Anesthesia Section 1

Front 1

Define analgesia.

Back 1

Absence of the awareness of pain, relief of pain without loss of consciousness.

Front 2

What are the best analgesics?

Back 2

Opioids (narcotics) such as Morphine, hydromorphone, Butophanol, Fentanyl

Buprenorphine/Buprnex is what is used at Bel-Rea

Front 3

What is pre-emptive analgesia?

Back 3

Analgesia that prevents pain before it starts.

Front 4

What is the purpose of pre-emptive analgesia?

Back 4

-If you treat pain before it begins, you may be able to better control pain.
-May also be able to use less General Anesthetic later
-Buprenorphine is one of the PA's (pre-anesthetic) used at Bel-Rea

Front 5

Define anesthesia.

Back 5

loss of sensation in a body part or the whole body

Front 6

What are local anesthetics?

Back 6

- end in -caine
such as Lidocaine, Mipivacaine, Bupivacaine, Tetracaine

-good for pain control

Front 7

Define local anesthesia.

Back 7

Use of a chemical agent on peripheral sensory nerves to produce disruption of nerve impulse transmission.
-Leads to temporary loss of sensation of local area
-No sedation
-Sometimes used with general anesthesia to enhance pain to enhance pain control post-op and decrease amount of General Anesthetic

Front 8

What is a common use for Tetracaine/Tritop?

Back 8

As an ointment on spay/neuter incisions.

Front 9

What is a common use for Lidocaine?

Back 9

Used for intubation in cats b/c of their tendency to develop laryngeal spasms.

Front 10

Define general anesthesia.

Back 10

-CNS depression (loss of consciousness)
-Analgesia-absence of pain perception
-Amnesia-absence of memory
-Muscle relaxation (absence of motor response to stimuli, absence of reflexes)
-All of these combine to produce a state that is sufficient to perform surgical, diagnostic and therapeutic procedures
-

Front 11

Define regional anesthesia.

Back 11

Local anesthetic injected into a major nerve plexus or close to the spinal cord (such as in an epidural).
-Blocks nerve impulses to and from a large area (entire limb, caudal part of body)
-loss of sensation and motor function

Front 12

What is dissociative anesthesia?

Back 12

-Disruption of nerve conduction pathways
-CNS *** stimulant***
-Scrambles pathways
-Trance-like anesthesia
-animal will look conscious, eyes open and forward

Front 13

Define catalepsy.

Back 13

Malleable rigidity- body is rigid but pliable.
Ketamine is a drug that induces this.

Front 14

Define balanced anesthesia.

Back 14

Several agents used in combination, based on concept that administration of a mixture of small amounts of several anesthetic agents increases the advantages but not the disadvantages.
-Safer, especially with sick animals.
-Helps give the right amount of anesthesia appropriate for the patient

Front 15

Define sedation/sedatives.

Back 15

-State of relaxation, decreased anxiety
-Causes sleepiness
-Pt is conscious but calm,
-Pt can be aroused with sufficient stimuli
Sedatives with analgesia-
-Xylazine/Rompun
-Metomadine/Dex, Domitor
-May or may not have analgesia

Front 16

Define tranquilizer/tranquilization.

Back 16

-State of relaxation, decreased anxiety
-Less sleepy compared to sedatives
-Reluctant to move
-awake but unconcerned with surroundings
-Can be aroused w/sufficient stimuli
-NO ANALGESIA
-May not respond to minor pain even though there is no analgesia

Front 17

Define neuroleptanalgesia

Back 17

Combination of sedative/tranquilizer with an opioid which causes profound sedation and analgesia.
-combination of meds increases the effects of each
-hypnotic state-->trance-like sleep
-Pt can be aroused with sufficient stimuli

Front 18

Define agonist.

Back 18

Drug that produces its effect by interacting with a specific receptor in the brain or on spinal cord.

-Fentanyl binds to Mu receptors
-Xylazine binds to Alpha 2 receptors

Front 19

Define antagonist

Back 19

Drug that occupies a specific receptor with little or no effect
-"kicks off" the agonist drug and binds to same receptor, stopping the effects of the agonist.
*REVERSAL DRUG
Ex:
-Nalaxone/Narcan is opioid antagonist
-Yohimbine is alpha 2 antagonist

Front 20

What is the formula for surgical fluids?

Back 20

10mls/kg/hr

Front 21

What is the weight classification for using a Non rebreathing system and the appropriate formula for the NRB systems O2 flow rate?

Back 21

<7 kgs

200 cc of O2/kg/minute

-Common to use at least 1L O2/min to prevent rebreathing of CO2

Front 22

What is the weight classification for using a Rebreathing system and the appropriate formula for the RB systems O2 flow rate

Back 22

-> 7kgs

30 cc O2/kg/minute

*NEVER USE LESS THAN 500cc of O2/MIN

Front 23

What is the formula for figuring the appropriate anesthetic reservoir bag/re-breathing bag?

Back 23

60mls/kg

**Always round up to the next L bag

Front 24

What is the formula for figuring Tidal volume? (amount of air per breath)

Back 24

10-15 mls/kg

Front 25

What is the formula for figuring out how many liters are left in an E tank?

Back 25

Convert PSI to liters of O2

PSI * 0.3 = liters of O2

Front 26

How do you convert liters in tank to minutes/hours remaining?

Back 26

Liters remaining
______________
Flow rate in liters minutes remaining

*liters remaining divided by flow rate in liters = minutes reaming. Divide this by 60 to get hours remaining.

Front 27

In regards to anesthesia machine, what are the functions of Oxygen?

Back 27

Feed basic metabolic needs

Carrier gas for anesthetic-assists with vaporizing

Front 28

How should O2 tanks be stored safely?

Back 28

1. Attached to anesthetic machine.
2. Attached to wall securely.
3. Use special holder racks to avoid having tank fall.
4. Lay on floor while changing out

Front 29

How much do full O2 E-tanks carry?

Back 29

600-660L at 2000-2200 PSI

Front 30

How much do full O2 H-tanks carry?

Back 30

7000L at 2000-2200 PSI

Front 31

What are some basic qualities of an inhalant anesthetic delivery system?

Back 31

-Deliver metabolic O2
-Vaporize volatile anesthetic liquids to their vapor state.
-Control in a very precise manner the amount of anesthesia delivered to the patient
-Remove exhaled CO2
-Remove exhaled waste gases
-Provides a means to assist ventilation

Front 32

What are some basic qualities of O2 tanks?

Back 32

Tanks are silver and green
-Sized by alphabet-A smallest
-Use a special wrench to turn tank on at cylinder valve, typically a half a turn

Front 33

What gauge is after the oxygen tank and used to monitor the tank's amount of pressure?

Back 33

Oxygen tank pressure gauge

Front 34

What is the purpose of the pressure regulator that is after the pressure gauge?

Back 34

REDUCES the pressure from compressed gas cylinders to a working constant pressure of approximately 50psi.

Front 35

What is the purpose of the O2 flowmeter?

Back 35

-Delivers calculated O2 to Pt.
-Color coded with a green knob for O2
-Flow control typically in Liters per minute
-Allows anesthetist to set the flow rate to flow through the machine to the patient at the right amount
-Silver ball should sit at O2 level mid-ball
**If flow rate reads ZERO patient is getting NO O2!!

Front 36

Rebreathing systems are also known as:

Back 36

Circle systems

Front 37

What size animal are rebreathing systems typically used on?

Back 37

>7kg

Front 38

What is the formula for O2 flow rates for a rebreathing system?

Back 38

30mls O2/kg/min

**NEVER less than 500mls/min
less may affect vaporizer output

Front 39

What size animal is a non-rebreathing system typically used on?

Back 39

<7kgs

Front 40

What is the formula for figuring NRB systems O2 flow rate?

Back 40

200 mls O2/kg/min

**common to set at higher at 1 L if formula arrives at a lower level to prevent rebreathing of CO2
& less than 500mls/min may affect vaporizer output

Front 41

What is the purpose of Precision vaporizer in a VOC?

Back 41

To allow controlled precise amounts of anesthetic gas to be added to carrier gas.
-Volitize gas liquid anesthetic to a gas state for gases that have a high vapor pressure

Front 42

Carrier gas plus anesthetic gas is called what as it exits vaporizer?

Back 42

Fresh gas

Front 43

What is the color that designates a ISO vaporizer?

Back 43

Purple

Front 44

What is the color designation for SEVO vaporizers?

Back 44

Yellow

Front 45

How does a non-precision vaporizer in circuit work?

Back 45

-Draws over vaporizer-animals BREATH draws O2 through vaporizer and volitizes gases
-Can be used with gases that have a low vapor pressure
-Allows amounts of anesthetic gas to be added to O2 but in a less precise manner.

Front 46

List the Anesthesia Machine flow chart for a Rebreathing system

Back 46

O2 tank----->
Pressure Regulator---->
Green O2 hose -->
Flow Meter------>
Precision Vaporizer----->
Fresh Gas Hose---->
Reservoir bag----->
Unidirectional Flutter valve-Inspriatory side---->
Y tubing---->patient---->
Y tubing---->
Unidirectional flutter valves-Expiratory side------>
Scavenger system (poisonous gasses removed) ---->
AND CO2 absorber CO2 removed ----> back to circuit through Unidirectional Flutter Valve-Inspiratory Side.

Front 47

What are the 3 functions of a Reservoir bag?

Back 47

1. Storage for gases prior to entering Patient
2. Monitor respirations
3. Allows positive pressure ventilation w/O2 or O2 and anesthetic gases

Front 48

What is the the procedure for emergency ventilating of a patient?

Back 48

-Close Pop Off valve
-fill Res Bag with O2--->
**USE FLOW METER ONLY**
-Ventilate to 15-20 cm water pressure on Manometer OR to RESISTANCE
-Open Pop up valve when done ventilating

Front 49

An anesthetized patient has a lower Tidal Volume because:

Back 49

lower depth of respiration
(along with decreased rate)

Front 50

What is the purpose of the Unidirectional Flutter valves?

Back 50

Allow one way flow of gases. Both types are required to prevent the rebreathing of exhaled gas containing CO2
Inspiratory is open during inspiration to allow gases to flow TO patient and closed upon exhalation.
Expiratory flutter valves are open when the animal exhales allowing wastes gases to go to scavenge system and CO2 absorber. They are CLOsed during inspiration.

Front 51

What is the purpose of the Scavenge?

Back 51

To take away POISON gases--exhaled waste ISO or SEVO from patients.

Front 52

What is Active scavenge?

Back 52

Uses suction to draw gas into scavenger.
-More efficient
-Used at Bel-Rea

Front 53

What is Passive Scavenge?

Back 53

Uses positive pressure of gas in machine to push gas into scavenger.
-Uses charcoal

Front 54

How long do passive scavenger system canisters last?

Back 54

12 hours or weight gain of 50 grams.

Front 55

What are the 2 purposes of the Pressure Relief Pop-off Valve?

Back 55

1. Vents excess gas

2. Prevents pressure build up in the system

Front 56

What are the ONLY 2 reasons the Pressure Relief Pop Up Valve should be CLOSED?

Back 56

-Ventilating Pt with positive pressure ventilation

-Doing a leak check

Front 57

What is the purpose of the the CO2 absorber?

Back 57

In a Rebreathing System, any gas not exiting to Scavenger system is directed to here for removal of CO2 and then remaining O2 is returned to the patient.

Front 58

What type of granules are used in the CO2 absorber?

Back 58

Soda lime granules

Barium hydroxide lime granules

Front 59

What happens when CO2 goes through the canister?

Back 59

A chemical reaction occurs that creates heat, moisture and deceased pH.

Front 60

How long does the typical CO2 canister last?

Back 60

6 to 8 hours of use

Front 61

How do you know the granules in a CO2 absorber are exhausted?

Back 61

Granules become hard and brittle.

Color change from white to a periwinkle blue---may be more visible in center of canister.
---can revert back to white

Front 62

What units are used on the Pressure Manometer?

Back 62

Centimeters of water pressure

Front 63

What is the purpose of the Pressure Manometer?

Back 63

To measure the pressure of gases within the pressure breathing system and THEREFORE Pt's airway and lungs.

Front 64

When is the Pressure Manometer used?

Back 64

Used when ventilating Patients, will indicate approximate pressure being exerted on lungs.
-Not to exceed 15-20 cm H2O or resistance is felt
--Also allows monitoring of pressure in system. Should NOT see a buildup.

Front 65

When is more pressure used when ventilating a patient?

Back 65

During thoracotomy or open chest procedure

Front 66

What is the purpose of the Negative pressure relief valve located near/ on the Unidirectional flutter valve-Inspiratory side?

Back 66

allows room air to enter circuit if O2 is discontinued

Front 67

What is the purpose of the Oxygen Flush Valve?

Back 67

To deliver 100% O2 to Reservoir bag, allows bag to be quickly filled.
-Bypasses flow meter, and vaporizer
-used in emergencies only for ventilation (use flow meter most of the time to fill res bag for ventilation)
--Used for pressure checking

Front 68

What is always FIRST ON, LAST OFF?

Back 68

O2

Front 69

What are the steps for connecting a Rebreather System?

Back 69

For patients >7kg

1. Connect Y tubing to the Inspiratory and Expiratory Unidirectional Flutter Valves

2. Connect Res bag to Res Bag port

3. Connect Scavenge system hose to scavenge port.

4. Make sure Pop Off Valve is OPEN

Front 70

What are the steps for connecting a NON-Rebreather System?

Back 70

For Pt's <7kg
1. Attach Fresh gas hose to Vaporizer outlet port (Clear hose at Bel-Rea)

2. Hook Up Scavenge tubing to tubing of breathing system

3. Make sure tubing's Pop Off valve is open.

Front 71

What is the definition of a Rebreathing System?

Back 71

A system in which all or part of the exhaled gases are returned to the system to be rebreathed by the patient.
-CO2 must be removed via the CO2 absorber
-Fresh gas is continuously added
-Requires lower O2 flow rate and less anesthetic gases compared to NRB. (30cc/kg/min)

Front 72

What is the definition of a Non-Rebreather system?

Back 72

An anesthetic circuit in which exhaled gases, including CO2, are NOT rebreathed.
A ONE WAY flow of gases.

Front 73

In an NRB, why is the fresh gas flow rate set higher?

Back 73

To prevent rebreathing of gases.

-High O2 flow rate flushes most exhaled gases through to scavange

Front 74

What size patients is the NRB system used and why?

Back 74

Less that 7 kg

-Y-Tube is shorter and has a tube within a tube-inner tube is for Fresh Gas

These smaller patients have smaller tidal volume that is incapable of having enough push to drive the circular system of a Rebreather System

Front 75

When do you do a pressure check?

Back 75

Beginning of day before starting procedures

-Anytime you change a piece of equipment on the machine such as Y tubing, NRB--->RB, Res Bag, CO2 granules, O2 tanks.....

Front 76

How do you do a pressure check ?

Back 76

-Occlude Y tubing
-Close Pop off valve
-Fill Res bag a little with O2 Flush and then Flow meter to 20cm of H2O on Manometer
-Watch for movement on Manometer
---->Movement equals leaks
Acceptable is less than 5cm H2o in 30 seconds
-OPEN POP OFF VALVE to release pressure
releasing occluded Y-tubing results in dust in CO2 canister

Front 77

What is used to measure heart rate during anesthesia?

What symbol represents the heart rate on the anesthesia form?

Back 77

Esophageal stethoscope

a closed circle

Front 78

How do you measure respirations during anesthesia?

How is this value represented on the anesthesia form?

Back 78

Watch the Res bag

Open circle

Front 79

Blood pressure- Systemic is represented by what on the anesthesia form?

What should the minimum reading be?

Back 79

A down arrow (V) with point on value.

80 mm Hg

Front 80

Blood pressure-diastolic is represented by what on an anesthesia form?

Back 80

An upward arrow ^

rarely monitored

Front 81

Mean arterial pressure is represented by what on an anesthesia form?

What is the minimum value for this?

Back 81

a dash

60 mm Hg

Front 82

What does a capnography machine measure?

Back 82

It monitors the concentration or partial pressure of carbon dioxide (CO2) in the End Tidal Volume of respiratory gas.

Front 83

The amount of CO2 in a breath is representative of what?

What is the typical range under anesthesia?

Back 83

The amount of CO2 in the blood stream.

35-45mm Hg

Front 84

What is the term for excess CO2 in the bloodstream?

How do you correct this during anesthesia?

Back 84

Hypercapnea ----->respiratory acidosis---decreased blood pH

Ventilate animal to stimulate them to exhale more

Front 85

Hyperventilation, increase in Respiration rate, decreasing CO2 in blood leads to what?

What can this also be an indicator of?

Back 85

Respiratory alkilosis

Animal's anesthesia is too light and may need to be increased

Front 86

What drugs are used for preanesthesia at Bel-Rea?

Back 86

Glycopyrrolate (Robinul-V)
Dilute Acepromazine (Promace)
Buprenorphine (Buprenex)

Front 87

What is the main induction drug used at Bel-Rea?

Back 87

Propofol (Diprivan, Rapinovet)

Front 88

What are the the meds used for maintenance of anesthesia at Bel-Rea?

Back 88

Isoflurane (Aerrane, Forane, IsoFlo) with O2

Sevoflurane (Ultane) with O2

Front 89

What are some alternative induction drugs used at Bel-Rea?

Back 89

Diazepam (Valium)

Ketamine (Ketaset, Ketaved, Vetalar)

Front 90

What are the properties of Glycopyrrolate?

Back 90

An anticholinergic given as a preanesthetic.
-these types of drugs block the action of acetocholine at Mu receptors of the parasympathetic nervous system.
**Drys secretions and helps prevent bradycardia during anesthesia**
-Longer action than atropine

Front 91

What are the properties of dilute Acepromazine (Promace)?

Back 91

A preanesthetic tranquilizer, Alpha blockers, cause vasodialation.

In addition to tranquilization, acepromazine has multiple other important systemic-effects including anti-cholinergic, anti-emetic, antispasmodic, antihistaminic and alpha-adrenergic blocking properties. Acepromazine causes hypotension due to decreased vasomotor tone. May cause seizures.

Front 92

What are the properties of Buprenorphine (Buprenex)?

Back 92

A preanesthetic drug
-Partial Mu agonist-antagonist.
-class of opiate drugs that bind to opiate receptors and prevent the sensation of pain produced by brain chemicals.
-A synthetic opiate that produces analgesia and sedation. May cause increased salivation.

Front 93

What are the properties of Propofol (Dipravan, Rapinovet)?

Back 93

Short-acting hypnotic that is unrelated to other general anesthetics with a mechanism of action that is not well understood.
-Produces a rapid and smooth anesthetic in dogs when given SLOWLY by IV.
-Produces sedation, restraint, or unconsciousness-depending on the dose.
-A single bolus lasts 2-5 minutes, which is good when rapid recovery is necessary.
-Apnea may occur if given to rapidly.
-Does not cross placenta-good for C-sections

Front 94

What are the properties of Ketamine?

Back 94

An alternate induction drug.
-A dissociative drug that produces malleable rigidity, amnesia and analgesia.
-Pharyngeal/laryngeal reflexes are maintained
-Because deep abdominal pain is not eliminated, with dissociative anesthesia, these are recommended only for restraint, diag. procedures and minor surgery.
-Produce minor cardiac stimulation and respiratory depression.
-May have a burning sensation at injection site.