Flashcards in Chpt. 8 - Tech Notes Deck (18):
What does incomplete patient preparation often result in?
In complications ranging from mild to life-threatening, especially when anesthetic procedures are performed in animals that are not young and healthy.
Any time saved by abbreviating patient preparation is often offset managing problems that could have been prevented.
Double-check all injectable drug doses before administration, and ensure ...
... that the concentration of an agent drawn into a syringe is the same as that used for drug calculations.
What should you do with syringes containing injectable agents?
Always label them with the name of the patient, the name of the drug, and the drug concentration if more than one concentration is available.
Why must vaporizer setting adjustments be anticipated as much as possible through close monitoring?
With inhalant agents there is a delay between when the dial setting is changed and when the patient depth changes.
When should you make larger and when more subtle dial changes?
With inhalant agents, if a patient is significantly lightly or deeply anesthetized, larger dial changes are warranted, whereas if the patient's anesthetic depth is lightly too light or deep, more subtle changes are needed.
Which anesthesia machine/circuit to use for patients weighing more than 2.5 to 3 kg and which to use for patients weighing less than 2.5 to 3 kg.
More than 2.5 to 3 kg:
- small anesthesia machine configured as a semiclosed rebreathing system
Less than 2.5 to 3 kg:
- non-rebreathing circuit
What to do with a patient after IM injection of preanesthetic medications!
Patient should be placed in a location that is quiet, but also one that permits close observation until the agent takes effect (for many drugs given IM, about 15 to 20 minutes).
How deeply anesthetized should a patient be during induction?
During anesthetic induction the patient should be sufficiently anesthetized to permit intubation, but anesthesia should generally be kept light until the tube is placed.
What does successful mask induction require?
Skillful restraint (enough to prevent operator and patient injury, but not so much as to restrict chest excursions or the airway).
MM color and CRT as well as ocular indicators of anesthetic depth are not easily observed, although monitoring requirements are no different with this method of induction.
Is it possible to accurately assess most monitoring parameters during chamber induction?
No, it is impossible.
Thus, the anesthetist must be vigilant and prepared to act quickly if the patient shows signs of compromise.
Things to consider when preparing for endotracheal intubation.
Select at least three tubes of slightly different diameters so that you are prepared if your first choice does not fit. Ideally the endotracheal tube should extend from the tip of the nose to the thoracic inlet.
How to assess readiness for endotracheal intubation.
Readiness for endotracheal intubation is characterized by unconsciousness, a lack of voluntary movement, an absent pedal reflex, sufficient muscle relaxation to allow the mouth to be held open, and no swallowing when the tongue is grasped.
Inflating the ET cuff
Slowly inflate the cuff until the leaking just ceases at a pressure of 20 cm H2O but resumes at higher pressures. Inflation should be checked again after 15 to 30 minutes of anesthesia, because tracheal diameter may increase as a result of muscle relaxation, or a slow, undetected leak in the cuff or pilot line may cause the cuff to deflate.
Particular care should be used when intubating cats, which have a narrow glottis that is easily traumatized. Irritation of the larynx during intubation causes laryngospasm, which can occlude the airway if severe.
Lubing the eyes
Artificial tear solution or other corneal lubricant should be instilled into the eyes of an anesthetized patient every hour. GA decreases tear secretions for a period of up to 24 hours after anesthesia, and some dogs may need periodic application of a corneal lubricant for up to 36 hrs after anesthesia.
During recovery the patient must be watched continuously at close range. This is often one of the most dangerous periods even for animals that have had no problems during induction or maintenance.
Recovering patients often consume more oxygen as a result of shivering. Oxygen administration during recovery is necessary to meet these needs.
A recovering patient should also be turned every 10 to 15 minutes to prevent pooling of blood in the dependent lung and tissues - a condition called hypostatic congestion.
After dental cleaning, oral Sx, or any other procedure in which blood or other fluids are present in the oral cavity, the cuff should be left partially inflated during removal to sweep out the fluid and prevent it from entering the airways.