1. PATIENT PREPARATION
CHAPTER 2 Part 2

2. PATIENT PREPARATION
IV CATHETERS: catheters are ideal for all anesthetic procedures
Can treat/prevent ______________, _________________, _______________________
Allows injection of medications such as antibiotics and analgesics and allows constant-rate-infusions
Provides access to a vein in an emergency (cardiac arrest, seizures ). Do not remove until animal is fully awake!
Allows _______________ agents to be injected (ex: thiopental)
Allows injection of _________________drugs

3. PATIENT PREPARATION
IV CATHETERS: Choose catheter size based on patient’s size and need
Risks with catheter placement:
_______- always remove air from IV line before connecting to patient
________________- don’t repeatedly advance and retract the stylet
_________________________________- avoid by using infusion pump or calculate drips/sec
_____________________- wipe area of catheter placement with an antiseptic and injection ports with alcohol
____________________________ – Just because the catheter is there, doesn’t mean all drugs should be given IV

4. PATIENT PREPARATION Fluids during surgery/anesthesia:
IV FLUIDS: the patient’s infusion rate will depend on body weight and procedure
Fluids during surgery/anesthesia:
_________________mL/kg/hr
intended to compensate for vasodilation and fluid loss during anesthesia/surgery
Isotonic, polyionic replacement crystalloids are the first choice for fluid therapy in healthy patients.

5. PATIENT PREPARATION
IV FLUIDS: fluid rates can be adjusted for those patients that are compromised
CV disease
Respiratory disease
Fluid rates for these patients are often kept at 5ml/kg/hr
An animal with excessive hemorrhage or low blood pressure during surgery can have fluid rates increased
Dogs: up to 40mL/kg/hr for max of 1 hour
Cats: up to 20ml/kg/hr for max of 1 hour
A quick way to estimate amount of fluids to give:*Give ______mL of fluid for every ______mL of blood loss

6. PATIENT PREPARATION
ANIMALS IN SHOCK: these patients need even more rapid fluid rates
Dogs: __________mL/kg/hr
Cats: ___________mL/kg/hr
___________of the calculated dose is given and then patient re-evaluated (a 10-20mL/kg bolus)
Animals in shock may show the following signs:
Pale mucous membranes
Low blood pressure
_____________________ heart rate in compensatory & decompensatory shock or slow heart rate in end stage shock

7. PATIENT PREPARATION
IV FLUIDS: drip sets (administration sets) help determine how fast the fluids are administered
Patients greater than 10kg use a _____________ set
Macrodrip sets are either 10gtt/mL or 15gtt/mL
VTI has 15gtt/mL sets
Patients less than 10kg use a _______________ set
Microdrip sets are 60gtt/mL

8. PATIENT PREPARATION
IV FLUID ADMINISTRATION SETS
MICRO
MACRO

9. PATIENT PREPARATION
IV FLUID ADMINISTRATION: most clinics have an IV fluid pump. The pump controls how many drops of fluid are delivered to the patient over a period of time.
If no pump is available, the anesthetist will need to calculate how many drops of fluid should be administered to the patient in a period of time as well as monitor the fluids closely.

10. PATIENT PREPARATION MATH Step 1: Obtain the patient’s weight in kgs.
If the patient’s weight was obtained in pounds, then you must divide by 2.2
Step 2: REMEMBER THE SURGICAL FLUID RATE: 10mL/kg/hr. Multiply the patient’s weight in kgs by 10. This will give you how many mLs the patient should receive in 1 hour known as the infusion rate.
Step 3: Determine the drip set necessary for the patient based on weight.
Step 4: Multiply the patient’s infusion rate by the drip set.
Step 5: Divide the number from Step 4 by 3600 (because there are 3600 seconds in 1 hour). THIS FINAL ANSWER WILL TELL YOU HOW MANY DROPS OF FLUID EACH SECOND THE PATIENT WILL RECEIVE EACH HOUR WHILE UNDER ANESTHESIA.

11. PATIENT PREPARATION Patient weighs 6 kg. Patient weighs 12 kg.
Surgical fluid rate is 10mL/kg/hr: 6 x 10 = 60 mL/hr
Patient needs microdrip set: 60 x 60 = 3600
3600/3600 = 1 drop/sec
Patient weighs 12 kg.
Surgical fluid rate is 10mL/kg/hr: 10 x 12 = 120 mL/hr
Patient needs a macrodrip set: 120 x 15 = 1800
1800/3600 = 0.5 drops/sec
0.5 drops/sec is impossible to count, but if we multiply by 10 it will tell us how many drops to administer in 10 seconds
0.5 x 10 = 5 drops/10 sec

12. PATIENT PREPARATION: Fluid Administration
Body fluids consist of water and solutes.
Water is 60% of body weight.
It is divided into _______and ______ (fluid in the vessels and fluid between the cells)
The other 40% is solutes
Blood volume is ____________of body weight in dogs & large animals and ___________-in cats

13. PATIENT PREPARATION Electrolytes: Body fluid solutes:
FLUID ADMINISTRATION
Body fluid solutes:
ions
large plasma proteins or colloids,
small nonionic particles such as glucose and small proteins
Electrolytes:
Cations
Sodium (Na+)
Potassium (K+)
Magnesium (Mg2+)
Calcium (Ca2+)
Anions
Chloride (Cl−)
Bicarbonate (HCO3−)
Phosphates (HPO42− and H2PO4−)
Proteins

14. PATIENT PREPARATION
____________________ is the solute concentration maintained in all body fluids. It is 300 mOsm/L
PRINCIPLES OF WATER AND SOLUTE BALANCE:
One-third of IV fluids administered will stay in the intravascular space. Two-thirds will diffuse into the interstitial space.
Colloids don’t pass freely through the vascular endothelium.
The presence of colloids in the intravascular space draws water into the space creating osmotic or oncotic pressure.
Some solute concentrations (Ca2+, K+) must be kept within a narrow range to maintain normal heart and muscle function.

15. PATIENT PREPARATION FLUID ADMINISTRATION FOR ANESTHETIZED PATIENTS
Anesthetic agents affect cardiopulmonary function by decreasing inotropy and heart rate. Many agents also cause vasodilation. This results in an overall decrease in cardiac output and hypotension.
This affects oxygen delivery to the tissues
IV fluids increase circulating blood volume and cardiac output

16. PATIENT PREPARATION
REVIEW OF IV FLUID TYPES: Crystalloids vs. Colloids
CRYSTALLOIDS: the most common fluid type. Used for fluid replacement and maintenance. The 3 general categories of crystalloids are:
_____________________(isotonic, polyionic, replacement solutions)
___________solutions
______________________solutions

17. PATIENT PREPARATION CRYSTALLOIDS: BALANCED ELECTROLYTE SOLUTIONS
Contain a solute profile similar to the extracellular fluid since dehydration , general diseases, and peri-operative hemorrhage deplete the ECF first.
This means higher concentrations of Na+ and Cl-
Examples: Plasmalyte, Normosol, Lactated Ringer’s

18. PATIENT PREPARATION CRYSTALLOIDS: SALINE SOLUTIONS
Contain ONLY Na+ and Cl-
Examples: Normal Saline & hypertonic Saline
NORMAL SALINE(0.9%): used to flush body cavities, flush catheters, blood transfusions
HYPERTONIC SALINE(3%, 5%, 7%): very concentrated and quickly draws water into the intravascular space and supports blood pressure, but rapidly diffuses out into the interstitial space. Used for profound hemorrhage, shock, increased intracranial pressure

19. PATIENT PREPARATION CRYSTALLOIDS: DEXTROSE SOLUTIONS (2.5%, 5%)
Used in cases of hypoglycemia, neonatal, debilitated animals, hyperkalemia, patients receiving insulin
Don’t use as the sole fluid. The sugar is rapidly metabolized to CO2 and water. The free water diffuses out into the interstitial space.

20. PATIENT PREPARATION
COLLOIDS: large molecules that do not readily leave the intravascular space
These are helpful in maintaining blood volume and pressure
Less side effects than hypertonic saline
Rapidly pulls water into the intravascular space
Examples: __________ or __________, __________________, _________________________

21. PATIENT PREPARATION COLLOIDS: PLASMA OR BLOOD
Contains albumin, clotting factors, globulins
Used in animals with acute blood loss, anemia, hypoproteinemia
Expensive
COLLOIDS: BLOOD SUBSTITUTES
Used for acute hemorrhage and anemias
Oxyglobin contains hemoglobin molecules of bovine origin similar to red blood cells that are able to carry oxygen.
The benefit is that there is no cross-match required
THIS PRODUCT IS NOT CURRENTLY AVAILABLE

22. PATIENT PREPARATION
COLLOIDS: SYNTHETIC COLLOIDS (*Hetastarch, *Vetstarch, Dextran)
More readily available than blood products
Less expensive and longer shelf life than blood products
Used in cases of shock, hypoproteinemia
Usually administered IV at rate of 10-20mL/kg/day; bolused slowly over minutes
30%-60% remains in the plasma after 24 hours, and a smaller percentage remains in the plasma for as long as days to weeks after administration.

23. PATIENT PREPARATION ADVERSE EFFECTS OF FLUID ADMINISTRATION
____________________– more likely in patients that are <5kg or those with cardiac or renal disease *reduce infusion rates
Ocular/nasal discharge
Chemosis
Subcutaneous edema
Increased lung sounds
Increased respiratory rate
Dyspnea
Coughing, restlessness
_____________________ – dilution of the RBC’s and plasma proteins.