Flashcards
Post Operative Care
Cards in this deck (84)
- 1Is the post-operative period classed as a high risk time?Yes - about 1/3rd of all deaths occurs in this period in small animals
- 2Why is the post-operative period difficult?Number of challenges that make effective post-anaesthesia care difficult
- 3What is classed as "the recovery-period"?The early post-op period before the animal is fully awake
- 4How long is the typical recovery for small animals?1st three hours after the end of anaesthetic agent administration
- 5What are the challenges that are faced in the post-op period compared to during anaesthesia?- Vet and nurse may be occupied with the next case
- Monitoring patients in the recovery area / kennel can be difficult
-> not tolerated by an awake patient
-> insufficient equipment to spare
- Difficult to provide oxygen support
- Visualization of the patient can be difficult - 6What is the key to post-op care?Observation and visualisation of the patient
- 7Why is the recovery period considered to be dangerous for horses?- High risk period
- Approx 30% of total mortality occurs
- Reduced monitoring/ oxygen supplementation/ unprotected airway
- Transition from recumbency to standing is critical and fractures are not uncommon - 8When does the recovery period end?- Defined when the animal is fully awake and the effects of teh anaesthetic agents on all body systems are gone
- For healthy - implies animal is awake, able to maintain own fluid and electrolyte balance and body temperature, cardiovascular and respiratory variables have returned to pre-anaesthetic values. - 9When does the recovery period end for high-risk patients?- Example horse after colic surgery
- Will enter second post-op phase that will extend for longer period of time
- Other interventions and supportive measures eg long-term fluid therapy will be required
- Post-op pain management is required throughout the whole post-op period - 10When is it safe to disconnect the patient from the anaesthetic breathing system and allow to breathe room air?Healthy animal
- Normally presence of a blink reflex indicates that an animal is sufficiently recovered from anaesthesia to breathe room air & maintain oxygen saturation
> 95 % - 11What is required to prevent hypoxaemia in the presence of respiratory depression?Provision of > 30 % FiO2
- 12What can happen with disconnection from the breathing system & oxygen delivery when respiratory depression is still present?Can lead to hypoxaemia
- 13Why is it important to consider when the patient is disconnected and oxygen is stopped?Relevant to the time that oxygen supplementation is discontinued during recovery from anaesthesia - can result in hypoxaemia and consequences if done at the wrong time
- 14What can be useful in the transition period for disconnecting?Pulse oximeter - measure the saturation and see whether the patient is able to maintain their own after the oxygen has been switched off
- 15What do you have to be aware of when you disconnect from the oxygen?- Previously delivered oxygen will form a buffer in the lungs
- Can take 1-2 minutes before SpO2 will fall
- Continue to monitor SpO2
- Will indicate whether continued oxygen supplementation is required in recovery - 16What do most practices have for the immediate recovery period?A dedicated recovery area for small animals which helps to facilitate observation and supportive care
- 17Where do horses recover when at a surgical facility?Padded box - also used for induction of anaesthesia
- 18What are the ideal features of a recovery area?- Close to central work area - continued observation
- Ideally one person stationed in this area whilst recovery happening
- Oxygen source available
- Heating source available
- Monitoring equipment available (pulse oximeter, ECG)
- Suction apparatus available to clear airway is needed - 19What should happen to the airway during recovery?Should remain clear and special attention paid to ensure this
- 20Is extubation routine in most patients?Yes
- 21Can a small animal be left alone if it hasn't been extubated?No
- 22When can extubation occur?Once swallowing reflexes have returned - sign that animal has protective laryngeal reflexes and is able to maintain its own airway
- 23What must not be done during extubation?Stimulate the animal to swallow by overly moving the tube - will go back to sleep and risk from aspiration
- 24What is a sign that a cat can be extubated?They will often lift their head or flick ears before swallowing - can be done at this stage
- 25What happens to the cuff during extubation?- Usually deflated
- Kept partially inflated if animal has aspirated some fluid into the trachea and this will help bring it out of the trachea and prevent going onto the lung - 26How should an animal be positioned after extubation?In cage with legs and head facing outwards so that good visual observation of the patient is possible.
Take care to ensure that the neck is stretched out so that the airway remains patent - 27Why is extubation in brachycephalic dogs and cats difficult?Immediately post-intubation is a high risk time for upper respiratory tract obstruction
- Long soft palate, struggle to breathe normally anyway - 28What is it essential to do with brachycephalic breeds?That the animal is awake enough to maintain a patent airway after extubation - prevent the soft tissues of the pharynx collapsing into the back of the throat
- 29What is required for extubating a brachycephalic breed?- Equipment available for rapid re-intubation:
IV induction agent, laryngoscope, ET tube - 30Is it okay to leave the extubation slightly longer in a brachycephalic dog?Yes - they tolerate it longer- leave until they swallow
- 31In what position is it useful to place brachycephalic breeds to aid with breathing post anaesthetic?On a wedge, so that the head is higher than diaphragm
- 32What is one of the main concerns with extubating, particularly if you have a patient with raised ICP?Coughing - will increase further
- 33What patients don't you want to cough whilst extubating?- Ophthalmological surgery: change in IOP is undesirable
- Animals with raised ICP
- Animals with cervical disc / skeletal abnormalities - 34When are you more likely to extubate if you don't want to stimulate coughing?Earlier but the patient still has to be able to protect their airway
- 35What should be the approach to a complication in recovery?- Observation is required to detect early!
- Stretch neck & pull out tongue
- Suction
- Re-anaesthetise & re-intubate
- Surgical intervention
- All might not be required - do as necessary - 36What can also be used within complications in recovery from anaesthesia?Judicious use of soluble c/steriods
- 37Which cases might require oxygen support in the recovery period?- Animals that are unable to maintain adequate haemoglobin saturation with oxygen in room air (21% oxygen)
- Lung pathology
- Compromised respiratory effort (e.g. fat animals)
- CVS disease
- Anaemia (try to increase O2 transport) - 38What are the ways that oxygen be supplied to help provide to patients?-Oxygen concentrator
- Anaesthetic machine & common gas outlet
- Pipeline oxygen & flowmeter - 39How do oxygen concentrators work?- Room air is drawn into the machine via a compressor & through a series of filters to remove dust & bacteria
- Compressed air is passed into a column which contains a zeolite molecular sieve (aluminum silicate)
- Nitrogen binds to the zeolite while oxygen passes through the sieve
- Just before zeolite in the first column becomes saturated with nitrogen a switch valve changes the output of the compressor to the second column
- Nitrogen in the first sieve is vented out – oxygen can be delivered to the patient via a small reservoir - 40What are features of using anaesthetic machine and common gas outlet?- Oxygen cylinders
- Size E oxygen cylinder holds 625 L of oxygen when full
- Therefore need to change cylinders relatively frequently
-> 5 L/min change cylinder after 125 minutes
- EXPENSIVE - 41With what supplies of oxygen is it a good idea to humidify it?Pipeline & cylinder
- usually not necessary for oxygen concentrators due to the humidity of room air - 42What does humidification allow and what is the advantage?- Prevents damage to the airways caused by desiccation
- important when delivery mechanism bypasses the nasal turbinates - 43What is the reservoir usually filled with for humidification?Sterile water
- 44How can oxygen supplementation take the form of?- Oxygen tent or cage
- Nasal administration of oxygen through small catheter inserted into the nasal cavity
- Face-mask
- Flow by - end of breathing circuit positioned next to nares
- Horses = tube fed from an oxygen pipeline source up the nasal cavity or via endotracheal tube - 45How is mask oxygen administered and what can it give?- A tight fitting face mask with a 5-6 L/min FGF can produce an FiO2 of 0.7-0.8
- Clear plastic face masks with a diaphragm are the best type of face masks to use
- Try not to obscure vision
- Do not squash the nares against the end of the mask
- Poorly tolerated by distressed patients - 46What are the advantages and disadvantages of mask oxygen?Adv:
- Quick and easy to do
- Relatively effective at increasing FiO2
Dis:
- Increase stress and worsening of dyspnoea
- Rebreathing of CO2
- Temperature and humidity increases inside mask - 47How is Flow-by oxygen administered?- Length of tubing connected to an oxygen source (e.g. anaesthetic breathing circuit & anaesthetic machine) is held within 2 cm of a patient’s nostril or mouth
- Try not to point the oxygen directly at the nares as this is poorly tolerated by most patients - 48What is the administration like by flow-by oxygen?FGF of 2-3 L/min can increase FiO2 to 0.25-0.4
- 49What are the advantages and disadvantages of using flow-by oxygen?Adv:
Quick and easy to do
Well tolerated especially by those who won't tolerate face mask
Dis:
Only moderate rise in FiO2 - 50What is an oxygen hood/ oxygen collar and how is it used?- Cling film should only cover 2/3 of the collar to allow carbon dioxide to be vented to the atmosphere
- Initially flood the hood with oxygen (1-2 L/min FGF for 1-2 minutes)
- FGF of 0.5-1.0 L/min will produce a FiO2 of 0.3-0.4 - 51What must be applied to any patient that has an oxygen hood or collar?Lubricant on the eye to prevent drying of the eyes
- 52What are the advantages and disadvantages of using an oxygen hood/collar?Adv:
- Quick and easy to do
- Well tolerated in dogs and cats
Dis:
- Only produces a modest increase in FiO2
- Inside the hood can become very hot and humid and therefore promote hyperthermia - 53What can be used to make an oxygen cage?- Commercial ones available
- Incubator
- Kennel with plastic front
- Just needs to be vented to allow CO2 out - 54How are oxygen cages used?- Oxygen cages are vented to prevent the build up of CO2
- Flow rate of O2 to fill the cage with oxygen depends on the volume of the cage
- High flow rates of O2 are required initially
- Flow rate of O2 can then be reduced to 1-2 L/min
- In homemade O2 cages the FiO2 is difficult to predict - 55What needs to be provided to an animal when using an oxygen cage?The animals metabolic consumption of oxygen
- 56What are the advantages of oxygen cages?- Easy means to provide oxygen to small patients in a stress free way
- Visual contact with the patient can be maintained as long as the doors or walls of the oxygen cage are made from transparent material
- An FiO2 of 50% can be achieved with most oxygen cages given a sufficient flow rate of oxygen into the cage - 57What are the disadvantages of oxygen cages?- Limited access to the patient; repeatedly opening the door will result in a drop in FiO2
- Environment becomes quickly warm and humid - measure body temp of patient regularly - may need to cool the cage by putting ice packs into the cage with patient - not contacting the patient
- Unsuitable for medium to large breed dogs due to sizes of cages available - 58How are nasal prongs used?- Available in three different sizes: newborn, paediatric & adult
-> correct size is found by measuring the distance between the left and right nares
- Flow rates of 1-2 L/min are well tolerated & can produce a FiO2 of 0.3-0.5
- Should be combined with humidification to prevent drying of the nasal membranes
- Better tolerated than nasal cannulae in brachycephalic dogs - 59What are the use of nasal catheters useful for?-Providing oxygen support for >24 hours to medium and large breeds o dog
- 60Why should commercially available silicone nasal catheters be used?- Less irritant to the nasal mucosa
- Dried mucous does not adhere to them so that they are easier to remove
- Available in multiple lengths and diameters - 61What are classed as poor candidates for nasal oxygen catheters?1. Brachycephalic breeds with stenotic nares
-> may also predispose to bradyarrhythmias due to increased vagal tone
2. Animals that are open mouth breathing
-> increased air mixing in the pharynx leads to a reduction in the effective FiO2 - 62What is the technique for placing a nasal cannula in a dog?- Distance from nose to medial/lateral canthus of eye is measured and marked on the catheter with tape
- Nostril desensitised with topical local anaesthetic (lidocaine) and wait 5 mins for effect
- Catheter inserted into ventral meatus of nose to the premeasured distance (ventromedially direction)
- Catheter sutured in place using butterfly tape and nylon sutures beside nostril and on side of face or top of head
- Elizabethan collar may be necessary to prevent removing the catheters - 63What is the flow rate of nasal catheters and how can it be changed?- 50-150 mls/kg/min or 1-2l/min to raise the FiO2 to 40-60%
- Higher flow rates are poorly tolerated and case sneezing
- Use bilateral to increase the flow - 64Should oxygen through nasal catheters be humidified?Yes - reduce desiccation of nasal turbinates and irritation
- 65If an animal is anaemic is pulse oximetry a useful guide to oxygen status?No - might be fully saturated but reduced carrying capacity
- 66When should an IV catheter be placed?At induction of anaesthesia
- 67When should the IV catheter be removed?- Depends on the patient
- Requirement for post-operative fluids
- Requirement for post-operative analgesia
- At least:
-> leave the catheter in place until the animal is fully recovered from anaesthesia
-> return to normal physiological function - 68How do you know what’s normal to guide post-op care?- Compare to pre-op parameters for heart rate and respiratory rate
- Normal body temperature
- Normal haemoglobin saturation with oxygen
- Provide appropriate support to maintain blood pressure - 69Why should a rectal temperature be taken using a rapid response digital thermometer?- Determine requirement for post-operative temperature support
- Baseline for further measurements - 70Why can body temperature full during the recovery period?- Patient may be inactive
- Effects of anaesthetic agents are still present
- Kennel area may be colder than the theatre
- Supportive warming measures may be removed - 71Why are warm water beds not used in post-op period?Vulnerable to damage
- 72What is it important to make sure when trying to heat a patient?That it is not too hot to burn them as they won't be able to move away from the heat source - never leave unattended on an electric heat device
- 73What should be considered when positioning and moving a patient?How that position/movement might hurt the patient particularly if they have a concurrent problem such as arthritis
- 74What are the issues surrounding recovery for geriatric patients?- Changes in routine are less well tolerated
- Muscle weakness can complicate recovery
- Lack of sleep increases fatigue and decreases the outcome due to reduced immune system, less likely to eat etc
- Post-operative delerium common with older patients - 75What is essential for looking after older patients?Tender loving care and looked after properly
- 76Give 3 methods of reducing heat loss during recovery time.- Insulation
- Environmental temperature
- Warming devices - 77How can insulation help reduce heat loss?Prevents animal coming into contact with cold surfaces and by reducing excessive clipping will stop reduction of natural insulation
- 78What is one of the most effective ways of reducing heat loss?Keeping a room warm
- 79Give 6 warming devices.- Electrical heat pads
- Warm lamps
- Incubators
- Warm water beds
- Hot packs
- Warm air circulating blankets - 80What does the level of monitoring required during the post-op period depend upon?ASA status of animal and abnormalities detected during anaesthesia
- 81What should all animals have monitored until in sternal recumbency?Temperature
Pulse
Respiration - 82How can measurement of arterial blood pressure be continued into the recovery period?- Arterial catheter placed in anaesthesia
- Doppler device - 83What does provision of most appropriate environmental conditions provide for recovery?Improve general comfort
Reduce fear and anxiety
Reduce pain experienced - 84What does good nursing care include?Careful attention to wounds, bandages and catheter sites to check that theses areas are dry and therefore not likely to become inflamed and infected
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- Foundations of clinical veterinary science - CVS1 (Anaesthesia - Jo Murrell) Flashcards on Post Operative Care, created by Rachael Jones on 05/12/2017.
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- Rachael Jones · Dec 2017
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- Apr 6, 2018
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