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Anaesthesia and analgesia

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Abstract

Patients with neurological disease may require anaesthesia for diagnostic or therapeutic procedures. The manifestations of the neurological condition determine the inherent risk of anaesthesia and whether or not an analgesic plan is required. This chapter deals with physiological considerations, anaesthesia of patients with intracranial disease, anaesthesia of patients with spinal disease, anaesthesia of patients with peripheral nervous system disease, intermittent positive pressure ventilation, perioperative patient monitoring, analgesia, fluid therapy.

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Figures

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21.1 Cerebral autoregulation. CBF is constant when CPP is between 50 and 150 mmHg.
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21.2 There is a linear relationship between CO and CBF except at the extremes, as the vessels are maximally constricted or dilated.
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21.3 Chronic increases in CO result in comensatory changes that normalize the pH of the CSF. This may be important in dogs with brachycephalic airway syndrome, such as this English Bulldog.
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21.4 An increase in the volume of one tissue component within the skull requires a compensatory decrease in the volume of the other tissues to prevent an increase in ICP.
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21.7 Administering ‘flow-by’ oxygen.
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21.8 Manual ventilation with a close-fitting facemask.
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21.11 Topical lidocaine spray applied to the larynx prior to intubation will inhibit the response to intubation.
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21.13 Positioning for surgery: the dog is positioned in sternal recumbency with the head level with the spine. Careful positioning and padding is essential to prevent occlusion of the jugular veins (arrowed).
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21.18 Endotracheal intubation with adequate support of the head and neck is essential for patients with cervical spinal lesions.
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21.19 Comfortable and supportive bedding in the intensive care unit or recovery ward is important.
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21.23 Preoxygenation prior to induction of anaesthesia in a patient with neuromuscular disease.
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21.24 Pressure applied to the cricoid cartilage during a rapid sequence induction of anaesthesia.
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21.25 Airway pressure monitored during inspiration. Do not exceed 20 cmHO unless the respiratory and cardiovascular impact of ventilation can be assessed accurately and continuously.
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21.26 Oxygen–haemoglobin dissociation curve.
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21.27 A multi-parameter monitoring unit displaying (from top): electrocardiogram; CVP waveform and measurement; invasive ABP waveform and measurements; and a plethysomograph with pulse rate and oxyhaemoglobin saturation ( O).
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21.28 A normal capnogram from a capnograph which measures inspired (Fi) and expired (ET) CO, O, NO and inhalant anaesthetic.
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21.29 A catheter in the dorsal pedal artery of a dog for invasive blood pressure measurement (foreground) and a non-invasive blood pressure cuff in position for non-invasive blood pressure measurement (background).

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