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Operative Care
ASR Certification Prep
Pre Operative Care
Pre-Surgical Planning:
Pre-surgery Examination & Blood work
Fasting
Set-up of prep area and operating room
Thermo regulation
Aseptic Preparation
Analgesic Regimen
Anesthesia
Aseptic Transfer to Surgical Field
Pre-surgery Examination
Examination should include:
Phenolics Lysol®, TBQ® Less affected by organic material than other disinfectants
Chlorhexidine Nolvasan® , Hibiclens® .Presence of blood does not interfere with activity. Rapidly
bactericidal and persistent. Effective against many viruses.
* The use of common brand names as examples does not indicate a product endorsement.
Aseptic Technique
• Preparation of the patient
Bland ophthalmic ointment to
eyes
remove hair from the surgery site (
#40 blade, vacuum)
initial or preparative scrub
– Povidone-iodinefollowed by alcohol rinse
– Chlorhexidine followed by saline rinse
move to surgical room / area
final surgical scrub/paint
– Povidone-iodine followed by alcohol rinse
– Chlorhexidine followed by saline rinse
– Duraprep®, Chloraprep®
sterile draping of surgical site
establish a sterile field
RECOMMENDED SKIN DISINFECTANTS
Alternating disinfectants is more effective than using a single agent.
Idophors Betadine®, Prepodyne®, Reduced activity in presence of organic matter. Wide range
Wescodyn® of micobicidal action Works best in pH 6-7
Cholorhexadine Nolvasan®, Hibiclens® Presence of blood does not interfere with activity. Rapidly
bactericidal and persistent. Effective against many viruses.
Excellent for use on the skin.
* The use of common brand names as examples does not indicate a product endorsement.
Peri-Operative Monitoring
Allows:
• Adequate anesthesia.
• Adequate analgesia
• Adequate immobilization
• ECG (EKG)
• Peripheral Perfusion
• Pulmonary Monitoring
• Temperature
• Blood Pressure
ECG (EKG)
An EKG measures the electric currents
generated by the heart.
Monitors heart function
Continuous monitoring with an EKG allows
early recognition of electrical changes
associated with disorders of conduction in
the heart and arrhythmias that may need to
be treated.
ECG (EKG)
Cardiac dysrhythmias:
• Tachycardia: excessive rapidity of the heart
Low ETCO2
End-tidal CO2 (ETCO2)
When displayed as a capnographic waveform much
useful information may be derived such as:
“Spiky” topped waves may indicate a waking animal taking
short, sharp breaths
Plateau with a drop to the right may indicate a leak in the
circuit as the pressure of inspiration is not held
Respiration
• Monitored by :
Observation of chest wall movement
Observation of breathing bag movement
Auscultation of breath sounds
Audible respiratory monitor
• Respiratory volume may be estimated visually,
by reservoir bag inflation, or by using a ventilator
or ventilometer
• Normal tidal volume is 10-20 mL/kg/respiration
• Normal respiratory sounds are almost inaudible
Respiration
• Normal respiratory rates can vary widely
– Should be evaluated along with tidal volume and
respiratory trends
– May indicate an underlying physiologic change
– Arrhythmic breathing patterns are usually the effect of a
medullary respiratory control problem
– However, some abnormal patterns may be normal in
certain species
A Cheyne- stokes pattern is normal for horse but
could be sign of heart failure or brain damage.
Apneustic breathing (inspiratory hold) seen in healthy
cats, dogs, and animals anesthetized with ketamine
Respiration
Tachypnea: inadequate anesthetic level, “too light”, pain,
hypoxemia, hypercarbia, hyperthermia,
CSF acidosis, drug effects
Suture/Staple Removal
The goal of the staples / sutures are to keep
the skin margins closed.
Evaluate incision healing prior to removal
Normal removal time is 10 to 14 days
References
• NIH website http://oacu.od.nih.gov/ARAC/surguide.pdf
• http://www.ruralareavet.org/PDF/Anesthesia-patient_Monitoring.pdf