I.  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 pinched?

                                                   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, ears)

                                                   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 more.

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 kept

                                                   i.      Atropine and Glycopyrolate

                                                 ii.      Epinephrine

                                                iii.      Dexamethasone Sodium Phosphate and Soludelta cortef

                                               iv.      Lidocaine

                                                 v.      Diphenhydramine/Benedryl

                                               vi.      Lasix and Mannitol

                                              vii.      Antisedin

                                            viii.      Naloxone