The overall goal of anesthesia is survival and optimum recovery from surgery. In order to accomplish this goal, the surgery patient must be continually monitored for changes, especially deterioration in respiration, cardiac function and tissue perfusion regardless of the specific surgery.
Pain management in veterinary medicine was practically unheard of twenty years ago, and it has advanced dramatically over the past decade. Not only is the physiology of pain and its effects becoming better understood, pain management is considered a vital part of most treatment plans.
Monitoring anesthetized patients is imperative for all procedures. All anesthetic drugs act as cardiovascular and respiratory depressants on varying levels, and they can compromise a patient's homeostasis at unpredictable times in unpredictable ways. Crises are rapid in onset and devastating in nature.
Critical patients and patients undergoing prolonged and invasive procedures may need more intensive monitoring due to their increased risk for anesthetic complications. Some of these methods of monitoring may become more common in the near future considering veterinary anesthesia has advanced dramatically over the past decade.
All anesthetic drugs act as cardiovascular and respiratory depressants on varying levels, and they can compromise a patient's homeostasis at unpredictable times in unpredictable ways. A patient must maintain adequate blood pressure for the duration of any surgical procedure because prolonged anesthetic hypotension can have devastating effects such as renal failure or brain damage.
CRI stands for continuous rate infusion, and its use is becoming more prevalent in the veterinary field as a method to control intraoperative and postoperative pain. It was not long ago that the best options for surgical pain management were intramuscular or bolus injections of opioids, which remain acceptable options, but CRIs can be a better option for patients undergoing prolonged, invasive or painful procedures.
Anesthesia is concerning for every patient, this is especially so when the patient has pre-existing conditions. The value of a thorough physical examination and detailed history cannot be underestimated as part of a balanced anesthetic plan because the goal of the plan is to maximize its' effects while minimizing patient complications.
Patients vary and accidents occur. This truth emphasizes the need for patient monitoring. One only need visit the exhibit hall of a major veterinary meeting to appreciate the advancements made in veterinary patient monitoring.
Anesthetic related mortality would appear to be an easily quantifiable statistic that could be used to measure the outcome of the profession's current anesthetic practices. However, to rely solely on death rate as the measure of the quality of anesthetic care provided is inadequate.
Patients are typically sedated or anesthetized and placed in sternal or lateral recumbency. Next, the cranial edge of the wings of the ilia are palpated.
Pulse oximeters are relatively inexpensive and provide continuous information about pulse rate and hemoglobin saturation. Pulse oximetry has limitations that need to be understood by the anesthetist.
Accurate measurement of pain perception in individual non-human patients is impossible. However, management of pain requires objective measures of effectiveness of the applied treatment.
Patient stress is probably a contributing factor in some cases of adverse patient outcome. Stress during induction of anesthesia can increase circulating catecholamine concentration predisposing the heart to arrhythmias.
In the past blood gas analysis and interpretation was performed primarily at university and large referral hospitals. The main argument against not using blood gas analysis to guide case management in private practice was the cost of purchasing and maintaining a bench-top blood gas analyzer. With the availability of relatively inexpensive point of care units such as the i-STAT and IRMA, blood gas analysis and interpretation has become more common.
The electrocardiogram is a useful monitoring tool, but its proper use requires training. It provides a heart rate and a picture of the electrical activity of the heart muscle. The anesthetist should be trained to recognize many commonly encountered intraoperative arrhythmias (e.g., multifocal and unifocal ventricular premature complexes, atrioventricular blockade, ventricular tachycardia, etc.) and the veterinarian should be prepared to treat arrhythmias when they occur (if necessary).
Anesthetic and pain related mortality would appear to be an easily quantifiable statistic that could be used to measure the outcome of the profession's current anesthetic practices. However, to rely solely on death rate as the measure of the quality of anesthetic care provided is inadequate.
Alpha 2 adrenergic agonists bind to alpha 2 receptors located in the dorsal horn of the spinal cord and brainstem, modulating the release of substance P, calcitonin gene-related peptide and various other neurotransmitters involved in rostral transmission of nociceptive information.
Clients frequently express concern about the anesthesia their dogs or cats need for professional oral evaluation and care.
For our local anesthetic blocks, we use a combination of lidocaine (quick onset, short duration) and bupivacaine (slow onset, long duration) with or without buprenorphine (acts at peripheral opioid receptors).
Two team members sound off about the recent California declaw bans.
Put yourself in others' shoes, paws, hooves or claws
Dr. Robin Downing has built a comprehensive osteoarthritis pain management system that uses a combination of modalities.
Certain cases of cancer may respond well to conservative analgesic therapy initially but eventually require multimodal analgesia.
A Q&A with veterinary anesthesiologist Dr. Kurt Grimm
Dr. Robin Downing discusses the advancement of pain management in animals.
