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Applied Clinical Veterinary Nursing > Anaesthesia for Airway, Dental and Ocular Surgery > Flashcards

Anaesthesia for Airway, Dental and Ocular Surgery Flashcards

(105 cards)

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1
Q

what are the main concerns with dental surgery?

A

access to face and mouth limited - difficult to check depth

patients commonly geriatric with underlying conditions

lots of water - aspiration risk, can become very cold

often final procedure of day when staff are tired

dentistry can be very painful

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2
Q
A
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3
Q

what are the anaesthetic considerations for dental surgery?

A

pain
haemorrhage
hypothermia
aspiration of water/fluids
length of procedure
concurrent diseases

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4
Q

why is it difficult to assess blood loss during dentals?

A

usually mixed with water - looks like more than it is

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5
Q

what are the the anaesthetic concerns for geriatric patients undergoing dental surgery?

A

reduced CV reserve
reduced FRC
reduced muscle mass, increased fat tissue
prone to hypothermia
may have reduced kidney +/- liver function

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6
Q

what does it mean if a patient has reduced CV reserve?

A

baroreceptor function may be reduced - more prone to hypotension

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7
Q

what does it mean if a patient has reduced FRC?

A

more prone to hypoxia

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8
Q

what should we consider in older patients which might have reduced liver/kidney function?

A

consider drug dosages - may have less or exacerbated effects/length of action

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9
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A
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10
Q

what pre-op considerations might we have for patients undergoing dental surgery?

A

full clinical exam
blood/urine testing
consider other disease processes
anorexic? (common in cats with dental disease)
any other diagnostic testing (U/S, x-ray, ECG)

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11
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A
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12
Q

what can we use for MAC sparing in dental procedures?

A

adequate analgesia
local blocks

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13
Q

what are our airway considerations when anaesthetising a patient for a dental procedure?

A

cuffed ET tube essential
mouth pack to avoid AP
care when turning patient - check for fluid in mouth
observe tube to ensure not kinking or twisting

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14
Q

what are the perioperative considerations for dental procedures?

A

protect airway - cuffed ETT, throat pack

long procedure - consider patient temperature, drug top-ups if req

look after the eyes (patient and staff)

haemorrhage

consider patient positioning

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15
Q

how can we make patients more comfortable during/after dental procedures

A

pad joints to avoid sores
consider effects of atelectasis
tube care when moving

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16
Q

what is the advantage of local blocks for dental procedures?

A

dentals are painful - blocks will reduce maintenance anaesthetic requirements

improve post-op pain management

may improve speed of recovery (eating)

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17
Q

what are the 4 main dental nerve blocks?

A

rostral maxillary (infraorbital)

caudal maxillary

caudal mandibular

mental

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18
Q

what does the infraorbital nerve block affect?

A

soft tissues, incisors, canines and premolar teeth

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19
Q

where is the infraorbital foramen located?

A

(in dogs) located on maxilla, dorsal to the third maxillary premolar

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20
Q

why should care be taken performing an infraorbital nerve block in cats/brachy dogs?

A

the foramen is located at the level of the medial canthus of the eye (needle could penetrate eyeball)

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21
Q

what does the caudal maxillary nerve block affect?

A

all bones of the maxilla

soft and hard palates

soft tissues of the nose, upper lip and dentition rostral to the maxillary second molar

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22
Q

where is the caudal maxillary foramen located?

A

just caudal and central to the last maxillary molar

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23
Q

what does the mandibular nerve block affect?

A

entire hemimandible teeth of the lower jaw

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24
Q

where is the mandibular foramen located?

A

needle inserted percutaneously at the ventral angle of the mandible

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25
why are bilateral mandibular nerve blocks discouraged?
due to risk of damage due to lack of sensation in the recovery period
26
what type of nerve block should not be administered bilaterally?
bilateral mandibular block
27
what does the mental nerve block affect?
lower incisors, skin and tissues rostral to the foramen
28
where is the mental foramen located?
ventral to the rostral root of the second premolars
29
why is the mental nerve block not often carried out in small animals?
can be tough to locate the foramen
30
which block may be preferred over the mental block in small animals?
mandibular
31
what equipment should be prepared for local block placement?
sterile needle and syringe local agent scrub alcohol wipe method of recording doses/times (sterile gloves)
32
what should be considered when administering local blocks to cats?
intubeaze - 2.27mg lidocaine per spray
33
what are the post-op considerations for dental procedures?
re-assess/pain score for analgesia remove mouth pack/gag dry off as much as possible for temperature maintenance tempt to eat continue fluids if necessary thorough discharge advice for owners - expect bleeding
34
why might an animal have ocular surgery?
cataract sx, enucleation, eyelid mass removal, entropion, cherry eye, trauma
35
what are important pre-anaesthetic considerations for ocular surgery?
is the animal experiencing pain could the eye rupture are there any underlying diseases e.g. diabetes are they on any medication what procedure is being performed
36
what should be ascertained before ocular surgery?
full clinical exam and hx pre-op screening if indicated
37
what should not be used for preparation for ocular surgery?
hibiscrub
38
what are the specific peri-operative considerations for ocular surgery?
preventing further trauma to eye, preserving sight maintenance of central eye for intraocular procedures adequate analgesia
39
what is the normal intraocular pressure?
15-20mmHg
40
what determines intraocular pressure?
a balance of aqueous humour production and absorption other factors e.g. pupil size, corneoscleral rigidity, extra ocular muscle tone, vascularity of the globe
41
why do we want to avoid acute increases in intra-ocular pressure?
to avoid damage to the eye
42
how can we manage intraocular pressure during surgery?
maintain a normal Co2 avoid coughing on intubation/extubation avoid drugs with emetic effects (e.g. morphine) be aware of effects of drugs on IOP and use drugs judiciously avoid neck restraint/jugular pressure positioning - avoid head down position
43
what is the oculo-cardiac reflex?
sudden reduction in heart rate associated with traction on the eye or surrounding structures
44
why does the oculo-cardiac reflex occur?
due to stimulation of the trigeminal and vagal nerves
45
how should the oculo-cardiac reflex be managed?
surgical manipulation should stop and manage by administration of anticholinergics
46
how can you maintain a central eye during ocular surgery?
most common is use of a NMBA
47
why is it essential for all ocular surgery patients to wear a bustEr collar?
to avoid scratching eye/rubbing face along surfaces for contact
48
which block might be used to provide analgesia during ocular surgery?
retrobulbar
49
what does a retrobulbar block affect?
cranial nerves II III IV V and VI
50
what are the important considerations post-op for ocular surgery?
analgesia - pre-emptive and multimodal buster collar - avoid mutilation fluid therapy if needed patient warming feed, give opportunity to defecate prevent vomiting/coughing post-op especially if IOP increased consider sedation if anxious/fractious
51
what is important to avoid after ocular surgery?
coughing/vomiting especially if IOP increased
52
what are the primary abnormalities in BOAS patients?
stenotic nares aberrant nasal turbinates elongated/thickened soft palate tracheal hypoplasia
53
what is primary BOAS?
where it is identified early on and present before significant clinical signs
54
what is secondary BOAS?
develops as a consequence of longstanding increase in respiratory pressures
55
how does boas cause secondary respiratory/digestive issues?
animal has to pull harder on inspiration, creating negative pressure in the throat/neck/chest
56
what are the secondary abnormalities of BOAS?
laryngeal collapse eversion of laryngeal saccules GI - reflux, regurgitation
57
why is IV access important in BOAS cases?
can rapidly proceed to induction of anaesthesia and intubation for prompt airway security
58
why is it important to prevent stress in BOAS cases?
to prevent raising temperature, causing panting and GI signs
59
why might we sedate a BOAS patient before placing an IV catheter?
if catheter placement is causing undue stress
60
why must sedated bOAS patients be observed closely?
can easily obstruct and regurgitate
61
why might we use sevo over iso for BOAS maintenance?
faster recovery of laryngeal reflexes
62
what might be the disadvantage of using sevo for BOAS patients?
quicker recovery may increase chance of dysphoria/anxiety/stress
63
what drugs are commonly used for premed for airway surgery?
ACP/A2 agonist combined with an opioid acp will provide longer sedation than an a2 agonist
64
how can we protect the airway in patients undergoing airway surgery?
pre-oxygenate intubation stylet may be helpful large range of ETT sizes - always cuff always have suction available head down until airway secured
65
what are the perioperative considerations during BOAS surgery?
airway management vital, may require ventilation support careful and close monitoring, watch ventilation maintain heat but avoid overheating eye care is crucial
66
what are the post-op considerations for BOAS surgery?
observe closely - don't remove ETT until swallowing and can maintain patent airway mild sedation can be useful if patient agitated ware with warming techniques oxygen supplementation (+pulse ox if tolerated) early discharge if stress + safe to do so
67
what should we always be prepared for when recovering a BOAS patient?
re-intubation
68
why might NSAIDs be avoided intra-op in BOAS patients?
in case steroids required for post-op obstruction
69
how does laryngeal paralysis often present?
stridor exercise intolerance panting coughing, hoarse bark
70
what is stridor?
abnormal, harsh high-pitched sound during inspiration/expiration resulting from airflow through an obstructed airway
71
what is stertor?
noisy breathing sound - like snoring low pitched
72
what are the non-surgical approaches to laryngeal paralysis?
weight loss exercise restriction owner education
73
what is the surgical approach to laryngeal paralysis?
laryngeal tie-back
74
how can a nurse help with a patient who presents with laryngeal paralysis?
put in quiet/stress free environment use a fan - cool and blow air into airways oxygen supplementation if not stressful start recording esp RR leave alone until calm (with observation) enquire with vet about butorphanol
75
what is laryngeal tie back surgery called?
unilateral arytenoid lateralisation
76
why do animals with laryngeal paralysis present with dyspnoea?
due to closure of the vocal cords
77
why should we assess the larynx under a light plane of anaesthesia?
anaesthetics affect mobility of the larynx
78
what are the pre-operative considerations for laryngeal tie-back surgery?
pre-oxygenate reduce stress anti-tussive drugs light plane of anaesthesia so that VS can assess larygngeal function pain management
79
what should be involved in post-op care after laryngeal tie-back surgery?
very close observation - AP high risk assess pain avoid things around neck wet food made into balls, elevated feeding and water avoid excitement - consider sedation if req
80
what are some of the presentations requiring bronchoscopy?
variable - chronic cough, suspected lung infection, feline asthma, airway parasites, chronic aspiration pneumonia, neoplasia
81
are patients requiring bronchoscopy likely to saturate well on room air?
no
82
what can be given to bronchoscopy patient as a bronchodilator?
terbutaline
83
why should care be taken when giving terbutaline as a bronchoconstrictor?
CV side effects - tachycardia
84
when might terbutaline be given?
may be given as a bronchodilator to bronchoscopy patients
85
why is bronchoscopy usually performed?
for sample collection (bronchial alveolar lavage)
86
what are the pre-op considerations for bronchoscopy?
history and clinical exam, assess degree of respiratory compromise rule out cardiac disease further testing, blood tests depending on px BGA, x-rays
87
what may be required for stabilisation pre-bronchoscopy?
O2 supplementation and sedation if required inhaled bronchodilators e.g. terbutaline systemic steroid and anti-tussive meds
88
what is the issue with the ET tube during bronchoscopy?
may not be able to maintain it in place - some larger tubes can fit scope inside
89
what are the temperature considerations during bronchoscopy?
patient easily cold - coupage, usually uncovered
90
which drug might be useful for bronchoscopy? why?
ketamine and propofol - have bronchodilatory effects
91
what are the airway management options for bronchoscopy?
large diameter ET tube - pass scope through small diameter tube - extubate and use TIVA SGAD/LMA
92
what is the most important piece of monitoring equipment during a bronchscopy?
pulse ox
93
why is it sensible to consider TIVA for bronschoscopy?
easier access to required areas avoids leakage of inhalant agent into surrounding air
94
what are the potential peri-operative issues during bronchoscopy?
hypoxia bronchoconstriction (esp after BAL) desaturation and shark fin capnograph (obstructive) reduced compliance laryngeal oedema (cats) airway/lung rupture - possible during FO removal or biopsy
95
what equipment should we get ready for a bronchoscope?
endoscope sterile saline collection pots mouth gag? urinary catheter (if blind BAL) syringes emergency box/induction agent
96
why is it valuable to take a pre-scope sample of the endoscope?
to ensure any abnormalities found (e.g. fungus) were not present in the scope before it was introduced to the patient
97
why does bronchoscopy often require multiple people?
needs to be fast coupage required as well as close monitoring of the patient things can go wrong quickly need quick access to emergency drugs/oxygen
98
why should the patient be monitored closely in the recovery period from bronchoscopy?
risky period - can easily occlude may have cough
99
how can we lower risk of occlusion after bronchoscopy?
keep head elevated, use towels monitor closely
100
how can we monitor/support the patient after bronchoscopy?
constant observation until fully recovered use pulse ox until no longer tolerated supplement oxygen
101
why should bronchoscopy patients be monitored regularly after the procedure?
tension pneumothorax can manifest clinically later in the recovery period
102
what are the potential post-op complications after bronchoscopy?
haemorrhage in the airways desaturation of oxygen pneumothorax due to damaged bronchi (poss tension pneumothorax)
103
when might pharyngostomy intubation be performed?
avoids the oral cavity - for cases where orotracheal intubation is not possible
104
what are the overall main challenges for dental/ocular/airway surgery?
access to head/eyes is limited - depth, avoid breathing systems that require access near head use appropriate monitoring, may have to attach pulse ox elsewhere close eye on capnography to ensure tube isn't kinking remember eye/mucous membrane lubrication
105

Applied Clinical Veterinary Nursing (31 decks)

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