Anaesthetic Recovery

Question 1

What is the recovery period?

Answer 1

Period between disconnection of anaesthetic administration to the time whent he animal can maintain unsupported recumbency

Question 2

Why is the role of monitoring recovery important?

Answer 2

• 60% of anaesthetic mortality occurs during recovery
• Often neglected time of anaesthesia
• Other staff may be dealing with next patient
• Patient is still under your care

Question 3

What does the duration of recovery depend on? Name 3

Answer 3

• Length of anaesthesia
• Condition of patient
• Age of patient
• Type of anaesthesia and route of admin
• Patients body temp

Question 4

What are the 4 main stages of recovery?

Answer 4

• HR increase
• RR increases and volume increases
• Eye position rotates centrally
• Reflexes become stronger e.g. palpebral, pedal, earf flick

Question 5

What should you give your patient before disconnecting them from the anaesthetic machine? And what benefit is there to us

Answer 5

Pure oxygen

Benefit: Reduces pollution of volatile agent

Question 6

When do you remove the ET tube from a patient?

Answer 6

• When the patient regains the swallow reflex

Question 7

What patients do you remove the ET tube earlier in and why?

Answer 7

Cats due to potential laryngospasm

Question 8

Do you wait longer or remove the ET quicker in brachycephalics

Answer 8

Wait longer

Question 9

What position should the patient be in when removing the ET tube?

Answer 9

Lateral or sternal recumbency with neck extended

Question 10

When removing an ET tube from the cat what should you also do?

Answer 10

Ensure cats tongue is at least partially out

Question 11

What must you remember to do before removing the ET tube?

Answer 11

• Check for reflex
• Untie mouth tape
• Deflate cuff

Question 12

What reflex do you look for in cats when wanting to remove the ET tube?

Answer 12

Ear flick

Question 13

How are anaesthetics eliminated (injectables, and inhalationals)

Answer 13

• Injectables - liver metabolises and excreted by kidney

- Inhalational - respiratory tract

Question 14

What can you give to speed up recovery?

Answer 14

Analeptics (reversal drugs)

Question 15

Name 2 things that affect pain in the recovery period?

Answer 15

• Surgical procedure
• Perioperative analgesics used
• Surgical technique

Question 16

Name 2 reasons why prolonged recovery may occur?

Answer 16

• Severe pain
• Persistent drug activity
• Hypothermia
• Too much or too little pain relief

Question 17

What can we do to ensure prolonged recovery does not occur?

Answer 17

• Adequate analgesia
• Keep animal warm
• Reverse the effects of drugs if possible

Question 18

Name the antagonist to opioids

Answer 18

Naloxone

Question 19

Name the antagonist to alpha-2-agonists

Answer 19

atipamezole

Question 20

Name the antagonists to benzodiazepines

Answer 20

flumazenil

Question 21

Name 2 common recovery problems

Answer 21

• Excitation (stormy recovery)

- Hypoxia

Question 22

What is a sign of excitation (stormy recovery)

Answer 22

• Pain

- Convulsions / epilepsy post myelography or in epileptic patients

Question 23

What would you do to monitor potential hypoxia in brachycephalics

Answer 23

Keep a pulse oximeter on the patient
Remain with it and ensure they are well ventilated
Provide oxygen

Question 24

Name 1 method you could use if the patient is hypoxic?

Answer 24

• Mask
• Intranasal catheter
• Tracheostomy tube
• Oxygen tent

Question 25

How often should you turn a patient that is unable to maintain sternal recumbency and why

Answer 25

- every 2 hours | - Reduce the risk of hypostatic congestion

Question 26

What can cause hypothermia in a patient during recovery

Answer 26

- anaesthetic used | - Prolonged procedure

Question 27

How do combat / prevent hypothermia

Answer 27

- Keep warm from pre-med onwards - Supplementary heating e.g. heat pads and blankets - Monitor patients temperature regularly - Efficient and quick procedure as possible

Question 28

What should you ensure you do prior to the patient leaving the surgery

Answer 28

- Ensure patient has fully recovered from anaesthesia - Clean patient up as much as possible before returning to owner - Ensure they are leaving with analgesics if necessary - Advise owner on any post-op complications that may occur and what is 'normal' - Ensure owner understands all information and provide contact details

Question 29

name the main things to do during post-operative monitoring

Answer 29

- Check vital signs - Maintain observations - Oxygenate - Avoid hypothermia - Manage pain - Reverse drugs if necessary - Turn recumbent patients - Monitor wounds