Anaesthesia Patient Monitoring

Here at NOAH we take anaesthetic monitoring very seriously indeed. We use only the best current recommended anaesthetic agents such as propofol and isoflurane. We have invested in key electronic monitoring equipment including pulse oximetry, capnography, ECG, blood pressure, temperature and respiration. This equipment is used for all anaesthetic cases including for MRI or operations. The key to safe anaesthesia is good patient monitoring. With careful checking of the patient and sensible interpretation of information from electronic monitoring equipment, any changes in measured vital signs will be recognised promptly and acted on. Monitoring equipment should not be relied on solely during anaesthesia and here at NOAH we consider manual monitoring of a patient’s vital signs compulsory. Electronic methods can add a substantial quantity and quality of data and trends in the patient physiological status.

We here at NOAH use capnography commonly as it assesses adequacy of ventilation and is an indirect monitoring tool and provides information on CO2 production, pulmonary perfusion, respiratory rate and pattern and CO2 elimination. Human medicine risk studies have documented that capnography and pulse oximetry, when used together, could aid in the prevention of anaesthetic- related errors. A high End-tidal CO2 occurs most commonly during anaesthesia due to hypoventilation, although it may also result from a low cardiac output. Hypoventilation may result from too depth of anaesthesia, drugs and respiratory muscle weakness. Correction of hypoventilation may involve assessing and adjusting the depth of anaesthesia or instituting assisted manual ventilation. An End Tidal CO2 lower than the reference range may result from hyperventilation due to too light a plane of anaesthesia or a patient’s response to surgical stimulation (or a leak around the endotracheal tube, which dilutes the End Tidal CO2). A low End Tidal CO2 can arise include obese patients with a reduced lung capacity and due to inadvertent endobronchial intubation. Correction of hyperventilation may involve increasing depth of anaesthesia and administering further analgesia. Apart from useful patient monitor during anaesthesia, capnography is of great benefit during cardiopulmonary cerebral resuscitation. Good chest compressions and the development of an adequate circulation, will result in the delivery of CO2 to the lung and, therefore, an End Tidal CO2 value will be recorded. This can be used as a measure of circulation success.

For general anaesthesia risk it is generally accepted that for healthy dogs and cats, the mortality rate is approximately 0.05 to 0.1%, and is probably around 1 to 2% for sick dogs and cats. Commonly reported risk factors for death include: poor health status, poor monitoring, age, intubation problems, and breed association. At NOAH we use on accepted classification of patients according to the table below

SA Definition Examples
1 A normal healthy patient Healthy patient for routine surgery
2 A patient with mild systemic or localized disease, that does not limit normal function Skin tumour, fracture, non-complicated umbilical hernia, and localized infection.
3 A patient with severe systemic disease that limits normal function Fever, dehydration, anaemia, cachexia and mild to moderate hypovolemia
4 A patient with severe systemic disease that is a constant threat to life Uraemia, toxaemia, severe dehydration and hypovolemia and congestive heart failure
5 A moribund patient who is not expected to survive without procedures in the next 24h Shock, multisystem insufficiency, sepsis, severe trauma
E A patient that needs anaesthesia in emergency, without enough data to allow ASA status classification Gastric dilatation and volvulus, respiratory distress

A pet with an ASA status above 2 is 10 times more at risk, and should get extra attention during anaesthesia, or could even be monitored by a specialist. Old pets are more at risk, independently of their physical status. Even if age in itself is not a disease, old pets have diminished physiological reserve, and therefore cannot compensate the effects of anaesthesia well as a young healthy pet. Additionally, they often have other underlying issues that can interfere with anaesthesia.

All patients undergoing any type of procedure are recommended to have pre-anaesthetic bloods performed to check full blood count, kidney and liver function amongst other parameters. If you want the best in anaesthetic monitoring for your pet undergoing any type of procedure then at NOAH they will get the best option.

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