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A&S - Week 9
Anaesthetic Complications & Ocular/Aural Surgery
| Question | Answer |
|---|---|
| What Are The Main Anaesthetic Complications? | -Cardiopulmonary arrest -Airway obstruction -Respiratory depression/arrest -Circulatory insufficiency -Hypothermia/hyperthermia |
| What Are The Causes Of Cardiopulmonary Arrest? | -Anaesthetic overdose -Hypoxia or hypercapnia -Hypotension -Dysrhythmias -Pre-existing heart disease -Vagal stimulation -Electrolyte imbalances -Hypothermia -Toxaemia |
| What Are The Signs Of Impending Cardiopulmonary Arrest? | -Changes to respiratory rate, depth, and pattern -Changes in pulse quality and rhythm -Unexplained changes in anaesthetic depth -Abnormal ECG rhythms |
| What Are The Signs Of Cardiopulmonary Arrest? | -No heart sounds -No pulse palpable -No respiratory movements, or agonal gasping/cheyne stokes breathing -Fixed and dilated pupils -Grey or cyanotic mucous membranes -Dry cornea -Loss of reflexes -Arrythmia on ECG |
| What Are The Steps To Cardiopulmonary Resuscitation? | -Get help -Airway (ensure patent airway present, is tube blocked? is APL valve open?) -Breathing (perform IPPV) -Circulation (external cardiac compressions, IVFT) -Drugs (adrenaline etc) -Electrical defibrillation -Follow up |
| How Is IPPV Performed On A Ayres T Piece/Bain/Circle? | -Close the APL valve -Squeeze the bag to inflate the lungs -Open the valve to allow the animal to exhale |
| How Is IPPV Performed On A Lack/Magill? | -Increase the fresh gas flow to aid the removal of inhaled carbon dioxide -Close the APL valve -Squeeze the bag to inflate the lungs -Open the valve to allow the animal to exhale *Not ideal circuit for IPPV |
| How Is IPPV Performed On A Humphreys ADE? | -Increase the fresh gas flow rate -Depress the pin in the APL valve (this temporarily closes it) -Squeeze bag to inflate the lungs -Release the pin to allow the animal to exhale |
| What Drugs Are Often Found In A Crash Kit And What Are Their Purposes? | -Adrenaline = Stimulates rate/strength of heart contraction -Atropine = Obstructs parasympathetic system -Lidocaine = Blocks transmission of impulses allowing sinus rhythm to resume -Furosemide = For pulmonary/cerebral oedema |
| What Equipment Might Be Found In A Crash Kit? | -ET tubes -Tracheostomy tubes -Needles -Syringes -IV catheters -Skin prep kit -Stethoscope -Timer |
| What Are The Signs Of Airway Obstruction? | -Increased respiratory effort/noise -Paradoxical chest wall movement -No movement of reservoir bag -Cyanosis |
| What Might Cause Airway Obstruction? | -Whilst intubated = Foreign bodies, vomit, secretions -Following extubation = Soft tissue entrapment (brachys), foreign bodes, laryngospasm, tracheal collapse |
| What Actions Must Be Taken If Airway Obstruction Is Suspected? | -Check ET tube is not blocked (attach pure oxygen, squeeze reservoir bag and make sure air enters chest via tube) -Replace ET tube or use suction if blockage -If not intubated, extend head and neck, check for obstructions, intubate -Tracheostomy |
| What Are The Causes Of Respiratory Depression/Arrest? | -Anaesthetic or opioid overdose -Chest wall movement inadequate -Respiratory movements unable to inflate lungs -Patient position -APL valve closed |
| What Are The Signs Of Respiratory Depression/Arrest? | -Reduced minute volume -Decreased respiratory rate -Increased ETCO2 -Cyanosis -Inflated chest, full reservoir bag, odd whistling |
| What Actions Must Be Taken If Respiratory Depression/Arrest Is Suspected? | -Remove underlying cause -Assess anaesthetic depth and pain levels -Supply 100% oxygen -Use IPPV |
| What Are The Causes Of Circulatory Insufficiency? | -Severe haemorrhage or fluid loss -Decreased venous return (pressure while patient is in dorsal recumbency) -Reduced peripheral vascular resistance -Hypotension -Myocardial depression (due to anaesthetic drugs) |
| What Are The Signs Of Circulatory Insufficiency? | -Weak myocardial pulse -Pale mucous membranes -Increased CRT -Low measured blood pressure -Increased heart rate -Poor urinary output -Diminished bleeding |
| What Actions Must Be Taken If Circulatory Insufficiency Is Suspected? | -Assess depth of anaesthesia -Rapid IV fluid infusion -Reposition patient if possible -Control haemorrhage -Inotropic drugs |
| What Are The Causes Of Hypothermia? | -Shivering is prevented under anaesthesia -Anaesthetic agents may cause peripheral vasodilation (acepromazine) -Visceral surfaces are exposed in abdominal surgery -Inspired anaesthetic gases are cold and dry |
| How Can Hypothermia During Anaesthesia Be Prevented? | -Choice of anaesthetic agents -Use of a thermovent -Warming aids -Monitoring IV fluids -Monitoring -Keep operating theatre warm |
| What Might Cause Hyperthermia During Anaesthesia? | -Hot environments -Reaction to certain drugs |
| Define Entropion | Condition in which the eyelids roll inwards causing irritation to the cornea. |
| What Are The Clinical Signs Of Entropion? | -Excess tear production -Epiphora (overflow of tears down the face) -Conjunctivitis -Corneal ulceration |
| How Are Patients With Entropion Prepped For Surgery? | -Protective ointment or jelly (viscotears) placed into the conjunctival sac -Eye area clipped (care to avoid clipper rash) -Conjunctiva flushed with 1:50 iodine solution, then 1:10 iodine prepare eyelids and surrounding skin |
| Why Is Chlorohexidine Gluconate Contraindicated In Ocular Surgery? | It is irritating and causes corneal ulceration. |
| What Are Some General Nursing Considerations For Entropion Surgery? | -ACP will cause the eyes to droop downwards, which will make it difficult for the vet to assess the eyes prior to surgery |
| Briefly Describe The Surgical Procedure Used To Correct Entropion | Slivers of skin are removed to turn the eyelid out/prevent inversion. |
| Define Ectropion | Condition in which the eyelid is oversized, and bags/droops open exposing the conjunctiva. |
| What Are The Clinical Signs Of Ectropion? | -Appearance -Conjunctivitis -Chronic keratitis (inflammation of the cornea) |
| How Are Patients With Ectropion Prepped For Surgery? | -Protective ointment or jelly (viscotears) placed into the conjunctival sac -Eye area clipped (care to avoid clipper rash) -Conjunctiva flushed with 1:50 iodine solution, then 1:10 iodine prepare eyelids and surrounding skin |
| What Are Some General Nursing Considerations For Ectropion Surgery? | -ACP will cause the eyes to droop downwards, which will make it difficult for the vet to assess the eyes prior to surgery |
| Briefly Describe The Surgical Procedure Used To Correct Ectropion | Excess skin is removed via a v shaped incision to take up the slack of the eyelid. |
| What Are Some Post-Operative Nursing Considerations For Entropion/Ectropion Patients? | -Buster collar to be applied immediately on recovery -Use of cold compresses to reduce swelling and post operative haemorrhage |
| Define Distichiasis | Condition in which distichia (abnormal eyelashes) emerge from the leading edge of the eyelid through tiny gland openings. |
| Define Ectopic Cilia | Condition in which eyelashes emerge from the inner eyelid (conjunctiva) and directly make contact with the cornea. |
| What Are The Clinical Signs Of Distichiasis And Ectopic Cilia? | -Epiphora -Conjunctivitis -Blepharospasm (spasm of eyelids, excessive blinking) -Corneal ulcers -Chronic keratitis |
| What Surgical Treatments Are Available To Correct Distichiasis And Ectopic Cilia? | -Plucking of abnormal lashes under sedation -Electrolysis (causes damage to the hair follicle) - longer lasting results but will still grow back -Surgery performed at referral centres to remove the eyelash roots, and cryotherapy |
| What Are Some Post-Operative Nursing Considerations For Distichiasis And Ectopic Cilia Patients? | -Prevention of patient interference |
| How Do Eyelid Tumours Cause Eye Irritation? | They rub against the cornea. |
| Briefly Describe The Surgical Procedure Used To Remove Eyelid Tumours | A wedge of the eyelid containing the tumour is removed, opposing edges are then sutured together. |
| What Is A Cataract? | An increase in the opacity of the fibres or capsule of the eye lens, can be primary or secondary to conditions such as diabetes mellitus. |
| Briefly Describe The Surgical Procedure Used To Remove Cataracts | -Specialist technique known as phacoemulsification -Needle vibrated by ultrasound and this breaks up the cataract -Particles are then aspirated |
| What First Aid Can Be Provided For Eye Prolapse Patients? | -Prevent eye from dehydrating, use saline, ophthalmic ointment, or water-soluble jelly -Prevent the animal from traumatising the eye |
| Briefly Describe The Surgical Procedure Used To Correct Eye Prolapses | -Lateral canthotomy (incision made at lateral canthus of eye) -Replacement of eyeball -Eyelids sutured closed for 2 weeks to prevent reoccurence |
| What Are Some Post-Operative Nursing Considerations For Eye Prolapse Patients? | -Prevention of patient interference |
| What Are The Clinical Signs Of A Corneal Ulcer? | -Blepharospasm (increase in blinking) -Epiphora (tear overflow) -Pain -Animal may rub eye with paw or along furniture etc |
| What Are The Treatment Options For Corneal Ulcers? | -Medical treatment with regular eye drops and NSAIDs -Debridement of ulcer using a cotton bud to remove loose tissue -Punctate Keratotomy (hypodermic needle used to scratch grid lines onto surface of damaged area - promotes healing) -Eyelid flaps |
| When Might Eye Enucleation Be Indicated? | -Gross trauma -Neoplasia -Untreatable glaucoma -Irreducible prolapse -Prolonged prolapse |
| What Are Some Client Considerations For Eye Enucleation? | -Cosmetic appearance a concern for many clients prior to surgery -Reassurance and counselling to clients needed - animals tend to tolerate this well |
| Briefly Describe The Surgical Procedure Used For Eye Enucleation | -Many techniques available, commonly a trans palpebral enucleation is performed -Eyelids first sutured together, eye then removed by dissection of the conjunctiva, optic nerve and blood vessels are clamped and carefully ligated |
| What Are Some Intra-Operative Nursing Considerations For Eye Enucleation Patients? | -Emovet pad often required, encourages clotting -Oculocardiac reflex can occur, a stimulus to the eye pressure, manipulation or traction gets transmitted to the vagal nerve and onto the heart, causes profound bradycardia, arrhythmias, and asystole |
| What Are Some Post-Operative Nursing Considerations For Eye Enucleation Patients? | -Prevention of patient interference -Monitor for haemorrhage |
| What Is Cherry Eye? | Protrusion of the tear gland associated with the 3rd eyelid, occurs due to a weakness of the glands normal attachment. |
| Briefly Describe The Surgical Procedure Used To Correct Cherry Eye | Gland placed back into position and sutured in place. |
| What Can Cause Aural Haematoma? | -Self mutilation, due to otitis externa -Autoimmune disease -Cushing's disease |
| What Are The Clinical Signs Of An Aural Haematoma? | -Fluid filled swelling on the concave surface of the pinna -Involves whole pinna or just a portion -Lesion undergoes fibrosis in time and a cauliflower ear will form |
| What Are The Treatment Options For Aural Haematomas? | -Needle aspiration= A large gauge needle is used to aspirate the haematoma, cavity then installed with corticosteroid -Incision and sutures= Incision made into pinna and haematoma drained, sutures placed around incision, but left open for drainage |
| What Are The Pros And Cons Of Using Needle Aspiration To Treat Aural Haematoma? | -Pros = Highly effective in early cases -Cons = Can slow healing and prevent tissue alignment |
| What Is An Alternative To Leaving The Incision Open In Aural Haematoma Surgery? | Placing of an active/passive drain. |
| What Are The Aims Of 'Salvage' Aural Procedures? | -Improve drainage and ventilation of the external ear canal -Remove chronically diseased tissue -Gain access to the external ear canal and tympanic membrane |
| What Is A Lateral Wall Resection (Aural Surgery)? | -The lateral wall of the vertical ear canal is removed -Performed when there is no disease to the medial wall or horizontal ear canal -Helps to increase drainage and ventillation |
| Briefly Describe The Lateral Wall Resection Procedure (Aural Surgery) | Surgeon makes two parallel incisions over the vertical canal, the skin flap created is dissected and the vertical ear canal is exposed. All but the distal one third of the ear canal is removed. Skin edges are then sutured, leaving an opening. |
| What Are Some Pre-Operative Nursing Considerations For Lateral Wall Resection (Aural Surgery)? | -Positioning in lateral recumbency with the affected ear uppermost, head slightly elevated -Inner and outer aspects of the pinna to be aseptically prepared -Ear canal to be cleaned by thorough flushing with saline and chlorohexidine gluconate |
| What Are Some Post-Operative Nursing Considerations For Lateral Wall Resection (Aural Surgery)? | -Bandage placed so that the pinna is positioned over the top of the head for ventilation -Buster collar to prevent self-mutilation -Regular cleaning of the ear and application of drops -Analgesia -Post op check 2 days and suture removal 10-14 days |
| What Are The Potential Complications To Lateral Wall Resection (Aural Surgery)? | -Poor surgical technique, failure to drain the horizontal canal properly -Poor patient selection, chronic irreversible changes in the remaining ear canal present -Failure to control underlying disease -Unremitting otitis media |
| What Is A Vertical Canal Ablation (Aural Surgery)? | -The vertical ear canal is completely removed -The horizontal canal is sutured to the skin -Indicated in diseases where the disease is confined to the vertical canal and has not reached the horizontal canal |
| Briefly Describe The Vertical Canal Ablation Procedure (Aural Surgery) | -Similar approach the lateral wall resection but the whole vertical canal is removed leaving only the horizontal canal -The tympanic membrane and bulla are left intact, therefore this procedure interferes less with hearing post op than a TECA |
| What Are Some Post-Operative Nursing Considerations For Vertical Canal Ablation (Aural Surgery)? | -Buster collar to prevent self-mutilation -Long term need to keep fur trimmed away from opening to horizontal canal, to allow ventilation |
| What Is A Total Ear Canal Ablation? | Surgical procedure in which the entire ear canal is removed. |
| When Might A Total Ear Canal Ablation Be Indicated In Patients? | -Chronic proliferative changes in the ear canal beyond the vertical canal -Complete ear canal stenosis -Continuing otitis externa following other salvage procedures -Severe trauma or neoplasia |
| What Are Some Pre-Operative Nursing Considerations For Total Ear Canal Ablation? | -Contamination risk - antibiotics needed -Positioning in lateral recumbency -Aseptical preparation to extend dorsally to midline including pinna, ventrally to midline, cranially to lateral canthus and caudally to mid cervical region |
| Briefly Describe The Total Ear Canal Ablation Procedure | Circular incision is made around the opening of the external ear canal and a vertical incision is made over the vertical canal. Entire canal is dissected, care to avoid facial nerve. Drain placed and closure in a T shape. |
| What Are Some Post-Operative Nursing Considerations For Total Ear Canal Ablation? | -Monitor TPR -Pain management -Antibiotics and IVFT -Hand feeding -Drain care, removed at 3-5 days post op -Head bandage may be contraindicated due to significant pharyngeal swelling -Buster collar to prevent self-trauma |
| What Are The Potential Complications To Total Ear Canal Ablation? | -Facial nerve injury – may be temporary due to stretching (neuropraxia) or permanent ( paralysis) -Wound dehiscence or infection -Haemorrhage from the retrogleniod vein -Vestibular signs -Chronic sinus tract and para-aural abscessation -Deafness |
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