Term
| what is classified as the recovery period? |
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Definition
1st 3 hours at the end of anaes. agent admin
-end is defined when animal is fully awake and effects of anaes. agents on all body systems are gone
i.e.in a healthy animal: animal awake, able to maintain own fluid, electrolyte balance and body T, Cv and resp variables returned to pre-anaes. values |
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Term
| why is the recovery period a high-risk period for SA? |
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Definition
-CV and resp. system effects of the drug are still present
- getting less support e.g. O2 removed
- dec. monitoring and observation of patient |
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Term
| Recovery period in horses |
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Definition
-period in which ~30% of total mortality occurs
-similar reasons to SA plus the transition from recumbency to standing |
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Term
| What is the second post-operative phase? |
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Definition
-high risk patients e.g. horse post colic surgery, enter a second post-op period after the initial recovery period
-extends for longer period of time
-other interventions and support measures are required e.g. long-term fluid therapy |
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Term
| Describe the ideal recovery ward |
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Definition
-close to central work area so can continually observe the patient/s
-ideally one person stationed in recovery area (generally a nurse)
-oxygen source, heating source, monitoring equipment and suction apparatus (to clear airway if needed) all available |
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Term
| placement of animals in recovery cagses |
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Definition
| care w. position of animal and in appropriately sized cage - extend the neck w. the tongue pulled out to clear the airway |
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Term
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Definition
-improve general comfort of the animal
-decr. fear and anxiety (which can help to dec. pain and analgesia requirement)
NB: cats and rabbits will be extremely stressed in noisy environments or next to dogs - ideally should be in separate areas
-decr. pain experienced |
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Term
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Definition
-vital! ideally should have person / nurse in recovery area until fully recovered
-T, pulse rate, resp. rate monitoring (3 vital signs) and pain, etc
-animals will suffer from discomfort if they develop a full bladder and so the bladder should be catheterised if necessary
-attention to wounds, bangages and catheter sites to check that dry and therefore not likely to become inflamed and infected |
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Term
| Airway mgmt in recovery period |
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Definition
-ensure it is clear and w/o obstruction
-O2 supplementation may be indicated in some patients |
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Term
| How can you judge when to remove supplemented O2? |
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Definition
| -blink reflex is a good indicator that able to breathe room air
-check w. pulse oximetry (care - will appear to be 100% if anaemic!)
-remember previously administered O2 will act as a buffer, so may take a few mins post-removal for resp. problems to appear |
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Term
| Oxygen supplementation indication |
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Definition
-unable to maintain adequate Hb saturation w. O2 in room air
-lung pathology / CVS dz. / anaemia / compromised resp. function e.g. excess fat |
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Term
| Oxygen supplementation admin. in post-op period |
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Definition
-nasal admin of O2 through small catheter into nasal cavity, through the nostrils or via face mask
-in horses - oxygen pipline up nasal cavity or via ETT
-in SA - oxygen tent |
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Term
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Definition
-can occur once swallowing reflexes have returned (indicate have protective laryngeal reflexes and able to maintain own airway) - care not to overstimulate (animal may still be slightly to deep)
NB: cats can often lift their heads up before they can swallow - can remove tube then |
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Term
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Definition
-cuff is usually deflating during extubation - in some animals amy be helpful to only partially deflate if some fluid aspirated into trachea
-after ensure the neck is stretched out and the airway remains patent |
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Term
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Definition
-must observe in order to identify!
-make sure there are facilities available to re-intube rapidly (and reanaes. if necessary)
i.e. laryngoscope, new ET tube (possible smaller in case decr. airway), IV hypnotic agent, IV access
-dont remove catheter until animal definitely ok, esp in brachiocephalics
-care to avoid coughing when extubating esp in opthalmic surgery / animals w. skeletal abnormalities / high intracr. P - coughing will incr. intropthalmic/ cranial P |
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Term
| Body temperature in recovery |
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Definition
| -esp important in SA, esp cats and small mammals - large SA:vol ratio so loose heat rapidly
-also consider foals and young farm animals
-exacerbated as animal is not moving and in cold kennel
-take rectal T in recovery - use digital thermometer - quicker so better tolerated - should have rectal T of 37C before left unattended |
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Term
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Definition
-will prolong recovery due to decr. in metabolic rate
-incr. O2 consumption and requirement due to shivering |
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Term
| Considerations when supporting body temp |
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Definition
-animals recovering from anaes. are unable to move away from a heat source that is too hot
-ensure hyperthermia and/or burning does not occur
-if excessive warmth is applied specifically to peripheral areas, it may lead to vasodil. and so INCR. heat loss and promote hypotension |
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Term
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Definition
| -insulation via bedding and blankets, bubble wrap or insulating foil
-avoid excessive clipping of hair in prep.
-environmental T! keeping the room warm is one of most effective ways of dec. heat loss |
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Term
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Definition
-electrical heat pads
-warm lamps
-incubators
-warm water beds
-hot packs
-warm air circulating blankets |
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Term
| Elecrical heat pads limitations |
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Definition
-most are not thermostatically controlled
-some are more effective when weight is applied to them
-animals in recovery may be able to chew through electrical cables - do not leave un-monitored! |
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Term
| Warming lamp considerations |
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Definition
| -ensure that lamp is appropriate height above animal to prevent burning |
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Term
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Definition
-provide a thermostatically-controlled warm environment for very small animals
-can also function as an oxygen tent |
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Term
| Incubators considerations |
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Definition
| -once animals are more awake they must be monitored closely - danger that they may fall down side / get trapped between tray and incubator |
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Term
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Definition
water is heated electrically and circulated through the matress so can be maintained at a constant T
-water provides cushioning |
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Term
| Warm water beds considerations |
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Definition
| -vunerable to puncture once animal is awake |
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Term
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Definition
-small bags that contain an element which when activated initiates a chemical exothermic reaction i.e the pack warms up
-reaction is reversible so the pack can be re-used |
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Term
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Definition
| -can become extremely hot when activated, so need to be wrapped in a protective cover when they are placed against the animal |
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Term
| Warm air circulation blankets |
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Definition
-a unit which blasts warm air through a blanket, generating a warm enviroment
-very effective at keeping animals warm during anaes and the recovery period
-disposable
-in studies in man, more effective than other warming techniques |
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Term
| Water air circulation blankets considerations |
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Definition
| -rel. fragile so can only be used when animal is immobile |
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Term
| Monitoring in post-op period |
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Definition
-requirment depends on ASA status of animal and any abnormalities were detected during anaes.
-all animals should have T, pulse, resp. monitored until awake and able to maintain sternal recumbency
-pulse oximetry, ECG, BP may also be useful, possible end tidal CO2 conc (catheter up nose of dogs - cats dont tolerate this well) |
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Term
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Definition
-depends of patient
-requirement for post-op fluids / analgesia
-at least leave in place until fully recovered from anaes. and returned to normal physiological functions |
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Term
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Definition
-inadequate post-op pain control leads to stress, dec. welfare, decr. food and water intake, incr risk of post-op complications such as automutilation and wound infection, delayed recovery
-resp syst. - animal less likely to put in full resp. effort if painful
-musculoskeletal system - if don't use then muscle wasting
-GI system - pain decr. gut motility
-stress response |
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Term
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Definition
| -objective measures are unreliable in the assessment of pain e.g. HR, resp rate, body T
-pain assesment based primarily on behavioural observations |
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Term
| Difficulties in assessing pain |
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Definition
-use behavioral observations but beh. affected by other factors, esp as in altered environment
-many analgesic drugs are often sedative - sedation does not always indicate adequate analgesia
-immediately post-anaes., the effects of anaes. can confound pain assessment |
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Term
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Definition
-cats rarely vocalise in response to pain
-can become depressed and sit hunched at the back of the cage
-often thought to not be in pain |
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Term
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Definition
-attention-seeking beh. leads more readily to admin. of pain relief c.f. cats' behaviour
-breed variation
e.g. labs - stoical
greyhounds - "whimpish" |
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Term
| Glasgow Composite Pain Scale |
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Definition
-mutli-dimensional pain scale to assess acute pain in dogs
-based on pyschometric principles
-diff. qu. regarding the dog's behaviour, each possible answer is assigned a score
-total score is calculated and provides an indication of the degree of pain
-serial application of the scale to an indiv. allow changes in pain score and so requirement for analgesia to be observed over time and can help to minimise variability in assessment from different individuals |
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