TECHNIQUES IN

ANESTHESIA
What Is Anesthesia?
 Absence of sensation
 Tranquilization
 Light/heavy sedation
 Local/general anesthesia
 Muscle relaxation
 Analgesia
 Neuroleptanalgesia (tranquilizer/opioid combo)
 Administration of 2+ drugs typical
Role of the Vet/VT
 Assume a considerable role in routine anesthesia
 Administration
 Monitoring
 Anesthesia used for
 Chemical restraint
 Management of acute pain
 Surgery
Administration Methods for Anesthesia
 Local Anesthesia
 Topical or injectable
 Regional Anesthesia
 Peripheral nerve block, epidural, spinal and intravenous
regional
 General Anesthesia
 Inhalation
 Balanced (inhalant, injectable, adjuncts)
 Total IV anesthesia
Local Anesthesia
 May result in less intraoperative pain from surgical incision if injected
pre-operatively.
 Agents vary in strength, duration, effect and method of use.
 NOT a general anesthetic.
 Exert their effects on neurons in the area closest to the site of injection
(but does not affect the brain); thus, no sedative effects.
 Not normally transferred trans-placental.
 Few effects on cardiovascular & respiratory systems.
 Overdosing will cause toxicity.
Local Anesthetic Agents
 Local agents used on skin
 Lidocaine
• Most commonly used
• Immediate onset and lasts 1-2 hours
 Bupivicaine
• Most commonly used
• Slower onset (20 min) and lasts longer (6 h)
 Mepivacaine
 Procaine

 Ophthalmic local agents

 Tetracaine
 Proparacaine
Local Anesthetics + Epinephrine?
 Lidocaine may be purchased with or without
epinephrine
 Why?
 Epinephrine causes constriction of blood vessels in area
of injection (decreases rate of drug absorption and
prolongs the effect of the lidocaine by 50%).
 Vasoconstriction also reduces the concentration of the
local anesthetic (reduces toxicity). This is more helpful in
short acting locals like lidocaine but less helpful for
longer acting locals like bupivacaine.
Local Anesthetics + Epinephrine?
 When NOT to use this mixture
 At an incision site (impairs tissue perfusion &
healing)
 On ears, tail or digits (because it will decrease
circulation)
 Animals with cardiac disease (use cautiously because
it increases risk of ventricular arrhythmias)
 Intravenously (due to its cardiovascular effects)
 Regional Anesthesia
 Blocks the nerves that supply a region of the body.
 Local anesthetic is administered near the nerve of a point
proximal to the region being anesthetized.
 Will decrease amount of general anesthesia required and gives
excellent short term analgesia post-surgically.
 Often used for dental extractions
 Paravertebral nerve block often used for cattle undergoing
abdominal surgery.
 Commonly used in human dentistry (Novocaine)
Regional Anesthesia
 How it works?
 Locate nerve
 Clip and prep
 Lidocaine/Bupivacaine mix (1:1, creates a shorter onset due to
lidocaine and a longer duration due to bupivacaine).
 Drugs diffuse through tissues and reaches target nerve.
 DO NOT inject directly into nerve (inject adjacent to it).
• May cause temporary or permanent loss of nerve function.
 DO NOT inject IV
• May cause unwanted CNS & cardiovascular effects.
 Give drug 10-15 min before the procedure.
Regional Anesthesia
 Examples
 Lameness exam in
horses
 Dehorning in cattle
 Abdominal surgery or
C-sections in cattle
 Dental blocks
 Chest surgery
 Limb amputation
 Declaws
General Anesthesia
 Produces a state of unconsciousness, relaxation,
analgesia and amnesia.
 Induced by administering an anesthetic agent
systemically (IV, IM or inhalant) that will distribute
to the brain.
 Most commonly used.
First Steps to Start Anesthesia
 Gather patient history
 Important pre-anesthesia questions:
 Fasting?
 Current condition?
 Changes in condition since scheduling?
 Current on preventive care?
 Scheduled procedure?
 Medications?
First Steps to Start Anesthesia
 Patient physical assessment
 Performed immediately before anesthetic administration.
 Important components:
• Level of consciousness
• Vitals/respiratory sounds
• Palpate pulse/auscultate the heart
• Body condition
 Weakness/gait/recumbency
 Parasites/wounds/tumors/lesions
 Discharge
 Mucous membrane color/capillary refill time (CRT)
.
First Steps to Start Anesthesia
 Diagnostic testing
 Pre-anesthetic screening must be explained to
owner.
 The purpose of these tests is to uncover
abnormalities that may impair the patient’s ability
to compensate, which may lead to unanticipated
complications.
Pre-Anesthetic Patient Abnormalities
 Treat abnormalities found in evaluation
 Dehydration
 Anemia
 Cardiac arrhythmia
 Respiratory compromise
 Major organ failure
 Electrolyte/acid-base imbalances
Pre-Anesthetic Patient Abnormalities
 The vet/VT is directly involved in the stabilization
process and must be prepared to:
 Accurately calculate doses
 Place intravenous (IV) catheters
 Set fluid administration rates
 Administer drugs, blood, and oxygen
Anesthetic Agents
 Anesthetic may be grouped in one or several ways:
 Route of delivery (topical, oral, injectable)
 Primary use (preanesthetic, sedative, induction or
maintenance)
 Drug class (depending on chemistry)
• Ex.: Agonist, antagonist, anticholinergics, tranquilizers,
sedatives, alpha-adrenergic drugs, opioids,
dissociatives, barbiturates
• See Anesthetic Pharmacology module
Anesthetic Equipment
Anesthetic Equipment
 Endotracheal tubes
 Maintain open airway
 Minimize risk of pulmonary
aspiration of blood, stomach
contents, etc.
 Ease supplemental oxygen flow
 Allow anesthetist to ventilate patient
 Numerous types
Endotracheal Tube Parts
 Connector
 Cuff
 Pilot balloon
 Valve (where syringe
goes in)
Anesthetic Equipment
 Laryngoscopes
 Visualize larynx
 Handle and blade
 Blade size ranges
Anesthetic Equipment
 Anesthetic masks
 Administer oxygen,
anesthetic gases to
intubated patients
 Choose smallest possible
size
Anesthetic Chamber
 Solid box to induce general anesthesia
 Small patients – feral, vicious, intractable
 Usually clear for observation
 Two ports: semiclosed rebreathing system
 Fresh gas
 Exit waste gas
Anesthetic Machine
 Deliver inhalant anesthetics and oxygen
 Used during general anesthesia
 General systems:
 Carrier gas supply (A)
 Anesthetic vaporizer (B)
 Breathing circuit (c)
 Scavenging system
Anesthetic Equipment
 Anesthetic machine preparation
 Machine assembly
 Check for leaks
 Non-rebreathing system
 Rebreathing system
 C-O-A-R-S-E-L-E-SS
 Carrier gas supply
 Gases into which liquid inhalant anesthetic evaporates
and carries vapor to patients: oxygen
Compressed Gas Cylinders
 2 sizes
 E tank (small)
 H tank (large)
 Rules for handling
 OHS
Anesthetic Vaporizers
 Holds liquid inhalant anesthetic
 Adds vaporized anesthetic to carrier
gas
 Most common is isoflurane
 The level of liquid anesthetic in the
vaporizer should be noted before
each procedure
 Fill at the end of the day
Breathing Circuits
 Circulate fresh gases
to patient
 Convey waste gases to
scavenging system
 Rebreathing
system
 Non-rebreathing
system
 Rebreathing Circuit Parts
 Parts:
 Unidirectional flow valves: inhalation,
exhalation
 Reservoir (rebreathing) bag
 Pop-off (pressure relief) valve
 CO2 absorbent canister
 Pressure manometer
 Corrugated breathing tubes
 Scavenging system
 Transfers waste gas outside building
 Periodic checking ensures proper flow
Endotracheal Intubation
Endotracheal Intubation
 Equipment needed:
 Right size tubes
 Hard roll gauze/IV tubing
 Gauze sponge
 Syringe
 Examination light
 Laryngoscope
 Stylet
Endotracheal Intubation
 Selecting a tube
 Size range from 3 – 14 mm
 Right diameter and length
 Diameter: prep 3 sizes
 So you have other options if your initial selected size
does not fit
 Most cats: 3-4.5mm
 20 kg dogs: 9.5-10mm
 Horse: 22-30mm
Endotracheal Intubation
 Length: tip of nose to thoracic inlet
 If too far in; may deliver gas to only one side of lung
 If cranial to thoracic inlet, the tube extending out of
mouth will be dead space
 Both situations may cause hypoventilation and
hypoxia
Thoracic Inlet
Endotracheal Intubation
 Preparing the tube
 Check for damage
 Check for a secure attachment
 Check the cuff
Steps in Endotracheal Intubation
1. Place patient in sternal recumbency.
2. Assistant grabs maxilla (behind canine), extends neck &
raises head.
3. Grasp tongue and open mouth (by pulling tongue down)
4. Adjust light to visualize larynx.
5. Use tube or laryngoscope to displace epiglottis ventrally
to visualize the glottis (aka vocal cords).
Steps in Endotracheal Intubation
6. Gently insert tube between vocal cords using a rotating
motion.
 Never force tube, if it doesn’t pass easily, change to smaller tube.
7. Place patient in lateral recumbency once tube is placed.
8. Secure tube with roll gauze or IV tubing (over nose for most
dogs, around head for cats and brachycephalic dogs).
 Not too tight to act as a tourniquet or pinch ET tube
9. Connect to breathing circuit.
10. Inflate cuff and check for leaks.
Endotracheal Intubation for Horses
 Performed blind (unable to visualize larynx)
1. Extend head & place speculum/mouth gag
2. Advance tube over tongue (stay center, molar teeth can
damage cuff).
3. Upon inspiration, advance tube gently.
4. If resistant: pull back 10-15cm.
5. Rotate tube while inserting (90 degrees).
6. Check for leaks (air passing out on expiration).
EI for Adult Cattle
 Speculum/mouth gag; extend head.
 Insert arm; reflect epiglottis forward.
 Remove arm; place tube in hand with beveled end in palm.
 Guide tube with the hand that’s in the mouth.
Checking Proper ET Placement
 Easy to accidentally go into esophagus
 Unable to keep patient anesthetized
 How to assure proper placement:
 Visualize larynx to see if ET tube is between cords
 Bag expansion/contraction
 Air movement out of ET tube on exhalation
 Motion of unidirectional valves on machine
 Palpation of neck: should be a single firm structure (trachea)
 Vocalization from patient (means its not in!)
 Normal waveforms (end-tidal CO2 monitor)
Endotracheal Intubation
 Cuff inflation
 Makes a seal between trachea and cuff (prevents
leaks)
 Checks for leaks
 Avoid overinflation
Endotracheal Intubation
 Laryngospasm
 Complication where glottis closes forcibly during
intubation (makes placing tube difficult)
 Most common in cats, swine & small ruminants
 Can lead to hypoxia and cyanosis
 Prevention is key
 Spray pharynx with lidocaine before attempting intubation
 Adequate anesthesia before attempting
 Wait for glottis to open (exhalation) before attempting
placement
 Repeat attempts worsen laryngospasm
Anesthetic Monitoring
 Must balance a sufficient anesthetic depth to
produce unconsciousness & insensitivity to pain.
 Must not compromise cardiovascular &
respiratory system function
Anesthetic Monitoring
 Cornerstone of successful anesthesia
 Subtle warning signs require quick action
 Complications develop quickly
 Maintain balance
 Monitor frequently
 Check multiple parameters
 Don’t leave it to instrumentation
 Don’t judge anesthetic depth by dose or setting
Stages and Planes of Anesthesia
 Changes in patient behavior, body movements, ocular
signs, reflexes and vital signs in response to the
progression from consciousness to deep surgical
anesthesia are observed and documented and divided
into four stages:
 Stage I: Period of Voluntary Movement
 Stage II: Period of Involuntary Movement
 Stage III: Period of Surgical Anesthesia
 Stage IV: Period of Anesthetic Overdose
Principles of Monitoring
 Should chart monitoring parameters every 5 minutes
 Careful observation to determine stage
 Should be between stage I & stage III
 Reflexes, eye position, jaw tone, movement in response to
stimulation
 Factors influence stage progression
 IV agents
 Inhalants
 Premedications
 Anesthetic protocol
Principles of Monitoring
 Monitoring parameters
 physical signs that answer 2 questions:
1. Is patient safe or in danger?
2. Is anesthetic depth inadequate, excessive, appropriate for this
procedure?
 Vital signs will answer 1st question
 Indicators of circulation
 Indicators of oxygenation
 Indicators of ventilation
 Reflexes wil answer 2nd question
 Palpebral, swallowing, pedal, corneal reflexes
Principles of Monitoring
 Careful observation of the patient (based on expected responses)
enables the anesthetist to determine the stage that the patient is in.
 Vital signs (T