+ Surgical Procedures 7.01 Implement techniques to prepare and monitor patients for surgery

+ Surgical Log Book Note all aspects of surgery Presurgical notes Surgical notes Postoperative recovery stages Required to meet legal and state regulations

+ Anesthesia Log Book Notes Patient status through Induction Maintenance Recovery TPR and BP every 5 minutes Fluid type and amount received Pain medications Oxygen flow rate

+ Pre-Anesthetic Patient Care Blood work – helps determine the proper anesthetic to use Physical examinations – evaluate each body system and vital signs Patients should be fasting Administer sedatives

+ Surgical Preparation Make patient urinate Clip surgical area Prep skin with a surgical scrub Place patient on table Apply monitors

+ Fluid Therapy IV catheter placement during pre-anesthesia preparation For administration of pain meds For quick access in the event of an emergency To prevent dehydration

+ Patient Monitors Pulse oximeter Measurement of vital signs by oxygenation status of the blood Shows oxygenation, temperature, heart rate, and respiratory rate Temperature probe Respiratory monitor Esophageal stethoscope – device placed in the esophagus next to ET tube emits sound of heartbeat throughout procedure Blood pressure monitor – measure blood pressure and tissue perfusion Electrocardiogram – measures electric currents of the heart

+ Anesthesia Machine Vaporizer – converts liquid anesthesia into a gaseous form Oxygen tanks – should be checked daily and replace when low Pressure valve Flow meter Soda lime canister – absorbs carbon dioxide Rebreathing bag Pop-off valve – releases excess amounts of gas Scavenger hose – prevents gas from leaking into room Corrugated tubing – tube through which gas flows to patient Y connector – attachment from tubing to ET tube Anesthesia chamber – chamber in which a patient is placed and gas is pumped in until anesthesia is achieved Anesthesia masks

+ Anesthesia Machine

+ Breathing Systems Non-rebreathing system Bain system Single tube attaches to patient Another hose passes through tube to deliver gas Rebreathing system Allows rebreathing of gas after passing through CO 2 canister

+ Anesthesia Induction The phase when drug is given to make animal sleep and remain unconscious May be injected or inhaled Once induced, an endotracheal tube should be placed Blank reflex is used to determine plane of anesthesia achieved

+ Intubation Procedure Performed by technician or veterinarian Passage of breathing tube down trachea Allows anesthesia gases to be administered during procedure Prevents aspiration

+ Anesthesia Planes Measured by assessment of involuntary reflexes Palpebral reflex – tapping figure over eyelid, if strong blink reflex noted patient is in light plane Pedal reflex – pinching skin between digits, withdrawal or movement indicates a light plane Plane I Induction Brief disorientation before passing into plane II Plane II Excitement Involuntary movements and vocalization present

+ Anesthesia Planes Plane III Light anesthesia Vital signs normal, pupils regular in size, and mild to no reflexes present Plane IV Overdose Deep plane Vital signs decreased, pupils fixed and dilated Could result in death

+ Patient Surgical Positioning Dependent upon procedure Common is dorsal recumbency Adjust height of table Adjust lights over operable area

+ Post-Anesthetic Care Taken off anesthesia machine Moved to a recovery area Monitor for swallow reflex to determine when ET tube should be removed Increased heart rate and respiratory rate Animal may begin to move around Monitor vital signs until patient is alert

+ Postoperative Care Monitor for Pain Infection Hemorrhage Signs of pain – restlessness, whining or vocalization, reluctance to move, chewing or biting at incision, anorexia, or change in behavior Provide pain control Withhold food for 12 hours in monogastric patient Large animals can be given small amounts of food and water when alert Provide home care instructions when animal is ready to be discharged Set up suture removal appointment