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Anesthesia Induction and Recovery

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Kristin Spring, CVT, VTS (ECC, Anest.), talks through an anesthesia induction with propofol and anesthesia recovery. What are some common anesthesia induction drugs used in your hospital? Which ones do you prefer for your patients and why?

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Kristin Spring's picture
Kristin Spring

CVT CVPP, VTS(Anes.), VTS(ECC)

Enrolled: 08/2011

Megan Brashear's picture
Megan Brashear

CVT VTS(ECC)

Enrolled: 07/2011

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Comments

Theresa Pellicano's picture

I have read that propofol does not cause tissue necrosis. May I have a reference please. : ) Thanks! Terry

Kristin Spring's picture

Basak P, Poste J, Jesmajian S. Propofol extravasation and tissue necrosis. Indian J Dermatol [serial online] 2012 [cited 2012 May 30];57:78-9.
Available from: http://www.e-ijd.org/text.asp?2012/57/1/78/92692

also,
Paediatr Anaesth. 2006 Aug;16(8):887-9.
Extravasation of propofol is associated with tissue necrosis in small children.
Roth W, Eschertzhuber S, Gardetto A, Keller C.
Source
Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria. winfried.roth@uibk.ac.at

Theresa,
Quite a few sources do say and show that extravasation has not caused tissue necrosis in their patients, but it does happen to some. Better to be safe than sorry!

Thomas Taormina's picture

It was a very good video. I always use a butterfly when titrating propofol. It is helpful when using to effect. Thank you.

Sara Gowan's picture

Nice video! I'm going to be using several of these anesth. videos to help train my newbie RVT's! :)

Kristy Stops's picture

We've been using Alfaxan for the last year at our hospital. I like it so much better than propofol for the following reasons: lasts longer (around 5 -8 mins) so you have longer to tube, and you can keep your iso low; less severe side effects - have only seen apnea a handful of times, when dose was too high, and have yet to see bradycardia or hypotension.

Megan Brashear's picture

Kristy, we are SO jealous that you alfaxalone, I've heard about it in a couple lectures and how magical it is! We're still waiting to get here in the US and can't wait to make a video about it!

helen bell's picture

Hi Dove crew;
Quick question: I understand it is standard to wait for the canine patient to swallow or move their tongue before extubation, however, I did wonder at the point when the patient could sit up and was still intubated. With this level of awareness, couldn't she swallow the tube or chew on it?

Megan Brashear's picture

Hi Helen! Most patients, by the time they are sitting sternal, are able to swallow and the tube can be removed, but not all. If the animal is sitting up and looking around they need to be closely monitored because they will (hopefully) be swallowing soon. But an animal who is sternal but not swallowing can still aspirate so that tube should stay in until they are seen swallowing. Brachycephalic breeds are especially prone to being almost awake but not chewing, they need to stay intubated as long as possible.

Robyn Watts's picture

Hi, Thanks for posting your video. I like what you guys are trying to accomplish!
My comment is during the recovery phase - if you deflate your cuff and your patient isn't swallowing yet - then do you not have an unprotected airway?? Aspiration can occur if you have a regurgitation issue at this point no??
Also it seems a bit confusing to call Diazepam a tranquillizer, but then refer to it by it's class (benzo). I realize it can be referred to as a mild tranquillizer, but the quiz lists both as a separate answers and this may be confusing to people who do not have a pharmacology background.

Megan Brashear's picture

Robyn, you are correct, with a deflated cuff aspiration can still happen, and if my anesthetized patient is still in lateral recumbency I will leave the cuff inflated until right before I pull it. In this particular dog, she was already sitting up and moving and I felt comfortable deflating and being ready to remove the tube. And thank you for the comment on the quiz, I will make that question less confusing!

Stephany Lerch's picture

For newly graduated technicians, it is excellent an excellent resource. Thank you all

Patrisha  Cutright 's picture

Great video! What are their any other complications when pulling out intubation tube? I'm currently in my second semester with Penn Foster and I'm working at a hospital so I'm really starting to get more hands on with the patients! Just trying to soak up as much as I can :)

Megan Brashear's picture

Patrisha, complications with extubation are usually related to a complication with the patient, such as aspiration of stomach contents or chewing the tube in half by waking up quickly. As long as the cuff is properly deflated and the tube is proper size, complications just from extubation are rare. Laryngeal irritation can occur but is not normally a problem for the patient.

Julie Fitzpatrick's picture

Have you started using Alfaxan? Any videos? It also has some amazing off label use in cats

Chris Green's picture

Hi Julie,

We have not started using it, we currently have 4 induction options here at DoveLewis, 1. Propofol, 2. Etomidate, 3. Ketamine/Benzodiazepine combo, and 4. Opioid/Benzodiazepine combo for our really debilitated patients. I would love to hear some of the reasons you use it though!