ANESTHETIC PROBLEMS AND EMERGENCIES

ANESTHETIC PROBLEMS AND EMERGENCIESThe Role of the Veterinary Technician in Emergency Care1Anesthetic problems will inevitably occur at somepoint in your career. No anesthetic experience isthe same, so beware of the false sense of security!ANESTHETIC PROBLEMS AND EMERGENCIES2ANIMALS THAT WILL NOT STAY ANESTHETIZEDAnimals wont stay anesthetizedCheck vaporizer setting Check level of anesthetic in the vaporizer Proper ET tube placement or air leakage around it Patient apnea Shallow respirations Proper assembly of anesthetic machine with tight connectionsAdequate oxygen flow Anesthetic machine/vaporizer is working properly Agonal breathing vs. light plane breathing

3ANIMALS THAT ARE TOO DEEPLY ANESTHETIZEDAnimals are too deeply anesthetized2 seconds Bradycardia Weak pulse; systolic blood pressure 2 seconds)Blood pressure cannot adequately perfuse superficial tissues May result from conditions present prior to inductionMay be secondary to blood loss during surgery May be seen in animals in deep anesthesia

DYSPNEA AND/OR CYANOSISDYSPNEA: respiratory difficultyCYANOSIS: bluish coloration of the mucous membranes indicating inadequate tissue oxygenation

AssessmentRespiratory character and volume Depth of anesthesia Associated with pain Proper ET tube placement ET tube blockage Oxygen saturation Arterial or end-tidal CO2

9Treatment of cyanosis/dyspnea1. Check O2 flow meter2. Turn off vaporizer and begin to bag the patient (IPPV)If the anesthetic machine is unavailable, an Ambu bag can be used to deliver room air3. Reintubate if necessary4. Continue until patient improves5. Close monitoring to ensure that cardiac arrest does not occurRadiographs and thoracocentesis might be needed

10TACHYPNEATACHYPNEA: rapid respirationsCAUSES:Surgical stimulationCommonly seen with opioid use Associated with light anesthesia accompanied by tachycardia and spontaneous movement May be seen in hyperthermic animals

11TREATMENT OF TACHYPNEACHECK ANESTHETIC DEPTHIs the animal too light?CAPNOGRAPH READINGObese patientsAssist or control ventilation

12RESPIRATORY ARRESTNot all cases require immediate action by the anesthetist: Cessation of respiratory effortsCan lead to cardiac arrest Temporary arrestMay follow injection of respiratory depressants or following a period of prolonged bagging Evaluate other vital signsHR/pulse quality:MM:ECGPulse oximeter reading:13Respiratory arrest (Contd)True arrestRequires immediate actionCan result from anesthetic overdose, cessation of oxygen flow, or preexisting respiratory diseaseMay be preceded by dyspnea or cyanosis and abnormal vital signsMay use Ambu bag, mouth-to-ET tube, or mouth-to-muzzle resuscitation

Use of an Ambu Bag

TREATMENT OF TRUE RESPIRATORY ARREST1. NOTIFY THE VETERINARIAN2. Turn off the vaporizer3. Place ET tube if not already doneEmergency tracheotomy? http://www.youtube.com/watch?v=3doQewrHdhQ4.Monitor for cardiac arrest5.Restore oxygen flow and begin bagging the patient6. Continue bagging every 5 seconds until vital signs improve7. Administer shock fluids- Dr. can decide on Dopram or reversal 8. Preserve warmth16CARDIAC ARRESTCardiac arrestNo heartbeat is auscultated or palpated Normal QRS complexes are absent No arterial pulse and blood pressure