ISSN 2398-2950      

Anesthesia: in respiratory impairment

ffelis

General

Factors

  • Highest risks are associated with period between sedation and endotracheal intubation Endotracheal intubation, and during the recovery period after extubation.
  • Priority is maintenance of tissue oxygenation.
  • Cats with reduced pulmonary reserve are less able to cope with the sudden changes associated with the onset of general anesthesia General anesthesia: overview.
  • Increased work of breathing because of respiratory compromise is very exhausting for the patient.
  • Accurate diagnosis of any condition causing respiratory impairment is essential in the management of these cases. Anticipation and planning ahead are essential for a good outcome.
  • Extrapulmonary causes of respiratory insufficiency affect pulmonary ventilation:
    • Obstructions: spasm, airway foreign bodies, neoplasia, laryngeal paralysis Larynx disease, stenosis, edema, retropharyngeal abscess.
    • Restrictions: diaphragmatic rupture Diaphragm: hernia, chylothorax Chylothorax, pyothorax, pleural effusion Pleural effusion, pneumothorax Pneumothorax, hemothorax Hemothorax, conditions restricting movement of thoracic wall (flail chest, neoplasia, obesity Obesity, etc), conditions increasing intra-abdominal pressure (ascites, gastric dilatation volvulus complex, etc).
  • Intrapulmonary conditions affect the normal balance between ventilation and perfusion in the lung, eg pulmonary edema Lung: pulmonary edema, neoplasia Lung: pulmonary neoplasia, contusions, embolism, pneumonia Pneumonia.
  • Respiratory distress often results in very distressed patients, especially when onset is acute. Sedation should be considered to prevent patient entering vicious circle and becoming more dyspneic.
  • Cyanosis in the conscious animal occurs with severe pathophysiological changes and indicates high anesthetic risk. It results from increased deoxyhemoglobin and may indicate hypoxia. Cyanosis may be difficult to detect. However, when diagnosed, immediate oxygen therapy is indicated.
  • Respiratory insufficiency is relatively difficult to assess in the absence of severe signs, eg cyanosis. Pulmonary function tests are difficult in animals, especially cats.

Pre-operative assessment

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Pre-operative preparation

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Pre-anesthetic preparation

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Induction and maintenance

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Monitoring during anesthesia

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Recovery of anesthesia

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Miscellaneous

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mathews K A & Dyson D H (2005) Analgesia and chemical restraint for the emergent patient. Vet Clin North Am (Small Anim Pract) 35 (2), 481-515, viii PubMed.
  • Rozanski E & Chan D L (2005) Approach to the patient with respiratory distress. Vet Clin North Am (Small Anim Pract) 35 (2), 307-317 PubMed.

Other sources of information

  • Grubb T (2016) Respiratory compromise. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia. 3rd edn. Duke-Novakovski T, de Vries M, Seymour C J (eds). Chapter 22.
  • Dugdale A (2010) Some respiratory considerations. In: Veterinary Anaesthesia Priniples of Practice. Wiley Blackwell. Chapter 47.
  • Nosworthy G D, Crystal M A, Grace S F & Tilley L P (2003) The Feline Patient. Lippincott Williams & Wilkins, 2nd edn.
  • Muir, Hubbell, Skarda & Bednarski (eds) (2000) Veterinary Anesthesia. 3rd edn. St Louis: Mosby Year Book. pp 455-474.

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