Patient Monitoring – if there is an alert, ALWAYS check
the patient before you check the machines!!!!!
A. Most important task for the monitor!
B. Is the patient breathing? Is
the patient’s heart beating? Does
the patient have a palpable pulse?
C. Eye position
i. Central pupils – awake or too deep
ii. Rolled pupils – under anesthesia
D. Palpebral reflex – touch the corner of the eyeball
i. Patient blinks – awake or light
ii. No blink – anesthesia or too deep
E. Jaw tone – how hard
is it to open the mouth?
i. Difficult to
open/cannot open – awake or light
ii. Easy to open – anesthesia or too deep
F. Toe pinch – does the patient pull it’s feet in when toe is
i. Withdraws quickly – awake
ii. Slow withdraw – light
iii. No response – anesthesia or too deep
G. Peripheral Pulse (inner thigh, tail base, armpit, feet, tongue,
i. Strong – awake or anesthesia
ii. Weak – too deep
H. Heart rate
i. Normal – awake or anesthesia
ii. High – waking up, painful, blood loss, shock
iii. Low – too deep, or specific drug (domitor)
I. Respiratory rate
i. Normal – awake
ii. Low, but within range – anesthesia
iii. High – light, pain, too hot
iv. Low – too deep
II. General Principles
A. It is better to be too light then too deep/dead.
B. When monitoring, don’t get into the habit of just doing the
vitals and writing the numbers every 5 minutes. Be constantly aware of what is going on. Things can go wrong. The
faster we react, the better to prevent serious/fatal problems.
C. Overall trends are more important than individual readings. That is even though the heart rate may still be in the normal
range, if it has been steadily falling for 15 minutes; the patient is on
too much anesthesia.
D. If the animal is too deep the first thing to do is turn off the iso.
E. “Sighing” the patient every 5 to 10 minutes can assist
ventilation. You do this by
closing the pop-off/plugging the bag and giving the patient a deep (up to
but not over 20 cm H2O) breath.
F. At the end of the procedure, turn off the gas agent, leave the
pop-off valve open and squeeze the bag until it is empty. Leave the patient on oxygen until it wakes up. The
patient can be extubated when it swallows twice or sits up and looks at
you. Brachycephalic dogs
(squished faces) need to have their tubes left in for as long as possible.
G. Premedication and pain control lower the doses needed for induction
and maintenance of anesthesia. Always
give all induction agents to effect even if the calculated dose calls for
H. If you don’t know what to do, don’t DO anything. Ask the doctor.
I. Know what drugs may be needed in an emergency and where they are
i. Atropine and Glycopyrolate
iii. Dexamethasone Sodium Phosphate and Soludelta cortef
vi. Lasix and Mannitol