Term
| What are anaes. A+E often associated with? |
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Definition
-a sick animal
-equipment failure
-inadequate preparation
-inadequate monitoring
Usually a combo of the above - any many / all are avoidable! |
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Term
| what classifies as "adequate" monitoring? |
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Definition
| would enable you to identify a problem before it became a big problem |
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Term
| Peri-vasc tissue sloughing - causes |
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Definition
| -irritant drugs e.g. thiopentane, GGE, dopamine |
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Term
| Peri-vasc tissue sloughing - prevention |
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Definition
-use secure IV catheter to prevent accidental slipping
-sedate patient if appropriate, esp if off the needle |
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Term
| Peri-vasc tissue sloughing - potential consequences |
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Definition
| -in horses it may damage recurrent laryngeal nerve and result in laryneal hemiplegai / roaring (nerve is close to jugular) |
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Term
| Peri-vasc tissue sloughing - tx |
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Definition
| -infiltrate with saline -can use quite large volumes |
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Term
| drug admin. errors - causes |
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Definition
| multiple people working in the same area / drugs not adequately labelled |
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Term
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Definition
-tell clinician ASAP
-know pharmacology - to enable correction
e.g. ketamine incorrectly used to flush IV catheter instead of hep. saline - horse becomes excited, paces etc - give alpha-2-agonist w. quick onset e.g. xylazine |
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Term
| Vomiting / regurgitation / reflux - differences? |
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Definition
Vomit = active
Regurgitation = passive
Reflux = type of regurgitation - see fluid at mouth
NB: reflux may be silent - fluid remains in oes.
Remember not all spp. can vomit
- dogs, cats, ferrits can vomit
-rabbits, horses can't vomit |
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Term
| Vomiting / regurgitation / reflux - causes / influences |
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Definition
-more likely if not in pain
-may be drug induced e.g. morphine, dexmedetomidine
-influenced by duration of pre-anaes. fasting ~6hours is adequate
(too short:full stomach
too long: incr. acidity) |
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Term
| Vomiting / regurgitation / reflux - danger periods |
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Definition
| -induction and recovery - airway not protected |
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Term
| Vomiting / regurgitation / reflux - prevent danger consequences |
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Definition
| -keep head elevated until ETT is placed ad cuff is inflated |
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Term
| Vomiting / regurgitation / reflux - tx |
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Definition
-head down if V/regurgitation noticed
-suction/swab out pharynx
-get ETT in asap!
-record of anaes. record |
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Term
| Reflux oesophagitis - risk factors |
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Definition
-excessive / inadequate starvation
-drugs e.g. opiods
-abdominal P
-abdominal surgery / long ops
-silent reflux |
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Term
| how do you know if silent reflux has occured during the op? |
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Definition
-may vomit blood tinged fluid in recovery
-may appear unable to swallow (painful!)
-appear distressed
-use Barium Swallow to observe oesophageal stricture (a poss. consequence) |
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Term
|
Definition
-haemorrhagic and inflamed oesp.
-poss. oesophaegeal stricture (narrowing of oes. w. inflam and scarring) |
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Term
|
Definition
-consider ranitidine IV to incr. pH of stomach contents if reflux noticied at start of anaes. (blocks acid secretion)
-if oes. stricture has occured, need to dilate endoscopically (best done at referral centre - can rupture oesp. if not careful) |
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Term
| Respiratory failure - mechanisms |
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Definition
-depression of resp. centre in brain e.f. anaes. OD / head injury
-interruption of nervous/NM transmission e.g. NMJ blocking drug
-impaired mvmt of thoracic cage e.g. sandbags, incr, intra-ab. P
-impaired lung mvmt e.g. pleural effusion
-airway obstruction e.g. brachycephalic / tumour/mass obstructing |
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Term
| respiratory tract obstruction - causes |
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Definition
-may be breed e.g. brachycephalic
-may be condition e.g. laryngeal mass |
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Term
| respiratory tract obstruction - identification |
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Definition
-incr. resp. effort
-paradoxical ventilation
-no airway mvmt at nose/mouth
-possible cyanotic MM (late indicator) |
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Term
| respiratory tract obstruction - action if animal conscious |
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Definition
(depends on cause)
-striaghten neck
-pull tongue forward
-check mouth and pharynx, apply suction if necessary
-administer O2, intubate if necessary
-coricosteriods if due to swelling (e.g. hydrocortisone - fast acting) |
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Term
| respiratory tract obstruction - action if animal intubated |
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Definition
-check ETT not kinked / obstructed / too long / faulty
-check breathing system |
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Term
| respiratory tract obstruction - prevention |
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Definition
-clos monitoring of animal
-have equipment prepared
-pre-oxygenation before potentially difficult intubation e.g. face mask, esp. if predisposed breed |
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Term
| Apnoea, resp. arrest, cyanosis - potential causes |
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Definition
-too light or too deep
-unnoticed resp. tract obstruction
-drug related e.g. fentanyl for additional analgesia, NMJ blockade (obliterate breathing- need IPPV), propofol (transient apnoea) |
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Term
| Cyanosis - potential causes |
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Definition
-inadequate oxygen supply
-very low cardiac output |
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Term
| Apnoea, resp. arrest, cyanosis - action |
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Definition
BEST ACTION - intubate and ventilate!
-turn off anaes. agent
-ensure 100% O2 administered - check O2 in cylinder and dialed up, check breathing system, tubes etc.
-confirm chest wall mvmt, listen for anything abnormal
-manually inflate lungs
-check pulse / heart rates ie. check not cardio-pul. arrest!
-check depth of anaes.
-specific antagonists if appropriate |
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Term
|
Definition
| cessation of an effective circulation |
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Term
|
Definition
-shock
-pre-existing CV dz.
-arrhythmias, catecholamine release
-hypovol / massive blood loss
-electrolyte / acid base abnormalities
-vagal reflexes e.g. ocular surgery
-anaes. OD
-hypoxia / hypercapnia / resp. arrest |
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Term
| Cardiac arrest - recognition |
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Definition
-no palpable pulse / heart sounds
-pale / grey / cyanotic MM
-no bleeding / dark blood at surgical site
-fixed, dilated pupils
-apnoea / gasping resp. pattern - care in horses - can think anaes. becoming too light, actually agonal gasping!
-ECG trace may be indicative of CPA |
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Term
|
Definition
-the earlier recognised the better chance of successful resuscitation
-carry out cardio-pul resuscitation
-remember to turn of anaes!
-avoid intracardiac route for drugs (difficult to get right area) |
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Term
|
Definition
-in man can just do cardiac compressions due to generally being primarily a cardiac problem
-in animals, CPA often due to resp. obstruction |
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Term
|
Definition
-airway obstruction
-VQ mismatch
-Equine Post-Anaes. Myopathy (EPAM)
-Neurpathy
-Fractures |
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Term
| What accounts for ~1/3 of anaes. deaths in horses? |
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Definition
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Term
| Anaes. A+E in horses - airway obstruction |
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Definition
-if head positioned lower than heart
-nasal congestion - remember obligate nose breathers
-care w. positioning |
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Term
| Anaes. A+E in horses - airway obstruction prvention |
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Definition
-phenylephrine up nostrils can constrict b.v. and so decr. nasal oedema
-when using a nasopharyngeal tube, ensure short and secrue so can't be aspirated
-leave oral ETT in place (but care as risk of biting in recovery) |
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Term
| Anaes. A+E in horses - VQ mismatch |
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Definition
i.e. vent.-perfusion mismatch
-commonly become hypoxic in anaes.
-high fraction inspired O2, IPPV does not always improve PaCO2, salbutamol to dilate airways, supplement O2 in recovery |
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Term
| Equine Post-anaesthetic Myopathy (EPAM) |
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Definition
-ischaemic damage to muscle - reperfusion injury
-muscles hard, hot, painful on palpation |
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Term
| Equine Post-anaesthetic Myopathy (EPAM) - muscles affected |
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Definition
-if lateral recumbency - tends to be relevant forelimbs affected
-if dorsal recumbency - tends to be hindquarters affected |
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Term
| Equine Post-anaesthetic Myopathy (EPAM) - identification |
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Definition
-muscles hard, hot, painful on palpation
-myoglobinuria - breakdown of musc/ myoglobin in urine (myoglobin is toxic to kidneys!)
-elevated CK and AST liver enzymes |
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Term
| Equine Post-anaesthetic Myopathy (EPAM) - prevention |
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Definition
-careful positioning on padded surface, w. limbs supported
-maintan MAP (mean art. P) > 60mmHg
-maintain oxygenation |
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Term
| Equine Post-anaesthetic Myopathy (EPAM) - tx |
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Definition
-analgesia
-fluids - flush out myoglobin
-nursing |
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Term
| Anaes A+E in horses - neuropathy |
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Definition
| -present as lame horse (but often not painful c.f. myopathy) |
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Term
| Anaes A+E in horses - neuropathy - prevention |
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Definition
-careful position e.g. cushion dome around eye
-remove headcollar during anaes - commonly facial nerve is affected |
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Term
| Anaes A+E in horses - fractures - occurence/causes |
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Definition
-may occur in induction or recovery
-commonly but not exclusively orthopaedic procedures
-"fight or flight" instinct - horses tend to panic! |
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Term
| Anaes A+E in horses - fractures - prevention |
|
Definition
-sedation and good analgesia
-quiet enviroment
-assisted recoveries
-head and tail ropes - steady horse in standing
-pool assisted recoveries |
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