anaesthetic death

RE: anaesthetic death

Gillian Mostyn — Sun, 15 Aug 2021 11:47:18 GMT

Regarding drugs - no - I don't have the time or inclination to research and then list them. I'm just saying there isn't a blanket rule to say all drugs are equally effective s/c.

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/232210#232210"]PS Nobody has told me whether respiration does or does not stop before the heart in GA emergencies??[/quote]

That obviously depends on whether they go into cardiac or respiratory arrest first.

RE: anaesthetic death

Anthony Todd — Sat, 14 Aug 2021 11:52:35 GMT

PS Nobody has told me whether respiration does or does not stop before the heart in GA emergencies??

RE: anaesthetic death

Anthony Todd — Sat, 14 Aug 2021 11:46:44 GMT

The only I/M reaction I ever remember was one. I/M depomed. lame and pain on pressure, no treat and resolved.

S/C none.

I wouldn't want to give every animal every jab I/M!!

Surely vaccs are S/C?

RE: anaesthetic death

Clive Ansell — Sat, 14 Aug 2021 11:09:50 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/232197#232197"] i'm sure there will be animals where S/C will be an advantage on occasions[/quote]

How many are giving injectables s/c when they are only licenced for IM or IV use? Dexafort, Dexadreson and Depo-Medrone spring to mind

RE: anaesthetic death

Anthony Todd — Sat, 14 Aug 2021 09:46:33 GMT

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/232193#232193"]Depends on the drug.[/quote]

Won't concern me, but can you list them, or comment further as I'm sure there will be animals where S/C will be an advantage on occasions

RE: anaesthetic death

Clive Ansell — Sat, 14 Aug 2021 07:55:24 GMT

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/232193#232193"]Depends on the drug.[/quote]

And the species.

I've found that triple combo (medetomadine/opiate of choice/ketamaine) given s/c in rabbits and guinea pigs works as quickly and as effectively as IM, but much less so in cats and dogs. Anecdotal of course

RE: anaesthetic death

Gillian Mostyn — Sat, 14 Aug 2021 07:19:31 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/232180#232180"] I seem to remember being told SC gives the same blood levels almost as quickly??[/quote]

Depends on the drug.

RE: anaesthetic death

Anthony Todd — Fri, 13 Aug 2021 16:52:32 GMT

Do people always give IM? I seem to remember being told SC gives the same blood levels almost as quickly??

RE: anaesthetic death

Julie Innes — Tue, 03 Aug 2021 20:51:53 GMT

Haha Clive, great minds..- I too use the blue needle/ orange needle / green needle due to the domitor/ Amsterdam bottles, thought I was the only one!

I had a nurse try to lecture me I should be using 25g for im injection, but it takes longer, and I've seen someone snap a 25g needle off in the leg of an angry cat!

RE: anaesthetic death

Anthony Todd — Tue, 27 Jul 2021 16:50:01 GMT

In a "normal" GA would I be correct in saying that respiration always stops before the heart? Only because the dramas we had were usually on induction [thio] when they never breathed or sometimes later when respiration appeared to stop.

I think I've mentioned the concentration trap when making up powders..........

What monitors are best for GA ie red traffic lights are better than amber......??

RE: anaesthetic death

ell — Tue, 27 Jul 2021 11:56:49 GMT

We added the death is a risk warning several years ago after noticing that referral centres had increased the number of warnings on their GA consent .

At first I thought that we might be adding too many warnings but now I am very glad that we have a fairly comprehensive list of possible complications. People in general seem more argumentative and less trusting so the more back up you have if or when things go wrong the better.

RE: anaesthetic death

Charlotte Marshall — Sun, 18 Jul 2021 20:59:06 GMT

Personally i give my triple combo i/v if at all possible as then it doesn't sting nearly as much. I always put the ketamine in the syringe first as mentioned previously so it goes in last whether I am giving i/v or i/m. We certainly do not have the time usually to be giving our combo in 2 or 3 doses!

RE: anaesthetic death

Anthony Todd — Sat, 17 Jul 2021 17:05:28 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231326#231326"]how to intubate properly[/quote]

For humans you used to be able to get a tyre pressure guage thingy which told you exactly..... but

Easier is to fill the bag loosely and squeeze it gently [having blown through the tube and then passed it...]

Connect your GA system.

Then, ear near the patient's pharynxlarynx squeeze bag and listen!!

When the pharting just stops, a little bit more [1-2ml only] via your blow-up syringe so the pharting stops.then kink/seal your blow-up tube.

It requires very very low cuff pressure to seal a tube, as it competes only with gentle GA respiration.!! [It's not a F1 tyre!!]

[Finally, after 10x6 edits! But if any one has any better edits please edit this. You /we may stop the next catastrophe!!]

RE: anaesthetic death

Evelyn Barbour-Hill — Fri, 16 Jul 2021 12:50:09 GMT

[quote userid="17318" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231305#231305"]Never used to place cat neuters and spays on gas but now I see they get hooked onto the anaesthetic machine even for a 5 minute procedure, often coming back with laryngeal oedema and spasms from the intubation. [/quote]

Maybe while they were learning up all the monitoring devices, somebody forgot to teach the boring stuff like how to intubate properly?

Thermovents? Yes, every time.

RE: anaesthetic death

Minnie — Fri, 16 Jul 2021 09:36:52 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231316#231316"]I don't where, when and why alll this p***ing about has crept into it. [/quote]

so is it time that we all had a good look and sorted it out before we get any more complications added to the prep routine (and nursing generally)? Vets please get more involved in some of the stuff being taught to your nurses either through the colleges, CPD or even reps and also what is being asked in exams. Teach your nurses to question and be critical , and not to just accept what is fed to them. Please help to get nursing back on track

RE: anaesthetic death

Clive Ansell — Fri, 16 Jul 2021 07:38:56 GMT

[quote userid="13526" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231303#231303"]The rationale for this is because ketamine stings++, and so a lot of cats will react violently to a ketamine injection if they are fully conscious.[/quote]

I think a few cats react that way, but most don't. I normally inject in the large epaxial muscle masses and get very few react to it. Most of the nurses I work with tend to favour the quads or triceps, and seem to get more reactions. Also lots of waffle about needle size, but again I find it makes little or no difference ( I have a personal system where I use blue needle for medetomidine mix, orange for antipamezole, green for nsaid - originally because it matched label colour on Domitor and Antisedan bottles, and just stuck with it. Works for me)

RE: anaesthetic death

Clive Ansell — Fri, 16 Jul 2021 07:31:48 GMT

I did a locum last year, where the qusd combo was split into 3 separate injections; midazolam and opiate --> 10 -15 min later medetomidine --> another 10 -15 minutes Ketamine. God knows why, and takes a stupid amount amount of time. Before each injection TPR has to be measured (again). After ketamine injection another TPR before and after intubation, then have to leak test the ET tube ec, etc etc etc. Will be at least an hour before throwing the first stitch!

Some of these cases are feral or semi feral CPL cats, so just just get more and more stressed with the increased pratting about, which I think increases the GA risk factor.

I don't where, when and why alll this p***ing about has crept into it.

RE: anaesthetic death

Minnie — Thu, 15 Jul 2021 17:15:37 GMT

[quote userid="17318" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231305#231305"]prepping takes forever as the nurses hook anything and everything that beeps and flashes onto the poor animal. Probably a more litigious clientele has led to us doing more cursory monitoring without much clinical benefit.[/quote]

got it in one

RE: anaesthetic death

Anthony Todd — Thu, 15 Jul 2021 16:02:35 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231267#231267"]How concerned should we be?[/quote]

Only in an attempt hopefully for others [my disasters are long gone but never forgotten] when you say "normal and stable" how was that assessed?

We have had nurses gazing at an animal gasping for breathe, great chest movements and regular!!!, but the tube was either kinked of blocked [good ol' Apalert saved the day, again just.....

Or the patient breathing [chest movements, BUT no Apalert 'cos the tube is blocked with gunge or worse, no Apalert 'cos it was not connected or turned off!!!

When our Apalerts stopped irritating people doing dentals and things everyone stopped, and looked at the theatre......!!!

Please realise i'm not trying to score points, claim perfection. or be a smart ass, but I'm sure all dinovets still remember each and every disaster and if we can stop just one....

Usually the reason is embarassing, gross, and very obvious.....

Do nurses always still blow through tubes before they pass them??? [golden oldie] example

PS And always compress the chest, just to be sure??

Geez, in this age of dials and percentages I hope people don't just wait for a gauge to tell them something is going wrong.....

RE: anaesthetic death

Tafara Mapuvire — Thu, 15 Jul 2021 15:38:14 GMT

There is way too much faffing around. On a good day my surgical time on a cat spay is about 5 minutes but the prepping takes forever as the nurses hook anything and everything that beeps and flashes onto the poor animal. Probably a more litigious clientele has led to us doing more cursory monitoring without much clinical benefit. Never used to place cat neuters and spays on gas but now I see they get hooked onto the anaesthetic machine even for a 5 minute procedure, often coming back with laryngeal oedema and spasms from the intubation.

RE: anaesthetic death

niamhjl — Thu, 15 Jul 2021 15:18:10 GMT

The rationale for this is because ketamine stings++, and so a lot of cats will react violently to a ketamine injection if they are fully conscious. If you split it, then they are already quite sedated by the time they get the ketamine and so don’t react to it. I don’t do this myself, personally, but this is why some people do it.

RE: anaesthetic death

Lucy Fleming — Thu, 15 Jul 2021 12:03:08 GMT

[quote userid="6406" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231297#231297"]DTK being split into DT +K 15 mins later I don't really understand? I was told by one vet it gives a smoother recovery but some of the bouncier recoveries I have seen have come from giving the Ket separately - maybe its just me? If somebody can explain to me why its better in a way I will understand I will take it on board[/quote]

I split mine this way, just because I find the ket component particularly stingy for injection (i know some people draw up the ketamine first so it is the last thing into the patient for the same reason) but I don't see any reason to delay prep any further for it... I jab with D+T as a premed, then once they are asleep bring them out, jab them with ketamine and get on with prepping (they're sleepy enough from the premed to get going).

I do agree that the prep phase can be painfully slow sometimes...we are a training practice so obviously can be slow for nurses who are just learning technique but even so...

RE: anaesthetic death

Anthony Todd — Thu, 15 Jul 2021 11:16:15 GMT

In the 60s a very successful vet in inner London used just to part the fur, swab with meths and spay between the fur parting. the "wet" fur kept away from the incision.....

AFAIK his problems were few.

Also pulling skin stitches too tight will usually/always give a subsequent "wound infection".

RE: anaesthetic death

Minnie — Thu, 15 Jul 2021 10:46:22 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29921/anaesthetic-death/231294#231294"]An inordinate amount of faffing seems to take place these days, particularly during the premed and prep phase. It is not unusual for a cat spey to take well over an hour in some places. There seems to be far too much monitoring at every step. Some places now that use triple combo (dom/torb/ket etc) are splitting this into 2 or in one case 3 separate injections with a gap in between. Then before the next injection yet another TPR has to be recorded. I find it annoying and frustrating, and cannot see how it improves patient safety at all[/quote]

was having exactly this conversation with a vet friend a short time ago. DTK being split into DT +K 15 mins later I don't really understand? I was told by one vet it gives a smoother recovery but some of the bouncier recoveries I have seen have come from giving the Ket separately - maybe its just me? If somebody can explain to me why its better in a way I will understand I will take it on board. The one thing I do know is that if you aren't careful and you have a 'cat day' in theatre you are going to lose a lot of op time.

Prep - again it does seem to be a lot more drawn out these days at some places and I do think some of that is coming from nurse training and some from reps eager to push their human products into the veterinary market (be careful which reps you let in - one visit and an impressionable nurse that does the ordering is all it takes). I don't recall having massive episodes of skin prep rashes, wound breakdowns or post op infections using hibi or iodine, or using 1/2 a pack of swabs to prep unless the animal was absolutely filthy and no we weren't giving routine antibiotics either - so what changed?

TPR does not have to be obtrusive and shouldn't be. I know some vets like a detailed running commentary and some prefer peace and quiet but unless the anaesthetic is going south or some other issue as far as I'm concerned I work around the surgeon not the other way round. I know the vet I used to work with was not impressed by having a sh***y thermometer wafted around at regular intervals near his op site and neither was I.

How much of how we work now is really down to patient safety and how much is down to protecting the operating team having to demonstrate 'standards'

RE: anaesthetic death

Anthony Todd — Thu, 15 Jul 2021 10:38:33 GMT

Anyone actually recording times from, say cage to cage or splitting stages? eg Cage,prep, skin incision, skin closed, cage etc. And while all the monitors are being connected who is, and how is respiration monitored.

Patients stop breathing always before the heart stops [apart from gross overdose of anaaesthetic agent.]