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Thursday, March 3, 2011

Peri-Operative Care

Amanda emailed me with this...

 My name is Amanda M**** and I am a student working on my Associate's Degree in Veterinary Technology.  I have an assignment to prepare a presentation on the preop, peri-op, and postop procedures for a surgery.  I have chosen Enucleation for my topic, but I'm having a hard time finding information specific to preop, peri-op, and postop procedures.  I read your post "Bye Bye Eye" from August 4, 2010, and it was helpful--especially the pictures (which are also hard to find).  I read that you welcomed questions, so I thought I'd send you a line.  If you have time, could you please tell me what is needed to take care of the animal surrounding the surgical procedure?  I thought you would be a perfect source of information, and I would appreciate, greatly, any information you'd be able to share with me!

That's a great question, Amanda, and one that ties in with the recent discussion and comments about the importance of technicians in anesthesia monitoring.  We veterinarians couldn't do our job without our support staff, so I'm happy to help illuminate exactly what they do in cases like this.

The veterinary technician or assistant helps perform the pre-anesthetic exam.  Often they are the ones collecting the blood and should be the ones performing the diagnostic tests. They check the anesthesia equipment for proper functioning (checking oxygen levels, performing leak tests on the machine, etc.), gather the surgical instruments and suture, prepare the monitoring sheets, and otherwise make sure everything is ready for the doctor.  Once it is time for surgery they may place IV catheters and set up fluid lines. 

Depending on state laws and legal certifications (when necessary) technicians may induce and intubate the patient.  They hook up the monitoring equipment and begin preparing the patient and sterilizing the surgical site.  During the procedure itself their primary responsibility is to keep track of the vital signs by monitoring and recording the data. They should also be examining the pet themselves (listening to the chest, feeling the pulse, checking gum color, etc.) and not just relying on the equipment.  If the doctor needs more suture, new instruments, or anything else, it is their responsibility to get it since the doctor is scrubbed and sterile.

The tech normally monitors the pet during the initial recovery and extubates them once they are swallowing.  Vital signs are taken again and the pet placed on a warming pad if necessary.  As the pet recovers the assistant is responsible for continuing to monitor, usually administering any post-op analgesics or other medications.  Depending on the nature of the surgery (routine versus uncommon) the tech will often discharge the patient, going over medications and at-home instructions.

Now these are the general instructions for just about any surgery.  An enucleation really isn't that much different.  Surgical shaving, scrubbing, and prep is different just because of the different location (such as versus a spay).  The doctor is doing a much different surgery than an neuter or splenectomy, but that's all the responsibility of the vet and not the tech.  Post-op instructions for most surgeries are going to be pretty similar, so there won't be that much difference from other surgeries.

Amanda, I hope this answers your questions!