Anaesthesia for veterinary nurses Clark, L. Monitoring the Anaesthetised Patient. In: Welsh, E. Anaesthesia for Veterinary Nurses.

Oxford: Blackwell Science, 2003. p. 219-246 P219 The level of sophistication of monitoring technology available in general practice has increased markedly in recent years. The choice of any particular monitoring technique may be governed by availability but should also take into account the patient status and the nature of the procedure being performed. Expensive and complex equipment is no substitute for good observation and sound clinical judgement. All available information must be assimilated and interpreted to allow appropriate decisions to be made. P224 Auscultation with a normal stethoscope will allow measurement of rate and rhythm and appreciation of mechanical activity It is quite possible for an ECG to appear normal when mechanical activity has ceased, and the ECG should never be used as the sole indicator of cardiac function.

P226 quadro ELECTROCARDIOGRAPHY IMPORTANT POINTS Electrocardiographs (ECGs) record electrical activity within the heart and allow the accurate diagnosis and treatment of cardiac arrhythmias ECGs do not supply any information regarding the mechanical activity of the heart or cardiac output ECG can appear normal when mechanical activity has ceased ECGs should never be used as the sole indicator of cardiac function An ECG is a non-invasive easy to use monitor that provides information not readily obtainable by other means

p227
Table 9.1 Normal blood pressure in conscious animals. Dog Cat Systolic pressure (mmHg) 110190 120170 Diastolic pressure (mmHg) 55110 70120
Mean arterial blood pressure = Diastolic pressure + (systolic diastolic pressure)/3

VENTILAO

P235 Monitoring ventilation Ventilation is assessed in terms of rate, rhythm and tidal volume. Observation of the reservoir bag can be used to measure respiratory rate and to estimate tidal volume; this method is very subjective.

Minute volume is the term used to describe the amount of gas expired by the patient per minute and is approximately 150250 ml/kg/min. The normal tidal volume for mammals is 1020 ml/kg/min. Minute volume (MV) = tidal volume (TV) x respiratory rate (RR) It is however the alveolar minute volume that is important in gas exchange. Animals with high respiratory rates, e.g. panting, may have low effective alveolar minute volumes because they are breathing a lot of dead space gas and therefore may be ventilating very ineffi ciently. Slower deeper breaths are generally more effi cient. p245 Clark, L. Monitoring the Anaesthetised Patient. In: Welsh, E. Anaesthesia for Veterinary Nurses. Oxford: Blackwell Science, 2003. p. 219-246

Sighing the patient (i.e. delivering supramaximal lung infl ation at 5-min intervals) prevents atelectasis, minimises hypoxia and hypercapnia and allows an appraisal of pulmonary compliance. Low compliance (lungs feel diffi cult to infl ate) may be caused by pressure on chest, pneumothorax or airway obstruction. High compliance indicates disconnection of the breathing system or endotracheal cuff leak.

RECUPERAO P249 Ideally patients will not be spending too long in the recovery area before returning to the hospital kennels or transferring to an intensive care unit. Consequently the kennels in the recovery area need only be large enough to allow patients to recover in comfort and safety, and to allow turning of the patient if and when required.

P251 Once disconnected from the breathing system, the patient is breathing room air, initially through an endotracheal tube, and should not be left unattended. The tie, which has been used to secure the tube in place, can be loosened although the cuff, if present, should remain infl ated until just before extubation, when it may be fully deflated. P252 Hamilton, J. Nursing the Patient in Recovery. In: Welsh, E. Anaesthesia for Veterinary Nurses. Oxford: Blackwell Science, 2003. p. 247-27 Generally speaking, in dogs, the endotracheal tube should be left in situ until the gag refl ex has returned. This generally indicates that the patient is able to protect their own airway in the event of regurgitation or vomiting.

Pulso forte Respiraao sem esforos (abdominal ou torcica) P253 TPC The colour of the mucous membranes and the capillary refi ll time (CRT) gives an indication of the peripheral circulation. A pale colour may indicate shock, anaemia or haemorrhage. A blue tinge (cyanosis) indicates severe hypoxia and brick-red membranes can indicate infection or septic shock. Additional or advanced patient monitoring may be indicated during unexpectedly prolonged recoveries, following individual abnormal or unexpected observations or to investigate trends such as a continuing decline in body temperature (see chapter 9). P254

Analgesia
On humane grounds it is necessary to provide analgesia when required. In the patient who is having a stormy recovery or who is vocalising during the recovery period, it may be diffi cult to tell if the reaction is due to pain or excitement

or is just part of the recovery process (Stage II). P256 CURATIVO It is good practice to cover any surgical wound with a light dressing postoperatively. This can be in the form of a simple adhesive strip with a centrally placed non-adherent dressing such as Primapore (Smith & Nephew), which will cover the incision site and protect it from contamination until the wound edges have formed a seal, which usually happens within 610 h. NUTRIO The willingness of a patient to eat is usually a good sign that the patient is comfortable. Most animals will sleep peacefully on a full stomach. Food and water should be offered as soon as the patient is suffi ciently recovered from the anaesthetic to eat and drink without risk of aspiration, if their medical condition permits it. P270 Ensuring the safe recovery of patients is a very important nursing skill to develop. Each recovery is different. Some may take minutes and be uneventful while others may be prolonged and take hours before the patient is stable enough to move.

Shivering = tremer Sighing = suspiro