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Should only occur only once endotracheal intubation completed and the patient has stable alveolar ventilation (i.e. no apnoea).
Successful maintenance relies on a number of factors including the choice of volatile agent, the breathing system used and the flow rate.
Good monitoring is a combination of traditional (relying on one’s senses) and modern monitoring equipment. Multi-parameter monitoring is the ideal but never rely upon equipment alone.
Key considerations for monitoring include: Anaesthetic depth, ventilation, the cardiovascular system and body temperature. 44, 53, 54
It is important to keep good records of any anaesthetic and specifically designed monitoring charts are ideal for this.
Look out for trends during the anaesthetic as these are more important than one off values. The charts make for easier hand overs and post op planning and allow the whole team to see when other medications were administered and at which dose.
Obviously your senses – sight, touch, hearing and smell are essential and you will need a thermometer, a pen and a stethoscope (ideally an oesophageal one).
It is important to continuously monitor the heart rate and rhythms well as other parameters linked to the CR system:
The ideal range for an animal under anaesthesia is between 36.5°C and 38.5°C for the dog and cat – this should be checked continuously via a probe or every 30 minutes as a minimum. It is important to maintain temperature body temperature to prevent delayed recoveries.
Many drugs given during premedication can affect the thermoregulatory centre and/or cause peripheral vasodilation, as can induction and volatile agents.
Other risk areas include if the patient is in a cold kennel, is wet and / or stationary and following surgery which has required open body cavities.
Important part of the monitoring process which measures:
Maintenance of blood pressure ensures adequate renal perfusion and therefore aids homeostasis
Mean Arterial BP gives information on the overall driving blood pressure and tissue perfusion. In cats and dogs maintain MAP at >60mmHg minimum, ideally >80mmHg.
Vasodilation results in hypotension and many of the drugs associated with anaesthesia will cause vasodilation.
Measures oxygen saturation of haemoglobin. The sensor is placed on depigmented extremities with a pulsatile capillary bed (e.g. tongue, digits) and the pulse rate is displayed.
Aim for oxygen saturation levels of above 90% (Ideally >95%)
Check airway pressure gauge on ventilators are set appropriately to avoid barotrauma.
Puppies and kittens are prone to hypoglycaemia. Ensure regular checks of blood glucose are performed and suitable treatment is available should it be required.
Un-Premedicated | Premedicated |
Dose for constant rate infusion | |
10 – 11 mg/kg/hour | 7 – 8 mg/kg/hour |
0.16 – 0.18 mg/kg/min | 0.11 – 0.13 mg/kg/min |
0.016 – 0.018 >mL/kg/min | 0.011 – 0.013 mL/kg/min |
Bolus dose for each 10 minutes maintenance | |
1.6 – 1.8 mg/kg | 1.1 – 1.3 mg/kg |
0.16 – 0.18 mL/kg | 0.11 – 0.13 mL/kg |
Un-Premedicated | Premedicated |
Dose for constant rate infusion | |
8 – 9 mg/kg/hour | 6 – 7 mg/kg/hour |
0.13 – 0.15 mg/kg/min | 0.10 – 0.12 mg/kg/min |
0.013 – 0.015 >mL/kg/min | 0.010 – 0.012 mL/kg/min |
Bolus dose for each 10 minutes maintenance | |
1.3 – 1.5 mg/kg | 1.0 – 1.2 mg/kg |
0.13 – 0.15 mL/kg | 0.10 – 0.12 mL/kg |