Anesthesiology - Monitoring 3

drraythe's version from 2016-04-15 10:58

Monitoring complications

Question Answer
What are the most common monitoring complications?Hypoventilation (apnea)
In hypoventilation, what Parameters are ↑ & which are ↓?↓ MV (minute volume)
Reduced RR
Low TV (tidal volume)
PaCO2 is ↑ (>45mmHg which is hypercapnia, hypercarbia ← synonyms)
(if RR = 0 that is apnea)
5 possible czs 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 cz. What are some general & specific ways to avoid/treat this problem?ET intubation/Oxygen therapy
IPPV (intermediate positive pressure ventilation)
Lighten depth of anesthesia
Warm PTx
When is apnea common to encounter? Why?Immediately after anesthetic induction, bc 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 czs of apnea during anesthesia? (5 less common czs?)(1) Anesthetic plane too deep
(2) Equipment failure (pop-off valve closed, ventilator stopped)
(3) Hypothermia
(4) Reflex apnea 2° 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 w/ the equipment, what should you do?CHECK THE PTx!
(Eyes, jaw tone, HR, RR, BP) check the anesthetic plane theyre in!
THEN check 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 w/ CHECKING PTx → is anesthetic plane good? If too deep, lighten. If that's fine, then check equipment (ESP POP OFF VALVE!). If machine problems, fix them & bag them. If not a prob w/ machine, check temp. If cold, warm them. If temp is normal, check w/ surgeon
If there is hyperventilation, what are 5 things you should rule out as possible czs?(1) Inadequate depth of anesthesia/analgesia
(2) Hypercapnia (rare)
(3) Hypoxemia
(4) Hyperthermia
(5) Metabolic acidosis
What is the 1st thing you'd check if there is hyperventilation? Explain what you'd doCheck the anesthetic depth! ↑ If reqd. Can ↑ FGF and/or inhalant agent % (MAX IS 3%), ventilate, bolus of injectable anesthetic if necessary
If the anesthetic depth is fine & the plane of anesthesia (the 1st thing to check) what would you check next & how (explain)?Check equipment!
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 PTx also plays a role
Dogs <60 BPM
Cats <100 BPM
Horses <20 BPM
5 main possible etiologies for bradycardia?Drug effects (opioids α-2 agonists)
High vagal tone
CNS dz & ↑ ICP (intracranial pressure)
If you see bradycardia, before you do anything else, do what? THEN what do you do?DONT trust monitor blindly! Reconfirm w/ esophageal stethoscope. Then check the PTx FIRST! What’s the BP like? What are the surgeons doing?
In case there is a sudden ↓ in HR, what 2 things should you do?Communicate w/ surgeon
Administer anticholinergic
5 big czs 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 PTx!! Are there other signs of awareness or pain?
(2) Treat underlying cz
(3) *Some conditions can only be resolved by Sx
(4) β-blockers (Esmolol, Propranolol)
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 czs of hypotension?(1) Hypovolemia (hemorrhage, inadequate fluid admin, relative hypotension due to vasodilation)
(2) Vasodilation (inhalant anesthetics or Acepromazine can cz this)
(3) Reduced CO through IPPV (intermittent positive pressure ventilation) or surgical manipulation
(4) Severe bradycardia
What are the 1st things you want to do if the PTx is hypotensive?Assess PTxs status
↓ anesthetic depth
After checking PTx & anesthetic depth & the PTx is still hypotensive, you want to look at FLUIDS. What are 3 options you can do w/ fluids to help w/ 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 bc of bradycardia, what can you do?Admin an anticholinergic
What are 2 drugs you can give CRI if there is hypotension?Dobutamine (sympathomimetic drug used in the Tx of heart failure & cardiogenic shock)
Dopamine (α adrenergic activity, help if hypotension due to ↓ SVR (systemic vascular resistance) )
How common is hypertension in animals? What are the 3 most common underlying czs?UNCOMMON in animals
Pheochromocytoma (neuroendocrine tumor of the medulla of the adrenal glands)
Underlying renal or cardiac dz
Mild hypoxemia
If the HR & BP are both ↑ simultaneously, what does this most likely indicate?Pain awareness
If the HR is ↓ & the BP is ↑, what does this most likely indicate?Reflex bradycardia, vasoconstriction
If the HR is ↑ & the BP is ↓, what does this most likely indicate?Hypovolemia
2° ↑ in HR (Tachycardia does NOT cz Hypotension!! The Hypotension czs the Tachycardia! It's reflex!)
If the HR & the BP are both ↓, what does this most likely indicate?Anesthetic plane too deep!

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