1. Response to Anesthetic Problems and Emergencies
Anesthetist and Recovery
We are going to talk about your response to:
Depth of anesthesia issues
Cardiac arrest
Recovery period problems

2. ANIMALS THAT WILL NOT STAY ANESTHETIZED
Double-check equipment
Vaporizer
Oxygen supply
ET tube
Double-check the patient
Respirations
Rapid and shallow?
Apneic?

3. ANIMALS THAT ARE TOO DEEPLY ANESTHETIZED
Respirations per min:
MM/CRT:
Heart rate: bradycardia
ECG:
Pulse quality:
Temperature:
Pupils:

4. TREATING EXCESSIVE ANESTHETIC DEPTH
Lower vaporizer setting
Notify veterinarian
Manually ventilate the patient
1. Close the pop-off valve
2. Fill the reservoir bag with pure oxygen and provide PPV
3. Repeat until animal shows signs of recovery
Reversals?
Fluids?
Warmth

5. RESPIRATORY ARREST -is it true?
Patient is not breathing on their own
Doesn’t always require action: 1. 2.
Assess other vitals:

6. RESPIRATORY ARREST True respiratory arrest: Begin manually ventilating
Warning signs:
Begin manually ventilating
Continue until vitals improve…
Then give them a chance!
*What if you don’t have an anesthetic machine?

7. CARDIAC ARREST
A sudden cessation of effective ventilation and circulation.
Signs it’s coming:
Cyanosis
Respiratory arrest
CRT > 2 sec
Weak arterial pulse
Very low BP readings
Abnormal ECG tracing
VPCs
V-fibrillation

8. CARDIAC ARREST Signs it’s here: No heart beat auscultated
No palpable arterial pulse
MM gray
BP <25 mmHg
Agonal breath
Asystole seen on ECG
Initiate CPCR: a team effort!
ASK FOR HELP

9. CARDIAC ARREST – ABCDE???
There is a critical window to restore oxygen delivery to the brain
How long??
Ideally, 5 people would participate in the resuscitative efforts (CPCR)
Performs chest compressions
Bags the animal
Assess the pulse during compressions and the ECG when compressions are temporarily suspended
Draws up and administers drugs on the veterinarian’s orders
Maintains a record of procedure

10. CARDIAC ARREST – CABDE Circulation restoration is most important
Artificially supply heart, lungs, and brain with oxygenated blood
Start compressions!
Positioning
Slightly different based on P size

11. CARDIAC ARREST - CABDE Circulation
Compression rate= 1-2 times per second
~80 times per minute for a large dog
~120 times for small dogs or cats
Chest should be compressed ~1/3 to 1/2 the diameter of the chest wall
Should feel a femoral pulse with each compression
Will also stimulate gas exchange

12. **Circulation should take priority over breathing, if working alone**
CARDIAC ARREST - CABDE
Compressions and bagging should be administered simultaneously.
Switch personnel every two minutes
**Circulation should take priority over breathing, if working alone**
What are you looking for?

13. CARDIAC ARREST - CABDE Advanced Life Support
Defibrillation may be started
Electric shock (J/kg)
No alcohol if defibrillating!
May switch to internal massage
What procedure would be performed?
Prep between ribs 7-8
Invasive, but can get higher return of CO

14. CARDIAC ARREST - CABDE Once CPCR is initiated:
Continue compressions until you have return of spontaneous circulation
Palpate pulse, continue ECG, auscultate continuously
Continue bagging after beat is back

15. CARDIAC ARREST - CABDE Airway and Breathing Intubate 100% oxygen
Ventilate every 10 seconds

16. CARDIAC ARREST - CABDE Advanced Life Support Drugs: Routes:
Epinephrine
Dopamine/dobutamine
Atropine
Lidocaine
Routes:
IV- drugs, fluids
IT – drugs
IC – last resort for drugs

17. ECG CARDIAC ARREST - CABDE
Periodically check for spontaneous contractions by discontinuing external compression
Done by either palpating for a pulse or looking for QRS complexes on the ECG.
Downside?

18. CARDIAC ARREST After Care:
Common for patient to repeat arrest within 24 hours
Neurological tests needed
Must be monitored extremely close

19. Prepare for Success! Have emergency supplies in a central location
Check frequently!

20. Prepare for Success! Post algorithms in treatment areas
Make emergency dosing charts
Calculated volumes of drugs based on weight classes

21. Recovery Period Problems
Regurgitation:
Vomiting:
Solutions:
FASTING
Pre-ax drugs?
Injectable anesthetics
Quick intubation with cuffed ET tubes
Leaving ET tube in place until P has swallow reflex

22. Recovery Period Problems
Seizures- spontaneous, uncontrolled twitching
Differentiate from reverse excitement phase, dysphoria, and/or pain
Animals that might have a rough recovery?
Solutions:
Seizures:
Remove external stimuli
Diazepam IV; possibly PR
Monitor for hyperthermia
Dysphoria:
Propofol or alpha-2

23. Recovery Period Problems
Dyspnea- most common cause of post-Ax death
*When is this most likely to occur?
Cats: laryngospasms  reflex closure of trachea
Prevention: extubate before reflex returns
Trauma to tracheal opening during intubation?
Solution: Check MM, SpO2 and positioning
Provide oxygen
Re-intubate if patient is crashing
What if you can’t intubate?

24. Recovery Period Problems
Dyspnea- most common cause of post-Ax death
Dogs: extubated too early or have extra tissue blocking tracheal opening
Which breeds more susceptible?
Prevention: leave tube in as long as possible
Longer if the intubation was difficult
Monitor positioning after extubation
Solution: Check MM, SpO2 and positioning
Provide oxygen
Re-intubate if patient is crashing

25. Recovery Period Problems
Prolonged recovery phase
Individual susceptibility to Ax drugs
Hypothermic
Prolonged anesthesia; excessive depth reached
Prevention: fluid therapy during sx;
start warming ASAP
Solution:
Warm them up!
Reversals if available

26. Reading Assignment Pages 336-337
Other reasons for the clinical signs of being too deeply anesthetized: (Start at Pale MM, stop at Respiratory Arrest) I would suggest reviewing the entire chapter, chapter key points, and Procedures 12-1 through