1. Anesthetic Problems and Emergencies
A&A Chapter 12 pg

2. Why Do Problems Arise? Human error Equipment error
Drug adverse effects
Patient factors
Anesthetic problems will inevitably occur at some point in your career.
No anesthetic experience is the same, so beware of the false sense of security!

3. Human Error
Failure to obtain an adequate history or physical exam on the patient
Ideally, every patient scheduled for anesthesia should have a complete PE, and a thorough history obtained with the owner present.
*Less than ideal circumstances are common:
Owner drops patient off in a hurry
Patient brought in by neighbor or friend
Receptionist takes the history
HISTORY?

4. Human Error Lack of familiarity with the anesthetic machine or drugs
Thank goodness for LVTs!

5. Human Error Fatigue Distracted or rushed Inattentiveness
Proper scheduling of surgeries can help with this
Distracted or rushed
Usually you have your surgical patient and…
Inattentiveness
Having a low level of anxiety is good!

6. Human Error Incorrect administration of drugs Inaccurate weight
Units, scale is off
Math errors – calculating OR drawing up
Use of wrong medication
Use of wrong concentration
Enro, ketamine, dexmed, pred
Incorrect route of administration
IV v. IM
Confusion between syringes

7. Equipment Failure CO2 ABSORBER EXHAUSTION
How is CO2 removed from a rebreathing system?
How is CO2 removed from a non-rebreathing system?
Best way to keep an eye on exhaled CO2?
↑ CO2 = Tachypnea, tachycardia, cardiac arrhythmias

9. Equipment Failure NO OXYGEN FLOW
Which two parts of the machine may be malfunctioning?
Oxygen tank: check for empty tank, disconnected hose,
leaks
Flow meter: will gradually fall as the O2 tank empties
Periodically check this!
*Which breathing system can go without new O2 flow longer?

10. Equipment Failure ANESTHETIC MACHINE MISASSEMBLED
The better you know this machine and the flow of gas, the quicker you will be able to solve problems.
*Where do some of the most common misassembled
parts happen on the machine?

11. Equipment Failure ENDOTRACHEAL TUBE PROBLEMS Blocked tube
Twisting or kinking of the tube (inappropriate positioning)
Accumulation of material such as blood, mucus, excess lubricant
*What tubes do you need to pay special attention to?
Blocked tube = decreased oxygen to patient
Solution: Check signs of tube properly in the trachea
If truly blocked  extubate or suction with RRC

12. Equipment Failure ENDOTRACHEAL TUBE PROBLEMS
Tube advanced too far into a bronchus
How do you solve this?
Cuff or tube is damaged
Solution?

13. Equipment Failure Wrong anesthetic in the vaporizer
VAPORIZER PROBLEMS
Wrong anesthetic in the vaporizer
Non-precise concentrations delivered
Solution:
Tipped over or over-filled
Vaporizer dial may be jammed

14. Equipment Failure POP-OFF VALVE PROBLEMS
The pop-off valve is inadvertently left closed
pressure builds  patient cannot exhale
=rupture of lungs and decreased venous return to
Two reasons why pop off would be left closed?
Solution:
*Can adjust the amount of gas in the reservoir bag by adjusting the pop off valve

15. Anesthetic Agents
“Every injectable or inhalation agent has the potential to harm a patient and, in some cases, cause death”. (Page 323)
Review the description of the physiological effects of pre-anesthetic and general anesthetic agents in chapter 3.

16. Anesthetic Agents
Anesthetic protocol should be chosen based on the patient’s needs
Anesthetist must be familiar with side effects
Such as?
Why is balanced anesthesia safer?

17. Patient Factors Trauma Age Weight Breed Organ disease
Urinary obstruction

18. Patient Factors TRAUMA PATIENTS Potential Problems:
Physical Status Classification= P3, P4 or P5
Potential Problems:
Respiratory distress
Pneumothorax:
No negative pressure  lung tissue collapse
Pleural effusion:
Fluid compressing lung expansion  lung tissue collapse
Pulmonary contusions/edema:
No gas exchange

19. Patient Factors TRAUMA PATIENTS Respiratory distress Solution:
FLUID AND/OR AIR SHOULD BE REMOVED BEFORE ANESTHESIA
Aseptic prep:
Lateral chest wall
7th-9th intercostal spaces
Clip and scrub

20. Patient Factors TRAUMA PATIENTS Respiratory distress Solution:
What therapy might we provide for the patient while they are stabilizing?

21. Patient Factors TRAUMA PATIENTS Potential Problems:
Cardiac arrhythmias
Pre-anesthetic ECG
What drug should you have on hand and know the dose for?
Shock/hemorrhage
What fluids might you prep?
Fractures/organ rupture anemia
Unknown internal injuries…what diagnostic test??

22. Patient Factors TRAUMA PATIENTS Solutions:
Stabilize patient- may be hours to days
decrease anesthetic risk!
Obtain rads, ECG, blood work

23. Patient Factors-Group Discussion
Geriatric
Pediatric
Brachycephalic
Sighthounds
Obese
Cesarean
Neonates
Cardiovascular disease
Respiratory disease
Hepatic disease
Renal disease/Blocked Tom
ASA Physical Status Classification (pg. 25)
Patient description and example
Potential problems
Solutions