general surgery and anesthesiology 4th study year fvm · –uveitis, glaucoma. patient monitoring,...
TRANSCRIPT
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Patient monitoring, anesthetic complications
Patient monitoring
General surgery and anesthesiology
4th study year FVM
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Patient monitoring, anesthetic complications
History
• 1625 – Santorio di Venezia– Temperature – spirituous thermometer– Pols frequency – using pendulum
• 1733 – Stephen Hales– Bloodily in horse
• 1896 – sphygmomanometer– Using cuff
2
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Patient monitoring, anesthetic complications
History
• 1903 – Willem Einthoven– Galvanometer – ECG– 1924 Nobel price
• 1935 – K. Matthes, G. Millikan, E. Wood– Pulse oximetry
• XX.th centuriy – John Scott Haldane– Capnography (1978)
3
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Patient monitoring, anesthetic complications
Monitoring
• Non-electronic = clinical
– Pulse rate, breathing, mucous membrane color, …
– Reflexes, pain, eye globe rotation, …
• Electronic = equipment
– ECG, oximetry, capnometry, temperature, muscle relaxation, …
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Patient monitoring, anesthetic complications
• Monitoring and assessment of selected parameters
• Patient and medical equipment
• Continually or repeatedly
• Marginal limits – alarms
• Monitoring is NOT a treatment !!!
• Help for diagnostics, therapy and prognosis
• Necessary for invasive and diagnostic procedures
Monitoring
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Patient monitoring, anesthetic complications
Monitoring
Negative consequences
• Risk and discomfort for patient
• Price
• Risk of non-precise measurements
• Wrong interpretation
• More intense concentration of staff on the monitor than on the patient
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Patient monitoring, anesthetic complications
Non-electronic monitoring
• Vision– Mucosa (color), movement (thorax, limbs), eye
(position, pupil), surgical site (bleeding), …• Touch
– Pols, CRT, muscle tone, temperature, …• Hearing
– Heart, lung, inhalation machine, electronic dev., …• Smell
– Leak of inhalation system
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Patient monitoring, anesthetic complications
Non-electronic monitoring
• Circulation
• Respiration
• Eyelids, eye globe, pupil
• Pharyngeal reflex
• Muscle tone
• Others
– Anus, flexor reflex, …
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Patient monitoring, anesthetic complications
Breathing
I. II.III.
IV.a b c
Tidal volume↑↑↑
apneaapnea ↓ ↓↓ ↓↓↓
Depth of respiration
deepsuper-ficial
deepsuper-ficial
apnea
Type Mixed diaphragmatic Apnea
Regularity irregular regular
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Patient monitoring, anesthetic complications
Abnormalities
• Drugs
– Opioids
– General anesthetics
– Muscle relaxants
• Respiration abnormalities
– Chest wall trauma
– Lung disease
Breathing
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Patient monitoring, anesthetic complications
I. II.III.
IV.a b c
Pulsestrong, accele-rated
? arthyt-mias ?
irregularnon
palpable
CRT < 1 s > 1 s
Mucous color pink cyanosis
Circulation
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Patient monitoring, anesthetic complications
Abnormalities• Drugs
– Anticholinergics – atropine
– Alpha-2 agonists – dex/medetomidine, opioids
– Dissociatives
• Cardiovascular abnormalities
– Heart disease
– Hypovolemia, shock
Circulation
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Patient monitoring, anesthetic complications
Esophageal stethoscope
• Blind tube with holes• Closest contact with the
heart• Minimum of disruptive
factors• Correlation of sounds and
SAP
(Sakamoto a kol. 1965)
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Patient monitoring, anesthetic complications
Eye signs
I. II.III.
IV.a b c
Globe Nystagmus
Pupilar reflex +++ ++ + 0 0 0
Tear production +++ ++ 0 0 0 0
Palpebral reflex +++ ++ 0 0 0 0
Corneal reflex +++ +++ + 0 0 0
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Patient monitoring, anesthetic complications
Analgezia Excitation Superficial anesthesia
Deep anesthesia
Paralysis
Eye signs
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Patient monitoring, anesthetic complications
Eye signs
Abnormalities
• Drugs
– Anticholinergics – atropine
– Dissociatives
– Muscle relaxants
• Eye abnormalities
– Uveitis, glaucoma
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Patient monitoring, anesthetic complications
Pharyngeal reflex
• Is missing between II. a III. stage of anesthesia
• Patient can be intubated
Abnormalities
• Dissociatives
• Cats
– Laryngospasm
– Deep anesthesia
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Patient monitoring, anesthetic complications
Muscle tone
Eyelids, accomodation
strabismus
Masseters
Larynx, pharynx
Limbsfore – hind
distal – proximal
Abdominal
muscles
Intercostal muscles
Diaphragma
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Patient monitoring, anesthetic complications
Others
• Anal sphincter
– Deep anesthesia
• Relaxation (muscle relaxation, opioids)
• Masseters
• Flexor reflex
• Ear moving – CATS
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Patient monitoring, anesthetic complications
Pain
• Pupil size
• Saliva production
• Vocalization
• Palpation response
• Mental status
• Spontaneous behavior
• (Trias, BP)
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Patient monitoring, anesthetic complications
• Clinical monitoring = non-electronic+ Cheap‒ Sone parameters imponderable‒ Non-precise, experience necessary, values?, …
• Electronic monitoring+ Precise (relatively), values, trends, …‒ Expensive‒ „Electronic error“, …
Comparison
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Patient monitoring, anesthetic complications
• Cardiovascular
• Respiratory
• Temperature
• Muscle relaxation
• Others
– Urine production
– Acid-base profile, …
– EEG, …
Electronic monitoring
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Patient monitoring, anesthetic complications
Monitoring in human medicine
• Electrocardiography• Pulse oximetry• Arterial blood pressure• Capnography• Spirometry• Temperature• Anesthetic agents,
gases
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Patient monitoring, anesthetic complications
Cardiovascular system
• Central part – heart
• Peripheral part – blood vessels
1. Delivery of oxygen, nutrition, hormones, …
2. Removal of metabolites
3. Maintenance of temperature
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Patient monitoring, anesthetic complications
Cardiovascular function
• Electrocardiography
• Pulse oximetry
• Blood pressures
• (Capnometry)
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Patient monitoring, anesthetic complications
Electrocardiography
• Heart frequency
• Heart rhythm
• 3 (5) leads (RA, LA, LL)
• Thorax
• Limbs
• Esophagus
• ST elevation analysis?
• Main II. lead
• (R wave preference)
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Patient monitoring, anesthetic complications
Electrocardiography
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Patient monitoring, anesthetic complications
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Patient monitoring, anesthetic complications
QRS complexes?
Synchronic pols
and QRS complexes?
ROSC HR > 200 /min
VT
ELECTROSHOCKPEA
ECG – line?
AsystoliaVF
ELECTROSHOCK
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Patient monitoring, anesthetic complications
Electrocardiography
Limitation
• Slow connection, leads "obstruct"
• Interference – cauterization
• Without correlation between ECG and C.O.
• PEA, VT – electric activity without hemodynamic
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Patient monitoring, anesthetic complications
• SpO2
– Hemoglobin saturation by oxygen
• Respiration
• Lung function
• Peripheral perfusion
– Sensor
• Tongue, ear, rectal, digital
SpO2 = 98 % ~ PaO2 = 100 mmHg
Pulse oximetry
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Patient monitoring, anesthetic complications
Pulse oximetry
99 % O2 bound to Hb
32
Systola
Pulzující krevNení pulzace
Venózní krev
Diastola
Čas
Arteriální krev
Arterioly s různým průměrem =pletysmografická křivka
Tkáň
Světloproniklétkání
Emitované
světlo
Intenzitasvětla proniklého tkání
Systola
Pulzující krevNení pulzace
Venózní krev
Diastola
Čas
Arteriální krev
Arterioly s různým průměrem =pletysmografická křivka
Tkáň
Světloproniklétkání
Emitované
světlo
Intenzitasvětla proniklého tkání
néinfračerve
červené
2maxmin/ln
maxmin/lnfSpO
Red 660 nm Infrared 940 nm
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Patient monitoring, anesthetic complications
Pulse oximetry
33
Sensor• Transmission• Reflexive
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Patient monitoring, anesthetic complications
Pulsní oxymetrie
• Advantages
– Simple, quick continuous measurement
• Disadvantages
– Interference – movement (tremor), arrhythmias, electrocautery, laser, fluorescent lamp, pigmentation, "dyshemoglobins", …
– Weak peripheral perfusion
– Hypothermia, hypotension, hypovolemia, low C.O., …
– Decrease of 400 mmHg (PaO2 500 → 100 mmHg)
= decrease of 1 % SpO2 (99 → 98 %)
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Patient monitoring, anesthetic complications
Hypoxia
(SpO2 < 90 %, PaO2 < 60 mmHg)
Interference
• Ischemia
• Pigmentation
• Electrocauterization
Pulse oximetry
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Patient monitoring, anesthetic complications
ABP = C.O. x SVR C.O. = HR x SV
•Arterial pressure – SAP, DAP, MAP
• Measured indirectly
• Oscilometric (cuff)
• Ultrasound – Doppler effect
• Measured directly (MAP 60–120 mmHg)
•Venous pressure – CVP, PVP
• Measured directly (CVP 0–5 cmH2O)
Blood pressure
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Patient monitoring, anesthetic complications
Arterial pressure
• Oscillometric
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Patient monitoring, anesthetic complications
Oscillometry
• Cuff size– 40 % of limb circumference– Smaller – overvaluation– Larger – undervaluation
• Cuff position– Under heart – overvaluation– Above heart - undervaluation
38
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Patient monitoring, anesthetic complications
• By ultrasound
– Doppler effect
Arterial pressure
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Patient monitoring, anesthetic complications
• Pressure transducer
• Ameroid manometer
Arterial pressure
1 systole2 dicrotic notch3 diastolePressure transducer with flushing
Artery – transducer connecting tubeArterial catheter
Monitor
F1/1 + heparin
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Patient monitoring, anesthetic complications
Arterial pressure
• Complication– Oscilo-, Doppler
• Reduction of perfusion up to 75 %
• Ischemia, edema, hematoma
– Bloodily
• Hematoma, thrombosis, Ischemia, infection, pseudo-aneurysma
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Patient monitoring, anesthetic complications
Oscilo- / Doppler / bloodily?42
Oscilo- Doppler Bloodily
Accuracy Relative Good High
Drug influence Important Less Non-important
Arrhythmias High High Low
Continuity No No Yes
Advantages Simplicity AccuracyAccuracy, blood
samples
Disadvantages Accuracy ComplicatedInvasively,
complicity
Technique,
priceLow Low High
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Patient monitoring, anesthetic complications
Central venous pressure
• Into v. cava cranialis or RA
• By catheter through jugular vein before RA
– With water column
– With electronic transducer
• Information of fluid balance
• Information of right heart function
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Patient monitoring, anesthetic complications
Venous pressure
Plu
nket
tSJ
2000
: E
mer
genc
ypr
oced
ures
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Patient monitoring, anesthetic complications
Central venous pressure
(CVP = 0–7 cmH2O)
Decreased CVP
• Hypovolemia
- Fluids
Increased CVP
• Heart, kidney insufficiency
- Causal
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Patient monitoring, anesthetic complications
Other blood pressures
• Swan-Ganz catheter
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Patient monitoring, anesthetic complications
Respiratory system
• Central part – lungs
• Peripheral part – airways
1. Oxygen delivery and other drugs
2. CO2 removal and other drugs
3. Maintenance of body temperature
4. Close "cooperation" with cardiovascular system
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Patient monitoring, anesthetic complications
Functional status of the lungs
• PAO2 PaO2
PaO2 / FiO2
Pathology < 200 300 > 500 NormalMiddle Mild
A-a gradient = PAO2 – PaO2
Normal < 15 mmHg Abnormal > 25 mmHg
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Patient monitoring, anesthetic complications
A-a gradient
Without pathology Lung pathology
FiO2 21 % (0,21) 21 % (0,21)
PaO2 74 mmHg 74 mmHg
PaCO2 58 mmHg 31 mmHg
PAO2 = FiO2 (PB – PH2O) – (PaCO2 / RQ)
PAO2 76,6 mmHg 110,4 mmHg
A-a gradient
= PAO2 – PaO2
2,6 mmHg 36,4 mmHg
A-a gradient < 15 mmHg (normal) > 25 mmHg (abnormal)
PB – barometric pressure (760 mmHg), PH2O – partial pressure of H2O (50 mmHg), RQ – respiration kvocient (0,8)
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Patient monitoring, anesthetic complications
• Pulse oximetry
• Capnometry
• Spirometry
• AA
• Blood gases
• Tomography
Respiration
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Patient monitoring, anesthetic complications
Monitoring in human medicine
• Electrocardiography• Pulse oximetry• Blood pressure• Capnography• Spirometry• Temperature• AA, resp. gases
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Patient monitoring, anesthetic complications
Respiratory frequency monitoring
• Using thermistor• By electro-impedance
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Patient monitoring, anesthetic complications
Capnometry/-graphy
• PaCO2 – gold standard respiratory evaluation• Healthy lungs – PaCO2 ~ EtCO2
• Lung ventilation• Lung perfusion (C.O.)• Tissue metabolism• End-tidal CO2 (EtCO2)
(35–40 mmHg)Non-invasive monitoring
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Patient monitoring, anesthetic complications
• Lung ventilation
• Lung perfusion
• End-tidal CO2 (EtCO2)
Capnometry
Side stream
Main stream
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Patient monitoring, anesthetic complications
Main-/Sidestream
Mainstream Sidestream
Accuracy Good High
Response Fast Slow
Dead space Enlargement Uninfluenced
Gas sample 0 50–150 ml min-1
Water trap No Yes
Connection ETR ETR, mask
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Patient monitoring, anesthetic complications
Capnography
• Capnometry/capnography
A-B base line D End-tidal CO2 (EtCO2)
B-C expirium D-E inspirium
C-D expiration plato
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Patient monitoring, anesthetic complications
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Patient monitoring, anesthetic complications
Capnometry/-graphy
• Gold standard of esophageal intubation
• Along with constant ventilation (IPPV) EtCO2
represents C.O.
• Capnogram not influenced by chest compression during CPR
• Sidestream – with inhalation mask too
• Monitoring of patient and breathing system
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Patient monitoring, anesthetic complications
Spirometry
• Frequency, volume, time– fR, VT, MV– Ti : Te, respiration pause
• Pressure in airways– PIP, PEEP
• Compliance
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Patient monitoring, anesthetic complications
• Pitot tube +
electronic module
• Manometer +
ventilometer
Spirometry
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Patient monitoring, anesthetic complications
Spirometry
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Patient monitoring, anesthetic complications
Gas monitoring– AA
• Oxygen – FiO2, EtO2 – low-flow, minimal-flow• Nitrous oxide – FiN2O, EtN2O• Isofluran, Sevofluran, Desfluran, Enfluran, … – Fi, Et• Interference – methane – large animals
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Patient monitoring, anesthetic complications
Electro-impedance tomography
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Patient monitoring, anesthetic complications
Temperature
• Core temperature
– Esophageal
• Rectal temperature
• Peripheral temperature
– Skin – interdigital
– About 2-4 °C lower
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Patient monitoring, anesthetic complications
Neurostimulators
– N. ulnaris
– N. peroneus
– N. facialis
• 60–80 mA
• 0,2 ms
Muscle relaxation
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Patient monitoring, anesthetic complications
1,0 0,8 0,6 0,4 0,4
A B C D E
Muscle relaxation
• Single burst stimulation
• Train-of-Four
– TOFR (T1:T4)
– TOFR ˃ 0,9
spontaneous breathing
• Tetanic stimulation
• Double-Burst-Stimulation
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Patient monitoring, anesthetic complications
"Train-of-four"
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Patient monitoring, anesthetic complications
(3.1–6.7 mmol/l)
• Young animals
• Diabetes mellitus
• Sepsis
• Insulinoma
• Portosystemic shunt
Glycaemia
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Patient monitoring, anesthetic complications
Urine production
(1–2 ml/kg/h)
• Catheter + sampling bag
• Kidney function
– Perfusion
– Circulatory volume
– (CVP)
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Patient monitoring, anesthetic complications
Oliguria
• Insufficient replacement + loss of fluids• Nephropathy• NSAIA• Morphine
- Fluids- NE, Furosemide, Glucose, Manitol- Dopamin, Dobutamin
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Patient monitoring, anesthetic complications
Acid-base status, blood gases
• pH (7,35–7,45)
• PaO2 (80–100 mmHg)
• PaCO2 (35–45 mmHg)
• HCO3- (22–25 mmol/l)
• (Kooxymetry)
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Patient monitoring, anesthetic complications
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Patient monitoring, anesthetic complications
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Patient monitoring, anesthetic complications
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Patient monitoring, anesthetic complications
Parameters (DOG)
• RR 10–20 /min
• HR 30–120 /min
• T 37.5–39.0 °C
• SpO2 95–100 %
• EtCO2 4.5–5.5 kPa (30–45 mmHg)
• BP SAP 120–140 mmHg
DAP 80–100 mmHg
MAP 100–110 mmHg
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Patient monitoring, anesthetic complications
Anesthetic complications
General surgery and anesthesiology
4th study year FVM
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Patient monitoring, anesthetic complications
Anesthetic complications
• Respiratory
• Cardiovascular
• Temperature
• Metabolic
• Neuromuscular
• Gastrointestinal
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Patient monitoring, anesthetic complications
• Abnormalities of gas exchange
– Hypoxia, hypercapnia, hypocapnia
• Obstructive disease of airways
• Hyperventilation
• Aspiration
• Lung edema
• Complication of intubation
Respiratory complication
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Patient monitoring, anesthetic complications
Abnormalities of gas exchange
HypoxiaBrain, heart, spinal cord, kidneys, liver
Sympathic activation
Tachy/bradycardia
Hyper/hypotension
↑ – ↓ C.O.
↑ – ↓ contractility
↑ – ↓ SVR
Hypercapniasee hypoxia
↑ CO2 – ↓ O2 in alveolus
Displ. of Hb dissoc. curve
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Patient monitoring, anesthetic complications
Hypoxia
(SpO2 < 90%, PaO2 < 70 mmHg)
V/Q mismatch, R/L shunt
• Apnea, hypoventilation
• Lung restrictive disease (internal, external)
• Low FiO2
• Obstruction of airways
• Anemia, hypotension, CPA
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Patient monitoring, anesthetic complications
Hypoxia
Management- Oxygen
- Oxygen collar
- Oxygen box
- Nasal catheter
- Artificial lung ventilation
- Bronchodilators
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Patient monitoring, anesthetic complications
Hypercapnia
(EtCO2 ˃ 55 mmHg)
• Hypoventilation
– Neuromuscular abnormalities (anesthetic depth)
– Restrictive diseases of thorax and abdomen
– Air, fluid, CO2 in pleural cavity
– Terminal phase of lung parenchyma abnormalities, rebreathing from death space
• Hyperthermia, increase of CO2 production
• Bicarbonate therapy
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Patient monitoring, anesthetic complications
Hypocapnia
(EtCO2 < 30 mmHg)
• Hyperventilation
• Obstruction or leak of breathing system
• Hypothermia
• Decrease of metabolic ratio
• Hypotension
– Lung (emboli, …)
– Systemic
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Patient monitoring, anesthetic complications
Cardiogenic oscillation
Sudden decrease to zero
Sudden decrease
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Patient monitoring, anesthetic complications
System leakage
Rebreathing
Rebreathing – Bain system
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Patient monitoring, anesthetic complications
Airways intake
Esophageal intubation
Endobronchial intubation
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Patient monitoring, anesthetic complications
Airways obstruction
Upper airways
• BOAS, obstruction, laryngeal paralysis
- O2, clear airways, steroids, diuretics, sedation
Lower airways
• Bronchospasm, asthma, anaphylaxis
- O2, bronchodilators, steroids, antihistaminic
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Patient monitoring, anesthetic complications
Spirometry
A. Normal B. Lung emphysema C. Extra-thoracic obstruction F. Intra-thoracic obstruction
C. Unilateral obstruction D. Upper airways obstruction G. Restrictive lung disease H. Muscle weakness
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Patient monitoring, anesthetic complications
Hyperventilation
Increase of MV
• Insufficient anesthetic depth, analgesia
• Hypoxemia
• Hypercapnia
• Hyperthermia
• Metabolic abnormalities (MAC, …)
- Causal
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Patient monitoring, anesthetic complications
Aspiration
Digestion, blood, saliva, …
• Decrease of tone of lower esophageal sphincter (anesthetics)
• Slower passage of gastric content
• Increased intraabdominal pressure (distension, laparoscopy, …)
- Food restriction, prokinetics, body position, hygiene
- Extubation after restoration of swallowing reflex
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Patient monitoring, anesthetic complications
Lung edema
• Patients with heart, kidney abnormalities
• Excessive fluid therapy
- Oxygenation
- Sedation
- Furosemide
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Patient monitoring, anesthetic complications
Complication of intubation
Irritation of larynx and traches
• Excessive pressure in cuff
• Dentistry
- Cuff-pressure max. 20 cm H2O
Cuff herniation
• Risk of airways obstruction
- Check-up before use
ETR obstruction
• Intubation error, secrets, (foreign body)
- Checking ET, Murphyho eye
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Patient monitoring, anesthetic complications
• Bradyarrhythmia (bradycardia)
• Tachyarrhythmia (tachycardia)
• Heart arrhythmias
• Systemic hypotension
• Systemic hypertension
• Cardiopulmonary arrest
Cardiovascular complication
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Patient monitoring, anesthetic complications
• Sinus bradycardia (< 60 beats/min)
– Anesthetics, vagal tone, hypothermia, hypoglycemia, hypertension, hyperkalemia, …
• AV block
– Anesthetics, vagal tone, … – Atropine, Ketamine, Atipamezol
• Sick sinus syndrom
– Valvular abnorm. … – Atropine
• PEA, asystolia
– CPR
Bradyarrhythmia
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Patient monitoring, anesthetic complications
Tachyarrhythmia
• Sinus tachycardia (> 180 beats/min)
– Anesthetics, analgesics, hypotension, hypovolemia, hypercapnia, hypokalemia, hypercalcemia, hypoxia, hypomagnesemia, …
• Atrial fibrilation
– Vagal tone, … – Lidokain, (Esmolol)
• Ventricular fibrilation
– CPR
• Ventricular premature complexes
– Lidocaine, Amiodarone
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Patient monitoring, anesthetic complications
Arrhythmias
• Ventricular arrhythmias
– Lidocaine 1–2 mg/kg + 0,025–0,1 mg/kg/min
– Amiodaron 2–5 mg/kg (incl. supraventricular)
• Supraventricular tachycardia
– Esmolol 0,05–0,5 mg/kg + 0,0025–0,2 mg/kg/min
– (Diltiazem 0,1–0,25 m/kg + 0,1–0,3 mg/kg/h)
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Patient monitoring, anesthetic complications
Hypotension
(SAP < 90 mmHg, MAP < 60 mmHg)
Decreased venous return
• Vasodilation, hypovolemia, bradycardia, IPPV, effusion, pneumothorax
• Isoflurane, Propofol, Acepromazine
- Fluids, Dopamine, NE, E, Vasopresine, Fenylefrine
Ventricular dysfunction
- Dopamine, Dobutamine, Norepinephrine, Epinephrine
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Patient monitoring, anesthetic complications
Hypertension
• Pain, insufficient anesthetic depth
• Hypoxia, hypercapnia
• Systemic hypertension
– Hyperadrenocorticism, hyperthyreosis, CRF, Diabetes mellitus, pheochromocytoma, hyperaldosteronismus
• Drugs (alpha-2 agonists, vasopressors, …)
• Metabolic acidosis
- Causal
- ACE-inhibitors, beta-blockers, Isoflurane, Propofol
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Patient monitoring, anesthetic complications
Cardiopulmonary arrest
• Clinical signs
– Apnea
– Non-palpable pulse and heart beat
– Absence of heart sounds
– Pale or cyanotic mucosa
– Mydriasis
– Muscle weakness (anal sphincter)
– Absence of bleeding
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Patient monitoring, anesthetic complications
CPA
• Diagnostics
– ABC – Airways, Breathing, Circulation
– Max. within 15 seconds!!!
• CPA – 100% YES – start BLS
• CPA – ??? – start BLS
• CPA – 100% NO – diagnostic and stabilization
• Management of CPA
– CAB – Circulation, Airways, Breathing
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Patient monitoring, anesthetic complications
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Patient monitoring, anesthetic complications
Small dogs, cats
Large dogs
Flet
cher
DJ
20
14
: C
PR
: Ba
sic
& A
dva
nce
d L
ife
Sup
po
rt
Chest compression
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Patient monitoring, anesthetic complications
Dogs withflat thorax
Dogs withtriangular thorax
Chest compression
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Patient monitoring, anesthetic complications
QRS complexes?
Synchronic polsand QRS complexes?
ROSC HR > 200 /min
VTELECTROSHOCK
PEA
ECG – line?
AsystoliaVF
ELECTROSHOCK
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Patient monitoring, anesthetic complications
Pulseless VT Fibrillation
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Patient monitoring, anesthetic complications
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Patient monitoring, anesthetic complications
Hypothermia
(37–38 °C, 98.6–100.4 F)
• Laparotomy, thoracotomy
• Inhalation anesthesia, CNS depression, muscle relaxation
• Acepromazine
- Warming
- 0,5 °C/h
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Patient monitoring, anesthetic complications
Hyperthermia
• BOAS, excessive coat
• Hyperadrenocorticism
- Oxygenation
- Cooling (alcohol on skin)
- Lavage of urinary bladder
- Acepromazine, Propofol
- IPPV
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Patient monitoring, anesthetic complications
Hypoglycemia
(3.1–6.7 mmol/l)
• Young animals
• Diabetes mellitus
• Sepsis
• Insulinoma
- Glucose (2.5%)
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Patient monitoring, anesthetic complications
Oliguria, anuria
(1–2 ml/kg/h)
• Nephropathy• Insufficient fluid substitution + fluid loss• NSAIDs• Morphine
- Fluid therapy- Furosemide, Glucose, Manitol- Dopamine, Dobutamine
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Patient monitoring, anesthetic complications
Myopathy, neuropathy
• Wrong positioning (HORSE)• Long anesthesia• Hypotension
- Patient positioning- Pad out of exposing body parts- Normotension, normovolemia
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Patient monitoring, anesthetic complications
Excitation, vocalization
• Pain
• Opiods, ketamine, benzodiazepins, propofol
• Hypoglycemia, hypothermia, hypomagnezemia
- Causal (glucose, temperation, MgSO4, …)
- Analgesics
- Diazepam, Barbiturates, Medetomidine
- Antagonisation
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Patient monitoring, anesthetic complications
Anaphylactiod reaction
• Drugs, disinfection agents, …
• Dyspnoe, edemas, tachypnoe, hypoxemia, tachycardia, arrhythmia, hypotension, erythema
- Oxygenation
- Fluid therapy (Crystaloids, colloids)
- Epinephrine, difenhydramine
- Bronchodilatans
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Patient monitoring, anesthetic complications
• Vomiting, regurgitation, defecation
– Extubation after swallowing recovery
– Enema
• Urination
– Catheterization
Gastrointestinal and neuromuscular abnormalities
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Patient monitoring, anesthetic complications
Pain
• Vocalization, restless, changes of body position, …
• impaired
– Homeostasis
– Immune response
– Wound healing
– Convalescence
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Patient monitoring, anesthetic complications
Post-resuscitation care
• Normoxia, normocapnia
• Mild hypertension
• Hydration
• Normothermia
• Repeated clinical examination
• Neurologic status
• Urine production
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Patient monitoring, anesthetic complications
• Hematology, biochemistry, acid-base
• Lung functions, oxygen saturation
• Analgesics?
• Antibiotics?
• Prevention of decubital lesions
Post-resuscitation care