Anesthesia – Managing Complications

Anesthetic Management of Commonly Encountered Complications Elizabeth Goudie-DeAngelis, DVM, MS The anesthetic plan was carefully formulated specifically for your patient. You took into account underlying pathologies and the procedure you are performing. The induction went well, but now that your patient is under general anesthesia you are encountering complications. Chances are your patient has hypotension, hypothermia, hypoventilation or a combination of the three. The best way to keep your procedures moving forward and your patient stable is to know how to predict, prevent and treat these three common anesthetic complications. Hypotension We do not have a way to easily, non-invasively, or accurately measure perfusion (the oxygenation of tissues at the capillary level), so in combination with hemoglobin saturation, we use blood pressure to make an approximation of tissue perfusion. Hypotension is defined as a systolic arterial blood pressure (SAP) under 90 mmHg. Ideally, we attempt to keep this number between 90 – 110 mmHg under general anesthesia because an SAP greater than 90 mmHg correlates to a mean arterial blood pressure (MAP) of 60 mmHg. The MAP is the number we are concerned with. With a MAP in the range of 60-120 mmHg the capillary beds of the kidneys and

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Analgesia – Pain Management

Indications for Local Analgesia Vicki L. Campbell, DVM, DACVECC, DACVAA (UT) Local analgesia is an underused technique that can greatly enhance the overall analgesia in a patient; lead to use of less systemic drugs; and may be used in situations in which sedation, heavy systemic analgesia or anesthesia is contraindicated. Many animals that present to emergency are in shock, and those that are not in decompensated shock may be in compensated shock. Those in compensated shock are able to compensate because their sympathetic nervous system is maintaining their blood pressure and helping to maintain their oxygen delivery. In the intensive care unit, critically ill animals are dynamic with potentially minute-to-minute changes in cardiac output, blood pressure and oxygen delivery. Almost all sedatives, analgesics and anesthetics blunt the sympathetic nervous system to some extent. This effect puts animals in the emergency department and critical care unit at risk for decompensation when receiving systemic drugs for analgesia, sedation or anesthesia. Local analgesic techniques may aid in decreasing systemic drug requirements in these patients. Although shock patients in general are at risk for systemic decompensation with systemic sedatives and anesthetics, there are specific conditions in which these drugs should be particularly avoided or

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