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Pages 26-41 Preanesthetic Patient Care Be sure the animal is correctly identified – use cage or collar ID If staying in the hospital, remove food the night before or have someone call owner to remind owner Make a check list of pre-operative procedures Physical exam the morning of surgery, including TPR IV CATHETERS IDEAL FOR ALL ANESTHETIC PROCEDURES!! Why? Can provide IV fluids for support during surgery (blood loss, dehydration, pre-existing problems, electrolyte abnormalities, long procedures, prevent/treat hypotension) Allows injection of medications such as antibiotics and analgesics and allows constant-rate-infusions Provides access to a vein in an emergency (cardiac arrest intra-op/recovery, seizures post-op). Do not remove until animal is fully awake! Allows irritating agents to be injected (ex: thiopental) Allows injection of incompatible drugs in separate syringes. IV CATHETERS CONT’D Choose catheter size/type based on patient’s size and need RISKS TO AVOID AIR- always remove from syringe line before injecting BROKEN TIP- don’t repeatedly advance and retract over stylet OVERHYDRATION- can avoid with infusion pump or calculated drips/sec - signs of over-hydration: eye/nose discharge, swelling of conjunctiva, SQ edema, increased lung sounds and respiration rate, dyspnea, coughing, restlessness SEPSIS- wipe area of catheter placement with an antiseptic and injection ports with alcohol HASTY INJECTION OF DRUGS IV FLUIDS Rate depends on the patient and the procedure. Fluids during surgery/anesthesia: 5-10 mL/kg/hr (10mL/kg/hr is typical) -intended to compensate for vasodilation and fluid loss during anesthesia/surgery The surgical fluid rate (aka prescribed rate) at VTI is 10mL/kg/hr When would you want to be extra-careful with your rate to avoid overhydration? - Patients with cardiovascular or respiratory disease - Can still give fluids, just modify the rate (5 mL/kg/hr) What about the animal that has excessive hemorrhage or low blood pressure in surgery? *These patients may be at risk for going into shock* Healthy young dogs can get up to 40 mL/kg for one hour. For cats, do not exceed 20 mL/kg for one hour (more at risk for overhydration) A “quickie” way to determine the amount of fluids to replace: If profuse hemorrhaging, give 3 mL fluids for every one mL of blood lost. Animals in Shock Rapid fluid rates: Dogs = 50-90 mL/kg/hr Cats = 40-60 mL/kg/hr Usually give as fractions (1/4 of total dose over 15min , then re-evaluate), as to not overload IV FLUIDS Drip sets determine how much and how fast you are giving fluids to a patient. Animal > 10kg: use 15 drops/mL set (also called macro-drip or standard drip) *macro drip sets also come in 10 drops/mL Animal < 10kg: use 60 drops/mL set (also called micro-drip or pediatric drip) What difference do you notice Between the 2 drip sets? IV FLUIDS CONT’D -If you are lucky, your clinic has a fluid infusion pump and it’s as simple as entering it in. -However, these are expensive, so not all clinics are able to use these on everyone. IV FLUIDS MATH My patient weighs 7 kg. Step 1: Surgery fluid rate is 10 mL/kg/hr Surgery fluid rate for this patient (aka infusion rate) = 70 mL/hr Step 2. Pick the appropriate drip set for the patient’s weight: patients less than 10kg use a 60 gtt/ml set. Step 3: determine how many drops of fluid should be given each second. To do this, multiply the infusion rate by the drip set and then divide this number by 3600. 70 mL x 1hour x 60 drips 1 hour 3600 sec 1 mL = 1.16 drips per sec OR 1.16 drips 1 sec x 10 sec = 11.6 drips per 10 sec *At this point you can round To the nearest whole number= 12 drips/10sec TYPES OF FLUIDS TYPES OF FLUIDS CRYSTALLOIDS -Most commonly used IV fluids - Distributed throughout total body water - 3 types: 1) Balanced electrolyte solutions -reflect the electrolyte composition of blood (sodium, potassium, chloride, magnesium, calcium) -examples: Lactated Ringers, Plasmalyte, Normosol) 2) Saline solutions -contain only sodium and chloride in water -normal saline (0.9%) -hypertonic saline (7.5%) is not used frequently. May be used with hypovolemia, shock. Pulls water into the vessels from the interstitial space. Do NOT use in cases of dehydration or electrolyte abnormalities. 3) Dextrose Solutions -2.5% or 5% Dextrose -used in hypoglycemia (or risk of development), hyperkalemia, and animals receiving insulin, neonatal animals, debilitated animals. -don’t use as the sole fluid (some fluids come COLLOIDS -Contain large molecules that do not leave the vasculature -osmotic pressure increases, water is pulled from interstitial spaces -helpful in maintaining blood volume and pressure -typically see less side effects than hypertonic saline 1) Plasma or blood -animals with acute blood loss or anemia, extensive burns, hypoproteinemic animals, those with coagulation problems -contains albumin, globulins, clotting factors -albumin doesn’t last long -$ 2) Synthetic Colloids (Hetastarch, Dextran) -shock, hypoproteinemia -can give with crystalloids at 5ml/kg over 5 minutes and repeated up to 4 times over 24 hours -more available than plasma, cheaper, lasts 12 to 36 hrs 3) Blood substitute (Oxyglobin) -similar to RBCs (binds and releases Oxygen) -no cross-match required -acute hemorrhage, chronic anemias