So thank you for joining us, for a lecture on an anaesthesia considerations for the dental patients. Hopefully we can reduce some of the anxiety that a lot of people feel regarding to dentistry anaesthesia, and gives you some tips to improve your patient care and safety and to make it a more positive experience for everybody. So, obviously on the webinar, you can't see me.
My name is Stacey. I qualified as a registered veterinary nurse in 2014. I worked in first opinion and then a mixture of first opinion, emergency and referral, and now I work for Perry referrals, a specialist veterinary dentistry and oral surgery.
I won the referral anaesthesia for the dentistry and I'm also the dental nurse there. I've completed my Ncert in anaesthesia and dentistry. I work with European dental specialist Rachel Perry.
That's us. Rachel's in the background, and that's me at the front. So that's my day job, and I also provide in-house CPD.
So as I mentioned, I work for Perry referrals, and we predominantly work out of North Downs specialist referrals in Bletchingley. So, who gets nervous about dentistry, anaesthesia? I think it's one of the procedures that as nurses sometimes we could see our name on the list to be working with and we think, oh goodness.
And there is a lot of factors involved with dentistry, anaesthesia, and I know when I first qualified, I was terrified and it wasn't an enjoyable experience for me. And the more I've learned and the more I have worked with people who did enjoy it, I've become really comfortable and I'm really passionate about making more nurses and vets more comfortable. For these dentistry procedures and the anaesthesia involved, so don't feel alone, we've all been there or still feel nervous about the dentistry anaesthesia, and hopefully after the end of this lecture, you'll feel a bit more comfortable.
It's a very vast subject, but today we will focus on airway security, hypothermia, hypertension, and we'll touch on what about pain. And there is also a lecture within this series which does cover dentistry and analgesia. So if you decide that you learned quite a lot from this one and you would like to learn more just about the pain, that might be a lecture for you to look into as well.
There are other considerations which we won't be able to go into detail today, but it's definitely worth bearing in mind. A lot of our patients presented for dentistry are geriatric. They have a low body condition score, they're malnutritioned.
They could be dehydrated from being anorexic, whether that's due to trauma or severe periodontal disease. They often are older, some have coexisting disease, or they could indeed be younger and be having co-existing disease. It can often be a long procedure.
We have to turn and move our patients sometimes. Often they're coming in and they're already painful, so this can make the anaesthesia and analgesia approach a little bit more difficult. And the big thing that we all seem to dislike is that the face is not accessible to us.
And there's some tips throughout this that we can talk about, to alleviate that. So we'll start with airway security, which is obviously of utmost importance. We do not advise anyone to be performing dentistry or oral surgery without a general anaesthetic and a secure airway.
So that means that they've had the general anaesthetic induction and that they have got a patent ET tube in their trachea to protect them. We always recommend that suction is on hand, so on the picture on the left, that's our dental machine and it has suction built in, so that's super handy. Doesn't have to be all fancy, you can have a separate suction device, and we recommend having that set up right from the beginning.
You may need it at induction, you could need it during the surgery, and you certainly should be using it prior to recovery. Make sure it's set up and ready to go. If you suddenly need suction, it's gonna be very stressful if you're running around trying to get all the parts together and plug it in.
Having everything ready and laid out, I often have them in a nice container. I spread it out for the picture. Everything you need to monitor your patient, your pre-medication drugs, got the interviews there for the cats, ready to maintain and offer that airway, some drugs to relax the larynx as they have very sensitive larynx, and we don't want that to spasm.
We always use a laryngoscope, and we sometimes if we find the cuff requires it, we will use sterile lube to assist the placement of that ET tube. We have a range of ET tube sizes because you're never quite sure until you can visualise what's going on back there, what size you might need. And we actually use these plastic ties, to stabilise that ET tube in place.
It then doesn't get wicked water off it, which makes the patient wet and cold. You can reuse them so it's better for the environment, you can sterilise them in EO if you wish to. They're more obvious to see, and they don't dig into the patient as much and they don't get caught on the drill piece either.
We've got the cuff and the eye lobes, so we've got everything ready for induction so that you can focus on your patients. We tend to use the armoured ET tubes now for our dentistry. Most dentistry suites haven't been created, to be a dentistry suite.
It's probably the last room they had available, or a very small room perhaps. And often you need to use an elbow connector to allow the airway not to be pulled on on the on the ET tube, to connect to the breathing system. Connected to the anaesthetic machine.
And also they're really good because they don't kink, as you can see on the left in comparison to your normal ones. Little bit more difficult to incubate with them because they are flexible, so we recommend using the laryngoscope and one of the tts. And once you've got the hand, the, sorry, of incubating with an armoured ET tube, you'll be good to go and you'll be able to incubate with any ET tube.
We do use cuff TT tubes even for cats. We do not use the red rubber ones. We use these guys with a high volume low pressure cuff, a radio opaque line, if God forbid it did break, and a bevelled tip, and the Murphy's eye on the top, so if the bottom area, the main airway is blocked, then you do have a slight rescue there if there's any mucus or or tissue blocking that bottom bit.
As I said, we should not be using these. They are very irritant. You cannot see if they're occluded, you cannot see if they're clean.
They like to hold on to cleaning chemicals and can irritate the trachea further, and not recommended. So if you can slowly dispose of those and replace them with the clear tubes, that would be a lot better for your patients. What we need to watch out for, particularly in dentistry, is occlusion of the ET tube, and that might be through debris.
Often there's quite a lot of extra liquid at the back of the throat with dentistry. Their saliva's been quite thick from the periodontal disease at times, particularly cats, just by incubating them can produce excess liquid. And that you can sometimes hear rattling through your breathing system, particularly on the modified teeth piece.
But what you would see on your catnograph is what we call a shark fin. I think for obvious reasons, and you can see the shark picture there. And as they're breathing out, they're meeting some resistance, and that needs to be looked into and mustn't be left.
We do not want to have a tube becoming occluded for any reason. To cough or not to cough, as I've mentioned, we always cough for dentistry. Be careful with your incubation, use some sterile lube should you need to get that cuff through.
Measure the pressure of the cuff if you can. We use the agal cys and we go up to 16 centimetres of water in cats and 20 centimetres of water in dogs. And this ensures you're not putting too much pressure on that trachea, which could cause tissue damage, which wouldn't be obviously notable at the time.
They may be having problems postoperatively the next day or 48 hours later. You can listen for leaks while you're getting used to using these tubes, the the agiocoil syringe tube. If you can't get these, then you should be closing the APL valve, squeezing and giving a gentle breath and saying in, in, in, while someone is listening, and gently puffing up your pilot balloon on your ET tube until they can't hear a leak.
You must go very gently so that we're not overinflating that cough and causing trauma. Particularly with cats. Always disconnect the patient between the ET tube and the circuit prior to turning.
This will avoid a tracheal tear. Remember to turn off your inhalant first, so that you're not contaminating the room in any staff members. Super important, it doesn't matter if you're only moving them a little bit, it's just not worth the risk.
So to protect the airway, we're also using quite a lot of water with our scaling and polishing and our extractions and the drill. If you can allow some natural drainage of the head. Always use a throat pack and change them regularly.
People often ask me how often should we change them, but it's a really difficult question to ask. We don't know what speed or how much water you're using, or how big your throat pack was or how well your natural drainage is. So keep an eye on them.
If they're saturated, change them, they're not going to work anymore if they're full of water. And you can get some special dental pack sponges. We use the ones on the right and we find them quite good.
You can get them really small, the 5x5 for cats and small dogs, and they go up to a 10 by 10 for your larger dogs. And by placing these, we're preventing aspiration, foreign bodies and fluid entering the respiratory tracts, and we're also preventing them from breathing around the tube. Keep the ETT tube cuffed until completely ready for excubation.
It is their only protection at that point, if they were to regurgitate and you let that pilot bloom down, they're more likely to aspirate that. As super important as it is to use the throat pack, it is more important to make sure that you have removed it prior to waking up your patient. You can place a piece of tape over a limb or the neck that tells you to do so, to remind you.
Put a poster up on the, ISO or the Sivo vaporizer, so when you go to turn it off, it's there, reminding you. And do try and get in the habit of both the vet and the nurse checking prior to finish the procedure. And use a light source, move the tongue, have a good look in those cheek pouches on those dogs with big flabby cheeks and make sure that you've definitely got everything out.
And again, we would then suck in the mouth to make sure any excess fluids, any blood or any debris has been removed. And at that point, it's really important that you don't soak the tongue, but make sure the tongue is nice and damp, because we've all woken up in the middle of the night with a really dry tongue, and it's a really unpleasant feeling. So just make sure the tongues.
Nice and wet at that point, but the rest of the mouth is nice and clear. And it's also really important, particularly in cats, that we ensure that their nares are clean. If they've got any blood or any toothpaste blocking their, their nose and they can't breathe through that, you're going to head into trouble.
So at that point, you can clean the nose and make sure that's all clear for their recovery. We don't recommend that you use the spring loaded gags to hold their mouth open for surgery. It can cause retinal blindness in cats.
There's a good paper here, feline complications from mouth gags that I would recommend reading. And what we use just like the one on the left, with cats and dogs, you can use a needle cap that's been cut down to be the right size. So you can see it's still allowing good access to the mouth, but not to the extent and the same strength of that horrible spring gag on the right is.
I'm gonna go back to the dog on the other picture and you can see that that's working well there as well. And it's not just about not causing post-op blindness, although that is quite common with cats, because the pressure of jaw being open is, is leaning on the nerve too much, but it's really uncomfortable. You don't want them to wake up with a jaw ache from having their mouth forced open for so long.
So that's airway security covered and we'll move on to temperature monitoring now. And something that a lot of nurses say to me about dentistry is, oh, my patient is always very cold. And I'm quite fortunate in that we've found ways and we're able to keep our patients normothermic, and hopefully I can share some tips with you, so your patients can recover quickly.
Patients that are cold recover so much more slowly. I, I've had a patient that had to go around several rooms and unfortunately did wake up chillier than I'm used to, and their recovery took up to an hour and a half to be fully standing and eating. And when my patients are normalthermic, I'm finding within 1015 minutes they're up and about.
So there is a marked difference, so it's something we really should aim towards is monitoring and controlling their temperature. It's something they can't do once you've placed them under general anaesthesia. Why do they become hypothermic?
There's many reasons, reduced muscle mass and fat coverage. We're using oxygen and perhaps sometimes we've got our fresh gas flow a little bit too high. We may need to be turning them regularly, so any warmth that you've kept in is being let go.
We do need to use a lot of water and some drugs we're giving are causing vasodilation, which again is going to allow them to lose heat. Some hospitals have quite a cold environment to keep things clean, so if we can try and warm up the theatre or the dental room prior to them coming in, then that will help you too. And often it can be quite a long procedure, and the longer we're under anaesthetic, the harder it is to keep them warm.
So if you can start right from the beginning, keeping them toasty, then you're gonna be. And a better chance to wake them up nice and warm than if you start looking into it halfway. So no matter what size of patients, little Chihuahua on the right, she's like wrapped up in a nice burrito.
She was quite naughty, but we needed to keep her toasty. And even the larger patients such as this tiger that we were able to treat at Mar Zoo, they still need to be kept warm, so we're keeping my head warm there. She actually got a little bit warm, so we took the blanket off in the middle picture.
But we still need to be monitoring that temperature and ensuring that we're acting on what we're seeing. So some tips that I keep them warm with, we use a bear hugger, that's in the middle there, and you can actually get reusable covers now which go through the washing machine really well. And then you don't have to worry about all this extra plastic going in the bin, which I think we're quite good at producing far too much plastic in the veterinary world.
You can get them in a small size or a large size, and we've had ours for 2 years now and we use them daily, and we haven't had to replace them. We cut the inco sheet or kennel liner, whichever you'd like to call them on the left, and we cut a muzzle sized hole, on the left. This is obviously for her face, by the looks of it, it's quite large.
And that will take all the water instead of it going on your patients, and I'll show you a picture of that in a moment. Wrap a blanket on them as soon as they've had their pre-medication or before, if you can, if they weren't hypothermic when they came in. There's the picture on the left.
All that water, it's a little bit of blood. It's mainly water, I, I promise you. Would have been on the patient's muzzle, and going into their head, and that's a spaniel under there, so you can imagine how wet the ears and the skull would have got.
So it's been collected on there, and we do change them regularly. We were about to change that when I took a picture. Middle 1 2 kg Chihuahua, she's actually got a little fleece vest on, that we place on all our patients.
And you can see on the bottom right, the cat has got one on too, and I can direct you to where we can get those shortly. And the middle one had a nice fleecy bed that actually sit the whole way across, so he started off nice and warm. On the right, we've got the heat moisture exchange, which is that green disc between the ET tube and the breathing circuit, which can help to warm their inspired gas.
And he's also got some socks on to keep him warm. I use baby socks a lot with my patients. Some can go into baby grows, but as I said, we've moved on to these new coats that we've found.
And they also lie on some beanie beds. They're not hot, but they do retain the patient's warmth, and they also keep them in position. We perform all our dentistry with the patient on their back.
We only move them for radiographs, and then most of the surgery is done with them on their back. So we don't need to move them too much and this keeps them nice and stable and comfortable and works really well as an insulation. And then you can also get these maps, I am 3 do them, and so did Junior cosy pad.
And they absorb the water away from the patient, and they're quite soft as well. So we're not putting them on an incho sheet or a cold metal table, which is just going to make them cold and drag away the warmth from them. There are other ways of keeping our patients, but we do need to be careful.
If we use hot hands, they could split and burn the patient or you, and then make them cold, so they're going to be even colder. Also, as the temperature within the hot hands gets colder, it could then start taking away temperature from the patient. Using a forced warm air system such as the bear hugger, but without a suitable cover could cause burns.
Placing a heavy blanket on smaller patients such as a heavy towel, could interfere with their ventilation. And using a hot microwavable disc on a patient could cause burns as well. As could a heat pad without very thick bedding.
I won't use a heat pad in any patients above 5 kg at all. And when I do use a heat pad on the smaller patient, there's a thick fat bed on top and then the buster bed. So it's warming what they're laying on opposed to them laying on or even very near it.
I've used hotdogs a little bit, you just need to be very careful. They're safe if you're following the manufacturer's guidelines. We've recently invested in some grooming tools and a hair dryer, in the dentistry room so that if they are getting damp at all from the dentistry prior to waking them up, we're being very careful, we're not burning the skin, obviously, but we are drying their fur, and making sure that they're completely dry before we take them to recovery.
So this little chihuahua came in for some dentistry. She was the little one that was wrapped up earlier in the towel, and she has good reason to be a bit naughty. Prior to the, the owner that brought her in for dentistry, owning her, she was, with a breeder, he was struggling to give birth.
She had a C-section on her back, on a heat pad with a thin blanket, lots of water involved in the C-section, and she received a terrible burn on her back. And you can see that was 4 years ago and she's left with this terrible scar. So we really must be careful when we're using our heat aids.
This is an example of one of my patients, it's just pointing to the HME there, . So yes, you can't see him very much, but he's got the bear hugger under there, he's got socks on. You have a dog fleece on, and he's got a blanket to keep the bear hugger warmth down.
He's got the inco sheet over his face to collect the water. He's got the plastic tie to hold the ET tube in place, the HME to warm his inspired oxygen, and the blue mat underneath to drain the water away to the drainage table below. He's nice and feisty.
We should be taking their temperature at least every 15 minutes. Some multi parameters will have a probe that you can put a cover on and insert into their rectum. We obviously can't use esophageal temperature probes in dentistry as it will get in the way of the dentist.
Monitor it more frequently if you're seeing a rapid change. They can change temperature very quickly, both cold and hot. And hypothermia is just as dangerous as hypothermia.
It can lead to their death, so be very careful, particularly if you've got a very thick coated dog, you may not need all of those heating aids. Record the temperature and act on it. So warming packs are available.
I'll talk to you about that later. There'll be a slide. And we'll move on to hypotension.
Which patients should I be monitoring the blood pressure for in dentistry, or indeed any surgery, but obviously today we are focusing on dentistry. Absolutely everybody, if you have the machine, which I believe most people will have some form of blood pressure monitoring device, even if it is old, it is better than nothing. Rabbits, pugs, thinner dogs, fatter dogs, fluffy dogs, kittens, cats.
There's a red panda at the top there we got to treat at the zoo. He had his blood pressure measured on the Doppler. Not the easiest to use, but it's better than nothing.
So everybody, for every procedure, should have their blood pressure monitored. Cats in particular seem to be left out when they've done studies, they've realised that cats aren't monitored as well. Perhaps the multi-parameter monitors aren't as accurate.
I would agree that they're sometimes not as accurate for our smaller patients, but it's important that we try and obtain something, even if it is our friend, the Doppler, that we don't leave the cats out. I like to take the blood pressure of all my patients proactively, temperament, providing that I can do so. If I know what's normal for them, then I know what's abnormal.
Obviously they're normally a little bit stressed on arrival, so I do take that into account. But if it's quite low to start with, that might want me to look into the patient a little bit further or prepare a bit more and anticipate problems that we might be having during the anaesthetic. And if you can keep them as relaxed as possible, so he's sitting in his own carrier.
We've got classical music on, he's got a cover over him, there's no dogs in the room. So we're trying to get as accurate blood pressure reading as possible before we administer any medication. Don't use tape on your blood pressure cuffs so that it's a teeny tiny tiny bit, but only if you really have to, and make sure you're ordering a new one to replace it.
It will affect your result. They're not that expensive and they aren't meant to be used over and over and over. They're single use, but that would be a terrible waste, so it's quite right that we use them as much as we can, but not overuse them to the point that actually you're just getting inaccurate results and it becomes stressful because it keeps popping off.
So if you can invest and have someone to keep an eye on your blood pressure cuffs and replace them as needed. And then through the sort of the front end of the animal isn't ours. I sort of work from the shoulders downwards, even the front limbs might not be very much accessible for us.
So you can place the blood pressure cuff on the hind limb. You can place it on the tail like the picture on the left, and you could use a multiparameter if you have one to measure the blood pressure, like the top middle picture. We've got the PET map there on the right.
I quite like the PET map for our smaller patients, and the multi-paretter seems to be more accurate with our larger patients. We should all be used to using the Doppler. As annoying and frustrating as it could be, it is accurate.
And then you have got to keep a good range of cuffs like the ones on the left so that you can monitor all patients' sizes and measure the cuff if you need to, it should be 40% of the circumference of the limb. So what is class hypertension under anaesthesia? When do I need to be acting on this?
If your mean is below 60, although if it starts trending towards 70, I'm gonna start acting on it, or a systolic below 100. It's so important to maintain a blood pressure. If it is below a mean of 60 for more than 15 minutes or below a systolic of 90, we've then got reduced tissue perfusion, accumulation of lactic acid leading to acidosis.
We could be damaging the kidneys, which might not be seen immediately. They might come back six months later with some sort of renal failure, or we could worsen some chronic renal failure. Severe hypertension will provide reduced coronary blood flow, reduced blood flow to the heart, and that will cause arrhythmias which can lead to cardiac arrest.
Hypertension also leads to prolonged recovery, which If it is allowed to get to that point, can lead to death. My mom had surgery recently, she had 2, a month apart, and one of them, she was incredibly hypothermic and hypertensive on recovery. They were trying to warm her up with a bear hugger, pushing loads of fluids into her, and she looked and felt awful.
The second one, she woke up warm and her blood pressure was lovely, and she looked like nothing had happened to her. And that really opened my eyes, you know, these patients can't say, God, I don't feel well. But seeing it in human form, it really sort of reiterated the literature that's out there about why it's so important.
So what's causing the hypotensive episode, in order to safely treat this hypertension, we need to first understand what is causing it. Could they have lost a lot of fluids? Have they had diarrhoea?
Have we lost a lot of blood? Are they dehydrated before we've started? Or perhaps do they have a low heart rate?
Have we given them some drugs that may have caused that low heart rate? Are they cold that can make them hypotensive, and if you've got a cold and hypotensive patient who's bradycardia and you want to offer an anti-chologenic to treat that, it's not going to work very well if you have a cold patient. So you can see why all these parameters fall into place like a jigsaw.
We need to keep them all appropriate for everything to be controlled and safe. They could be hypertensive because they're too deep. You may have the vaporizer on too high, or they could have reduced cardiac output.
And that could be from a cardiac disease, or it could be again for the drugs that we've given. So this is the chunkiest slide. So math is your cardiac output, which is your volume of blood being pumped by the heart, times by your systemic vascular resistance, and that's the resistance to blood flow.
So blood pressure treatment choices, depending on what's going on, you can reduce the inhalants, that's the first step always. Check that your blood pressure cuff size and position is correct. If the cuff's popped off or it slid down, you're using a cuff that's too small or too large.
It's a bit annoying, maybe a bit embarrassing, but actually that's a really, really good answer to a problem. Nice and quick and easy. Sort out the cuff size and position and you get a normal reading.
Lovely, your patient's fine and you can relax. If it's in the right place and you've reduced your inhalant and you're still suffering with hypotension, you can trial a fluid bolus, but be very careful with fluids. It's not always the answer, as we've established, there's many reasons why we could be hypotensive.
We would trial a fluid bolus at 5 mL per kilo, and we would give that over 15 minutes, usually using Hartman's solution. However, if your patient is very bradycardic. And hypertensive, it's very unlikely that a fluid bolus is going to help, and we must be careful, particularly with cats that we're not overloading them with fluids.
So we would then offer an anticholinenogenic such as glycoperonium. You could potentially reverse alpha 2 agonists, not IV, you should be doing the IM, otherwise it's just too much of an insult on the heart. But remember you're then reversing the analgesia effects of the alpha 2, taking away that good sedative, and you would have given that meatomidine or dexamedatomidine for a reason.
So it might be that we need to treat it differently. Or if none of that's working, we may need to reach for vasopressor. So if you would like to see any posters and pocket guides, do let me know that I've created to help you manage hypertension and then you can just follow it as a guide if you would like.
Most important thing for all aspects of anaesthesia in any procedure, more particularly one that we're not comfortable with, sometimes such as dentistry, and if we are anticipating hypertensive episodes or the patient isn't very well, what potential problems could arise, let's talk about them, write them down, and what steps shall we take to prevent them. All the team must be comfortable with their approach, and if these problems do occur, how should we treat them? And we should learn if we can to communicate and learn from one another.
We all do different CPD, we all have separate interests, but if we can come together to talk about what we've learned and how that can benefit our patients, then in my eyes, that's only a really good thing. Discharge instructions, we often think about that as the procedure that they've had, you know, they've had a dental to give them soft food, they've had a castrate, don't let them lick. But what about the anaesthesia care?
The, the owner doesn't know anything about the anaesthesia, 99.9% of the time. So yes, we should be telling them about how to care for the surgery they've had, but also what to expect from an anaesthesia point of view.
They may feel a bit sick, they may have a sore throat, they may. Not want to eat as much that evening. They may be a little bit sleepy with some of the drugs that we've given them, and they may take a couple of days to come back to being completely how they usually were.
If we can preempt those complications, we can divert the owner away from them. We can give them the correct care guidelines which will calm the owner. They feel like they're more in control, and give them a list of when they might need to contact you, so they don't feel silly or question whether they should or shouldn't, particularly if they're anorexic for too long, have become having a productive cough, or they have developed a concerning mentation postoperatively.
So if you're still with me, thank you very much. The last few bits I've added in just as extra tips for dentistry, anaesthesia, normally we would place an IV catheter in all patients, we definitely would put them in all patients, but normally we would place it in a cephalic vein in the front limb. If you think about how much debris and dirt is created on the scaling teeth, some of that can go near.
The IV catheter. So where possible, I try and get used to placing it in the back limb. It can take some practising for sure.
So perhaps place one in the front, induce them, wrap it all up and cover it so it's still patent and you've got it. And while they're asleep in a mobile, you could then place one in the back limb, and that's a good way to practise as well. And owners don't seem to mind if you've just left two small clip patches.
As I said, you don't get much access to the mouth, and we're all used to putting the SPO2 probe on the tongue. You can put it on the toe like this, or the fold of skin by the groyne, the penis, the vulva. I find the toe works quite nicely in most patients, and if none of that works, you could try the ear, but again, you're venturing into the dentist's space.
And as much as we have all of these amazing monitoring equipment in many practises, you really must remember that auscultation of the chest and heart is still very important. No monitor's going to tell you about a murmur that's developed or crackly chests, so it's very important that we are monitoring them hands on, feeling pulses, listening to chests, as well as using all our fancy equipment that we're lucky to have. I also can't recommend enough calculating your emergency drugs for every patient prior to induction.
This is the chart that we use and it's got fluid rates and it's got rescue drugs and emergency drugs as well. So the bare minimum for me would be atropine and adrenaline. I would be using those in an emergency.
I often to control blood pressure in the face of bradycardia, I am using glycos, so it's something that I always have near. I have a small emergency box in my dental room and there is a, obviously an emergency cart in the entire hospital. But to have something literally within arm's reach should you need it, particularly in more sick patients, we reassure you that it's there, and if you need it, you're not going to waste time.
You're also not then wasting time in a stressful situation trying to do math. So I think having it written out that anyone can grab and draw up the drugs you might need if you are unfortunate to be in such a situation takes a lot of stress away from you. And preoperative checklists, they use it in the human world all the time.
Every patient, every time. Your patient should be labelled with a neck tag, and you can confirm their ID that it's them. You've checked the consent form, what are we doing?
Have we permission? Have we permission for a genuine anaesthetic, or have we just written dental? That's not informed consent.
They must know what you're performing on that animal. Have you checked your breathing system? Is it appropriate for your size of patient?
And is the APL valve open? Very, very, very important. Just because you left it open yesterday doesn't mean it's open today.
It could have been knocked, it could have broken, someone else could have used it. We also assign the ASA grade and we will talk about their airway. Are we anticipating any problems?
Are they brachycephalic? Do they have a feeding tube? Has there been facial trauma?
And do they have any allergies or drug sensitivities that we're aware of? If you can read through their history and have a look at any anaesthetic forms and see if there was any untoward events that someone else went through that we can avoid, because the owner might not have been aware that anything happened, so you can't rely on them to tell you all the things. And what about pain?
Well, we've covered a lot and in a separate lecture we will discuss all the different pain. Treatments that you can offer to your patient for dental surgery. I can offer other lectures if there's anything in particular you wanted to discuss in-house, then let me know.
Thank you for listening and thank you to the webinar vet for having me. It's a real joy to be able to help relax dentistry and increase how well we do it and take some of the stress away. So thank you very much.
Any questions, or if I haven't been clear about anything or it's raised a thought in your mind, then feel free to send me a text or a WhatsApp to my work number or indeed email me if you'd like to. Thank you very much for listening.