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Surgery > L4: Pre- and postoperative care > Flashcards

L4: Pre- and postoperative care Flashcards

1
Q

Anesthesia-related mortality

A

It’s highest for dogs and cats in postoperative period. Next risk is maintenance.

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2
Q

Anesthesia-related mortality in cats

A

Risk is 2x higher than in dogs. Possibly due to small size (hypothermia, overhydrating), uncooperative behaviour, prone to laryngospasm, Sensitivity to local anesthesia drug toxicity, reduced glucoronidation (slower drug metabolism)

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3
Q

ASA categories amount

A

5

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4
Q

ASA I

A

Apparently healthy
(mild periodontal disease, patellar luxation…)

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5
Q

ASA II

A

Mild systemic disease (Neonatal or geriatric animals, compensated cardiac disease, small tumors)

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6
Q

ASA III

A

Severe systemic disease (Chronic cardiac disease, fever, dehydration, cachexia, anemia)

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7
Q

ASA IV

A

Severe systemic disease that is life threatening (Heart failure, renal failure, hepatic failure, severe hypovolemia)

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8
Q

ASA V

A

Moribund; patient is not expected to live longer than 24h without surgery (endotoxic shock, multiorgan failure, severe trauma)

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9
Q

Goal of preoperative care

A

Planning for and anticipating complications is necessary to minimize the chance of adverse events

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10
Q

What details is included to preoperative care (6)

A
  1. Thorough anamnesis
  2. Full clinical examination
  3. Laboratory data
  4. Patient stabilization
  5. Determination of surgical risk
  6. Client communication

Have to be ready with medicines, calculations!

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11
Q

Anamnesis vitae includes

A

Basic information (species, breed, age, gender…) & lifestyle (diet, exercise, environment…)

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12
Q

Anamnesis morbi includes

A

-Reason for surgery
-Clinical signs and duration
-Past medical problems and treatment
-Current medical problems and treatments
-Prior anesthesia (used drugs, complications and recovery)

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13
Q

Why breed is important in anamnesis?

A

Anatomical differences and genetic predispositions have to be taken into consideration

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14
Q

Anemnesis of brachycephalic breeds

A

-Small hypoplastic trachea, elongated soft palate, stetonic nares
-Laryngeal mm prone to swelling
-Predisposition to gastroesophageal reflux
-Increased tone of n. vagus
-Higher risk of hypoxia

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15
Q

Anamnesis of toy breeds

A

-Hypothermia
-Catheter placement
-Questionable accuracy of monitors
-Intubation is more difficult
-Accuracy of drug dosages
-Hands-on assessment limited during anesthesia

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16
Q

Anamnesis of giant breeds

A

-Lower drug dosages required
-Considered geriatric at younger age
-Patient handling more difficult

17
Q

Mutation of MDR-1 gene

A

In herding breeds, causes prolonged effect of some drugs

18
Q

Why age is important in anamnesis?

A

Pediatric and geriatric patients are at a higher risk.

19
Q

Risk of pediatric patients

A

-Immature organs and defence mechanisms
-Prone to hypothermia, hypoglycemia, regurgitation
-Blood loss more dangerous

20
Q

Risk of geriatric patients

A

-Reduced response to hypercapnia, hypoxemia
-Slower metabolism and healing, decreased organ function
-Prone to hypothermia, regurgitation

21
Q

Clinical examination of cardiovascular system (3)

A

-Heart auscultation
-Pulse (peripheral, kukaan ei oikeesti tee tätä käytännössä töissä)
-Mucous membranes

22
Q

Clinical examination of respiratory system (4)

A

-Breathing patterns and noises
-Lung auscultation
-mucous membranes
-Palpation of trachea

23
Q

Hydration status (3)

A

-Mucous membranes
-Turgor
-Eyes

24
Q

What things are included to clinical examination? (8)

A

1.Cardiovascular system
2.Respiratory system
3.Hydration status
4.Gastrointestinal and urinary system
5.Integumentary system
6.CNS
7.BCS
8.Temperature

25
Q

What to recommend for diagnostic tests

A

Packed cell volume, total protein, glucose, urea

26
Q

Patient stabilization

A

-Should be done to all patients prior to sedation if possible
-Hemodynamics, respiratory function, hydration status

27
Q

What to consider about sedation and analgesia? (5)

A
  1. Choise of drugs and its several factors
  2. Optimal pain control during and after anesthesia
  3. Multimodality
  4. NSAIDs and opioids usual
  5. Familiar protocol usually best
28
Q

Oxygenation

A

Pre-oxygenation usually warranted to prevent hypoventilation and hypoxemia. Started before induction and intubation. Administration continued after intubation.

29
Q

Thermoregulation

A

Hypothermia is very common complication => hypoxia, prolonged recovery, increased infection risk, worse cardiovascular parameters. Warm infusions are not so effective. Warming should be started as soon as possible.

30
Q

Why infrared light is not recommended without a folium blanket?

A

May promote inflammation and burn skin!

31
Q

Purposes of intraoperative fluid management? (3)

A
  1. Maintenance of hemodynamics
  2. Maintenance of the catheter
  3. Amortization of fluid and blood loss
32
Q

Starting doses of fluids?

A

5ml/kg/h for dogs
3ml/kg/h for cats
reduce 25% each hour, unless blood or fluid loss

33
Q

Most often used fluids?

A

Ri-Lac or Hartmann’s solution (not NaCL 0,9%)

34
Q

Why positioning is important?

A

-Intubation, catheterization
-Procedure, monitoring
-Well-being of the patient

35
Q

What belongs to postoperative care? (6)

A
  1. Pain management
  2. Nutritional management
  3. Wound care
  4. Care related to procedure (immobilization etc)
  5. Other care possibilites
  6. Home care with good instructions
36
Q

Postop pain management

A

Better options in the clinic. Keep in the clinic until proper analgesia. Home: NSAIDs, tramadol, fentanyl/lidocain patch, gabapentin…

37
Q

Patient has to be closely monitored until (8)

A
  • Has been extubated
  • Is laying on sternum, head elevated
  • Is able to swallow, has normal ocular reflex
  • Has a strong and regular peripheral pulse
  • Has an oxygen saturation of >94%
  • Has no suspicion of upper airway obstruction
  • Has effective analgesia
  • Has no evident bleeding
38
Q

Wound care principals (7)

A

*Owner must be instructed in detail
* Wound care should be provided daily (usually up to 14 days)
* Wound exudate should be removed
* Cleaning with physiological solution is recommended
* Wound gels may be applied
* Suture material usually removed after 7-14 days
* A follow-up is also warranted in case an intradermal pattern was used

Surgery (9 decks)

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