Anesthesia Exam 1

Front 1

When did Anesthesia first begin?

Back 1

1846
Ether
Boston

Front 2

Define General Anesthesia

Back 2

Includes:
immobilization
muscle relaxation
unconsciousness
Freedom from pain
Drug induced unconsciousness characterized by controlled, reversible depression of the CNS, and analgesia. The patient is NOT arousable and sensory, motor and automatic reflexes are attenuated.

Front 3

Define Neuroleptanalgesia

Back 3

combination of neuroleptic agent (tranquilizer/sedative) and an analgesic agent (opiate) to produce a heavy sedation and analgesia

Front 4

3 Killers = Anesthesia Machine

Back 4

Flowmeter= too little- hypoxemia
Vaporizer= too much - depress respiration
pop-off valve= too tight- rupture lungs- pneumothorax.

Front 5

Define hypoxemia

Back 5

Hypoxemia is when the arterial blood has a partial pressure in and around 80 mmHg and below.

Front 6

Why do we use O2 in anesthetized patients?

Back 6

Anesthetized patients encounter respiratory depression; therefore, without supplemental oxygen hypoxemia is very possible
Minimum FIO2 = 35%

Front 7

Capacity of O2 in E cylinder =

Back 7

660

Front 8

Capacity of O2 in H cylinder

Back 8

6600

Front 9

Pressure in E & H cylinders

Back 9

2200 psi

Front 10

When should the cylinder be changed?

Back 10

200 psi

Front 11

Anesthetic vaporizer: VOC

Back 11

precision, complex design, vaporizer is OUT of circuit

Front 12

Anesthetic vaporizer: VIC

Back 12

non-precision, simple design, IN circuit, carrier gas.

Front 13

What factors effect output concentration of the anesthetic vaporizer?

Back 13

Altitude
Temperature
Tipping

Front 14

What is the function of a patient breathing system?

Back 14

function of any PBS is to deliver O2 +/- anesthetic gases & eliminate carbon dioxide.

Front 15

How do you determine what size reservoir bag to use?

Back 15

tidal volume (10-20ml/kg) X 6 = 600ml = 1 liter bag (always round up!)

Front 16

Advantages and Disadvantages of Charcoal Absorption

Back 16

Advantages: absorbs hydrocarbons, initial cost is low, mobility
Disadvantages: not good for N2O, doesn't last forever (50 grams or 8-12 hrs), flow is limited, added resistance

Front 17

In what species do we commonly use cole ET tubes?

Back 17

birds

Front 18

What considerations should be made for intubation?

Back 18

design
measurement--> length (graduations in cm)
ID (measured in mm) - get largest diameter decreased airway resistance

Front 19

What should you do before intubation?

Back 19

Clean/dry tubes
check cuff
pre-measure (tip of nose to thoracic inlet)

Front 20

List 5 reasons why endotracheal intubation is performed.

Back 20

1. less wasted gas
2. more anesthetic
3. less regurgitation danger
4. IPPV- intermediate + P ventilation
5. O2 administration

Front 21

List and describe 5 type of endotracheal tubes.

Back 21

1. Cole = birds
2. Tracheostomy
3. Macgill -bevel
4. Murphy- bevel and hole
5. Wired - avoid kinks

Front 22

Outline the preparatory steps for intubation of both large and small animals

Back 22

- clean tube w/ checked cuff
- measure length and width
- laryngoscope, stylet, and lidocaine (if a cat)

Front 23

Common complications associated with endotracheal intubation.

Back 23

- bronchial puncture, etc - obstruction
- bronchial intubation
- ETT damage- puncture, etc

Front 24

Why is fasting recommended in most patients?

Back 24

anesthetics relax the lower esophageal sphincter and decrease GI motility. This leads to increase reflux and increase risk of aspiration. Increased risk of bloat in ruminants.

Front 25

What are the recommendations for fasting?

Back 25

12 hours in monogastrics
12-36 ruminants
small mammals, birds, neonates- short to no fasting- risk of hypoglycemia

Front 26

T/F fasting is necessary in true emergencies

Back 26

false

Front 27

Which of the following is not considered minimum preanesthetic blood tests?
1. PCV
2. TS
3. Creatinine
4. Blood Glucose

Back 27

3. Creatinine `

Front 28

A 12 hr fast is recommended for a 6 day old kitten undergoing repair of atresia ani?

Back 28

False

Front 29

That same kitten would be an ASA class 1 patient?

Back 29

false

Front 30

How does pain effect anesthesia?

Back 30

painful patients will require larger doses of drugs to achieve anesthesia. Larger doses=more side effects

Front 31

How to prepare the patient's body?

Back 31

-A clean patient is a good patient
- If possible, bathe dirty patient prior to procedure
- clean hooves
- rinse out horse's mouths- always some remaining hay in there
- a dog with lot of fleas and ticks try to get most of the ectoparasites off PRIOR to anesthetizing

Front 32

What is the minimum blood work before anesthesia?

Back 32

PCV (packed cell volume)
TS (total solids) = albumin +globulins that bind to proteins
BUN and BG

Front 33

What blood work should be considered preanesthesia?

Back 33

PCV, TS, BUN, BG, CBC, Chemistry, Urinalysis

Front 34

What is an ASA status

Back 34

classification of physical status based on the information you have at the time you're ready to anesthetize

Front 35

ASA Classification: 1

Back 35

normally healthy animal

Front 36

ASA Classification: 2

Back 36

discrete systemic disease

Front 37

ASA Classification: 3

Back 37

serious, non-incapacitating systemic disease

Front 38

ASA Classifciation: 4

Back 38

Life threatening

Front 39

ASA Classification 5:

Back 39

moribound with death expected within 24 hours

Front 40

As ASA classification increases risk of anesthesia_______?

Back 40

increases

Front 41

A patient who is undergoing anesthesia for a mast cell tumor removal is an ASA status?

Back 41

2

Front 42

A patient undergoing anesthesia for a cruciate repair is

Back 42

3

Front 43

A patient undergoing anesthesia for a life-threatening procedure- (foreign body)

Back 43

4

Front 44

Opioids have no effect on the cardiovascular system?

Back 44

false

Front 45

Which of the following is not a characteristic of Acepromazine?
1. sedation
2. analgesia
3. anti-histamine
4. penile protrusion

Back 45

analgesia

Front 46

Why is it important to provide pre-emptive analgesia?

Back 46

providing analgesia to the patient prior to the painful stimulus
- decreases inhalant requirements
- prevents wind-up
- decreases post-op analgesic requirements
- improves recovery

Front 47

Diazepam acts on ______ receptors

Back 47

GABA A receptors (enhances binding)

Front 48

Diazepam provides

Back 48

muscle relaxation
anxiolysis

Front 49

What can be used to reverse benzodiazepines?

Back 49

flumazenil

Front 50

Phenothiazines like acepromazine causes sedation by binding to?

Back 50

blocks dopamine receptors

Front 51

What are some adverse effects of acepromazine?

Back 51

hypotension- extreme vasodilation
decreases CO, SV, MAP
don't use in epileptic patients
penile prolapse
effects clotting

Front 52

xylazine is a

Back 52

alpha 2 agonist

Front 53

Alpha 2 agonists cause

Back 53

vasoconstriction and reflex bradycardia, decrease sympathetic tone
BIPHASIC BLOOD PRESSURE RESPONSE

Front 54

Alpha 2 agonists provide

Back 54

sedation and analgesia

Front 55

General opioid pharmacology

Back 55

rapid onset of action
duration of action is dependent
hepatic metabolism
species dependent
ileus

Front 56

Morphine

Back 56

best analgesia, can cause excitement in cats, IV-histamine release (don't give to dog with mast cell tumor)

Front 57

Hydromorphone

Back 57

more potent than morphine, good analgesia/mild/moderate sedation

Front 58

Fentanyl

Back 58

DOSE IN MICROGRAMS
100x more potent than morphine

Front 59

large doses of fentanyl may cause

Back 59

significant bradycardia and respiratory depression

Front 60

What is the problem with reversing fentanyl

Back 60

may require more than 1 administration of naloxone

Front 61

when should Butorphanol be considered

Back 61

not enough analgesia alone, no procedure that causes pain
Used for diagnostic procedures

Front 62

Why is buprenorphine a good drug to send home?

Back 62

prolonged onset of action, long duration of action, can be given sublingual or OTM

Front 63

Atropine

Back 63

binds to muscarinic recpetors and blocks PS effects
NO sedation or analgesia

Front 64

Which of the following agents would more likely increase the sympathetic tone?
1. propofol
2. ketamine
3. alfaxolone
4. thiopental
5. acepromazine

Back 64

ketamine
all others will decrease HR

Front 65

Which of the following agents provides analgesia?
1. propofol
2. thiopental
3. alfaxolone
4. all of the above
5. none of the above

Back 65

none of the above

Front 66

a cat with a history of chronic renal failure comes to your practice for a dental. Which of the following agents would be contraindicated?
1. propofol
2. ketamine
3. diazepam
4. thiopental
5. alfaxolone

Back 66

2. ketamine

Front 67

which of the following agents would be the best to use in patients with liver disease?
1. propofol
2. ketamine
3. alfaxolone
4. thiopental
5. pentobarbital

Back 67

1 propofol

Front 68

which of the following agents is most likely going to produce post induction apnea?
1. propofol
2. ketamine
3.thiopental
4. alfaxolone
5. tiletamine

Back 68

propofol

Front 69

Describe the advantages of inhalant anesthesia

Back 69

cost effective, predictable, easy to administer, fast onset/offset, supplemental oxygen

Front 70

Describe the disvantages of inhalant anesthesia

Back 70

system required to administer, environment unfriendly, health hazard

Front 71

List the characteristics of an ideal inhalant?

Back 71

low blood solubility, stable, inexpensive, no renal or hepatic toxicity, minimal excitement, minimal uptake, breathing system, minimally metabolized, non-toxic, non-irritating, environmentally friendly

Front 72

Calculate the maximum concentration of an inhalant with a known vapor/barometric pressure?

Back 72

vapor pressure/ barometric pressure (760 mmHg) * 100

Front 73

Describe the benefits of an inhalant with low solubility/partition coefficient?

Back 73

there will be faster onset and offset

Front 74

What factors maximize the rate of delivery of anesthetic gas to the alveoli?

Back 74

increasing the cocnentration while ventilating
cardiac output
decrease dead space
ventilation for patient
increase flow rate

Front 75

Factors that determine anesthetic uptake from alveoli to blood

Back 75

blood-gas solubility
cardiac output
difference in Pa and Pv of anesthetics

Front 76

Describe the relative distrubution of cardiac output to the major organ groups and why this is important in inhalant anesthesia?

Back 76

some of these organ groups (kidney and rain) recieve more cardiac output and get more of the inhalant

Front 77

State what factors affect the elminination of inhalant gases the patient?

Back 77

reverse process
high flow
ventilate the patient

All increase elimination

Front 78

ACVA recommendations for monitoring patients under anesthesia include:

Back 78

Circulation- adequate blood flow to organs and tissues
oxygenation- ensure adequate oxygen delivery in arterial blood
ventilation
temperature

Front 79

Name 3 clinical skills that can be used to evaluate the cardiovascular system?

Back 79

1. mucous membranes- gross assessment of perfusion

2. manual palpation of pulse

3. capillary refill time

Front 80

What is an esophageal stethoscope and what does it measure?

Back 80

The esophageal stethoscope is a blind-ended tube passed into thoracic esophagus at the level of the heart connected toe ar pieces.
It measures heart sounds, heart rate, and rhythm reliable, but is a poor indicator of adequacy of circulation.

Front 81

What is an ECG and what does it measure?

Back 81

Electrocardiography:
- detects electrical activity of the heart, heart rate, rhythm

Front 82

What are the types of blood pressure monitoring?

Back 82

Direct (invasive)- beat by beat values-arterial catheter,
Indirect: occlusion of artery using cuff to detect returning blood flow. OR blood through artery cause vibrations in arterial wall and translated to electrical signals

Front 83

What are the methods for indirect blood pressure monitoring and what are the limitations of these

Back 83

Doppler- reliable systolic pressure
Oscillometric

Front 84

Name 3 clinical obseravations that can be used to monitor the pulmonary system

Back 84

Thoracic ascultation -resp rate
tidal volume - indirectly from movement in reserviour bag and thoracic cage, mucous membranes- color

Front 85

How do the respiratory rate monitors work and what do they measure

Back 85

usse a thermometer placed in airway to detect temperature differece between inspired and expired gases translated into an electrical signal. DOES NOT indicate tidal volume, NOT a true measrue of ventilation or oxygentation

Front 86

What is a repirometer and what does it measure

Back 86

compares calculated tidal volume and minute ventlation

Front 87

How is capnography a measure of ventilation

Back 87

Capnography measures end-tidal carbon dioxide tension and inspired carbon dioxide tension.

Front 88

ACVA recommendations for monitoring patients under anesthesia include:

Back 88

Circulation- adequate blood flow to organs and tissues
oxygenation- ensure adequate oxygen delivery in arterial blood
ventilation
temperature

Front 89

Name 3 clinical skills that can be used to evaluate the cardiovascular system?

Back 89

1. mucous membranes- gross assessment of perfusion

2. manual palpation of pulse

3. capillary refill time

Front 90

What is an esophageal stethoscope and what does it measure?

Back 90

The esophageal stethoscope is a blind-ended tube passed into thoracic esophagus at the level of the heart connected toe ar pieces.
It measures heart sounds, heart rate, and rhythm reliable, but is a poor indicator of adequacy of circulation.

Front 91

What is an ECG and what does it measure?

Back 91

Electrocardiography:
- detects electrical activity of the heart, heart rate, rhythm

Front 92

What are the types of blood pressure monitoring?

Back 92

Direct (invasive)- beat by beat values-arterial catheter,
Indirect: occlusion of artery using cuff to detect returning blood flow. OR blood through artery cause vibrations in arterial wall and translated to electrical signals

Front 93

What are the methods for indirect blood pressure monitoring and what are the limitations of these

Back 93

Doppler- reliable systolic pressure
Oscillometric

Front 94

Name 3 clinical obseravations that can be used to monitor the pulmonary system

Back 94

Thoracic ascultation -resp rate
tidal volume - indirectly from movement in reserviour bag and thoracic cage, mucous membranes- color

Front 95

How do the respiratory rate monitors work and what do they measure

Back 95

usse a thermometer placed in airway to detect temperature differece between inspired and expired gases translated into an electrical signal. DOES NOT indicate tidal volume, NOT a true measrue of ventilation or oxygentation

Front 96

What is a repirometer and what does it measure

Back 96

compares calculated tidal volume and minute ventlation

Front 97

How is capnography a measure of ventilation

Back 97

Capnography measures end-tidal carbon dioxide tension and inspired carbon dioxide tension.

Front 98

ACVA recommendations for monitoring patients under anesthesia include:

Back 98

Circulation- adequate blood flow to organs and tissues
oxygenation- ensure adequate oxygen delivery in arterial blood
ventilation
temperature

Front 99

Name 3 clinical skills that can be used to evaluate the cardiovascular system?

Back 99

1. mucous membranes- gross assessment of perfusion

2. manual palpation of pulse

3. capillary refill time

Front 100

What is an esophageal stethoscope and what does it measure?

Back 100

The esophageal stethoscope is a blind-ended tube passed into thoracic esophagus at the level of the heart connected toe ar pieces.
It measures heart sounds, heart rate, and rhythm reliable, but is a poor indicator of adequacy of circulation.

Front 101

What is an ECG and what does it measure?

Back 101

Electrocardiography:
- detects electrical activity of the heart, heart rate, rhythm

Front 102

What are the types of blood pressure monitoring?

Back 102

Direct (invasive)- beat by beat values-arterial catheter,
Indirect: occlusion of artery using cuff to detect returning blood flow. OR blood through artery cause vibrations in arterial wall and translated to electrical signals

Front 103

Define Anesthetic depth

Back 103

The depth of anesthesia is the balance between the amount of anesthetic, magnitude of surgical stimulus, and patient’s physiologic state. We monitor depth through: observation, changes in reflexes, changes in muscle tone and changes in respiration

Front 104

Stage 1 of anesthesia:

Back 104

voluntary movement: from initial administration to loss of consciousness. Most variable stage

Front 105

Stage II

Back 105

involuntary movement/delirum
from loss of consciousness to onset of a regular pattern of breathing
nystagmus in horses

Front 106

stage III

Back 106

surgical anesthesia
plane 1= light
plane 2 = moderate
plane 3 = deep

Front 107

Stage IV

Back 107

anestetic overdose
extremem CNS depression

Front 108

Species differences when monitoring depth of anesthesia

Back 108

eye position, reflexes, nystagmus, jaw tone, muscle relaxation

Front 109

Eye position/movement

Back 109

small animals, cattle, small ruminannts, pigs: ventral eye rotation
horses: medial or lateral or central, nystagmus- light

Front 110

Horses: eye reflexes & positions

Back 110

medial rotation or slow roving eyeball = medium plane
nystagmus- very light
lacrimation- light
palpebral reflex- medium

Front 111

Species variations: pupil size

Back 111

dogs and people- constriction
cats & horses- dilation

Front 112

Jaw tone is a reliable indicator of depth of anesthesia in small animals but not in horses (T/F)

Back 112

True

Front 113

Define MAC

Back 113

% set for animal to stay asleep and under
Standardized index for measuring potency (amount administered in order to get an effect)
The minimum alveolar concentration of an anetehtic at 1 atm that produced immobility in 50% of subjections

Front 114

MAC =

Back 114

ED 50 for inhalants

Front 115

T/F
MAC is inversely proprotional to the gas/oil partition coefficient

Back 115

T

Front 116

The MAC of isoflurane is?

Back 116

1.3%

Front 117

The MAC of sevoflurane is?

Back 117

2.3%

Front 118

The MAC for Halothane is

Back 118

0.87%

Front 119

The MAC for desflurane is

Back 119

7.2%

Front 120

The MAC for Nitrous Oxide is

Back 120

188%

Front 121

Factors that Increase the MAC

Back 121

hyperthermia
cns stimulants
hyperthyroidism
high levels of circulating catecholamines

Front 122

Factors that decrease the MC

Back 122

neonates and geriatric patients
hypoxemia
hypercapnia
hypotension
hypothermia
cns depressant drugs
pregnancy

Front 123

All of the following increase MAC except:
1. hyperthermia
2. hypercapnea
3. hyperthryoidism
4. CNS Stimulants

Back 123

hypercapnea

Front 124

Which of the following increase MAC?
1. hypoxemia
2. hypotension
3. pregnancy
4. high levels of catecholamines
5. hypercapnea

Back 124

high levels of catecholamines increase MAC

Front 125

Which of the following decrease MAC?
1. hyperthermia
2. cns depressents
3. hyperthyroidism
4. cns stimulants
5. hypertension

Back 125

2. cns depressents

Front 126

What should be given to all anesthesia cases?

Back 126

adequate fluid therapy and hemodynamic support!

Front 127

What are the advantages to using Nitrous oxide?

Back 127

greater blood solubility than N2, rapid onset/offset, analgesia

Front 128

What are the disadvantages to using nitrous oxide?

Back 128

not potent
can interfere with CO2 monitoring
can exacerbate pathological condition
presssure necrosis

Front 129

How can you calculate the amount of oxygen left in a tank?

Back 129

take the normal pressure of cylinder (2200psi)/total capacity in L = actual pressure left/ x liters

Front 130

How can you calculate how much time you have left of O2?

Back 130

x liters/ flow rate (liters/mins)