A&E in anaesthesia

Question 1

Why might you get tachycardia, hypotension and apnoea immediately after propofol administration?

Answer 1

The induction agent was administered too quickly

Question 2

What should you do next if you get tachycardia, hypotension and apnoea immediately after propofol administration?

Answer 2

Administer 1-2 breaths and give the patient time to start breathing spontaneously

Question 3

What happens if a capnograph wave does not drop to zero for inspired CO2? What should you do?

Answer 3

the dog is rebreathing –> check the soda lime and the breathing system

Question 4

What might cause tachycardia one hour into a surgery? 7

Answer 4

• pain
• light anaesthesia
• hypovolaemia
• hypotension
• hypoxaemia
• hypercapnia
• hyperthermia

Question 5

What should you do to determine why an animal has become tachycardic under GA?

Answer 5

• palpate pulse
• take BP
• look at MM colour
• evaluate blood loss
• evaluate anaesthetic depth
• check pulse oximeter, capnograph, blood gas (O2 and CO2)

Question 6

How can you estimate blood loss?

Answer 6

• count swabs (hold 5-8ml of blood each)
• DOG = 80-90ml/kg normal blood
• CAT = 60-70 ml/kg normal blood

Question 7

What might you do in the case of blood loss causing tachycardia under GA? 5

Answer 7

• calculate blood loss
• administer a bolus of crystalloid fluid (if doesn’t work use a colloid, if not give a blood transfusion)
• decrease anaesthetic depth
• switch anaesthesia to a less cardio-depressant drug
• last resort = start a dopamine infusion to increase BP

Question 8

Why might you have a central eye position and a brisk palpebral reflex?

Answer 8

the depth of anaesthesia is too light (immediate actin = increase the vaporiser setting, then possibly administer more analgesia)

Question 9

T/F: morphine causes respiratory depression

Answer 9

True

Question 10

What should you do if you see an overinflated bag?

Answer 10

open the pop-off valve to relieve the pressure

Question 11

What happens if the pop-off valve is closed? 2

Answer 11

• gas flow from flowmeters has nowhere to escape

- increased intra-thoracic pressure as lungs inflate

Question 12

What does increased alveolar pressure cause? 4

Answer 12

• compression (collapse) of pulmonary capillaries (reduced preload)
• compression of heart chambers (decreased filling)
• compression of aorta (increased afterload) –> dramatic reduction in CO –> circulatory arrest
• alveolar damage/rupture

Question 13

What should you check for after increased intra-thoracic pressure? 4

Answer 13

• check for pneumothorax
• check HR goes back up to normal
• check MM, SpO2
• check for other problems too

Question 14

Why might the SpO2 reading be too low? 3

Answer 14

• there is an obstruction of the ETT (commonest cause in cats because it is a small tube)
• medetomidine-induced vasoconstriction
• anaemia

Question 15

Why might airway obstruction occur? 3

Answer 15

• kinking of the ETT
• material within the ETT
• overinflation of the tube cuff
• ACTION: remove the ETT to check if obstructed.

Question 16

List causes of prolonged anaesthetic recovery - 7

Answer 16

• hypothermia
• hypoglycaemia
• hepatic or renal failure
• very thin/fat animals
• hypovolaemia
• hypotension
• cardiovascular collapse
• If no recovery = brain death (brain hypoxia)*

Question 17

Why might a cat have a ruptured trachea when under GA? 2

Answer 17

• cuff overinflation

- problems intubating the cat

Question 18

What should you do if you suspect a cat has a ruptured trachea?

Answer 18

take xray to check for pneumomediastinum or pneumothorax (depending on whether the rupture was cranial or caudal to the carina). Place chest drain +/- repair (if large).

Question 19

Define CPCR

Answer 19

Cardiopulmonary cerebral resuscitation

Question 20

What are the 3 main steps in CPCR?

Answer 20

• Intubation
• Ventilation
• Cardiac massage (for 2 minutes then check ECG to see if anything is occurring)

Question 21

How many people do you need for CPCR?

Answer 21

3 people:
1.) feel pulses
2.) ventilate
3.) CPCR 
Swab round as CPR is hard work.