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Year 3 MOD > Anaesthesia: Essentials of Monitoring and Intraoperative Complications > Flashcards

Anaesthesia: Essentials of Monitoring and Intraoperative Complications Flashcards

1
Q

What is the aim of monitoring?

A

To have the triad of:
Unconsciousness
Analgesia
Muscle relaxation

Also to maintain physiology, anaesthetic depth, prevent suffering and there are legal implications

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2
Q

Why is monitoring essential?

A

There is a risk of anaesthetic related mortality

Too light and the animal might climb off the table

Too deep leads to deteriorating function and possibly death

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3
Q

How can a patient be monitored using minimal technology?

A

Using our senses

  • Touch- pulse, thoracic excursions
  • Smell- smell of isoflurane
  • Hear changes in breathing pattern
  • Monitoring versus measuring
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4
Q

How can the CNS me monitored with minimal technology?

A

Reflexes- palpebral, corneal

Anal tone

Eye position and movement

Lacrimation

Changes in autonomic tone: sweating/CV changes

Muscle tone- tension un muscles

Movement- light- could be about to die

Response to surgical stimulation

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5
Q

How can the CV system be monitored with minimal technology?

A

Auscultate, palpate and observe

Pulse/HR- dogs 50-100, horse 20-40, cat 80-160

Pulse quality- subjective

MM: colour indication of oxygenation and perfusion

CRT- indicator of blood volume and capillary tone

Haemorrhage

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6
Q

How can the respiratory system be monitored with minimal technology?

A

Listen, observe, touch and smell

Rate- horse 4-10, Dog 10-20, Cat 15-30

Rhythm

Ausultation

Reservoir bag movement

MM colour

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7
Q

Name some every day equipment that can be used for monitoring

A

Stethoscope- oesophageal stephoscope for auscultation of the heart and lung sounds even with drapes

Thermometer- rectal- avoid hypo/hyperthermia

ECG- no information about cardiac input

Arterial blood pressure

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8
Q
A
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9
Q

What is normal arterial systollic pressure, diastollic pressure and mean pressure?

A

Systollic- 80-140mmHg

Diastollic- 50-90mmHg

Mean- 60-90mmHg

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10
Q

What is the gold standard for arterial blood pressure?

A

Invasive blood pressure

Gold standard, continuous readings

Takes time to place indwelling arterial cannula

Expensive equipment

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11
Q

//What is pulse oximetry and what are its limitations

A

SpO2

Measures % saturation of haemoglobin

Normal is above 95%

Limitations: Hypoperfusion/vasoconstriction, bright lights, movement, anaemia

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12
Q

What species can the dopples be useful for?

A

Exotics

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13
Q

What is capnography, what are its uses and limitations?

A

Measures end tidal CO2

Normal is 35-45mmHg, inspired CO2 should be 0

Other uses- correct ETT placement, confirms cardiac output, indicates problems with breathing systems

Limitations- can become kinked/clogged, delay in reading

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14
Q

What is blood gas analysis?

A

Arterial (or venous) sample of blood

The gold standard for gas analysis

High cost of equipment

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15
Q

What are the common factors that cause complications during anaesthesia?

A

Patient factors- species, breed, weight and age

Anaesthetisa factors

Procedure factors

Systems affected- CNS, CV, Resp, renal and hepatic

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16
Q

What are the common complications of anaesthesia?

A

Three Hs

Hypotension

Hypothermia

Hypoventilation- hypercapnia, hypoxaemia

Others- bradycardia, tachycardia

17
Q

What is the mean arterial pressure and what would it be if the patient was in hypotension?

A

MAP >60 to maintain vital organ perfusion

Hypotension- MAP <60 or Systolic AP <90

18
Q

What are the causes of hypotension during anaesthesia?

A

Reduced cardiac output- reduced stroke volum/HR

Reduced systemic vascular resistance

19
Q

How should hypotension be treated during GA?

A
  1. Check cuff- repeat reading
  2. Check plane of anaesthesia and reduce
  3. Check HR- treat if low
  4. Give fluid therapy- crystalloids 10ml/kg over 10-15 mins
  5. Drugs- vasopressors, positive inotropes
  6. Change position
  7. Stop ventilation
20
Q

What are the potential consequences of hypotension?

A

Organ/tissue damage- acute kidnet injury and myopathy

Severe hypotension- poor perfusion of the heart- arrhythmias, death

21
Q

What patients are more prone to hypothermia and what are the causes during GA?

A

Small patients are more prone

Causes: increased heat loss, reduced heat production, abolished behavioural responses, alterations in hypothalamic function

22
Q

How can hypothermiabe prevented?

A

Pre-op warming

Blankets

Bubble wrap

Warm air

Heated mats

Heat and moisture exchanger

most effective if started before anaesthesia

23
Q

What are the consequences of hypothermia?

A

Cardiovascular and haematological:

Arrythmias can be fatal, coagulopathies, reduced immine function- post op infection

Metabolic:

Reduced drug metabolism- prolonged effects and delayed recoveries
Shivering increases O2 demand

24
Q

What can hypoventilation lead to?

A

Hypercapnia- increased CO2

Hypoxaemia- Hypoxaemia

25
Q

What are the causes of hypoventilation?

A

Effects of drugs on CNS and respiratory muscles

Positional changes- Dorsal v sternal recumbancy

26
Q

What is hypercapnia?

How can it be confirmed?

At what level should treatment be supplied?

A

Increased CO2 in blood

Measured either- sampling arterial blood or via capnography

Normal 35-40, Hypercapnia is >45mmHg

Treatment if >60mmHg

27
Q

What are the causes of hypercapnia?

A

Hypoventilation- main cause

Breathing systems- non-rebreathing, not enough FGF, exhausted soda lime

28
Q

How is hypercapnia treated?

A

Increase minute ventilation- MV

Lighten plane of anaesthesia- reduce vaporiser setting, reduce drug administration

Mechanical ventilation- squeezing of reservoir bag- IPPV

29
Q

What is hypoxaemia?

How is it diagnosed?

When is treatment needed?

A

Reduced O2in the blood

Measured by sampling arterial blood or pulse oximiter

Treatment if SpO2 <90mmHg or PaO2 <60

30
Q

What causes hypoxaemia during anaesthesia?

A

Not enough O2 delivery

Profound hypoventilation

Impaired gas exchange- disease, positional compression

Airway obstruction

Severe hypovolaemia ‘shock’

31
Q

How is hypoxaemia treated?

A

Increase O2 delivery to 100%

Start mechanical ventilaiton

Increase gas exchange- bronchodilation, nor dorsal, head up

Check ET tube for mucus/blood clots

Restore circulating volume- fluids, vasopressors

32
Q

What are the causes of bradycardia during anaesthesia?

A

Increased parasympathetic activation- drugs, vagal response

Hypothermia

Disease- hyperkalaemia, raised inta cranial pressure

33
Q

What are the consequences of bradycardia?

A

Reduced cardiac output

Reduced blood pressure

Reduced perfusion- organ/tissue damage

34
Q

How is bradycardia during anaesthesia treated?

A

Not due to disease, depends on blood pressure

If MAP >60 no need

If below 60- atagonise drugs, give parastympatholytics

If due to disease- treat underlying disease

35
Q

What casues tachycardia during anaesthesia?

A

Increased sympathetic tone- pain

Hypovolaemia

Hyperthermia

Hypercapnia

36
Q

What are the consequences of tachycardia?

A

Cardiac dysfunction- heart failure, malignant arryhtmias, death

37
Q

How is tachycardia during GA treated?

A

Pain= analgesics

Hypovolaeamia- restore circulating volume

Hyperthermia- cool

Hypercapnia- reduce anaesthetic plane, start ventilation

If severe can use beta blockers and lidocaine

Year 3 MOD (40 decks)

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