Achieving an optimal recovery begins with premedication and your perioperative protocols. These should be considered throughout the anaesthetic.
In a study of deaths associated with veterinary anaesthesia in the United Kingdom, covering (117) practices, (98,036) dogs and (79,178) cats, almost 50 per cent of canine fatalities and over 60 per cent of feline fatalities occurred in the recovery period or up to 24 hours post-surgery. 70
While the actual numbers of fatalities were low the study authors of the study referenced above also noted:
“That nearly 50% of the postoperative deaths in this study occurred within three hours of the end of anaesthesia suggested that if closer monitoring and management of patients in this early postoperative period were instituted, then mortality might be reduced.”
Ideally a dedicated member of staff should be continuously monitoring the patient until extubation and then performing regular checks on the patient until conscious.
- Adequate oxygenation
- Timing of extubation
- Airway and ventilation (pulse oximeter very useful in recovery)
- Cardiovascular system (heart and pulse rate, mucous membranes and CRT)
- Body temperature - Active warming if core temperature low. Use passive warming if temperature normal
- Analgesia – use multimodal approach and check timings / top up doses if needed
- Ensure all stimulation e.g. bandaging, taking temperatures, has been completed before turning off the maintenance agent
- Extubation should ideally be performed in the recovery area to reduce the stimulation from moving the patient
- Keep stimulation e.g. noise, unnecessary handling, to a minimum during the recovery period
- Fluid therapy – consider if indicated to replacing ongoing losses post operatively
When animal is actively swallowing and laryngeal reflex is restored. Inspect mouth with laryngoscope prior to extubation if haemorrhage, swelling or obstruction with mucous suspected. Remember to remove throat packs. Failure to extubate at the correct time may result in reflux and regurgitation/ aspiration
Cats: Have a sensitive larynx which is prone to spasm, therefore extubate just before swallow! Ear flick reflex is a good indicator.
Brachycephalics: Often tolerate intubation for much longer. Can leave ET Tube in place to ensure patent airways until dog starts swallowing.
Maintenance with Alfaxan