Difference between revisions of "Recovery From Anaesthesia"

Revision as of 11:13, 8 September 2010

CLINICAL TECHNIQUES ()Map ANAESTHESIA (Map)

Introduction

The post operative period is an important stage within an anaesthetic procedure, both immediately after the anesthetic and once the patient is back in wards/stables etc.

Immediately Post Anaesthetic

The major concern after any anaesthetic procedure is the airway of the patient. Commonly the anaesthetic agent is turned off, if inhalation agents have been used, or the infusion is stopped in cases of total intravenous anaesthetic procedures, the animal is maintained on oxygen for a short period of time. This also allows the anaesthetist to ventilate the patient, if intubated, if they are not spontaneously breathing. Once happy that the patient is breathing spontaneously and has received sufficient oxygen the oxygen is turned off and the patient is allowed to breath room air. This is important in patients that have received nitrous oxide during a procedure, or patients with known airway disease. Oxygenation of these patients should be monitored closely with a pulse oximeter or, if available, blood gas analysis

Endotracheal Tube removal

The time of endotracheal (ET) tube removal varies between species. In any patient , however, close monitoring should continue before and after removal of the ET tube. In dogs, it is possibly to leave the tube in until the dog is sitting in sternal as many dogs will tolerate ET tube placement. However, it can be removed when the patient is swallowing spontaneously. Many practices will remove it to prevent the paitent chewing on the tube and thereby damaging it. In cats, ET tubes should be removed before the animal rouses as laryngeal spasm may occur, which may lead to laryngeal oedema and obstruction. In horses, ET tubes may be removed early to prevent damage, and a nasal tube can be placed if there are concerns.

Temperature

On concern with patients undergoing anaesthesia is hypothermia. this make it important to monitor temperatures of patients during and after any anaesthetic. This allows for implementation of methods to try and prevent further temperature loss and to try warm up the patient.

Post Operative Analgesia

Post operative analgesia is often forgotten but it of great importance in any anaesthetic procedure. A variety of agents can be used systemically or locally. The patient should be closely monitored after the procedure and pain assessed regularly to adjust the analgesic protocol appropriately.

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+|linkpage =Clinical Techniques
+|linktext =CLINICAL TECHNIQUES
+|maplink1= Anaesthesia Content Map - WikiClinical
+|pagetype=Clinical
+|sublink1=Anaesthesia
+|subtext1=Anaesthesia
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 ==Introduction==
 The '''post operative period''' is an important stage within an anaesthetic procedure, both immediately after the anesthetic and once the patient is back in wards/stables etc.
 ==Immediately Post Anaesthetic==
-The primary concern after any anaesthetic procedure is to maintain the airway of the patient. Commonly after the anaesthetic agent is turned off, if [[Inhalation Agents|inhalation agents]] have been used, or the infusion is stopped in cases of total intravenous anaesthetic procedures, the animal is then maintained on oxygen for a short period of time. If required, the anaesthetist can also ventilate the patient, if intubated, if they are not spontaneously breathing adequately. Once the patient is breathing spontaneously and has received sufficient oxygen to remove the anaesthetic agents from the respiratory 'dead space' and to allow the arterial oxygen tension to equilibrate to normal levels, the oxygen can be turned off and the patient allowed to breathe room air. This time on oxygen post-operatively is particularly important in patients that have received [[Nitrous Oxide|nitrous oxide]] during a procedure, or patients with known airway disease; oxygenation of these patients should be monitored closely with a [[Pulse Oximetry|pulse oximeter]] or, if available, [[Blood Gas Analysis|blood gas analysis]].
+The major concern after any anaesthetic procedure is the airway of the patient. Commonly the anaesthetic agent is turned off, if [[Inhalation Agents|inhalation agents]] have been used, or the infusion is stopped in cases of total intravenous anaesthetic procedures, the animal is maintained on oxygen for a short period of time. This also allows the anaesthetist to ventilate the patient, if intubated, if they are not spontaneously breathing. Once happy that the patient is breathing spontaneously and has received sufficient oxygen the oxygen is turned off and the patient is allowed to breath room air. This is important in patients that have received [[Nitrous Oxide|nitrous oxide]] during a procedure, or patients with known airway disease. Oxygenation of these patients should be monitored closely with a [[Pulse Oximetry|pulse oximeter]] or, if available, [[Blood Gas Analysis|blood gas analysis]]
 ===Endotracheal Tube removal===
-The time of ''endotracheal (ET) tube removal'' varies between species. In any patient, however, close monitoring should continue before and after removal of the ET tube. In dogs, it is possible to leave the tube in until the dog is sitting in sternal recumbency as many dogs will tolerate ET tube placement; sometimes it can even be removed when the patient is swallowing spontaneously. It is especially important to exubate brachycephalic dogs later rather than sooner as the soft palate can occlude the airway. A delay in removing the tube can result in the patient chewing on the tube and damaging it. In cats, ET tubes should be removed before the animal becomes conscious to reduce the risk of laryngeal spasm which may result in damage. In horses, ET tubes should be removed early to prevent damage, and a nasal tube can be placed to provide a supplementary oxygen if this is indicated, and also to aid drainage.
+The time of ''endotracheal (ET) tube removal'' varies between species. In any patient , however, '''close monitoring''' should continue before and after removal of the ET tube. In dogs, it is possibly to leave the tube in until the dog is sitting in sternal as many dogs will tolerate ET tube placement. However, it can be removed when the patient is swallowing spontaneously. Many practices will remove it to prevent the paitent chewing on the tube and thereby damaging it. In cats, ET tubes should be removed before the animal rouses as laryngeal spasm may occur, which may lead to laryngeal oedema and obstruction. In horses, ET tubes may be removed early to prevent damage, and a nasal tube can be placed if there are concerns.
 ===Temperature===
-One concern with patients undergoing anaesthesia is hypothermia; it is important to [[Manual Techniques for Anaesthesia Monitoring#Temperature|monitor the temperature]] of patients during and after any anaesthetic. If necessary, techniques to try and prevent further temperature loss and to try warm up the patient can be instigated as soon as possible. Indirect heat sources such as 'hot hands' (examination gloves filled with hot water and tied off with a knot at the wrist) placed between the patient and a towel, for example are required for heating the patient that is slightly hypothermic, and preserving heat loss from the extremities by insulating the limbs with 'bubble wrap' will all help to maintain the patient's core temperature. Never use a direct heat course as the animal is not able to move away from the heat and can potentially sustain tissue burns as a result.
+On concern with patients undergoing anaesthesia is hypothermia. this make it important to [[Manual_Techniques#Temperature|monitor temperatures]] of patients during and after any anaesthetic. This allows for implementation of methods to try and prevent further temperature loss and to try warm up the patient.
 ==Post Operative Analgesia==
 '''Post operative [[Pain#Analgesics|analgesia]]''' is often forgotten but it of great importance in any anaesthetic procedure. A variety of agents can be used [[Systemic Analgesia|systemically]] or [[Local Analgesia|locally]]. The patient should be closely monitored after the procedure and pain assessed regularly to adjust the analgesic protocol appropriately.
-[[Category:Anaesthesia]]