Transcript Slide 1

Pages 26-41
Preanesthetic Patient Care
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Be sure the animal is correctly identified –
use cage or collar ID
If staying in the hospital, remove food the
night before or have someone call owner to
remind owner
Make a check list of pre-operative procedures
Physical exam the morning of surgery,
including TPR
IV CATHETERS
IDEAL FOR ALL
ANESTHETIC PROCEDURES!!
Why?
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Can provide IV fluids for support during surgery
(blood loss, dehydration, pre-existing problems,
electrolyte abnormalities, long procedures,
prevent/treat hypotension)
Allows injection of medications such as antibiotics
and analgesics and allows constant-rate-infusions
Provides access to a vein in an emergency (cardiac
arrest intra-op/recovery, seizures post-op). Do not
remove until animal is fully awake!
Allows irritating agents to be injected (ex: thiopental)
Allows injection of incompatible drugs in separate
syringes.
IV CATHETERS CONT’D
Choose catheter size/type based on patient’s size and
need
 RISKS TO AVOID
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AIR- always remove from syringe line before injecting
BROKEN TIP- don’t repeatedly advance and retract over
stylet
OVERHYDRATION- can avoid with infusion pump or
calculated drips/sec
- signs of over-hydration: eye/nose
discharge, swelling of conjunctiva, SQ
edema, increased lung sounds and
respiration rate, dyspnea, coughing,
restlessness
SEPSIS- wipe area of catheter placement with an antiseptic
and injection ports with alcohol
HASTY INJECTION OF DRUGS
IV FLUIDS
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Rate depends on the patient and the
procedure.
Fluids during surgery/anesthesia:
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5-10 mL/kg/hr (10mL/kg/hr is typical)
-intended to compensate for vasodilation and fluid loss
during anesthesia/surgery
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The surgical fluid rate (aka prescribed rate) at VTI is
10mL/kg/hr
When would you want to be extra-careful
with your rate to avoid overhydration?
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Patients with cardiovascular or
respiratory disease
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Can still give fluids, just modify the rate (5
mL/kg/hr)
What about the animal that has excessive hemorrhage
or low blood pressure in surgery? *These patients
may be at risk for going into shock*
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Healthy young dogs can get up to 40 mL/kg for one
hour.
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For cats, do not exceed 20 mL/kg for one hour (more
at risk for overhydration)
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A “quickie” way to determine the amount of fluids to
replace:
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If profuse hemorrhaging, give 3 mL fluids for every one mL
of blood lost.
Animals in Shock
Rapid fluid rates:
Dogs = 50-90 mL/kg/hr
Cats = 40-60 mL/kg/hr
Usually give as fractions (1/4 of total dose
over 15min , then re-evaluate), as to not
overload
IV FLUIDS
Drip sets determine how much and how fast
you are giving fluids to a patient.
Animal > 10kg: use 15 drops/mL set
(also called macro-drip or standard drip)
*macro drip sets also come in 10 drops/mL
Animal < 10kg: use 60 drops/mL set (also
called micro-drip or pediatric drip)
What difference do you notice
Between the 2 drip sets?
IV FLUIDS CONT’D
-If you are lucky, your clinic has a fluid
infusion pump and it’s as simple as
entering it in.
-However, these are expensive, so not all
clinics are able to use these on everyone.
IV FLUIDS
MATH
My patient weighs 7 kg.
Step 1: Surgery fluid rate is 10 mL/kg/hr
Surgery fluid rate for this patient (aka infusion rate) = 70 mL/hr
Step 2. Pick the appropriate drip set for the patient’s weight:
patients less than 10kg use a 60 gtt/ml set.
Step 3: determine how many drops of fluid should be given each
second. To do this, multiply the infusion rate by the drip set and
then divide this number by 3600.
70 mL x 1hour x 60 drips
1 hour
3600 sec
1 mL
= 1.16 drips
per sec
OR
1.16 drips
1 sec
x
10 sec
=
11.6 drips
per 10 sec
*At this point you can round
To the nearest whole number=
12 drips/10sec
TYPES OF FLUIDS
TYPES OF FLUIDS
CRYSTALLOIDS
-Most commonly used IV fluids
- Distributed throughout total body water
- 3 types:
1) Balanced electrolyte solutions
-reflect the electrolyte composition
of blood (sodium, potassium,
chloride, magnesium, calcium)
-examples: Lactated Ringers,
Plasmalyte, Normosol)
2) Saline solutions
-contain only sodium and chloride in
water
-normal saline (0.9%)
-hypertonic saline (7.5%) is not used
frequently. May be used with
hypovolemia, shock. Pulls water into the
vessels from the interstitial space. Do NOT use
in cases of dehydration or electrolyte
abnormalities.
3) Dextrose Solutions
-2.5% or 5% Dextrose
-used in hypoglycemia (or risk of
development), hyperkalemia, and animals
receiving insulin, neonatal animals,
debilitated animals.
-don’t use as the sole fluid (some fluids come
COLLOIDS
-Contain large molecules that do not leave the
vasculature
-osmotic pressure increases, water is pulled from
interstitial spaces
-helpful in maintaining blood volume and pressure
-typically see less side effects than hypertonic saline
1) Plasma or blood
-animals with acute blood loss or anemia,
extensive burns, hypoproteinemic animals,
those with coagulation problems
-contains albumin, globulins, clotting factors
-albumin doesn’t last long
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2) Synthetic Colloids (Hetastarch, Dextran)
-shock, hypoproteinemia
-can give with crystalloids at 5ml/kg over 5
minutes and repeated up to 4 times over 24 hours
-more available than plasma, cheaper, lasts 12 to 36
hrs
3) Blood substitute (Oxyglobin)
-similar to RBCs (binds and releases Oxygen)
-no cross-match required
-acute hemorrhage, chronic anemias