Perioperative care

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Perioperative care

• Belinda Farnfield

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Perioperative care

• Perioperative care aids rapid recovery
• Careful planning
• Analgesia (see separate presentation)
• Avoid heat loss
• Careful anaesthetic monitoring
• Aseptic technique
• Appropriate husbandry

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The anaesthetic period

• Not just the anaesthetic itself
• Begins when you fist do something to the animal
• eg move it to another room
• change its cage
• change its group
• remove food
• Hence need to think in terms of PERIoperative
  care, not just POSToperative care

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Responsibility

• Lasts for the whole perioperative period
• Including after hours
• Good communication with other staff essential
• Be contactable
• A phone number where you can be reached

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Careful planning

• Plan any alterations in husbandry carefully
• Acclimation period may be needed
• Check all equipment carefully
• Use a check list
• Check dose rates for anaesthetic drugs to be used

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Emergencies

• Common ones are
• Run out of oxygen
• Run out of isoflurane
• Vaporiser left at too high a setting
• Vaporiser not connected properly
• Leak in breathing system
• Incorrect doses used of injectable drugs
• All preventable with careful planning

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Analgesia

• Pain relief in the immediate recovery period can
  be provided by using an analgesic drug in any
  pre-anaesthetic medication
• Administer further analgesia as necessary
  during/after procedure
• Good surgical technique can minimise tissue
  trauma, reducing pain from wounds
• Avoid excess tension when placing sutures
• Bandages may be useful in larger species

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Heat loss

• Anaesthetic drugs interfere with thermoregulation
• Hypothermia slows recovery
• Avoid heat loss, right from the start

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• Prepare skin carefully
• Avoid excess use of spirit (top picture)
• Choose appropriate drapes
• Insulate (bottom picture)
• Provide supplementary heat
• Heat blankets
• Incubators for recovery

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Monitor depth of anaesthesia

• Make sure you know how to assess depth of
  anaesthesia
• Species agent specific
• Ask for advice, read
• Check depth very carefully before you carry out
  painful procedure

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To monitor successfully

• More than one piece of information needed to
  build up a picture of the overall status of the
  animal
• Check more than one reflex
• Observe vital signs eg respiration
• Simple monitoring equipment may be helpful
• Can provide early warning of a problem

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Pulseoximetry - probe on extremity
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Displays oxygen saturation and pulse rate
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Make sure you can recognise signs of an
anaesthetic overdose

• And know what action to take
• Video clip Overdose of isoflurane in the mouse

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Prevent Wound Infection

• Adopt aseptic techniques, make full use of
  sterile drapes and instruments
• Clip hair and clean incision site
• Good personal hygiene, use sterile gloves
• Wear gown, mask and hat for more major surgery
• Check wounds daily in the post-operative period

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Recovery

• Quiet environment
• Provide supplementary heat
• Aim for good observation with minimal disturbance

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Caging and Bedding

• Clean, warm, comfortable bedding
• Take care with sawdust and wood shavings
• stick to wounds
• Make use of paper bedding and Vetbed
• May need to adapt caging

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Monitor Bodyweight, Food and Fluid Intake

• Monitor food and fluid intake
• offer palatable food
• Weigh the animals daily and record
• calculate weight loss
• adjust for growth if necessary
• Consider if need fluid therapy eg SC fluids
• Assess urine and faecal output

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Key to good perioperative care

• Recognise pain distress in the species strain
  you are working with
• If you plan to work with an unfamiliar species
• Spend some time with technicians doing husbandry
• Learn to recognise normal behaviour
• Learn to recognise normal response to handling

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When Does The Recovery Period End?

• Conscious, mobile, coordinated
• Able to eat, drink and defend itself within
  group
• Has the animal reached or gained on its
  pre-operative body weight?
• Do you have a healthy animal with normal food and
  water intake?
• Are wounds healed, sutures or staples removed?