Exam 1 - Post-op Complications Flashcards
(45 cards)
What are the normal recovery period activities?
Turn off anesthetic gas Patient regains gag or swallow reflex Extubation Regains consciousness Sits sternal Walks
What should be monitored during recovery?
Cardiovascular status Ventilation Oxygenation Pain Body temperature Tolerance of the ET tube Signs of abnormal behavior
What are some recovery related complications?
Emergence delirium, Mu agonist opioid dysphoria, pain, laryngeal trauma, regurgitation, aspiration +/- pneumonia, upper airway obstruction, hypoventilation and hypercapnea, and hypothermia
What three problems have the same clinical signs?
emergence delirium, Mu agonist opioid dysphoria, and pain
What clinical signs are associated with recovery related complications?
Vocalization in dogs, uncontrolled or controlled muscle movements, anxiety, dysphoria, and hyperthermia in cats associated with opioid dysphoria
What is emergence delirium?
post-anesthetic excitement
What can be done to mitigate emergence delirium?
administer a tranquilizer (acepromazine/dexmedetomidine)
What does dysphoria mean?
you cannot interupt the behavior
What condition is associated with Mu agonist opioid dysphoria in cats?
hyperthermia
What can be done to mitigate Mu agonist opioid dysphoria?
Naloxone or butorphenol
If pain is an issue, what can be administered to mitigate it?
a mu agonist
What can regurgitation lead to?
esophagitis, pneumonitis, or pneumonia
How do you mitigate regurgitation?
maintain appropriate ET cuff pressures
If a patient is hypoventilating or hypercapneic with an elevated ETCO2, what may you need to do?
assist ventilation with an ambu-bag or O2
If there is an upper airway obstruction, what should be done?
reintubate the patient
What are common complications in our feline patients?
pain, respiratory distress, hyperthermia, and hyperactivity
What are common complications in our canine patients?
pain and hypothermia
What are the causes for post-operative pain?
deficiency of pain medication, tissue trauma, surgical complication, and is often associated with hypothermia
How is post operative pain managed?
assess pain scores regularly, multimodal pain management, and work up potential surgical complications
What are the pain management drugs used for cats?
Meloxicam (NSAID) - 24 hour duration
Buprenorphine (opioid) - 4-8 hour duration, causes hyperthermia
Bupivicaine - local block - 3-5 hours
What are the pain management drugs used for dogs?
Carprofen - NSAID- 12-24 hour duration
Hydromorphone - opioid - 4-6 hour duration, causes sedation and hypothermia
Bupivicaine - local block - 3-5 hours
Tilly is a Junior female, now spayed, DSH who presented from NW IA HS. Her pre-op PE revealed she was an overall healthy cat, however her BCS was 3 and she was obviously pregnant. Her pre-op BW was PCV 30%, TS 6.5 mg/dL, Glucose 122 mg/dl, and Azostick 5-15. She was spayed yesterday. Her incision was approximately 100% longer due to her pregnancy status. This am she is QAR and reluctant to come to the front of the cage. She ate ~ 40% of her evening meal. She did not defecate and had a small amount of urine in her litterbox
Vital parameters – Temp 102.8, HR 200, RR 40. color pink, crt 1 sec, hydration – possibly mildly dehydrated – slow skin tent and tacky mm
PE - painful on incisional palpation. Abdomen markedly tense and cannot palpate thoroughly. No obvious fluid.
What is Tilly’s Pain score?
a. 1
b. 2
c. 3
d. 4
b. 2
Tilly is a Junior female, now spayed, DSH who presented from NW IA HS. Her pre-op PE revealed she was an overall healthy cat, however her BCS was 3 and she was obviously pregnant. Her pre-op BW was PCV 30%, TS 6.5 mg/dL, Glucose 122 mg/dl, and Azostick 5-15. She was spayed yesterday. Her incision was approximately 100% longer due to her pregnancy status. This am she is QAR and reluctant to come to the front of the cage. She ate ~ 40% of her evening meal. She did not defecate and had a small amount of urine in her litterbox
Vital parameters – Temp 102.8, HR 200, RR 40. color pink, crt 1 sec, hydration – possibly mildly dehydrated – slow skin tent and tacky mm
PE - painful on incisional palpation. Abdomen markedly tense and cannot palpate thoroughly. No obvious fluid.
Her analgesia plan was buprenorphine given as a pre-med, buprivacaine line block, Meloxicam in recovery. What medications are currently controlling her pain?
a. Buprenorphine
b. Bupivicaine
c. Meloxicam
c. Meloxicam
Tilly is a Junior female, now spayed, DSH who presented from NW IA HS. Her pre-op PE revealed she was an overall healthy cat, however her BCS was 3 and she was obviously pregnant. Her pre-op BW was PCV 30%, TS 6.5 mg/dL, Glucose 122 mg/dl, and Azostick 5-15. She was spayed yesterday. Her incision was approximately 100% longer due to her pregnancy status. This am she is QAR and reluctant to come to the front of the cage. She ate ~ 40% of her evening meal. She did not defecate and had a small amount of urine in her litterbox
Vital parameters – Temp 102.8, HR 200, RR 40. color pink, crt 1 sec, hydration – possibly mildly dehydrated – slow skin tent and tacky mm
PE - painful on incisional palpation. Abdomen markedly tense and cannot palpate thoroughly. No obvious fluid.
What do you want to do to manage her pain?
a. Give second dose of Meloxicam early
b. Give a dose of buprenorphine at 0.02 mg/kg IM
c. Prescribe an oral medication such as gabapentin
b. Give a dose of buprenorphine at 0.02 mg/kg IM