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What are 3 things a tech should know/do during an anesthetic emergency?
Recognize signs of crises & alert ver; anticipate needed supplies; assist the vet.
What are 6 factors which can attribute to an anesthetic emergency?
Geriatric (reached 75% of life expectancy), pediatric (<3mths), brachycephalic, sighthounds, obese, cesarean.
What can you do to help a geriatric patient during anesthesia?
Do a pre-anesthetic history, physical & screening test; reduce anesthetic doses by 30-50%; allow more time to take effect.
What are some problems than can occur with a geriatric patient?
They have a poor response to stress; recovery may be pronounced; hypothermia; overhydration.
What can you do to help a pediatric patient during anesthesia?
Weigh accurately & dilute injectable drugs; reduce dosages; use inhalation.
What are some problems that can occur with a pediatric patient?
Hypoglycemia (avoid prolonged fasting); high risk for hypothermia & overhydration.
What are some problems that can occur with brachycephalic breeds?
Airway obstruction - preoxygenate, induce rapidly (IV), delay extubation, observe closely during recovery. They have a high vagal tone, use an anticholinergic.
What type of drug should you avoid in sighthounds?
What are some things you can do to help an obese patient during anesthesia?
Preoxygenate; dose according to actual weight; induce rapidly; assist ventilation if necessary; delay extubation; observe closely during recovery.
What are some things you can to help a c-section patient during anesthesia?
Preoxygenate; IV fluids; lowest effective dose of anesthetic; avoid ketamine/diazepam & barbiturates.
What drugs should you avoid giving a cesarian patient?
Ketamine/diazepam & barbiturates.
What should you do for a neonate during a c-section?
Oxygen by mask; atropine for bradycardia; reversing agents; doxapram.
What are some types of emergency situations?
Shock, patient doesn't stay anesthetized, patient too deep, respiratory depression, abnormal breathing patterns, bradycardia, tachycardia, cardiac dysrhythmias, cardiac arrest, vom/aspiration/regurgitation, malignant hyperthermia.
Definition of shock
Inadequate tissue perfusion leading to cellular hypoxia, metabolic acidosis & ultimately, cell death.
What are the 4 types of shock?
Hypovolemic, vasculogenic, cardiogenic & obstructive.
What are 4 types of shock?
Hypovolemic, vasculogenic, cardiogenic & obstructive.
What is hypovolemic shock?
A decrease in circulating blood volume due to loss of fluid.
What conditions can cause hypovolemic shock?
Hemorrhage, vomiting, diarrhea, diuresis, burns or fluid sequestration.
What is vasculogenic shock?
The vascular space is increased which leads to a decrease in blood pressure.
What conditions can caue vasculogenic shock?
Sepsis, anaphylaxis, drug overdose.
What is cardiogenic shock?
A failure of cardiac output.
What conditions may cause cardiogenic shock?
Dysrhythmias, valvular insufficiency, congenital defects, heart muscle problems.
What is obstructive shock?**
A restriction in blood flow.
What conditions may cause obstructive shock?
GDV, pneumothorax, cardiac tamponae (cardiac output is blocked).
What are some signs of shock?
Tachycardia, tachypnea, hypotension (prolonged CRT), hypothermia, weakness, restlessness, depressio, reduced urine output, coma, pupil dilation, leads to cardiopulmonary arrest.
How do you treat shock?
Rapid IV fluids, dopamine or dobutamine, lidocaine or propranolol, glucocorticoids, antibiotics for sepsis, diuretics for oliguria/anuria.
Why do you give dopamine or dobutamine for shock?
To increase the contraction of the heart.
Why do you give lidocaine or propranolol for shock?
It helps with arrhythmias.
What are 5 errors/problems which can lead to a patient not staying anesthetized?
The endotrach tube, vaporizer, delivery system, oxygen tank & patient.
What do you need to check with the endotrach tube to make sure it's working?
Is it in the trachea, large enough, cuff inflated, kinked, firmly connected to the machine?
What do you check with the vaporizer to make sure it's working properly?
Is it connect to the oxygen, to the delivery system, correctly set, filled, calibrated?
What do you check with the delivery system to make sure it's working properly?
Are there any leaks, is the oxygen flow adequate?
What do you check with the oxygen tank to make sure it's working properly?
Is it on, is there an adequate supply in the tank?
What do you check with the patient if they're not staying under?
Are they hypoventilating?
What are some signs that the patient is too deep?
Dilated pupils, no reflexes, bradycardia, delayed CRT, hypoventilation, no muscle tone.
What are 2 things that can cause a patient to become too deep?
The equipment or the patient.
What should you check with the equipment if the patient is too deep?
Is the vaporizer setting or calibration correct? Is the correct anesthetic in the vaporizer?
What should you check with the patient if they are too deep?
Are they hypothermic, in shock, have a preexisting disease, check drug doses or interactions.
How do you treat/avoid a patient becoming too deep?
Proper machine checkout, decrease or turn off vaporizer setting; ventilate patient; warm patient; reverse drugs if possible.
What are some signs of respiratory depression?
Reduced respiratory rate, reduced tidal volume, cyanosis.
What are some causes for respiratory depression?
Patient is too deep; anesthetic drugs; surgical positioning (pressure on check or diaphram); hypocarbis (ventilating too fast); CNS or metabolic disease.
How do you treat respiratory depression?
Lighten plane; 'sigh' all patients; supplement if <10rpm; correct surgical positioning; use doxapram if nothing else is effective.
What are some signs of abnormal breathing patterns?
Increase effort -abdominal breathing; decreased movement of chest or reservoir bag; cyanosis; unusual sounds -rales, crackles, muffled.
What are some causes of abnormal breathing?
Patient too deep; misplaced endotrach tube; obstruction w/in resp system(aspirated material, musous); obstruction w/in equipment (endotrach tube, delivery tube, closed popoff valve; disease of respiratory system.
How do you treat abnormal breathing?
Check popoff valve & ventilation bag first!! Assess depth-lighten if necessary; ventilate & watch chest-no movement ~obstruction; can disconnect system & aspirate endotrach tube.
Sign of bradycardia?
Dogs = <60 bpm
Cats = <100 bpm
What are some causes of bradycardia?
Anesthetic plane too deep; increased vagal tone; hypothermia; metabolic problems; late stages of hypoxia.
How do you treat bradycardia?
Lighten anesthetic plane if possible; support ventilation; keep patient warm; administer anticholinergic (atropine).
What are signs of tachycardia?
Dogs - large >120bpm
medium >140bpm
small >150bpm
Cats - >200bpm
What are some causes of tachycardia?
Patient too light; hypotension, hypovolemia, shock; inadequate ventilation-early stage of hypoxemia; drug induced (ketamine, anticholinergics); hyperthermis.
How do you treach tachycardia?
Adjust anesthetic depth if necessary; provide adquate fluid support; support ventilation; check temp, maintain normothermia.
What are some signs of a cardiac arrhythmia?
Irregular pulse rate & pressure; pulse deficits; irregular heart sounds; hypotension; pallor, cyanosis; abnormal ECG tracing.
What are some causes of cardiac arrhythmias?
**Drug sensitizes heart to epinephrine. Too light or too deep; anesthetic drugs; hypoxemia; hypercarbia; electrolyte or acid-base imbalance; surgical manipulation.
How can you prevent cardiac arrhythmias?
Presurgical PE & labwork; correct any hydration & metabolic imbalances b/4 anesthesia; fluids for cardiac support; porper anesthetic depth monitoring; follow proper drug protocol.
How can you treat cardiac arrhythmias?
Assess & adjust anesthetic depth; ventilation; fluid therapy.
What are some signs of cardiac arrest?
Resp arrest; no pulse; no heart sounds; dilated, fixed pupils; lack of bleeding at surgical sites; blue/gray tissue color; ECG changes.
What are some causes of cardiac arrest?
Inadquate ventilation which leads to resp arest; anesthetic overdose; hypothermia; acidosis, other metabolic problems; cardiovascular disturbances.
How do you treat cardiac arrest?
CPR; epinephrine; after resuscitation give dopamine or dobutamine; evaluate CNS status.
What are some causes for vomiting, aspiration, regurgitation?
***Drugs (opiates, barbiturates, xylazine); light anesthesia (stage 2); feeding b/4 anesthesia; stress, excitement; surgical manipulation.
What are some signs of aspiration?
Cyanosis; bronchospasm (wheezing, can't breath in); apnea or tachypnea. On radiograph: pulmonary edema, pneumonia.
How do you prevent aspiration?
Fast 12 hours b/4 anesthesia; avoid stress & excitement; acepromazine; rapid induction techniques (avoid stage 2); leave cuff inflated until ready to extubate.
How do you treat vomiting?
Place in sternal recumbancy; keep mouth open, tongue out; tilt table head downward; afterward, examine & cleanse pharynx.
How do you treat aspiration?
Suction airway, may lavage w/ sterile saline; administer O2; broad-spectrum antibiotics; steam or mist; coupage; if bronchospasm occurs - steroids or aminophylline.
What is malignant hyperthermia?***
A hypermetabolic state induced by drugs which leads to uncontrolled increase in temperature, metabolic crisis which may lead to death.
What are some predisposing factors to malignant hyperthermia?
Genetics; infections; drugs (ketamine, anticholinergics, inhalation drugs, succinylcholine); environmental stress & excitement.
What are some early signs of malignant hyperthermia?
Hyperventilation, tachypnea; elevated body temp; skin & MM flushed which leads to cyanosis; tachycardia & dysrhythmmias; BP first elevated, the profoundly decreased; muscle rigidity.
What are some late signs of malignant hyperthermia?
Muscle rigidity; core body temp 108-110; severe metabolic acidosis; hemolysis, coagulopathy; acute renal failure; hypoglycemia; cerebral edema; death.
How can you prevent malignant hyperthermia?
Be aware of signs to recognize while monitoring post-anestheic patients.
How do you treat malignant hyperthermia?
Remove triggering agents, if possible; IV fluids; cool body -bath, snow, hose down; oxygen; diuretics; corticosteroids.

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