CHAPTER 2 Part 2

PATIENT PREPARATIONIV CATHETERS: catheters are ideal for all

anesthetic proceduresCan treat/prevent ______________, _________________,

_______________________Allows injection of medications such as antibiotics

and analgesics and allows constant-rate-infusionsProvides access to a vein in an emergency (cardiac

arrest, seizures ). Do not remove until animal is fully awake!

Allows _______________ agents to be injected (ex: thiopental)

Allows injection of _________________drugs

PATIENT PREPARATIONIV CATHETERS: Choose catheter size based on

patient’s size and needRisks with catheter placement:

_______- always remove air from IV line before connecting to patient

________________- don’t repeatedly advance and retract the stylet

_________________________________- avoid by using infusion pump or calculate drips/sec

_____________________- wipe area of catheter placement with an antiseptic and injection ports with alcohol

____________________________ – Just because the catheter is there, doesn’t mean all drugs should be given IV

PATIENT PREPARATIONIV FLUIDS: the patient’s infusion rate will

depend on body weight and procedureFluids during surgery/anesthesia:

_________________mL/kg/hrintended to compensate for vasodilation and fluid

loss during anesthesia/surgery

Isotonic, polyionic replacement crystalloids are the first choice for fluid therapy in healthy patients.

PATIENT PREPARATIONIV FLUIDS: fluid rates can be adjusted for those

patients that are compromisedCV diseaseRespiratory diseaseFluid rates for these patients are often kept at 5ml/kg/hr

An animal with excessive hemorrhage or low blood pressure during surgery can have fluid rates increasedDogs: up to 40mL/kg/hr for max of 1 hourCats: up to 20ml/kg/hr for max of 1 hourA quick way to estimate amount of fluids to give:*Give

______mL of fluid for every ______mL of blood loss

PATIENT PREPARATIONANIMALS IN SHOCK: these patients need even

more rapid fluid ratesDogs: __________mL/kg/hrCats: ___________mL/kg/hr___________of the calculated dose is given and then

patient re-evaluated (a 10-20mL/kg bolus)Animals in shock may show the following signs:

Pale mucous membranesLow blood pressure_____________________ heart rate in compensatory &

decompensatory shock or slow heart rate in end stage shock

PATIENT PREPARATIONIV FLUIDS: drip sets (administration sets) help

determine how fast the fluids are administeredPatients greater than 10kg use a _____________

setMacrodrip sets are either 10gtt/mL or 15gtt/mL

VTI has 15gtt/mL sets

Patients less than 10kg use a _______________ setMicrodrip sets are 60gtt/mL

PATIENT PREPARATIONIV FLUID ADMINISTRATION SETS

MACRO MICRO

PATIENT PREPARATIONIV FLUID ADMINISTRATION: most clinics

have an IV fluid pump. The pump controls how many drops of fluid are delivered to the patient over a period of time.If no pump is available, the anesthetist will

need to calculate how many drops of fluid should be administered to the patient in a period of time as well as monitor the fluids closely.

PATIENT PREPARATION

Step 1: Obtain the patient’s weight in kgs. If the patient’s weight was obtained in pounds, then you

must divide by 2.2Step 2: REMEMBER THE SURGICAL FLUID RATE:

10mL/kg/hr. Multiply the patient’s weight in kgs by 10. This will give you how many mLs the patient should receive in 1 hour known as the infusion rate.

Step 3: Determine the drip set necessary for the patient based on weight.

Step 4: Multiply the patient’s infusion rate by the drip set.

Step 5: Divide the number from Step 4 by 3600 (because there are 3600 seconds in 1 hour). THIS FINAL ANSWER WILL TELL YOU HOW MANY DROPS OF FLUID EACH SECOND THE PATIENT WILL RECEIVE EACH HOUR WHILE UNDER ANESTHESIA.

MATHMATH

PATIENT PREPARATIONPatient weighs 6 kg.

Surgical fluid rate is 10mL/kg/hr: 6 x 10 = 60 mL/hrPatient needs microdrip set: 60 x 60 = 36003600/3600 = 1 drop/sec

Patient weighs 12 kg.Surgical fluid rate is 10mL/kg/hr: 10 x 12 = 120 mL/hrPatient needs a macrodrip set: 120 x 15 = 18001800/3600 = 0.5 drops/sec0.5 drops/sec is impossible to count, but if we multiply

by 10 it will tell us how many drops to administer in 10 seconds

0.5 x 10 = 5 drops/10 sec

PATIENT PREPARATION: Fluid Administration

•Body fluids consist of water and solutes.

•Water is 60% of body weight.•It is divided into _______and ______ (fluid in the vessels and fluid between the cells)•The other 40% is solutes•Blood volume is ____________of body weight in dogs & large animals and ___________-in cats

PATIENT PREPARATIONFLUID ADMINISTRATIONBody fluid solutes:

ions large plasma proteins or colloids, small nonionic particles such as glucose and small

proteinsElectrolytes:

Cations Sodium (Na+) Potassium (K+) Magnesium (Mg2+) Calcium (Ca2+)

Anions Chloride (Cl−) Bicarbonate (HCO3

−) Phosphates (HPO4

2− and H2PO4−)

Proteins

PATIENT PREPARATION____________________ is the solute concentration

maintained in all body fluids. It is 300 mOsm/LPRINCIPLES OF WATER AND SOLUTE

BALANCE:One-third of IV fluids administered will stay in the

intravascular space. Two-thirds will diffuse into the interstitial space.Colloids don’t pass freely through the vascular

endothelium.The presence of colloids in the intravascular space

draws water into the space creating osmotic or oncotic pressure.

Some solute concentrations (Ca2+, K+) must be kept within a narrow range to maintain normal heart and muscle function.

PATIENT PREPARATIONFLUID ADMINISTRATION FOR

ANESTHETIZED PATIENTSAnesthetic agents affect cardiopulmonary

function by decreasing inotropy and heart rate. Many agents also cause vasodilation. This results in an overall decrease in cardiac output and hypotension. This affects oxygen delivery to the tissues IV fluids increase circulating blood volume and

cardiac output

PATIENT PREPARATIONREVIEW OF IV FLUID TYPES: Crystalloids vs.

ColloidsCRYSTALLOIDS: the most common fluid type.

Used for fluid replacement and maintenance. The 3 general categories of crystalloids are:_____________________(isotonic, polyionic,

replacement solutions)___________solutions______________________solutions

PATIENT PREPARATION

CRYSTALLOIDS: BALANCED ELECTROLYTE SOLUTIONSContain a solute profile similar to the

extracellular fluid since dehydration , general diseases, and peri-operative hemorrhage deplete the ECF first.This means higher concentrations of Na+ and Cl-

Examples: Plasmalyte, Normosol, Lactated Ringer’s

PATIENT PREPARATIONCRYSTALLOIDS: SALINE SOLUTIONS

Contain ONLY Na+ and Cl-

Examples: Normal Saline & hypertonic SalineNORMAL SALINE(0.9%): used to flush body

cavities, flush catheters, blood transfusionsHYPERTONIC SALINE(3%, 5%, 7%): very

concentrated and quickly draws water into the intravascular space and supports blood pressure, but rapidly diffuses out into the interstitial space. Used for profound hemorrhage, shock, increased intracranial pressure

PATIENT PREPARATIONCRYSTALLOIDS: DEXTROSE SOLUTIONS

(2.5%, 5%)Used in cases of hypoglycemia,

neonatal, debilitated animals, hyperkalemia, patients receiving insulin

Don’t use as the sole fluid. The sugar is rapidly metabolized to CO2 and water. The free water diffuses out into the interstitial space.

PATIENT PREPARATIONCOLLOIDS: large molecules that do not

readily leave the intravascular spaceThese are helpful in maintaining blood volume

and pressureLess side effects than hypertonic salineRapidly pulls water into the intravascular

spaceExamples: __________ or __________,

__________________, _________________________

PATIENT PREPARATIONCOLLOIDS: PLASMA OR BLOOD

Contains albumin, clotting factors, globulinsUsed in animals with acute blood loss, anemia,

hypoproteinemiaExpensive

COLLOIDS: BLOOD SUBSTITUTESUsed for acute hemorrhage and anemiasOxyglobin contains hemoglobin molecules of bovine

origin similar to red blood cells that are able to carry oxygen.

The benefit is that there is no cross-match requiredTHIS PRODUCT IS NOT CURRENTLY AVAILABLE

PATIENT PREPARATIONCOLLOIDS: SYNTHETIC COLLOIDS

(*Hetastarch, *Vetstarch, Dextran)More readily available than blood productsLess expensive and longer shelf life than

blood productsUsed in cases of shock, hypoproteinemiaUsually administered IV at rate of

10-20mL/kg/day; bolused slowly over 15-60 minutes

30%-60% remains in the plasma after 24 hours, and a smaller percentage remains in the plasma for as long as days to weeks after administration.

PATIENT PREPARATIONADVERSE EFFECTS OF FLUID ADMINISTRATION

____________________– more likely in patients that are <5kg or those with cardiac or renal disease *reduce infusion rates Ocular/nasal discharge Chemosis Subcutaneous edema Increased lung sounds Increased respiratory rate Dyspnea Coughing, restlessness

_____________________ – dilution of the RBC’s and plasma proteins.