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429 Cards in this Set
- Front
- Back
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What are the 2 recognized non-animal risks in vet hosp?
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Radiation
Trace Anesthetic Gases |
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What are 6 less recognized non-animal risks in vet hosp?
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Hazardous chemical spills
Fire Tornado Earthquake Flood Robbery |
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Businesses with ____ employees musthave emergency plans documented in writing to deal with events. What do businesses with less than ___ need to have?
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11+
Need to have a plan but don't need to be documented *EACH EMPLOYEE MUST UNDERSTAND THE PLAN AND KNOW HIS ROLE* |
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The potential risk assoc with anesthetic gases has been recognized since ____ by what society?
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1974
The American Society of Anesthesiologists |
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Name 7 health problems associated with repeated exposure to anesthetic gases.
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Spontaneous abortion rate
Congenital abnormalities found in offspring of women Congenital abnormailities found in offspring of men Cancer rate in women Hepatic disease in women Renal disease in women Cognitive skills are decreased |
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Unscavenged levels in vet operating rooms averaged _____ compared to ____ when scavenged.
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4.7ppm
1.4ppm |
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How long are anesthetic metabolites (halothane) found in patients?
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20 days
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How long is N2O exhaled for?
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56 hours
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How long are traces of gases (halothane) found in the urine of anesthesiologists?
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64 hours
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Has there ever been a study done that conclusively links trace levels of inhalent anesthetics to any disease?
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NO but because of links, OSHA created standards and recommendation for dealing with anesthetic gases.
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What is the purpose of scavnaging equipment?
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Collect the excess anesthetic gases and remove them from the operating room environment.
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How are gases removed via a scavenging system?
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Exhausting them to the outdoors via passive system
Exhausting them outdoors via active system (suction) Absorption with activated charcoal |
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Do you need to scavenge isoflurane out of the operating room even though it is minimally metabolized?
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YES
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What is the largest source of anesthetic gases leaking into room?
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Pop-off valve
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What are 4 routine maintenance procedures you need to do for your anesthetia equipment?
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Routine cleaning
Daily checks for leaks Frequent calibration (4 months?) Records of all maint checks |
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After disconnection from anesthetic machine, where should the animal be placed?
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Well ventilated area for recovery
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What are 4 ways to minimize gas use?
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Use low fresh flow rates (10ml/kg/min)
Use nonbreathing systems only on animals <2-3 kgs Reduce the use of masks and induction chambers (dumps anesthetic gas into room when take off lid) Eliminate use of N20 (needs higher gas flow rates) |
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What should your anes. levels be for potent nesthetics?
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<2ppm
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What should your anes levels be for N20?
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<25 ppm
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What are 4 common sources of leaks of anes gases?
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Uncuffed ET tubes
Holes in rebreathing bags The pressure relief valve (pop-off valve) Spilled liquids |
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What are 3 things that are your responsibility as a vet to ensure safety of employees regarding risks in vet clinic?
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ID potential hazards
Develop an action plan to deal with the hazard Communicate the plan to all empoyees |
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Give an example of secondary labeling.
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Buy alcohol by the gallon and pour it into smaller bottles for use - these smaller bottles must be labeled.
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When do you need to label common chemicals (ie bleach)?
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When it is used in a manner that is outside its normal use (for disinfection)
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When do you need to label bleach - for laundry or for disinfection?
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DISINFECTION
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Health care professionals who abuse substances generally use more than ___ substances.
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4
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What is usually required to recover from overdose of xylazine?
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Ventilation
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What should you give to someone that ODed on detomidine and butorphanol?
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IV fluids and naloxone
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What is the maximum concentration of isoflurane at room temp?
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33%
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1ml of isoflurane liquid becomes ____ml of isoflurane vapor?
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200ml
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What is the open drop method of anes delivery?
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Patient is enclosed in a chamber to which anesthetic is added; great with agents of low vapor pressure (ie methoxyflurane)
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What type of drug is great in an open drop method of anes delivery?
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Agents of low vapor pressure (ie methoxyflurane)
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What is the modified open drop method of anes delivery?
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Anesthetic machine is used to deliver a specific controlled flow and concentration of anesthetic and oxygen.
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What device regulates the agent concentration in the modified open drop method?
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Vaporizor
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In what type of anes delivery method is agent concentration not monitored?
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Open drop method
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What is the modified open system of anes delivery?
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Oxygen and anes vapor is delivered to patient via "primitive" circuit; difficult to control oxygen and anes concentration; dilution with room air; when animal inhales they may inhale some expired gas along with fresh air
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Is it easy to give an animal a breath of fresh air in an open system?
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NO - difficult because when animal inhales they may inhale some expired gas (along with fresh gas)
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What is a semi-open system?
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A resevoir is added to minimize dlution with air; patient gets 100% fresh gas with every inhalation
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What is another name of modern semi-open system?
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Non-rebreathing
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What are the 2 functions of the anesthetic machine function?
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Deliver oxygen and volatile anesthetic to resp system
Remove CO2 from resp system |
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What 2 components make up the high pressure system?
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O2 and N2O cylinders
Pressure regulators |
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What color is the O2 cylinder in the US?
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Green
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What color is the O2 cylinder in any other country besides US?
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White
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What color is the N20 cylinder?
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Blue
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WHat is the pressure of a full O2 cylinder?
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2200 PSI
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What is the pressure of an N20 cylinder?
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750 PSI
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Does the pressure inside the O2 cylinder drop as you use the gas and why?
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Yes - O2 stored in cylinder as gas
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Does the pressure inside the N20 cylinder drop as you use the gas and why?
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No - N2O stored as liquid; only drops when all liquid is gone
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What do pressure regulators do?
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Adjust the variable tank pressure to a constant pressure (50-60psi)
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What are the 5 components of a low pressure system?
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Flowmeters
O2 flush valve Vaporizer Oxygen failsafe Common gas inlet and outlet |
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What isthe anesthetic vaporizer?
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Can be adjusted to deliver a specific gas concentration (%)
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What 3 things determine how the anesthetic vaporizor functions?
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Anesthetic agent (agent specific)
Temp compensated Flow compensated |
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If temp increases in the vaporizor, then the vaporization will (inc/dec)
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Increase
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What is the anesthetic breathing circuit?
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Connects the fresh gas outlet to the patient to the anesthetic machine
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What are the 2 commonly used breathing circuits in vet med?
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Circle rebreathing (most commonly used)
Non-rebreathing |
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How does the circle rebreathing system work?
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Exhaled gas is cleansed of CO2 and the remaining gas is rebreathed.
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What does the amount rebreathed depend on in the circle rebreathing system?
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Fresh gas flow rate
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What is the minimum flow equal to in the circle rebreathing system?
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Minute oxygen consumption (VO2) - 3-5 ml/kg/min
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What happens if you set the flow rate higher in the circle rebreathing system?
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The extra O2 goes out the pop-off valve
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What is is the % inhaled O2 and the % exhaled O2 in the circle rebreathing system?
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21% O2 inhaled
16% 02 exhaled |
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What do flowmeters do?
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Regulate the flow rate (liters/min) of the O2 and N2O that enters the vaporizer and is delivered to the breathing circuit.
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Is the flow meter for the O2 and N2O separate or the same?
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Separate
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What do one way (unidirectional) valves do?
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Maintain a one way flow of gas withn the circuit; minimizes dead space (therefore the dog does not breath in its previously exhaled gas)
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What do the pressure relief (pop-off) valves do?
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Remove excess gas from the system (any gas flow rate >VO2)
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At what level of VO2 will the pop-off valves remove the gas?
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>VO2
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Where does the waste gas go after leaving the pop-off valve?
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Scavenging system
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What should you do to the pop-off valve when squeezing rebreathing bag for assisted ventilation?
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Close the pop-off valve
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What is the passive system waste scavenging system?
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Waste flows passively from the pop off valve through charcoal canister or out of the room
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What is hte vacuum interface waste scavenging system?
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Waste gas is actively removed via vacuum
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What is the purpose of the reservoir (rebreating) bag?
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Allows inhaled and exhaled gas to move into and out of the system; aids in monitoring RR and aids in delivering an assisted breath
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What are 2 things the reservoir (rebreathing) bag helps with?
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Monitor RR
Deliver an assisted breath |
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What should the size of the rebreathing bag be?
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3-5X Vt
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How does the CO2 absorber canister produce carbonate?
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Reacts with water and CO2 to produce carbonate
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Is the CO2 canister exothermic or endothermic?
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Exothermic (feels hot)
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What color is the CO2 canister limestone before and after it is used up?
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White before
Purple after |
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What does the pressure gague tell you?
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How hard to squeeze the bag to deliver a breath (15-20 cm H2O)
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What does the Y-piece do?
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Connects 2 breathing hoses to ET tube/mask
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What type of patients use a non-rebreathing circuit?
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Small patients (<5kg)
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How does a non-rebreathing circuit work?
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Gas flows from vaporizer and common gas outlet to the ET tube
FGF pushes the exhaled CO2 away from patient end of the circuit |
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Does the patient inspire CO2 in the non-rebreathing circuit and why?
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NO
FGF pushes exhaled CO2 away from patient end of circuit |
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What is FGF?
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Fresh Gas Flow
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How high is the FGF in the non-rebreathing system?
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High (>150 ml/kg/min)
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What are the 2 advantages of a high FGF in a non-rebreathing circuit?
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Dead space is minimized
Resistance to breathing is minimized |
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What are 2 disadvantages of a high FGF in a non-rebreathing system?
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Expensive
Patient continually breaths cold, dry gas |
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What does Doppler measure (2)?
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HR
BP |
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What does the capnometry measure (2)?
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RR
EtCO2 (end tidal) |
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What does pulse ox measure (2)?
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HP
SpO2 |
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What does mechanical ventilation do to preload, minute volume, BP, and afterload?
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Decreases preload
Increases minute volume Decreases BP Increases afterload |
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Does mechanial ventilation increase PaCO2?
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NO
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What is the single most important aspect of anesthesia?
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Monitoring
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What 4 things are most important to monitor during anesthetia?
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Depth of anesthesia
CV status Resp status Oxygenation |
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What are the 6 ACVA Monitoring Guidelines?
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Ensure bl flow to tissues in adequate
Ensre adequate oxygen concentration in the patient's arterial blood Ensure the patient's ventilation is adequately maintained Record monitored variables at regular (q 10 min) intervals Maintain a legal record of significant events Ensure a responsible individuall is aware the patient's status at all time during anesthesia and recovery |
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Is depth of anesthesia rountinely recorded?
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NO
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What 3 things is anesthetic depth based upon?
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Somatic muscle tone
Respiratory patterns Ocular signs |
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What is stage I?
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Analgesia
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What is stage II?
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Delirium
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What is stage III?
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Surgical (Planes 1-4)
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What is stage IV?
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Resp Paralysis
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What CNS changes (5) do you see with anesthetic depth?
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Movement in response to surgery
Eye reflexes (palpebral reflexes) Position of eye in orbit Pedal reflexes Anal tone (EEG (research)) |
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What muscle do you look for relaxation when monitoring anesthetic depth?
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Jaw tone
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What is the MAC for surgery?
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1.5
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Is eyeball position (in monitoring anes depth) more useful in large or small animal?
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Large animal
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Where will the eye be rotated if in a light anes plane?
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Ventromedial or dorsolateral
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Where will the eye be rotated if in moderate anes plane?
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Slightly ventral but centrally positioned
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Where will the eye be rotated if in deep anes plane?
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Central with dolated pupil
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How loose should the jaw be if the patient is just right (out of 10)?
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5-7/10
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What if the patient has a fast HR and high BP under anesthesia?
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Too light
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What is the patient has a fast HR and low BP under anes?
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Moderate anes
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What if the patient has a slow HR and low BP under anes?
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Deep anes
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What is the animal is breathing fast and deep?
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Too light
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What if the animal is breathing fast and shallow?
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Too deep
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What if the animal stopped breathing?
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Too deep
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What if animal is breathing slowing and deep?
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Just right
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What are the best 2 ways to monitor CV during anes?
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HR
BP |
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Name 4 ways to masure HR during anes
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Palpatin of pulse
Auscultate heart sounds - esophageal stethoscope ECG (measures electrical deflections from baseline) Pulse Ox (counts pulses) |
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How do you measure BP during anes?
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Indirect - Doppler, Oscillometric
Direct - Pressure transducer coupled with an arterial catheter |
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What is Doppler BP used for in exotics?
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Monitor HR
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Does Doppler report systolic or diastolic values?
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Systolic
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What is the best way to track BP trends?
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Doppler (or oscillometric)
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Name 3 limitations of Oscillometric BP monitors.
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Smaller patients
Motion Lower pressures |
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What 4 values does the oscillometric BP monitors display?
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HR
Systolic BP Diastolic BP Mean BP |
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What precent of the limb/tail circumference should the BP cuff be?
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40-50%
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What value is hypotension?
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Mean BP <60 mmHg
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What 6 situations could cause hypotension?
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Excessive anesthetic depth
Hypovolemia Circulatory shock Sepsis Drugs - Ace, Propofol, Morphine, Inhalants Histamine release |
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What 4 drugs cause hypotension?
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Ace
Propofol Morphine Inhalents |
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What 5 situations could cause hypertension?
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Inadequate anesthetic depth
Pain Hypercarbia Fever Drugs - catecholamines, ketamine, A2 agonists |
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What 3 drugs reliably produce hypertension?
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Catecholamines
Ketamine A2 agonists |
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Which lead in an ECG is typically monitored during anes?
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Lead II
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What does an ECG tell you (2)?
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HR
Rhythm |
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What 9 situations reliably produce tachycardia?
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Inadequate anes depth
Hypotension Drugs - Ketamine, Thiopental, Anticholinergics, Sympathomimetics Hyperthermia Hypercarbia Hypoxemia Anemia Hyperthyroidism Anaplylaxis |
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What 4 drugs reliably produce tachycardia?
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Ketamine
Thiopental Anticholingerics Sympathomimetics |
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What 9 situations reliably produce bradycardia?
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Excessive inhalation anesthetic depth
Drugs - Opioids, A2 agonists, cholinesterase inhibitors Pre-existing cardiac disease Vagal reflexes - oculocardiac, laryngeal/pharyngeal stimulation, visceral manipulation Hyperkalemia Hypertension Hypothermia Terminal hypoxemia Cushing's reflex - high intracranial pressure |
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What 3 drugs reliable produce bradycardia?
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Opioids
A2 agonists Cholinesterase inhibitors |
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What 3 things stimulate vagal reflexes?
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Oculocardiac
Laryngeal/Pharyngeal Visceral manipulation |
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What is the Cughing's Reflex?
|
High intracranial pressure
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What are 5 ways to monitor respirations?
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RR
Resp depth Respirometer Capnometry Pulse Ox |
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What are 3 ways to monitor RR/Depth?
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Observe chest wall excursions
Observe rebreathing bag Airway thermistor probe |
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4 ways to measure ventilation (RR and volume)
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Chest wall movement
Breath sounds through esophageal stethoscope Breathing bag movement Airway thermister probe |
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What are the 2 aspects of ventilation?
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RR
Resp volume |
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What are the 2 aspects of resp monitoring?
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RR
Resp depth |
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What are the 2 ways to measure ventilation?
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RR and volume
Minute volume |
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What are 3 ways to measure ventilation (minute ventilation - rate and volume)
|
Capnometry/Capnography
Blood Gas analysis Respirometer |
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What is capnometry?
|
Continuous non-invasive measurement of CO2 concentration in inspired and expired air
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What technology does capnometry use?
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Infra-red abs tech
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What does the end expired CO2 of capnometry correlate to?
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Arterial CO2
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What 3 situations reliably produce hypercarbia?
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Hypoventilation
Dead space rebreathing Hyperthermia |
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What is the most common reason for hypercarbia?
|
Anesthetic depression
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What 8 situations can produce hypoventilation?
|
Anesthetic depression (MOST COMMON)
Airway obstruction Intracranial disease Neuromuscular disorders Thoracic/abd restrictive disease Pleural space fluid/air Severe pulmonary disease Iatrogenic (improper ventilation settings) |
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What is oxygenation?
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Delivery of O2 to tissues
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What is Oxygenation dependent on (2)?
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CO
O2 content of blood |
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What is cardiac output dependent on (2)?
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HR
BP |
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How can you measure oxygenation (3)
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BP and HR
Hb (PCV) SpO2 (pulse ox) |
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What does 1/3 PCV equal?
|
Hb
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How can you calculate Hb?
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1/3 PCV
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What should PCV never fall below?
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20%
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What is pulse ox and how does it work?
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Continuous real time estimates of arterial Hb saturation with O2; can detect hypoxemia early
Measures transmission of light at 2 wavelengths through a pulsatile vascular bed |
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Where can you put the pulse ox to monitor Hb (4)?
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Tongue
Vulva Penis Ears |
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What is the lowest you can let Hb go to?
|
7 (1/3 PCV)
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Name 5 factors that limit oxygen saturation
|
Low inspired O2 concentration
Hypoventilation Pulm or pleural space disease - primary lung disease, pulm edema, atelectasis Circulatory failure Abn Hb |
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Name 2 conditions that result in abnormal Hb
|
Carboxyhemoglobin
Methemoglobin |
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Name 8 things that could interfere with pulse ox measurements
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VC - hypothermia or drug induced
Motion Shivering Ambient light Pigmentation Poor sensor positioning Carboxyhemoglobin Methehoglobin |
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Does pulse ox detect anemia?
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no
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What is normal pH?
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7.35-7.45
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What is normal pO2?
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5x FiO2
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What is normal pCO2?
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35-40 mmHg
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If room air is 20% O2, then what is the patient's pO2?
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100%
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If patient is breathing 100% O2, then what is his pO2?
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500%
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What is normal HCO3?
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23-26
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What is normal base excess?
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-5 to 3
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What are the 9 criteria for euthanasia?
|
Without pain, distress, anxiety, or apprehension
Short time to loss of consciousness Reliable and irreversible Safe for personnel Compatable with requirement and purpose (food animal - no barbiturates) Performed with available drugs or equipment Compatable with species, age, and health Equipment is easily maintained Safe for predators and scavengers |
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Can you use barbiturates for food animal euthanasia?
|
NO
|
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What is the national average adoption rate?
|
24%
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What is the biggest cause of employee turnover in the shelter?
|
Dealing with euthanasia
|
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Name the 3 modes of action of euthanatizing agents
|
Hypoxia
Direct depression ofneurons necessary for life function Physical disruption of brain activity and destruction of neurons necessary for life |
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Is hypoxia acceptable in awake patients?
|
NO
|
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What is hypoxia?
|
Induction of paralysis (lack of respiration) resulting in hypoxia
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Name the 2 ways you can induce death via hypoxia
|
CO
CO2 (N2O and argon are conditionally acceptable methods) |
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How does CO cause death?
|
Combines with Hb preventing its combination with O2
|
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Does CO cause death immediately?
|
No, but it is insidious
|
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What are 3 limitations (to personnel) to using CO to euthanize an animal?
|
Very hazardous to personnel
Cumulative Dificult to detect |
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Which species is CO suitable for?
|
Most small species
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What are the latest recommendations for source of CO?
|
Bottled gas
|
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What does euthanasia via CO require?
|
Properly designed chambers (cannot leak!!)
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What percent CO is used to cause euthanasia?
|
6%
|
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How quickly does collapse occur when using CO to cause euthanasia?
|
.5-2 min
|
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How quickly does death occur when using CO to cause euthanasia?
|
5-7 min
|
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How does CO2 cause death?
|
Depresses vital centers (cerebral cortex, subcortical structures, and myocardium)
|
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What areas of the body (3) are affected by CO2 during euthanasia?
|
Cerebral cortex
Subcortical structures Myocardium |
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Name 2 benefits of using CO2 to cause euthanasia.
|
Moderately rapid
Minimal hazard to personnel |
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Where is the animal placed when performing euthanasia with CO2?
|
Closed chamber
|
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Is the time to death longer or shorter for immature and neonates using CO2?
|
Longer
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What species is CO2 used for to cause euthanasia?
|
Lab an
Cats Sm dogs Rabbits Amphibians Fish Reptiles Swine |
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How does nitrogen and argon produce death?
|
Displaces O2 (inspired O2 less than 2% must be produced rapidly)
|
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Should animals be anesthetized/sedated before euthanasia with Nitrogen/argon?
|
YES
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What should you warn O about when inducing death via hypoxia?
|
Some reflex (not censcious) motor actvity may be maintained
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What are 6 ways to produce death via direct depression of neurons necessary for life?
|
Inhalant anesthetic drugs
Barbiturates Chloral hydrate T-61 MS 222 (amphibians and fish) |
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Any inhalant anesthetic can be used for euthanasia except _____
|
N2O (not reliable)
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What inhalant anesthetic is most effective at causing death and for what 2 reasons?
|
Halothane
Reasonably rapid induction Non-offensive odor |
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What is a problem with using isoflurane as a euthanasia device?
|
Pugnant odor (animals hold their breath - may require more drug)
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|
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Should you put animals euthanized with ether in the fridge?
|
NO - clicks on and explodes
|
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For what size animals are inhalant anesthetics useful?
|
Small animals - venipuncture is difficult
|
|
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What is the number 1 anesthetic used to euth an?
|
Pentobarb injection
|
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What if you give pentobarb (to euth) to the wrong animal (3)?
|
Alkalinize the dog
Give fluids Diurese |
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What are 4 advantages to using barbiturates for euth?
|
Rapid onset of action
Smooth induction Minimal discomfort Less expensive than other agents |
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Name 5 disadvantages to using barbiturates for euth.
|
Req IV injection
Restrain each animal Drugs must be strictly accounted for Terminal gasps Drugs persist in env - wildlife issue and food issue |
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What type of injection (for euth) can you use if IV injection is distressful or dangerous?
|
Intraperitoneal
|
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When can you use intracardiac injections for euth?
|
ONLY if the an is sedated, unconscious, or anesthetized
|
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What does chloral hydrate do and how does it cause death?
|
Cerebral depression
Hypoxemia |
|
|
Chloral hydrate is an acceptable type of euth in ____ animals only if the animal is ______ and the drug is admin ______
|
Large animals
Heavily sedated and administered IV |
|
|
Can chloral hydrate be used in SA to produce death?
|
NO - side effects (movement with induction)
|
|
|
Where can you get T-61?
|
Canada
|
|
|
What 3 types of drugs make up T-61?
|
Gen anesthetic
Curariform Local anesthetic |
|
|
What is the only way T-61 can be admin?
|
IV
|
|
|
What are 2 perks of using T-61 for euth?
|
No terminal gasps
No movement |
|
|
Is KCl acceptalbe as the sole euth agent?
|
NO - must be under gen anes
|
|
|
What 2 ways can KCl be admin?
|
IV
Intracardiac (only after under gen anes) |
|
|
What are the 3 injections given to people for capital punishment?
|
Sodium thiopental - induce sleep
NM blocker - paralysis KCL - stop heart |
|
|
What is the biggest problem with capital punishment?
|
Finding a vein
|
|
|
Name 2 acceptable physical methods of euth
|
Penetrating captive bolt
Microwave induction |
|
|
What is the advantage to using penetrating captive bolt?
|
No free projectiles
|
|
|
What is the disadvantage to using penetrating captive bolt?
|
Aesthetically displeasing
|
|
|
Name 5 species penetrating captive bolt can be used in.
|
Ruminants
Horses Swine Rabbits Dogs (anything used for food) |
|
|
Name points you can hit on an animal using penetrating captive bolt.
|
Forehead
Medulla (behind the head) |
|
|
What 2 species can you use microwave irradtiation on for euth?
|
Mice
Rats |
|
|
What is the advantage to using microwave irradiation for euth?
|
Loss of consciousness in less than 100 ms and death in less than 1 second
|
|
|
What are 2 disadvantages to suing microwave irradiation for euth?
|
V expensive
Only for v sm an |
|
|
Are the following conditionally or always acceptable forms of euth:
Euthanasia by blow to head Cerv dislocation Decapatation Electrocution Gunshot Thoracic compression |
Conditionally acceptable
|
|
|
Name 3 adjunctives to euth
|
Stunning
Pithing Exsanguination |
|
|
Name 3 things you can use in conjunction with stunning/pithing
|
Pharm agents
Exsanguination Decapitation |
|
|
Is death ensured with stunning/pithing?
|
No
|
|
|
How quickly is consciousness lost with stunning/pithing?
|
Rapidly
|
|
|
Can exsanguination be used as a sole means of euth?
|
NO
|
|
|
What should you tell an o that wants to witness the euth (6)?
|
There is a potential for:
Vocalization Mucle twitches Failure of eyelids to close Urination Defecation Agonal resp |
|
|
Why should you not place an ECG on a euth patient?
|
Heart may continue to ave electrical activity for up to 10 min
|
|
|
How should you confirm death in euth patient?
|
Listen to heart and watch for resp then listen to heart again 5 min later
|
|
|
If you sedated the animal prior to euth, will you need more or less euth drug?
|
Use more or else may take animal longer to die (not necessarily longer to fall asleep)
|
|
|
What is pain?
|
An aversive sensation and feeling associated wtih actual/potential tissue damage; a protective mechanism for the body
|
|
|
Name the 5 pain pathways
|
Transduction
Transmission Modulation Projection Perception |
|
|
What are the 2 types of pain?
|
Pathologic
Physiologic |
|
|
What are the 2 types of pathologic pain?
|
Peripheral
Central |
|
|
What is physiologic pain?
|
Activation of high threshold peripheral pain receptors (nociceptors) by painful noxious (thermal, mechanical, chemical) stimuli; minimal tissue damage; a protective warning
|
|
|
What is pathologic pain (2)?
|
Pain generated by activation of nociceptors
Pain generated by impulse that would not normally produce pain (non-nociceptor mediated) |
|
|
What 3 types of injury can cause pathologic pain?
|
Inflammation
Neuro pain Cancer pain (?) |
|
|
What is a nociceptor?
|
High threshold peripheral pain receptors
|
|
|
How do you cause non-nociceptor mediated pain (2)?
|
Increase excitability
Decrease Inhibitory substances |
|
|
What is stress?
|
Biological responses in an attempt to cope with disruption/threat to homeostasis
|
|
|
What are the 2 locations of pain?
|
Somatic (skin, bones/tendons)
Visceral (organs) |
|
|
What are the 2 types of somatic pain?
|
Supf
Deep |
|
|
What are the 3 mechanisms of pain?
|
Inflamm
Mechanical Idiopath |
|
|
What are the 3 types of sensitivity to pain?
|
Primary hyperalgesia
Secondary yperalgesia Central algesia |
|
|
What are 4 ways to evaluate pain?
|
Behavior - Attitude, activity, appetite
Physiology - HR RR, BP Blood cortisol - cortisol and catecholamines Response to mainpulation - palpation, phys stimulation |
|
|
What are the 4 components of pain scoring system?
|
Behavior - attitude, activity, appetite
Severity of pain Duration of pain Mechanism of pain |
|
|
Name the 4 therapeutic approaches to pain.
|
Preemptive
Multimodal Mechamism based - target drug for specific pain Integrated |
|
|
What is the best type of drug for treating acute pain?
|
Opioids
|
|
|
What 3 things do opioids produce?
|
Analgesia
Euphoria Sedation |
|
|
Which opioid receptor is most often used for analgesia
|
Mu
|
|
|
Why do you worry when using an opioid in a horse?
|
dECREASED GI function
|
|
|
Are the following opioid agonists or agonists/antagonists:
Morphine Methadone Meperidine Fentanyl Hydromorphone Oxymorphone |
Agonists
|
|
|
Are the following opioid agonists or agonists/antagonists:
Pentazocine Butorphanol Buprenorphine Nalbuphine Nalorphine |
Agonists-antagonists
|
|
|
What is a common opioid antagonist?
|
Naloxone
|
|
|
What 3 things do A2 agonists provide to patient?
|
Sedation
Musc relaxation Analgesia |
|
|
What anesthetic drug is most often used in horses for colic pain?
|
A2 agonists
|
|
|
Name 4 commonly used A2- agonists
|
Xylazine
Detomidine Romifidine Medetomidine |
|
|
Name 3 A2 antagonists
|
Yohimbine
Tolazoline Atipamazole |
|
|
Which has a higher A2:A1 ratio:
Xylazine Medetomidine |
Medetomidine (1620:1)
|
|
|
How do local anesthetics work?
|
Block Na channels and decrease nerve transmission (sensory and motor)
|
|
|
Name 4 local anesthetics
|
LIDOCAINE
Mepivacaine Bupivacaine Ropivacaine |
|
|
Name 3 contraindications for epidurals
|
Coagulopathy
Skin conditions Hypotension |
|
|
Name 4 situations that you should use pain busters
|
Spinal trauma
Amputation TECA Neuroma |
|
|
Is the lidocaine patch absorbed systemically?
|
NO
|
|
|
What 3 drug combo do you use for severe pain?
|
Morphine
Lidocaine Ketamine (put all 3 in same syringe) |
|
|
What 4 pathways does inflammation activate?
|
Phoppholipase A2
Cyclo-oxygenase (COX) Lipoxygenase (LOX) Nuclear factor kappa beta (NFkB) |
|
|
Phospholipids + phospholipase =
|
Arachadonic acid
|
|
|
Arachadonic acid + COX =
|
Prostaglandins
|
|
|
Arachadonic acid + LOX =
|
Leukotrienes
|
|
|
Do COX 2 selective inhibitors exert analgesic effects on (peripheral or central) COX2
|
BOTH
|
|
|
What 3 things do NSAID provide?
|
Antiinflamm
Antipyretic Analgesic |
|
|
What 2 things does COX2 inhibition provide to patient?
|
Decreased inflamm peripherally
Decreased sensitization in dorsal horn of spinal cord |
|
|
Which isoform in inducible (COX1 OR COX2)
|
COX2
|
|
|
What 2 things does COX1 produce and what are their effects?
|
Prostaglandins (PGE2) - VD effect on kidneys
Prostacyclin - antithrombogenic when released by endothelium and cryoprotective when released by gastric mucosa |
|
|
What induces COX2?
|
Inflammation
|
|
|
What do corticosteroids do to COX2
|
Blocks COX2
|
|
|
Why is it not always beneficial to block COX2 (2 reasons)
|
Constitutive in certain tissues
Physiologic functions - wound healing |
|
|
How do NSAIDS work?
|
Block COX
|
|
|
Are opioids useful for chronic pain?
|
NO (<2 days)
|
|
|
Name 5 common side effects of NSAIDS
|
Gastric distress
Renal damage Antithrombic effect Hypersensitivity reactions Hepatopathy (Carprofen in labs esp) |
|
|
Are NSAIDS useful for chronic pain?
|
YES (esp arthritis)
|
|
|
What does a ratio of <1 and >1 mean in regards to NSAIDS?
|
<1 = COX1
>1 = COX2 |
|
|
Do all NSAIDS exhibit COX1 AND COX2?
|
Yes (to some extent)
|
|
|
Are aspirin and ketoprofen <1 OR >1?
|
<1 (COX1)
|
|
|
Are carprofen, deracoxib, and meloxicam <1 or >1
|
>1 (COX2)
|
|
|
Which NSAID is most COX1?
|
Ketoprofen
|
|
|
Which NSAID is most COX2?
|
Deracoxib
|
|
|
What could COX2 NSAIDS cause that COX1 does not?
|
Glaucoma
|
|
|
What additional benefit does COX2 have that COX1 does not?
|
Anti-angiogenic (in addition to the usual antiinflamm, antipyretic, and analgesic properties of all NSAIDS)
|
|
|
Name 6 analgesic adjuncts that can be used with NSAIDS and an example of each
|
Dissociative ketmine
Anticonvulsant - gabapentin Tricyclic antidepressant - amitryptyline Central analgesics - tramadol Phenothiazines - ace Alternative therapy - acupuncture, massage, etc. |
|
|
Is deracoxib more or less likely to cause gastric ulcers than aspirin?
|
Less
|
|
|
Are the following acceptable ways to use locals?
Inject into SQ to desensitize nociceptors Inject into areas near nerves Inject into epidural and subarachnoid space Inject intra-articularly Spray on MM Apply to intact skin |
yes
|
|
|
What is a disadvantage to applying a local to intact skin?
|
Limited absorption
|
|
|
How do locals work?
|
Stabilize membranes (decreases nerve impulses) by binding to NA channels which prevents the depolarization process
|
|
|
Locals are weak acids or weak bases?
|
Weak bases
|
|
|
Do locals dissociate into ionized or unionized forms in water?
|
BOTH
|
|
|
Is the ionized or unionized for of a local more water soluble?
|
Ionized
|
|
|
How are locals purchased (acidic or basic/solution or solid)?
|
Acidic solution
|
|
|
Since locals are purchased in an acidic solution, are they more ionized or unionized?
|
Ionized
|
|
|
Once the local is injected into the body, does it form more ionized or unionized particles?
|
Unionized (was originally in a highly acidic solution making it highly ionized)
|
|
|
Is the unionized local anesthetic form more or less lipid soluble?
|
More lipid soluble - important for diffusion through cell membranes to reach Na channels
|
|
|
What must the unionized local anesthetic do in the cell before impacting the Na channel?
|
Go back to the ionized form
|
|
|
How are local anesthetics metabolized?
|
Liver
|
|
|
What does the ratio of ionized to unionized local anes form depend on (2)?
|
pKa of drug
pH of env |
|
|
What 2 things does a drug's pKa determine?
|
Degree of ionization
Onset of action |
|
|
As the pKa of a drug is increased, there is (more or less) freely diffusable drug available (at tissue pH 7.4)
|
Less (therefore the onset of action is delayed)
|
|
|
pKa of Bupivacaine = 8.1
pKa of Lidocaine = 7.6 Which has a slower onset of action? |
Bupivacaine
|
|
|
Are locals (more or less) effective in an acidic env and why?
|
Less because less uncharged drug is present
|
|
|
Does tissue with infection adn swelling have a higher or lower pH?
|
Lower
|
|
|
Is the ionized or unionized for of the drug responsible for its action?
|
Ionized
|
|
|
What are 2 addtional factors that affect activity of local (besides pKa and pH)
|
Protein binding
Lipid solubility |
|
|
As the protein binding of a drug is increased, the duration of the anesthetic effect is (prolonged or shortened)?
|
Prolonged
|
|
|
If lidocaine is more protein bound than procaine (80% vs 60%) then which has a longer duration of action?
|
Lidocaine
|
|
|
As the lipid colubility of a drug is increased, the potency and toxicity are (increased/decreased)?
|
Increased
|
|
|
If bupivicaine is more lipid soluble than lidocaine (27 vs 3) then which is more potent and potentially toxic?
|
Bupivicaine
|
|
|
What are the 3 types of nerve fibers?
|
Motor
Autonomic Sensory |
|
|
Nerve fibers are classified as large and small depending on (2)?
|
Diameter
Degree of myelin coating |
|
|
The more myelin, the (faster or slower) an impulse travels?
|
Faster
|
|
|
The more myelin, the (easier or harder) it is to block?
|
Harder (large nerve fibers have more myelin making them more difficult to block)
|
|
|
How many nodes of ranvier do you need to block if there is myelin?
|
3 (if no myelin then need to block shorter seg)
|
|
|
Which 2 types of nerve fibers control pain?
|
A-delta
C |
|
|
Are A-delta and C fibers bigger or smaller?
|
Smaller
|
|
|
Are A0delta and C fibers more easily blocked?
|
YES
|
|
|
Which is blocked first:
Pain and temp Touch and motor |
Pain and temp
|
|
|
Can a broken legged dog with a local anes block be pain free and still move its limb?
|
YES
|
|
|
What are fibers called that are on the outer side of the nerve?
|
Mantel fibers
|
|
|
What are fibers called that are on the inner side of the nerve?
|
Core bundle
|
|
|
The mantel fibers supply the (distal or proximal) parts of the body?
|
Proximal
|
|
|
If blocking the arm with a local,which is anes first (shoulder or fingers)?
|
Shoulder
|
|
|
What regains sensation first (shoulder or finger)?
|
Shoulder
|
|
|
When do you know the patient is fully recovered from local anes?
|
When they can move fingers/toes
|
|
|
Does co-admin of EPI and a local shorten or prolong the duration of the local?
|
Prolong (EPI is a VC)
|
|
|
Does hyaluronidase speed up or slow down the onset of action of a local anes
|
Speeds up (and broadens the effets)
|
|
|
Does hyaluronidase enhance or restrict the systemic absorption of a local?
|
Enhances absorption (potentially increases the toxicity)
|
|
|
Which site of injection provides the shortest onset to time of activity?
|
Intrathecal
|
|
|
Which site of injection provides the longest onset to activity?
|
Peripheral nerve block
|
|
|
During pregnancy, will the ester linked local anes be prolonged or shortened and why?
|
Prolonged (plasma cholinesterase activity is reduced)
|
|
|
What are 4 clinical signs of toxicity and their order of appearance?
|
Seizure
Apnea Hypotension Death |
|
|
What 3 factors determine the concentration of local anes in systemic circulation (and therefore toxicity)?
|
Dose
Abs rate Metabolism |
|
|
What was the first local anes used (1885) and why is it still used today?
|
Cocaine
VC properties |
|
|
What was the first nontoxic local anes used (1905)
|
Procaine
|
|
|
What is the order of appearance for the following drugs in history?
Bupivacaine Lidocaine Mepivacaine Ropivicaine |
Lidocaine 1940
Mepivacaine (Carbocaine) 1960's Bupivacaine (Marcaine) 1965 Ropivacaine (Naropin) 1996 |
|
|
What are the 3 chemical components of local anes?
|
Aromatic ring
Intermediate chain (ester or amid linkage) Secondary or tertiary amine |
|
|
Name 2 ester linked local anes
|
Cocaine
Procaine |
|
|
Name 2 amide linked local anes
|
Lidocaine
Ropivacaine |
|
|
Why are ester linked local anes great?
|
Rarely see allergic rxns
|
|
|
Why are ester linked local anes not great?
|
Short anes duration (<1hour) - rapidly metabolized in the blood
|
|
|
Procaine has a (high/low) potency and a (long/short) duration
|
Low potency
Short duration |
|
|
How can you prolong procains duration of effect?
|
Give with penicillin (forms salt and delays absorption and prolongs duration of effect); procaine is in excess of the penicillin so there is an immediate local anesthetic effect
|
|
|
What local is dropped in the eye to desensitize the cornea for minor procedures and tonometry?
|
Proparacaine
|
|
|
Why are amide local anes great?
|
Have an intermediate/long anes duration (2-8 hours) due to liver metabolism
|
|
|
What is a disadvantage of using amide-linked drugs?
|
Allergic reaction
|
|
|
Name 2 local anes that have an intermediate potency (2 hours)
|
Lidocaine
Mepivacaine |
|
|
Name 2 drug that have a higher potency (4-8 hours)
|
Bupivacaine
Ropivacaine |
|
|
What local anes is also an antiarrhythmic?
|
Lidocaine
|
|
|
What 2 local anes are the most widely used in vet med?
|
Lidocaine
Mepivacaine |
|
|
What is lidocaine spray used for (2)?
|
To desensitize the larynx when performing ET intubation (gorillas and cats)
Desensitize the urethra |
|
|
What is ELMA cream?
|
Eutestic Mixture of Lidocaine and Prilocaine
|
|
|
Is EMLA cream absorbed through intact skin?
|
Yes (lipid soluble)
|
|
|
Does EMLA cream have a prolonged time to effect?
|
Yes - 60 min
|
|
|
What is a eutectic mixture and give an example?
|
The individual components are soluble in each other and the resulting compound has a lower melting point than the components
A 50:50 mixture of lidocaine powder and prilocaine powder for an oil that penetrates intact skin better than either drug alone |
|
|
What is Cetacaine and why could it cause in cats?
|
A local benzocaine spray used for ET tubing humans
Causes methemoglobin in cats (so use lidocaine instead) |
|
|
Does xylazine have local anes properties?
|
Yes (3-4 hour duration)
|
|
|
What is sometimes used as an epidural in cattle and horses?
|
Xylazine
|
|
|
If a local anes is given intra-op, what does it prevent?
|
Wind up
|
|
|
What can locals be used in combo with (2) to produce a cooperative patient?
|
Sedation
Tranquilization |
|
|
Why are locals used when an animal is under gen anes?
|
inimizes the req concentration of the inhalent
|
|
|
Why are locals used before surgery?
|
Provides post-op pain mgt
|
|
|
Why are locals better than opioids post-op?
|
Muscle relaxation
|
|
|
What is the easiest, most reliable, and safest local anes technique?
|
Direct injection of local drug into tissue
|
|
|
What should you do to the lidocaine if desensitizing large areas?
|
Dilute lidocaine with sterile saline solution
|
|
|
What is the magic number to keep the lidocaine dosage under?
|
10mg/kg
|
|
|
What is a side effect of lidocaine?
|
Seizures
|
|
|
What local is used most often?
|
Lidocaine 2%
|
|
|
What are 2 ways to use a local?
|
Mult intraderm/SQ injections of 0.5ml of lidocaine
Slow injection local anesthetic while advancing the needle along the line of proposed incision ("linear infiltration"/"line block") |
|
|
Why can't you inject locals IV (2)?
|
Toxicity
Not effective |
|
|
What do you do to absorption, local anes effect, and duration (up to 50%) if combining EPI with a local?
|
Reduce absorption
Increase local anesthetic effect Increase local anesthetic duration |
|
|
What body locations should EPI not be injected into and why (3)?
|
Tissues supplied by end arteries (ears, tail)
VC Local ischemia Necrosis |
|
|
Excessive doses or inadvertent IV admin of locals may cause (4)?
|
Seizures
Apnea CV collapse (hypotension) Death |
|
|
What is a painbuster?
|
Catheter placed in a wound and tunneled out the side to deliver local anes for many hours without mult injections
|
|
|
What percent lidocaine do you normally use?
|
1-2%
|
|
|
What percent ropivicaine do you normally use?
|
0.2%
|
|
|
In dogs, what size needle and how much lidocaine is normally used?
|
22 gague
1-2ml |
|
|
Why (2) is ropivicaine better than lidocaine?
|
Lasts 2x as long
Rapid onset of action |
|
|
What anatomic structures (4) does a maxillary nerve block block?
|
Maxilla
Upper teeth Nose Upper lip |
|
|
Where (2) can you insert our needle for a maxillary nerve block?
|
Floor of orbit
Infraorbital foramen |
|
|
What anatomic structures (4) does the mandibular alveolar nerve block block?
|
Canine
Incisors Skin and mucosa of chin Skin and mucosa of lower lip |
|
|
Where can you block the mandibular alveolar nerve in a horse?
|
Mental foramen
|
|
|
What 2 nerves do you block for dehorning?
|
Cornual branch of the zygomaticotemporal nerve
Infratrochlear nerve |
|
|
What 3 nerves do you block for a declaw and what local anes drug can you use?
|
Radial (0.3ml)
Medial (0.3ml) Ulnar (0.3ml) (block nerves just above the carpus!!) 0.2% Ropivacaine |
|
|
What 2 drugs can you use in a declaw chronically, and why can't you used NSAIDS?
|
Buprenorphine
Tramadol NSAID cause problems in cats |
|
|
What type of nerve block is used for standing surgery in cattle and where can you inject and what does it block?
|
Paravertebral nerve blocks
Lateral processes of T13, L1, L2 Blocks the flank |
|
|
Why can't you inject a local after L3 in cattle?
|
Causes weakness in hind limbs
|
|
|
What is IVRA and why is it used?
|
Intravenous Regional Anesthesia
For anesthesia of an extremity distal to a tourniquet |
|
|
What are 2 reasons a tourniquet is useful in surgery?
|
Helps with hemostasis
Keep local anes in the area |
|
|
Name 2 procedures that a blood free surgery site is ideal for (and therefore you should use IVRA)
|
Removing FB from paws
Taking biopsies |
|
|
Where is the tourniquet placed for IVRA in the foreleg and hindleg of a horse.
|
Proximal to elbow for surgery of front leg
Proximal to hock for surgery of hind leg |
|
|
Where is the 2% lidocaine injected when doing a IVRA?
|
IV!!!!!!! (make sure the tourniquet doesn't slip!!!!)
|
|
|
One IV local anes injection = ____ specific nerve injections
|
6
|
|
|
How quickly will regional anes of the limb be with IVRA and how long will it last?
|
Within 10 min
As long as tourniquet is on |
|
|
What is the max amount of time the touniquet should remain on with IVRA?
|
2 hours
|
|
|
What happens in tourniquet is left on for 4 hours? 8 hours?
|
4 - reversible shock
8 - death (sepsis and endotoxemia) |
|
|
What is a usual problem with the animal that had IVRA?
|
Parasthesia in limb (usually reversible)
|
|
|
What 4 reasons are intercostal nerve blocks uesful for?
|
Chest laceration
Rib fractures Placement of chest tube Postop analgesia after thoracotomy |
|
|
How many intercostal spaces should you block before/after in interecostal nerve block and why?
|
2-3 before
2-3 after Considerable overlap of nerve supply |
|
|
Where should the needle be inserted for an intercostal nerve block?
|
Caudal to rib near the intervertebral foramen
|
|
|
Why use an epidural?
|
Produce anesthesia caudal to the umbilicus
|
|
|
What 4 sx procedures should you use an epidural for?
|
C-section (little anes gets to the fetus)
Sx of rear quarter Repair pelvic fracure Perineal sx |
|
|
Where do you give an epidural?
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Midline of LS (L7-S1) space (just caudal to wings of ilium)
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Is the epidural places cranial or caudal to the wings of the ilium?
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Just caudal
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You should feel a distinct pop when the epidural needle is advanced through the ______
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Interarcuate ligament (lig. flavum)
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Should there be spinal fluid or blood apriated during epidural?
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NO
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Should there be resistance when injecting epidural?
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NO
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Which animal has the longest spinal cord?
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Pig
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How long does a lidocaine epidural last?
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1.5 hours
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How long does a bupivacaine or ropivacaine epidural last?
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3-5 hours
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Name 4 advantages of epidural
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Good musc relaxation
Postop analgesia Min effects on the body (maybe some hypotension) Low cost |
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Name 4 potentail complications of an epidural
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Inadequate anesthesia - animal is awake during sx
Sx time is limited Hypotension Resp depression/apnea |
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Why should you never block the caudal cervical vertebrae?
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Phrenic n. is here which innervates the diaphragm
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If you give an excessiv amount of anes for an epidural, what 2 things may happen
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Hypotension
Resp depression/apnea |
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What is the one requirement if using an opioid for an epidural
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Must use preservative free morphine(ASTRAMOPH)
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What is the onset of analgesia when using an oioid for an eidural?
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1-2 hours
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Qhat is the duration of analgesia when using an opioid for an epidural?
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8-12 hours
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Name 5 advantages of using an opioid epidural
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Profound somatic/visceral pain relief
No motor blockade (great for total hip sx) No sensory blockade Ne depression of sympathetic nervous system Reversal of systemic side effects with naloxone |
