High-risk patients: Supportive care, monitoring, and postoperative care (Proceedings)
Supportive care is based on recognition of patients needs
Focused monitoring and patient evaluation leads to individualized care.
What "anesthetic concerns" have you identified for this patient?• "100 things are missed due to not looking for every 1 thing missed due to not knowing".
• Preanesthetic physical examination and laboratory analyses - individualized "minimum data base" based on risk
• diagnostic imaging radiographs, contrast studies, CT, MRI, ultrasonography, scintigraphy, etc.
• other directed testing
ASA physical status categories
American Society of Anesthesiologists (ASA)
Hypoventilation requires patient support
Endotracheal intubation, ventilatory support by IPPV manual or mechanical ventilation based on patient monitoring, evaluate and address the underlying problem.
Hyperventilation and/or panting are less common, but may reflect hyperthermia, pain, or occur as a side-effect of specific drugs. Control of body temperature, management of pain, and control of ventilation may be necessary.
Support for Circulatory compromise
Hypotension is a common problem due to hemorrhage and/or vasodilatation. Circulatory support is largely based on fluid therapy, including crystalloids, and colloids. A variety of fluids are now available, with blood substitutes serving and important need. Vaso-active agents help support blood pressure, cardiac function, and tissue perfusion.
Hypothermia is an almost universal problem in small animal anesthesia and many areas of critical care. Risks of thermal support have been great with older heating strategies. The forced warm air systems offer a new method and much better means of providing thermal support.
Delayed recovery from anesthesia