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Definition of Anesthesia
Simple:
Complete:
A state of controlled and reversible unconsciousness achieved through injectable or inhaled drugs characterized by the absence of:
Pain Memory Motor response Reflexes
Phases:
Incoordination/ excitement Progressive relaxation Unconsciousness Continues until maintenance level achieved
Elimination:
Most injectable medications>>liver metabolism>>renal excretion (except ketamine in cats = direct to kidneys) Inhalants eliminated through lungs
Minimum database consists of ? Minimum dose to effect (premeds,correct existing px) Endotracheal tube Fluid therapy
THE ART OF ANESTHESIA These stages and planes are not well defined in every animal. The technician monitoring anesthesia of the patient must evaluate as many variables and indicators as possible to determine the patients depth of anesthesia. The technician must ensure that the patient does not feel surgical pain but must avoid excessive anesthetic depth.
STAGE I
Immediately after the administration of an inhalant or injectable agent animal is conscious but disoriented, shows reduced sensitivity to pain all reflexes are intact, animal is still awake, may struggle, urinate and/or defecate
IDEALLY SHORT = DANGEROUS
STAGE II
loss of consciousness BUT involuntary excitement all reflexes intact (exaggerated)
yawning
potentially hazardous for the animal d/t release of epinephrine >>>> cardiac arrhythmias Stage II ends when patient shows signs of muscle relaxation, decreased reflex activity and slower respirations.
IDEALLY SHORT = DANGEROUS
PLANE 2
PLANE 3
PLANE 4
STAGE IV
DONT GO HERE !!
complete cessation of respiration circulatory collapse DEATH
standard dose is calculated, drawn into syringe injected as needed directly into vein to effect
Induction (cont)
2. Intramuscular Injection
cannot be handled easily ie? usually requires a larger dose cannot be given to effect slower induction lengthy recovery time
useful for animals that
3. Oral Administration of injectables *feral in big carrier an extra-label use -- not used routinely beware of producing aspiration avoid contact with eyes
NOT RECOMMENDED
Inhalation Agents
Need to use rapid acting inhalant agents 1. Mask Induction
Cautions:
Prevention
use tight-fitting mask use preanesthetic sedation
Cautions: small patients only difficult to monitor patient risk of vomiting/regurgitation hyperthermia waste gas contamination of room + exposure of personnel Another option for fractious cats
Intubation
Position
Sternal, extend neck, tongue out Soft palette may be in way Epiglottis Arytenoid cartilages
Visualize
Place
Confirm
Secure
GENERAL ANESTHESIA
(CONTINUED)
MAINTENANCE OF ANESTHESIA
Two important tasks: 1. monitor patient closely to ensure that vital signs remain within normal ranges 2. maintain patient at an appropriate level of anesthesia so no pain is felt THE KEY TO EFFECTIVE AND SAFE ANESTHESIA . . . IS PATIENT MONITORING.
Oh dont listen to that thing ie pulse ox # can be low for several reasons? Check more than one thing
Cardiac rhythm can also be affected by anesthetic agents, Cardiac monitoring: direct palpation- where? auscultation esophageal stethoscope cardiac monitor
NOTE: The presence of a beating heart does not necessarily imply adequate circulation
at moderate depth of anesthesia, normal rate = _?_breaths per minute <6 and should be using IPPV?
Hyperventilation and tachypnea due to build-up of CO2, disease?,pain Type of respiration: thoracic or abdominal (when?)
contributing causes:
prevention:
Check temp q 15min Warm iv fluids Circulating hot water blanket/ hot water bottles Bair Hugger NEVER electric blanket*
7) Electrocardiography
Normal rythym
P,QRS, T
>200 cat >170 dog
Tachycardia
Bradycardia
ECG Abnormalities
Heart block PVC
Fibrillation
Respiratory Arrythmia
normal
In anesthesia log
SQ>IM>IV
INJ>INHALANT
4. patients temperature inverse relationship 5. breed of the patient (ie sighthound w/ _?_) Stages of Recovery progresses back through the same anesthetic stages that occurred during induction
MONITORING
recovery should take place in an area where animal can be monitored closely: emergency kit oxygen monitoring equipment check vital signs every 5 minutes: MM color, CRT, respiratory effort + temp q 15min until >98 ADMINISTRATION OF OXYGEN for 5 minutes after discontinuation of anesthetic agent: keeps patient oxygenated eliminates waste gases through scavenger system allows periodic bagging >>>>>> reinflates collapsed alveoli
EXTUBATION
remove when swallowing reflex returns Exception: brachycephalic = delay extubation till can lift the head remove the ET tube at the end of inspiration if blood or fluid had accumulated in oral cavity, leave cuff of tube partially inflated
as remove the tube >>>>> prevents these fluids from flowing down trachea
STIMULATION OF THE PATIENT may hasten recovery by gentle stimulation >>>>>>> reticular activating center rubbing face, head and neck, moving the limbs turn the patient over every 10 to 15 minutes (avoids ?)
POSTOPERATIVE ANALGESIA
before the animal experiences postoperative pain
tranquilization and/or use of analgesic medications never left alone on a table or in a cage with the door left open