Anesthesia Machine And Er Drugs Ch 1

Front 1

1.Endotracheal tubes:
Advantages of cuffs?
How a cuff works?

Back 1

1. Prevents leakage of gas around tube
2. Reduces risk of aspiration
3. Prevents inhalation of room air
4. Allows you to breathe for patient if patient gets too deep.

Cuff fills space in trachea. Seals around endotracheal tube: prevents vomit from aspirating into the lungs and causing pneumonia.

Front 2

Tube measurement:

What if the tube is too long?
Why is it important too keep tube from slipping?

Back 2

Measure tube from tip of dog's nose to thoracic inlet or just past. If to be is too long it will slip into one bronchi and only one lung will participate.
It's better to stick out of mouth if too long .
Make sure tube is marked or tied to top of mouth with gauze to prevent it from slipping back in because sometimes it slips in during anesthesia. (patient might awake)

Front 3

Anesthetic machine functions?
4

Back 3

1. delivers 100% oxygen/ room air oxygen is 21% (bc respiration and pulse decrease under anesthesia)
2. Vaporizes liquid anesthetic. Oxygen is the carrier gas.
3.Delivers anesthetic gas (vaporizers specific for Isoflourine)
4.Remove exhaled gases (scavenging system gets rid of excess gas.)

Front 4

IPPV:?

Back 4

Intermittent Positive Pressure Ventilation (a sigh breathe, periodically breathe for them just to be safe even when patient is not "crashing" (to prevent lung collapse)

Front 5

Gas cylinders:
Green?
Blue?
Etanks?
Htanks?
PSI for full tanks?

Back 5

Green: o2 oxygen
Blue: nitrous oxide
Etanks: small
Htanks: Large
Etanks and H tanks are 2200 PSI when full.

Front 6

Flow meters?
what does it do and how is it measured?

Back 6

1. set the flow rate of oxygen (reduces pressure so o2 pressure not to high)
2. measured in liters per minute (L/min)
*ball tells how high flow rate.

Front 7

Vaporizers? What does it do and what is it designed for? What to take into consideration?

What is a yold

Back 7

1. converts liquid anesthetic to a gas state
2. Each vaporizer designed for a particular vapor pressure

1. compensate for temp. warm temp will make anesthetic dissolve faster.
2.oxygen flow rate will control how much gas is getting to client.
3. back pressure (pressure in breathing circuit)

Yolk is where the tank attaches to machine, it's specif. to certain types of gas. ex. o2 for o2.

Front 8

Tidal volume:

Back 8

What you breath in a normal breath. ex.10ml per kg.
20 lb dog/ 200

formula is (5 x tidal volume) to measure reservoir bag size.

Front 9

Reservoir bag:

Back 9

1. fills with gas and o2.
2. movmnt. of bag corresponds to animals respiration (provides a tidal volume of air)
3.useful check for location of endotracheal tube
4. Able to mechanically ventialte bagging (giving a sigh breath. IPPV)
* Big enough for d og to breathe in fully, but not too big to prevent waste of money and meds.

Front 10

Advantages of bagging?

Back 10

1. prevents atelectasis (collapsed lung lobes)
2. flush airways and alveoli with fresh gas.
3. means of artificial respiration in respiratory arrest

Front 11

Oxygen flush valve?

When not to push o2 flush valve.

Back 11

1. allows o2 to bypass vaporizer
2. delivers pure o2 to patient
(button located next to flowmeter, fills breathing circuit with o2)
(Delivers 30-50 liters per minute oxygen value)
*Never press oxygen flush value with animal hooked up to circuit. too much pressure.
Oxygen flush valve bypasses vaporizer,Any o2 delivered to patient has no anesthetic gas with it.

Front 12

Pop off valve functions?

Hazards:

Back 12

1. pressure release valve
2. usually kept partially open
3. allows waste gas to leave to scavenging system.
4. Allows to bag patient , if close.

Open pop off goes to scavenging system, closed pop off goes back into circuit to be reused: co2 absorber takes out co2 and leaves gas.
*pop off determines how full bag is, closed pop off causes pressure to build and can epand lungs in dogs and kill them. Pop off valve should not be closed completely unless breathing for patient.

Front 13

Carbon Dioxide absorber canister:

Changing canister and con?

Back 13

1. contains soda lime
2. color changes in soda lime (white to blue)
3. recycles and cleans anesthetic gas.
4.Exothermic:generates heat.
if co2 is not removed, o2 levels drop and causes organ failure. Canister removes co2 from air.
*color changes due to ph change. when blue it's totally saturated with co2.
*Isoflourine can cause temporary color change and can be misleading*
-for filling leave a centimeter of space at top for air circulation.

Front 14

Pressure manometer:

Back 14

1. measure pressure of gas into anesthetic system.
2. measured in milliliters of mercury (mmHg)
3. When bagging, a patient, NEVER go ABOVE 15 mmHg.
Reads pressure in patients lungs, alarm goes off at 25 cm. of water.

*Diaphragmatic hernia/ bag patient the whole time*

Front 15

Scavenging System:

Back 15

1.Active: active vac, tube connects to system
2. Passive: F-air canisters: conatins activated charcoal (huge surface area of charcoal) it binds anesthetic gas. *weigh them when they come in, replace after increase weight listed on bottle. 12 hrs of use or increase of 50 grams. Get rid of.

Front 16

Anesthetic breathing system

Back 16

Rebreathing circuit: allows re-circulation of exhaled gas-use rebreathing if animal is greater than 15 lbs.

*Non-rebreathing, no exhaled gas returns to the patient. for a dog less than 15 lbs.

Front 17

Rebreathing system:

Back 17

aka "circle system"
1.require lower oxygen flow rates
2. must have co2 absorber.

Con: 1.Increased resistance to airflow difficult for small animals.
2.lots of weight from tubes (sm. animals.)
3. change slower to occur, response to vaporizer is slower than a non-rebreathing.

PRO: decreased oxygen flowrates less expensive, use less o2 and co2.

Front 18

non-rebreathing system: "

Back 18

aka Bain system
1. for animals<7kg in size (less than 15 kg.)
2. require high oxygenflow rates.

-1 tube scavenging system
(ex.F-air)
- other tube hooks to vaporizer
Con: high flow rate, uses lots of o2 and co2 gases.
pro: 1.less pressure on endotracheal tube, less drag and pull.
2. less resistance to airflow, easier to breathe.
3. increases flow rate to prevent rebreathing co2.
4. anesthetic vaporizer setting changes quicker.
*bag 3/4 full for tidal volume and pop off valve is pencil shape on bag.

Front 19

Flow rates of oxygen:

Back 19

Induction and recovery
chamber 5L/min.
facemask 300ml/kg/min

Maintenance:
non-rebreathing 200ml/kg/min
rebreathing systems 50ml/kg/min closer to 25.

*Rougher the induction, the rougher the recovery and vice versa.

Front 20

Patient factors that increase Anesthetic risk.

Back 20

1. Geriatric patient
2. Pediatric patients
3. Brachyocephalic dogs
4.Sight hounds
5. obese animals
6. Cesarean patients
7. Trauma patients
8. Cardiovascular patients
9/ Respiratory disease
10.Hepatic disease
11. Renal disease
12.Urinary obstruction

Front 21

Geriatric patients

Back 21

1. have a decrease in organ function *Esphetic (liver) and kidney(renal) >most drugs metabolized by liver and excreted by kidneys, may not be able to metabolize or ecrete drugs properly and can build to toxic levels.
2.at risk for hypothermia, decreased ability to maintain body temp. slows bl. flow to organs.
3. allow longer time to respond to drug
4.pre-anesthetic bloodwork
5. decreased anesthetic dosage

*always have a bl. pressure drop. bl. pressure leads to decreased profusion of organs.

Front 22

Pediatric patients

Back 22

1. inefficient excretion of drugs
2. avoid prolonged fasting
3. weigh accurately
4. at risk for hypothermia
5. decrease anesthetic dosages
6. use inhalents over injectables
Risks: decreased ability of liver to metabolize drugs (not developed enough for some drugs)
-hypoglycemia (low bl. sugar.) Drink water up to surgery, dehydrated patients not good for surgery) kittens given low cal before surgery and some puppies eat up to an hour before surgery.

Front 23

Brachycephalic dogs:

Back 23

1. anatomy leads to obstruction of airway (elongated soft palette problematic)
2.preoxygenate
3..delay extubation (pull tube too early and respl. might fail, wait til up and running, premed with propyphol.
4. observe closely during recovery.
5. include anit'choinergic in anesthetic protocol (decreases salivia production,bronchila secretions. ex. atropine used to treat bradycardia (slow heart rate.)
Risks: decrease premeds (premeds that don't suppress cardio and resp.)
*get under ASAP and up ASAP: use reversible drugs.

Front 24

Sight hounds

Back 24

1. Increased sensitivity to Thiopental
2.Use other drugs than barbiturates.

EX: greyhounds, afghans, whippet, russian wolfhounds (no fat)
*decreased ability of liver to metabolize some drugs esp. barbiturates. (pentobarbitol)
*use prophynol, ketamine, Diazipan (valium)

Front 25

Obese animals:

Back 25

1. accurate dosing is difficult (dose at ideal weight ex. 35 ideally but 45 lbs, dose at 35.
2.poor distribution of anesthetic
3. may have respiratory difficulty.
4. dose according to ideal weight.

Front 26

Cesarean patients:

Back 26

1. drugs will cross placenta and affect the newborn
2. use minimal doses of anesthetic
3. may need to use a resp. stimulant in newborns

>most drugs suppress cardio and resp.
C-section: alot of prepwork, shave , scrub, mask down (prob. safest if not stressed out), valium, min. effect onresp. ASAP speed and IV line valium

*Give big dose of pain meds after.

Front 27

Trauma patients

Back 27

1. stabalize patients prior to anesthesia
2. shock and hemorrahage is common
3. cardiac arrythmias may be present (abnormal heart rate.)

Front 28

Capillary Refill time:

Back 28

Press on gums, if color returns under 2 secs.
Pale gums sign of hypotension.

Front 29

Cardio disease patients:

Back 29

1. PRe- oxygenate before induction bc/ poor oxygen levels.
2. avoid agents that decrease heart rate or cause arrythmias.
3. circulation is compromised.
NO domitor/ Bradycardia( slow heart rate) decrease heart rate. hypotension in bl. stream.
NO Ketamine/ leads to Tachycardia (increased heart rate and muscle tremors.)

EX: Dentals (chewing bac leads to bl. stream, land in kedneys or heart valves.
leads toChronic bacteremia leads to chronic scarring of valve, makes them leaky, land in kidney, leads to kedney disease.

Front 30

Respiratory disease patients

Back 30

1. avoid stress and unnecessary handling
2. pre oxygenate
3. avoid using nitrous oxide
4.intubate rapidly and control ventialtion.
IPPV "bag throughout, every 1 min.)
*Quick induction/ Quick recovery
*risk of collapsed lungs. Ateclastis.?
IV fluids in risk patients

Front 31

Liver disease patients

Back 31

1. decreased metabolism of anesthetic agents
2. decreased production of bl. clotting factors
3. may be anemic or icteric
4. inhalation anesthetic preferred over injectables
5. expect prolonged recovery time

-tell client about risks
-majority of drugs metabolized through liver and excreted kidneys
-perform bl. clotting tests before (dobermans)
Inhalent over inject. require less metabolism than injectables when being excreted.
-risks effects may be prolonged

*Chronic disease leads to anemia (not enough hemoglobin, decreased red bl. cells. mass)
* TEST: Icteric/ Jaundice: Increase Bilirubin
cats noticed on top of heads
dogs noticed insclera (check pcv.)

Front 32

1st sign of kidney disease

Back 32

1. drink more water/pee more
2 less concentrated , loses alot of water.
PU/PD Polyuric (lots of urine)
Polydypsic (lots of drinking)
check bl. work , and urinalysis, first. use PCV/TP

Front 33

Renal disease patients:

Back 33

1. decreased excretion of anesthetic drug
2. electrolyte imbalances are common (potassium leads to arrythmea, sodium)
3. rehydrate before surgery
4. decrease dose of anesthetic drugs
5. caution with barbiturates
*EKG would be appropriate and IV for profusion of organs, bl. pressure increase hydration, and access for ER cart.

Front 34

Patients with urinary obstruction

Back 34

1. dehydration, acidosis, uremia, and hyperkalemia are common.

*blocked tom cat. Blocks up system, patient becomes toxic and can become unconscious.
*hyperkalemia/ increase potassium
*hypokalemia/ decreased potassium leads to arrythmea

mask sedation is safest and valium is good for calming

Diurese/ flush system, catheter.

Front 35

General approach to ER

Back 35

Stay CALM
1.think before doing anything
2. well stocked crash cart
3. post doses for ER drugs
4. above all do no harm

*often bl. pressure drops before crashing, Eye position and jaw tone.
Epinephrine: Intracardiac

CAUSES:
Human error/ math error,. not paying attention, proper monitoring
2. Equipment failure/ Old co2 absorber tablets.(immune system suppressed)
3. running out of oxygen, endotrach. tube pushed too far down (in one bronchi so 1 lung is working)
4. pop off valve, pressure build up.

Front 36

Animals that wont stay asleep:

Back 36

1. check vaproizer and anesthetic setting (run our of gas animal may feel pain and awake with abdomen open)
2. check level of anesthetic
3. endotracheal tube placement (tube may not be in trachea) (1st place to check)
4. check cuff cuff may be inflated but too small)
5. check respirators
6. check anesthetic machine
7. check oxygen flow rate.

*check neck should feel 1 tube. trachea.

TEST* Agonal/ near death
Too deep big breaths before crashing, Too light big breathe (be cautious. Check jaw tone and eye mvmnt.)