Anesthetic Record Positioning Your Patient Recovering Your

Report
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).

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