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Anesthesia Angst Kelly Lynn Cronin, MBA, BS, PHR, VTS (ECC), RVT

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Presentation on theme: "Anesthesia Angst Kelly Lynn Cronin, MBA, BS, PHR, VTS (ECC), RVT"— Presentation transcript:

1 Anesthesia Angst Kelly Lynn Cronin, MBA, BS, PHR, VTS (ECC), RVT
Operations Manager Advanced Animal Hospital Group Owner/CEO Success Strategies Veterinary Consulting

2 Veterinary Technician Appreciation Week is October 16th-22nd!
We LOVE our technicians! Veterinary Technician Appreciation Week is October 16th-22nd!

3 What’s Mine is Yours You are welcome to take pictures, I would be happy to you a copy of the presentation. Share with anyone who needs some anesthesia help.

4 At: http://www.wallpaperden.com/dog-face-3.shtml
First Rule of Anesthesia For Anesthetics Never Panic At:

5 Second Rule of Anesthesia Never Let Go of a Closed Pop Off Valve

6 Preparation

7 Safe Anesthesia Starts Before Your Patient Arrives

8 At: http://www.wallpaperden.com/dog-face-3.shtml
Pre-Anesthesia Requirements General Consent Forms Discussion of Risks Physical Examination Medications & Fluids Pre-anesthetic tests Specific Pre-anesthetic Protocols At:

9 At: http://www.wallpaperden.com/dog-face-3.shtml
Food should be withheld for 12 hours prior to admission in normal cats and dogs over age 4 months. Why? Exceptions? How do we mitigate hypoglycemia in these patients? How do we test for BG during anesthesia? Exceptions – young animals, diabetics 6-16 wks food withdrawn for no more than 4 hours DVM should choose if food is withheld based on length of procedure, insulin should be adjusted, patient monitored hourly and glucose supplementation adjusted accordingly glucose monitoring more often based on initial glucose measurement J Am Anim Hosp Assoc 2011; 47:---–---. DOI /JAAHA-MS-5846 At:

10 Discuss Anesthesia Concerns with the Owner Discuss the Risks of Anesthesia

11 Premedication Premedication
-Adjust heart rate for anesthetic depression -Control operative pain -Multi-modal anesthesia reduce induction meds -Dry up secretions -Reduce patient anxiety -Reduce anesthetist anxiety

12 Blood samples should be drawn prior to premeds if it is not excessively stressful to the patient as premeds may influence the results of certain tests Example – Acepromazine can decrease patient PCV up to 30% Screensaver image courtesy of 8screensaver.com

13 Pre-anesthetic medications should be administered:
-30 to 45 minutes prior if given SQ. -15 to 20 minutes prior if given IM Image courtesy of profilethai.com

14 A phenothiazine tranquilizer No analgesic properties
Acepromazine A phenothiazine tranquilizer No analgesic properties Addition of an opioid reduces the acepromazine dose and the likelihood of hypotension or excessive sedation Ace is no longer a concern with seizure patients -old adage no ace in seizure pets – no longer hold to that Garner, J., Kirby, R. and Rudloff, E. (2004), THE USE OF ACEPROMAZINE IN DOGS WITH A HISTORY OF SEIZURES. Journal of Veterinary Emergency and Critical Care, 14: S1–S17. doi: /j t x Screensaver image courtesy of 8screensaver.com

15 Atropine /Glycopyrrolate
Heart rate increase Decrease secretions Parasympatholytic Anticholinergic Difference glycopyrrolate and atropine? Screensaver image courtesy of 8screensaver.com

16 Butorphanol adds a short acting analgesic effect Recommended use
Opioid Butorphanol adds a short acting analgesic effect Recommended use Butorphanol has an antagonistic effect when used with mu agonist opioids such as morphine, hydromorphone, fentanyl, or oxymorphone More effective for sedation than for analgesia Antagonist- blocks or dampens a response – so don’t mix or if you do be sure that you give enough time between Around 2 hours duration of action Screensaver image courtesy of 8screensaver.com

17 Opioids Many options morphine, hydromorphone, fentanyl, buprenorphine or oxymorphone Varied duration of action Effective for sedation and analgesia Can cause vomiting Can cause respiratory depression Vomiting may be useful for patients with no NPO prep Screensaver image courtesy of 8screensaver.com

18 Anesthesia Monitoring and Maintenance

19 Doppler or Oscillometric?
ASA anesthesia guidelines 1. Healthy 2. Mild systemic disease. 3. Severe systemic disease not incapacitating. 4. Incapacitating disease 5. Moribund patient not expected to live Doppler or Oscillometric? Screensaver image courtesy of scenicreflections.com

20 What constitutes anesthesia ?
Wallpaper image courtesy of Computer Wallpapers at: In my mind this means quality sedation fits the description. I also argue that I have in 25 years in vet med had several sedations go very bad. Everything warrants an anesthesia monitoring sheet. What constitutes anesthesia ? Anesthesia is a temporary induced state with one or more of analgesia , paralysis , amnesia, and unconsciousness.

21 What warrants intubation? What warrants a catheter?
What warrants an emergency drug sheet? Any drug with respiratory depression

22 Set Yourself up for Success
-Leak test your machine prior to every use -Care for ET Tubes correctly -Check ET tubes prior to use -Stylets? -Cuff inflation - Use the right sized tubes and system for your patient Dry et tubes inflated to prevent chlorhex crystal formation (rinse well) Store deflated Inflate before using Give a moment or two if using any numbing agent on the laryngeal flaps in cats (use cautiously in short procedures), give care with a stylet, never introduce past the end of the tube Wallpaper image courtesy of Lord Channel and WallPaper4God.com at:

23 Cautionary Tale

24 Most Dangerous Periods During Anesthesia?
Induction Recovery “Dark Cat” wallpaper image courtesy of AnimalWallpapers.net AT:

25 Anesthesia monitoring
Parameter times? 1st route of parameter correction Time required to change anesthetic depth Image courtesy of

26 Got O2? Discussion re-breather vs. non re-breather
Discussion dead space Flow rate Flush Valve Lung inflation

27 Anesthesia Monitoring
End Tidal CO2 First and best warning Better at assessing respiratory quality than SPO2 Great warning for faulty equipment Wallpaper image courtesy of ScenicReflections.com at: t

28 Anesthesia Monitoring
Temperature Affects everything else Is affected by everything else Is all too often ignored Wallpaper image courtesy of ScenicReflections.com at: t

29 Anesthesia Monitoring
Blood Pressure A must in small patients and cats >60 mm Hg MAP A dry kidney is a dead kidney Lasting effects Wallpaper image courtesy of ScenicReflections.com at: t

30 Anesthesia Monitoring
Pulse Oximetry Gets the most love Deserves it least Wallpaper image courtesy of ScenicReflections.com at: t

31 Best Anesthesia Monitoring Device?

32 Anesthetic Agents

33 What is the Correct Setting on an Anesthesia Vaporizer?
For a Million Dollars What is the Correct Setting on an Anesthesia Vaporizer?

34 Why are fluids so important during anesthesia?
Surgical fluids Why are fluids so important during anesthesia? Vasodilation Surgical Rate

35 There are no safe anesthetic agents, there are no safe anesthetic procedures. There are only safe anesthetists.—Robert Smith, MDa

36 Etomidate Short acting intravenous
Used for conscious sedation if not combined in multi-modal induction Good for cardiovascular compromise Rapid onset of action Head trauma- Decreases intracranial pressure and maintain a normal arterial pressure Free screensaver image available at scenicreflections.com

37 Ketamine Pain Killer Used alone elevates BP (stimulates circulatory)
Antidepressant Agitation and confusion Given IV/IM NMDA receptor antagonist or classified as dissociative Free screensaver image available at scenicreflections.com

38 Valium/Midazolam Benzodiazapine
Profoundly potent anxiolytic,  amnesic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative Given IV/IM (valium stings)/rectal Rapid onset of action Flumazenil is the reversal agent Free screensaver image available at scenicreflections.com

39 Propofol Given IV Hypnotic/amnestic Rapid onset of action
Causes respiratory depression Not much analgesic effect Potential pain on injection Vasodilation sometimes leads to lower BP Serial use in cats is contra-indicated due to red blood cell destruction/ 28 is also contra-indicated in cats Free screensaver image available at scenicreflections.com

40 Alfaxan Given IV for induction/IM for sedation Rapid onset of action
Rapid elimination No extra-vascular tissue irritation Consecutive days use is fine Less respiratory depression Not analgesic Free screensaver image available at scenicreflections.com

41 Isoflurane Halogenated Ether Inhalation anesthetic
Mechanism of action is not understood  Analgesic Muscle relaxant Potent vasodilator Free screensaver image available at scenicreflections.com

42 Reversible Sedatives Dexdomitor -synthetic α2-adrenoreceptor agonist -off label in cats -reversed with antipamezol -peripheral vasoconstriction - bradycardia light,sound and pain reactive -hyperexcited dogs may have reduced effects Free screensaver image courtesy of stockpile .com

43 Reversible Sedatives Xylazine -Rompun -synthetic α2-adrenoreceptor agonist -makes cats vomit -reversed with yohimbine -sedative -analgesia Free screensaver image courtesy of stockpile .com

44 Questions? Thank You! Kelly.lynn.cronin@gmail.com


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