Anaesthesia help :)

Re: Anaesthesia help :)

Siobhan Steven — Sat, 14 Jan 2012 01:33:21 GMT

As the Sx progresses you can start turning down the iso %, this is best to do as you get more experienced and used to working with certain surgeons, and you are sure you won't need radiographs or bandages etc.

Otherwise...turn off iso, disconnect circuit from ET tube, occlude end of circuit firmly with thumb, used 'flush valve' to fill bag (either on a non-rebreath or re-breath circuit) with O2, never do this while the circuit is still attached to patient (esp on non-rebreath but make it a habit not to do it at all) as you will rupture the alveoli in the lungs as there is no pressure reduction from the O2 cylinder to the patient in non-rebreath systems.

Give the patient 5 mins +/- on O2, depends on patient, as some will defy you and sit straight up and others will remain quite 'chilled' for longer, but as room O2 is 21%, the balance of room air vs medical O2 is more conjusive to quick recovery unless otherwise indicated (hypoxia etc).

I have worked with anaesthatists/vets who do vary the protocol from here....

Some untie the tube tie, leave the cuff up and wait for the swallow reflex and then deflate the cuff, others leave the tie done up, cuff up and wait for swallow reflex others untie and take cuff down. Its more important for you to know why...the cuff is there to prevent aspiration if the patient regurges, the tie is obviously there to keep the tube in place..

Personally, I undo the tie, wait for a swallow, while also assessing palpebral reflex (blink), its not unheard of for the patient to pretty much have its palpebral return, swallow and then sit up all at once! Then you have to be very quick at deflating the cuff!

Again, with experience, you can start to gauge when some of these reflexes will return depending on the drugs used in and prior to Sx the length of the Sx & the individual patient. A lot of anaesthesia is down to 'feel' as it is not an EXACT science.

Re: Anaesthesia help :)

Mark Hedberg — Fri, 13 Jan 2012 15:35:58 GMT

Hi, Rachel!

When I was in practice, we generallyturned off the iso, disconnected the circuit, gave it a blast of 02 from the tank to flush out the iso, then reconnected to let the patient get some 02 while recovering. Once we got muscle tone, deflate the cuff and untie the tube tie, then extubate. Turn off the 02 because otherwise the nurses grouch at me. (I'm a vet, you know the jokes nurses tell about us!)

That said, my way probably violates a few H&S regulations (mainly the quick blast of 02 to clear out the tube), so definitely check with your Clinical Coach to make sure I'm not teaching any bad habits. Alternatively, get in touch with your lecturer at Uni - we're always interested in fixing any problems you have. After all, we want you to succeed! :)

Good luck in your training!

Cheers!

Re: Anaesthesia help :)

Cloudy Weather — Fri, 13 Jan 2012 14:49:04 GMT

I think what will really help you is if you get someone to teach you WHY you do something. For example, you deflate the bag before disconnecting et tube to prevent people breathing in isoflourane, you turn of iso first as you know longer require animal to be under and keep on oxygen until animal shows signs of coming around (blinking), you extubate a dog when it has a swallowing reflex as this means it can breath on its own, but you must remove tube before a cat swallows because you could damage their larynx. It is important to avoid deflating the ET tube cuff until the animal is ready to extubate because the cuff provides protection against aspiration (this is particularly important in dentals)

It is all very new and takes time to feel confident so never feel stupid for asking questions. Knowledge is power ;p I think once your learn why you are doing something it because much easier, it is particularly important when you start to do more advanced ops when things might not go as smoothly, anesthetic varies from individual and so sometimes working down a list does not work, you need to understand why you do things so you can react to an animals individual reactions. Just ask someone as you are doing things to explain why you are doing it stage.

Hope this made some sense! Sorry just been on nights so my brains a bit mushed!x