BOOK
Perioperative Care, An Issue of Veterinary Clinics of North America: Small Animal Practice, E-Book
(2016)
Additional Information
Book Details
Abstract
This issue, Guest Edited by Dr. Lori Waddell, focuses on Perioperative Care in dogs and cats. Articles include: Oxygenation and ventilation, Heart rate and rhythm, Acid/base and electrolyte disturbances, Blood pressure management, Thermoregulation, Anemia and oxygen delivery, Analgesia, Assessment of perfusion and fluid balance, Hemostasis monitoring and treatment, and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Perioperative Care | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Perioperative Monitoring\r | vii | ||
| Assessment of Fluid Balance and the Approach to Fluid Therapy in the Perioperative Patient\r | vii | ||
| Anemia and Oxygen Delivery\r | vii | ||
| Oxygenation and Ventilation\r | vii | ||
| Perioperative Acid-Base and Electrolyte Disturbances\r | vii | ||
| Perioperative Monitoring of Heart Rate and Rhythm\r | viii | ||
| Perioperative Blood Pressure Control and Management\r | viii | ||
| Inadvertent Perianesthetic Hypothermia in Small Animal Patients\r | viii | ||
| Postoperative Hemostasis Monitoring and Management\r | ix | ||
| Analgesia in the Perioperative Period\r | ix | ||
| Nursing Care: Care of the Perioperative Patient\r | ix | ||
| Wound Care\r | ix | ||
| Peri-Surgical Nutrition: Perspectives and Perceptions\r | x | ||
| VETERINARY CLINICS OF\rNORTH AMERICA: SMALL\rANIMAL PRACTICE\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| November 2015 | xi | ||
| January 2016 | xi | ||
| March 2016 | xi | ||
| RECENT ISSUES | xi | ||
| July 2015 | xi | ||
| May 2015 | xi | ||
| March 2015 | xi | ||
| Perioperative Monitoring | xiii | ||
| Assessment of Fluid Balance and the Approach to Fluid Therapy in the Perioperative Patient | 895 | ||
| Key points | 895 | ||
| INTRODUCTION | 895 | ||
| THE IMPORTANCE OF MONITORING | 896 | ||
| FLUID BALANCE IN PERIOPERATIVE PATIENTS | 897 | ||
| THE ROLE OF THE PHYSICAL EXAMINATION IN ASSESSING PERFUSION AND HYDRATION | 898 | ||
| APPROACH TO FLUID THERAPY IN THE PERIOPERATIVE PATIENT | 899 | ||
| Acute Resuscitative, Rehydration, and Maintenance Fluid Therapy | 900 | ||
| Acute resuscitative fluid therapy | 900 | ||
| Rehydration fluid therapy | 900 | ||
| Maintenance fluid therapy | 900 | ||
| Preoperative Fluid Balance | 901 | ||
| Intraoperative Fluid Balance | 901 | ||
| Postoperative Fluid Balance | 902 | ||
| Intravenous Fluid Types | 902 | ||
| Risk Factors for Developing Complications of Fluid Therapy | 904 | ||
| RESUSCITATION ENDPOINTS AND GOAL-DIRECTED THERAPY | 905 | ||
| UPSTREAM ENDPOINTS OF RESUSCITATION | 906 | ||
| Arterial Blood Pressure | 906 | ||
| Shock Index | 907 | ||
| Central Venous Blood Pressure | 907 | ||
| DOWNSTREAM ENDPOINTS OF RESUSCITATION | 909 | ||
| Lactate | 909 | ||
| Central and Mixed Venous Oxygen Saturation (ScvO2/SvO2) | 909 | ||
| Venoarterial CO2 Gradient | 911 | ||
| DIRECT ASSESSMENT OF THE MICROCIRCULATION | 911 | ||
| CURRENT CONTROVERSIES AND FUTURE CONSIDERATIONS | 911 | ||
| SUMMARY | 912 | ||
| REFERENCES | 912 | ||
| Anemia and Oxygen Delivery | 917 | ||
| Key points | 917 | ||
| INTRODUCTION | 917 | ||
| DETERMINANTS OF TISSUE OXYGENATION | 917 | ||
| HEMOGLOBIN | 919 | ||
| MICROVASCULAR DETERMINANTS OF OXYGEN DELIVERY | 920 | ||
| Rheologic Control of Arteriolar Tone | 920 | ||
| Precapillary Oxygen Delivery | 921 | ||
| Microvascular Variations in Hematocrit and Blood Viscosity | 921 | ||
| Plasma Skimming | 923 | ||
| ANEMIA | 923 | ||
| PHYSIOLOGIC ADAPTATIONS TO ANEMIA | 924 | ||
| Cardiac Output | 924 | ||
| Oxygen Extraction | 925 | ||
| CLINICAL APPROACH TO ANEMIC PATIENTS | 925 | ||
| Assessment of Tissue Oxygenation | 925 | ||
| Methods for Enhancing Oxygen Delivery and Tissue Oxygenation | 926 | ||
| SUMMARY | 927 | ||
| REFERENCES | 927 | ||
| Oxygenation and Ventilation | 931 | ||
| Key points | 931 | ||
| PREDICTING RESPIRATORY CONCERNS | 931 | ||
| Evaluation | 931 | ||
| TYPES OF SURGICAL PROCEDURES | 932 | ||
| IMMEDIATE POSTOPERATIVE SUPPORT | 933 | ||
| HYPOXEMIA | 933 | ||
| HYPOVENTILATION | 937 | ||
| Combined Ventilatory and Oxygenation Failure | 939 | ||
| SUMMARY | 939 | ||
| REFERENCES | 940 | ||
| Perioperative Acid-Base and Electrolyte Disturbances | 941 | ||
| Key points | 941 | ||
| INTRODUCTION | 941 | ||
| PREOPERATIVE DERANGEMENTS | 943 | ||
| Metabolic Acidosis | 943 | ||
| Lactic Acidosis | 944 | ||
| Hyperkalemia | 945 | ||
| Hypochloremic Metabolic Alkalosis | 946 | ||
| INTRAOPERATIVE DERANGEMENTS | 947 | ||
| Hypoxemia/Hypercapnia | 947 | ||
| POSTOPERATIVE DERANGEMENTS | 948 | ||
| Hypernatremia | 948 | ||
| Renal Tubular Acidosis | 949 | ||
| SUMMARY | 950 | ||
| REFERENCES | 950 | ||
| Perioperative Monitoring of Heart Rate and Rhythm | 953 | ||
| Key points | 953 | ||
| NATURE OF THE PROBLEM | 953 | ||
| Introduction | 953 | ||
| Mechanisms of Arrhythmia Formation | 954 | ||
| Role of Transient Imbalances | 955 | ||
| APPROACH TO MANAGEMENT | 955 | ||
| Diagnosis of Perioperative Arrhythmias | 955 | ||
| Decision to Treat | 955 | ||
| Therapeutic Options | 958 | ||
| MONITORING AND CLINICAL OUTCOMES | 959 | ||
| COMPLICATIONS AND CONCERNS | 961 | ||
| SUMMARY | 962 | ||
| REFERENCES | 962 | ||
| Perioperative Blood Pressure Control and Management | 965 | ||
| Key points | 965 | ||
| BLOOD PRESSURE CONTROL | 966 | ||
| Ultra-Short-Acting Blood Pressure Control Systems | 966 | ||
| Short-Acting Blood Pressure Control Systems | 966 | ||
| Long-Acting Control Systems | 967 | ||
| Causes of Hypotension During Anesthesia | 967 | ||
| Indirect Indicators of Hypotension | 968 | ||
| CONDITIONS THAT MAY ALSO CAUSE HYPOTENSION | 968 | ||
| Hypoxemia | 968 | ||
| Hypercapnia | 968 | ||
| Intermittent Positive Pressure Ventilation | 969 | ||
| Local Anesthetics Used for Spinal or Epidural | 969 | ||
| Surgical Procedures and Position of Animal | 969 | ||
| Abdominal Distention | 969 | ||
| Closed Exhaust Valve on the Anesthetic Breathing System | 969 | ||
| Tension Pneumothorax | 969 | ||
| Electrolyte and Acid/Base Imbalances | 969 | ||
| Hypothermia | 970 | ||
| Pulmonary embolism | 970 | ||
| Hypersensitivity Reaction | 970 | ||
| BLOOD PRESSURE SUPPORT | 970 | ||
| Fluid Therapy | 970 | ||
| Anticholinergics | 970 | ||
| Atropine | 971 | ||
| Glycopyrrolate | 971 | ||
| Sympathomimetics | 971 | ||
| Mixed inotropes and vasopressors | 971 | ||
| Dopamine | 971 | ||
| Ephedrine | 972 | ||
| Norepinephrine | 972 | ||
| Epinephrine | 972 | ||
| Inotropes | 972 | ||
| Dobutamine | 973 | ||
| Vasopressors | 973 | ||
| Phenylephrine | 973 | ||
| Vasopressin | 973 | ||
| CARDIOVASCULAR ACTIONS OF DRUGS USED FOR PREANESTHETIC MEDICATION | 973 | ||
| Acepromazine | 973 | ||
| Benzodiazepines | 973 | ||
| α-2 Adrenergic Agonists | 974 | ||
| Xylazine | 974 | ||
| Medetomidine and dexmedetomidine | 974 | ||
| OPIOIDS | 974 | ||
| Morphine | 974 | ||
| Meperidine (Pethidine) | 974 | ||
| Methadone, Hydromorphone, Oxymorphone | 974 | ||
| Butorphanol and Buprenorphine | 975 | ||
| INDUCTION OF ANESTHESIA | 975 | ||
| INJECTABLE ANESTHETIC DRUGS | 975 | ||
| Thiopental | 975 | ||
| Propofol | 975 | ||
| Alfaxalone | 976 | ||
| Etomidate | 976 | ||
| Ketamine and Benzodiazepine Combinations | 976 | ||
| Tiletamine/Zolazepam Combination | 976 | ||
| INHALATIONAL ANESTHETIC DRUGS | 976 | ||
| Isoflurane and Sevoflurane | 976 | ||
| Nitrous Oxide | 977 | ||
| SUMMARY | 977 | ||
| REFERENCES | 977 | ||
| Inadvertent Perianesthetic Hypothermia in Small Animal Patients | 983 | ||
| Key points | 983 | ||
| INTRODUCTION | 983 | ||
| Physiology of Thermoregulation and the Response to Hypothermia | 984 | ||
| Core Versus Peripheral Temperature and Patterns of Heat Loss | 986 | ||
| Mechanisms of Heat Loss and Hypothermia | 987 | ||
| Anesthetic Effects on Body Temperature | 988 | ||
| Deleterious Effects of Hypothermia | 988 | ||
| INDICATIONS FOR TECHNIQUES TO MINIMIZE HYPOTHERMIA | 989 | ||
| TECHNIQUES AND MECHANISMS OF HEAT CONSERVATION | 989 | ||
| Passive Techniques | 990 | ||
| Active Techniques | 990 | ||
| Metabolic Techniques | 990 | ||
| COMPLICATIONS | 991 | ||
| SUMMARY | 991 | ||
| REFERENCES | 991 | ||
| Postoperative Hemostasis Monitoring and Management | 995 | ||
| Key points | 995 | ||
| INTRODUCTION | 995 | ||
| HEMOSTATIC RESPONSE TO SURGICAL STRESS | 996 | ||
| SURGICAL STRESS AND POSTOPERATIVE THROMBOPHILIA | 996 | ||
| POSTOPERATIVE HYPERCOAGULABILITY IN VETERINARY MEDICINE | 997 | ||
| COMORBIDITIES THAT CAN EXACERBATE SURGICAL STRESS | 998 | ||
| DIAGNOSING COAGULATION DISTURBANCES IN THE PERIOPERATIVE SETTING | 999 | ||
| PERIOPERATIVE ANTICOAGULANT THERAPY | 1001 | ||
| Parenteral Anticoagulants: Heparins | 1001 | ||
| SURGERY-SPECIFIC MODIFICATIONS | 1002 | ||
| RISKS ASSOCIATED WITH ANTICOAGULANT AND THROMBOLYTIC THERAPY | 1003 | ||
| PERIOPERATIVE PLANNING | 1003 | ||
| SUMMARY | 1005 | ||
| REFERENCES | 1005 | ||
| Analgesia in the Perioperative Period | 1013 | ||
| Key points | 1013 | ||
| INTRODUCTION | 1013 | ||
| WHY SHOULD I TREAT PERIOPERATIVE PAIN? | 1013 | ||
| HOW DO I DETERMINE IF MY PATIENT IS IN PAIN? | 1014 | ||
| HOW DO I CREATE AN ANALGESIC PLAN? | 1015 | ||
| WHICH OPIOID DO I CHOOSE? | 1015 | ||
| Tramadol and Tapentadol | 1018 | ||
| CHOOSING A NONSTEROIDAL ANTI-INFLAMMATORY DRUG | 1018 | ||
| HOW CAN I INCORPORATE A LOCAL ANESTHETIC? | 1019 | ||
| WOULD AN α2-AGONIST BE HELPFUL? | 1020 | ||
| WOULD AN ANALGESIC ADJUNCT BE BENEFICIAL? | 1021 | ||
| N-Methyl-d-Aspartate Antagonists | 1022 | ||
| Anticonvulsants | 1022 | ||
| Tricyclic Antidepressants | 1023 | ||
| Serotonin–Norepinephrine Reuptake Inhibitor | 1023 | ||
| Nonanalgesic Drugs | 1024 | ||
| WHAT NONPHARMACOLOGIC THERAPIES COULD BE INCORPORATED IN THE ANALGESIC PLAN? | 1024 | ||
| SUMMARY | 1024 | ||
| REFERENCES | 1024 | ||
| Nursing Care | 1029 | ||
| Key points | 1029 | ||
| INTRODUCTION | 1029 | ||
| DEVELOPING NURSING CARE PLANS | 1029 | ||
| Assessment | 1030 | ||
| Technician Conclusion (Analysis) | 1030 | ||
| Planning Care | 1030 | ||
| Implementation | 1032 | ||
| Evaluation | 1032 | ||
| RESPIRATORY NURSING CARE | 1032 | ||
| Artificial Airway Management | 1032 | ||
| Humidification | 1034 | ||
| Coupage | 1034 | ||
| Suctioning | 1034 | ||
| Tracheostomy site care | 1036 | ||
| Endotracheal tube care | 1036 | ||
| Oral care | 1036 | ||
| Complications | 1037 | ||
| Chest Tubes | 1037 | ||
| Chest tube care | 1037 | ||
| Chest Drainage | 1038 | ||
| Intermittent (manual) aspiration | 1038 | ||
| CONTINUOUS SUCTION/ASPIRATION | 1038 | ||
| NURSING CONSIDERATIONS | 1039 | ||
| CARDIOVASCULAR NURSING CARE | 1040 | ||
| Cardiovascular Monitoring Techniques | 1040 | ||
| Arterial blood pressure and continuous electrocardiographic monitoring | 1040 | ||
| Vascular Catheter Care and Maintenance | 1040 | ||
| Intravascular catheter maintenance | 1040 | ||
| Arterial catheter maintenance | 1041 | ||
| Constant rate infusions | 1041 | ||
| Nursing consideration | 1041 | ||
| RECUMBENT PATIENT CARE | 1042 | ||
| Decubital Ulcers | 1042 | ||
| Decubital ulcer prevention | 1042 | ||
| Lung Atelectasis | 1043 | ||
| Prevention and management of atelectasis | 1044 | ||
| Aspiration Pneumonia | 1044 | ||
| Prevention and management of aspiration pneumonia | 1044 | ||
| Bladder and Bowel Maintenance | 1044 | ||
| Nutrition | 1045 | ||
| RENAL NURSING CARE | 1045 | ||
| Ins and Outs | 1045 | ||
| Quantifying Urine Production | 1045 | ||
| Urinary Catheter Care and Maintenance | 1046 | ||
| Urinary catheter care | 1046 | ||
| Urinary collection system | 1046 | ||
| SUMMARY | 1047 | ||
| REFERENCES | 1047 | ||
| Wound Care | 1049 | ||
| Key points | 1049 | ||
| INTRODUCTION | 1049 | ||
| PHASES OF WOUND HEALING | 1049 | ||
| Inflammatory Phase: Time 0 | 1050 | ||
| Debridement Phase: Time 6 to 12 Hours After Wound Initiation | 1050 | ||
| Repair Phase (Proliferation Phase): 3 to 12 Days After Wound Initiation | 1051 | ||
| Fibroplasia | 1051 | ||
| Angiogenesis | 1052 | ||
| Epithelialization | 1052 | ||
| Maturation Phase (Remodeling Phase): 7 Days to Several Months after Wound Initiation | 1052 | ||
| FACTORS AFFECTING WOUND HEALING | 1052 | ||
| Infection | 1052 | ||
| Location | 1053 | ||
| Nutrition | 1053 | ||
| Medications | 1053 | ||
| Metabolic Diseases | 1054 | ||
| Radiation Therapy | 1054 | ||
| Species Differences | 1054 | ||
| WOUND CARE | 1054 | ||
| Lavage | 1054 | ||
| Debridement | 1055 | ||
| Antibiotic Coverage | 1055 | ||
| Wound Environment | 1056 | ||
| WOUND CLOSURE | 1057 | ||
| Primary Closure | 1057 | ||
| Delayed Primary or Secondary Closure | 1057 | ||
| Second Intention Healing | 1057 | ||
| Negative Pressure Wound Therapy | 1058 | ||
| DRAINS | 1058 | ||
| BANDAGING | 1058 | ||
| Contact Layer | 1059 | ||
| Intermediate and Outer Layers | 1061 | ||
| NOVEL TREATMENTS | 1061 | ||
| SUMMARY | 1063 | ||
| REFERENCES | 1063 | ||
| Peri-Surgical Nutrition | 1067 | ||
| Key points | 1067 | ||
| NUTRITION IN HOSPITALIZED SURGICAL PATIENTS | 1067 | ||
| ENTERAL SUPPORT AND IMMUNONUTRITION | 1068 | ||
| Arginine | 1068 | ||
| Glutamine | 1069 | ||
| Omega-3 Fatty Acids | 1069 | ||
| OTHER POTENTIAL IMMUNONUTRIENTS | 1070 | ||
| The Impact of Immunonutrition in Human Patients | 1070 | ||
| Elective surgery patients | 1070 | ||
| Critically ill patients | 1071 | ||
| Immunonutrition in Veterinary Patients | 1072 | ||
| Assisted Enteral Nutrition | 1073 | ||
| Parenteral Support | 1076 | ||
| SUMMARY | 1079 | ||
| REFERENCES | 1080 | ||
| Index | 1085 |