Recovery

What are some risk factorsof recovery in dogs and cats?

• age

• weight

• SAS status

• emergency procedures (greater risk)

• nature of procedure

• breed (brachycephalic)

What are some risk factorsof recovery in horses?

• ASA status

• age

• surgery type

• prolonged duration of anaesthesia

• OOH surgery

Why is the recovery phase of anaesthesia dangerous?

• Level of physiological support greatly reduced

• Level of monitoring reduced

• Some problems manifest themselves after a delay

• May be specific dangers relating to species, breed, health status or surgery

List some common recovery problems

• Hypothermia

• Emergence delirium

• Hypoxaemia

• Hypotension/hypertension

What are the causes of hypothermia post anaesthesia?

Anaesthesia: drugs, clipping, surgical spirit, open body cavity

What are the consequences of hypothermia post anaesthesia?

• Reduced MAC requirement

• Delayed recovery

• Shivering (increased oxygen consumption)

• Problems with wound healing (delays)

How can hypothermia in anaesthesia be prevented?

• Heat pads, forced air blankets, flush body cavities with warm fluids

• Make sure to monitor temperature

earlier this is done the more successful it will be

What is emergence delirium defined as in people?

‘state of dissociation of consciousness' where the patient is incoherent, inconsolable, irritable, and uncooperative’

How long does emergence delirium last?

Self limiting, 5-15 minutes

Risk of injury to animal and handlers

How is emergence delirium prevented/treated?

• Chemical (sedation) or physical restraint

• Reduce stimulation, reduce noise and light level

• Ensure adequate analgesia

What are the possible causes of hypoxia/hypoxaemia in recovery?

• Airway obstruction

• Inadequate ventilation (e.g. patient still too deeply anaesthetised or too painful to breathe post-thoractotomy)

• Poor gas exchange (e.g. pnuemonia/ congested lungs/ atelectasis)

What are the clinical signs of hypoxaemia in recovery?

• Cyanotic mucus membranes

• Tachypnoea/ dyspnoea

• Stertor/ stridor

• Reduced level of consciousness

How do you treat hypoxaemia in recovery?

• Ensure patent airway

• Ventilate

• Oxygen

• Additional therapy

  • Analgesia

• only extubate when animal can maintain airway patency

How can hypoxaemia in recovery be prevented?

Only extubate when animal can protect its own airway (can maintain airway patency)

How can you prevent/treat hypotension/hypertension in recovery?

Utilise fluid therapy/vasoactive drugs during and after anaesthesia

(Only tends to be a problem when animal critically ill)

List some of the GI complications that can occur in dogs and cats in recovery?

Gastric reflux/regurgitation (+pneumonitis)/aspiration structure

What may increase the risk of gastric reflux post anaesthesia in dogs and cats?

• Repeated anaesthetics,

• Orthopaedic surgeries

• frequent recumbency changes

• Large/ giant breed dogs

• Barrel-chested dogs

• common in brachycephalic dogs

What is the protocol for gastric reflux in dogs?

• Check ET tube cuff

• Head down and suction oropharynx

• Check pH of regurgitate

• Place stomach tube and lavage stomach and oesophagus until clear fluid comes out (suction to remove fluid)

• ?bicarbonate / sucralfate

What complications may happen in dogs + cats during recovery from anaesthesia?

• airway obstruction

• Tracheal tear/rupture

  • Related to over inflation of ET tube cuff and predominantly in dental cases

• Blindness

  • Related to cerebral ischaemia because of hypotension or use of mouth gags

How can tracheal tear in cats be prevented?

Consider pharyngeal packing as an alternative measure to protect the airway

What complications may happen in horses during recovery from anaesthesia?

• Colic

• Myopathy/neuropathy

• Fracture

What complications may happen in ruminants during recovery from anaesthesia?

• Regurgiation/aspiration

• Bloat

What complications may happen in pigs during recovery from anaesthesia?

• Respiratory obstruction

• Hyperthermia/sunburn

How can recovery problems be reduced?

• Monitory animals as much as possible

• Communication to others if they will be responsible for recovery about any complications

• Anticipate any problems if possible

• Rapid recognition/ intervention reduces severity