9 tips for uneventful anesthesia and recovery

Super tech Tasha McNerney has had to give Dr. Sarah Wooten a bit of advice in the operating room before. Click on the image above to watch "Back Office Blunders: Run along and do your doctor stuff."Uneventful. Routine. Boring. Not how you want to define your life, but definitely how you want to define your anesthetic cases. In these cases, uneventful is actually the ultimate goal! Before you or your team rev up for your next full surgery day, here are nine tips I found ridiculously helpful from a recent Fetch dvm360 Launchpad Learning session, “Anesthesia basics and beyond: Things you learned in school but have forgotten.” In this session, the original Anesthesia Nerd, Tasha McNerney, BS, CVT, VTS (anesthesia and analgesia), discussed how to make your anesthesia as smooth and uneventful as possible.

1. The critical period for brachycephalics

McNerney says brachycephalics are most likely to have a problem with hypoxia during induction or postoperatively. Monitor these guys closely at all times but especially during induction and until they are fully recovered.

2. Is it pain or is it dysphoria?

McNerney says that while dysphoric patients are not focused at all on their surroundings, patients in pain will display an element of focus and awareness of surroundings. If you have a postop patient in which you can't tell the difference between pain and dysphoria, reduce drugs that can cause dysphoria (such as a constant-rate infusion of fentanyl) and add in something like dexmedetomidine, which has pain control and is sedating. Acepromazine is not a good choice because it does not provide any pain control, says McNerney.

3. Make surgery less nauseating

When it comes to pain management, McNerney recommends maropitant (Cerenia) to make patients more comfortable postop. A study showed that Cerenia prevents perioperative nausea and vomiting and improves recovery in dogs undergoing routine surgery.1 Cerenia, however, is not a substitute for postop pain management.

4. Well-thought-out warmers

McNerney prefers a Hot Dog to a Bair Hugger because it doesn't dry out her electrocardiography leads, it's quiet, and it doesn't blow air around the surgical site. Blowing air has been associated with increased bacterial counts near surgical sites, which is a no-no, especially with orthopedic surgery. If you don't have a Hot Dog, McNerney suggests using warmed intravenous fluids and wrapping the patient in bubble wrap (core and extremities) to retain heat. It's cheap and easy.

5. Inundate the pain

Soaker catheters are also known as wound or diffusion catheters, and McNerney says these tools are a cheap and easy way to increase patient care and comfort postop, especially in limb amputations, large skin mass removals and mastectomies.

6. For orthopedics, long-acting is where it's at

Nocita (Aratana) is a long-acting bupivacaine liposome injection suspension that provides extended, targeted, local pain control for up to 72 hours postop. McNerney prefers using this product to provide longer term pain control for tibial plateau leveling osteotomy (TPLO) patients over an epidural because it doesn't have any of the negative side effects associated with epidurals, such as bladder management. Her anesthesiologist prefers this product because dogs are up and walking faster and go home faster with better pain control.

7. Illuminate your intubation

While it is unofficially considered the technician badge of honor to intubate blindly, McNerney encourages the use of tools, i.e. laryngoscopes, that have been designed to make our jobs easier and safer. Laryngeal tears are a real thing, and the light from a laryngoscope can help you visualize any structural abnormalities that may go missed by your doctor. Who knows-you may end up being the diagnostic hero of the day!

8. Try the bubble test

An easy way to check for leaks is the soapy water test. Spray all the connections with soapy water, turn on the oxygen, close the pop-off valve and occlude the tube. Any leaks will be easily visible as bubbles.

9. Tasha's two cents on tubes

Still using orange endotracheal (ET) tubes? McNerney says throw them out! Orange tube cuffs are low volume and high pressure and put the trachea at risk for damage and necrosis. Clear tubes, on the other hand, have high-volume, low-pressure cuffs that are much safer. If you are hearing any nonsense about the incompatibility of clear tubes with computed tomography (CT) scans, that is hearsay. Clear ET tubes are compatible with CT. Just avoid the ET tubes that have a blue radiopaque blue line. You heard it here, folks.

And ... 4 more quick tips, straight from McNerney

Save your techs! The importance of establishing a standard of care

No gurgling allowed!

How monitoring equipment is like certain male celebrities (which one do you think is Ashton Kutcher?)

Why you should do electrocardiography before you start

Reference

1. Hay Kraus BL. Efficacy of maropitant in preventing vomiting in dogs premedicated with hydromorphone. Vet Anaesth Analg 2013;40:28-34.