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Individual plan

Patient preparation, anesthetic plan, preanesthetic medication, pain management and anesthetic management of patients with comorbidities.

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.

References

References for AAHA Anesthesia Guidelines for Dogs and Cats.

Step 3: Patient Preparation

The patient should be stabilized before anesthesia as anesthesia and surgery can exacerbate pre-existing physiologic compromise.

Hypoventilation

Hypoventilation can be estimated by observing respiratory rate and depth (very subjective) and can be quantified using capnometry. Hypoventilation can cause hypercarbia, with subsequent respiratory acidosis, and hypoxemia. Thus, hypoventilation should be corrected.

Step 2: Equipment Preparation

Prior to the start of any general anesthesia or sedation-only procedure, it is critical to ensure that all equipment and monitors are turned on, are functioning, and have undergone appropriate safety checks.

Caudal Mandibular Regional Blocks

For additional information on other dental nerve block techniques, see the 2019 AAHA Dental Care Guidelines for Dogs and Cats . Caudal mandibular (inferior alveolar) regional blocks  INDICATIONS: Dental and orofacial surgery on the mandible (i.e., dental extractions, mass removals, fracture repair, etc.) This desensitizes all tissues to midline on the ipsilateral side.  INSTRUCTIONS:  1.  Select and calculate the full dose of a local anesthetic, i.e., lidocaine (cats = 2–4 mg/kg, dogs = 4–6 mg/kg), bupivacaine (cats = 1 mg/kg, dogs = 2 mg/kg), or ropivacaine (cats = 1 mg/kg, dogs = 2 mg/kg).*  2.  Prior to the procedure or extraction is performed, choose intraoral vs. extraoral approach, based on clinical indication, and personal preference. 3. The mandibular foramen or nerve can often be palpated on the lingual side of the mandible, just rostral to the angle of the mandible and just caudal to the last molar in approximately the middle 1/3 rd of the mandible (as measured from dorsal to ventral). NOTE:  The foramen is often difficult to palpate in very small patients like cats and small dogs.

Phase 1: Preanesthesia

An individualized anesthetic plan with specific and sequential steps ensures the continuum of care throughout the entire anesthetic process. A complete anesthetic plan must address all phases of anesthesia, with inclusion of perioperative analgesia throughout each phase. Although each patient should be treated as an individual, having a set of anesthesia plans that are used repeatedly is appropriate.

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