Anesthesia Recovery

Return of pts ability to maintain resp, circulatory functions like mental, sensory and motor abilities

Define anesthesia recovery?

6-24hrs after anesthesia

Most anesthetic related deaths occur when?

When inhalant or infusion is turned off

When does recovery being?

1. gas/ tiva off

2. Post O2 - 5mins

3. Untie ET tube

4. Check palpebral refelex

5. Deflate cuff

6. Pull tube after multiple swallows

What are the rules of extubation?

2 TPR's every 10-15mins

How many TPR's should the sx team get before passing pet off to primary services?

Emergency delirium

pain

Dysphoria

Anxiety/ fear/ aggression

Full bladder or benzodiazepine disinhibition

What signifies a rough recovery?

A transient state of irritation and disassociation that is unresponsive to consoling

What is Emergency delirium?

Dilated pupils

Nystagmus

Tongue incoordination,

Vigorus head shaking/ front leg movements

What signs will you see w/ Emergency delirium

Inhalent / ketamine

Emergency delirium is induced by what?

Give low dose of induction agent (prop/ alfax)

Tranquilizer (ace)

Sedative (A2 agonist dex)

What are tx for Emergency delirium?

Agitation/ vocalizing

Winning

Dilated pupils

looking at affected areas

Inconsistent positioning

Responsive to surroundings

What are signs of pain on recovery?

Give IV opioids

What are tx for pain?

Restlessness,

Vocalization

Tachycardia/ Tachypnea (or opposite)

Hyperthermia

Unresponsive to consoling

What are signs of dysphoria?

Opioids

What is dysphoria usually caused by?

Give Naloxone at a low dose

How do we tx dysphoria?

If behavior resumes after sedation for 20 mins

How do you differentiate dysphoria from Emergency delirium?

Low dose buprenorphine - partial mu agonist

Butorphanol - mu antagonist

What other drugs could we use to tx dysphoria if we dont have naloxone on hand?

Tachycardia

Resopnsive to surroundings

prolonged behavior

Regular pupil size

What are signs of anxiety/ fear?

Resolve w/ consoling measures

How do we differentia anxiety from Emergency delirium?

Flumazenil iv SLOWLY

How do you resolve benzodiazepine disinhibition?

A2 agonists/ prop CRI instead of inhalant

Pain management

Safe/ pleasant environment

How can you minimize a rough recovery?

Hypothermia

Shivering

increased o2 demand

meperidine iv to decrease

Vomiting/ nausea

Regurgitation/ aspiration

What are some things that can cause poor recovery?

Trauma

ET tube bite

burn

Hypoxia

DEATH

What are tragic causes of poor recovery?

Inflamation causing edema causing hypoxia

What is the main concern for extubation in a brachycephalic patient?

-Mannitol or hypertonic saline soaked pack at larynx for 30-40 mins b4 extubation

-Dexamethasome -SP

-Tranquilization and analgesia

-keep intubated longer

-have O2 source near

What are some ways to avoid hypoxia in brachycephalic patients?

Regurgitation and aspiration pneumonia

What is the major complication of laryngeal paralysis recovery in a lab?

Suction of esophagus

Avoid flipping over

Keep sternal w/ head elevated

Partially deflate ET tube at extubation

How do you prevent aspiration pneumonia laryngeal paralysis surgery?

Quickly, make sure ears and whisker reflexes are present

How do cats recover?

Laryngospasms

Cortical blindness - mouth open too long

What are complications cats can face during recovery?

Hold down

make sure nystagmus and ataxia are under control

may need to sedate w/ xylazine and keep intubated till swallowing

What do you do in a horse to extubate?

Sternal position,

intubating till swallowing and moving head,

Give hay,

How do you recover a ruminant?