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199 Cards in this Set

  • Front
  • Back
Name 2 ways to minimize regurgitation and aspiration
in ruminants.
Pre-op starvation for 12-18 hrs
Withhold water for 12 hrs
How do pka, lipid solubility and protein binding
affect drugs?
Lipid solubility - potency
Protein – duration of action
pKa – speed of onset
How long can you keep propofol after you open it?
up to 24 hours max b/c it is a great medium for bacterial growth
What proportion of total body water is present on IC compartment; plasma?
ICF space holds 2/3 of total body water (40% of BW)

ECF space holds 1/3 of total body water:
•Plasma 1/12 of body water (5% of BW)
•Interstitial compartment (15% of BW)
Name 5 potential problems with liver disease.
HYPOALBUMINEMIA decreased protein binding leads to increased unbound/active drug available = increased sensitivity
HYPOGLYCEMIA - esp post-op
DRUG METABOLISM - avoid KMTAX
COAGULATION PROB - severe liver dz
HYPOTHERMIA - liver regulates thermogenesis
How long doesa fentanyl patch take to achieve full effect in dog & cats?
24 hrs in dogs
12 hrs in cats
What are the 5 causes of hypoxemia & which does not respond to O2 supplementation?
•Diffusion impairment
•decreased FiO2 – low inspired [O2]
•Hypoventilation
•R/L pulm shunting – does not respond to supp O2
•V/Q mismatch
What is the MACV for H, I, S & D?
H 0.8-0.9
I 1.5
S 2.4
D 8
Which lasts longer - buprenorphine or morphine?
buprenorphine lasts 6-8 hrs longer than morphine
Supreventricular arrhythmias are fairly _______.
benign
List 4 specific conditions to remember when anesthetizing a rabbit, and detail a suitable technique for anesthetic management of a 1 yr old rabbit OVH.
- Chronic resp dz. and diarrhea
- handling
- stress prone
- difficult intubation
_______ is not used for small mammal induction - very pungent & unpleasant.
isofluorane
What is the dive response seen in birds that can lead to problems during induction?
Dive response – stress response seen in diving birds/water fowl. Apnea or bradycardia can occur for up to 5 min just by placing a mask on them. Also bradycardia occurs, with blood being distributed mostly to the kidneys, heart and brain. Premed with benzodiazepine, also preoxygenate
What is the usefulness of determining the alveolar-arterial PaO2 gradient?
provides a useful guide as to the efficiency of gas exchange in the lungs
What drugs should be avoided in patients with hepatic disease?
KMTAX
ACP, ketamine, thio, xylazine/medetomidine
Define azotemia & its cause.
azotemia – mild elevation of urea(BUN) and creatinine in plasma, no signs except mild PU/PD. 75% of functional nephrons must be lost before azotemia develops.

causes of azotemia:
– pre renal – dehydration, hypovolemia, high protein diet
- renal – decreased functional nephrons
- post renal – outflow obstruction
Over what range does renal intrinsic autoregulation maintain constant blood flow through the glomeruli, and when does it cease to work?
80-180mmHg
min perfusion pressure is 60mmHg
What sedation/premed drugs should be avoided in patients with renal dz?
high doses of ACP
alpha 2 agonists
Name 2 non-depolarizing agents. How are they metabolized?
vecuronium – hepatic metabolism, 40% excreted in the bile.
- atracurium – eliminated by spontaneous degradation, popular with critical care patients.
Buprenorphine is a ________agonist.
partial Mu
Where is diazepam metabolized?
liver
Why is diazepam never given IM?
pain on injection - venous irritation, thrombophlebitis
What is the effect of ketamine on IOP?
increases IOP
Which injectable agent causes temporary adrenal suppression?
etomidate
What kind of pigs are prone to hypoventilation so you must intubate & provide supplemental O2?
pot-bellied pigs
Which breathing system has HIGH resistance to breathing?
circle (rebreathing)
With which breathing system is soda lime required?
circle
With which breathing system is denitrogenation required?
circle
Is a low or high FGF required with circle system?
LOW
Calculate the FGF requirements for 3 kg cat using Bain or T-Piece (non-rebreathing) system.
BW (kg) divided by 5
then multiply X 2 = FGF
3 kg div by 5 = 0.6L
0.6L x 2 to 3 = 1.2-1.8 L/min
What is the difference b/w crystalloids & colloids?
crystalloids - expands entire ECF
colloids - expands IVS/IC volume
What does loss of palpebral reflex indicate?
deep anesthesia
Which eye reflex is a poor indicator of depth?
corneal reflex
Eyes are rotating during anesthesia - this indicates what?
light/medium anesthesia
Ventromedial eyes indicates what?
"surgical plane"
Central eyes indicates what?
deep or awake
Wide fissure indicates what?
light or deep
What does lacrimation during anesthesia indicate?
light anesthesia
What does dry eyes during anesthesia indicate?
deep or Ketamine was used
What happens to the swallowing reflex with increase in anesthesia depth?
tone decreases
During what stages of anesthesia would you see the pedal withdrawal reflex?
light only
Is the ear flick reflex reliable?
no but good for cats
Define allodynia?
pain response to non-noxious stimuli (gentle touch)
End tidal CO2 is decreased with hyper or hypoventilation?
decreased with HYPERventilation
End tidal CO2 is increased with hyper or hypoventilation?
increased with HYPOventilation
_____= [Hb] x (%SPO2) = [(o.oo3) x (PaO2)]
CaO2
Treatment of O2 toxicity: never use FIO2 >0.6 for more than _____ hrs
24
What is the difference b/w hypoxia & hypoxemia?
hypoxemia = PaO2 <60mmHg
hypoxia = general reduction in O2 delivery d/t hypoxemia or decreased CO
What is the tx for ventricular tachycardia?
lidocaine
What is the tx for v-fib?
defibrillation or lidocaine bolus followed by epinephrine (adrenaline)
When should a-fib be treated?
do not tx until a/f animal has recovered from GA unless compromising CO
Which inhalational agent increases the sensitivity to catecholamines?
halothane
Dobutamine produces mil peripheral _____.
vasodilation
Dopamine:
_____ at low doses
positive inotropy & chronotropy
diuresis
Ephedrine:
vaso_____
positive inotrophy & chronotropy
vasoconstriction
VIC = positioned_____ circuit
VOC = positioned_____ circuit
VIC = inside circuit
VOC = outside circuit
What are the advantages of rebreathing systems?
low gas flow requirements
low volatile agent consumption
closed or low flow options
expired moisture & heat are conserved
low explosion risk
less pollution
If soda lime granules are exhausted what should they look/feel like?
hard or flinty
fresh granules are crumbly
Soda lime canister: filled canister volume should consiste of ~___% absorbent granules & ___% air space
50%
50%
Tidal volume = _____ml/kg
10-15
Minute volume (RR x TV) is ~ at ____ml/kg/min
200
ASA classification 1-5:
Which is excellent and which is critical
1 = excellent
5 = critical
When should the IV pre-med be given? IM or SQ drugs?
IV: 15-20 min b/f induction
IM/SQ: 30-40 min b/f
Would the dose be less if given IV or IM?
IV
What is the DOA of morphine in dogs? cats?
dogs: 3-4 hrs
cats: 6-8 hrs
What is the DOA of methadone?
slightly less potent than morphine but longer DOA
4-6 hrs
What is the DOA of fentanyl?
onset with 3-5 min a/f given IV
lasts 20 minutes
What is the DOA of butorphanol?
2-3 hrs
What is the DOA of buprenorphine?
6-8 hrs
Is naloxone short or long acting?
short acting
How can risks assoc with medetomidine be minimized?
combine with another sedative to reduce dose of medetomidine
constant observation
always have atipamezole (reversal) on hand
never give atropine if animal develops bradycardia
provide supplementary O2
check HR b/f discharging animal
______ is metabolized in liver and has 2 major active metabolites.
diazepam
Doppler U/S:
probe contains ______ that emits U/S waves
piezoelectric crystal
Doppler U/S:
Where is probe positined?
over a peripheral artery and taped in position
Doppler U/S: the pressure at which the pulse becomes audible is the _____ pulse
systolic
How much water is found in the ICF?
2/3 of total body water (40% of BW)
How much of BW does plasma consume?
5%
______ are small particles and rapidly redistribute outside IVS
crystalloids
______ are large molecules that remain in the vasculature for a prolonged period
colloids
Whihc stays in the vasculature longer - colloids or crystalloids?
colloids
Crystalloids or colloids: if aim is to expand entire ECF?
crystalloids
Crystalloids or colloids: if aim is to expand the intravascular volume?
colloids
Malignant hyperthermia can be triggered by all volatile agents but _____ (and _____) are most freq the cause.
halothane
isofluorane
How would you anesthetize a pot bellied pig for castration?
intranasal midazolam spray to sedate
medetomidine + ketamine IM
OR
telazol + xylazine
reverse a2 at end of procedure to speed recovery
always intubate b/c prone to hypoventilation
2% lidocaine injected into testicle & around injection site
Define multimodal analgesia.
simultaneous admin of analgesic agents w/different modes of action (i.e. opiod + NSAID + a2)& different side effects, which may act synergistically & achieve optimal analgesia with less side effects than large doses of single drug
What is the most common side effect of NSAIDs?
GI ulceration
Name 2 opioids that are partial agonists.
buprenorphine
butorphanol
Fentanyl Patch:
onset in cats should be within _____hrs and longer _____ hrs in dogs
analgesia should last for ____days
12 hrs in cats
12-24 hrs in dogs
3 days
What is the blood-gas solubility coefficient?
amount of anesthetic dissolved in blood & in gas when the 2 phases are in equilibrium
fraction expressed as whole number
(i.e. 2/1 = 2, 1/2 = 5)
Blood-gas coefficient:
20:1 or 1:1 - which is more potent?
large B:G = more soluble
small B:G = insol = faster
more potent????
Define MAC.
minimum concentration of anesthetic agent which will prevent purposeful movement in response to a supramaximal (painful) stimulus in 50% of patients
What does halothane contain as a preservative?
0.01% thymol
_____ has extensive hepatic metabolism - up to 20% of inhaled dose
halothane
What are the advantages of using newer inhalants such as desfluorane & sevo?
sevo:
-less resp depressant than iso
-non-irritant to URT
-good preservation of hepatic, renal, & splanchnic BF

desfluorane:
-extremely stable & has minimal hepatic or renal toxicity

Both are good for operations requiring rapid recovery, small/baby patients, diabetic patients, prolonged procedures on obese animals or extremely sick patients
Esters or Amides:
lidocaine
bupivacine
mepivacine
all are amides
Which nerves are blocked 1st -smaller or larger ones?
smaller nerves blocked 1st
Which of the following is the smallest nerve type - A, B or C?
C
How are esters metabolized? amides?
esters: by PABA (para-aminobenzoic acid)
amides: metabolized by liver (>95%) w/renal excretion
What is the toxic IV dose for lidocaine & bupivacaine?
lidocaine - 10 mg/kg
bupivacaine - 4 mg/kg
What are the CNS effects of a local anesthetic overdose?
CNS depression
followed by agitation, muscle twitching & convulsions
What are the CVS effects of a local anesthetic overdose?
direct myocardial depression resulting in bradycardia & decreased CO
hypotension
What is the tx for local anesthetic overdose?
seizures: IV diazepam/midazolam + supplemental O2
bradycardia: antimuscarinics (atropine or glycopyrrolate)
______ dogs may react badly to opioids and become dysphoric.
sled dogs - Huskies, Samoyeds
What is the pre-med default setting?
ACP (0.05 mg/kg) + Morphine (0.3 mg/kg) IM
What would you give a healthy young dog for sedation for skin testing?
pethidine or medetomidine alone IM
What is the default setting for GA maintenance?
iso (halo, sevo) +/- NO
With ______ respiratory depression is more marked than with halothane.
iso
inhalational agents:
______ - acts more rapidly and can change concentration more rapidly d/t it's lower B:G solubility
sevo
Which inhalational agent should you avoid if concerned about expandable gas pockets (GDV, intestinal obstruction) or potential hypoxia?
nitrous oxide
What is the sedation default setting for a cat?
Ace 0.05-1.0 mg/kg + either morphine OR buprenorphine OR pethidine (meperidine) OR methadone mixed & given SQ
What is the inhalant default setting for a cat?
iso +/- NO
What is 0.3 mg dose of any drug (15 ml/kg) for 5 kg cat?
0.1 ml
0.3 mg/kg X 5 kg = 1.5 mg divided by 15 = 0.1 ml
OR
0.3 mg/kg X 1 kg/15 ml = 0.02 mg/ml X 5 kg = 0.1 ml
True or False
Line blocks are NOT recommended for anesthesia for c-section.
T
Cattle are extremely sensitve to which drug?
xylazine
What drug can be abortifactant in the last trimester of pregnancy in cows?
xylazine
What are the potential complications of GA in ruminants and list ways to prevent?
regurgitation - prevent by pre-op starvation for 12-18 hrs, no water for 12 hrs, elevate head
bloat - no highly fermentable food for 24 hrs prior
salivation - don't use atropine - makes saliva more viscus
hypoventilation
What is the triple drip used in cattle?
guafenesin + K +/- X
What is the risk of using xylazine in sheep and how can it be minimized?
pulmonary edema - even at low doses
give xylazine IM instead of IV
Llamas & alpacas are less sensitive to _____ than other ruminants.
xylazine
What is used for induction and maintenance in llamas & alpacas?
induction: xylazine + ketamine
maintenance: iso or halothane
Cow with dystocia, straining for last 3 hrs, can palpate live calf but manual delivery not possible - must do C-section. What do you use?
xylazine + butorphanol (no benzos)
caudal epidural: lidocaine + xylazine
inverted L-block
paravertebral anesthesia
don't use line block
What is the "come back another day" rule?
horse fails to respond to several doses of a2 or other sedatives and is difficult to restrain & excitable - have them come back another day and give them some ACP to give prior to returning
It is essential to have ____ ready drawn up to administer if horse shows signs of arousal during anesthesia.
top-ups:
thio
ketamine
diazepam + ketamine
midazolam + ketamine
Horses: the combo of recumbency & GA combined with time & other factors result in ______ (PaO2 < 60 mmHg) despite provision of 100% O2.
hypoxemia
Equine post-anesthetic myositis (EPAM: fit animals on _____ diet are more likely to succumb
high protein
T or F
The degree of training will not predispose a horse to EPAM.
F - it will
How can EPAM be avoided?
'let-down' animals prior to anesthesia - esp fit animals -rest & stop high protein diet
Muscle relaxants (neuromusc blockers) have no analgesic properties but are verys useful for ______ surgery.
intraocular
What are NMB most commonly used for?
ocular procedures - cataract surgery
deep laparotomies - c-section, OVH (esp horses)
rapid mgt of ventilation (esp horses)
What are the 3 essential prereqs for use of NMB?
ensure consciousness
ensure adequate analgesia
ensure means of supporting ventilation
What is the sequence for the onset of muscle paralysis with NMB?
face, jaw, tail
neck & distal limb
proximal limb
pharynx/larynx
abdominal muscles
intercostal muscles
diaphragm
NMB:
depolarizing - _______
non-depolarizing - _____, _____
depol: succinylcholine
non-depol: atracurium, vecuronium
How is atracurium e;liminated?
spontaneous degradation (Hoff man elimination)
Guafenesin blocks transmission of nerve impulses at the ______ of the SC, brainstem & sub-cortical areas.
internuncial neurons
______ is used for TIVA in horses & triple drip in cattle combined with ketamine & xylazine.
guafenesin
You should not use guafenesin concentrations of ____% in horses b/c it can cause hemolysis and potentially lead to thrombophlebitis of jugular veins.
>10%
What are the ABC's of basic life support?
A - assistance - establish airway
B - breathing support
C - circulatory/cardiovascular support
DO NOT USE DRUGS
How many people are needed to competently perform CPR?
4
What are the 2 choices for cardiovascular support with CPR?
closed or open chest heart massage
CPR: IV fluids - use ____ & ____
crystalloids & hypertonic soln
How should epinephrine (adrenaline) be used in CPR?
low dose 1st (0.01-0.02 mg/kg)then is no response give high dose
What is the danger is using epinephrine (adrenaline) in CPR?
myocardial dysfunction & neurological outcomes
_______ is not for routine use in CPR.
calcium gluconate
What is the tx for ventricular tachycardia?
lidocaine
Which induction agent undergoes the most hepatic metabolism?
halothane - up to 21% metabolized
Most drugs used in anesthesia undergo hepatic metabolism except for ____ & ____ which undergo spontaneous degradation.
renifentanyl
atricurium
What is the autoregulation of hepatic BF?
total hepatic BF is maintained over wide range of blood pressures and changes in portal venous BF (or hepatic arterial BF)
Which induction agent undergoes the most hepatic metabolism?
halothane - up to 21% metabolized
___% of functional nephrons are lost before azotemia develops.
75%
Most drugs used in anesthesia undergo hepatic metabolism except for ____ & ____ which undergo spontaneous degradation.
renifentanyl
atricurium
What is the autoregulation of hepatic BF?
total hepatic BF is maintained over wide range of blood pressures and changes in portal venous BF (or hepatic arterial BF)
What are the 5 potential problems of anesthesia in patients with liver dz?
hypoalbuminemia
hypoglycemia
drug metabolism - avoid KMTAX
coagulation problems
hypothermia
___% of functional nephrons are lost before azotemia develops.
75%
What are the pre-renal factors that could cause an increase in BUN?
dehydration
hypovolemia
high protein diet
What the amount of normal urine production and why is this important?
1-2 ml/kg/hr
useful indicator of GFR which is an indicator of arterial BP
Intrinsic regulation: the kidney maintains constant BF thru glomeruli over wide range of BP. When does this mechanism stop?
when mean arterial BP (MAP)drops below 60 mmHg
Normal plasma potassiumis _____ mmol/l.
3.5-5 mmol/l
Describe the mgt of a diabetic patient.
deprive of food 6 hrs pre-anesthesia
give 1/3 to 1/2 of their normal insulin dose on the morning of the surgery
monitor blood glucose pre-GA and thru out procedure
VSD with ____ to ____ shunting is common.
L to R
What are the specific considerations to think about with rabbits?
chronic resp dz, diarrhea
handling - vertebral fxs
stress prone
difficult intubation
large gut, small thorax
varied response to drugs
easy to inject IV (good veins)
Name the sedative drugs that can be used in rabbits.
ace
ace + butorphanol
diazepam
glycopyrrolate
fentanyl
medetomidine
midazolam
Name the analgesic drugs that can be used in rabbits.
buprenorphine
butorphanol
morphine
pethidine
carprofen
meloxicam
What is important to remember about fluid balance in pediatric anesthesia?
high body water content
large ECF compartment
List the 5 causes of hypoxemia & state which will respond to O2 supplementation.
hypoventilation - will respond to O2 supplementation
decreased FiO2-low inspired O2 concentration
diffusion impairment
V/Q mismatch
R-L pulmonary shunt
9 yr old Cavalier King Charles Spaniel in for dental. Has Grade III/IV systolic murmur & has been dx with mitral valve endocariosis. Currently being tx with Enalapril (ACE inhibitor). What is a suitable anesthetic protocol?
aim to maintain a slightly higher than normal HR to reduce regurgitant flow
low dose ACP + opioid with chronotropic effects (meperidine/pethidine) - not propofol (inotropic)
avoid a2's they increase SVR & decrease HR
etomidate & K/midzaolam
maxillary nerve block
severely affected animals - mask induction best
What are the advantages of using hypertonic saline over other IV fluids?
-rapid IV volume expansion
-rapid restoration of MAP
-increased CO
-mild peripheral vasodilation
-improved O2 delivery
-reduced blood viscosity
-reduced ICP
-promotes urine production
Hypertonic saline is useful in management of ______.
shock
What are the disadvantages of hypertonic saline?
increased Na, Cl
decreased K
What does the pressure gauge indicate?
indicates pressure of gas upstream from pressure of regulator valves
What is the fxn of one-way valves?
ensures that expired gases flow away from animal & pass thru a CO2 absorber (soda lime cannister) b/f they can be rebreathed
What does the Y-piece join?
corrugated tubing
What is the fxn of the pop off valve?
helps keep bag partially inflated - should be open unless "bagging" patient
What is the scavenger for?
removes anesthetic waste gases from immediately vicinity of machine & patient
The ______ allow the patient to be manually ventilated.
rebreathing bag
The soda lime cannister removes ______ from exhaled gases.
CO2
Pulse Ox: explain how it works and give normal ranges for dogs & cats.
-provides pulse rate
-measures the Hb saturation of arterial blood
-LED probe placed on tongue, lip fold, toe webbing, vulva, prepuce - absorbence of light by Hb & oxyHb
Excellent - 97-100%
Good: 94-96%
NOT OK: 91%
BAD 90%
Explain how a capnograph works.
-continuous measurement of carbon dioxide tensions in inspired & expired gas
-provides information about the resp & CV systems
-uses infrared radiation passed thru expired gas mixture to measure [CO2]
Explain how a Doppler BP monitor works.
piezoelectric crystal probe positioned over peripheral artery
sound waves bounce off of RBCs & reflect back to converted sound
the pressure at which the sound is audible is the systolic pressure
Explain how the DINAMAP works.
Device for indirect non-invasive automated mean arterial pressure. Cuff inflated automatically to pressure greater then anticipated systolic pressure then the pressure is slowly released. Oscillations begin at systolic pressure, are maximal at mean pressure and fade out at diastolic pressure. MAP is measured directly and SAP and DAP are calculated from built-in algorithms.
7 yr old 30 kg male Lab w/acute CCR (cranial cruciate rupture). Describe the anesthetic protocol for performing a TPLO on this dog.
premed (+ continue post-op): opioids - morphine, fentanyl, methadone
NSAIDS - pre & post-op - carprofen, meloxicam
intra-op infusions of FLK (fentanyl/lidocaine/K) or MLK (morphine/lidocaine/K)
epidural analgesia - lidocaine/bupivacine, morphine (DOA 6-24 hrs)
fentanyl patch - last 3-5 days but onset takes up to 24 hrs
intrasynovial analgesia - lidocaine/bupivacine & morphine
______ is a hyperoncotic soln and must always be given via catheter since extravasc injection of any concentration can cause tissue necrosis.
guafenesin
What is the max concentration of guafenesin that be given to cattle?
5% gaufenesin max b/c cattle RBCs are more sens to the osmotic-associated destructive effects of GGE than horses
NSAIDS should be avoided in ___ patients.
renal
_____ has renal vasodilator effects so in low doses m/b beneficial in patients wiht mild renal insufficiency to improve renal prefusion.
ACP
Nitrous oxide is contraindicated with _____ since it will accumulate in gas-filled viscis & thus exacerbate condition.
GDV
What is the treatment for ventricular tachycardia & ventricular tachyarrhythmias
lidocaine
______ by caudal epidural is rapidly absorbed and works well as a technique for sedating adult bulls.
xylazine
Llamas and alpacas are LESS sensative to _______ than cattle.
xylazine
What is the classic sedative combination used by equine vets for standing castration?
xylazine/butorphanol
Why is ACP not good for sedating horses?
no very effective
used to "take edge off" of young horses but very unpredicatable
Why are benzos not used in horses for standing sedation?
can cause muscle relaxation & disorientation
Give 3 examples of cases where using newer inhalational agents (sebvo & desflurane) m/b esp useful.
-geriatric or neonatal patients
-diabetic patients
-patients with ostructive airway dz
-small furries
-any case where rapid recovery is desirable
With local anesthetic toxicity - _____ signs precede -____ signs.
CNS before CVS
What are the key clinical CNS effects of LA overdose?
-initial transient CNS depression
-followed by agitation, muscle twitching, convulsions
What are the key clinical CVS effects of LA overdose?
-direct myocardial depression leading to bradycardia & decreased CO
-hypotension
What is the tx for local anesthetic toxicity?
fluids
seizures: IV diazepam/midazolam + supplementary O2
bradycardia: atropine or glycopyyrolate
Describe a suitable anesthetic protocol for anesthesia of cat for OVH.
pre-med: ACP + morphine
induction: propofol
maint: iso
non-rebreathing system (Bain or T-piece)
intra-op fluids: LRS
peri-op analgesia: NSAID (carprofen) + opioid (morphine)
What are NMB commonly used for?
-ocular procedures
-deep laparotomies (OVH, C-section - esp horses)
-rapid mgt of ventilation (esp horses)
Give an example of meds used for daibetic dog.
rapid-sequence induction using fentanyl-midazolam, propofol, epidural analgesia & main with iso/sevo