Anesthesia Angst Kelly Lynn Cronin MBA BS PHR VTS ECC RVT Operations Manager Advanced Animal Hospital Group OwnerCEO Success Strategies Veterinary Consulting Veterinary Technician Appreciation Week is October 16th22nd ID: 761360
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Anesthesia Angst Kelly Lynn Cronin, MBA, BS, PHR, VTS (ECC), RVTOperations Manager Advanced Animal Hospital GroupOwner/CEO Success Strategies Veterinary Consulting
Veterinary Technician Appreciation Week is October 16th-22nd! We LOVE our technicians!
What’s Mine is Yours
At: http://www.wallpaperden.com/dog-face-3.shtml First Rule of Anesthesia For Anesthetics Never Panic
Second Rule of Anesthesia Never Let Go of a Closed Pop Off Valve
Preparation
Safe Anesthesia Starts Before Your Patient Arrives
At: http://www.wallpaperden.com/dog-face-3.shtml Pre-Anesthesia Requirements General Consent Forms Discussion of Risks Physical Examination Medications & Fluids Pre-anesthetic tests Specific Pre-anesthetic Protocols
At: http://www.wallpaperden.com/dog-face-3.shtml Food should be withheld for 12 hours prior to admission in normal cats and dogs over age 4 months. Why? Exceptions? How do we mitigate hypoglycemia in these patients? How do we test for BG during anesthesia? J Am Anim Hosp Assoc 2011; 47:---–---. DOI 10.5326/JAAHA-MS-5846
Discuss Anesthesia Concerns with the Owner Discuss the Risks of Anesthesia
Premedication
Blood samples should be drawn prior to premeds if it is not excessively stressful to the patient as premeds may influence the results of certain tests Example – Acepromazine can decrease patient PCV up to 30% Screensaver image courtesy of 8screensaver.com
Image courtesy of profilethai.com Pre-anesthetic medications should be administered: -30 to 45 minutes prior if given SQ . -15 to 20 minutes prior if given IM
Acepromazine A phenothiazine tranquilizer N o analgesic properties A ddition of an opioid reduces the acepromazine dose and the likelihood of hypotension or excessive sedation A ce is no longer a concern with seizure patients Screensaver image courtesy of 8screensaver.com Garner, J., Kirby, R. and Rudloff , E. (2004), THE USE OF ACEPROMAZINE IN DOGS WITH A HISTORY OF SEIZURES. Journal of Veterinary Emergency and Critical Care, 14: S1–S17. doi:10.1111/j.1476-4431.2004.t01-27-04035.x
Atropine / GlycopyrrolateHeart rate increase Decrease secretions Parasympatholytic Anticholinergic Difference glycopyrrolate and atropine? Screensaver image courtesy of 8screensaver.com
Butorphanol Opioid Butorphanol adds a short acting analgesic effect Recommended use Butorphanol has an antagonistic effect when used with mu agonist opioids such as morphine, hydromorphone , fentanyl , or oxymorphone More effective for sedation than for analgesia Screensaver image courtesy of 8screensaver.com
Opioids Many o ptions morphine, hydromorphone , fentanyl , buprenorphine or oxymorphone Varied duration of action Effective for sedation and analgesia Can cause vomiting Can cause respiratory depression Screensaver image courtesy of 8screensaver.com
Anesthesia Monitoring and Maintenance
Doppler or Oscillometric?Screensaver image courtesy of scenicreflections.com ASA anesthesia guidelines 1. Healthy 2. Mild systemic disease. 3. Severe systemic disease not incapacitating. 4. Incapacitating disease 5. Moribund patient not expected to live
Wallpaper image courtesy of Computer Wallpapers at: http://www.freecomputerwallpapers.net/view/guard_cat_wallpaper-1600x1200.html What constitutes anesthesia ? A nesthesia is a temporary induced state with one or more of analgesia , paralysis , amnesia, and unconsciousness.
What warrants intubation? What warrants a catheter?What warrants an emergency drug sheet?http://csuvth.colostate.edu/emergencydrugcalculator /
Wallpaper image courtesy of Lord Channel and WallPaper4God.com at:http://wallpaper4god.com/en/background_cat/ Set Yourself up for Success -Leak test your machine prior to every use -Care for ET Tubes correctly -Check ET tubes prior to use - Stylets ? -Cuff inflation - Use the right sized tubes and system for your patient
Cautionary Tale
“Dark Cat” wallpaper image courtesy of AnimalWallpapers.net AT: http://www.animalwallpapers.net/wallpaper/Dark-Cat/ Most Dangerous Periods During Anesthesia? Induction Recovery
Anesthesia monitoring Parameter times? 1 st route of parameter correction Time required to change anesthetic depth Image courtesy of http://nature-desktop.blogspot.com
Got O2? Discussion re-breather vs. non re-breatherDiscussion dead space Flow rate Flush Valve Lung inflation
Wallpaper image courtesy of ScenicReflections.com at: http://www.scenicreflections.com/download/278007/BLACK_CAT_Wallpaper/ t Anesthesia Monitoring End Tidal CO2 First and best warning Better at assessing respiratory quality than SPO2 Great warning for faulty equipment
Wallpaper image courtesy of ScenicReflections.com at: http://www.scenicreflections.com/download/278007/BLACK_CAT_Wallpaper/ t Anesthesia Monitoring Temperature Affects everything else Is affected by everything else Is all too often ignored
Wallpaper image courtesy of ScenicReflections.com at: http://www.scenicreflections.com/download/278007/BLACK_CAT_Wallpaper/ t Anesthesia Monitoring Blood Pressure A must in small patients and cats >60 mm Hg MAP A dry kidney is a dead kidney Lasting effects
Wallpaper image courtesy of ScenicReflections.com at: http://www.scenicreflections.com/download/278007/BLACK_CAT_Wallpaper/ t Anesthesia Monitoring Pulse Oximetry Gets the most love Deserves it least
Best Anesthesia Monitoring Device?
Anesthetic Agents
For a Million Dollars What is the Correct Setting on an Anesthesia Vaporizer?
Surgical fluids Why are fluids so important during anesthesia? VasodilationSurgical Rate
There are no safe anesthetic agents, there are no safe anesthetic procedures. There are only safe anesthetists.—Robert Smith, MDa
Etomidate Short acting intravenousUsed for conscious sedation if not combined in multi-modal inductionGood for cardiovascular compromise Rapid onset of action Head trauma- Decreases intracranial pressure and maintain a normal arterial pressure Free screensaver image available at scenicreflections.com
Ketamine Pain Killer Used alone elevates BP (stimulates circulatory)Antidepressant Agitation and confusion Given IV/IM NMDA receptor antagonist or classified as dissociative Free screensaver image available at scenicreflections.com
Valium/ MidazolamBenzodiazapine Profoundly potent anxiolytic , amnesic , hypnotic , anticonvulsant , skeletal muscle relaxant , and sedative Given IV/IM (valium stings)/rectal Rapid onset of action Flumazenil is the reversal agent Free screensaver image available at scenicreflections.com
Propofol Given IV Hypnotic/amnestic Rapid onset of action Causes respiratory depression Not much analgesic effect Potential pain on injection Vasodilation sometimes leads to lower BP Serial use in cats is contra-indicated due to red blood cell destruction/ 28 is also contra-indicated in cats Free screensaver image available at scenicreflections.com
Alfaxan Given IV for induction/IM for sedation Rapid onset of action Rapid elimination No extra-vascular tissue irritation Consecutive days use is fine Less respiratory depression Not analgesic Free screensaver image available at scenicreflections.com
Isoflurane Halogenated Ether Inhalation anesthetic Mechanism of action is not understood Analgesic Muscle relaxant Potent vasodilator Free screensaver image available at scenicreflections.com
Reversible SedativesDexdomitor- synthetic α2-adrenoreceptor agonist -off label in cats -reversed with antipamezol -peripheral vasoconstriction - bradycardia light,sound and pain reactive - hyperexcited dogs may have reduced effects Free screensaver image courtesy of stockpile .com
Reversible SedativesXylazine -Rompun -synthetic α2- adrenoreceptor agonist -makes cats vomit -reversed with yohimbine -sedative -analgesia Free screensaver image courtesy of stockpile .com
Questions? Thank You!Kelly.lynn.cronin@gmail.com