Cat anaesthetic Protocols

RE: Cat anaesthetic Protocols

janine redman — Sat, 03 Dec 2016 19:47:27 GMT

S/c not I/m for triple in cat spays?

we use ACP/ buprenorphine and then alfaxan in nice cats and no tube

we use triple I/M in lively cats but they don't like it so is it as effective s/

we did use the charity quadruple mix for a bit but think we lost the dose schedule

RE: Cat anaesthetic Protocols

Kate Richardson — Sat, 03 Dec 2016 19:37:48 GMT

alveolus

ˌalvɪˈəʊləs,alˈvɪələs/

noun

ANATOMY

a small cavity, pit, or hollow, in particular:
- any of the many tiny air sacs of the lungs which allow for rapid gaseous exchange.
- the bony socket for the root of a tooth.

RE: Cat anaesthetic Protocols

Anthony Todd — Sat, 03 Dec 2016 13:23:26 GMT

[quote user="Evelyn Barbour-Hill"]I don't think it would be possible unless you deliberately poked the tip into the alveolus.[/quote]

In a pug "coughing" with the tube still in??? I'd rather hang the head, or rather did so, with no problems for many years and many animals. [Tube out or none, I admit]

RE: Cat anaesthetic Protocols

Evelyn Barbour-Hill — Fri, 02 Dec 2016 12:53:04 GMT

[quote user="Anthony Todd"]You must have to be careful your sucker doesn't dislodge a developing clot somewhere I would have thought? [/quote]

You'd have to be astonishingly careless and clumsy to dislodge the blood clot from an alveolus with the suction tip. I don't think it would be possible unless you deliberately poked the tip into the alveolus.

RE: Cat anaesthetic Protocols

Martin Atkinson — Fri, 02 Dec 2016 10:31:58 GMT

[quote user="Gillian Mostyn"]

While Vetey gets on with some other very important job I suppose?

[/quote]No disrespect was meant to the nurses, it was more a dig at Anthony, I have no doubt that my nurses' jobs are far more important than mine.

RE: Cat anaesthetic Protocols

Anthony Todd — Fri, 02 Dec 2016 01:21:53 GMT

[quote user="Evelyn Barbour-Hill"]All a bit irrelevant if you have employed the suction properly. You have employed the suction properly, haven't you?[/quote]

No never, nor sutured, rather like they do it with seeming success in humans.

You must have to be careful your sucker doesn't dislodge a developing clot somewhere I would have thought? Mine used to bleed a bit after an extraction I admit.

Would be nice to have suction while in action though, particularly with water cooled drills or ultrasound, even human dentists do that.

RE: Cat anaesthetic Protocols

Evelyn Barbour-Hill — Fri, 02 Dec 2016 00:24:41 GMT

[quote user="Anthony Todd"]

[quote user="Martin Atkinson"]Not sure your nurses would agree when they have to clean the floor![/quote]

Thought of using the offensive "Duurrrr" but then thought, better not, just say "spread some newspaper down or if you're really posh use a large sterile stainless steel bowl", trouble is the gunk and blood bounces off steel but is absorbed by the paper.

[/quote]

All a bit irrelevant if you have employed the suction properly. You have employed the suction properly, haven't you?

RE: Cat anaesthetic Protocols

Anthony Todd — Thu, 01 Dec 2016 23:56:49 GMT

[quote user="Martin Atkinson"]Not sure your nurses would agree when they have to clean the floor![/quote]

RE: Cat anaesthetic Protocols

Gillian Mostyn — Thu, 01 Dec 2016 21:10:23 GMT

[quote user="Martin Atkinson"]Nursey sits and watches the patient in the recovery ward until this happens.[/quote]

While Vetey gets on with some other very important job I suppose?

RE: Cat anaesthetic Protocols

Martin Atkinson — Thu, 01 Dec 2016 17:26:27 GMT

[quote user="Anthony Todd"]Simpler to hang the head over the edge of the table[/quote]Not sure your nurses would agree when they have to clean the floor!

[quote user="Anthony Todd"] judging by the cuff pressures I've seen and the ease of damaging the larynx I think removing a tube with the cuff in inflated would not be a good idea....[/quote]Of course the cuff is not over-inflated because we've all taken heed of this thread! So it comes out easily.

[quote user="Anthony Todd"]Not sure an animal can "cough" with an endo tube in place[/quote]Erm...they are trying to cough the tube out! OK gag or swallow reflex is also useful. Nursey sits and watches the patient in the recovery ward until this happens.

RE: Cat anaesthetic Protocols

Anthony Todd — Thu, 01 Dec 2016 17:09:45 GMT

[quote user="Martin Atkinson"]Which is why I was taught: a) don't deflate the cuff or remove the tube until they have a cough reflex and b) don't deflate the cuff before withdrawing the tube after dental procedures.[/quote]

Simpler to hang the head over the edge of the table and, judging by the cuff pressures I've seen and the ease of damaging the larynx I think removing a tube with the cuff in inflated would not be a good idea....

Not sure an animal can "cough" with an endo tube in place so better to remove it when the animal starts bucking the tube and before it chews it to bits.

RE: Cat anaesthetic Protocols

Martin Atkinson — Thu, 01 Dec 2016 16:46:46 GMT

[quote user="Thomas Johnson"]My concern would be that the cuff is several centimetres down the trachea past the larynx, so if the pharynx isn't packed then material from the mouth could get into the top of the trachea, and once the air is removed form the cuff could then make its way down into the lungs.[/quote]Which is why I was taught: a) don't deflate the cuff or remove the tube until they have a cough reflex and b) don't deflate the cuff before withdrawing the tube after dental procedures.

RE: Cat anaesthetic Protocols

Evelyn Barbour-Hill — Thu, 01 Dec 2016 15:40:16 GMT

[quote user="Thomas Johnson"]

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]the cuff on an endotracheal tube is not there to prevent inhalation of stuff, though it does serve as a sort of extra rather pathetic final defence[/quote]

Well, thank goodness for that "rather pathetic" but airtight, and therefore water and gunk tight, seal against all sorts of nasties going directly, without any impediment, into the lungs on every inspiration.....

[/quote]

My concern would be that the cuff is several centimetres down the trachea past the larynx, so if the pharynx isn't packed then material from the mouth could get into the top of the trachea, and once the air is removed form the cuff could then make its way down into the lungs.

[/quote]

Thank you, Thomas.

Always disconnect the tube when turning or otherwise moving the patient. Steady the tube in place by holding the mouth lightly shut upon it. In my practice turning the animal is always done by two people: one operates the legs, the other holds the head and neck with one hand and uses the other hand to lend support wherever required.

Cuffed tubes are meant to be cut shorter if necessary. That's why the little inflation tube is not attached to its whole length.

RE: Cat anaesthetic Protocols

Anthony Todd — Thu, 01 Dec 2016 11:39:45 GMT

[quote user="Martin Atkinson"]

[quote user="Kate Richardson"]

It's not the end of the tube that causes the problem, it's the cuffed area

[/quote]I think we will have to agree to disagree on this.

[/quote]

I'd have a look at Dr Google first....

This jumped out, although unrelated:

Occlusion of central artery of Airway obstruction the retina and blindness

From a chart in: Indian J. Anaesth. 2005 PG ISSUE : AIRWAY MANAGEMENT ; 49 (4)

[re the use of gags???]

and this goes into other points raised in this thread:

http://www.anaesthesiauk.com/article.aspx?articleid=100165

Which doesn't mention damage by the soft tip of the endotube.

RE: Cat anaesthetic Protocols

Anthony Todd — Thu, 01 Dec 2016 11:18:29 GMT

Too true, I hadn't thought of that [another Durrrr again].

My only rather lame defense is that we always hung the patients head over the end of the prep table after the tube was removed until it was raised by the patient.

Anything like blood, saliva, water etc. dripped out onto newspaper and was not inhaled or swallowed.

RE: Cat anaesthetic Protocols

Martin Atkinson — Thu, 01 Dec 2016 11:08:32 GMT

[quote user="Kate Richardson"]

It's not the end of the tube that causes the problem, it's the cuffed area

[/quote]I think we will have to agree to disagree on this.

RE: Cat anaesthetic Protocols

Thomas Johnson — Thu, 01 Dec 2016 11:02:38 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]the cuff on an endotracheal tube is not there to prevent inhalation of stuff, though it does serve as a sort of extra rather pathetic final defence[/quote]

[/quote]

RE: Cat anaesthetic Protocols

Anthony Todd — Thu, 01 Dec 2016 08:22:41 GMT

Sorry, had my own "Durrr" moment....

Forgot:

8. Deflate cuff as soon as vapouriser off, or dental finished. And always before you remove endo- tube.....

RE: Cat anaesthetic Protocols

Anthony Todd — Wed, 30 Nov 2016 20:49:21 GMT

[quote user="Kate Richardson"]It's not the end of the tube that causes the problem, it's the cuffed area[/quote]

I agree with you, it's too much cuff pressure [there is even a pressure gauge for humans!] but without personal evidence except the link I posted.

Er, but not according to Malcolm Atkinson though; he's a sharptube tip man.... [see posts passim]

Come to think of it, and it hasn't been raised, where should the angled end of an endo tube end up, ideally???

Probably most, including mine, were way too near, if not down one major bronchi...!!

RE: Cat anaesthetic Protocols

Kate Richardson — Wed, 30 Nov 2016 20:40:38 GMT

It's not the end of the tube that causes the problem, it's the cuffed area

RE: Cat anaesthetic Protocols

Anthony Todd — Wed, 30 Nov 2016 20:36:09 GMT

[quote user="Marie Kubiak"]Disconnecting does help but the tube is still only anchored at a single point [/quote]

Sorry again but, if cuffed, although the "momentum" of a disconnected tube is very small, if the cuff is inflated then the end is unlikely to touch the trachea much, if at all.

An inflated cuff gives you two spaced points of anchorage too.

It may well be, by the way, that the problems with tubes with or without cuffs, is that they end up around, or in, one of the lungs and not supplying both with anaesthetic and/or O2 as they may be inserted too deeply so cutting to a suitable length, which I've never thought of, may be a good idea.

RE: Cat anaesthetic Protocols

Anthony Todd — Wed, 30 Nov 2016 20:12:17 GMT

[quote user="Marie Kubiak"]I didn't think it was such a stupid point so please feel free to expand as 'Durrrr' lacks any real value to the discussion.[/quote]

Sorry, but you didn't mention it and it is surprising how many people think that detaching the tube will cause instant asphyxia and how many nurses forget to disconnect.

I only "durred " because it has happened in my practice to the sheer amazement of the vet and nurse.....

Next time I'll say "it may not have occurred to you but it is better to detach etc, etc.

I'd be very surprised if a tied-in tube moved much when detached from the machine when turning the patient. They are very light and not restricted.

If you are using an inflated cuff, even at respiratory pressure, I doubt if the tube would move at all, even if not tied in.

Sorry again. I've had many a "Durrr" moment, as you will discover on here.... usually I just accept a well meaning "Durrrr".

RE: Cat anaesthetic Protocols

Marie Kubiak — Wed, 30 Nov 2016 20:01:00 GMT

[quote user="Anthony Todd"]

[quote user="Marie Kubiak"]Could it also be turning the patient mid-dental (or repeatedly) making things worse whereas as neuters etc tend to stay in one position?[/quote]

Durrrr, even a dinovet knows to disconnect the tube from the Y piece before you move them ....

Reconnect them once settled....

[/quote]

Disconnecting does help but the tube is still only anchored at a single point so there will still be movement of the intratracheal tube during rotation of an animal with varying degrees of damage to tracheal epithelium at tube contact points (including around cuff if inflated). The more rotations and the less gentle the movements, the greater the cumulative damage and risk of complication presumably?

I didn't think it was such a stupid point so please feel free to expand as 'Durrrr' lacks any real value to the discussion.

Marie

RE: Cat anaesthetic Protocols

Anthony Todd — Wed, 30 Nov 2016 19:39:36 GMT

[quote user="Martin Atkinson"]That was absolutely the reason why it happened in my one and only crackle puss.[/quote]

See further replies following....

RE: Cat anaesthetic Protocols

Anthony Todd — Wed, 30 Nov 2016 19:38:02 GMT

[quote user="Evelyn Barbour-Hill"]the cuff on an endotracheal tube is not there to prevent inhalation of stuff, though it does serve as a sort of extra rather pathetic final defence[/quote]

[quote user="Evelyn Barbour-Hill"]It's distressing to read that tracheal damage by the cuff is most often seen after dental procedures, as it implies that some people are still pumping the cuff up hard "because it's a dental".[/quote]

Couldn't agree more, and with your influence we may be able to get the idea across that the tube needs to be disconnected at those pale blue connector thingys between the tube and the wrinkly plastic or heavy black rubber tubes, which are there for a reason, but can be open for a few seconds without death or disaster.

And, somehow, we have to get the idea across that respiration is not a high pressure rocket launching Tour-de-France bike tyre pressure situation but, what, 10cms of water [to be advised, I'm sure].

Cuff pressure needs to be just above that!!