient cannot move away from the source - Blood flow may no conduct heat away - Body pushed into heat source - *always observe and monitor T - Avoid direct contact to avoid burns o Use towel for insulation
49
What are some circumstances where hyperthermia occurs?
- Heavy-coated dogs on circle rebreathing system - Post op in cats o If used mu-opioids, ketamine, intra-op hypothermia - Malignant hyperthermia
50
What is the treatment for hyperthermia?
- Turn of supplemental heat, remove blankets, ice packs - Water, alcohol to inguinal and axillary regions - Fans: careful corneal ulcers - Acepromazine?
51
What is important with extubation in brachycephalic breeds?
- Late extubation to avoid airway obstruction - *BE PATIENT - * keep period between extubation and full alertness as SHORT as possible

ANESTHESIA (27 decks)

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