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Anesthesia and Sugery > Anesthetic Complications: 7 > Flashcards

Anesthetic Complications: 7 Flashcards

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1
Q

Predictable complications

A

hypoventilation
hypoxemia
hypotension

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2
Q

Hypoventilation

A

insufficient elimination of CO2 from body relative to CO2 production
reduction in alveolar minute ventilation/VA

respiratory acidosis can occur

monitored by PCO2 during ventilation
35-45 mmHG
(blood gas or ETCO2)

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3
Q

Hypercapnia

A

PaCO2 greater than 45 mmHg

hypoventilation

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4
Q

Hypoventilation causes

A

dead space

increase RR/TV

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5
Q

factors that decrease TV

A

abdominal distention
obesity
thoracic pain

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6
Q

factors increase dead space

A 
malfunction/missing one way valve
improper CO2 absorbent
cracked inner tube coaxial circuit
too many adapters between ET tube and hose
Not using a septum in Y piece
ET tube extending past the incisors
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7
Q

Rebreathing CO2

A

can lead to hypercapnia

exhausted CO2 absorbant
malfunctioning scavenging system
inadequate O2 flow rates (non rebreather)

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8
Q

elevated CO2

A

hyperventilation or rebreathing of CO2

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9
Q

Hypoventilation

A

monitor Co2
most common complication of anesthetized patients

giving a breath 1-2 times a minute will likely prevent hypoventilation

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10
Q

If PaCo2 approaching 60 mmHg

(hypoventilation)

A

intermittent positive pressure ventilation should be started a controlled RR and TV

assess depth not excessive

ensure one way valves function/no cracks/fresh CO2 absorbent

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11
Q

Keep dead space to a minimum

hypoventilation

A

using appropriate length ET tube
not use more than one adapter
if patient less than 3KG use pediatric size

make surgeon is not leaning/resting instruments on thorax

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12
Q

Hypoxemia

A

reduced O2 concentration in blood

insufficient amount of O2 in arterial blood to meet body’s metabolic demands

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13
Q

Hypoxemia monitoring

A

predicted Pa02 is approx. 4-5 times the inspired O2 concentration

100% O2
Pa02 400-500mmHG
Pa02 less than 60mmHg is severe

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14
Q

less than ideal oxygen

A

02 100% and Pa02 80-400mmHg

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15
Q

ventilation to perfusion inequality

V/Q mismatch

A

ventilation and blood flow are mismatched at the level of the alveoli
inefficient gas exchange between lungs and pulmonary blood
most common cause of reduced 02 in an anesthetized patient

positioning patient in dorsal recumbency or in head down position for longer periods of time

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16
Q

V/Q ratio less than 1

A

perfusion is occurring but ventilation is not

atelectasis and bronchial intubation

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17
Q

V/Q ratio greater than 1

A

dead space ventilation

ventilation is present but perfusion is not
“Wasted ventilation”

thromboembolism
severe hypovolemia
hypotension

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18
Q

Diffusion impairment

A

hypoxemia cause
prevents the normal uptake of 02 from alveoli and pulmonary capillary blood

pulmonary edema
interstitial pneumonia
pulmonary fibrosis

rarely primary cause of hypoxemia in animals

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19
Q

Anatomical shunts

A

congenital heart abnormalities-blood shunted from right side of heart to left without passing through lungs (not oxygenated)

tetralogy of Fallout
reversed patent ductus arteriosus
ventricular septal defects

are not responsive to 02 therapy

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20
Q

Severe hypoventilation

A

can lead to elevated c02 level
significant dilution of partial pressure of 02 in alveoli and lead to hypoxemia

post operative period when breathing room air -concern

respond to 02 therapy easily

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21
Q

Low inspired 02

A

human error:
running out 02 during procedure
using too low 02 flow rate
using nitrous oxide too high concentration combined with 02

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22
Q

Hypoxemia prevention

A

pre-oxygenated 3-5 minutes prior to induction
100% 02 regardless of inhalant agent
minimize anesthesia and surgery time
check 02 source
calculate 02 flow rate for type of anesthesia

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23
Q

Hypoxemia with 100% 02

A

increased peak airway pressure
hold positive pressure in lungs 3-5 seconds (can decrease cardiac output)
Positive end expiratory pressure
use bronchodilator (albuterol)

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24
Q

Hypotension

A

below normal arterial blood pressure

MAP less than 60 mmHg or SAP less than 80 mmHg

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25
Hypotension monitoring
oscilometric or doppler techniques systolic only with Doppleer mean only with arterial catheter
26
Hypotension causes
inhalants-depress cardiovascular system reduced blood hypovolemia/hemorrhage inadequate volume administration or replacement dehydration
27
vascular tone reduction
shock sepsis histamine release
28
hypotension prevention
``` balanced anesthesia approach keep inhalant concentration to a minimum provide IV crystalloid fluid ensure adequate fluid volume adequate heat source ```
29
Hypotension treatment
``` turn down vaporizer if too deep 5-20 ml/kg bolus crystalloid fluid hypertonic saline 4-6ml/kg dogs, 2-3ml/kg cats inotropes: dopamine and dobutamine norepinephrine, ephedrine, etc. ```
30
Absolute Hypovolemia
loss of intravascular volume results when intravascular fluid losses exceed gains
31
Relative Hypovolemia
increase in intravascular space due to loss of vasomotor tone (vasodilation) normal intravascular volume but larger space to occupy
32
Hypovolemia monitoring
``` monitor circulating blood volume and tissue perfusion: pale mucous membranes prolonged CRT thready pulse quality cool/cold temp tachycardia hypotension ```
33
scarcely perceptible pulse
commonly rapid | feels like a fine mobile thread/cord under palpating finger
34
Hypovolemia | monitoring
PCV-low/anemia TP-low/hypoproteinemia Lactate-greater than 2mmol/L/poor tissue perfusion Urine Output-less than 0.5mL/Kg/hr poor perfusion/hypovolemia Central venous pressure-low <0cmH20 or decreased CVP hypovolemia
35
absoute | (Hypovolemia) causes
acute hemorrhage trauma water or electrolyte loss plasma loss
36
relative (Hypovolemia) causes
adverse drug reactions sepsis anaphylaxis caution Acepromazine
37
Hypovolemia prevention
crystalloid fluids 5 ps multiple peripheral IV catheters and central line
38
Hypovolemia | treatment
normal blood loss 10-20%, greater than 20% needs immediate treatment ``` replacement crystalloid fluids shock 90-90ml/kg dogs 40-60ml/kg cats 3:1 ratio of blood loss 1/4 total volume as bolus ```
39
Colloid therapy
restore oncotic pressure | if TP is <3.5 g/dL
40
Hypertonic saline
rapid, low volume resuscitation uncontrolled hemorrhage short lived effects 4-6ml/kg dogs, 2-3 ml/kg cats contraindications: severe dehydration, cardiac disease, hypernatremic
41
PCV<20% or TP <3.5 g/dL
whole blood: 25% circulating blood lost packed RBC: PCV<20% but TP adequate
42
PCV adequate but TP <3.5 g/dl
fresh frozen plasma<1 year: coagulation fresh frozen plasma>1 year: hypoproteinemia, coagulation, restore plasma proteins hemaglobin based oxygen carrier
43
Hypothermia
below normal body temp 101-102.5F a decrease of just 2 degrees can have adverse effects
44
Hypothermia classification
mild: 90-99 F moderate: 96-98 F severe: 92-96 F critical <92F
45
Hypothermia | monitoring
every 15-20 minutes
46
Hypothermia causes
``` heat loss (vasodilation in anesthetic agents) large surgical incisions (fur clipping) prolonged anesthesia/surgery cold surgical scrub (water or alcohol) cool/cold saline abdominal avage cold operating table cool ambient environment ```
47
Hypothermia | prevention
warm room blankets/bair hugger IV fluid warmer wrap extremities
48
Hypothermia | No-Nos
use electric heating pads=thermal burns | use fluid bags/bottles with a towel
49
Hypoglycemia
below normal glucose levels
50
normal glucose levels
70-120 mg/dL below 60 mg/dL=immediate treatment
51
hypoglycemia | caution
watch for in pediatric, diabetic, hepatic, portal systemic shunt, insulinoma, septicemia, endotoxemia
52
Hypoglycemia | consequences
coma hypotension prolonged recovery from anesthesia with depression, weakness, or seizures
53
at risk patients monitored
prior to induction every 30 minutes intraoperative postoperative
54
Hypoglycemia treatment
dextrose added to their IV fluid therapy 2.5%-5$
55
Hyperthermia
above normal body temperature
56
Hyperthermia causes
``` excessive heat source fever bactrial infection contamination of IV fluids/drugs malignant hyperthermia syndrome triggered by stress loss of CNS temperature regulation Thyrotoxicosis Pheochromocytoma cats given pure mu opioid disassociate agents (ketamine, etc) ```
57
Hyperthermia | prevention
treatment not instigated until 105.8 F ``` turn off heat sources use cooler fluids apply alcohol to inguinal and axillary and paws use fan provide 02 ``` do not use ice packs or submerge in water can cuase vasoconstriction
58
Hyperventilation
excessive elimination of c02 from body | leads to hypocapnia
59
Hyperventilation monitoring
Pac02 less than 35mmHg | less than 25 mmHg severe cerebral vasoconstriction and brain ischemia
60
Hyperventilation causes
inadequate anesthetic depth or response to pain overzealous ventilation significant hypoxemia leading to hypoxic drive hyperthermia low inspired oxygen concentrations increased c02 production
61
Hyperventilation | prevention/treatment
administer analgesic drugs decrease TV/RR supplemental 02
62
Hypertension
above normal arterial blood pressure
63
Awake patients hypertension
MAP 120mmHg SAP>160mmHg DAP>95mmHg
64
general anesthesia | hypertension
MAP>100mmHg
65
Severe and Chronic | hypertension
SAP>180mmHg DAP>120mmHg cause damage to eyes, kidneys, heart, brain, and peripheral vessels
66
monitoring equipment
hypotension and hypertension the same
67
causes hypertension
``` pain inadequate depth hypercapnia anesthetic drugs (ketamine, telazol, Xylazin, Dexmetatomadine) can cause a transitory increase in blood pressure renal disease, hyperadrenocoricism, hyperthyroidism, diabetes mellitus, heart failure, pneochomocytoma anemia fever metabolic acidosis cushings/intracanial pressure ```
68
treatment: hypertension
administer additional analgesics assess anesthetic depth (too light?) keep C02 normal range Esmolol (beta adrenergic antagonists)-if already taking then Phenoxybenzamine
69
Apnea
temporary cessation of breathing
70
causes: apnea
rapid admin of induction (propofol, ketamine/diazepam, thiopental) overdose of anesthetics cardiopulminary arrest equipment (pop off valve, ventilator malfunction)
71
treatment: apnea
``` place ET tube ventilate provide 02 assess depth-too light? inspect machine and ventilator begin CPR ```
72
Barotrauma
excessive peak airway pressure during positive pressure ventilation that results in lung injury
73
causes: barotrauma
closed pop off valve improper ventilator settings manometer above 20cm h20 using flush valve when non rebreathing circuit attached
74
treatment: barotrauma
thoracocentesis to correct pneumothorax provide 02 check pulse and begin CPR
75
postoperative myopathy
damage done to skeletal muscles likely due to hypoperfusion and ischemia after a period of recumbency
76
causes: postoperative myopathy
common large dogs incorrectly positioned on surgical table
77
treatment: myopathy
provide support/padding for limbs | IV fluid therapy, analgesic drugs, sedatives, physical therapy
78
prolonged recovery causes
``` hypoventilation hypercapnia hypoxemia metabolic acidosis hypoglycemia hypotension hypothermia hepatic and renal disease overdose of anesthetic drugs ```
79
prolonged recovery treatment
balanced anesthesia correct underlying condition provide supplemental 02 provide fluid therapy
80
reversible agents: opiods
opioid overdose=use butorphanol
81
reversible agents: Alpha 2
Dexmedatomine, xylaxine, Romifidine=use yohimbe, antisedan, tolozine
82
reversible agents: Benzodiazepines
Diazepam, Midazolam, Zolazepam=use Flumazenil
83
reversible agents: | Phenothiazines
Acepromazine, Promazine=no reversal agent

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