Anaesthetic Emergencies

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45140051451401fffd9}}}}}\pard\sb0\sl-24
0{\bkmkstart Pg1}{\bkmkend Pg1}\par\pard\ql \li3124\sb0\sl-276\slmult0
\par\pard\ql\li3124\sb216\sl-276\slmult0 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf1\f2\fs24 ANAESTHETIC EMERGENCIES AND ACCIDENTS \par\pard\qj
\li1800\ri1599\sb146\sl-420\slmult0\fi719 \up0 \expndtw0\charscalex102
\ul0\nosupersub\cf2\f3\fs24 Some common anaesthetic emergencies and accidents
which may be \up0 \expndtw0\charscalex100 encountered during anaesthesia are
listed below with a brief outline of the problem \up0 \expndtw-3\charscalex100 and
recommended treatments. \par\pard\ql \li2160\sb99\sl-276\slmult0 \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 1.\ul0\nosupersub\cf3\f4\fs24
\ul0\nosupersub\cf1\f2\fs24 Failure of circulation under GA/ Cardiovascular
collapse /Hypotension: \par\pard\qj \li2160\ri1597\sb30\sl-414\slmult0\fi360
\up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Such complication
usually results due to excessive loss of blood during \line \up0
\expndtw0\charscalex100 anaesthesia. The loss may be sudden or in prolonged
operations. Estimation of \line \up0 \expndtw0\charscalex103 loss is difficult.
Such complication is taken care by administering compatible \line \up0
\expndtw0\charscalex100 blood or plasma expanders like dextran. Don\u8217?t give
excessive dextran as it may \line \up0 \expndtw-2\charscalex100 lead to failure of
clotting mechanism. Prognosis is generally poor in patients with \line \up0
\expndtw0\charscalex102 excessive pre operative fluid losses leading to circulatory
failure. Such type of \line \up0 \expndtw0\charscalex102 emergency can be prevented
with appropriate fluid therapy before, during and \line \up0 \expndtw-
5\charscalex100 after the operation. \par\pard\ql \li2160\sb120\sl-276\slmult0 \up0
\expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 2.\ul0\nosupersub\cf3\f4\fs24
\ul0\nosupersub\cf1\f2\fs24 Sudden hypotension: \par\pard\qj
\li2160\ri1598\sb11\sl-413\slmult0\fi360 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf2\f3\fs24 Such type of emergency is seen in patients during
surgery, may be caesarians \line \up0 \expndtw0\charscalex105 in cattle and sheep
or due to sudden pressure on the coeliac complex when \line \up0
\expndtw0\charscalex105 handling liver or spleen in dogs and cats. The emergency is
characterized as \line \up0 \expndtw-5\charscalex100 follow: \par\pard\qj
\li2880\ri5187\sb2\sl-420\slmult0 \up0 \expndtw-4\charscalex100
\ul0\nosupersub\cf4\f5\fs24 �\ul0\nosupersub\cf5\f6\fs24
\ul0\nosupersub\cf2\f3\fs24 The pulse becomes imperceptible. \up0 \expndtw-
4\charscalex100 \ul0\nosupersub\cf4\f5\fs24 �\ul0\nosupersub\cf5\f6\fs24
\ul0\nosupersub\cf2\f3\fs24 Respiration ceases. \par\pard\ql \li2880\sb99\sl-
276\slmult0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf4\f5\fs24
�\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf2\f3\fs24 Veins dilate (noticed in
the tongue). \par\pard\ql \li2880\sb144\sl-276\slmult0 \up0 \expndtw-
\ul0\nosupersub\cf2\f3\fs24 Pupils remain normal in size indicating working heart.
\par\pard\qj \li1800\ri1601\sb42\sl-400\slmult0\fi720 \up0 \expndtw0\charscalex102
Immediately stop the operation and let the blood pressure come to normal. \up0
\expndtw-3\charscalex100 Avoid such emergency by gentle surgery. \par\pard\ql
\li2160\sb123\sl-276\slmult0 \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf1\f2\fs24 3.\ul0\nosupersub\cf3\f4\fs24
\ul0\nosupersub\cf1\f2\fs24 Shock: \par\pard\qj \li2160\ri1598\sb30\sl-
415\slmult0\fi360 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf2\f3\fs24
Primarily develops due to over dosing of the anaesthetic or excessive fluid loss
\up0 \expndtw0\charscalex105 during surgery. Treatment is executed on the
general principles of the \up0 \expndtw0\charscalex107 management of shock.
Such a complication is normally prevented by \up0 \expndtw0\charscalex100
administering pre operative steroids along with compatible IV fluids before and
\up0 \expndtw-5\charscalex100 during the surgery. \par\pard\ql \li2160\sb100\sl-
4.\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf1\f2\fs24 Disturbances in cardiac
rhythm: \par\pard\qj \li2160\ri1600\sb26\sl-420\slmult0\fi360 \up0
\expndtw0\charscalex103 \ul0\nosupersub\cf2\f3\fs24 A variety of disturbances
in the cardiac rhythm may be seen during \up0 \expndtw-5\charscalex100
anaesthesia. \par\pard\ql \li2520\ri1599\sb289\sl-410\slmult0\tx2880\tx2880 \up0
\expndtw0\charscalex104 a)\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24
Bradycardia\ul0\nosupersub\cf2\f3\fs24 : Such a emergency is not serious until or
unless it is too \line\tab \up0 \expndtw0\charscalex101 severe. Usually seen in
deep anaesthesia, hypothermia, drugs and vagal \line \tab \up0
\expndtw0\charscalex100 reflexes. Treat with an anticholinergic e.g atropine. If an
anticholinergic \par\pard\sect\sectd\fs24\paperw11900\paperh16840{\shp
10000\shplid1
ffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101010
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45140051451401fffd9}}}}}\pard\sb0\sl-24
\ul0\nosupersub\cf2\f3\fs24 2 \par\pard\ql \li2880\sb1\sl-256\slmult0 \up0
\expndtw-3\charscalex100 does not correct the problem consider the use of dopamine
as an infusion \par\pard\qj \li2880\ri1600\sb29\sl-420\slmult0 \up0 \expndtw-
2\charscalex100 at a rate of 2-10ug/kg/min. Add 80 mg to 500mL fluid to give
160ug/mL \up0 \expndtw-3\charscalex100 and infuse 0.01-0.06mL/kg/min.
\par\pard\ql \li2520\ri1597\sb0\sl-415\slmult0\tx2880\tx2880\tx2880\tx2880 \up0
\expndtw-1\charscalex100 b)\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24
Tachycardia\ul0\nosupersub\cf2\f3\fs24 : Can be from pain, hypercarbia, hypoxemia,
hypovolaemia. \line\tab \up0 \expndtw0\charscalex105 It is also seen in young
animals or during shock or in animals \line \tab \up0 \expndtw0\charscalex101
premedicated with atropine. Generally not serious. Consider using 2% \line \tab
\up0 \expndtw-1\charscalex100 lignocaine HCl (without adrenaline) intravenously if
the increase in heart \line \tab \up0 \expndtw-2\charscalex100 rate is too much.
\par\pard\ql \li2520\ri1599\sb0\sl-
412\slmult0\tx2880\tx2880\tx2880\tx2880\tx2880 \up0 \expndtw0\charscalex100
c)\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24 Heart conduction
abnormalities: \ul0\nosupersub\cf2\f3\fs24 Common in all the animals under all
\line\tab \up0 \expndtw0\charscalex103 forms of anaesthesia appreciated only after
recording ECG. The most \line \tab \up0 \expndtw0\charscalex104 common are SA
block, AV block, T wave changes etc. Generally not \line \tab \up0 \expndtw-
1\charscalex100 alarming and most of such arrhythmias disappear once adequate
oxygen \line \tab \up0 \expndtw-1\charscalex100 exchange is established as
these changes are mostly associated with \line \tab \up0 \expndtw-
5\charscalex100 myocardial hypoxia. \par\pard\ql \li2160\sb114\sl-
276\slmult0\tx2520 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 5.
\tab \up0 \expndtw-5\charscalex100 Heart Failure: \par\pard\qj
\ul0\nosupersub\cf2\f3\fs24 The common types of heart block seen are
\ul0\nosupersub\cf1\f2\fs24 ventricular fibrillation \ul0\nosupersub\cf2\f3\fs24
and \line \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf1\f2\fs24 ventricular
asystole or arrest of the heart or cardiac standstill. \ul0\nosupersub\cf2\f3\fs24
Such an \line \up0 \expndtw0\charscalex103 emergency mostly develops when there is
overdosing of the anaesthetic drug. \line \up0 \expndtw-4\charscalex100 Revival is
very important since brain cells are very sensitive to hypoxia. Generally \line
\up0 \expndtw-5\charscalex100 brain damage is irreversible if circulatory failure
is for more than \up0 \expndtw-5\charscalex100 3-4 min. \par\pard\ql
\li2160\ri3229\sb0\sl-420\slmult0\tx2520\tx2880 \up0 \expndtw-5\charscalex100
respiration remains normal till respiratory center becomes anoxic. \line\tab
\up0 \expndtw-5\charscalex100 The following remedies can be adopted in heart
failure: \line \tab \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf4\f5\fs24
�\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24 Immediate cardiac
massage: \par\pard\ql \li3240\ri1599\sb0\sl-420\slmult0\tx3600 \up0
\expndtw0\charscalex102 \ul0\nosupersub\cf2\f3\fs24
a)\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24 Compression of heart
through intact chest wall: \ul0\nosupersub\cf2\f3\fs24 It should be \line\tab
\up0 \expndtw0\charscalex103 forcible and fairly rapid, more than \up0
\expndtw0\charscalex103 60/min in dogs and small \par\pard\qj
\li3600\ri1598\sb0\sl-400\slmult0 \up0 \expndtw0\charscalex100 animals (done with
hands) and 30-40/min in large animals (done \up0 \expndtw-5\charscalex100 with the
foot or knee). \par\pard\ql \li3240\ri1598\sb0\sl-
413\slmult0\tx3600\tx3600\tx3600 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf1\f2\fs24 b)\ul0\nosupersub\cf3\f4\fs24
\ul0\nosupersub\cf1\f2\fs24 Direct cardiac massage: \ul0\nosupersub\cf2\f3\fs24 No
time is wasted for preparation of the \line\tab \up0 \expndtw0\charscalex100 site.
Incision is given in the 6\ul0\super\cf6\f7\fs23 th\ul0\nosupersub\cf2\f3\fs24
intercostal space. Reach the heart \line \tab \up0 \expndtw-3\charscalex100 and
massaging is done by squeezing the heart from the apex \line \tab \up0
\expndtw-5\charscalex100 towards the base. \par\pard\ql \li2880\ri1598\sb0\sl-
420\slmult0\tx3240 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf4\f5\fs24
�\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24 Further treatment:
\ul0\nosupersub\cf2\f3\fs24 The further treatment will depend upon the type
\line\tab \up0 \expndtw-5\charscalex100 of the heart failure. \par\pard\ql
\li3240\ri1599\sb0\sl-420\slmult0\tx3600 \up0 \expndtw-3\charscalex100
a)\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24 Cardiac standstill:
\ul0\nosupersub\cf2\f3\fs24 Inject 5 ml of adrenaline HCl (1:10,000) or 2-3
\line\tab \up0 \expndtw-4\charscalex100 ml of 10% calcium chloride direct into the
ventricle and quickly \par\pard\sect\sectd\fs24\paperw11900\paperh16840{\shp
10000\shplid2
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c09e24d1bc5fe11f1169e2696d8df685e25f0fdeea1a36af662e209e0373a7dedc40268658b7ef8dd47
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bbbcb7f87daccfe21d17c29347a946d15d477325ed878b7c3fe2df0df85b4cd03c2ff00186d7c7fa9f8
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45001451450014514500145145001451450014514500145145001451450014514500145145001451450
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3c2fe25f0778afc3f737bab6917177a078c3c37abf843c476fa6f883c3d7fa47897c397ba9f8635fd6f
437d67c37ac693ad41a7eab7f05aea102dccbbbf163fe0bc7ff0004e8f1afed15f0abc1dfb737ec7da4
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cdabe97e1ff00166afe02f02ea9e26d1ac6f20d3b5ed47c17e13bed52daeae7c39a3cb67d0514500145
14500145145001451450014514500145145001451450014514500145145001451450014514500145145
00145145001451450014514500145145001451450014514500145145001451450014514500145145001
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45001451450014514500145145001451450014514500145145001451450014514500145145001451450
015f9c1f09ff00e0931fb067c1afdb6be30ffc143fc1df02bc3e9fb587c63f106b7e20bcf8877a1174e
f004fe2cf03f837c19e3a6f85fe07d2e1d2fc13e15f107c43b9f0c7887c67e3ef89d2e81aa7c65f16f8
abe2e7c648358f88f73e0ef1edf784adff0047e8a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00fffd9}}}}}\pard\sb0\
sl-240{\bkmkstart Pg3}{\bkmkend Pg3}\par\pard\ql \li9988\sb0\sl-276\slmult0
\expndtw0\charscalex102 massage into the coronary artery. Simultaneously 10%
calcium \par\pard\ql \li3600\sb148\sl-276\slmult0 \up0 \expndtw-3\charscalex100
gluconate, 10-20 ml is administered by IV route. \par\pard\ql
\li3240\ri1598\sb30\sl-
414\slmult0\tx3600\tx3600\tx3600\tx3600\tx3600\tx3600\tx3600\tx3600\tx3600\tx3600 \
up0 \expndtw-3\charscalex100 b)\ul0\nosupersub\cf5\f6\fs24
\ul0\nosupersub\cf1\f2\fs24 Ventricular fibrillation: \ul0\nosupersub\cf2\f3\fs24
The best and the most specific treatment \line\tab \up0 \expndtw0\charscalex101 for
this type of emergency is to pass the electric current through \line \tab \up0
\expndtw0\charscalex100 myocardium. The alternative treatment includes injection of
1% \line \tab \up0 \expndtw-3\charscalex100 lignocaine HCl @1-4mg/kg, IV which
helps to depress the cardiac \line \tab \up0 \expndtw-2\charscalex100 contractions,
decrease the excitability and so helps in overcoming \line \tab \up0 \expndtw-
3\charscalex100 the fibrillation. Methoxamine, a pure alpha adrenergic
agonist \line \tab \up0 \expndtw0\charscalex106 drug, can also be used as it
increases myocardial contractions \line \tab \up0 \expndtw-4\charscalex100 without
causing vasoconstriction. Use of 8.4% sodium bicarbonate \line \tab \up0 \expndtw-
1\charscalex100 (1 mEq/kg) is also useful as it counters acidosis and improves
the \line \tab \up0 \expndtw-1\charscalex100 action of epinephrine. The total dose
of 8.4% sodium bicarbonate \line \tab \up0 \expndtw-5\charscalex100 to be given is
calculated as under: \par\pard\ql \li2520\sb120\sl-276\slmult0 \up0 \expndtw-
5\charscalex100 \ul0\nosupersub\cf1\f2\fs24 mEq of 8.4% NaHCO\ul0\sub\cf7\f8\fs24
3\ul0\nosupersub\cf1\f2\fs24 = Wt. of animal (kg) x Duration of arrest (min)
\par\pard\li6120\sb1\sl-276\slmult0\fi0\tx8280 \up0 \expndtw-3\charscalex100
5\tab \up0 \expndtw-3\charscalex100 2\par\pard\ql \li2520\sb1\sl-260\slmult0
\up0 \expndtw-2\charscalex100 Important: \ul0\nosupersub\cf2\f3\fs24 During direct
cardiac massage, positive pressure ventilation with \par\pard\qj
\li2160\ri1599\sb37\sl-410\slmult0 \up0 \expndtw0\charscalex105 oxygen is a must
and continued till circulatory failure is vanished. The chest \up0
\expndtw0\charscalex100 shouldn\u8217?t be closed until spontaneous heart beats are
present for at least 20 min. \up0 \expndtw-5\charscalex100 After chest closure,
create the negative pressure with suction pump. \par\pard\ql \li2160\sb121\sl-
6.\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf1\f2\fs24 Respiratory
acidosis: \par\pard\qj \li1800\ri1598\sb9\sl-416\slmult0\fi720 \up0
\expndtw0\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Such an emergency develops when
minute respiratory volume is decreased \up0 \expndtw0\charscalex100 leading to
decreased excretion of CO\ul0\sub\cf6\f7\fs24 2\ul0\nosupersub\cf2\f3\fs24 and
resultant respiratory acidosis. The most \up0 \expndtw0\charscalex104 common causes
for such an emergency are low total gas flow in the semi-closed \up0
\expndtw0\charscalex100 system, exhausted soda lime in the closed system and any
type of obstruction in the \up0 \expndtw0\charscalex103 airway. Respiratory
acidosis is always of serious nature when it is prolonged and \up0 \expndtw-
3\charscalex100 death of the patient may result if pH of the blood falls below 6.7.
\par\pard\qj \li1800\ri1599\sb18\sl-400\slmult0\fi720 \up0 \expndtw-3\charscalex100
Remedy includes maintenance of proper gas flow; replacement of soda lime if \up0
\expndtw-4\charscalex100 exhausted and always intubate the animal. \par\pard\ql
\li2160\sb123\sl-276\slmult0 \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf1\f2\fs24 Hypoxia: \par\pard\qj \li2160\ri1598\sb30\sl-
415\slmult0\fi360 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf2\f3\fs24 This
is characterized clinically by cyanosis of mucous membranes. It is \up0
\expndtw-4\charscalex100 dangerous when prolonged because may lead to brain damage
and development of \up0 \expndtw0\charscalex102 comatose condition. It should
always be avoided by proper oxygenation of the \up0 \expndtw0\charscalex104 patient
during anaesthesia may be by using positive pressure ventilation with \up0
\expndtw-5\charscalex100 external source of oxygen.
\par\pard\sect\sectd\fs24\paperw11900\paperh16840{\shp
10000\shplid3
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0102030405060708090a0bffc400b511000201020404030407050404000102770001020311040521310
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2a35363738393a434445464748494a535455565758595a636465666768696a737475767778797a82838
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51400514514005145140051451400514514005145140051451400514514005145140051451400514514
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45140051451401fffd9}}}}}\pard\sb0\sl-24
\ul0\nosupersub\cf1\f2\fs24 Laryngeal and bronchial spasms: \par\pard\qj
\ul0\nosupersub\cf2\f3\fs24 Mostly seen in cats under ether anaesthesia and can be
controlled by relaxant \up0 \expndtw0\charscalex100 drugs. Remedy includes
sprinkling of local anaesthetic on the larynx. Always \up0
\expndtw0\charscalex105 intubate the animal and ensure proper airway. Intravenous
pethidine is quite \up0 \expndtw-5\charscalex100 helpful and prevents reoccurrence.
\par\pard\qj \li2160\ri1599\sb2\sl-420\slmult0\fi360 \up0 \expndtw-2\charscalex100
Bronchial spasms are uncommon and are particularly seen in ruminants
\up0 \expndtw-3\charscalex100 because of aspiration of regurgitated material.
\par\pard\ql \li2160\sb99\sl-276\slmult0 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf1\f2\fs24 Respiratory tract obstruction: \par\pard\qj
\li2160\ri1598\sb30\sl-415\slmult0\fi360 \up0 \expndtw0\charscalex105
\ul0\nosupersub\cf2\f3\fs24 This results due to the base of the tongue or
epiglottis and seen when the \up0 \expndtw0\charscalex100 animal is not intubated.
Such an obstruction can be overcome by extending the \up0 \expndtw0\charscalex103
head and drawing the tongue out. However over extension of the tongue may \up0
\expndtw0\charscalex102 cause obstruction in pigs. To prevent such a complication,
always intubate the \up0 \expndtw-5\charscalex100 animal during anaesthesia.
\ul0\nosupersub\cf1\f2\fs24 Respiratory arrest/apnea: \par\pard\qj
\ul0\nosupersub\cf2\f3\fs24 Such an emergency develops due to overdosing of
anaesthesia using primarily \line \up0 \expndtw-2\charscalex100 the injectable
anaesthetics and also with some of the inhalant anaesthetics. Use of \line \up0
\expndtw-1\charscalex100 muscle relaxant drugs can also cause apnea. The emergency
can be controlled as \line \up0 \expndtw-5\charscalex100 follows: \par\pard\ql
\ul0\nosupersub\cf2\f3\fs24 Stop the anaesthetic administration immediately.
\par\pard\ql \li2880\ri1599\sb42\sl-400\slmult0\tx3240 \up0 \expndtw-
\ul0\nosupersub\cf2\f3\fs24 Support ventilation with artificial respiration e.g.
IPPV, chest pressing \line\tab \up0 \expndtw-5\charscalex100 etc. \par\pard\ql
\li2880\ri5039\sb12\sl-410\slmult0\tx3240 \up0 \expndtw-4\charscalex100
\ul0\nosupersub\cf2\f3\fs24 Administer antagonist if available. \line \up0
\expndtw-4\charscalex100 \ul0\nosupersub\cf4\f5\fs24
�\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf2\f3\fs24 Administer respiratory
stimulants. \line\tab \up0 \expndtw-4\charscalex100 - Picrotoxin, @ 1mg/kg, IV
(Toxic) \par\pard\ql \li3240\sb121\sl-276\slmult0 \up0 \expndtw-4\charscalex100 -
Leptazol, @ 2-4mg/kg, IV (Dogs & cats); 1g total dose in horses & cattle.
\par\pard\ql \li3240\ri669\sb42\sl-400\slmult0 \up0 \expndtw-1\charscalex100 -
Nikethamide (Coramine): Commonly used respiratory stimulant. @ 10-25ml, \up0
\expndtw-2\charscalex100 IV in large animals; 1-3ml, IV in dogs and cats.
\par\pard\ql \li3240\sb123\sl-276\slmult0 \up0 \expndtw-5\charscalex100 - Doxaprim,
1-3ml, IV in dogs and cats. \par\pard\ql \li2160\sb144\sl-276\slmult0 \up0
\ul0\nosupersub\cf1\f2\fs24 Induction apnea: \par\pard\qj \li2160\ri1599\sb32\sl-
412\slmult0\fi360 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf2\f3\fs24 Mostly
seen during barbiturate or propofol anaesthesia in dogs. There is \line \up0
\expndtw-2\charscalex100 respiratory depression leading to hypoxia and increased
pCO\ul0\sub\cf6\f7\fs24 2. \ul0\nosupersub\cf2\f3\fs24 High oxygenation \line \up0
\expndtw0\charscalex104 with approximately 97% O\ul0\sub\cf6\f7\fs24
2\ul0\nosupersub\cf2\f3\fs24 removes the hypoxic condition but
pCO\ul0\sub\cf6\f7\fs24 2\ul0\nosupersub\cf2\f3\fs24 levels \line \up0 \expndtw-
2\charscalex100 remains below CO\ul0\sub\cf6\f7\fs24 2\ul0\nosupersub\cf2\f3\fs24
threshold in the respiratory centre - animal ceases to breathe. \line \up0
\expndtw0\charscalex106 After redistribution of the anaesthetic in the body
tissues, depression of the \line \up0 \expndtw0\charscalex102 respiratory centre is
reduced, pCO\ul0\sub\cf6\f7\fs24 2 \ul0\nosupersub\cf2\f3\fs24 levels rise above
the CO2 threshold in the \par\pard\sect\sectd\fs24\paperw11900\paperh16840{\shp
10000\shplid4
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45140051451401fffd9}}}}}\pard\sb0\sl-24
\expndtw0\charscalex103 respiratory centre - normal breathing starts. Slow rate of
injection reduces the \par\pard\ql \li2160\sb148\sl-276\slmult0 \up0 \expndtw-
3\charscalex100 incidence of such a complication. \par\pard\ql \li2160\sb144\sl-
12.\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf1\f2\fs24 Corneal abrasions:
\par\pard\qj \li2160\ri1599\sb6\sl-420\slmult0\fi360 \up0
\expndtw0\charscalex103 \ul0\nosupersub\cf2\f3\fs24 This type of complication
develops due to decreased tear production during \up0 \expndtw0\charscalex104
anaesthesia, most common in ketamine anaesthesia. Use topical
eye \up0 \expndtw-3\charscalex100 ointment/ocular instillations to avoid this.
\ul0\nosupersub\cf1\f2\fs24 Hepatitis: \par\pard\qj \li2160\ri1600\sb6\sl-
420\slmult0\fi360 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Commonly
seen when halothane is used. The other possible causes are \up0
\expndtw0\charscalex100 hypoxaemia and hypotension. Treat with supportive
medicines. Avoid such \up0 \expndtw-3\charscalex100 complication. \par\pard\ql
\ul0\nosupersub\cf1\f2\fs24 Hypertension: \par\pard\qj \li2160\ri1600\sb26\sl-
420\slmult0\fi360 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf2\f3\fs24 Rarely
seen when lots of pain, hypercarbia or too light level of anaesthesia. \up0
\expndtw-3\charscalex100 Treatment is as per the cause. \par\pard\ql
\ul0\nosupersub\cf1\f2\fs24 Hyperthermia: \par\pard\qj \li2160\ri1598\sb6\sl-
420\slmult0\fi360 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf2\f3\fs24 Seen in
heavy hairy breeds of dogs or when there is inadequate heat loss. \up0 \expndtw-
3\charscalex100 Remedy includes cooling of the patient with cool water.
\ul0\nosupersub\cf1\f2\fs24 Malignant hyperthermia: \par\pard\qj
\ul0\nosupersub\cf2\f3\fs24 Rare condition in pigs, horses and dogs mostly develops
with succinyl choline \line \up0 \expndtw-1\charscalex100 and volatile
anaesthetics. Characterized by tachycardia, muscle rigidity, increased \line
\up0 \expndtw-2\charscalex100 ventilation with hyperthermia. Treatment includes
removal of the triggering agent. \par\pard\ql \li2160\sb99\sl-276\slmult0 \up0
\ul0\nosupersub\cf1\f2\fs24 Hypothermia: \par\pard\qj \li2160\ri1599\sb30\sl-
415\slmult0\fi360 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf2\f3\fs24 Results
due to lack of insulation as cold tables, open body cavities etc. Also \line
\up0 \expndtw0\charscalex100 develops when there is vasodilation and hypovolaemia.
Temperature below 32\ul0\super\cf6\f7\fs23 O\ul0\nosupersub\cf2\f3\fs24 C \line
\up0 \expndtw0\charscalex105 may lead to death. Bradycardia and sub-
normal temperature are the \line \up0 \expndtw0\charscalex103
characteristics. Treatment includes warming of the patient: water bottles in the
\line \up0 \expndtw-2\charscalex100 axilla & groin area; use of blankets and
provision of warm environment. \par\pard\ql \li2160\sb120\sl-276\slmult0 \up0
\expndtw-3\charscalex100 18.\ul0\nosupersub\cf5\f6\fs24
\ul0\nosupersub\cf1\f2\fs24 Renal failure: \par\pard\qj \li2160\ri1598\sb6\sl-
420\slmult0\fi360 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Normally
results due to hypotension, hypovolaemia and inadequate IV fluids \line \up0
\expndtw-2\charscalex100 during anaesthesia. Such a complication must be avoided
with proper IV fluids. \par\pard\ql \li2160\sb119\sl-276\slmult0 \up0 \expndtw-
3\charscalex100 19.\ul0\nosupersub\cf5\f6\fs24 \ul0\nosupersub\cf1\f2\fs24
Vomition and regurgitation: \par\pard\qj \li2160\ri1599\sb6\sl-420\slmult0\fi360
\up0 \expndtw0\charscalex102 \ul0\nosupersub\cf2\f3\fs24 It is commonly seen in
ruminants and other animals, when the patient is not \line \up0 \expndtw-
2\charscalex100 properly prepared for the surgery \up0 \expndtw-2\charscalex100
(improper fasting etc.). Always do proper \par\pard\ql \li2160\sb119\sl-
276\slmult0 \up0 \expndtw-3\charscalex100 fasting to avoid this complication.
\par\pard\sect\sectd\fs24\paperw11900\paperh16840{\shp
10000\shplid5
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45140051451401fffd9}}}}}\pard\sb0\sl-24
\expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs24 ANAESTHETIC ACCIDENTS:
1.\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf1\f2\fs24 Explosions and fires
\par\pard\qj \li2520\ri1598\sb42\sl-400\slmult0\tx2880 \up0 \expndtw-
1\charscalex100 2.\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf1\f2\fs24
Postural accidents: \ul0\nosupersub\cf2\f3\fs24 Facial/radial paralysis in large
animals when casting \line\tab \up0 \expndtw-5\charscalex100 on the hard
surface. \par\pard\qj \li2520\ri1599\sb4\sl-420\slmult0\tx2880 \up0
\expndtw0\charscalex104 \ul0\nosupersub\cf1\f2\fs24
3.\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf1\f2\fs24 Local necrosis:
\ul0\nosupersub\cf2\f3\fs24 When accidental perivascular injection of
irritant \line\tab \up0 \expndtw-4\charscalex100 anaesthetics e.g. chloral hydrate
or thiopentone Na (Barbiturate slough). \par\pard\qj \li2520\ri1599\sb17\sl-
400\slmult0\tx2880 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf1\f2\fs24
4.\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf1\f2\fs24 Venous
thrombosis:\ul0\nosupersub\cf2\f3\fs24 May develop with higher concentration
(>5%) of \line\tab \up0 \expndtw-3\charscalex100 thiopentone Na.
\par\pard\sect\sectd\fs24}

Anaesthetic Emergencies

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