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287 Cards in this Set
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What problems might you see with sedation?
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respiratory depression
Be careful w/Brachiocepha. dogs Vomiting: aspiration** bradycardia |
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Which becomes more sedated from a neuroleptic combo,dog or cat?
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dog
cats are easier to handle, but will not appear as sedated |
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Why should you preoxygenate your patient?
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allows longer time for intubation before hypoxia is a consideration
perfuses the myocardium prior to adminstering drugs that aren't great for the heart |
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When should you not preoxygenate?
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When the animal is fighting it, don't want to increase catecholamine release
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when should you not use a mask for induction?
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Nervous, excited animals
airway obstruction, pulmonary dz |
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Which induction agent do you bolus?
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Thiopental
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Fluid rate for most patients
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10 mls/kg/hour
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What can you do to help with hypothermia?
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use a circulating warm water heating blanket
circulating warm air blanket fluid warmers Min. excessive scrubbing |
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What phases should be considered for a anesthetic protocol?
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Premed
Induction Maintenance Recovery |
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When does the recovery phase begin?
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When the vaporizer is turned off
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When should the ET cuff be deflated?
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just prior to extubation, not when the vaporizer is turned off
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Does oxygen contribute to cooling the animals?
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yes, if left on a circuit monitor their temperature
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What is the best way to treat emergence delirium if you are not sure of the pain status?
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tranquilizers and analgesics
Tranquilizers alone if no pain |
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What is the use for local anesthesia in small animal?
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minimize cardiopulmonary effects
reduce the amount of anesthetic |
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What is the use of local anesthetic in equine?
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Diagnostics
standing procedures Be careful w/recovery, so they don't hurt themselves use Mepivicaine, not lidocaine |
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Use of local in food animals?
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Much more used than general anesthesia
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What do local anesthetics do?
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Reversibly block the propagation of action potentials along nerve axons
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lidocaine MOA
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prevent rapid influx of sodium into the nerve axons that produce an A.P.
blocks transmission |
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Are sodium channels identical in all tissues?
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No, and they result in differing effects
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What drugs are ester local anesthetics?
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Procaine, cocaine
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What drugs are amide local anesthetics?
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Lidocaine
Bupivicaine Mepivicaine |
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What does the structure of the drug determine?
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Time of onset
Potency Duration |
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What does lipid solubility effect?
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determines the intrinsic local anesthetic potency
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What does the protein binding effect?
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Primary determinant of local anesthetic duration
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Lidocaine characteristics
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quick onset, short duration, intermediate potency
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Bupivicaine characteristics
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long onset, long duration, high potency
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What is absorption dependent on with local anesthetics?
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vascularity
Add epi to vasoconstrict areas, except ears, toes, tails |
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Are small, unmyelinated or large, myelinated (motor) blocked first?
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Small, unmyelinated
The large, myelinated are blocked last |
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Do cats have a lower toxicity for lidocaine?
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Yes, 6mg/kg vs. 12mg/kg in the dog
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First sign of lidocaine toxicity
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CNS signs
mostly seizures in animals |
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Which local anesthetic is the most cardiotoxic?
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Bupivacaine, don't give IV
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Where does most of the cardiovascular effect occur?
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In the myocardium, decrease excitability
vasodilation |
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how do you use local anesthetics?
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topical
perineural spinal/epidural intrapleural (high systemic absorption) |
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Where do you do an epidural in small animals?
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lumbosacral
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Where do you do an epidural in large animals?
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Sacrocoxygeal
Intercoxygeal |
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What nerves do you block in a carpal block?
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Palmar branch of ulnar nerve
Dorsal branch of ulnar nerve Median nerve Superficial branches of radial nerve |
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Brachial plexus block
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can limit amount of inhalant you use
usually use bupivicaine |
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What are 3 MOAs of NMB?
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Central
Peripheral - presynaptic Peripheral - postsynaptic |
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What do central NMB do?
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depress NM transmission thru spinal polysynaptic pathways that maintain normal skeletal muscle
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What are examples of central NMB?
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Gaufenesin
Benzodiazepine Alpha 2 agonist |
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Peripheral presynaptic MOA
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Inhibit Ach synthesis or
inhibit Ach release |
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Peripheral postsynaptic MOA
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Nondepolarizing
Depolarizing |
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Nondepolarizing characteristics
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No fasciculation
Effects can be reversed by anticholinesterase agents physically block channel |
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Nondepolarizing NMB drugs
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Atracurium
Pancuronium Gallamine d-Tubocurarine Cl |
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Depolarizing characteristics
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transient muscle fasiculations
metabolized by pseudocholinesterase mimics Ach to open channel, than stops |
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Does succinylcholine have a lot of contraindications?
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Yes, very limited use
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Pancuronium
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No histamine release
eliminated through the bile relatively inexpensive |
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Vecuronium
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similar to Pancuronium except eliminated thru hepatic and renal excretion
$$$$ |
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Atracurium
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NMB of choice
eliminated by body temp & pH "Hoffman Degradation" Not effected by hepatic or renal dz |
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Reversal of nondepolarizing NMB
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anticholinesterase drugs
Physostigmine, neostigmine, edrophonium, neostigmine |
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How do you prevent the muscarinic effects of anticholinesterase drugs used to reverse NMB?
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Give an anticholinergic drug
Atropine |
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When would you use an NMB with an anesthetized animal?
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controlled ventilation: don't want them to "buck" the ventilator
*Foals and calves monitor w/nerve stimulation |
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Indications for muscle relaxants
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Ventilation
adjunct to anesthesia Increase surgical access Intubation (cats & pigs) |
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Should you get a baseline prior to giving the NMB?
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yes
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Which patterns of nerve stimulation is more sensitive indicator of residual NMB?
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Train-of-four
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Two most important properties of NMB
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Prevent animal from breathing
No sedative or analgesic effects |
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What are the 3 most important factors regulating cerebral blood flow and intracranial pressure?
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CO2 tension
Arterial O2 tension Blood pressure/cerebral autoregulation |
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Does increased CO2 cause vasodilation or vasoconstriction?
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vasodilation
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Hypoxia leads to...
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increased cerebral blood flow, which increase intracranial pressure
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What is the MAP range for normal cerebral blood flow?
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50-150 mmHg
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Should you stop an animal's antiepileptic medication prior to anesthesia?
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No, maintain them
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What drugs do you want to avoid with seizure patients?
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Phenothiazine (ace)
Dissociatives (ketamine) |
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What are goals for CNS disturbances and anesthesia?
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monitor fluid
decrease CO2 (25-30mmHg) medical therapy (mannitol, furosemide, corticosteroids) |
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Spinal cord surgery concerns
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moving the patient
myelogram can cause seizures have diazepam ready |
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Spinal cord patients and pain management
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Pre-emptive analgesia (opioids)
Intra-op: CRI, topical Gelfoam, MLK Post-op: Patches, Opioid CRI |
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Primary objectives for ocular surgery
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Normal IO pressure
Central eye position Dilated pupil Immobilization Pain free |
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Oculocardiac reflex
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can cause Bradycardia
Bigeminy AV blokck due to inadequate relaxation of extraocular muscles and hypercapnia |
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How do you handle oculocardiac reflex?
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Atropine, IV if bradycardia results
Stop manipulating the eyeball |
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Normal Intraocular pressure for dogs and cats
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10-26 mmHg
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preanesthetic meds for ocular patients
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relieve anxiety, suppress coughing, prevent vomiting
Anticholinergics, tranquilizers, sedatives, opioids |
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Proparacaine
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Topical anesthetic for the eye
short duration of analgesia not for longterm use |
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EYE LUBE
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EYE LUBE
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Topical administration of anticholinergics
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Mydriasis
Diltation angle closure Increase IOP *systemic use, little effect on IOP |
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use of tranquilizers in ocular procedures
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prevent gagging/vomiting -> decrease IOP (acepromazine)
enhance ocular muscle relaxation (Diazepam) |
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Full agonist opioids and ocular surgery
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Miosis = dogs
Mydriasis = cats, rats, mice, monkey analgesia vomiting, retching, gagging |
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Agonist-antagonist opioid and ocular surgery
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#1 choice @ PU
Butorphanol mild sedation, less Cardiopulmonary depression, less vomiting |
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Buprenorphine and ocular anesthesia
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cats: transmucosally
long duration, slow onset |
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Do all commonly used injectable anesthetics decrease IOP?
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Yes
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What can be administered to the larynx that could help with the cough reflex?
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Lidocaine topically
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What do all inhalant anesthetics accomplish?
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decrease in arterial blood pressure
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What is special about an Endotracheal tube during ocular surgery?
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It has a wire so it won't be kinked during the procedure
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Do nondepolarizing muscle relxants paralyze all skeletal muscles?
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Yes, must monitor breathing
wean off ventilator and if spontaneous rebreathing doesn't occur, reverse the NMB |
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Recovery from ocular surgery
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Opioids post-op
NSAID Sedative/tranquilization Keep Warm and monitor breathing |
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What age are veterinary patients considered to be a neonate?
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3 months
Well-developed by 12 weeks |
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What is the main goal for neonate hearts?
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heart rate
Cardiac output is dependent on heart rate |
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What is different for the neonate respiratory?
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Higher resting resp. rate
Small airways (obstruction) Pliable rib cage |
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What is a good guideline for fasting?
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1 month = 1hour up to
4 month = 4 hours 6 months = 8 hours adult 8-12 hours |
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What organs are not fully developed and can prolong effect of drugs?
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heptaic microsomal enzymes
renal function |
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Key to success for neonatal anesthesia
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maintaining body temp
short surgical and anesthesia time |
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Do neonates respond differently to drugs?
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decreased metabolism
exaggerated responses *Reduce drug doses* |
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What is a good benzodiazepine for neonates?
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midazolam
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Which drugs should be avoided in neonates?
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Acepromazine: can't reverse, heat loss, vasodilation
Medetomidine: significant bradyarrhythmias |
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Induction for neonates
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Inhalant via face mask
Foals: Nasotracheal tube than oral endotracheal tube |
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Is inhalant or injectable safer for neonates?
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inhalant safer, doesn't require the extensive metabolism to excrete the drugs
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Main points for neonatal anesthesia
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Maintain heart rate
Maintain body temp Short surgical/anesthesia time Reduce drug doses Protect airway |
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Age-related Cardio changes
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Not able to compensate as well for anesthetic changes
increased vagal tone |
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What cardiac arrhythmias should you be concerned with?
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2nd degree heart block
Bundle branch block VPC Atrial Fib |
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If you see a 2nd degree block during surgery you should...
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treat with atropine if blood pressure is inadequate
B.P. normal, don't treat |
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What drugs should be avoided with myocardial dz?
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Alpha 2: Bradycardia
Thiopental: VPC Ketamine: Tachycardia |
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What landmarks should you palpate for a canine epidural?
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dorsal spionous process of L7
iliac prominences on either side |
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What two techniques can you use to ensure correct placement of epidural?
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hanging drop tech.
lack of resistance |
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When should you not do an epidural?
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Septicemia
skin infection over the site coagulation problems neurological patients direct trauma to the injection site |
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Common drugs used for epidurals in the dog
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Morphine
Bupivicaine Medetomidine Ketamine Fentanyl or Combinations of them |
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What is the landmark for a brachial plexus block?
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point of the should
blocks C6-T1 |
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Which foramen should you block for maxillary teeth?
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Infra-orbital, block PM3 to I1
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Which foramen should you block for some mandible teeth?
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Mental PM2 to I1
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Which foramen should you block for all mandible teeth?
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Mandibular Foramen M3 to I1
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What does the proximal paravetebral injection block?
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T13, L1, L2
aka Hall, Farguharson, Cambridge |
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Equine local face blocks
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Supraorbital
Infraorbital: lip and nose Auriculopalpebral: eyelid |
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What leads to cardiogenic shock?
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Pump failure
myocardial dz, valvular dz, pericardial effusion |
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What leads to hypovolemic shock?
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Fluid failure
hemorrhage, severe vomiting/diarrhea burns 3rd space/edema |
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What causes distributive or vasodilatory shock?
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Pipe failure; inadequate vasomotor tone
sepsis trauma ANESTHESIA: controlled Hypoadrenocorticism anaphylaxis |
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What is the difference between anaphylaxis and anaphylactoid?
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MOA
Anaphylaxis utilizes IgE for mediation Anaphylactoid rxns are identical but occur by other means than IgE mediation |
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What is shock?
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Inadequate oxygen delivery/consumption to/by tissues to meet metabolic demands
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Oxygen delivery is determined by...
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CO and CaO2 (oxygen in arterial blood)
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CaO2 (oxygen in arterial blood) is determined by...
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oxygen saturation -> Hemoglobin bound (most of it)
Partial pressure of O2 (free portion of oxygen) |
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Does shock always have to be systemically?
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No, it can be local
this could lead to a general shock |
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What are the stages of shock?
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Compensatory
Early decompensatory Late decompensatory (terminal) |
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What is the order of oxygen demand of organs?
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Brain; 1st
Kidneys: 2nd The rest of the body |
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What are the 3 compensatory mechanisms?
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Increase CO (sympathetic, ionotropy,chronotropy)
RAA ADH-Vasopressin |
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What endpoints can help you with fluid amount?
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CVP 3-10 cm H20
Normalized HR, CRT, Temp improved Acid/Base, lactate decreased |
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Will most animals benefit for O2 supplementation?
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Yes, especially if Hb is normal, but saturation is low
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When should you use catecholamines?
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Inadequate perfusion w/adequate volume
Decreased UOP with adequate overall perfusion They will increase SV & HR |
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What is your best choice of catecholamine to use to increase cardiac contractility?
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Dobutamine
Dopamine: as you increase dose, increases vasoconstriction |
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What is your best choice of catecholamine to use to increase systemic vascular resistance?
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Dopamine
Norepi Epi Vasopressin: doesn't increase myocardial O2 demand |
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Do the positives out way the negatives with steroid shock use?
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No, only use if in anaphylaxis
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when are Antibiotics appropriate with shock patients?
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septic
pneumonia Bowel is compromised: prevent bacT translocation (injectable Cephalosporin) |
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Is analgesia warranted w/shock?
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yes
helps them breathe calm opiods and locals are very beneficial |
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Why is cardiogenic shock different than distributive or hypovolemic?
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It usually has fluid overload
give Lasix, vasodilators Oxygen support |
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What do all general anesthetics do?
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decrease cardiac output
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What is considered with cardiac patients and pre-op meds?
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Improve ventricular fx (inotropes)
Treat existing arrhythmias maintain circulating volume (fluids!!) correct anemia |
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Acepromazine
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Low doses
Anti-arrhythmic vasodilation, but nothing compared to inhalant |
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Anticholinergics
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used to treat bradyarrhythmias
increased heart rate leads to increased myocardial work useful in patients who can't tolerate low HR |
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Who gets alpha 2?
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healthy strong HEarts
Exception: Cats with hyperthyroidism, helps maintain afterload for them |
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Benzodiazepine...good for cardiac patients?
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Yes, minimal cardiac effects!!
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Opiods...good for cardiac patients?
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Good choice!
mild bradycardia from incresed vagal tone no decrease in contractility (except meperidine) |
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Which opioids may release histamine?
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Morphine
Meperidine lead to hypotension |
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Injectables for cardiac patients?
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Etomidate>Dissociative > Thiobar & Propofol
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General principles for Cardiac Dz anesthesia
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Avoid Tachycardia or bradycardia
Careful with fluids Avoid hypovolemia Maintain contractility PREOXYGENATE patient |
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What could you induce a cardiac patient if you did not have etomidate?
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Mask induction w/isoflurane
monitor blood pressure |
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What are the two categories for respiratory disease?
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Extrapulmonary
Intrapulmonary |
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What is great sedative for respiratory patients?
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low dose of Ace, little respiratory effect
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What should induction be like for a respiratory patient?
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Fast, so you can access airway quickly
Mask, not good cannot ventilate well |
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what should you consider with brachiocephalic animals?
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PREOXYGENATE
don't mask down need more ET to pick from Delay extubation Never rest well due to redundant tissue |
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What is the most common anesthesia complication?
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Respiratory
*apnea *hypoventilation *loss of airway *hypoxemia |
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Which injectable anesthetics produce apnea?
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Thiopental
Ketamine Propofol can |
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Do all anesthetized patients hypoventilate?
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YES
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what aspect of tidal volume decreases during anesthesia?
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Alveolar ventilation
dead space usually remains the same |
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Why can CO2 be elevated?
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Hypoventilation
or Equipment malfunction |
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How can you lose your airway?
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Inadvertent extubation
Mucus plug/blood in ET Overinflation of cuff too short ET too long ET, only one lung ventilated |
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When should a cuff leak and not leak?
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Leak > 20cm H2O
No leak < 20 cm H2O |
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When should you deflate the cuff?
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Before extubating, not when the machine is turned off
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What are reasons for hypoxia during GA?
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Low inspired Oxygen
Hypoventilation barriers to diffusion (extrapulmonary) Ventilation-perfusion mismatch Right to left shunt (pulmonary) |
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what is the first thing you should do with your anesthesia machine after you leak check it?
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turn on your oxygen flow meter
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What are acceptable heart rates for small animal in general?
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Large dogs 60 bpm
small dogs 80-90 bpm puppies/kittens higher than adults |
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What should you think about with MAP< 60 mmHg?
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decreasing anesthetic depth
improving peripheral fluids increasing C.O. vasopressors |
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Inhalant anesthetics cause hypotension by 2 ways?
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1. Vasodilation
2. decrease C.O. |
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Normal fluid rate for anesthesia w/healthy hearts
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5-10 mg/kg/hr
usually 10 |
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Should you restrict fluids before anesthesia?
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No this is not necessary
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What diagnostics should you do the day of anesthesia?
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PCV: ~20%
TP: >3.5 g/dL bolus fluids prior to anesthesia if hemoconcentration is present |
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What volume should hetastarch not exceed?
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20 ml/kg/day
coagulopathies |
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What are the fasting guidelines for ruminants?
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Fasted 24-48 hours (at best 72)
water 12-24 hours |
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What potential problems can arise with G.A. in ruminants?
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regurgitation/aspiration
bloat respiratory hypoventilation nerve paralysis |
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What is the reason for using anticholinergics in cattle?
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Bradycardia, not salivation
atropine to treat or prevent bradycardia |
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Standing sedation in bovine protocol
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Xylazine + Opioid + local anesthetic
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What can be added to a standing procedure to enhance the sedation?
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Pentobarbital
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Should you use a premed with triple drip?
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Yes, tranquilizer or sedative
Premed 15-20 minutes before induction |
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What two combos are good for bolus induction in cattle?
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xylazine + ketamine
diazepam + ketamine |
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Will atropine help with bradycardia and salivation in pigs?
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Yes, it will help with both
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Best injectable anesthesia in pigs...
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telazol with xylazine
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the three"P" rule
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poor pressure
padding position |
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Where is most of the total body water?
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Intracellular - 67%
Extracellular -33% |
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What are the components of the extracellular space?
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Intravascular
Extravascular *Interstitial *Transcellular |
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What are the forces that influence fluid shifts?
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serum osmolality
effective circulating volume |
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Does water or Na+ move? who moves it?
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Water moves
ADH effects water Plasma osmolality increases thirst and ADH -> moves water |
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What effects Na+?
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Aldosterone
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What are the 3 components of daily fluid requirements?
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Replacement
Maintenance Ongoing losses |
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What is the calculation for replacement fluids?
|
%dehyrations x weight (kg) = amount (L)
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What is the composition of replacement fluids?
|
plasma
high in Na+ low in K+ Normosol R, LRS, Plasmalyte |
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What is the composition of maintenance fluids?
|
plasma
same as replacement fluids |
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Ongoing losses composition
|
depends on what fluid you are losing
measure UOP, vomit, and any drains if needed |
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What is the shock dose for a dog? How much should you give at once?
|
60-90ml/kg
give about 30 and then reevaluate |
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What is the shock dose for a cat? How much should you give at once?
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40-60 ml/kg
give about 20 ml/kg then check |
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What are the fluid types?
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Isotonic
Hypotonic Hypertonic Crystalloids: crystals/salts Colloids: neg. Large MW particle |
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When should you use a crystalloid?
|
volume expansion, replacement, maintenance, ongoing losses
80% of the volume infused will equilibrate w/in an hour |
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Positive effects of colloids
|
replace IV space only
long duration (12-36 hrs) less leakage from vessels |
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when should you use a colloid?
|
volume expansion
hypoproteinemia |
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Natural colloids
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whole blood
plasma human albumin |
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Artificial colloids
|
hetastarch
dextran gelatins oxyglobin |
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Hypertonic saline uses
|
resuscitation
head trauma only lasts 20 min., give w/colloids & crystalloids don't use if dehydrated |
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What should owners do if bleeding?
|
direct pressure to bleeding
talk owner to putting a makeshift muzzle on, unless they are having difficult breathing |
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what should a ready area consist of?
|
crash cart
"kits" for different procedures monitoring equipment |
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what are the categories for regulating tissue perfussion?
|
immediate: baroreceptors, local factors
intermediate: Renin, angiotensis long-term: oral fluid intake, renal control |
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What is the primary survery?
|
mainly the cardiorespiratory
initial evaluation ABC's of trauma |
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What is a distracting injury?
|
non-lethal issues (fractures, swellings)
distracting from lethal issues (pnemothorax, cardio) |
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Should the issues of the primary survery be addressed before moving on?
|
Yes, correct abnormalities in the primary survey because these are the critical systems for the patient
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What are clinical signs of traumatic shock?
|
tachycardia
pale M.M. cool extremities dull mentation hypotension |
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What is the fluid rate for colloid administration?
|
10-20 mL/kg over 20-30 minutes
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When should you use hypertonic saline?
|
patients refractory to colloids & crystalloids
give 3-5ml/kg |
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When should patients receive blood products?
|
When they have lost 25-30 % of their blood volume
rough dosage: 10 mL/lb of BW to increase PCV by 10% |
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What is the secondary survey?
|
After primary survey, do a complete PE with any diagnostics needed
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What are the different types of trauma?
|
Shock trauma
Thoracic trauma Flail chest |
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what are options for delivering oxygen to resp. distress patient?
|
face mask - stressful?
cage nasal (might need two canulas) |
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What are common chest abnormalities with thoracic trauma?
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Flail chest
pulmonary contusion rib fracutures diaphragmatic hernia hemothorax |
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When can cardiac contusions manifest as severe arrhythmia?
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24-48 hours later
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When does a patient need mechanical ventilation?
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when they cannot maintain adequate concentrations w/supplemental alone
SpO2= 90 PaO2> 60 PaCO2 <60 |
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Where should your needle go for thoracocentesis?
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Cranial to the rib
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how should hemoabdomen be managed?
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belly band initially
if BP and PCV do not approve you might have to do surgery, but usually resolve without |
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What should be the goal systolic pressure for patients with belly bands and hemoabdomens?
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70-80 not 90
we don't want to disturb any clot that might be forming |
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What is involved with a diagnostic peritoneal lavage?When do it?
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Do it when you have a high suspicion , but a neg. abTap
Catheter 2-3 cm behind umbilicus flushed with warm isotonic sol. |
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What can help with pain in orthopedic traumas?
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Local blocks
Stabilization!! Epidurals systemic opioids |
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What fluids should you administer for head injury patients?
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Hypertonic saline
crystalloids Mannitol for edema |
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What other guidelines should be monitored with head trauma (e.g. glucose, temp.)
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Normal glucose; not hypo/hyper
hypothermic a little (98-99) elevate head don't occlude jugular No steroids, no hyperventilation |
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Spinal injury stabilization
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rigid surface
steroids stabilize cardiorespiratory |
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What are two poor prognostics w/spinal injury?
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Schiff-Sherrington
Loss of Deep pain |
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what is sepsis?
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an overwhelming inflammation to an INFECTION
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what is usually the result of sepsis that leads to death?
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septic shock and MODS
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what is septic shock?
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acute ciculatory failure and persistent arterial hypotension (despite appropriate volume resuscitation) associated with sepsis (INFECTION)
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what are the most common parameters for feline sepsis?
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bradycardia
hypothermia |
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Common dz associated with sepsis (remember the P's)
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Pancreatitis(abscess)
Peritonitis Pyometra/Prostatitis Pyelonephritis Pyothorax Pneumonia *BactT translocation in Gut *Endocarditis |
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Canine parvovirus causes sepsis by...
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bacT translocation of the intestinal track
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Which organisms commonly cause sepsis?
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E coli
Enterococcus Clostridium Streptococcus Pseudomonas |
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What is SIRS?
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a wide spread inflammatory response to an infectious or a noninfectious insult
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Examples of noninfections causes leading to SIRS
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heat stroke
sterile pancreatitis immune Dz neoplasia Burns Severe trauma |
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How many of the criteria must be met to be classified as SIRS in dogs? cats?
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Dogs: 2 out of 4
Cats; 3 out of 4 |
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What are the criteria for SIRS?
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Hyper or Hypothermia
Tachycaridia (or Bradycardia in cats) Tachypnea Leukopenia/philia (dogs, left shift) |
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MODS definition
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clinical syndrome of acute, potentially reversible dysfunction of organs or ogans systems NOT directly involved in the primary dz process.
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Can SIRS be associated with sepsis?
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Yes, it is most commonly
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What are the main pro-inflammatory mediators?
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TNF-alpha
IL1 IL6 Platelet activating factor |
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What does TNF-alpha do?
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Produced by monocytes/macrophages
Earliest detection to endotoxin T-cell activator Triggers IL1, 1L6 Induction of apoptosis of endothelial cells Induction of NO |
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What does IL1 do?
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Peaks after IL1
Neutrophil chemotaxis B-cell activation and Ab production Endothelial release of PAF, Prostacyclin, pro-coag |
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What does IL-6 do?
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Best correlates w/severity and mortality
Main initiator of the acute phase response T-cell/Bcell/Ab activator Pyrogen |
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What does PAF do?
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Anaphylactoid Rxn
Neutrophil/Platelet activation Bronchoconstriction Increased vascular permeability |
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What are some anti-inflammatory mediators?
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IL10
IL4 glucocorticoids IL 13 Transforming growth factor-beta |
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Are inhalants more CV depressive in horses?
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Yes, the same potency will cause more depression in a horse than small animal
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Do you need to fast a horse prior to anesthesia?
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Yes, not for aspiration but for ventilation purposes
If really anxious give a little hay, but no grain at midnight |
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What is the best injectable sedative for the horse?
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Alpha 2, Xylazine
can use Ace too, has antiarrhythmic properties (don't use for sole sedation) |
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Do you use full mu opioids in the horse?
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No, they are more dysphoric, excited, and increase in motor activity
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What is the first thing to leave when using to leave with sedation?
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Sedation
the cardiovascular side effect will accumulate and the animal could become hypotensive |
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What is the most common induction agent used in horses?
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Ketamine
produces good induction, recovery |
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What is a unique characteristic about equine anesthesia?
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Wash out the mouth
No leather on halters |
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What are the two greatest factors for post anesthetic myopathy?
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hypotension
length of time the horse is recumbent |
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How do you check to see if a horse was intubated properly?
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Push on chest to check for air
capnometer will be sure to tell you |
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What is an endotracheal tube replaced with for recovery in horses?
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A nasotracheal tube
if a head procedure is done they might leave the endotracheal tube in for recovery |
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When using Ketamine what should you monitor for anesthetic depth?
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eye reflex
swallowing respiratory rate** |
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What are the eye signs for good surgical plane in the horse?
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slow palpebral reflex
strong corneal reflex no nystagmus no lacrimation cover eyes w/a towel |
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Do horses recover better with injectable or inhalant?
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injectable
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Why do horses get dobutamine to effect during anesthesia?
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it is a + inotrope to keep their blood pressure up, you will see the heart rate do down actually
normally you will not see changes in the horse's heart rate during anesthesia |
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Foals usually get what before endotracheal induction?
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Nasotracheal tube
usually mask down w/inhalant diazepam works well for sedative |
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do foals' heart rates change?
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yes, and will have lower blood pressure as well
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What age of foals is it important to administer dextrose during anesthesia?
|
2 months
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Are young ruminants considered monogastric or ruminants?
|
monogastric, rumen not fully functioning
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What is the fasting regimen for a ruminant?
|
Off feed 18-24 hrs
water 12 hours |
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Is butorphanol a good opioid for large animals?
|
Yes, provides good analgesia and decreases the CV depression of inhalants
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Which jugular should you catheterize in llamas?
|
right, to avoid esophagus
they have valves in their jugular, so it is difficult to advance |
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What is a good protocol for inducing llamas?
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GG until they "cush"
bolus of ketamine |
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Are llamas or bovine more sensitive to xylazine?
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Bovine
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What are the 5 vitals?
|
TPR +
Blood pressure Pain rating (before, during, after) |
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What are steps for pain perception?
|
Transduction
Transmission Modulation Perception |
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Transduction
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right at the point of pain, incision
substance P, PG NSAIDS attenuate transduction:COX |
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Transmission
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local to spinal cord
local block can minimize transmission |
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Modulation
|
spinal cord; dorsal horn
modulates the pain Ketamine, opioids attenuate modulation |
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Perception
|
how the brain perceives pain
use sedation (acepromazine, opioids) |
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What is allodynia?
|
they are painful everywhere
did not receive proper pain, so the surrounding area to the pain becomes hyperalgesia |
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What is the pain scaling of faces called?
|
Wong-Baker faces
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What are Adelta fibers?
|
They are myelinated and activated by mechanical and thermal noxious stimuli.
Faster than C fibers |
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What C fibers?
|
Unmyelinated
stimulated by chemical, thermal, mechanical, and cold noxious stiumli. Slow than A fibers |
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What are Adelta and C fibers found?
|
Skin muscles, joint: both
Visceral: rich in C |
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What are the different receptors in the dorsal horn for modulation?
|
NMDA (Ketamine)
GABA (benzos) Alpha-2 receptors (Xylazine, Detomidine) Opioid |
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Opioid side effects
|
Bradycardia
Respiratory depression Min effect on vasculature |
|
|
What reverse whether it is full or partial opiods?
|
Antagonist
Naloxone Naltrexone If you didn't have, could use butorphanol |
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|
What is a good opiod for epidurals?
|
Morphine
Long duration |
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|
Should you put fentanyl patch right on incision with nothing else?
|
No, it takes 12-24 hours for patch to be effective
Can put anywhere on the body |
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|
Where should you put a lidocaine patch?
|
Right on the incision
acts on injured nerves only pain has to superficial |
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|
What does COX-1 do?
|
It is an endogenous enzyme important for renal and GI function
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What is COX2?
|
An inducible enzyme by trauma
|
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|
Should NSAIDS be used to control pain?
|
No, couple with an opioid to improve pain management
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|
Does hypothermia effect drug metabolism even in healthy livers?
|
Yes, it is exacerbated
|
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|
Do all inhalants decrease portal vein blood flow?
|
Yes, but iso and sevo both maintain adequate O2 delivery to meet hepatic demands
|
|
|
What are considerations for hypoproteinemia?
|
Increased unbound drug
careful with fluids *hetastarch requires liver and kidney to be effective |
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|
What are key characteristics for anesthetic drugs and liver dz?
|
Short duration
reversible not metabolized by the liver Opioids are safer, sevo, iso, propofol |
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|
How much blood flow do the kidneys receive from cardiac output?
|
25%
|
|
|
Do anesthetics increase or decrease GFR?
|
Decrease
Direct: Renal blood flow Indirect: CV function, neuroendocrine |
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|
Drugs that are nephrotoxic?
|
Methoxyflurane
NSAIDs |
|
|
What does hyperkalemia look like on an ECG? (potassium excretion is dependent on renal function)
|
Peaked T wave
prolonged PR interval widened QRS Loss of P wave Bradycardia |
|
|
What is considered oliguria?
|
< 0.27 mL/kg/hr
|
|
|
what is considered anuria?
|
< 0.08 mL/kg/hr
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