Today's Veterinary Nurse

SEP-OCT 2017

Practical, peer reviewed, state-of-the-art companion animal nursing and technical educational articles with CE. Promotes better health for animals and career growth and development for veterinary technicians and veterinary assistants.

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CONTINUING EDUCATION TODAY'S VETERINARY TECHNICIAN | September/October 2017 | 41 may be preferable to maximize airway diameter and decrease resistance of breathing. If a cuffed ET tube is used, care must be taken not to overinflate the cuff because the tracheal tissue is very fragile. The use of laryngeal mask airway has been reported in kittens; however, the incidence of lower esophageal reflux was greater when compared with ET tubes. 9 Owing to the small patient size and tidal volume, an increase in apparatus dead space is of significant concern. Causes of increased dead space include ET tubes that are too long and inappropriately sized wye-piece and capnograph connectors. FIGURE 1 demonstrates a capnograph with rebreathing due to an increase in apparatus dead space in a small patient. Therefore, oxygen supply and a breathing circuit with a pediatric-sized wye-piece and bag should be available to assist with ventilation in small patients. Nonrebreathing systems may be a better choice in most of these patients to reduce breathing resistance and to facilitate faster changes in anesthetic concentration if inhalational agents are used. Unfortunately, the fresh high gas flow rate required by these circuits (2–3 times respiratory minute volume) may predispose the patient to hypothermia. Because of the high risk of desaturation in these patients, the importance of preoxygenation with an appropriately sized mask before induction of anesthesia cannot be overemphasized. Equipment for monitoring the various organ systems during the perianesthetic period should be available and used until the patient has recovered and is able to maintain normal homeostasis. To reduce the risk of accidental fluid overload, equipment for administering IV fluids, such as pediatric burettes, fluid pumps, and syringe pumps, is advisable. An accurate weight for all patients is of the utmost importance, particularly for small patients, in which an overdose of fluids or drugs can have a catastrophic effect. With very small patients, it is advisable to use a small scale that can give an accurate weight in grams (FIGURE 2) . PREMEDICATION Neonatal patients are seldom premedicated; however, with the possible exception of extremely debilitated or ill patients, premedication is beneficial in pediatric/ young dogs and cats. The use of a balanced drug combination can alleviate stress and significantly decrease the subsequent amounts of induction and maintenance agents required. Drugs that are short acting and reversible are recommended. Drug selection and dose depend on the patient's age and physiologic status. In very young patients, the blood–brain barrier is more permeable, and central nervous system responses to drug administration may be exaggerated. The altered drug uptake, metabolism, distribution, and excretion of drugs by neonatal patients compared with pediatric and adult animals should also be taken into account. Regardless of the drug chosen, care must be taken with drug doses because this subset of patients is also less able to tolerate absolute or relative overdoses. Peer Reviewed FIGURE 1. Increased inspired carbon dioxide due to an increase in apparatus dead space in a small patient. FIGURE 2. A puppy being weighed on an infant scale for accuracy.

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