Anesthetic Record Positioning Your Patient Recovering Your Patient ANESTHETIC RECORDS • http://safetyservices.ucdavis.edu/iacuc/att ending-veterinarian/AnesthRecord.pdf • http://www.nyu.edu/ovr/doc/anesthesia.pdf ANESTHETIC LOGBOOK • Minimum: date, client name, patient ID, physical status, procedure, anesthetic protocol • Animal’s response to anesthesia • Record all controlled substances • Allows a veterinarian to assess the protocols he/she uses MEDICAL RECORDS AND ANESTHESIA FORMS MUST BE COMPLETE AND ACCURATE (These are legal documents!) • Can help to determine which anesthetic agents should or shouldn’t be used on a patient (based on its history and past anesthetic procedures) ANESTHESIA FORMS • Can be very detailed. – Pre-operative: • TPR, blood work, drugs used (in amount, dose and concentration of drug), time anesthetic agents given – Intra-operative: • Fluid rate, time surgery began, type of surgery, vital signs throughout anesthesia (including, temperature, pulse, respiration, blood pressure, blood gases), end of surgery, end of inhalation anesthesia – Post-Operative • Recovery remarks (smooth? Lengthy? Extra meds needed? Temperature) POSITIONING YOUR PATIENT • Support your patient during induction. REMEMBER YOUR PATIENT’S HEAD • When moving your patient, disconnect him/her from the anesthesia hoses. It is crucial to protect the endotracheal tube and do not let it hurt your patient! – Similarly, be sure that the hoses do not pull the endotracheal tube. – Do not let your endotracheal tube become kinked. • When positioning and tying down your patient, try to keep the position as natural as possible without injuring the animal’s neck or limbs. – Hyperextension of the neck – airway obstruction, Overextension of the legs – respiratory interference, Too tight ropes – decreased blood circulation • Don’t place anything heavy on your small patients that would compromise their breathing • Tilting the table for the surgeon can actually be harmful to the patient’s heart and lungs if too much pressure is placed on the diaphragm. • Bad lung? Place the normal side up as long as possible. • Lubricate the eyes q 90 minutes (ESPECIALLY IF GIVEN ATROPINE) RECOVERY RECOVERY PERIOD PERIOD BETWEEN DISCONTINUATION OF ANESTHESIA AND THE TIME THE ANIMAL STANDS AND WALKS. LENGTH OF TIME DEPENDS ON: • Length of anesthesia directly correlates with length of recovery • Patient’s underlying conditions • Anesthetic chosen and route given. Inhalation agents = quicker recovery than injectables, IV recovery is shorter that IM RECOVERY • Hypothermic animals take longer to recover • Breed dependent OXYGEN ADMINISTRATION • When gas is turned off, continue to administer oxygen for 5 minutes or until patient swallows • Anesthetic gases are removed via anesthesia machine • Reinflate the lungs by bagging the patient with oxygen • Oxygen can be administered via mask, flow by, intranasally, oxygen cage, or manmade E-collar tent if tube is not in place STAGES • REMEMBER THE STAGES OF INDUCTION OF ANESTHESIA? They’re baaaaaack!! (But in reverse) – Increase in heart and respiration rates, pupil returns to central location, reflexes return. – Shivering and swallowing begins, animal vocalizes and begins to move THE SUGERY’S OVER, CAN I RELAX? • NO! • Animal is always at risk for something to happen, no matter how well the procedure went • Don’t put an animal in “the back” to recover. The more eyes on the animal, the better • Keep your equipment close by: stethoscope, thermometer, oxygen, crash cart, pulse ox WHAT’S MY JOB? • VITALS – q 5 minutes. – Mucous membrane color, CRT, heart rate, respirations, temperature. Keep your hands on the patient – Monitor temp frequently until 99.5, then be sure temp is holding in normal range • Watch for vomiting/seizures/any abnormal behavior. • Extubation WHAT’S MY JOB? • Airway maintenance • Comfort your patient – Pain control – preferably before any pain is experienced. – Keep him calm – Don’t let them injure themselves- no food/H2O – Keep the patient warm • Stimulate your patient to stimulate its brain – Talk, pet, gentle toe pinching, EXTUBATION • Usually when the patient swallows – This protects the animal from vomiting • At the end of inspiration • Not all animals will swallow 1st when they are ready to be extubated – Movement of the limbs, head, tongue flicking, chewing on tube – REMOVE THE TUBE! – Don’t wait long in cats, can produce laryngospasms • ALWAYS LEAVE A BRACHYCEPHALIC BREED’S TUBE IN LONGER! – Until lifting its head on its own MY PATIENT IS EXTUBATED, SO IT MUST BE ABLE TO BREATHE, RIGHT? • Problems can still arise • If the airway seems compromised (noisy breathing), position the head and pull the tongue forward • Reintubate HOME CARE • Patients should be allowed to settled in at home for at least 1 hours before offering water. • Initially water should be offer in limited amounts until it is clear that the patient will not vomit after drinking and that they are not interested in “guzzling” large amounts of water. • HOME CARE • If the patient has been home for at least 2 hours, has not vomited at all, and is exhibiting some interest in food, they can be offered a small meal • The meal should not exceed 25% of their normal meal size. • The patient can resume their normal meal routine the following day unless told to do otherwise by the attending doctor. • Post anesthesia, pets can be unsteady on their feet. The evening after anesthesia owners should be cautioned to be careful with them on stairs, and in situations that would not normally be considered dangerous (such as cats jumping down from high places).