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60 Cards in this Set
- Front
- Back
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what are two important preoperative considerations for a dog with mitral valve disease |
- assess the magnitude and severity of secondary heart changes (look at the LA) - assess the severity of the regurgitation |
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what are three important intraoperative considerations for patients with MVD |
- avoid fluid excess - avoid increasing regurgitatoin: avoid bradycardia and vasoconstriction - promote forward flow: vasodilation |
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how would radiographs help with anesthesia decisions in MVD |
- look for cardiomegaly and LA enlargement - check the lungs |
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what are the anticipated problems w/ anesthesia for a patient with MVD |
anesthesia: hyptension, hypoventilation, hypothermia disease: fluid overload/ CHF procedure: depends, pain |
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what would be the goals for anesthesia in a patient with MVD |
-- avoid excessive fluid administration w/o letting the patient become hypotensive -- avoid increased regurgitation -- promote forward flow - decreased afterload |
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how about an opioid for premedication |
fine as long as the bradycardia can be mediated |
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what could be used to mediate the bradycardia from an opioid |
anticholinergic |
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how about a benzodiazepine as a premedication |
it would be fine b/c there are not many CV effects it causes sedation when used with an opioid -- this might not be needed. |
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what about acepromazine as a premedication |
NOT recomended - the hypotension would cause the need for fluids to restore BP - this is a really long acting drug and there is not much that can be done to control its effects.
it does decrease SVR which would decrease afterload, but it is not worth the other effects. |
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what about dexmedetomidine as a premed |
NOT recomended -- causes vasoconstriction and bradycardia (increased regurgitation) |
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what would be the first choice for induction of a patient with MVD |
propofol: causes vasodilation and decreases myocardial contractility. most patients w/ MVD don't have systolic dysfunction so this is ok. it can be titrated to the effective lowest dose.
it does have respiratory effects. |
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what about ketamine and benzodiazepine for induction |
causes HR and BP increase could be used but not the first choice |
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what about etomidate and benzodiazepine for induction |
could be used, but not the first choice very little CV effects, but expensive propofol has a smoother recovery causes adrenal suppression for 4-6 hours (most patients are fine) |
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what about an opioid and benzodiazepine for induction |
could be used, but not the first choice -- a high dose of opioids is probably overkill in this patient. it will depress the respiratory system a lot and the patient may end up on a ventilator. |
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what would be best for anesthetic maintenance in a patient with MVD |
iso or sevo + local anesthesia depending on the surgery |
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what type of fluids would be used in a patient with MVD |
fluids 3-5 mg/kg crystalloids |
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what could be used for post operative analgesia in a MVD patient |
opioids NSAIDs |
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what should be monitored during surgery |
- HR: should be normal - BP - Temp |
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what would the preanesthetic considerations for a patient with DCM |
- correct the underlying problem is possible - administer cardioprotectives if indicated (positive inotropes) - administer diuretics or restrict fluids if indicated - avoid excitement |
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what are the intraoperative considerations for patient with DCM |
- aim for a normal HR - avoid hyper or hypotension - avoid hyper or hypervolemia - avoid agents that suppress systolic function and administer positive inotropes - avoid vasoconstriction |
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what would be best if DCM was diagnosed in a preanesthetic work up for a surgery |
consider delaying surgery for a few days to start the patient on DCM treatment and try to make it a better surgical candidate. |
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what would be the anticipated anesthetic problems related with DCM |
fluid overload/CHF poor DO2 is probably arrhythmias |
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Name 3 important goals for anesthesia in the DCM patient |
1. limit/eliminate arrythmias to make sure they don't contribute to the poor systolic function 2. avoid fluid overload 3. ensure adequate DO2 --- avoid bradycardia and tachycardia, increase contractility |
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what about opioids + anticholinergics as a premedication |
first choice |
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what could be added to the opioid/anticholinergic if the dog needed more sedation |
benzodiazepine |
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what about acepromazine as a premedication |
decreasing the afterload would be beneficial, BUT treating the hypotension that would happen secondarily could lead to fluid overload |
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what about dexmedatomidine as a premedication |
No -- don't want to increase afterload or cause bradycardia |
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what about etomidate/benzodiazepine as an induction drug |
this would be a good first choice -- especially when there is not a ventilator. etomidate will not decrease systolic function further |
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opioid/benzodiazepine as an induction agent |
this could be used if an opioid CRI will be used for maintenance, BUT ventilation will need to be available. |
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what about propofol as an induction agent |
NO - this will affect systolic function which is already affected. this is a negative inotrope. |
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what about ketamine/benzodiazepine for induction |
NO -- DCM pathophysiology includes the SNS and there is concern about the negative effects of ketamine when the SNS is not working well. |
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what about Alfaxalone for induction |
not certian about the systolic affects -- would not use at this time |
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what would be the best method of anesthesia maintenance for the DCM patient |
iso or sevo + balanced anesthesia |
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what is balanced anesthesia so important in the DCM patient |
inhalants are negative inotropes and this would be a problem for the DCM patient |
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what would be the best options for balanced anesthesia |
opioids: need ventilation (manual or mechanical) could add lidocaine: if there are arrhythmias. this is a weak negative inotrope and would not be used on it's own (w/ an opioid) |
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what would be monitored with a DCM patient under anesthesia |
-- HR and rhythm: ECG -- BP: -- CVP - will be high when CO is low and should decrease as CO gets better --Temp |
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what fluid rate would be used |
3-5 ml/kg/hr count everything that goes into the patient |
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what positive inotrope could used during surgery |
dobutamine (does not cause vasocontriction like dopamine can at high concentrations) |
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what should be assessed in the HCM patient preoperatively |
- severity of disease: cardio consult - assess for a dynamic outflow tract obstruction - assess arrhythmias - avoid excitement - administer beta blockers if inidcated - administer diuretics/restrict fluids if indicated |
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what are some intraoperative considerations for HCM patients |
- avoid tachycardia: aim for mild bradycardia - avoid vasodilation: aim for mild vasoconstriction - avoid hypovolemia, hypervolemia - avoid hypertension |
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which drug could be good b/c it causes bradycardia and vasoconstriction |
alpha 2 agonists |
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what would be the goals of anesthesia in a patient with HCM |
- optimize stroke V and CO - maintain adequate myocardial perfusion (mild to moderate bradycardia) - limit/decrease LVOT obstruction - limit/ decrease arrhythimias |
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what are the anticipated problem with anesthesia in a HCM patient |
- CHF - arrhythmia --> sudden death |
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what about an opioid premdication |
Yes - this should be included could be used on it's own if the cat is calm |
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what about dexmedetomidine premed |
could be used in addition to an opioid if more sedation is needed |
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what about benzodiazepine premed |
could be used if additional sedation is needed |
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what about an anticholinergic premed |
only if the patient is is really bradycardic (remember that we want a low HR) |
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what about acepromazine premed |
NO - it is not a great sedative and it decreases SVR (we want SVR to be normal to increased) |
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what about propofol for induction |
it could be used in less severe cases when it is carefully titrated. tends to cause systemic vasodilation (we want normal to increased) |
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what about etomidate/benzodiazepine for induction |
this is a good combination |
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what about ketamine/benzodiazepine for induction |
NO - causes sytemic stimulation --> increased HR. (we want a low HR in HCM cats) |
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what about opioids/benzopiazepine for induction |
NO - don't use opioids in cats b/c it can cause excitement at high doses |
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what about maintenance for HCM cats |
iso sevo |
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what should be monitored in an HCM cat under anesthesia |
HR and rhythm BP Temp |
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what was that conservative fluid rate |
3-5 ml/kg/hr |
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what would be first line of defense in hypotension in a HCM cat |
vasoconstriction -- phenylephrine |
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why would a positive inotrope not be used first |
don't want to increase myocardial O2 consumption through contraction |
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should heart medication be given the day of surgery |
yes, except ACE inhibitors |
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what could be done when there is SSS or 3rd degree AV block |
medical management of HR: positive chronotropes, temparary pace maker |
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what drugs would be used as a positive chronotrope during medical management of SSS and 3rd degree AV block |
isoproterenol high dose dopamine |
