Recovery period

• recovery is the period between administration of anaesthetic and the time the animal can maintain unsupported sternal recumbency.
• duration of recovery periods depend on:

  Duration of procedure.

  Condition of the patient- critically ill animals will recovery slower.

  Age of the patient- neonates/geriatrics have a slower recovery.

  Drugs used, type of anaesthesia and route of administration.

  Patient body temperature (hypothermia)
• signs a patient is recovering:

  HR increases

  RR increases

  Respiratory volume increases

  Eye position rotates centrally

  Reflexes palpebral, pedal, ear flick become stronger.

  Gag reflex returns, may swallow.
• oxygen disconnection:

  patient should receive pure oxygen for several minutes after anaesthetic administration has decreased to reduce pollution.

  Brachycephalic a expected to have oxygen.
• Removal of ET tube:

  Removed when the patient regains swallowing reflex.

  deflate cuff before.

  once extubated, place in sternal or lateral recumbency, with the neck extended.

  cats- remove tube prior to return of gag reflex to prevent laryngospasm, often when an ear flick is present.

  Brachycephalies tubes should be left as long as the patient can tolerate it.
• Pharmacological influence on recovery (injectable drugs)

  removed from blood by liver and excreted by kidneys.
• Pharmacological influence on recovery (inhalational)

  Eliminated via the respiratory tract
• If delayed recovery occurs an antagonist drug can be given to reverse the effects of some components of the anaesthesia e.g. Naloxone, atipamezole, flumazenil under VS direction.
• post operative pain=

  can lead to sympathetic activation and tachycardia.

  untreated can lead to depression and delayed recovery.
• Multi-modal analgesia= achieved using opioids and NSAIDs together and can be complemented with LA or ketamine.
• Potential causes of prolonged recovery=

  Prolonged activity of drugs e.g. ACP, liver/kidney problems.

  Severe pain causing depression.

  pain relieving surgery may lead to resting.

  hypoxia
• Hypothermia:

  anaesthesia will affect thermoregulation and may cause vasodilation.

  can delay recovery, reduce immune system and clotting function.

  acts of shivering can lead to oxygen consumption which results in hypoxaemia.
• Causes of hypothermia:

  • prolonged procedure
  • Can affect small/old patient.
  • Abdominal/thoracic surgery
  • Clip and cold prep
  • FGF in non-rebreathing circuits.
• to prevent hypoxia, ensure animal can ventilate efficiently independently.

  Advisable in brachycephalic
• Stormy recovery due to:

  Pain

  Associated with emergence from the influence of anaesthetic drugs.

  Convulsions or epilepsy.
• Stormy recovery- if a patient is drowsy and is incapable of maintaining sternal recumbency, should be turned every 2 hours.
• Responsibilities of RVNS in recovery:

  • Maintain observations regularly, remember risks of complications.
  • Observe monitor and record TPR ensuring the airways remains patent.
  • Ensure the ventilation is adequate to avoid hypoxia and provide oxygen if any doubt.
  • monitor for return of cranial nerve reflexes and return of consciousness.
  • Extubating of the patient once gag reflex returns
  • Avoid hypothermia by keeping patient warm and monitoring body temperature.
  • Monitor signs of pain
  • monitor op wound site for complications or interference.