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Recovery

Recovery is a critical phase of anesthesia that includes a continuation of patient support, monitoring, and record keeping. It begins when the anesthetic gas is turned off. It does not end at the time of extubation.

Patients recovering from anesthesia require monitoring by someone trained in the recognition of complications. Although many complications occur throughout anesthesia, most anesthesia-associated deaths occur during recovery, especially in the first 3 hours. Forty-seven percent of canine anesthetic mortalities and 60% of feline anesthetic mortalities have been reported to occur in the postoperative period.38

Continue regular monitoring of parameters until they return to near baseline. Pulse oximetry, blood pressure monitoring, and periodic auscultation are valuable for detecting life-threatening complications. Continue to monitor the electrocardiogram and blood pressure in those patients at significant risk of life-threatening hypotension or dysrhythmias.

Respiratory depression persists during the early recovery from anesthesia. Continue supplemental oxygen until SpO2 measurements are acceptable when breathing room air.

Extubate when the patient can adequately protect its airway by vigorously swallowing. Deflate the cuff immediately before removing the ET tube. With patients that have undergone a dental procedure or oral surgery, it is beneficial to position the nose slightly lower than the back of the head and leave the ET tube cuff slightly inflated during extubation. This will help clear blood clots and debris from the trachea and deposits any fluid or debris into the pharyngeal region, where it can drain from the mouth or be swallowed, thereby reducing the risk of aspiration.

Recovery from anesthesia can be prolonged in hypothermic patients, resulting in increased morbidity.39 Provide adequate thermal support until the patient’s temperature is consistently rising and approaching normal.

Reapply eye ointment during the recovery period, especially if an anticholinergic was administered, until an adequate blink reflex is present. Express the bladder if distended to minimize any dis-tention-related discomfort.

Reassess the patient's pain level and, if necessary, adjust the plan for postoperative pain management. Adequate analgesia and a quiet environment encourage smooth recovery. Evaluate patient for dysphoria, emergence delirium, and pain. Treat if necessary.7

Discharge of a patient having undergone anesthesia should occur only after the patient is awake, aware, warm, and comfortable. Evaluate the animal for its responses and its ability to interact safely with owners and maintain physiologic homeostasis. Provide written instructions for owners, outlining the dose and potential side effects of analgesics and other medications to be given to the patient at home.

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