The Veterinary Nurse’s Practical Guide to Small Animal Anaesthesia

Description:

An accessible guide to small animal anaesthesia for the veterinary practice

The Veterinary Nurse’s Practical Guide to Small Animal Anaesthesia meets the need for a single practical guide to veterinary anaesthesia and its potential complications. Written by practicing veterinary nurses, the guide analyzes each stage in turn, beginning with a discussion of pre-assessment and pre-medication of patients. Most critically, it reviews the normal functioning of each physiological system in small animals before detailing common problems caused in these systems by anaesthesia.

Developed for the day-to-day needs of veterinary nurses, readers will also find:

• Step-by-step guides to addressing specific issues such as GDV, brachycephalic patients, aggressive patients, and more
• Detailed guidelines for interpreting common test results and biometrics such as capnography and ECGs
• Chapters designed for easy reference in specific emergency situations

The Veterinary Nurse’s Practical Guide to Small Animal Anaesthesia is an essential tool for veterinary nurses and veterinary technicians.

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Preface

The role of the veterinary nurse within the veterinary team has changed drastically since the infancy of the profession many years ago. With professional recognition in the United Kingdom (UK) came accountability for their conduct and the requirement to undertake continuing professional development. Every registered veterinary nurse (RVN) in the UK makes a declaration to ensure the health and welfare of animals committed to their care.

As veterinary nursing has developed over the years, so too has the discipline of veterinary anaesthesia. The use of safer anaesthetic protocols, availability of monitoring equipment and the changes in the education of veterinary nurses, have all contributed to a reduction in mortality and morbidity of patients. Anaesthesia has become a large portion of the veterinary nurse’s role in the veterinary practice. While some revel in undertaking the task, it can be daunting to many. The RVN’s role in anaesthesia, under the veterinary surgeon’s direction, is to act as the eyes and ears of the veterinary surgeon, reporting any changes that may occur and reacting appropriately. RVNs also play a pivotal role in the recovery stages of the peri-anaesthetic period and the pain assessment of patients under their care.

Despite the RVN’s role in veterinary anaesthesia, currently, there is no practical guide to anaesthesia directed solely at the veterinary nurse. Although veterinary anaesthesia textbooks do exist, they tend to focus strongly on pharmacology and are text-heavy which may be better suited to the veterinary student studying for exams. While there are veterinary anaesthesia textbooks directed at the RVN, these are currently dated. The goal of the veterinary nurse’s practical guide to small animal anaesthesia is to provide the RVN in practice with a quick reference book that can be utilised in an emergency, while also being in-depth enough that it can be used to research a topic. It is intended for both the experienced RVN, and those just starting their journey.

All involved in the production of this textbook are RVNs who share a passion for anaesthesia while having worked as specialist anaesthesia nurses at times during their careers. Many of the chapters provided have also been peer-reviewed by European and American board specialists in anaesthesia and analgesia. We hope that this guide will become a useful tool for the RVN in practice and that it will help with the provision of anaesthesia that is safe and reduces mortality and morbidity.

Table of contents :

Cover
Title Page
Copyright Page
Contents
List of Contributors
Preface
Chapter 1 Pre-Anaesthetic Assessment and Premedication
Patient Assessment
History
Physical Examination
Cardiac and Thoracic Auscultation
Body Condition Scoring (BCS)
Hydration
Patient Temperament
Other Considerations
Premedication
Administration of Premedication
Acknowledgements
References
Chapter 2 Interpreting Blood Results
Haematology
Red Blood Cell Count and Packed Cell Volume (RBC and PCV)
High PCV
Low PCV
White Blood Cell (WBC) and Neutrophil Count
High Count
Low Count
Lymphocytes and Monocytes
Eosinophils and Basophils
Platelets
High Count
Low Count
Biochemistry
Proteins (TP, ALB, GLOB)
High Levels (Hyperproteinaemia)
Low Levels (Hypoproteinaemia)
Hepatic Parameters (ALKP, ALT, BIL)
High Levels
Renal Parameters (CREA, BUN, InPHOS)
High Levels
Low Levels
Glucose (GLU)
High Levels (Hyperglycaemia)
Low Levels (Hypoglycaemia)
Electrolytes
Sodium (Na+)
High Levels
Low Levels
Potassium (K+)
High Levels
Low Levels
Calcium (Ca2+)
High Levels
Low Levels
Conclusion
References
Chapter 3 Cardiovascular Physiology
Blood Flow Through the Heart
Conduction Through the Heart
Vascular System
Pulmonic Circulation
Systemic Circulation
Cardiac Output
Stroke Volume
Heart Rate
Anaesthetic Considerations for Patients with Cardiovascular Disease
References
Chapter 4 Respiratory Physiology and Ventilation
Respiratory Anatomy
Pulmonary Ventilation
Central Regulation of Respiration
Chemical Regulation of Respiration
Mechanics of Breathing
Inspiration
Expiration
The Effects of Anaesthesia on Normal Respiratory Physiology
Indications for Ventilation
Initiation of Ventilation
Manual Ventilation
Mechanical Ventilation
Volume Cycling Versus Pressure Cycling Ventilation
Positive End-expiratory Pressure (PEEP) and Alveolar Recruitment Manoeuvres (ARM)
Possible Harmful Effects of Artificial Ventilation
Ventilation Strategies to Prevent Some of the Possible Negative Effects of IPPV
On the Lungs
On the Cardiovascular System
On the Intracranial Pressure
On Blood Gas and Acid–Base Disturbances
Troubleshooting During Mechanical Ventilation
Anaesthetic Machine and Breathing System
Ventilators
Patient
Weaning the Patient Off the Ventilator
References
Chapter 5 Blood Pressure Regulation and Monitoring
What Factors Contribute to Blood Pressure
The Importance of Blood Pressure Regulation During Anaesthesia
How Do We Measure Blood Pressure?
Non-invasive/Indirect Blood Pressure Monitoring
Doppler
Oscillometric
High Definition Oscillometric (HDO) Devices
Invasive Blood Pressure Monitoring
Treatment of Hypotension Under General Anaesthesia
Drugs to Treat Hypotension
Positive Inotropes
Adrenaline/Epinephrine, Ephedrine, Dobutamine, Dopamine, Noradrenaline/Norepinephrine
Vasopressors
Adrenaline/Epinephrine, Dopamine, Ephedrine, Noradrenaline/Norepinephrine, Phenylephrine, Vasopressin
Anticholinergics
Glycopyrolate, Atropine
Treatment of Hypertension Under General Anaesthesia
Summary
Quick Reference Terminology and Definitions
References
Chapter 6 Capnography and Spirometry
Capnography/Capnometry
Capnograph Device Options
Information Provided from a Capnograph
Carbon Dioxide
Interpretation of Carbon Dioxide Values
The Normal Capnogram
Analysis of the Capnogram
Common Abnormal Capnography Waveforms and Their Interpretation
Spirometry
Acknowledgements
References
Chapter 7 Pulse Oximetry
Introduction
How Does the Pulse Oximeter Work?
Data Interpretation
SpO2 and PaO2
Hypoxaemia
Plethysmograph
Anaemia and Abnormal Haemoglobin Forms
Anaemia
Methaemoglobin
Carboxyhaemoglobin
Tips and Tricks
Advanced Technology – Masimo Pulse Co-Oximetry
References
Chapter 8 Practical ECGs
ECG Fundamentals
Normal Conduction
The ECG Machine
The ECG Cables
The ECG Complex
Common ECG Complexes and Rhythms
Sinus Rhythms
Normal Sinus Rhythm
Sinus Arrhythmia
Sinus Tachycardia
Sinus Bradycardia
Supraventricular Arrhythmias
Atrial Fibrillation
Second Degree Atrioventricular Block
Third Degree Atrioventricular Block
Sick Sinus Syndrome
Ectopic Ventricular Complexes
Ventricular Premature Complex
Ventricular Escape Complex
Ventricular Arrhythmias
Ventricular Tachycardia
Accelerated Idiopathic Ventricular Rhythm
Ventricular Fibrillation
References
Chapter 9 Fluid Therapy
Fluid Distribution and Composition
Movement of Fluid in the Body
Fluid Disturbances
Dehydration vs. Hypovolemia
Intravenous Fluid Therapy During the Peri-Anaesthetic Period
Fluid Selection
Crystalloids
Hartmann’s Solution/Compound Sodium Lactate
Lactated Ringer’s Solution
Normal Saline
5% Dextrose Solution
Hypertonic Sal
Colloids
Gelatines
Dextrans
Hydroxyethylstarches (HES)
Albumin
Whole Blood
Plasma (Fresh/Fresh Frozen/Stored)
Fluid Supplementation
Potassium
Sodium Bicarbonate
Calcium
Glucose
Fluid Delivery Systems
Giving Sets
Fluid Pumps and Syringe Drivers
References
Chapter 10 Induction Agents
Stages of General Anaesthesia
Injectable Anaesthetics
Propofol
Pharmacokinetic Properties
Pharmacodynamic Properties
Tips and Tricks
Special Considerations
Alfaxalone
Pharmacokinetic Properties
Pharmacodynamic Properties
Tips and Tricks
Special Considerations
Propofol and Alfaxalone Total Intravenous Anaesthesia – TIVA
Special Considerations
Ketamine
Pharmacokinetic Properties
Pharmacodynamic Properties
Tips and Tricks
Special Considerations
Co-Induction
Special Considerations
Etomidate
Pharmacokinetic and Pharmacodynamic Properties
Special Considerations
Thiopental
Inhalational Anaesthesia Induction
Acknowledgements
References
Chapter 11 Inhalant Anaesthetic Agents
Pharmacokinetics of Inhalant Agents
Distribution
The Inspired Concentration of Inhalants
Blood: Gas Solubility
Ventilation
Elimination
Minimal Alveolar Concentration (MAC)
The Ideal Inhalant Agent
Physiological Effects of Inhalant Agents
Isoflurane
Sevoflurane
Desflurane
Vaporisers
Saturated Vapour Pressure
Desflurane
Position on the Back Bar
Key Fill Systems
Nitrous Oxide
Advantages and Clinical Uses
Disadvantages
Personal Safety
Monitoring of Exposure
Limiting of Exposure
References
Chapter 12 Intubation
Placement of an ETT
Equipment
ETT or Similar Device
Laryngeal Masks
Armoured ETT
Securing the ETT
Laryngoscope
A Stylet
Lidocaine
Technique
Confirming Placement
Inflating the Cuff
Cleaning ETT
Alternative Intubation Techniques
Nasotracheal Intubation
Intubation Using a Pharyngotomy
Retrograde Intubation
One Lung Intubation
Tracheostomy
Troubleshooting
Brachycephalic Patients
Equipment for Difficult Intubation
How to Deal with an ETT that Is Difficult to Remove
Summary
References
Chapter 13 The Anaesthetic Machine and Breathing Systems
Introduction
Gas Supply
Oxygen Cylinders
Nitrous Oxide Cylinders
Oxygen Concentrators
Cylinder Manifold
Liquid Oxygen
Pressure Gauges and Regulators
Alarms
Safety Features
The Anaesthetic Machine
Flowmeters
Back Bar
Common Gas Outlet
Oxygen Flush
Anaesthetic Machine Leak Test
Scavenging System
Active Scavenging System
Passive Scavenging System
Breathing Systems
Non-Rebreathing Systems
Fresh Gas Flow
Paediatric T-Piece
Bain
Lack
Rebreathing Systems
Circle Fresh Gas Flow Rates
Carbon Dioxide Absorbing
Hybrid System
Fresh Gas Flow
Breathing System Selection
Storage and Repeated Use of Breathing Systems
References
Chapter 14 Anaesthesia Recovery
Introduction
Preparing to Recover
Handover to the Recovery Team
Monitoring in the Recovery Period
Delayed Recovery
Sedation in the Recovery Period
Pain Management
Airway Management and Hypoxaemia
Airway Obstruction
Hypoxaemia
Temperature Management
Hypothermia
Hyperthermia
Haemodynamic Instability
Coexisting Disease Considerations
Conclusion
References
Chapter 15 Pain
The Pain Pathway
Transduction
Transmission
Modulation
Projection
Perception
Pain Management
Opioids
Ketamine
Lidocaine
Alpha-2-Adrenergic Agonists
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Other Analgesics
Nursing Care for the Painful Patient
Pain Assessment
Pain Scoring Systems
Validation
Application of Pain Scales
Pitfalls of Pain Scoring Systems
Acknowledgements
References
Chapter 16 Local Anaesthetic Techniques
The Nervous System
Mechanism of Action
Performing Local Anaesthetic Techniques
Techniques for the Head
Techniques for the Upper Jaw and Nose
Maxillary Nerve Block
Infraorbital Nerve Block
Palatine Nerve Block
The Lower Jaw
The Mandibular Nerve Block
The Mental Nerve Block
Ocular Nerve Blocks
The Retrobulbar Block
Auricular Nerve Blocks
Techniques for the Forelimbs
Brachial Plexus Nerve Block
RUMM Block
Techniques for the Hindlimbs
The Epidural
Femoral, Sciatic, and Psoas Nerve Block
Bier’s Nerve Block
Digital Nerve Block
Thoracic Nerve Block
Intercostal Nerve Block
Techniques for Neutering
Testicular Block
Ovarian Pedicle
Other Techniques
The Erector Spinae Plane Nerve Block
Quadratus Lumborum Nerve Block
Local Anaesthesia for Post-Operative or Chronic Pain Conditions
Wound Soaker Catheters
Intrapleural Analgesia
Epidural Catheters
Nursing Care for Patients Following Local Anaesthetic Techniques
Acknowledgements
References
Chapter 17 Constant Rate Infusions and Calculations
What Are CRIs
Advantages of CRIs
Analgesia
Blood Pressure Regulation
Hypnosis
Administration
Calculations
Acknowledgements
References
Chapter 18 Case Studies
Brachycephalic Patients
Renal Disease
Hyperthyroidism
Diabetes Mellitus
Hepatic Disease
The Aggressive Patient
Paediatric Patient
Geriatric
Respiratory Patient
Caesarean Section
Gastric Dilation-Volvulus
Urethral Obstruction
Cardiac Disease
Acknowledgements
Index
EULA