Peri-anesthesia Monitoring and Complications III

Make sure we are maintaining good O2 delivery throughout anesthesia period - practical

Why to we monitor BP?

MAP (Mean arterial pressure)

What value is most important when monitoring BP?

greater or equal to 60mmHg - small

greater or equal to 70mmHg - large

What is the ideal MAP in small animals? What is it in large animals?

Oscullometric

Doppler

What are two indirect ways of monitoring BP indirectly/non-invasively?

Less accurate and reliable

Non-continuous

What are cons of non-invasive BP?

Arrythmias

Hypo/hypertension

Movement

When is NIBP less accurate and reliable?

Hemorrhage

Infection

Phlebitis

Pain

Thrombosis

What are complications of invasive BP?

High pressure occludes atrial blood flow and w/ gradual cuff deflation

How does a oscillometric work?

Most accurate

Least accurate

MAP is ___ accurate and Diasotolic pressure is ___ accurate in oscillometric mechanisms?

Width should be 30-40% of circumference of leg/ attachment sight

What should cuff size for an oscillometric mechanism be?

Falsely low

Falsely high

If an oscillometric cuff is too big it will read ___ and too small will read ___?

Same level as base of heart.

Where should a oscillometric cuff be placed?

Shoulder joint

What are land marks for if a patient is standing, sternal or dorsal of where the cuff should be placed?

Sternum

Where are landmarks of if a patient is lateral that a cuff should be placed?

Erroneously high

Erroneously low

If a cuff is lower we will get a ___ reading and if its higher we will get ___ readings?

Joint

Metatarsal

You shouldn't place the cuff on a ___ unless its a pig then place it on the ____?

Snuggly - too loose = wrong readings

The cuff should fit ___?

The artery should aline here

What does this mark dictate?

Movement

What should you avoid when the oscillometeric is running?

Does the pulse rate match - if yes the reliable

How do you access the accuracy of the NIBP machine?

Check again - dont tx anything based on only one reading

If readings show a sudden change what should be done?

Systolic pressure

The doppler method will only measure what?

Critical/ high risk patients

Routine for horses under inhalent anesthesia

When should invasive BP be used?

Dorsal pedal artery

Where do you set a IBP in a dog?

Auricular a.

Where do you set a IBP in pigs / ruminants?

Facial a.

Transverse facial a.

Metatarsal a.

Where can you set an IBP in horses?

Turn down inhalant

What is the first step to tx hypotension?

BP= CO x SVR (vascular resistance)

How do you calculate BP?

(Pre-load x compliance x contactility)/SVR

How do you find SV?

Anesthetics

ACE

Shock

What causes a drop in SVR?

Decrease anesthetics

NE (Vasopressors)

How do you tx a decrease in SVR?

Vasodilation

A patient under anethesia has bright red mucus membranes what are we seeing?

Vasoconstriction (poss anemia)

A patient under anesthesia has pale pink mucus membranes what are we seeing?

Anti-cholinergics

Decreased anesthetics

How can we tx a drop in HR caused by anesthetic drugs?

Dehydration

Blood loss

SVR

What can cause preload to decrease?

Decrease anesthetics

Fluids

Vasopressors

How do you treat a decrease of preload?

Before

Dehydration should be corrected ___ anesthesia?

Giving a fluid bolus of 5ml/kg x 1-2 times to see if BP increases

What is the fluid challenge test?

5mL/kg/hr

What is the standard fluid rate for a dog?

3mL/kg/hr

What is the standard fluid rate for a cat?

Crystalloid

At 10% of blood loss what can you replace w/?

Colloid

At 10-20% blood loss what can you replace w?

Transfusion

At more than 20% blood loss what can you replace with?

8%

7%

Dogs blood volume is __% of their body weight

Cats blood volume is __% of their body weight?

37kg x 80ml/kg = 2960ml

900/2960= 30.4%

Transfusion

A 37 kg dog lost 900mls of blood what kind of fluid replacement should they get?

10kg x 70ml/kg = 700ml

69/700 = 9.8%

Crystalloid fluid replacement

A 10kg cat lost 69mls of blood. What kind of fluid replacement should they get?

Increase

Decrease

Vasoconstriction will ___ effective circulation.

Vasodilation will ___ effective circulation?

Decrease inhalent

Vasopressor

How can you fix preload?

Pericardial effusion

HCM

(Be aware of before)

What can cause decrease in compliance (Lusitrophy)?

Anesthetics and drugs

DCM

What can cause decrease in contractility (inotropy)?

Decrease anesthetics

Dobutamine

Dopamine

How do you increase contractility?

SpO2 - slope should be going up fast

What can you use to diagnose a decrease in contractility?

Diluted

Horses

Dobutamine and dopamine have to be _____ and ___ are very sensitive to it?