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| ANESTHETIC MONITORING: YOUR QUESTIONS ANSWERED
Table 4. Assessing Vital Signs of Sedated/Anesthetized Patients Clinical Evaluation
Circulation
UÊPalpation of peripheral pulses UÊAuscultation of heart beats using a regular
stethoscope, Doppler, or esophageal stethoscope
UÊAssessment of capillary refill time (CRT) Ventilation
UÊObservation of chest wall movements UÊExcursion of rebreathing–reservoir bag UÊAuscultation of lung sounds UÊFogging of endotracheal tube or face mask
Oxygenation UÊAssessment of mucous membrane and tongue color
Depth of Anesthesia
Assessment of: UÊPalpebral, corneal, and swallowing reflexes UÊEyeball position UÊJaw tone UÊMuscle and anal tone UÊResponse to noxious or surgical stimulation UÊPurposeful movements
LINK TO PAIN MANAGEMENT
GUIDELINES View the AAHA/AAFP Pain Management Guidelines for Dogs & Cats at aahanet.org/publicdocuments/ painmanagementguidelines.pdf.
Postoperative Pain
UÊUse of pain scales to provide consistent pain assessments over time
UÊObservation of animal's behavior and cardiorespiratory variables during early recovery (first hour after extubation)
UÊAssessment of the degree of pain and differentiation of it from residual sedation or silent pain
CRT = capillary refill time;
*Delirium: sudden, severe confusion and rapid changes in brain function; †
UÊPersonnel: There is no single piece of monitoring equipment that can replace the role of a capable and vigilant anesthetist monitoring an anesthe- tized patient. The ACVA monitoring guidelines rec- ommend trained personnel be present for continu- ous evaluation of a sedated/anesthetized patient. See Anesthesia Specialty for Veterinary Technicians
28 Today's Veterinary Practice January/February 2012 Dysphoria: an emotional state marked by anxiety, depression, and restlessness
UÊDocumentation: When a patient is under general anesthesia, all vital signs must be evaluated and recorded on an anesthetic record at least once every 3 to 5 minutes. The anesthetic record becomes part of the patient's medical record and legal documentation.
(page 24) for information on technician certification in veterinary anesthesia.
UÊDifferentiation between delirium,* dysphoria,† and pain
Specific Variables
Presence, absence, strength; frequency of heart beats with simultaneous peripheral pulses
Prolonged CRT (> 2–3 seconds) suggests poor tissue perfusion or dehydration
Presence, absence, regularity, frequency, characteristics, pattern, and depth of respiration
Pink (adequate oxygenation) versus pale and/or cyanotic blue color (inadequate oxygenation)
Light anesthesia: UÊStrong palpebral and corneal reflex UÊCentral eye position UÊSwallowing, muscle twitching, and purposeful movements
UÊIncrease in heart and respiratory rate with/ without vocalization
Moderate anesthesia: UÊVentral rotation of the eyeball UÊLoss of palpebral reflex with sluggish corneal reflex
Deep anesthesia: UÊMuscle relaxation and loss of jaw tone UÊCentral eye position UÊNo corneal reflex UÊNo response to surgical stimulation UÊSlow heart and respiratory rate, weak pulses
UÊVocalizing, thrashing, salivation, vomiting UÊFrequent changes in body position UÊSelf-mutilation UÊAggression toward personnel (ie, when palpating surgical site)
UÊIncreases in heart rate and/or blood pressure UÊChanges in respiratory rate, pattern, or effort