Term
| Why monitor (today's goals)? |
|
Definition
-decrease patient morbidity
-decrease hospital stay
-increase recovery quality |
|
|
Term
|
Definition
1. Status 1: Excellent anesthetic risk (healthy, happy patient in for elective procedure)
2. Status 2: good anesthetic risk (mild dz state-compensated; necessary procedure)
3. Status 3: Fair anesthetic risk; patient with moderate disease processes (controlled CHF/CRH, fever, dehydration, anemia, complicated fracture or trauma)
4. Status 4: Guarded anesthetic risk (patient with moderate to severe dz processes that are not controlled)
5. Status 5: poor anesthetic risk (patient with severe systemic dz that will likely succumb within 24 hours, regardless of therapy-DIC, multi-organ failure)
6. Emergency-any patient undergoing anesthesia in an emergent situation-in addition to ASA status |
|
|
Term
| Physical parameters to monitor: |
|
Definition
-heart/pulse rate
-respiratory rate
-anesthetic depth
-MM and CRT
-blood loss |
|
|
Term
| Mechanical parameters to monitor: |
|
Definition
-ECG
-End-tidal CO2
-oxygen saturation
-blood pressure
-temp |
|
|
Term
| How monitor heart rate/pulse rate? |
|
Definition
-stethoscope
-palpate pulse
-hear the pulse?
(also on monitor-don't forget to check patient) |
|
|
Term
| Peripheral pulse palpation |
|
Definition
-assess pulse quality (strong vs. weak; pulse pressure=SAP-DAP)
-does NOT indicate blood pressure
-dog-femoral, dorsal pedal, lingual
-cat-femoral, dorsal pedal?
-horse-facial, auricular, metatarsal
-ruminants-facial, auricular, metatarsal |
|
|
Term
| How to check if patient is breathing: |
|
Definition
-watch chest rise
-reservoir bag
-esophageal stethoscope
-RR from monitro |
|
|
Term
|
Definition
-all about eye position and reflexes
-eye position: central: could mean too light, too deep, or just right; depend on spp; Ventromedial (dogs and cats): usually means appropriate depth if slight or no palpebral; Nystagmus in horse (too light!)
-reflexes: elimination of all reflexes, patient too deep; measure on a scale of 1 to 5, from no response to marked response |
|
|
Term
|
Definition
1. jaw tone: reliable in dogs/cats, not LA
2. palpebral reflex: may spp, varies with depth; if present with a central eye, too light (d/c)
3. PLR/Size: varies with drugs used; dilated could mean too deep
4. Corneal reflex: if this is lost, patient is too deep or dead
5. Important to remember: they don't all read the book |
|
|
Term
| Other important parameters: |
|
Definition
|
|
Term
|
Definition
-1 ml blood=1 gm
-4X4 gauze sponge=10=15 ml
-12 X 12 lap sponge=50-75 ml
-don't forge the suction container? |
|
|
Term
|
Definition
-monitors electrical activity of heart
-typically use LEAD II in SA |
|
|
Term
|
Definition
-Sinus ar
-sinus tchycardia
-sinus bradycardia
-atrial fibrillation
-2nd Degree AV block
-ventricular premature contractions
-ventricular tachycardia
-ventricular bigeminy
-ventricular fibrillation |
|
|
Term
|
Definition
-measured with a capnograph-infrared sensor
-waveform can provide LOTS of info! (ETT placement, CV monitor)
-sampling-sidestream, mainstream |
|
|
Term
| Capnography advantages/disadvantages |
|
Definition
-advantages: non-invasive, continuous, automoatic, provides important vital info
-disadvantages: only approximates PaCO2 (shunt), may need ABG to clarify |
|
|
Term
|
Definition
-pulse oximetry (SpO2)-> oxygen saturation of hemoglobin
-sensor that emits red and intfra-red light (transmittance, reflectance)
-principle based on light absorption of Hg
-value given is 1% |
|
|
Term
| Oxyhemoglobin Dissociation |
|
Definition
-keep in mind when using pulse ox
-normal is 97-100%
-<95% is BAD
-SpO2 does not equal PaO2
-even if 100%, may still have problems oxygenating |
|
|
Term
| Dis-/Advantages of measuring oxyhemoglobin dissociation |
|
Definition
+: non-invasive, easy to place, continuous
-: affected by: movment, pigment, vasoconstriction; carboxyhemoglobin, methemobglobin |
|
|
Term
|
Definition
-indirect method most commonly used: Doppler (SAP), Oscillometric-Dinamap (SAP, DAP, MAP)
-direct or invasive=gold standard: provides continuous monitoring, but...arterial catheterization, expensive monitor, risk of hematoma, infx, tissue necrosis |
|
|
Term
|
Definition
(+): non-invasive, can hear it, use on any patient, inexpensive, rechargeable, portable
(-): systolic measurement only, don't drop the probe, not automatic |
|
|
Term
| Oscillometric Dis-/Advantages |
|
Definition
(+): non-invasive, SAP, DAP, MAP, Automatic, portable
(-): not continuous, less reliable, more expensive |
|
|
Term
| Temperature measurement during sx |
|
Definition
-temp is critical (esophageal or rectal probes, nasal)
-hypothermia (decreases metabolism, slows recovery)
-hyperthermia: can often occur with overzealous warming, certain drugs, malignant hyperthermia |
|
|
Term
| Other important things to monitor: |
|
Definition
-anesthesia machine
-circuit placement
-endotracheal tube placement
-ETT cuff inflation
-BP cuff placement
-Is the thermometer in the patient?
-decrease human error! |
|
|
Term
| More involved anesthesia monitor: |
|
Definition
-degree of paralysis (NM blockade)-peripheral nerve stimulation
-urine output (urinary catheter)
-electrolytes, Acid/base, blood gas (arterial line easiest, can do frequent draws; mixed venous sample: tongue and ear veins)
-central venous pressure (central line placement)
-CO |
|
|
Term
|
Definition
-HR/RR/BP vary for individual patient
-EtCO2 values should be 35-45 mm Hg
-O2 saturation should be >95%
-temp change affects physiology (avoid)
-sinus arrhythmia-normal |
|
|
Term
| When should I be concerned? |
|
Definition
-HR depends on many things
-key is to maintain CO and BP
-MAP <60 mmHg affects renal perfusion (in LA MAP should be between 70-80 mmHg)
-EtCO2 indirectly reveals CO:
1. EtCO2>60=dec alveolar ventilation (hypercapnea, hypoventilation)
2. EtCO2<30=incre alveolar ventilation(hypocapnea, hyperventilation) |
|
|
Term
| Pulse ox of 92% approx PaO2=? |
|
Definition
|
|
