NON-TOXIC PEST CONTROL
NON-TOXIC PEST CONTROL
QUARTERLY BEAT / DECEMBER 2021 ///
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Monitoring the Anesthetized Patient - Part 2
JANE QUANDT , DVM, MS, DACVA, DACVECC Professor, University of Georgia VETgirl, Forum Consultant/Contributor
Normal ETCO2 levels are 35-40 mm Hg , with a normal shape. • Increased ETCO2 levels (45 mmHg) can be due to decreased alveolar ventilation (HYPOventilation), increased metabolism (sepsis, malignant hyperthermia, rebreathing carbon dioxide (broken one way valves, exhausted carbon dioxide absorbent), and increased CO2 production (bicarbonate injection). • Decreased ETCO2 levels (30 mmHg) can be due to increased alveolar ventilation (HYPERventilation), decreased CO2 production, normal CO2 production, but decreased perfusion /return of CO2 to lungs, and respiratory arrest. • Abnormal capnogram waveforms can signify esophageal intubation, obstructed/ kinked ET tube, obstructed breathing circuit, leaking anesthetic circuit, disconnection of ET tube from circuit, and sample port and scavenge port are interchanged. F. Temperature Small, thin and/or very sick patients often become hypothermic under anesthesia. Heat loss is accelerated by cold, dry oxygen flowing into the respiratory tract, exposure of viscera to a cold operating room, vasodilating drugs (ace), drugs that alter thermoregulation (opioids) and alcohol-based surgical scrubs. Hypothermia can be minimized by using warm fluids or fluid line warmers, water circulating heating pads, wrapping legs and bodies in insulating material (i.e. bubble wrap) and minimizing oxygen flows. Every effort should be made to return a patient’s body temperature to near normal postoperatively. This includes the use of heating pads, heat lamps and warm air circulating pads; when using any warming device, always be careful not to burn patients. Although these external devices may not dramatically increase the core body temperature, further heat loss will be prevented. Permissive hypothermia is a method used during anesthesia to reduce the metabolic rate and cellular function during cardiovascular or neurosurgeries.
Hyperthermia may occur with excessive muscle activity or malignant hyperthermia. Hyperthermia in cats has been documented. Treatment includes cooling extremities with alcohol, removal of any external heat sources (i.e. pads, lamps), and low doses of vasodilating drugs (acepromazine) if necessary. Most animals return to a normal body temperature within 1 hour following initiation of treatment. Animals with a history of possible malignant hyperthermia should be monitored closely for signs of hyperthermia; dramatically increased PaCO2 (arterial blood gas) and/ or ETCO2 (capnometer) levels will confirm the diagnosis. ALL inhalant anesthetics , including isoflurane and sevoflurane, should be avoided in patients prone to malignant hyperthermia. Exercise induced collapse (EIC) in Labrador retrievers is associated with hyperthermia. However, this form of hyperthermia is NOT malignant hyperthermia, and patients with EIC can be safely anesthetized as any other patient would be. G. Anesthetic Machine The anesthetic machine should be monitored throughout the anesthetic period. Things that should be check regularly including, liquid inhalant levels and vaporizer settings, oxygen flowmeter, oxygen line pressures/E tank levels, patency of endotracheal tube, airway pressure, pressure relief (“pop off”) valve patency, reservoir bag, CO2 absorbent (color change and heat) and ventilator control settings. Summary “You don’t have to provide monitoring for every patient…only those you can’t afford to lose” -Anonymous
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NON-TOXIC PEST CONTROL
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