1. Anesthetic Problems and Emergencies A&A pg. 319

2. Why Do Problems Arise?  Human error  Equipment error  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 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 *ALWAYS LABEL SYRINGES

7. Equipment Failure  CO 2 ABSORBER EXHAUSTION How is CO 2 removed from a rebreathing system? How is CO 2 removed from a non-rebreathing system? Best way to keep an eye on exhaled CO 2 ? ↑ CO 2 = Tachypnea, tachycardia, brick red mucous membranes, cardiac arrhythmias

8. Equipment Failure  NO OXYGEN FLOW Which two parts of the machine may be malfunctioning? Flow meter: will gradually fall as the O 2 tank empties  Periodically check this! Oxygen tank: check for empty tank, disconnected hose, leaks *Which breathing system can go without O 2 flow longer?

9. 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 you think the most common misassembled part happens on the machine?

10. 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 How would this scenario lead to cardiac arrhythmias? Solution : Check signs of tube properly in the trachea  If truly blocked  extubate or suction with RRC

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

12. Equipment Failure  VAPORIZER PROBLEMS Wrong anesthetic in the vaporizer  Solution: Tipped over or over-filled  Solution: Vaporizer dial may be jammed  Solution:

13. Equipment Failure  POP-OFF VALVE PROBLEMS The pop-off valve is inadvertently left closed Two reasons why pop off would be left closed?: Solution: open the pop-off valve and/or decrease the oxygen flow rate. *Can adjust the amount of gas in the reservoir bag by adjusting the pop off valve

14. 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.  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?

15. Patient Factors  Trauma  Age  Weight  Breed  Organ disease Urinary obstruction

16. Patient Factors  TRAUMA PATIENTS Physical Status Classification= P3, P4 or P5 Potential Problems:  Respiratory distress Pneumothorax/Pleural effusion:  No negative pressure or fluid compressing lung expansion Pulmonary contusions/edema: fluid in lung parenchyma  No gas exchange FLUID SHOULD BE REMOVED BEFORE ANESTHESIA *What therapy might we want to provide while patient is stabilizing?

17. Patient Factors  TRAUMA PATIENTS Potential Problems: Cardiac arrhythmias  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

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