Anesthesia- Monitoring 3

kelseyfmeyer's version from 2015-11-03 14:40

Monitoring complications

Question Answer
what are the most most common monitoring complications?hypoventilation(apnea)(hyperventilation), bradycardia(tachycardia), hypotension(hypertension), hypothermia
in hypoventilation, what parameters are inc and which are dec?DEC MV(minute volume), reduced RR, low TV(tidal volume), PaCO2 is INC (>45mmHg which is hypercapnea, hypercarbia <--synonyms)... (if RR=0 that is apnea)
5 possible causes of hypoventilation?(1) deep anesthesia (2) positioning (3) severe hypothermia (3) musculoskeletal paralysis (NMBA<---neuromuscular blocking agent) (4) drug induced resp. depression (propofol, etomidate, ketamine...)
how can temp affect respiration?hypothermia=hypoventilation
treating hypoventilation is often dependent on the cause. what are some general and specific ways to avoid/treat this problem?ET intubation, oxygen therapy, IPPV (intermediate positive pressure ventilation), lighten depth of anesthesia, warm pt...
when is apnea common to encounter? why?immediately after anesthetic induction, because of a relative anesthetic overdose
what do you do if there is apnea immediately following anesthetic induction?check pulse, ventilate 3-4xs/min, pressure not >20cmH2O
how big of a deal is apnea during anesthesia?EMERGENCY
what are the 4 MOST common causes of apnea during anesthesia? (5 less common causes?)(1) anesthetic plane too deep (2) equipment failure (pop-off valve closed, ventilator stopped) (3) hypothermia (4) reflex apnea secondary to visceral traction. (Less common: extreme hypercarbia/hypoxemia, CNS dz (brain edema), metabolic alkalosis, open thorax, NMBA)
what should you do before you start to fiddle with the equipment, what should you do?CHECK THE PT! (eyes, jaw tone, HR, RR, BP) check the anesthetic plane theyre in! THEN chec equipment (esp pop-off valve)... **DON'T FORGET TO VENTILATE!
look at chart on slide 11, on what to do if there is apnea--now talk out the flow chart on what to doSTART WITH CHECKING PT--> is anesthetic plane good? if too deep, lighten. if that's fine, then check equipment (ESP POP OFF VALVE!). If machine problems, fix them and bag them. If not a prob with machine, check temp. if cold, warm them. If temp is normal, check with surgeon
if there is hyperventilation, what are 5 things you should rule out as possible causes?(1) inadaquate depth of anesthesia/analgesia (2) hypercapnea (rare) (3) hypoxemia (4) hyperthermia (5) metabolic acidosis
what is the first thing you'd check if there is hyperventilaiton? explain what you'd doCheck the anesthetic depth! inc if required. Can inc FGF and/or inhalant agent % (MAX IS 3%), ventilate, bolus of injectable anesthetic if necessary
if the anesthetic depth is fine and the plane of anesthesia (the first thing to check) what would you check next, and how(explain)?check equipment! check rebreathing bag, absorber granules, one-way valves, fresh gas flow, breathing circuit
which kind of animal will tend to hyperventilate?small dogs.
what is considered bradycardia in dogs? cats? horses? what other factor?size of pt also plays a role. Dogs <60BPM, cats <100BPM, horses <20BPM
5 main possible etiologies for bradycardia?drug effects (opioids alpha 2 agonists), high vagal tone, hyperkalemia, hypothemia, CNS dz and inc ICP (intracranial pressure)
If you see bradycardia, before you do anything else, do what? THEN what do you do?DONT trust monitor blindly! reconfirm with esophageal stethoscope. Then check the pt FIRST! what's the BP like? what are the surgeons doing?
in case there is a sudden decrease in HR, what two things should you do?communicate with surgeon, administer anticholinergic
5 big causes of tachycardia?(1) sympathetic stimulation! (pain, awareness) (2) hypovolemia/hypotension (3) hypercarbia/hypoxemia (4) anemia (5) myocardial dz
4 approaches to treating tachycardia?(1) check patient!! are there other signs of awareness or pain? (2) treat underlying cause (3) *some conditions can only be resolved by sx (4) beta blockers (esmolol, propanolol)
what is the SAP(systolic) for it to be considered hypotension?<90mmHg
what is the MAP(mean) for it to be considered hypotension in...small animals? horses?SA: <60mmHg. HORSE: <70mmHg
4 main etiological causes of hypotension?(1) hypovolemia (hemorrhage, inadequate fluid admin, relative hypotension due to vasodilation) (2) vasodilation (inhalant anesthetics or acepromazine can cause this) (3) reduced CO through IPPV (intermittant positive pressure ventilation) or surgical manipulation (4) severe bradycardia
what are the first things you want to do if the pt is hypotensive?assess pts status, dec anesthetic depth and dec anesthetic depth if appropriate
after checking pt and anesthetic depth, and the pt is still hypotensive, you want to look at FLUIDS. what are three options you can do with fluids to help with hypotension?(1) bolus of LRS (10ml/kg, repeat if indicated) (2) colloids (hetastarch 5 ml/kg, followed by CRI) (3) hypertonic saline (max 5ml/kg)
if the hypotension is because of bradycardia, what can you do?admin an anticolinergic
what are two drugs you can give CRI if there is hypotension?dobutamine (sympathomimetic drug used in the treatment of heart failure and cardiogenic shock), dopamine (alpha adrenergic activity, help if hypotension due to dec SVR ( systemic vascular resistance) )
how common is hypertension in animals? what are the three most common underlying causes?UNCOMMON in animals. pain, hypercapnea, pheochromocytoma (neuroendocrine tumor of the medulla of the adrenal glands), underlying renal or cardiac dz, mild hypoxemia
if the HR and BP are both inc simultaneously, what does this most likely indicate?pain awareness
if the HR is dec and the BP is inc, what does this most likely indicate?reflex bradycardia, vasoconstriction
if the HR is inc and the BP is dec, what does this most likely indicate?hypovolemia, vasodilation, secondary inc in HR
if the HR and the BP are both dec, what does this most likely indicate?anesthetic plane too deep!