Game Plan

There are 3 main elements of preparation

1. a general review of the procedure to determine the equipment, supply, anesthetic agent, and personnel needs

2. preparation of the patient, equipment, associated supplies,
   and agents that will be administered

3. communication with the anesthesia care team prior to
   commencing the procedure.

Patient History Checklist (6)

1. Confirm the procedure to be performed

2. Gather historical information

3. Confirm compliance with fasting instructions

4. Confirm vaccines and other preventive care are current

5. Inquire about drug allergies or reactions

6. Note pertinent medical problems and communicate these to the attending veterinarian

Client Communication Checklist (7)

1. Present the standard consent form and obtain the client’s signature

2. Present a fee estimate and obtain the client’s signature

3. Complete any financial transactions (deposits, payments, insurance)

4. Answer the client’s questions

5. Inform the client of the nature of the procedure, the expected outcome, and the expected time of completion

6. Communicate the date and time of discharge if known

7. Determine an emergency communication protocol, including client phone number, availability, and schedule

Physical Examination Checklist (9)

1. Double-check the patient’s identity

2. Weigh the patient

3. Confirm the patient’s sex and reproductive status

4. Determine the patient’s hydration status

5. Determine the vital signs

6. Perform a physical assessment, focusing on the cardiovascular and pulmonary systems

7. Determine the patient’s pain score and physical status class

8. Communicate to the attending veterinarian any pertinent physical abnormalities

9. Note any concurrent conditions that may be best treated while patient is under anesthesia

Direct Patient Preparation Checklist (6)

1. If patient is hospitalized, make arrangements for preanesthetic fasting

2. Perform diagnostic tests, convey results to the attending veterinarian, and highlight abnormal data

3. Give medications ordered by the attending veterinarian

4. Place IV catheter and administer fluids if indicated

5. Administer preanesthetic medications

6. Make any necessary preparations for postoperative care

Equipment Preparation Checklist (3)

1. Gather all necessary equipment

2. Prepare the anesthetic machine

3. Check that all equipment is in good working order

The Pre-Induction Checklist (10)

1. Patient name, owner consent, and procedure confirmed

2. Intravenous (IV) catheter (cannula) placed and patent

3. Airway equipment available and functioning

4. Endotracheal tube cuffs checked

5. Anesthetic machine checked today

6. Adequate oxygen supply for proposed procedure

7. Breathing system connected, leak-free, and adjustable pressure-limiting valve open

8. Person assigned to monitor patient

9. Risks identified and communicated

10. Emergency interventions available

The Pre-Procedure Checklist (3)

1. Patient name and procedure confirmed

2. Depth of anesthesia appropriate

3. Safety concerns communicated

The Recovery Checklist (8)

1. Safety concerns regarding Airway

2. Safety concerns regarding Breathing

3. Safety concerns regarding Circulation (fluid balance)

4. Safety concerns regarding Body temperature

5. Safety concerns regarding Pain

6. Assessment and intervention plan confirmed

7. Analgesia plan confirmed

8. Person assigned to monitor patient

risk level of ASA 1

minimal

risk level of ASA 2

low

risk level of ASA 3

moderate

risk level of ASA 4

high

risk level of ASA 5

extreme

risk level of ASA 6

none

criteria of a ASA 1

Normal, healthy patient

criteria of a ASA 1

Patient with mild systemic disease

criteria of a ASA 3

Patient with severe systemic disease

criteria of a ASA 4

Patient with severe systemic disease that is a constant threat to life

criteria of a ASA 5

Moribund patient that is not expected to survive without the operation

criteria of a ASA 6

Brain dead - Organ donor

Factors of Game Plan (5)

1. Clinic Factors

2. Personal Factors

3. Equipment Factors

4. Patient Factors

5. procedure factors

whats under Patient Factors (4)

1. Signalment

2. history

3. five freedoms

4. client factors

what are the 5 freedoms

1. Freedom from hunger and thirst

2. Freedom from discomfort

3. Freedom from disease

4. Freedom from injury

5. Freedom from pain

what is under procedure factors

1. Pain

2. pain pathway

3. Multimodal Pain management

define perioerative

around the time of surgery

Consequences of untreated pain (9)

1. Catabolic state

2. Suppresses the immune response

3. Delays wound healing

4. Increased anesthetic risk due to increased doses of anesthetic agents needed to maintain anesthesia

5. Patient suffering

6. Harder to get pain under control when pain meds are given

7. Leads to windup

8. Decrease in quality of life (five freedoms)

9. Stressful for caregivers and clients

cardiovascular signs of pain (4)

1. Hypertension

2. Tachycardia

3. Tachyarrhythmias

4. Peripheral vasoconstriction (pale mm’s)

respiratory signs of pain (6)

1. Tachypnea

2. Shallow breathing

3. Exaggerated abdominal breathing

4. Panting

5. Open mouth breathing

6. Dilated Pupils

movement signs of pain (7)

1. Changes in gait

2. Changes in activity level

3. Development of exercise intolerance

4. Decreased performance

5. Reluctance to jump or do stairs

6. Shifting weight

7. Standing or laying in abnormal positions

Reactions to touch/handling/forced activity signs of pain (4)

1. Vocalization (groaning, purring)

2. Growling

3. Biting

4. Kicking

general appearence signs of pain (8)

1. Facial expressions

2. Appearance

3. Attitude (ADR)

4. Grinding teeth

5. Altered head carriage

6. Lack of grooming

7. Uninterested in surrounds

8. Hiding