Anesthetic Records and Monitoring

Question 1

what is the governing body for legislation and standards of practice

Answer 1

CVO

Question 2

what falls under the following acts:
- veterinarians act
- controlled drugs and substances act

Answer 2

Veterinarians Act: MRs, including anesthetic records

Controlled Drugs and Substances Act: controlled drug log

Question 3

what are the 3 required records related to anesthestia

Answer 3

1) Controlled Drug Log
2) Anesthesia and Surgery Log
3) Medical Record

Question 4

where should you store the controlled drug log

Answer 4

away from the controlled drugs, since it can be a target of theft

Question 5

what is the surgery/anesthesia log

Answer 5

list of all procedures done

Question 6

why is the medical record part of the required records related to anesthesia

Answer 6

because the anesthetic log (record) is within and it is the main source of info for the V, C, P

Question 7

what is the purpose of the anesthetic record in anesthesia during and in the future

Answer 7

DURING:
- monitor physiological variables
- indicate need for adjustments in the protocol (ex. changes in inhalant concentration)
- indicate needs for additional treatment (ex. fluids)

AFTER:
- informs future anesthetic management

Question 8

what is a major purpose of the anesthetic record for the team

Answer 8

can see trends to inform current and future practices and helps with communication of patient status to the team

Question 9

T/F anesthetic record requirements can vary depending on if you are in-hospital vs mobile

Answer 9

T

Question 10

what is included in the individual patients medical record and anesthesia (for in-hospital anesthesia) (5 + an extra consideration if LA)

Answer 10

1) pre-operative assessment and rationale
2) anesthetic monitoring chart
3) post-operative assessment
4) prescribing/dispending information
5) discharge instructions (CA) or care instructions (LA)

For LA: also include drugs administered and the withdrawal time

Question 11

T/F the anesthetic record should include the pre-operative assessment and baseline lab analysis if performed

Answer 11

T

Question 12

how do we record drug information on the anesthetic record

Answer 12

in QUANTITY (g, ug, or mg) as well the time of administration (exception being inhalants where we put the dialed %)

especially important to include the START and END of anesthesia

Question 13

how do we record fluid therapy on the anesthetic record

Answer 13

1) total amount administered (volume)
2) rate over time of administration

Question 14

what physiological variables are recorded on the anesthetic record and what is their code

Answer 14

• HR (.)
• RR (x)
• BP
  (systolic: v; diastolic: ^; mean: -)
• temperature (at at least the beginning and end)

Question 15

what is included in the post-anesthetic assessment

Answer 15

• pain scores
• physiological variables (includes MM colour and CRT)
• activity, concerns, etc.

Question 16

what is a recommendation if giving sedation

Answer 16

to monitor and record physiological variables, especially if heavy sedation or compromised animal

Question 17

what provides the standards for patient medical records and facility records (2)

Answer 17

Veterinarians Act and Accreditation Standards for Veterinary Facilities

Question 18

Why do we monitor patients under anesthesia

Answer 18

dramatically reduces morbidity and mortality; improves the quality of anesthesia and analgesia

Question 19

when do we monitor patients

Answer 19

immediately following sedation, during anesthesia, post-anesthesia until normal physiological variables and stable

Question 20

what period is associated with the highest morbidity and mortality
a) pre-operative
b) operative
c) recovery

Answer 20

recovery

Question 21

what do we typically measure during anesthesia (broad - 2 categories)

Answer 21

depth and physiological variables

Question 22

in general, what is the relationship between depth and physiological variables

Answer 22

as you depress the CNS (get deeper), physiological variables lower

linear relationship

Question 23

we monitor and record variables related to depth and physiology every ___ mins

Answer 23

5

Question 24

How should we go about determining/assessing patient depth and physiological variables

Answer 24

using more than one variable to assess

Question 25

what are ways to monitor patient depth using: - physical exam - monitors

Answer 25

physical exam: - physiologic variables - eye position and movement - eyelid movement - reflexes - tear production - jaw tone monitors: - EEG

Question 26

in general, as patients become deeper what happens to eye position

Answer 26

moves ventromedially

Question 27

what does eyelid movement tell us about patient depth and what is the exception

Answer 27

movement = too light; exception being ketamine where patient may still blink even if adequately anesthetized

Question 28

what does nystagmus tell us about patient depth

Answer 28

too light

Question 29

which palpebral is lost first

Answer 29

lateral lost first

Question 30

how do we assess palpebral in horses

Answer 30

as one reflex (fan eyelids)

Question 31

tearing is used to indicate light plane of anesthesia in what animal

Answer 31

horses

Question 32

jaw tone is a very helpful indicator of depth in

Answer 32

cats

Question 33

how do signs related to depth of anesthesia in dogs and cats differ between inhalant and injectable anesthesia

Answer 33

jaw tone: tight in a medium light plane of anesthesia with injectable eye position: stays central regardless of depth with injectable palpebral reflex: present in a medium light plane and slow in a medium deep plane with injectable

Question 34

what are the components of the physical exam (manual) to monitor physiological variables in an anesthetized patient

Answer 34

observe: - mm rolour - RR palpate: - pulse (or auscult) - CRT - temperature of extremities

Question 35

what types of monitors can we use to monitor HR

Answer 35

- stethoscope (standard or esophageal) - EKG (standard or esophageal)

Question 36

what types of monitors can we use to monitor pulse rate

Answer 36

- pulse oximeter - pulse minder - doppler BP monitors - oscillometric BP monitors

Question 37

what types of monitors can we use to monitor BP

Answer 37

- doppler BP monitor - oscillometric BP monitor - invasive (direct)

Question 38

why is EKG not a heart PERFORMANCE indicator

Answer 38

it is just measuring electrical activity

Question 39

what is the standard EKG placement (where and what colour)

Answer 39

3 lead: RF (white), LF (black), LH (red)

Question 40

why can EKG be misleading

Answer 40

- may not have good contact of the leads - it reads deflection from baseline so may get two deflections on a single beat or other artifacts making the rate inaccurate

Question 41

what does a pulse minder do

Answer 41

detects perfusion to display pulse rate

Question 42

what are the components of a doppler (4)

Answer 42

- piezoelectric crystal - box to convert US waves to audible sound - cuff (placed proximal to probe) - sphingomanometer

Question 43

pressure determined using a doppler represents _______ pressure in the dog and __________ pressure in the cat

Answer 43

systolic; mean

Question 44

T/F Doppler gives accurate BP regardless of extremes (hypo or hypertension) in all species

Answer 44

F; it does give reliable pressure readings but only useful in dogs and cat

Question 45

cuff size in small animals should be

Answer 45

35-40% of the circumference of the placement site for a Doppler and 30-40% of the circumference of the placement site for an oscillometric monitor

Question 46

what information will an oscillometric bp monitor display

Answer 46

- systolic - diastolic - mean - pulse rate

Question 47

if you had a hypo/hypertensive patient or a patient with an arrhythmia is it better to use a doppler or oscillometric monitor

Answer 47

doppler

Question 48

what can we use to measure: - oxygenation (O2) - ventilation (CO2)

Answer 48

Oxygenation: - pulse oximeter - arterial blood gas Ventilation: - arterial blood gas - capnograph (ETCO2)

Question 49

how does a pulse oximeter work and what info does it give us

Answer 49

uses red and infrared light to measure hemoglobin oxygen saturation SpO2; heart rate/pulse rate

Question 50

what do we want to see on a SpO2 reading

Answer 50

>90% (normally 90-100 in arteries)

Question 51

what is a major disadvantage of pulse oximeters

Answer 51

only telling you hemoglobin saturation not oxygen content so it assumes normal hemoglobin levels...

Question 52

T/F vasoconstriction and skin pigmentation can interfere with pulse oximeter readings

Answer 52

T

Question 53

what can blood gas analyzers be used to measure

Answer 53

CO2, O2, pH, Hb, electrolytes, glucose, lactate....

Question 54

why do we measure END tidal CO2

Answer 54

at the end of an exhale there is less expired CO2 mixing with inspired O2, making the reading a more accurate indicator of arterial CO2 concentration...

Question 55

how is capnography and pulse oximetry similar

Answer 55

both use infrared