Monitoring 1

  1. Stages of anesthesia

    • stage 1

      • beginning of induction to loss of consiousness

    • stage 2

      • excitement / delirium stage followed by loss of consciousness

    • stage 3

      • surgical stage

  2. Anesthetic depth

    • based on observation and parameters

    • patients go through the stages in ascending or descending orders

      • 1 >2>3>2>1

    • more critical patients requires less anesthetic drugs

  3. ASA Status

    1. normal patient with no disease

    2. patient with mild systemic disease

    3. patient with severe systemic disease limiting activity but not in capitating

    4. extremely critical patient not expected to live 24 hours regardless of surgery

  4. What we look at to monitor depth

    1. CNS function

    2. What can they still react to??

      1. palpebral reflex

        1. touching around the eye

      2. corneal reflex

        1. touching the cornea

      3. PLR

      4. jaw tone

      5. anal reflex

      6. pedal reflex

      7. Eye position?

        1. are they looking right at you or rotated ventrally?

        2. prefer rotated ventrally

      8. how relaxed are their muscles

    3. Cardiovascular function

      1. heart rate

      2. cardiac output

        1. pulses strong or weak

      3. arterial BP

      4. MM and CRT

      5. venous pressure

    4. respiratory function

      1. resp rate

      2. resp patter and depth of breaths

      3. Pulse ox.

      4. co2 monitoring

      5. blood gases

      6. tidal volume

What should we monitor regularly?

  1. Every 5 minutes

    1. HR, RR, BP, ETCO2, and Spo2

  2. temp every 10-15 mins

  3. continually check the monitor, constantly check your patient yourself

  4. patient depth

Preparation of equipment

  • Select and leak check your machine and system

  • ET tube selection

    • needs to be long enough to reach first rib (bifurcation of lungs)

    • picking right size comes with experience

    • leak check your tubes

    • tie gauze to secure the tube

  • grab a laryngoscope for intubation

Intubation supplies

  1. should pick 2-3 tube sizes: what you think you need, one size above and one size below

  2. different kinds of ET tubes

    1. guarded have metal spring reinforcements for surgeries where the neck must be flexed or deviated

      1. keeps et tube and the trachea from collapsing

  3. laryngoscope

Other supplies needed

  • catheter supplies

  • fluid lines and supplies with your calculated drip rate

Order of event

  • verify patient

  • physical exam and big 3

  • obtain an anesthesia protocol

  • premed your patient

  • induction and intubation/monitoring

  • recovery

Venous access

  • 1 catheter is a good start, but never hurts to have more

    • always ensure patency before pushing drugs

  • arterial catheters to check blood gas

  • jugular catheter

Induction

  • check heart rate after administering premeds

  • give induction meds at appropriate rate

    • some have to be given slowly

  • aim to push drugs until you can safely intubate

    • jaw tone loose

    • eyes ventrally deviates

    • weak/absent palpebral

    • decreased respiration

Intubation

  • visualize larynx with laryngoscope and place at base of tongue BELOW epiglottis

  • push tube in no further than bifurcation at first rib

  • always note how much air you have to put in the ET tube cuff if you put air in

  • tie the ET tube in securely and do not push it in or pull it out while tying

    • tie in middle of mouth and go behind head/ears

    • tie behind canines if going over the nose

    • always use bow/quick release behind head or over nose

HR and Rhythm

  • always listen or feel a pulse for yourself

  • watch ECG for rhythm

  • know normal parameters for each patient

Respiration

  • EVERY PATIENT UNDER ANESTHESIA IS HYPOVENTILATING!!!!

  • assist respiratory depression and decreased tidal volume with intermittent positive pressure ventilation

    • IPPV

  • ventilators are sometimes needed for animals who continue to not breath on their own

Blood Pressure Monitoring

  • non-invasive vs. invasive monitoring

  • non-invasive

    • blood pressure cuff and monitor or doppler

  • invasive

    • arterial BP monitor