REHAB | Postoperative Care 3. Dysphoria It is very important to train your team to differentiate between pain and dysphoria. Both can lead to crying, whining and bizarre behavior. Dysphoric dogs who cry should stop when you sit next to them, interact with them, or call their name. Mild sedation such as the “rescue dose” of dexmedetomidine, is helpful for these patients. The goal is not to fully sedate them, but to “take the edge off” and help them relax as they recover. Truly painful dogs who cry will not stop for any reason. 4. Warmth Optimal body functions require optimal body temperature. Yet most patients wake up hypothermic after anesthesia. This in turn can affect blood pressure, infection rate and metabolism. There are many warming devices available to fight hypothermia during surgery. Yet your best efforts still may not prevent hypothermia. Therefore, it is important to continue to warm up your patient after surgery. The same warming devices you use during surgery can be used after surgery. As long as patients are hypothermic (<100 degrees F), their temperature should be taken every 30 minutes. This could be done even more often, e.g. every 15 minutes, especially in cats and small dogs, who could quickly become hyperthermic while unsupervised. Options include: Heating lamps. They are certainly not ideal or safe but may be acceptable as long as hyperthermia or worse (skin burns) don’t occur. A heating pad or warming blanket can be moved from the OR to the recovery area. If at all possible, it would be ideal to have a separate warming device dedicated to recovering patients. Use towels or a blanket warmed up in the dryer. Be sure to cover the feet to decrease heat loss. Consider warming up the IV fluids, or using a heat source to warm up the fluids. Make sure it does not touch the patient’s skin, and that it is close to the IV catheter to be effective. As you become familiar with the different techniques, you will notice that some work better for you than others. Or that you like some methods and dislike others. What matters, is that you and your nursing team become proficient enough to tailor various warming techniques to each patient. In other words, it will be more challenging to maintain the temperature of a Yorkie during a lengthy laparotomy, than the temp of an overweight Labrador during a quick mass removal. Fighting and treating hypothermia is good patient care. www.kruuse.com
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