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GENERAL ANESTHESIA

Reading Assignment Chapter 2, pp 51-118 in VAAA

Definition of Anesthesia
Simple:

drug induced unconsciousness

Complete:

A state of controlled and reversible unconsciousness achieved through injectable or inhaled drugs characterized by the absence of:
Pain Memory Motor response Reflexes

Components of General Anesthesia


1) Preanethesia

Minimum data base + patient status>>anesthetic protocol

2)Induction animal leaves state of consciousness

Phases:
Incoordination/ excitement Progressive relaxation Unconsciousness Continues until maintenance level achieved

Components of General Anesthesia (cont)


3) Maintenance sufficient anesthesia administered to keep patient at
appropriate depth of anesthesia

Loss of protected reflexes


during this time Surgical procedures performed

CLOSE MONITORING IS ESSENTIAL

4) Recovery (reversal of induction) begins when the conc. Of


anesthethetic agent begins to decrease in CNS

Elimination:
Most injectable medications>>liver metabolism>>renal excretion (except ketamine in cats = direct to kidneys) Inhalants eliminated through lungs

SAFETY OF GENERAL ANESTHESIA


General anesthesia is not without risk. Monitoring by a trained individual is the single most important factor in preventing serious anesthetic problems. Multiple precautionary steps minimize risk:

Minimum database consists of ? Minimum dose to effect (premeds,correct existing px) Endotracheal tube Fluid therapy

CLASSICAL STAGES AND PLANES OF ANESTHESIA


Animals pass through a series of anesthetic stages and planes, roughly correlated with changes in anesthetic depth. Animals show a progressive loss of: pain perception>> motor coordination>>consciousness >>reflex responses>>muscle tone>>> cardiopulmonary function

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

pupils dilated struggling animal may injure itself

actions are not under conscious control

unpleasant for the animal or staff

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

STAGE III (VAA table 2-1; p. 57)


Subdivided into FOUR planes:
PLANE 1 light patient will not tolerate surgery respiratory pattern becomes regular eyeballs start to rotate ventrally gagging and swallowing reflexes gone or heavily depressed other reflexes present but less brisk medium suitable for most surgery usually unconscious and immobile respirations regular but shallow (12 to 16) relaxed skeletal muscles heart rate and blood pressure mildly decreased palpebral reflex gone eyes: sluggish papillary light response eyeballs central or rotated ventrally pupils slightly dilated deep animal appears deeply anesthetized significant depression of respiratory and cardiovascular functions respiratory rate = less than 12 breaths per minute shallow respirations heart rate is significantly reduced pulse strength is reduced capillary refill time (CRT) is increased eyes: poor pupillary light reflex eyeballs central pupils dilated weak or absent reflexes marked skeletal muscle relaxation too deep respiratory effort is primarily abdominal muscular in nature further decrease in respiratory effort and effectiveness eyes: fully dilated pupils no papillary light response dry eyes no muscle tone dramatic drops in heart rates and blood pressure pale mucous membranes prolonged CRT nearing death

PLANE 2

PLANE 3

PLANE 4

STAGE IV
DONT GO HERE !!
complete cessation of respiration circulatory collapse DEATH

INDUCTION TECHNIQUES AND AGENTS


Injectable Anesthetic Agents 1. Intravenous Injection one of the most common induction techniques

standard dose is calculated, drawn into syringe injected as needed directly into vein to effect

Through Stage I and II quickly to ?

endotracheal intubation constant infusion to effect --more complex

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

may be more suited for critical patients

Cautions:

Prevention
use tight-fitting mask use preanesthetic sedation

anesthetic gas pollution of room risk of stressing patient

may be dangerous with animals with poor respiratory function


Myth about masking

Inhalation Induction (cont)


2. Anesthetic Chamber Induction
uses sturdy, see-through container

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

Watch in in between cartilages (where goes if to side or over?) Timing (cats)


Cough Watch rebreathing bag Condensation in tube hair test Bag and observe

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.

A. Monitoring Vital Signs


Vital signs = those variables that indicate response of an animals homeostatic mechanisms to anesthesia
Rely on your own senses first and foremost, confirm with electronic devices

Oh dont listen to that thing ie pulse ox # can be low for several reasons? Check more than one thing

Monitoring Vitals (cont)


1. Heart rate and rhythm Normal minimal heart rates: dog=>? beats per minute cats=>? bpm Lower heart rates may indicate excessive anesthetic depth
result of a depressant effect of anesthetic on heart rate and myocardial function

Cardiac rhythm can also be affected by anesthetic agents, Cardiac monitoring: direct palpation- where? auscultation esophageal stethoscope cardiac monitor

esp. halothane, xylazine

NOTE: The presence of a beating heart does not necessarily imply adequate circulation

Monitoring Vitals (cont)


2. Capillary refill time CRT reflects perfusion of tissue with blood but not infallible prolonged CRT indicates that tissues have reduced blood supply due to: vasoconstriction, low blood pressure (what drugs?), shock, excessive anesthesia

Monitoring Vitals (cont)


3. Mucous membrane color gingival, conjunctiva, tongue, vulva or prepuce pale mm color = poor perfusion or ? bluish discoloration = cyanosis = stagnant blood flow or lack of oxygen Yellow can mean?

Monitoring Vitals (cont)


4. Pulse strength subjective, palpate a major artery reflects adequacy of blood circulation throughout the body hypotension = weak, thready pulse 5. Blood loss
estimated by counting used sponges

How much blood in a gauze pad?

if excessive, predisposes to shock

Monitoring Vitals (cont)


6. Respiration rate and depth
monitor by observing animals chest or reservoir bag

monitor: respiratory rate

depth of respiration (tidal volume)

at moderate depth of anesthesia, normal rate = _?_breaths per minute <6 and should be using IPPV?

atelectasis = partial collapse of alveoli, bag or


sigh animal every 5-10 minutes

d/t decrease in tidal volume (25%)

Hyperventilation and tachypnea due to build-up of CO2, disease?,pain Type of respiration: thoracic or abdominal (when?)

Monitoring Vitals (cont)


7. Thermoregulation
hypothermia = the most common anesthetic complication
MOST TEMP LOSS OCCURS WHEN?

contributing causes:

ALCOHOL USE IN PREP NO MUSCLE ACTIVITY


DECREASED METABOLIC STATE (d/t drugs)

OPEN BODY - Flush

prevention:

Check temp q 15min Warm iv fluids Circulating hot water blanket/ hot water bottles Bair Hugger NEVER electric blanket*

B. Use of Instruments to Monitor Vital Signs


1. Blood pressure
Systolic ventricles contract (highest) Diastolic between contractions (lowest) MAP - Average

2. Doppler blood pressure monitors


Manual cuff inflate/deflate uses sound

3. Oscillometer blood pressure monitors


Automatic ie Dynamap

Use of Instruments to Monitor Vital Signs (cont)


4. Central venous pressure ( CVP )
Catheter into jugular to anterior vena cava

5. Blood gases arterial blood sample a. Oxygen


Free molecule in plasma (PaO2) Blood Gas Analyzer Bound on hemoglobin (Sao2) Pulse Oximeter

b. Carbon dioxide (PaCO2) blood gas analyzer 6. Capnography monitors CO2

7) Electrocardiography
Normal rythym

P,QRS, T
>200 cat >170 dog

Tachycardia

Bradycardia

<60 dog <100 cat

ECG Abnormalities
Heart block PVC

Fibrillation
Respiratory Arrythmia

normal

C. Reflexes and Other Indicators of Anesthetic Depth


Reflex = 1. Reflex activity --diminishes w/ deeper anesthesia 2. Palpebral reflex -- blink 3. Swallowing reflex indicator to pull e-tube 4. Pedal reflex squeeze digit>>pulls leg back 5. Ear flick reflex tickle inside of ear 6. Corneal reflex corneal contact >> blink/retract 7. Laryngeal reflex closes epiglottis 8. Muscle tone jaw tone 9. Eye position and pupil size I central II ventral III central 10. Salivary and lacrimal secretions why we need lube 11. Heart and respiratory rates reflexes discussed prev. 12. Response to surgical stimulation pain response

Increase HR and increase RR

D. Judging Anesthetic Depth


monitor as many variables as possible consider all the information
each animal is unique and has an individual response to increasing anesthetic depth

E. Recording Information during Anesthesia

drug log controlled substance log patients record

In anesthesia log

RECOVERY FROM GENERAL ANESTHESIA


Recovery period = the period between _?___and _?___ Factors affecting length of recovery period: 1. length of anesthesia direct relationship 2. condition of the patient -- disease 3. type of anesthetic given and route of administration

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 ?)

REASSURING THE PATIENT


quiet, calm, gentle handling, low light situation minimize patient discomfort blankets/padding, pain meds

POSTOPERATIVE ANALGESIA
before the animal experiences postoperative pain

(more on these drugs in another lecture)

NURSING CARE application of supplemental heat if patient hypothermic


warm towels hot water bottles circulating warm water pads

remember NEVER electric heating pads

PREVENTING PATIENT SELF INJURY


some patients will go through period of excitement a stormy recovery

Padding to avoid head banging

tranquilization and/or use of analgesic medications never left alone on a table or in a cage with the door left open

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