Anesthesia: Monitoring, Maintenance, Recovery (Outcome 5)

Front 1

Eye lubricant should be placed in the eyes of anesthetized patients a MINIMUM of once every ___________ minutes.

Back 1

60 minutes

Front 2

When the small animal patient is positioned on the surgery table, it is important to ensure that the animal is placed in as normal of a position as possible; most importantly, hyper-flexion and hyper-extention of the limbs must be avoided. In the "worst case scenario", placing the limbs in these abnormal positions could lead to:
a) Temporary paresis
b) Permanent paresis
c) Temporary paralysis
d) Permanent paralysis

Back 2

d) Permanent paralysis

Front 3

Placement of heavy drapes and blankets on small animal anesthetic patients is likely to cause a decrease in:
a) Tidal volume
b) Respiratory rate
c) Heart rate
d) Blood pressure

Back 3

a) Tidal volume

Front 4

Hyper-flexion of the neck of patients maintained on inhalant anesthetics should be avoided as it may lead to

a) Bradycardia
b) Bardypnea
c) Endotracheal tube obstruction
d) Coughing
e) Regurgitation

Back 4

c) Endotracheal tube obstruction

Front 5

Heating devices are commonly used in small animal anesthetic patients to prevent hypother; however, not all heating devices are safe: some may burn patient's skin. Which of the following heating devices should NOT be used due to the fact that they are MOST likely toncause thermal burns to patient's skin?

a) circulating hot water heater
b) forced-air warming blankets (e.g. Bair Hugger)
c) foil blankets
e) electric heating pads

Back 5

e) electric heating pads

Front 6

To prevent radial nerve paralysis in equine anesthesia patients placed in RIGHT lateral recunbancy, the anesthetist should pull the:

a) right forelimb cranially
b) right forelimb caudally
c) left forelimb cranially
d)left forelimb caudally

Back 6

a)right forelimb cranially

Front 7

Which of the following species is MOST prone to development of neuropathies and myopathies secondary to prolonged general anesthesia?

a) cats
b) dogs
c) horses
d) cattle

Back 7

c) horses

Front 8

If an anesthetic patient has UNILATERAL pulmonary disease affecting the RIGHT lung, and must be placed in lateral recumbancy, the anesthetist should place the patient in ________ lateral recumbancy to maximize pulmonary gas exchange.

Back 8

Right lateral

Front 9

It has been suggested that, following IV induction and the successful placement of the ET tube in small animal patients, anesthetists remove the needle and syringe from the IV catheter port.

What is the reason for doing this?

Back 9

To avoid accidentally pushing plunger and overdosing patient
NOTE: Can remove once animal is all hooked up to O2 and Iso.

Front 10

If an intubated, anesthetized patient that is hooked up to anesthetic machine must be turned over or repositioned, the ET tube should be temporarily disconnected from the anesthetic hose.
What TWO complications may occur if this is NOT done?

Back 10

1)Result in damage of trachea
2)Airway obstruction

NOTE: laryngospasm in cats

Front 11

Some surgery tables can be tilted, so that the patient's head can be placed in a downward position. This may be done to allow the veterinary surgeon to have easier access to some organs and tissues. Surgery tables that can be tilted are able to assume a variety of slopes, including steep slopes (i.e. slopes >15 degrees).

What complications may arise with an anesthetic patient placed on a steep slope?

Back 11

Compromise heart and lung function due to pressure
* Will have to ventilate patient more often

Front 12

Why is the halter removed from equine anesthetic patients after they are induced and placed in lateral recumbancy?

Back 12

To avoid damaging the facial nerve/nerve paralysis

Front 13

Ruminants are known for the large amounts of saliva that they produce while conscious; they also continue to produce amounts of saliva while they are under general anesthetic.

a) Describe how ruminant patients should be positioned during anesthesia
b) In relation to saliva production, what is the main risk for ruminant patients that do NOT have their heads positioned properly?

Back 13

a) Head must be kept lower than larynx
b) Aspiration/pneumonia of saliva

Front 14

Like equine anesthetic patients placed lateral recumbancy, bovine anesthetic patients placed in lateral recumbancy are also susceptible to developing myopathies and neuropathies. Radial nerve damage is one of most common neuropathies in both species.
What is the BEST way to prevent this nerve damage in CATTLE?

Back 14

*Because of the anatomical difference between horses and cattle,
pulling forearm cranially is impossible *

-Support/elevate top leg to reduce pressure on lower leg (this takes weight off)
- Padding/cushioning

Front 15

Which phase of the anesthetic process is generally considered to be the MOST dangerous period for the patient?

a) patient preparation
b) pre-medication
c) induction
d) maintenance
e) recovery

Back 15

e) recovery

Front 16

Which of the following species is an obligated nasal breather?

a)dog
b)cat
c) horse
d) cattle
e)swine

Back 16

c) horse

Front 17

Which of the following species is MOST prone to develop nasal congestion and dyspnea after prolonged general anesthesia?
a) dog
b) cat
c) horse
d) cattle
e) swine

Back 17

c) horse

Front 18

In which of the following species is it ROUTINE for the ET cuff to be kept fully inflated or partially deflated during extubation?
a) dog
b) cat
c) horse
d) cattle
e) swine

Back 18

d) cattle
*Due to excess salivation need to pull out inflated cuff when extubation to prevent aspiration

Front 19

In canine and feline anesthetic patients, the anesthetic recovery period is defined as the period between the discontinuation of the anesthetic and the time that the patient is able to:
a)swallow
b) vocalize
c) respond to external stimuli
d) hold themselves in sternal recumbancy without assistance
e) stand and walk without assistance

Back 19

e) stand and walk without assistance
*Possibility of complications decreases greatly

Front 20

Canine and feline anesthetic patients are MORE likely to have "rough" or "stormy" recoveries if they were NOT given:
a)supplemental O2 post-op
b) supplemental O2 pre-op
c) preanesthetic medications
d) an inhalant anesthetic

Back 20

c) preanesthetic medications

Front 21

In feline patients, delaying the removal of the ET tube in the anesthetic recovery period is NOT advised as it predisposes the patient to:
a) hypoxemia
b) hypocapnia
c) epistaxis
d) emesis
e) laryngospasm

Back 21

e) laryngospasm

Front 22

Dyspnea and airway obstruction can occur after the extubation of equine anesthetic patients; this is best prevented by:
a) placing nasopharyngeal tube
b) placing patient in sternal recumbancy
c) administering post-op analgesics
d) administering post-op sedatives

Back 22

a) placing nasopharyngeal tube

Front 23

Anesthetists observing the eyes of equine anesthetic patients in recovery period will usually notice ____________ and ___________ as patient becomes more conscious.

Back 23

Nystagmus and tearing eyes

Front 24

For canine and feline anesthetic patients, it is advised that vital signs be monitored a minimum of once every _____ minutes during the recovery period.

Back 24

5

Front 25

Most patients recovering from anesthetic will shiver. This can greatly increase the patient's need for ___________.

Back 25

Oxygen

Front 26

It is advised that canine and feline patients recovering from anesthetic be given supplement oxgen for a minimum of ________ minutes (or until the patient swallows).

Back 26

5

Front 27

Describe the procedure for determining WHEN to extubate canine patients; include breed differences if applicable.

Back 27

- First sign of swallowing
- Brachycephalics once up and alert
* Monitor so don't bite off ET tube

Front 28

Describe the procedure for determining when to extubate a feline patient.

Back 28

- First signs of ANY reflexes

Front 29

You are the animal health technologist assigned to monitor "Cienfuegos", a 4 year old domestic shorthair cat that is recovering from a short (5 minutes) procedure (neuter) under general anesthetic.
Cienfugeos was given Acepromazine intramuscularly as a premed and induced with Dexmedetomidine, Ketamine and Butorphanol intramuscularly. Cienfugeos' preanesthetic workup was normal with the exception of mildly elevated blood urea nitrogen (BUN).
Cienfugeos is having a prolonged recovery from his anesthetic. What two factors are likely causing his recovery to be prolonged?

Back 29

- Induction was IM instead of IV
*makes for slow recovery

- Kidney function (BUN was high)
* Ketamine is excreted via kidneys

Front 30

In preparing the anesthetic patient for extubation, the anesthetist normally deflates ET tube cuff and unites the tube; however, in small animal patients that have undergone dental prophylaxis or oral surgery this protocol is usually altered.
Explain how the protocol in these patients differs from standard procedure and why this is done.

Back 30

- Partially deflate cuff to extubate in case any blood or debris has collected
*this avoids it from being aspirated into trachea

- Hang head down before extubation

Front 31

Describe the procedure for determining when to extubate equine patients

Back 31

- Swallowing, paddling limbs

Front 32

Which of the following species is most likely to have sudden, unexpected movements while being maintained under general anesthetic without having any obvious change in signs of anesthetic depth?
a) dog
b) cat
c) horse
d) cattle
e) swine

Back 32

c) horse
* Injectable to get them back down

Front 33

Which of the following species is most likely to develop hypoxemia, hypoventilation and hypotension during the maintenance phase of anesthesia?
a) dog
b) cat
c) horse
d) cattle
e) swine

Back 33

c) horse
-Heavy animal, blood pooling to side of lung
* dorsal (on back) worse

- ventilation to help hypoxemia
- fluids increase hypotension
- decrease isoflurine (possible too deep)
- drug common for low BP
* dobutamine

Front 34

The maintenance of general anesthesia in canine and feline patients is MOST commonly done with:
a) an inhalant anesthetic
b) repeat intravenous boluses of an injectable anesthetic(s)
c) constant rate infusion of an injectable anesthetic(s)
d) intramuscular injection of an injectable anesthetic(s)

Back 34

a) an inhalant anesthetic

Front 35

Hypoventilation is most likely to occur in an equine anesthetic patient placed in:
a) right lateral recumbancy
b) left lateral recumbancy
c) dorsal recumbancy
d) sternal recumbancy

Back 35

c) dorsal recumbancy

Front 36

_____________ has been shown to contribute to the incidence and severity of myopathy in equine anesthetic patients
a) Hypoventilation
b) hypotension
c) hyperventilation
d) hypertension

Back 36

b) hypotension
* pressure on muscles

Front 37

It is important for the anesthetist to remember that the administration of positive ionotropes like dobutamine can cause ___________ in equine anesthetic patients
a) vomiting
b) arrhythmias
c) apnea
d) tachypnea

Back 37

b) arrhythmias

Front 38

Ruminants tend to hypoventilate while they are under general anesthetic; this can cause:
a) hyperoxemia and hypercarbia
b) hypoxemia and hypercarbia
c) hyperoxemia and hypocapnia
d) hypoxemia and hypocapnia

Back 38

b) hypoxemia and hypercarbia
- poor exchange O2 & CO2
- decreased O2, increased CO2

Front 39

The maintenance of general anesthesia in porcine patients is most commonly done with:
a) an inhalant anesthetic
b) repeat intravenous boluses of an injectable anesthetic(s)
c) constant rate infusion of an injectable(s)
d) intramuscular injection of an injectable anesthetic(s)

Back 39

a) an inhalant anesthetic
* same as small animals

Front 40

As a general rule, canine and feline patients that are maintained on isoflurane and that the anesthetist determines are SLIGHTLY too light should have their vaporizer dial setting increased by ______ to ________%

Back 40

0.5 to 1%

Front 41

As a general rule, canine and feline patients that are maintained on isoflurane and that the anesthetist determines are SLIGHTLY too deep should have their vaporizer dial setting decreased by _____ to _____%.

Back 41

0.5 to 1%

Front 42

As a general rule, canine and feline patients that are maintained on isoflurane and that the anesthetist determines are SIGNIFICANTLY too light should have their vaporizer dial setting increased to between _____ and ______%.

Back 42

3 and 5%
* turn dial back down once animal is back asleep

Front 43

What is the general rule, for small animal patients that are maintained on inhalant anesthetic and that the anesthetist determines are SIGNIFICANTLY too deep?

Back 43

Turn inhalant OFF
- Increase O2 flow rate
- Ventilate animal

Front 44

Positive pressure ventilation acts to ensure that the patient:
a) receives an adequate amount of O2
b)exhales an adequate amount of CO2
c) receives an adequate amount of O2 and exhales an adequate amount of CO2

Back 44

c) receives an adequate amount of O2 and exhales an adequate amount of CO2

Front 45

In the animal, inhalation is normally triggered by:
a) a decreased level of co2 in the arterial blood
b) a decreased level of o2 in the arterial blood
c) an increased level of co2 in the arterial blood
d) an increased level of o2 in the arterial blood

Back 45

c) an increased level of co2 in the arterial blood

Front 46

Respiratory rates in anesthetized animals are lower than respiratory rate in non anesthetized animals. This is due to the fact that many an anesthetic agents and adjuncts:
a) increase the responsiveness of the respiratory center in the brain to co2
b) increase the responsiveness of the respiratory center in the brain to O2
c) relax the intercostal muscles and the diaphragm
d) decrease the responsiveness of the respiratory center in the brain to co2
e) decrease the responsiveness of the respiratory center in the brain to O2

Back 46

d) decrease the responsiveness of the respiratory center in the brain to co2

Front 47

Tidal volumes in anesthetized animals are lower than tidal volume in non anesthetized animals. This is due to the fact that many anesthetic agents and adjuncts:
a) increase the responsiveness of the respiratory center in the brain to co2
b) increase the responsiveness of the respiratory center in the brain to O2
c ) relax the intercostal muscles and the diaphragm
d ) decrease responsiveness of the respiratory center in the brain to co2
e ) decrease the responsiveness of the respiratory center in the brain to O2

Back 47

c ) relax the intercostal muscles and the diaphragm

Front 48

Due to the fact that most anesthetized animals have a decreased respiratory minute volume, they are prone to:
a ) hypercarbia and hyperoxemia
b ) hypercarbia and hypoxemia
c ) hypocarbia and hyperoxemia
d ) hypercarbia and hypoxemia

Back 48

b ) hypercarbia and hypoxemia

Front 49

Due to the fact that most anesthetized animals have a decreased respiratory minute volume they are prone to having a ______ blood pH
a) high
b ) neutral
c ) low

Back 49

c ) low
*CO2 causes pH to decrease

Front 50

Atelectasis occurs in anesthetized animals primarily due to:
a ) low respiratory rate
b ) high respiratory rate
c ) low tidal volume
d ) high tidal volume

Back 50

c ) low tidal volume
* Have to make sure lungs expand to pop out aveoli to prevent them collapsing

Front 51

Which species is most prone to developing hypercarbia hypoxemia and atelectasis under general anesthesia?
a ) cats
b ) dogs
c ) sheep
d ) horses
e ) pigs

Back 51

d ) horses

Front 52

Animals with a body condition score of _______ are most prone to developing hypercarbia hypoxemia and atelectasis under general anesthesia.
a) 1/5
b )2/5
c )3/5
d )4/5
e )5/5

Back 52

e )5/5
* obese animals more prone because they can't expand their lungs as much

Front 53

Prevention of atelectasis can be prevented in most animals by manually ventilating the patient a minimum of once every _______ minutes
a) 2
b ) 5
c ) 10
d ) 15
e ) 20

Back 53

b ) 5

Front 54

When providing manual or mechanical ventilation, the patient must be intubated. Ventilating the patient through an anesthetic mask will not deliver adequate levels of oxygen to the lungs and may also cause:
a ) rupture of the alveoli and respiratory acidosis
b ) rupture of the alveoli and respiratory alkalosis
c ) pneumothorax
d ) laryngitis and laryngospasm
e ) stomach distention and regurgitation

Back 54

e ) stomach distention and regurgitation
* because forcing air down the esophagus and into the stomach

Front 55

Prevention of atelectasis can be prevented in most animals by manually ventilating the patient periodically. When doing this, the anesthetist must ensure that the pressure use did not excessive. The pressure should not exceed ______cm h2o in small animal patients
a) 15
b ) 20
c ) 30
d ) 40
e ) 50

Back 55

b ) 20
*memorize

Front 56

When providing controlled manual ventilation to a patient, the pop-off valve should be:
a) open
b) partially closed
c) completely closed

Back 56

c) completely closed

Front 57

What is the common term used to describe the inflation of the patient's lungs by squeezing the rebreathing bag of the anesthetic machine?
a) huffing
b) bagging
c) packing
d) gasping
e) wheezing

Back 57

b) bagging

Front 58

If the ventilation rate is too high when performing assisted ventilation it may cause:
a) Respiratory acidosis
b)Respiratory alkalosis
c) tachypnea
d) tachycardia

Back 58

b)Respiratory alkalosis
*Ventilation too high
-blowing off CO2
-So increase CO2 = acidic
- Decrease CO2 = alkaline

Front 59

Manual Ventilation

Back 59

Delivery of fresh gas (or oxygen) to the patient accomplished by the anesthetist squeezing the rebreathing bag of the anesthetic machine

Front 60

Mechanical Ventilation

Back 60

Automatic delivery of fresh gas (or oxygen ) to the patient accomplished by a mechanical ventilator (machine)

Front 61

Assisted Ventilation

Back 61

A type of ventilation in which the anesthetist delivers a volume of fresh gas (or oxygen ) to the patient to supplement that gas that the patient is inhaling through spontaneous respiration.

Front 62

Controlled Ventilation

Back 62

A type of ventilation in which the anesthetist delivers all the fresh gas (or oxygen ) that is required by the patient as spontaneous respiration is not occurring.

Front 63

Positive Pressure Ventilation

Back 63

Any procedure by which the delivery of fresh gas (or oxygen) to the patient's lungs is assisted or controlled.

Front 64

Pain Pathway
"Transduction"
Step ______ & definition

Back 64

Step 1:
Noxious stimuli (chemical, thermal, mechanical) are transformed into electrical signals

Front 65

Pain Pathway
"Transmission"
Step ______ & definition

Back 65

Step 2:
Conduction of impulses from peripheral pain receptors to the spinal cord

Front 66

Pain Pathway
"Modulation"
Step ______ & definition

Back 66

Step 3:
Amplification or suppression of pain impulses by neurons in the spinal cord

Front 67

Pain Pathway
"Perception"
Step ______ & definition

Back 67

Step 4:
Processing and recognition of pain in the brain

Front 68

Multimodal Therapy

Back 68

-Using several anesthetic drugs
*each w/ different mechanism of action
- Results in lower doses and side effects
* Increases safety

Front 69

Pre-emptive Therapy

Back 69

-Administering analgesics BEFORE surgery
*Decreases analgesic requirements
& minimizes CNS sensitization

Hint 69

Pain control prior to surgery

Front 70

Minimum Systolic BP
Cat:
Dog:

Back 70

Cat: 100mmHg
Dog: 100mmHg

Front 71

Minimum HR
Cat:
Small Dog:
Medium Dog:
Large Dog:

Back 71

Cat: 120 BPM
Small Dog: 80 BPM
Medium Dog: 70 BPM
Large Dog: 60 BPM

Hint 71

Larger the animal, lower BPM

Front 72

Minimum RR
Cat:
Dog:

Back 72

Cat: 8 RPM
Dog: 8 RPM

Front 73

Minimum MAP
Cat:
Dog:

Back 73

Cat: 60mmHg
Dog: 60mmHg

Front 74

Minimum Percent Arterial Oxygen Saturation
(Spo2/Sao2)

All species:

Back 74

All species: 96%

Front 75

Ventilation

Back 75

The movement of gases into and out of the lungs and upper airway

Front 76

Apnea

Back 76

A temporary absence of spontaneous breathing

Front 77

Atelectasis

Back 77

Partial or complete collapse of the lung

Front 78

Respiratory Arrest

Back 78

Cessation of normal respiration due to failure of the lungs to function effectively

Front 79

Dyspnea

Back 79

Difficult or labored breathing

Front 80

Respiratory Minute Volume

Back 80

=tidal volume x respiratory rate

Front 81

Tidal Volume

Back 81

The volume of air that passes into (or out of) the lungs in a single breath

Front 82

Respiratory Rate

Back 82

The number of breaths that occur in one minute