Anesthetic Recovery

What is the risk of anesthetic mortality in small animals?

0.15-1.35%

What animal has a high risk of anesthetic mortality?

Cats

What should be done prior to discontinuing anesthesia?

Give more analgesia if needed

Gage need for additional sedation

Why do you need to ensure proper analgesia before waking up?

It is easier to effectively treat the pain if the analgesic is on board before waking up

What is post-anesthetic dysphoria?

Caused by brain partial pressure of inhalation anesthetic decreases slowly and regaining consciousness

What are some signs of post-anesthetic dysphoria?

Involuntary motor movements that can cause harm

Biting

Vocalization

What is post-anesthetic dysphoria influenced by?

Species, breed, anesthetic used, pre and post op sedation/analgesia, pain, ambient noise and activity

What can you do to help with post-anesthetic dysphoria?

Mild restaint and speaking to calm the patient

IV sedation with ace, dexmedetomidine, propofol

Additional analgesia

When is acepromazine a good option to help with post-anesthetic dysphoria?

Bulldogs or other brachycephalics

When do you turn off the vaporizer?

In the recover area after all procedures are done (includes nail clipping and ear cleaning). After bandages have been placed and expression of the urinary bladder is attempted

When do I disconnect the patient from oxygen?

Anesthetic vapor is turned off. Patient is spontaneously ventilating.

Minimal degrees of hypoventilation (end-tidal CO2 is normal)

oxygen saturation of hemoglobin is appropriate

What can you do to decrease anesthetic concentration quicker?

If on a circle system, increasing the oxygen flow to dilute the anesthetic

Describe the cause of hypoxemia in the recovery period

Dogs and cats under anesthesia can have a CO2 of 50mmHg normally

Why can a patient have a arterial CO2 of 50mmHg during anesthesia?

Because they are breathing 100% O2 so they can still be oxygenated

Know how to use the alveolar gas equation

OK

What do we do to ensure proper oxygenation in recovery?

If end-tidal is not within normal limits then they will keep breathing high partial pressures of oxygen form the anesthesia machine

At what Hb saturation with oxygen do you no longer need to supplement oxygen?

>94%

When do you extubate dogs?

When they can swallow because then they can protect their airway from regurgitant or saliva or if they can lift their head

What drug can decrease a patients response to an endotracheal tube?

Opioids due to cough suppressant

When do you extubate cats?

Slightly before a swallow reflex because they will cough very quickly after swallowing

What can cause increased risk for airway obstruction?

Brachycephalic

Oral mass

Any airway swelling

Nasal mucosa swelling for patients that are semi-obligate nasal breathers (horses, pigs, camels)

Everted laryngeal saccules

What are the critical periods for brachycephalics?

After premed before ET tube

Induction

During recovery

If you have a brachycephalic what do you need to have ready during recovery?

Induction dose of propofol, laryngoscope, endotracheal tube, face mask and oxygen

What can you do after extubating to help with breathing?

Open mouth slightly and pull tongue forward

Monitor hemoglobin

Monitor for signs of inspiratory obstruction

After extubation, what happens to airway resistance as air flow increases?

It increases

What is a sign that a patient is actually breathing easier after extubation?

Longer inspiratory time and lower inspiratory flow

When can you remove the catheter?

When the patient is extubated and hemodynamically stable unless patient is very aggressive

What are other post-anesthetic concerns?

Gastroesophageal reflux

Hypothermia

Hyperthermia

Prolonged recovery

What are consequences of post-op hypothermia?

Increased risk of infection

Increased bleeding

Alterations of immune function

Altered cardiac conduction

Prolonged recovery

Why is shivering bad post op?

Increases tissue oxygen demand and is painful for the patient

What drug can cause hyperthermia in cats?

Opioids, specifically hydromorphone

What drug can cause hyperthermia in dogs?

Ketamine

What can you give to quicken recovery?

Reversal of alpha 2 agonist of benzodiazepine

Reversal of opioid (careful as this effects analgesia)

What does atipamezole do?

Reversal of alpha-2 agonists

What does flumazenil do?

Reversal of benzodiazepine

What patients have an increased risk of hypoglycemia?

Young patients or diseases like diabetes