Emergency anesthesia: What should we do? (Proceedings)
The risk of anesthesia is higher in emergency cases compared with elective cases. Most of these patients are compromised and this increases the danger of anesthesia, especially in cases when there is no time to optimize the condition of the patient before anesthesia. Some of these cases are performed at night and the increased risk may be related to inadequate personnel help during this time. The personnel may also be tired as a result of the long day resulting in inattentiveness to problems.
Emergency cases are those that involved diseases or injury that pose an immediate risk to an animal's life or long term health. Some of these cases will need anesthesia. Cases of note in small animal practice include: acute diaphragmatic rupture, gastric dilatation-volvulus, fracture repair due to trauma, septic abdomen, hemoabdomen, blocked urethra, ruptured urinary bladder and C-section.
When these cases are presented, oxygen supplementation and fluid therapy should be instituted immediately while the initial assessment is being done. Pertinent blood work should be done following the initial examination. The most important problems that will complicate anesthesia should be identified and stabilization should be done before anesthesia.Preoperative preparation
Emergency cases can have one specific problem or a combination of different problems. The cardiovascular compromise is a common problem in emergency cases. They can have hypovolemia, dehydration, shock, and arrhythmias. Fluid resuscitation should be performed in these animals. With continuous bleeding, the goal of fluid resuscitation should be to maintain a mean arterial pressure (mmHg) in the 60s. Arrhythmias can be present in animals involved in vehicular accident, patients with electrolyte imbalances, and in gastric dilatation-volvulus. Arrhythmias are usually controlled with lidocaine.
The following are problems that should be identified, managed, and corrected before anesthesia: