SUPPLEMENT
AAHA Anesthesia Guidelines for Dogs and Cats
Crisis Management: How to Handle
Emergencies and Complications
What Really Works in Anesthetic and
Perioperative Care
RALPH HARVEY, DVM, MS, DACVA
Distribution of these papers is sponsored by a
generous educational grant from Abbott Animal Health.
Crisis Management: How to Handle Emergencies
and Complications
RALPH HARVEY, DVM, MS, DACVA
Things Can Go Wrong!
problems from minor excess physiologic depression
Anesthesia is intended to be a controlled, benign, and
to death.
reversible process. Unfortunately, anesthetic drugs
produce their effects primarily by limited depression
An overdose with barbiturates should be managed
of vital processes. The inherent dangers of anesthesia
with physiologic support of ventilation, continuous
and the debilitation of injuries and illness that require
monitoring of cardiopulmonary function, and IV
anesthesia and surgery predispose the patient to risks
fluid therapy to speed recovery and improve cardio-
of serious complications and emergencies. Most anes-
pulmonary function. In the context of cumulative
thetic complications and emergencies can be related
overdoses from repeated injections of barbiturates
to human errors, equipment problems, ventilatory
to prolong anesthesia, the intravenous administra-
problems, or circulatory problems. Most anesthetic
tion of bicarbonate at 0.5 to 1.0 mEq/kg can speed
emergencies and complications can be prevented or
recovery from barbiturate overdose by favoring elim-
adequately managed.
ination. The nonspecific stimulant-antagonist drug,
doxapram, can be dangerous in treating depression
Human Error
due to barbiturate overdose. This stimulant can result
Human error is ultimately responsible for the major-
in very deleterious stress and should not substi-
ity of problems encountered with anesthetic manage-
tute for good care and proper dosing of anesthetics.
ment. The importance of vigilance in anesthetic care
Overdoses with other anesthetics are also managed
cannot be overemphasized. It has been noted that
with supportive care, which is often adequate in mild
hundreds of errors are made due to not looking for
to moderate overdose situations.
every one error made due to not knowing.
Fortunately there are specific antagonist drugs availIt should be recognized that there is a significant degree
able to counteract the effects of some anesthetic
of safety with familiarity. Errors are more common
drugs. For narcotics, the pure antagonist agent,
when the anesthetist is not familiar with either the
naloxone, will reverse effects of an overdose. With a
drugs or equipment being used. Miscalculation of
large overdose or a longlasting narcotic, renarcoti-
anesthetic drug doses is a common error. The narrow
zation can occur with a return to the effects of the
therapeutic index of most anesthetic drugs makes
narcotic agent. For the tranquilizer/sedatives xylazine
correct dose determination or titration crucial. An
and dexmedetomidine, and other alpha-2 agonists,
absolute or relative overdose of anesthetic can cause
there are specific antagonists available. One of these,
Adapted from AAHA/OVMA Toronto 2011 Proceedings © 2011 American Animal Hospital Association. All rights reserved.
2
Crisis Management: How to Handle Emergencies and Complications
yohimbine, was approved for use in dogs years ago
vaporizers, vaporizers filled with the wrong agent,
to reverse the effects of xylazine. Atepamezole is a
or overfilled vaporizers are common problems.
better antagonist for dexmedetomidine and is often
Delivery of nitrous oxide in combination with too
effective by titration of reduced doses (approved for
little oxygen should be carefully avoided and is not
SC administration) to secure prompt recovery with
always prevented by “fail-safe” systems incorporated
less excitement and stress than would result from the
in modern machines.
administration of a higher dose.
Kinked or plugged endotracheal tubes cause respiraNonspecific partial reversal of anesthetic depression
tory obstruction. Improper cuff inflation can result
is possible by administration of the respiratory stim-
in obstruction, tracheal injury, or allow for aspira-
ulant doxapram, but this is usually not an appropri-
tion pneumonitis. Improper placement of endotra-
ate replacement for positive pressure ventilation and
cheal tubes is very common, even in species that are
other supportive care. Although the net effect can
easily intubated. Correct placement should always be
be life saving, nonspecific reversal has been associ-
verified.
ated with residual undesirable effects related to CNS
stimulation and even deaths! Other stimulants have
An inability to adequately fill the rebreathing bag or
been advocated to correct excessive effects of vari-
to provide positive pressure ventilation by squeez-
ous anesthetics, but the benefits are usually very
ing the bag often indicates major leaks or discon-
limited.
nections. These can result in a failure to deliver
anesthetics and oxygen and substantially contribute
Anesthetics administered by an incorrect route can
to anesthetic gas pollution of the veterinary hospi-
have very adverse effects. The extravascular injection
tal. Stuck valves in the anesthesia machine or circuit
of barbiturates can cause severe irritation and slough-
can cause difficulty in ventilation. Inappropriate
ing of surrounding tissue. Extravasation should be
rebreathing of exhaled gases or the accumulation of
treated immediately with generous infiltration of
excessive pressure results. Patients that consistently
the site with lidocaine and saline, followed by warm
seem to be too deep or too light may indicate that
compresses. Errors in the administration of anesthet-
the vaporizer is out of calibration due to wear and
ics also include the misidentification of drugs and
tear, there is accumulation of deposits within the
accidental use of the wrong medication.
vaporizer, or other factors. These common problems
emphasize the importance of regular inspection and
Equipment Problems
maintenance of equipment.
Among the most serious anesthetic complications
is the failure to deliver oxygen to the patient. This
Electrical problems with monitoring or support-
can be caused by respiratory obstruction or misused
ive equipment risk injury to personnel as well as to
or defective anesthetic equipment. Empty tanks or
patients. Inadequately grounded or protected equip-
misconnected gas lines and breathing circuits prevent
ment can cause electrical burns, electrocution, or
the delivery of oxygen. Such problems must be recog-
fires. Unsafe or substandard equipment should be
nized and corrected immediately. Empty anesthetic
repaired or replaced.
3
Crisis Management: How to Handle Emergencies and Complications
Ventilatory Complications
appropriately treat the problem. Incorrect manage-
Hypoventilation due to anesthetic overdose is one
ment may compound the problem and cause decom-
of the most frequently encountered and serious
pensation and immediate deterioration.
complications in anesthesia. Inadequate breathing occurs with either relative or absolute over-
Cyanosis rarely occurs in anesthetized patients breath-
doses of many anesthetics. Weakened, debilitated
ing oxygen. In order for cyanosis to develop, hemo-
animals are more susceptible to the ventilatory
globin must be present in sufficient quantities and in
depression that may occur secondary to circula-
the reduced (non-oxygenated) state. Hypoxemia that
tory depression and inadequate perfusion of CNS
accompanies anemia therefore will not become evident
respiratory centers, electrolyte imbalances, muscle
through cyanosis. When cyanosis of either mucous
relaxant drugs, or thoracic injury. Support of venti-
membranes or blood in the operative field does occur,
lation requires endotracheal intubation and posi-
oxygen should be administered and adequate ventila-
tive pressure breathing, preferably with oxygen.
tion and pulse quality should be ensured.
Identification and correction of the primary problem is then undertaken.
Bradycardia
Bradycardia is often associated with procedures or
Hyperventilation is often due to inadequate anes-
drugs that cause increases in vagal parasympathetic
thetic depth and represents an excessive response to
nervous system tone. Difficult endotracheal intuba-
surgical stimulation. It is important to rule out the
tions, deep abdominal surgical procedures, intraocu-
possibility of carbon dioxide accumulation, due to
lar surgeries, and some surgeries on the neck or in
exhausted absorber granules or improper connec-
the thorax can all cause vagal-mediated bradycardia.
tion of the breathing circuit, as the cause of hyper-
Atropine or glycopyrrolate administration is effec-
ventilation. Panting can occur with narcotics and
tive in prevention of most vagal effects. Treatment
thereby decrease the effective ventilation. Most often
after the vagal effects become evident is often less
this represents an inconvenience to the surgeon. A
rewarding.
less common cause of panting is actual hyperthermia. Erratic or jerky breathing patterns also usually
Non-vagal bradycardias may result from exces-
indicate improper anesthetic depth. As before, airway
sive anesthetic depth, hypoxia, or hypothermia.
obstruction and various causes of carbon dioxide
Bradycardia can be a very serious sign of a significant
accumulation should be ruled out.
anesthetic emergency. Administration of atropine
and attention to possible causes is imperative.
Pallor and Cyanosis
that it may occur as a compensatory response to
Cardiopulmonary Arrest and
Cardiopulmonary-Cerebral Resuscitation
either excessively light or deep planes of anesthesia.
Every member of a veterinary hospital staff should
Reduced cardiac output due to anesthetic depression
be prepared to constructively contribute in an emer-
or increased sympathetic tone due to pain can cause
gency resuscitation. Although not addressed here,
pallor. It is important to identify the cause in order to
CPCR must be addressed in every hospital.
Pallor of mucous membranes is a complex sign in
4
Crisis Management: How to Handle Emergencies and Complications
Hypotension
ment of anesthetic plane, and support measures to
Hypotension is caused by either decreased cardiac
avoid cardiovascular deterioration are necessary.
output, increased capacitance of the vasculature, or
inadequate blood volume. Intraoperative fluid therapy
Ventricular tachycardias are a much more serious
at 10 ml/kg/hr is often appropriate for replacement in
emergency. An occasional ventricular ectopic beat
many surgical patients, but increased volumes can be
is cause for concern but not necessarily indicative
necessary. Clinical evaluation to distinguish between
of patient distress. When ventricular arrhythmias
hypovolemia and reduced cardiac-output states as
become frequent or progress to ventricular tachy-
causes of hypotension can be based on patient history
cardia, immediate treatment is required. Ventricular
and evaluation, including central venous and arterial
arrhythmias indicate an irritated, hypoxic, or
pressures.
diseased myocardium.
Vasodilatation is a very common side effect of many
Ventricular tachycardia should be treated with intra-
anesthetic drugs. The tranquilizer acepromazine is a
venous bolus injection of 2% lidocaine at a dose of
hypotensive drug, particularly at higher doses. The
1, 2, or 3 cc in small-, medium-, or large-size dogs
volatile anesthetics also cause significant vasodilata-
respectively. This rule of thumb will allow for imme-
tion. Most anesthetics also are potent cardiac depres-
diate therapy without an accurate dose calculation,
sants, again particularly at higher doses. Hypotension
which could contribute to a life-threatening delay. It
under anesthesia is therefore most appropriately
has been recommended that propranolol is the drug
managed by reduction of anesthetics and fluid
of choice for treating ventricular arrhythmias in cats.
administration as primary management.
Lidocaine is also effective in cats. Total dose limitation is more important in cats due to their smaller
Tachycardia
body size and blood volume.
Heart rates above 180/min in dogs and 200/min in
cats are associated with decreased efficiency and
Success in emergency management of ventricular
increased workload. Tachycardia can be due to fear,
arrhythmias is evaluated by continuous ECG moni-
pain, inadequate anesthetic depth, pre-anesthetic
toring. Bolus injections of lidocaine can be repeated
excitement, or a rough induction of anesthesia.
to a total accumulated dose of about 10 mg/kg without
Hypotension causes a compensatory tachycardia.
significant risk of overdose. When two or three injec-
These causes of supra-ventricular tachycardia should
tions are required over a period of 15–20 minutes, it
be recognized and treated.
is necessary to convert to a continuous IV infusion of
lidocaine at 30–80 micrograms/kg/min. Refractory
Compensatory tachycardia in response to hypovole-
arrhythmias may require conversion to therapy based
mia and hypotension results in decreased coronary
on alternative antiarrhythmic medication.
artery blood flow and increased myocardial workload. If other conditions contribute to hypoxia there
Delayed Recovery
is significant risk of development of more serious
Delayed recovery from anesthesia is managed by
arrhythmias. Fluid therapy for hypovolemia, adjust-
recognition of differential causes and a rule-out of
5
Crisis Management: How to Handle Emergencies and Complications
individual possibilities. A systematic approach to
field resistance electric heating systems are very
potential causes will provide for balanced care, with
effective and can be much less costly to use.
correction of often multiple factors such as hypothermia, inadequate fluid support, reduced metabolism
Warm water bottles or surgical gloves filled with
or clearance of drugs, and debilitation associated
warm water have been shown to be rather inef-
with the stress of anesthesia and surgical trauma.
fective in raising the body temperature of hypo-
Deterioration due to a hypoxic episode must be
thermic patients and at the same time constitute a
considered.
significant risk of causing thermal burns at the site
of contact. Circulating warm water blankets are a
Hypothermia
much better alternative to warm water bottles or
Hypothermia is among the most common of
gloves, but these are of limited efficacy in rewarm-
anesthetic complications. Body heat is lost with
ing hypothermic patients. Forced warm air heating
preparation of the surgical site, contact with
systems are more effective than circulating warm-
cool surfaces such as surgical tables, breathing of
water blankets and can also be used to cool hyper-
dry anesthetic gases, and evaporation from the
thermic patients when set to deliver unheated
airways and the surgical field. Moderate hypo-
ambient air. Proper use of forced air systems must
thermia is a frequent problem, even with atten-
include some type of dispersive blankets to envelop
tion to each of these factors. Body temperatures
the patient in warmed air and avoid hot spots by
down to approximately 92°F increase oxygen
distributing the warmed air. The dispersive blan-
and energy requirements during recovery, but
kets and the high consumption of electricity both
most patients can tolerate this level of hypother-
increase the cost of use of the forced warm air
mia. More extreme hypothermia causes delayed
systems.
recovery, reduces tissue perfusion, and increases
morbidity and mortality.
Other Complications
Many other complications and emergencies can
The risks of thermal injury are so great with older
occur during or be associated with anesthesia. These
consumer-style electric heating pads that their use
include anaphylactic-like reactions, hyperthermia,
in anesthetized, sedated, or depressed (many criti-
biochemical imbalances, gastroesophageal reflux,
cally ill) patients is considered extremely hazard-
regurgitation, vomiting, aspiration, and many surgi-
ous. A very different dispersed field or amorphous
cal complications such as hemorrhage and pneu-
resistance electrical heating blanket to avoid ther-
mothorax. Avoidance of complications and effective
mal injury and safely warm the patient is now avail-
management of emergencies requires continued vigi-
able from at least two sources. These new dispersed
lance and immediate appropriate action.
6
What Really Works in Anesthetic and
Perioperative Care
RALPH HARVEY, DVM, MS, DACVA
In recent years, anesthesia has become better and
North American colleges of veterinary medicine.
safer, in that we are now able to provide successful
Through the North American Veterinary Technician
anesthetic management for patients who would not
Association, licensed veterinary technicians may
have had a reasonable chance a few years ago. In many
now pursue Veterinary Technician Specialist certi-
cases, these are even managed as outpatients, quickly
fication in anesthesia with advanced training and
returned to their owners in full recovery. Our choice
skills in veterinary anesthesia and membership in the
of anesthetic drugs has greatly expanded, and safer
Association of Veterinary Technician Anesthetists.
anesthetic agents are indeed responsible for much of
the improvement noted. The use of more sophisti-
Monitoring and Attention to Detail
cated monitoring and better physiologic support has
In addition to veterinarians, well-trained technicians
become widespread, with continued rapid growth
continuously evaluate the patient throughout anes-
apparent in this area. In spite of increased owner
thesia. Awareness of the ever-changing condition of
expectations and the fact that veterinarians now have
the anesthetized patient is a shared responsibility that
sicker patients presenting with concurrent diseases,
can only be shared effectively and safely when the
injuries, or debilitation, we can increasingly manage
medical team works together. We intend to remain
our patients successfully with the improvements in
aware of even subtle changes in patient status under
anesthesia and related perioperative care.
anesthesia. We must always recognize that challenges
to the welfare of our patients come not only from
Better Training and Ongoing Training
their underlying illness or injury, but also as unde-
This paper on veterinary anesthesia helps to provide
sired effects that even the best anesthetic care may
an update on current and developing methods.
present.
Continuing education seminars and numerous
other contemporary publications attempt to further
Modern monitoring equipment is increasingly avail-
these same goals. The education of veterinar-
able at reasonable cost for veterinary use. We no longer
ians and veterinary technicians now includes rather
need to rely upon out-of-date, poorly serviced, unsafe,
extensive attention to anesthesia and related topics.
and inappropriate equipment that has been discarded
Veterinarians with advanced training in anesthesia
from human patient use. Fortunately, however, there
and board certification by the American College of
is good-quality equipment still available from the
Veterinary Anesthesiologists are now involved in
human patient market. Increasingly, that equipment
the training of new veterinary students at almost all
now can be found with good warranty protection,
Adapted from AAHA/OVMA Toronto 2011 Proceedings © 2011 American Animal Hospital Association. All rights reserved.
7
What Really Works in Anesthetic and Perioperative Care
recent service records, and, importantly, with design
able inhalant, sevoflurane, can be used to provide for a
and function capabilities well suited to veterinary
remarkably rapid yet smooth induction and recovery
patient needs. There is also good-quality equipment
from anesthesia, and can provide for a rapid change in
available specifically for the veterinary patient. Medical
the level of anesthesia as needed. Appropriate use of
equipment sold exclusively for veterinary use does not
these new agents requires skill and knowledge and will
receive the degree of oversight and approval required
be addressed more fully. All anesthetics have a limited
for human-use equipment. In spite of this, there is
therapeutic index, or margin of safety. All can depress
very good veterinary-specific medical equipment. The
vital functions, and inappropriate use can result in
demands of veterinarians, and of animal owners, for
loss of life. It is useful to remember the old guideline:
improved anesthetic delivery, monitoring, and support
“There are no safe anesthetics, just safe anesthetists.”
has fueled the growth of this industry.
While we enjoy a wealth of new options and opportuNo longer is the application of relatively advanced
nities in veterinary anesthesia, we must make changes
monitoring equipment and anesthesia machines
in our anesthetic strategies carefully, recognizing
limited to academic institutions or referral practices
that experience is necessary to identify any abnor-
with heavy surgical caseloads. Monitoring of electro-
mal responses from those that should be expected.
cardiogram, temperature, blood pressure, and pulse
Careful and conservative use of any new anesthetic
oximetry are rapidly becoming more routine, even in
or technique is crucial. “Nobody likes an adventurous
general veterinary practices. Airway monitoring of
anesthetist!”
carbon dioxide and anesthetic gases in the breathing
circuit is also becoming more popular. Proper use of
Individualized Anesthetic Care
these technologies requires a good working knowl-
Much more important than the choice of which
edge of the normal values, the significance of devia-
specific anesthetic drugs or equipment we use,
tions, and an understanding of appropriate manage-
however, is the manner in which we select them and
ment options.
the skill and care with which they are used in our
patients. Best use of various options requires an indi-
New Options in Anesthetics
vidualized approach to anesthetic management. In
Through the use of a good variety of injectable and
treating infectious diseases, veterinarians wouldn’t
inhalant anesthetics, great anesthetic safety and
choose the same antibiotic for every patient or condi-
convenience is possible for our patients. Remarkable
tion encountered. Similarly, the best choice among
improvements have developed in outpatient anesthe-
options in anesthetic care requires recognition of
sia. The recent popularity of several injectable anes-
individual needs and individual risk factors, which
thetics, most popularly propofol, has greatly improved
vary widely among veterinary patients. We recognize
our options. Product shortages have resulted from the
breed sensitivities and relative contraindications in
removal of defective generic products, but we can
the choice of anesthetics. For many years, breed asso-
manage this temporary supply-and-demand issue.
ciations have provided warnings based on anecdotal
Isoflurane has been the strongly predominant inhal-
reports. With continued research, some of these have
ant anesthetic for several years. The more newly avail-
been or will be substantiated. Others perhaps will
8
What Really Works in Anesthetic and Perioperative Care
be refuted. In the absence of clarifying data, caution
the family for more years. With an aging pet popula-
dictates selection and use of the best anesthetics from
tion, and with keen interest in keeping pets as very
among the many choices available.
functional members of the family group, we have the
opportunity to care for many more geriatric patients.
Patient differences that are important in anesthetic
These much-loved pets often receive more extensive
care are obviously not only those that relate to species,
pre-anesthetic evaluations, which help to identify
breed, and age differences. As a simple example,
marginal reserve function and any subclinical organ
patients undergoing elective surgery or those who are
disease or dysfunction. Geriatric patients have dramat-
traumatically injured both need analgesic therapy.
ically reduced requirements for many anesthetics and
Opioid analgesics, for instance, have varying efficacy
could be overdosed at standard recommended drug
and duration of action. The range of choices allows
doses. Armed with this information, the veterinarian
for brief, mild analgesia such as for an outpatient
can individualize anesthetic care to minimize the risks
neuter, all the way to profound analgesia for the care
of complications. Typical of this patient type would
of a substantially traumatized animal.
be the older dog presented for routine dental care.
Through our improved care, we can extend not only
Pre-anesthetic Evaluation and
Screening
the lifespan, but also the “healthspan” of these animals.
Better anesthetic care also includes a more thorough
Outpatient Anesthesia
pre-anesthetic evaluation, which can fit nicely into a
As human patients, we expect to have most mini-
comprehensive approach of well-patient care and the
mally invasive medical procedures, and even many
work-up of the non-elective patient. Pre-anesthetic
substantial surgeries, conducted on an outpatient or
evaluations should be tailored to the needs of the
same-day basis. Reduced hospital costs are not the
patient. For example, the pre-anesthetic evaluation
only concern driving this change in human patient
of a diabetic patient would include blood glucose
care. Everyone is happier and can return to daily
determination(s) to help guide physiologic support
routines more quickly with shorter hospital stays.
as a part of the anesthetic care. Basic physical findings
This applies to veterinary medicine as well. Better
may lead to more extensive evaluations. For example, if
anesthetic care is a major component of this change.
a heart murmur is detected in a young cat, an echocar-
Clients personally experience it in their own medical
diogram may be performed to rule out cardiomyopa-
care from the perspective of patients, and now they
thy before subjecting the animal to the stresses of anes-
expect it in the veterinary care we deliver for their
thesia. Not all patients need the same level or intensity
pets as well. Reliable, fast, and smooth recovery from
of pre-anesthetic evaluation or screening. Matching
anesthesia is a wonderful feature of many of the more
the process to the patient becomes cost effective for the
modern anesthetic methods. While every patient
pet owner as well as for the practice owner.
differs, we’ve come to expect more and more of our
patients to bounce back quickly.
Geriatric Patient Care
It is fortunate that the improved role of pets in our
Prior Preparation Prevents Problems
society has in various ways kept animals as a part of
Readiness includes anticipation of contingencies and
9
What Really Works in Anesthetic and Perioperative Care
willingness to consider, and perhaps move along
Supportive Care
to, what we have in mind as the “Plan B” for that
As an example of basic physiological support, the
patient. This is recognition of whatever else might
provision of fluid therapy and appropriate patient
be likely to happen for this animal other than the
warming devices is increasingly commonplace in
expected course of events. Those who are ready
veterinary anesthetic care. Fluid therapy is an appro-
for these contingencies can intercept developing
priate measure to compensate for the vasodilatation
problems before they reach the “crisis” stage. This
and hypotension that can commonly occur with the
requires attentiveness to warning signs. Good anes-
best of anesthetic techniques. We also recognize,
thetic monitoring and appropriate responses to
through the increased use of blood pressure monitor-
changing patient status are much more successful
ing, that many of our patients can become hypoten-
strategies for patient care than would be any level of
sive. Our older patients may be particularly suscep-
expertise in crisis management.
tible to deleterious consequences of inadequate tissue
perfusion.
Pain Management
Our clients expect optimal control of animal pain.
Patient warming devices that gently circulate warm
Clients expect the best in anesthetic survival and in
air or warm water have replaced dangerous electric
relief of pain. Their most basic expectations are that
heating pads and bags or bottles of warm (or hot)
their pet will survive and that it will not hurt. We do
water. All too often, electric heating pads and hot
have the tools available to effectively manage proce-
water bags and bottles have either burned animals
dural, traumatic, and perioperative pain. We also
or failed to properly prevent hypothermia. With
have increasingly fine methods for very effectively
individualized patient management, which includes
managing the more chronic pains of degenera-
physiologic support, those animals with particular
tive joint disease and cancer. The three principles of
needs or susceptibilities are better prepared for the
effective pain management are: (1) preemptive anal-
rigors of anesthesia and surgery.
gesia, (2) balanced analgesia, and (3) willingness to
dose to effect. Application of these principles can
A very different dispersed field or amorphous resis-
help us devise very effective pain management for
tance electrical heating blanket to avoid thermal
every patient. Smart use of analgesic strategies offers
injury and safely warm the patient is now available
tremendous benefit through relief of unnecessary pain
from at least two sources. These new dispersed field
and suffering. Improvements in the areas of the recog-
resistance electric heating systems are very effective
nition and management of animal pain have been
and can be much less costly to use. Forced warm air
arguably greater than in any other aspect of veterinary
heating systems are more effective than circulating
anesthesia. Benefits include not only improved patient
warm-water blankets and can also be used to cool
comfort, but also reduced anesthetic requirements,
hyperthermic patients when set to deliver unheated
shortened hospital stays, improved immune function,
ambient air. Proper use of forced air systems must
and reduced morbidity and mortality.
include some type of dispersive blankets to envelop
the patient in warmed air and avoid hot spots by
Good quality pain relief is also very cost effective.
distributing the warmed air. The dispersive blankets
10
What Really Works in Anesthetic and Perioperative Care
and the high consumption of electricity both increase
care is indeed moving forward. Many animal owners
the cost of use of the forced warm air systems.
assume that the veterinary anesthetic care and pain
management their animals receive are already at a very
Summary
high level of sophistication, perhaps even comparable
There seems to be little upper limit to the sophisti-
to that afforded to human patients. Our obligation to
cation of medical care demanded by the pet-owning
do the best we can for our patients and for our clients
public. Improvements in all areas of veterinary medi-
requires that we move forward and maintain very
cine are being rapidly embraced. The standard of
high standards in providing anesthesia and analgesia.
11