Anesthesia Sgu Svm Term 5 Q2

Front 1

Problem w/gas induction

Back 1

-Inhalation slower- excitement stages
-Adrenaline release -dysrhythmias
-Increased oxygen demand
-Harm by restraint
-Non protected airway
-More pollution
-Irritant, breath holding

Front 2

problem w/IV induction

Back 2

-drug calculations
-respiratory depression

Front 3

what determines the effects of IV drugs?

Back 3

-blood flow to the brain (cardiac output)
-pKa of the drug (amt of non-ionized drug bc non-ionized form crosses to the brain and is fat soluble)

Front 4

pKa of Propofol and at what pH is it fully ionized?

Back 4

-pKa = 11
-ionized at pH of 7.4

Front 5

the four pharmacokinetic and physiochemical properties of the ideal injectable agent

Back 5

–water soluble
–long shelf life
–stable
–potent

Front 6

which part of the drug is used: protein bound or non-protein bound?

Back 6

non-protein bound

Front 7

Define: Therapeutic index

Back 7

a comparison of the amount of a therapeutic agent that causes the THERAPEUTIC effect to the amount that causes TOXIC effects.

Front 8

4 things that cause reduced drug-protein binding

Back 8

-low protein amt
-renal dz
-liver dz
-old age

Front 9

which is wakeup due to: redistribution or metabolism?

Back 9

redistribution

Front 10

ketamine, phencyclidine, & tiletamine are all what?

Back 10

dissociative agents (reduce of block signals to the conscious mind from other parts of the brain)

Front 11

1. short-acting barbituate:
2. long-acting barbituate:

Back 11

1. thiopental
2. pentobarbital (euthanasia)

Front 12

barbituates have a relatively ___ therapeutic index

Back 12

low

Front 13

which ion channel do they work on and what do they cause?

Back 13

-chloride channel
-they increase the duration of GABA dependent chloride channel opening --> hyperpolarisation

Front 14

Thiopental is very acidic or alkaline? in a 2.5% soln, what is the pH?

--the only way it is given?

Back 14

very alkaline (weak acid)
-10

--IV

Front 15

40% of dogs on thiopental develop what?

Back 15

bigeminal rhythm

Front 16

Thiopental: side effects

Back 16

-may have a dose-dependent reduction in CP and SVR
-may see tachycardia
-respiratory depression

Front 17

Thiopentone: in what type of dog do we NOT use this in and why?

Back 17

-Sighthounds

--prolonged recovery
--genetic hepatic metabolic defect – first step of hepatic metabolism
--contribution from low % body fat
--slow recovery in thin animals

Front 18

why is it relevant that Propofol is a "phenol ‘Propyl phenol"

Back 18

bc cats cannot get rid of phenols

Front 19

W/ drugs, you wake from __1__ and
recover by __2__?

Back 19

1. redistribution
2. metabolism

Front 20

Propofol: side effects

Back 20

-HUGE respiratory depressant (worse than thiopental)
-cardiac depressent
-decr BP by vasodilation
--NO cardiac dysrhythmias, analgesia

Front 21

Propofol: problem w/injection

Back 21

-marked pain, venus spasm, and thrombophlebitis

Front 22

the "Key point" Propofol reaction

Back 22

extended rigid forelimbs, flaccid hindlimbs

Front 23

alfaxalone/alphadolon is licensed for use in what spp?
--do not use in what spp?

Back 23

cats (also used in sheep, goats, pigs, monkeys)
--do NOT use in dogs (the new Alfaxan can be used in dogs)

Front 24

Alfaxalone: what can it cause?

Back 24

histamine release
swollen paws, ears

Front 25

What is so beneficial about Alfaxalone/Alfaxan?

Back 25

-it LACKS depressant effects on the myocardium
-it does NOT induce cardiac arrhythmias NOR sensitize the conductive tissue of the heart
-it has MINIMAL effects on peripheral tissue vascular resistance and blood flow
-causes LITTLE respiratory depression at clinical doses in either dogs or cats
-LACKS a dose-dependent increase in respiratory depression until doses exceed 3 times the labeled dose

Front 26

Alfaxalone: pharmacokinetics are similar to what other drug?
--meaning ?

Back 26

propofol
--rapid induction (< 30s IV) (--> also effective administered IM
-rapid hepatic metabolism
-short duration of action
-rapid recovery (through both redistribution and metabolism)
-no accumulation (so suitable for TIVA and CRI)
-renal excretion
-wide safety margin

Front 27

Difference between injection propofol IV and alfaxalone IV

Back 27

alfaxalone causes no tissue irritation if extravasated

Front 28

Alfaxalone: effects and side effects

Back 28

-good muscle relaxation
-mild respiratory depression
-decr tidal volume and rate
-animals disturbed during recovery may paddle and twitch violently (so sedate for recovery and recover in quiet tranquil environment)

Front 29

what do dissociative anesthetics do?

--examples

Back 29

"separate" thalamic and limbic systems
-good analgesics (poor muscle relaxants, poor hypnotics)

--ketamine, tiletamine, phencyclidine

Front 30

Ketamine:
1. what type of drug is it?
2. routes
3. very good in which spp/animals

Back 30

1. NMDA antagonist
2. all (including oral)
3. exotics, fractious animals

Front 31

what does a patient look like on ketamine?
-BUT
--what do we often do with ketamine?

Back 31

may appear conscious (eye opening, muscle contraction, swallowing)

-BUT is unable to process or respond to sensory input

--combine it with a 2nd drug as a muscle relaxant

Front 32

CNS effects of ketamine:

Back 32

-muscle rigidity
-laryngeal swallowing/coughing while intubating
-hypersalivation
-analgesia

Front 33

ocular effects of ketamine

Back 33

-dilated central pupils
-nystagmus
-corneal reflexes maintained
-eyes remain open - risk of drying
-increased intraocular pressure

Front 34

cardiovascular system effects of ketamine

Back 34

-stimulates the sympathetic nervous system and inhibits noradrenaline uptake --> so stimulates the cardiovascular system
-BUT has direct myocardial depressive effects --> more seen in shocked patients
-MAY RAISE INTRACRANIAL PRESSURE

Front 35

respiratory effects of ketamine

Back 35

-reflexes may remain intact
-bronchodilation
-breathing supported but rapid IV bolus can cause apnea

Front 36

what is in the classic triple drip (TIVA) in field anesthesia?

Back 36

guaifenesin, ketamine, and xylazine

Front 37

ration os Tiletamine and zolazapam in Telazol/Zoletil

Back 37

1:1

Front 38

Telazol/Zoletil: side effects

Back 38

salivation
muscular spasms
vomiting
vocalisation
apnea
hypertension and tachycardia
unpleasant recoveries

Front 39

what spp is telazol/zoletil used for mostly?

Back 39

pigs and wildlife capture

Front 40

why is heavy premed prefered when using Etomidate?

Back 40

Myoclonic activity can occur post-induction

Front 41

what is the safety margin of etomidate?

Back 41

large - lethal dose is 16 times higher than the hypnotic dose

Front 42

good CV effect of etomidate

Back 42

maintains hemodynamic stability better than any other agent

Front 43

endocrine effects of etomidate

Back 43

Marked inhibition of adrenal synthesis of cortisol, aldosterone, corticosterone (but no problems with a single dose)

Front 44

when is etomidate not recommended?

Back 44

-in animals w/pre-existing adrenocortical suppression
-not recommended for CRI (continuous rate infusions)

Front 45

when is etomidate recommended?

Back 45

Mainly used in small animal anaesthesia:
-High risk patients
-Patients with cardiovascular instability
-Animals scheduled for interventional cardiac surgery

Front 46

give a brand name for Fentanyl + Fluanisone (Opioid/Butyrophenone)

--what does it do
---side effects
----in what spp is it used and what is it used with?

Back 46

-Hypnorm

--neuroleptic (major tranquilizer)

---severe respiratory depression

----in rabbits w/diazepam/midazolam

Front 47

What is Immobilon?

--side effects


---who is it a risk to?

Back 47

-Etorphine + Phenothiazine

--Marked CV and Respiratory effects

---Risk to personnel

Front 48

ideal agent for TIVA (total intravenous anesthesia)

Back 48

Non cumulative
Rapidly metabolized
No active metabolites
Non-irritant
No side-effects

Front 49

common TIVA combination used in horses

Back 49

guafenesin (muscle relaxant), alpha-2 agonist (hypnotic and analgesic) (xylazine, romifidine, detomidine), and ketamine (analgesic/anesthetic)

Front 50

maximum infusion for TIVA

Back 50

2 hours (every drug accumulates)

Front 51

Agents used for TIVA in small animals

Back 51

mainly propofol based agents, plus opioids and ketamine

Front 52

"Vapors are NOT ____"

Back 52

gases (they are liquids which are vaporized in a carrier)

Front 53

vaporization: define equilibrium

Back 53

the number of molecules entering gaseous state equals the number leaving it

Front 54

what is SVP? define it

Back 54

-static vapor pressure: the static pressure of vapour in equilibrium with liquid

Front 55

Vaoprization is...

Back 55

-totally temperature dependent
-the evaporation of a volatile liquid in a ‘closed’ container

Front 56

the higher the SVP...

--most inhalational agents have what? what does this require?

Back 56

-the more volatile the agent

a very high SVP; vaporisers are required

Front 57

SVP of:
1. Sevoflurane
2. Halothane
3. Isoflurane
4. Desflurane

Back 57

1. S: 160 mm Hg
2. H: 239 mm Hg
3. I:240 mm Hg
4. D: 664 mm Hg

Front 58

benefits of a modern vaporiser

Back 58

-Temperature compensated
-Flow compensated

Front 59

the rate at which inhalant anesthetics rise in the plasma/blood stream depends on:

Back 59

-Ventilation
-Concentration of agent in carrier gas
-Cardiac output (inversely)
-Solubility of agent in the
body (inversely)

Front 60

the blood:gas partition coefficient is:

Back 60

solubility
-the ratio of the amount of anaesthetic in blood and gas when the two phases are of equal pressure and volume
(where does the anesthetic want to be)

Front 61

blood:gas coefficient - what happens w/the less soluble agents?

Back 61

the less soluble they are, the less they are washed away, and the faster the alveolar concentration rises

Front 62

uptake of an agent is determined by:

Back 62

-the rate and depth of ventilation
(hyperventilation will accelerate uptake)
(respiratory depression will slow uptake)

Front 63

which will wake up slower: a fat animal or a thin one?

Back 63

a fat one (holds onto an anesthetic agent) (depends on the agent's solubility in fat)

Front 64

what is: end-tidal concentration

Back 64

-concentration in the last bit of breath breathed out

Front 65

what is MAC?

---what is it used to compare?

Back 65

-minimal alveolar concentration
-minimal end-tidal concentration that prevents 50% animals responding from a supramaximal stimulus.

---the potency of an agent

Front 66

**average MAC of halothane

Back 66

0.08 - 0.09

Front 67

** average MAC of isoflurane

Back 67

1.4

Front 68

**average MAC of sevoflurane

Back 68

2.3

Front 69

**average MAC of desflurane

Back 69

8

Front 70

what increases MAC?

Back 70

Neonate
Hyperthermia
Hyperthyroidism
Catacholamines

Front 71

what decreases MAC?

Back 71

Age
Pregnancy
Hypotension
Hypothermia
Hypothyroidism
Opioids and Alpha-2 agonists

Front 72

what happens to MAC, induction, and recovery w/a high fat soluble agent?

Back 72

-low MAC
-slow induction and recovery

Front 73

what happens to MAC, induction, and recovery w/a low fat soluble agent?

Back 73

-higher MAC
-fast induction and recovery

Front 74

negative affects of inhalational agents on the animal

Back 74

-Cardio and respiratory depression
-Formation of carbon monoxide with soda lime
-(Formation of other toxic gases)

Front 75

what is the only inhalation agent that has a negative effect on the anesthetist? what does it do?

Back 75

-Nitrous oxide
-bone marrow suppression, teratogenesis

Front 76

effects of nitrous oxide

--high or low MAC?

Back 76

-minimal respiratory and CV effects
-analgesia

--Very high MAC

Front 77

why use Nitrous Oxide?

Back 77

-'second gas effect’
-‘adjunctive anaesthesia’
-reduces concentration of other inhalational agents
-analgesic effect

Front 78

what is the "second gas effect?"

Back 78

where administration of one gas will accelerate initial uptake of another anaesthetic gas given at the same time

Front 79

why does N2O make such a good agent to use to get the 'second gas effect?'

Back 79

it is associated with low blood gas solubility and high MAC of N2O

Front 80

how does N2O cause "diffusion hypoxia?"

--when can this happen?

---how do you prevent it?

Back 80

-N20 washes out down a concentration gradient into the alveolus and dilutes the oxygen concentration
--at the end of anesthesia
---always provide an enriched oxygen source for ten minutes after turning off nitrous oxide

Front 81

difference between the MAC of N2O in cats and in dogs

Back 81

MAC of nitrous oxide in cats may be higher than in dogs

Front 82

advantages of N2O

Back 82

-second gas effect accelerates anaesthetic uptake
-reduces requirements for more depressant agents; ‘adjunctive anaesthetic’
-analgesia

Front 83

disadvantages of N2O

Back 83

-low potency in animals
-potential for hypoxia
-diffusion into gas-filled spaces
-expensive
-potential for human abuse

Front 84

Halothane has metabolic hepatic hypoxia in what spp?

Back 84

guinea pigs

Front 85

solubility of iso

--CV effect

---safer to use in what spp?

Back 85

-Lower solubility

--Different CV depression

---SAFER in dog

Front 86

what do animals do with sevo that cause a problem w/induction?

Back 86

breath holding

Front 87

between iso and sevo, which one is the irritant?

--which one has a faster induction in cats?

---which one has a faster recovery in horses?

Back 87

iso

--sevo

---sevo

Front 88

CV effects of Halothane, iso, and sevo:
1. which cause dose-dependent cardiac depression?
2. which cause vasodilation --> hypotension?

Back 88

1. ALL 3
2. Isoflurane and Sevoflurane –vasodilation, hypotension. Do not sensitise to cardiac arrhythmias. Little difference in cardiac depression.

Individual responses in relation to cardiac depression (large SDs)

Front 89

When doing a study on the respiratory effects of halo, iso, and sevo, what problem did most studies have?

Back 89

maintaining spontaneous ventilation at 2 MAC

Front 90

the most clinically used local anesthetics are ___

--examples

Back 90

amides

--lidocaine, bupivacaine, ropivacaine, mepivacaine

Front 91

halflife of amides vs half life of esters

--how are they both metabolized

Back 91

-amides: a few hours
-esters: a few minutes

--amides: hepatic metabolism w/renal excretion
--esters: pseudocholinesterases (PABA)

Front 92

examples of esters used for local anesthetics

Back 92

-prilocaine, tetracaine, cocaine

Front 93

**MOA of local anesthetics

Back 93

block sodium channels in the ‘closed state’ to prevent sodium ion influx during an action potential ("membrane stabilizing")

Front 94

2 ways local anesthetics block Na channels

Back 94

1. impair propagation of the action potential in the axon
2. interact directly with specific receptors on the sodium channel, inhibiting sodium ion influx
3. (also perturb the lipid membrane of the neuron)

Front 95

what happens to vascular uptake and duration of action to drugs that cause vasodilation (ex lidocaine)

Back 95

-more rapid vascular uptake
-shorter duration of action

Front 96

local anesthetics w/ a pKa close to 7.4 have what?

Back 96

a faster onset of action

Front 97

how much of lidocaine is protein bound?

--bupivicaine?

Back 97

-lidocaine: 64%
--bupivacaine: 96%

Front 98

vasoactivity influences:

--meaning:

Back 98

speed of onset, duration of action and potency

--vasodilators cause a more rapid vascular uptake and a shorter duration of action

Front 99

problem w/using epinephrine (vasoconstrictor) and local anesthetics

Back 99

vasoconstrictors prolong the action of local anesthetics (don't use together for ring blocks or spinal anesthesia)

Front 100

2 ways local anesthetics block peripheral and central sensitization (analgesia)

Back 100

1. block transmission of impulses to the spinal relay station
2. block transduction of noxious stimuli into electrical signals at nerve endings

Front 101

what influences the toxicity of local anesthetics?

Back 101

-dose
-route of administration (interpleural > intercostals > epidural > infiltration)
-rate of absorption from injection site
-acid-base status (acidosis incr risk of toxicity (rare))
-rate of metabolism of specific drug
p-resence of adrenaline

Front 102

first sign of systemic overdose w/LAs

Back 102

-CNS signs: sedation followed by convulsions

Front 103

signs of systemic OD w/LAs

Back 103

1. CNS: sedation followed by convulsions
2. CVS: cardiovascular depression and arrhythmias
3. Respiratory depression: depress ventilatory response to hypoxia

Front 104

bupivicaine has a strong affinity for what type of tissue?

Back 104

cardiac

Front 105

CVS effects of a systemic OD of LAs

Back 105

-direct myocardial depression
-hypotension (local vasodilation and autonomic impairment)
-Arrhythmias - conduction delay and heart block

Front 106

CNS effects of a systemic OD of LAs

Back 106

-initial transient depression
-agitation, muscle twitching, convulsions
-initial state of excitement due to blockade of inhibitory centers in cortex

Front 107

what does adding opioids do to local anesthetics effects?

--most common ones used for articular and epidural blocks

Back 107

-Increase efficacy and extend duration of block

--Morphine, buprenorphine

Front 108

what does adding alpha2 agonists do to local anesthetics effects?

--which two?

Back 108

-may extend duration and incr efficacy of local blocks

--Medetomidine and dexmedetomidine

Front 109

1. onset time of lidocaine
2. duration of action of lidocaine
3. onset time of bupivicaine
4. duration of action of bupivicaine

Back 109

1. 10-15 minutes
2. 1-2 hours
3. 20-30 minutes
4. 2.5-6 hours

Front 110

where does lidocaine act?
-onset (slow or rapid)
--duration of action (short of long)

Back 110

centrally acting analgesic
-rapid
--relatively short

Front 111

what can develop w/lidocaine?

Back 111

tachyphylaxis

Front 112

when is lidocaine used as an IV infusion?
--what will you see w/i 2 min of a bolus inj? when will it disappear?
---which spp is very sensitive to the toxic effects of lidocaine?

Back 112

-for treatment of ventricular tachyarrhythmias, central analgesia, prokinetic effects
--anti-arrhythmic effects; within 10 to 20 minutes
---cats

Front 113

two things mepivicaine is used for

Back 113

-equine nerve blocks
-intra-synovial anesthesia

Front 114

pKa of bupivicaine and what it means
--is it long or short lasting? why?

---more of less potent than lidocaine? why?

Back 114

8.1 - means slow onset of action
--long acting bc highly protein bound
---4x more potent bc high lipid solubility

Front 115

which is more cardiotoxic: lidocaine or bupivicaine?

Back 115

bupivicaine is SIGNIFICANTLY more cardiotoxic (may cause cardiotoxicity before neurotoxicity)

Front 116

significance of L-bupivicaine

Back 116

significantly less neurotoxic and cardiotoxic than racemic bupivicaine

Front 117

why use Ropivacaine (naropin) over bupivicaine

Back 117

less cardiotoxic
quicker return of full motor function (selective for sensory fibers over motor fibers)

Front 118

systemic lidocaine infusion is standardly used in what spp?

--effects

Back 118

-dogs and horses

-central analgesia and prokinetic effects

Front 119

when do you use local anesthetics as "splash blocks?"

Back 119

on ovarian ligaments, peritoneum or abdominal wall; or on surgical wounds

Front 120

what can you use to reduce pain on injection of LAs?

Back 120

sodium bicarbonate (1:9)

Front 121

for cruciate surgery, what do you use:
1. pre-incisional
2. post-surgical

3. problem using bupivicaine

Back 121

1. mepivicaine + morphine
2. bupivicaine + morphine

3. might be toxic to synovial tissues

Front 122

what agent do you use for intrapleural/intraperitonial LA?

--how long does it last?

Back 122

bupivicaine or ropivicaine

--4-6 hours

Front 123

what do you use for IV regional analgesia (Bier block)

Back 123

lidocaine

Front 124

where do you place the needle for proximal/distal paravertebral nerve blocks?

-how long does it last?

Back 124

dorsal aspect of the T13, L1, L2

-90 minutes

Front 125

what do you do in an intercostal nerve block?

-what do you use?

Back 125

block at least 2-3 adjacent intercostal spaces

-bupivicaine

Front 126

where do the nerves cme from for a brachial plexus block?

--what nerves must you block?

---what is this good for?

Back 126

-derives from spinal nerves C6, C7, C8, T1
--must block radial, ulnar, musculocutaneous, median and axillary nerves
---useful for all surgery including and distal to the elbow

Front 127

two ways to do a digital nerve block

Back 127

1. block superficial branches of radial and median nerve, dorsal and palmar branches of the ulnar nerve
2. ring block is alternative

Front 128

what do each of these blocks desensitize:
1. Infraorbital and maxillary
2. Mental
3. Mandibular-alveolar
4. Retrobulbar - be careful of what?

Back 128

1. upper lip, nose and upper rostral teeth
2. anterior mandible
3. skin, mucosa and teeth of mandible
4. must take care to avoid intravenous injection or damage to the globe

Front 129

large animals nerve blocks:
1. Mandibular - what does it desensitize?
2. Mental - what do you use it for?
3. Supraorbital - what does it block?
4. Auriculopalpebral - what does it do?

Back 129

1. practically the whole of the lower jaw and all of the teeth and alveoli on that side.
2. to suture wounds of the lower lip
3. sensory fibres to the upper eyelid and in part to the skin of the forehead
4. prevents voluntary closure of the eyelids but doesn’t in any way desensitize them

Front 130

two nerve blocks for ocular sx

Back 130

retrobulbar ner block
Peterson's nerve block (cattle and horses)

Front 131

Spinal anesthesia: where to inject?
1. Subarachnoid block
2. Epidural block

Back 131

1. inject into cerebrospinal fluid bathing spinal cord
2. inject into extradural space

Front 132

agents used for epidurals

Back 132

lidocaine
bupivicaine
morphine
‘triple combination’

Front 133

potential adverse effects of epidurals

Back 133

hypotension (common)
-respiratory depression
-coagulopathies and skin infections
-dural puncture
-coat abnormalities
-pruritus (opioids)
-bradycardia (rare)

Front 134

what can extradural anethesia produce?

Back 134

produces ‘chemical sympathectomy’ at level of extradural spread

Front 135

does extradural anesthesia cause hyper or hypotension?
--what happens to peripheral resistance? by what %?

Back 135

is it a combined α and β blockade that produces both arteriolar and venous dilation (mostly venous)
--total peripheral resistance drops by 18-20%

Front 136

how do you treat hypotension from extradural anesthesia?

Back 136

-usually managed with supportive IV fluid therapy
-best choice for treatment is ephedrine (alpha1 agonist)

Front 137

what agent do you use for epidural catheter?

Back 137

bupivicaine

Front 138

Classical Triad of anesthesia (the three things you want to produce)

Back 138

unconsciousness
reflex suppression / analgesia
muscle relaxation

Front 139

what is Guaifenesin

--mainly in which spp?

Back 139

centrally acting NMB w/no action at neuromuscular jnct

--cattle and horses

Front 140

what does guaifenesin cause

--side effects

---metabolism

Back 140

-tranquillisation, ataxia, recumbency

--no major CVS or respiratory changes

---hepatic metabolism

Front 141

*** 3 risks of usingguaifenesin

Back 141

Irritation, hemolysis, thrombophlebitis

Front 142

the 3 prerequisites of muscle relaxation

Back 142

Ensure unconsciousness!
Ensure adequate analgesia
Ensure you can provide artificial ventilation

Front 143

NMBAs are NOT...

Back 143

anesthetics nor analgesics

Front 144

if an animal is too light under anesthesia WITHOUT neuromuscular block, you will see...

Back 144

Changes in ventilation: faster, deeper
Changes in eye position: the eye will rotate upwards
Palpebral reflex

Front 145

If an animal is paralyzed (neuromuscular blocker) but NOT unconscious

Back 145

muscle twitching of head - paradoxical jaw tone and tongue twitching, mydriasis, lacrimation, salivation, tachycardia, hypertension, arrhythmias, increased ETCO2

Front 146

what % of post-junctional nicotinic receptors must be blocked before transmission begins to fail?

Back 146

75% (still have mm fn)

Front 147

when ___% are blocked, transmission ceases completely

Back 147

90%

Front 148

order in which mm are affected

Back 148

1. muscles of expression, jaw and tail
2. muscles of neck and distal limb
3. muscles of proximal limb
4. muscles of swallowing and phonation (pharynx, larynx)
5. muscles of abdominal wall
6. intercostal muscles
7. diaphragm

Front 149

what do depolarizing agents do?

Back 149

mimic the action of acetylcholine at the neuromuscular junction but remain bound to post-junctional receptors (unlike ACh)

Front 150

example of a depolarizing agent

--what will you see?

Back 150

suxamethonium/succinylcholine

--initial muscle contraction (fasciculations) followed by muscle relaxation

Front 151

advantages of suxamethonium

--was used to facilitate intubation in what spp?

Back 151

-fastest onset of all NMDAs
-spontaneous recovery w/o need for reversal
-short acting
--cat and pigs

Front 152

disadvantages of suxemthonium

Back 152

-painful muscle fasciculations
-myalgia
-hyperkalaemia and arrhythmias
-anaphylactic reactions
-**assoc w/malignant hyperthermia
-muscarinic cardiac effects

Front 153

non-depolarizing relaxants

Back 153

-Quaternary ammonium compounds (BIG compounds) structurally related to ACh
-Aminosteroids (vecuronium, rocuronium)
-Benzylquinolium (curariform) derivatives: atracurium

Front 154

advantages of non-depol agents

Back 154

-incremental doses can be given
-relatively easily reversed
-duration fairly predictable
-fewer side-effects than suxamethonium
-no painful initial fasiculations
-can "top off" to maintain paralysis as drug wears off

Front 155

advantage of amino-steroids (vecuronium, rocuronium)

Back 155

no histamine release

Front 156

advantages of vecuronium

Back 156

-no histamine release
-very cardiostable
-can give w/renal disease - little effect on clearance
-minor hepatic metabolism (depends on biliary excretion for termination of effect)

Front 157

what happens w/hepatic dz when using vecuronium?

--what is vecuronium also called?

Back 157

-duration of action is prolonged

--the "cleanest" of the currently available NMDAs

Front 158

what's special about Rocuronium?

Back 158

it's the fastest of the non-depol agents

Front 159

problem w/benzylquinolium compounds

Back 159

-tendency to cause histamine release
- < 10% of the drug is excreted unchanged by the liver and kidneys
-partially degraded by Hoffman elimination
-also eliminated by hepatic pathways
-laudanosine metabolite - epileptiform (looks like seizures)

Front 160

most commonly used benzylquinolium in horses?

--used in what patients?

Back 160

atracurium

-those w/liver and renal dz

Front 161

how to reverse the non-depol agents
--commonly used anticholinesterase agents
--new reversal agent? used to reverse ?

Back 161

-classic: anticholinesterase: blocks ACh breakdown so that [ACh] rises and displaces NMB combined with an antimuscarinic
--neostigmine and edrophonium
---Suggamadex;reverses rocuronium

Front 162

why do we need to combine anticholinesterases with anticholinergics?

--what are these?

Back 162

bc increased plasma concentrations of ACh cause muscarinic side-effects

--salivation, bradycardia, bronchospasm, defaecation, urination

Front 163

what is the most potent non-depolarizing agent reversal agent?
--what do you need to combine it with?
---potential side effect?

Back 163

-Neostigmine (drug of choice in profound blockade)
--an anticholinergic
---cardiac arrhythmias (especially if animal is hypercapnic)

Front 164

non-depol agent reversal agent of choice in horses
--why?
---more or less potent than neostigmine?

Back 164

Edrophonium
--doesn't slow the heartrate and doesn't cause central excitement
---less potent (fewer muscarinic affects)

Front 165

when is reversal/recovery complete?

--what is recurarization? when does it happen?

Back 165

-good jaw tone and brisk palpebral reflex
-beware “fish-eye” appearance
--return of neuromuscular blockade - ‘recurarisation’; can happen if reversal agent starts to wear off (may need another dose)

Front 166

peripheral nerve stimulation:
1. when is it used?
2. what does it do?
3. what does it allow?

Back 166

1. ONLY used to monitor non -depolarising agents
2. gives an idea of how “occupied” the NMJ is by relaxant, ‘how deep is the paralysis’
3. allows titration of NMBA intra-operatively & assessment of recovery post-operatively

Front 167

where do you put the peripheral nerve stimulator to monitor these nerves:
1. Ulnar nerve
2. Peroneal nerve
3. Facial nerve

Back 167

1. medial aspect of elbow
2. lateral cranial tibia
3. lateral aspect of the face

Front 168

the most common stimulation pattern from the peripheral nerve stimulator is called ___?

Back 168

Train of Four

Front 169

rank the spp from msot to least anesthetic risk: cats, dogs, rabbits

Back 169

rabbit > cats > dogs

Front 170

how is a cat's metabolism different than a dog's?

--what does this mean for administering drugs?

Back 170

-cats are deficient in glucuronide synthase
-inability to ‘conjugate’

--results in major differences in dose and duration of many drugs.

Front 171

which NSAID cannot be used in cats? why?

Back 171

Acetaminophen (paracetamol)
--VERY toxic, very prolonged effect, liver damage, methaemoglobin

Front 172

Slow elimination of NSAIDS in cats means what?

Back 172

you give lower doses less frequently.

Front 173

cats: why is the metabolism of Propofol slow?

Back 173

-cats lack the enzymes to conjugate glucuronides
-have problems metabolizing triglycerides produced by metabolism of the lipid in original versions

Front 174

cats: will Propo-clear be less toxic?

Back 174

still won't metabolize but no lipids

Front 175

three problems w/using opioids in cats

Back 175

-High doses cause increased muscle tone and dysphoria
-Dilated pupils may cause panic.
Occasional hyperthermia

Front 176

when using local anesthetics (lidocaine, bupivicaine), which spp has a higher risk of systemic OD: dogs or cats?

Back 176

cats

Front 177

what is the "shock response" triad in cats?

Back 177

-bradycardia
-hypothermia
-hypotension

Front 178

what two things do you use for pre-an meds in cats?

--what do you add if the cat is crazy?

Back 178

ace + morphine or buprenorphine

--ketamine IM

Front 179

Cats: what meds do you use for skin testing?

Back 179

Medetomidine/midazolam

Front 180

Cats: what meds do you use when critical?

Back 180

Fentanyl/midazolam

Front 181

Cats: which med combination can cause excitement? Esp in what age/breed?

Back 181

Ketamine and midazolam
--you adults, Bengals, and Oriental cats

Front 182

Cats: what can oral ketamine be used for? And can is cause?

Back 182

Use in killer cats
--causes hypersalivation, corneal ulceration

Front 183

What can you use to facilitate intubation in catatonic cats?

Back 183

supplementary IV propofol/ sevo by mask

Front 184

Cats: IV induction drugs
--what does the dose of each of these depend on?

Back 184

Propofol
thiopental
ketamine
alfaxalone

--what was used to sedate/premed

Front 185

Cats: what CANNOT be used to help w/laryngospasm on intubation?

Back 185

Astra-Zeneca Xylocaine Spray

Front 186

Cats: what type of breathing system is used for anesthesia?

--what are cat’s prone to under GA?

Back 186

non-rebreathing system (Ayre’s T-piece, Bain)

-- hypothermia (Bair huggers, warming devices )

Front 187

Cats: 60% of deaths happen when?

Back 187

Recovery (from lack of care)

Front 188

Equine: how can you cut the anesthetic death rate in half?

Back 188

Ace as premed

Front 189

Equine: difference between halothane and isoflurane?

Back 189

None

Front 190

Equine: what happens to the anesthetic death rate when you give romifidine?

Back 190

Slight incr

Front 191

Equine: when do emergencies from anesthesia show and how to they present?

Back 191

-during anaesthesia (induction and during maintenance)
-during the immediate recovery period (airway obstruction, Physical damage, myopathy etc)
-over the next few days (resultant physical problems, post-op colic etc)

Front 192

Equine: problem w/standing sedation in stallions

Back 192

penile relaxation

Front 193

Equine: why would field anesthesia (TIVA) be considered safer?

Back 193

only because it is only used for short procedures

Front 194

Equine: what needs to be available when doing field anesthesia?

Back 194

ET tube, oxygen cylinder and Hudson valve

Front 195

Equine: 2 ways to do field anesthesia

Back 195

repeated bolus injections OR infusion

Front 196

Equine: what are the 3 options for surgical anesthesia?

Back 196

Standing, field, and surgical suite

Front 197

Equine: what can you use when doing surgical anesthesia in a sx suite rather than standing of field?

Back 197

Inhalational anesthesia or TIVA w/O2 and ventilator support

Front 198

Equine: prolonged use of alpha2s, even for sedation, can cause ___?

Back 198

reduce gut motility --> prolonged use can cause ileus

Front 199

Equine: starvation for how long for prolonged anesthesia?

Back 199

8-12 hours

Front 200

Equine: T/F in many clinics, hematology and biochem are done before elexctive sx

Back 200

False: in many clinics, no bloodwork is done before elective sx

Front 201

Equine: hematology and biochem are mandatory before what type of sx? What are they testing for?

Back 201

emergency colic surgery
-evaluating hypovolaemia, endotoxaemia

Front 202

Equine: opioids used in horses

Back 202

Morphine
Methadone
meperidine (im only)
Fentanyl
Butorphanol
Buprenorphine

Front 203

Equine: pros of opioids

Back 203

-effective and essential pre-emptive analgesia
-effective and essential analgesic agents
-effective (slow onset) given by epidural injection

Front 204

Equine: 2 side effects of opioids in horses

Back 204

-overdose in unsedated horses may cause excitement and stereotypic behaviour
-repeated doses impair GI motility

Front 205

Equine: how do opioids help intra-operatively

Back 205

Effective in stabilizing anesthesia

Front 206

Equine: T/F itra-operative opioids significantly reduce the MAC of inhalational agents

Back 206

False: opiods do NOT significantly reduce MAC of inhalation agents

Front 207

Equine: drugs used for sedation

Back 207

-acepromazine
-alpha2 agonists
--either (or both) plus
opioids

Front 208

Equine: effects of acepromazine
--effect on GI
---long or short acting?
----effect on BP

Back 208

-effect less obvious than alpha 2 agonists.
-mild ‘tranquilliser’:
-Mood altering. Needs time to effect
--antispasmodic
---long acting
----depressed for 6-8hrs

Front 209

Equine: risk of ace in stallions

Back 209

penile priapism/relaxation

Front 210

Equine: when do you use ace

Back 210

-to calm the frightenedapprehensive animal
-training – low doses only (ex shoeing)
-for premedication

Front 211

Equine: which agents are the mainstay of sedation in horses?
--what can horses do even when deeply sedated w/these agents?
---these drugs are routinely combined w/what?

Back 211

alpha2 agonists
--respond to touch and kick
---opioids

Front 212

Equine: alpha 2 agonists uesd in horses

Back 212

xylazine
detomidine
Romifidine
(medetomidine)

Front 213

Equine: IM dose is how much higher than the IV dose?

--how much time?

Back 213

2-3xs

--30 min

Front 214

Equine: drug combination of choice to feisty, unmanageable horses

--how long do you wait?

Back 214

IM acepromazine, detomidine, butorphanol mixed

--wait 30-45 mins

Front 215

Equine: choosing between aloha2 agonists (medetomidine, detomidine, romifidine, and xylazine):
1. selectivity (rank)
2. duration of action (rank)
3. muscle relaxation
4. analgesia
5. infusion

Back 215

1. medetomidine > detomidine > romifidine > xylazine
2. romifidine > detomidine > medetomidine> xylazine
3. romifidine is LESS of a muscle relaxant
4. xylazine or medetomidine is best
5. detomidine, medetomidine

Front 216

Equine: which alpha2 has less ataxia

Back 216

romifidine

Front 217

Equine: which alpha2 (+ opiod) do you use for standing sx?

Back 217

Xylazine or detomidine

Front 218

Equine: problems w/GA in a horse

Back 218

Cardiac arrest
Hypoxia
Hypercarbia
Post-operative complications (myopathy, neuropathy, spinal damage)

Front 219

Equine: anesthetic induction in adults always given...

Back 219

IV

Front 220

Equine: 5 induction combinations used (can be after ace premed)

Back 220

-Alpha 2/ketamine ± benzodiazepine
-Alpha 2 /Guiaphenesin/ Ketamine
-Alpha 2 and/or ACP plus thiopental
-Guiaphenesin /thiopental or ketamine
-Propofol or alfaxalone (currently not practicable)

Front 221

Equine: RVC rule w/Ketamine use

Back 221

DO NOT draw up or give BEFORE alpha2 is given

Front 222

Equine: guaifenesin is NOT a ___?

-useful for ___

--side effects

Back 222

an anesthetic (IS a m relaxant)
-in combinations for induction and maintenance of anaesthesia in horses
--irritant if injected peri-vascularly - haemolysis, phlebitis

Front 223

Equine: why do we use ketamine (+/- diazepam) for field induction

Back 223

-Good quality induction
-Minimal cardiopulmonary depression
-High safety margin
-Can top up or infuse to prolong
-Excellent Recovery (especially if no benzodiazepine)

Front 224

Equine: 3 different drugs/combinations used for field top ups

Back 224

-Ketamine (alpha2): 25 – 50% of induction dose - (limit the xylazine)
-Thiopental (will impair recovery if used repeatedly)
-Ketamine/midazolam (25 % of induction dose) - beware too much midazolam gives a poor recovery

Front 225

Equine: ideal time period for use of TIVA

Back 225

short (up to 1 hour)

Front 226

Equine: what do horses look like/appear on a tripla drip

Back 226

'light' - strong palpebral reflex, lacrimation, swallowing, vocalisation, gentle purposeful responses to sx stim (use local to prevent)

Front 227

Equine: paradoxical signs of trip drip OD

Back 227

rigid limbs, opisthotonus

Front 228

Equine: what is known as "the ultimate in sedative/opioid combinations"
-what drug is it?
--what is the reversal agent?
---when can you NOT use it?

Back 228

Immobilon
-etorphine + acepromazine
--diprenorphine (Revivon)
---in animals intended for food

Front 229

Equine: what type of system is used for inhalational anesthesia?

Back 229

Closed system w/minimum flow rates oxygen consumption
(5mls/kg/min)

Front 230

Equine: basic guidelines for anesthesia

Back 230

-plenty of eye lubrication
-support limbs
-optimize ventilation
-catheterize bladder

Front 231

Equine: what do you do w/a horse's legs in:
1. lateral recumbency
2. dorsal recumbency

Back 231

1. under-forelimb forward, under-hindlimb back, upper limbs supported
2. DO NOT extend hindlimbs (mm and nn damage is stifles locked for long)

Front 232

Equine: what do you do w/a horse's head in
1. lateral recumbency
2. dorsal recumbecy

Back 232

1. head slightly raised
2. head up but NOT stretched (could cause laryngeal paralysis)

Front 233

Equine: w/intra-operative anesthesia, there is often no CV change until when?

Back 233

the horse moves

Front 234

Equine: why are opioids not always useful?

Back 234

they can cause movement even under anesthesia

Front 235

Equine: which inhalant causes the worst myocardial depression?

Back 235

halothane

Front 236

Equine: which inhalant causes the worst vasodilation?

Back 236

isoflurane

Front 237

Equine: causes of hypotension during anesthesia

Back 237

myocardial depression and low HR
vasodilation

Front 238

Equine: dangers of hypotension

Back 238

-Severe –-> cardiac arrest
-Moderate and prolonged –-> myopathy
-Contribution to poor gut blood flow and post-op colic

Front 239

Equine: how to improve hypotension

--do not do what ? unless very very severe

Back 239

Improve by improving CARDIAC OUTPUT - positive inotropes (ex dobutamine, ephidrine), reduce volatile, give fluids
--do not give drugs to vaso-constrict (e.g. phenylephrine)

Front 240

Equine: w/inhalational anesthesia, what is commonly quoted as major contributor to mortality

Back 240

CVS depression

Front 241

Equine: what is the problem w/blood pressure being used as an indirect indicator of cardiac output during inhalational anesthesia?

Back 241

is it NOT an indicator

Front 242

Equine: what are the two most popular inotropes used during inhalational anesthesia

Back 242

-dobutamine (alpha1 agonist, given by infusion)
-ephedrine (alpha and beta effects, given as bolus)

Front 243

Equine: problem w/treating hypoxemia during inhalational anesthesia

--possible methods

Back 243

nothing works!!

--IPPV using 100% oxygen (does not always work)
--bronchodilator (albuterol)
-improve CO (improves oxygen delivery)

Front 244

Equine: experimental methods for treating hypoxemia during inhalational anesthesia

Back 244

-use of nitrogen in carrier gas (nitrogen in the skeleton of the lung)
-Positive End Expiratory pressure (‘sighing’)
-pulsed nitric oxide

Front 245

Equine: T/F hypercapnia is usually a response to hypoxia

Back 245

False: hypoxic horses usually breath well and are not very hypercarbic

--is it possibly a response to hyperoxia

Front 246

Equine: why is detection of cardiac arrest difficult w/o electronic monitoring?

--what is the success rate of resuscitation?

Back 246

bc horses continue breathing for a lone time after the heart stops

--good if it is instituted in time

Front 247

Equine: possible reasons for cardiac arrest during anesthesia

Back 247

-High vagal tone (need anti-cholinergic if surgery may cause a vagal reflex)
-Severe hypotension means that heart is inadequately perfused
-Heart almost always stops in asystole

Front 248

Equine: how to treat a cardiac arrest during anesthesia

Back 248

-switch off volatile agent
-IPPV with 100% oxygen
-External Cardiac Massage (horse in lateral – front legs forward, jump on heart landing on knees)

Front 249

Equine: a reversible TIVA includes...

Back 249

-Benzodiazepine-based agent
-Opioid based agent (Immobilon!)
-Alpha 2 based agent

Front 250

Equine: 3 propofol-based techniques/combinations of TIVA

Back 250

-Propofol/ketamine
-Propofol/alpha 2
-Propofol/alpha 2/ketamine

Front 251

Equine: what do you use to reverse a TIVA of climazolam and ketamine
-which is given at induction?
--which has a higher infusion rate? (mg/kg/hr)

Back 251

Sarmazenil
-ketamine
--ketamine

Front 252

Equine: why is propofol unsuitable for induction anesthesia in large horses?

Back 252

cannot inject enough fast enough

Front 253

Equine: why would you combine medetomidine w/propofol

Back 253

medetomidine is an analgesic and hypnotic that has a rapid recovery w/no need for an antagonist

Front 254

Equine: w/medetomidine/propofol infusions, how do we keep the cardiopulmonary parameters normal?

Back 254

keep the animal well-oxygenated

Front 255

Equine: problem w/using Alfaxan in horses

Back 255

very expensive

Front 256

Equine: agents commonly used for partial intravenous infusion (PIVA)

Back 256

lidocaine
ketamine
medetomidine

Front 257

Equine: IV lidocaine is the idea analgesic for after what sx and why?

Back 257

ideal analgesic post-colic surgery bc it has a positive effect on gut motility

Front 258

Equine: nasal swelling during recovery can be reduced by ?

Back 258

phenylephrine nasal drops

Front 259

Equine: problems that show during or after anesthesia (mainly after prolonged)

Back 259

-injury (corneal abrasions, fractures)
-nasal edema and respiratory obstruction
-myopathy
-neurapraxia and neuropathy (facial, femoral)
-pulmonary edema
-myelomalacia

Front 260

Equine: 2 types of post-anesthetic myopathy

Back 260

standard and sporadic

Front 261

Equine: what can standard post-anesthetic myopathy be caused by?

Back 261

-prolonged recumbency
-poor positioning
-prolonged hypotension
-hypoxaemia
-NO evidence of any relationship to feeding or fitness

Front 262

Equine: what can sporadic post-anesthetic myopathy be caused by?

Back 262

unknown, but possibly related to "tied-up" syndrome (many muscles involved, can occur several days post-op)

Front 263

Equine: what is essential to use when treating post-anesthetic myositis?

Back 263

fluids bc it is essential to prevent renal damage from free myoglobin

Front 264

Equine: side effects of Immobilon

Back 264

-excitement on induction
-tachycardia and hypertension
-severe respiratory depression
-muscle tension
-PRIAPISM
-recycling after antagonist, so may throw excitement stage 6-12 hours after

Front 265

Equine: what can be used to treat spinal cord malacia?

Back 265

Immobilon

Front 266

Equine: problem w/accidental contamination of Immobilon in man

--how do you treat accidental injection?

Back 266

-it may be absorbed across mucous membranes/through cuts, damaged skin etc
--human antagonist – Naloxone (must be in date)
--if that fails, use diprenorphine

Front 267

Rum: In which spp is:
1. GA more practical
2. LA +/- sedation more practical

Back 267

1. goats and sheep
2. cattle

Front 268

Rum: out of these 5 techniques, which one CANNOT be used for obstetric and laparotomy procedures: epidural, inverted L-block, dorsal paravertebral, lateral paravertebral, line-block

Back 268

cannot use the line-block

Front 269

Rum: name 4 local anesthetic techniques

Back 269

Caudal epidural
Blocks for laparotomy
IV regional analgesia
Cornual blocks (cattle or goats)

Front 270

Rum: which agents cause hypoxia in ruminants and in which spp is it the worst?

Back 270

alpha 2 agonists
-sheep

Front 271

Rum: are really sensitive to what drug?

Back 271

xylazine

Front 272

Rum: when can you NOT use xylazine?

Back 272

pregnancy (it's ecbolic)

Front 273

Rum: T/F the dose of detomidine in ruminants is similar to that for the horse

Back 273

true

Front 274

Rum: caudal epidural anesthesia
1. where do you do it
2. what is it used for?
3. which agents can be used (which is the most common)
4. what do you try to prevent?
5. max recommended volume

Back 274

1.C1-C2 intercoccygeal space
2. to abolish rectal straining - calving, uterine, vaginal prolapse
3. Lidocaine (most common). xylazine, morphine, procaine in europe
4. limb paralysis
5. 6 - 8 mls

Front 275

Rum: what is the most commonly used block in practice for laparotomy for any reason?

Back 275

inverted-L block

Front 276

Rum: T/F the inverted L-block is less effective than paravertebral but easier

Back 276

true

Front 277

Rum: need to make sure you do what w/an inverted L-block?

Back 277

infiltrate each layer to hit all the nerves

Front 278

Rum: what are you trying to block w/a paravertebral block?

Back 278

aiming to block the nerves after they have left the spinal canal (dorsal and ventral branches)

Front 279

Rum: how to do a dorsal paravertebral block

Back 279

Needle aimed to hit wing, then ‘walked’ back - pushed through the transverse ligament
--Can go behind each process (hit nerve of segment in front) or go behind and in front of alternate transverse processes

Front 280

Rum: how much lidocaine is used where in a dorsal paravertebral block?

Back 280

--15 mls 2%lidocaine below process then 5 mls above as withdraw needle (nerve is above and below the wing)

Front 281

Rum: dorsal paravertebral block: what nerves does it block and for how long?

Back 281

blocks T13, L1, L2, L3

--lasts 90 minutes

Front 282

Rum: what does the lateral paravertebral block and how is it done?

Back 282

blocks T13, L1, L2

--lateral approach above and below each transverse process of L1, L2, L4

Front 283

Rum: why do we not like the line block?

Back 283

-incomplete anaesthesia (especially of the peritoneum - though can re-inject local when reach it)
-incomplete relaxation of abdominal muscle
-distortion of normal tissue
-expensive - large vol of LA used

Front 284

Rum: what type of anesthesia do you sue for distal limb surgery?

--which limb is it mostly used for?

Back 284

IV regional anesthesia (digital amputations, deep infections)

--hindlimb

Front 285

Rum: how do you do it and how much is used?

Back 285

-use tourniquet and provide supplementary analgesia
use up to 30 mls lidocaine (in adults) w/o adrenaline

Front 286

Rum: Cornual nerve block
1. what is it used for?
2. which nerve are we blocking?
3. this nerve is found between...

Back 286

1. dehorning
2. cornual branch of zygomaticotemporal nerve
3. lateral canthus of eye and horn

Front 287

Rum: Cornual nerve block
1. problem in goats
2. where is this problem in goats found?
3. what else do you use to provide LA?

Back 287

1. accessory sensory supply (infratrochlear nerve) which is difficult to block completely
2. halfway between medial canthus and horn bud
3. provide additional ring block around base of horn

Front 288

Rum:
1. what 2 blocks do you use for eye enucleations or ocular sx?
2. which nn are blocked?
3. which agents are used?
4. which of these blocks is safer?

Back 288

1. Retrobulbar or Peterson's blocks
2. cranial nerves III,IV, V, VI and ciliary ganglion
3. bupivacaine or lidocaine
4. Peterson’s block (though more technically challenging

Front 289

Rum: T/F the tail vein is a common spot for LA

--T/F the milk vein should only be used when there are no other veins left

Back 289

false: usually the tail artery

--true

Front 290

Rum: name the only drugs licensed for use in adult cattle

Back 290

Xylazine
Detomidine

Front 291

Rum: Xylazine
1. which route is NOT licensed
2. major concern
3. do not use when? why?

Back 291

1. IV
2. hypoxia
3. during the last trimester of pregnancy: increases uterine contractions and vascular resistance, abortigenic

Front 292

Rum: Detomidine in comparison to xylazine in cattle

Back 292

-Effective sedative - licensed for cattle in Europe
-no dose sensitivity spp difference
-Hypoxia is similar
-Less hypnotic - cow less likely to go down
-Less uterine effects

Front 293

Rum: what is a useful alternative in pregnant cattle
1. can also be used to ?
2. careful bc ?

Back 293

ace/morphine
1. enhance sedation
2. regurgitation

Front 294

Rum: in recumbency, boat and regurgitation can be due to ?

Back 294

esophageal sphincter being covered with fluid

Front 295

Rum: potential complications of GA

Back 295

regurgitation
bloat
salivation
respiratory depression
hypoxemia

Front 296

Rum: there is a high risk of regurgitation w/what dz?

Back 296

displaced abomasum

Front 297

Rum: difference between active and passive regurgitation

Back 297

active: under light anesthesia
passive: deep anesthesia, position, drug specific, dz specific

Front 298

Rum: Bloat
1. what is it caused by?
2. what does it contribute to?

Back 298

1. caused by accumulation of CO2 and methane in the rumen; no eructation while unconscious
2. contributes to hypoventilation

Front 299

Rum: what do you NOT do when salivation is a complication of anesthesia? why?

Back 299

Do not administer atropine!

-atropine induces ileus and increases viscidity of saliva --> could lead to respiratory obstruction

Front 300

Rum: what can cause hypoventliation and/or hypoxemia?

Back 300

-central depression due to drugs
-V/Q mismatch due to recumbency
-low chest wall and pulmonary compliance
-abd pressure on the diaphragm
-expanding rumen

Front 301

Rum:
1. how do you premed for GA?
2. best/easiest site for catheter
3. agents used for anesthesia

Back 301

1. use sedative agents at low doses
2. auricular vein is easiest site for catheter placement (Dr. C says jug v)
3. ketamine/midazolam, thiopentone (Dr. C says xylazine followed by ketamine)

Front 302

Rum: advantages of ketamine/midazolam induction

Back 302

-small volume
-minimal cardiovascular depression
-regurgitation prior to intubation rare
-relatively fast recovery

Front 303

Rum: agents used in triple drip

Back 303

GGE/ketamine/xylazine
(cattle more sensitive to haemolysis than horses, so 5% GG is preferred in this species)

Front 304

Rum: what do you HAVE to do even when using the triple drip?

Back 304

still need to intubate and give oxygen

Front 305

Rum: positioning for endotracheal tube

Back 305

always keep head elevated and mouth below poll, so that saliva, regurgitation drains downwards and out

Front 306

Rum: minimum O2 supply

Back 306

5 ml/kg/min

Front 307

Rum:
1. eye signs when anesthesia is light
2. normal HR
3. normal RR
4. best way to measure direct BP
5. tidal volume
6. ETCO2 low or high?

Back 307

1. eye down when very light
2. HR 45 - 80
3. RR 15 - 30
4. can measure direct BP using auricular artery
5. small tidal volume (4-6 ml/kg)
6. tends to be very high.

Front 308

Rum:
1. how are they placed during recovery?
2. what do they need during recovery

Back 308

1. sternal recumbency, well supported
2. supplementary oxygen, maintain ET tube in situ until chewing/ swallowing starts

Front 309

SmRum: special problems w/small ruminants and anesthesia/sedation

Back 309

-Goats: sensitivity to local (or just straight overdose)
-Sheep: more likely to get pulmonary edema with xylazine or other alpha 2 agonists

Front 310

SmRum: in goats, which is better: jugular vein or cephalic?

--in sheep?

Back 310

jugular

--cephalic bc less moveable skin

Front 311

SmRum: which drugs do you use for epidural anesthesia and how much?

Back 311

-lidocaine, morphine, (xylazine)
--5 - 8 mls 2% lidocaine without epinephrine

Front 312

SmRum: list of sedative agents used

Back 312

-alpha2 agonists - xylazine, medetomidine
-ace
-morphine, buprenorphine
-diazepam, midazolam
-benzodizepines

Front 313

SmRum: what do you have to be careful w/when using ace?

Back 313

regurgitation if recumbent

Front 314

SmRum: alpha2s
1. careful w/in what spp
2. risks
3. which type of injection is less risky?

Back 314

1. sheep
2. pulmonary edema and related hypoxaemia
3. less risk with IM injection than IV

Front 315

SmRum: diazepam or midazolam
1. less ___ than alpha2s
2. how long to they work?

Back 315

1. less CVS depression
2. short acting (10 mins)

Front 316

SmRum: more likely to regurgitate when using what type of induction?

Back 316

mask induction

Front 317

SmRum: how should they be positioned until intubated?

Back 317

keep in sternal recumbency

Front 318

SmRum: when recovery, don't remove ET tube until what?

Back 318

they can remain in sternal recumbency

Front 319

Camelids/llamas: why is IV catheterization so hard?
--which v is the best?
---what is a good option for sedation

Back 319

-veins have valves - difficult to thread a catheterize
-carotid artery lies close to the vein
-thick skin– up to 1 cm in males
--right jugular vein, high up; cephalic or saphenous vein if desperate
---IM injection

Front 320

Camelids/llamas: tubing it diffucult.
1. what do you need
2. size of tube (length and diameter)

Back 320

1. laryngoscope and guide-wire (essential!!); desensitize larynx with lidocaine before intubation
2. 35 - 40 cm long , 8-10 mm diameter tube

Front 321

Camelids/llamas: for sedation, they are less sensitive to ___ than other ruminants
---what may improve sedation and analgesia?

Back 321

-xylazine
-opioids

Front 322

Camelids/llamas: prone to what during GA?

--must give what during recovery?

Back 322

-hypoxemia

--supplementary O2

Front 323

Baby ruminants (incl creas):
1. how long do you fast them?
2. good sedatives
3. what do you use for mask induction
4. what do you use for short duration sx? (drug and technique)

Back 323

1. not for long (rumination only begins at 8 - 12 weeks old)
2. diazepam/midazolam are excellent sedatives
3. mask induction ideally with sevoflurane
4. TIVA using xylazine/ketamine

Front 324

Baby ruminants (incl creas): normal doses and toxic doses of (mg/kg):
1. lidocaine
2. bupivicaine
3. ropivicaine

Back 324

1. N = 5; T = 10-20
2. N = 2; T = 3.5-4.5
3. N = 1.5; T = 5

Front 325

Baby ruminants (incl creas): T/F post-op analgesia is generally not given for disbudding of goat kids
--what do you have to remember w/goat kids and NOT cattle?

Back 325

true

--extra branches

Front 326

Baby ruminants (incl creas): what drugs are used for disbudding?

Back 326

procaine and lidocaine

Front 327

Rum: one thing you have to consider w/post-op analgesia in ruminants that you DON'T have to consider w/horses, dogs, cats, etc...

Back 327

Food animal and cost limitations

Front 328

Pig: problem w/IM injection in pigs

Back 328

drugs often deposited into fat

Front 329

Pig: 3 things you need to consider about the pig CV when anesthetizing

Back 329

-small heart relative to body mass
-rapid heart rate
-tachycardia markedly reduces cardiac output

Front 330

Pig: things that need to be considered about the respiratory system when anesthetizing

Back 330

-high incidence of rhinitis, pneumonia, pleuritis, ‘shipping fever’
-upper airway easily obstructed
-airway secretions easily obstruct airway

Front 331

Pig: sites for IM injections in:
1. commercial pigs
2. pet pigs
3. length of needle needed

Back 331

1. close to the ear base
2. thighs, epaxial muscle
3. use long needle

Front 332

Pig: where do you give IV injections?

Back 332

auricular vein (dorsal surface of ear)

-Limb veins OK once asleep

Front 333

Pig: where do you place an IV catheter

--what do you use to help raise the vein?

Back 333

dorsal auricular vein

--an elastic band

Front 334

Pig: sedatives and premeds used in pigs (+ examples)

Back 334

-butyrophenones (Azaparone, Droperidol)
-acepromazine
-alpha2 agonists (xylazine, medetomidine)
-dissociative agents (ketamine, tiletamine/zolazepam)
-anticholinergics (atropine, glycopyrrolate)

Front 335

Pig: brand name for azaparone
1. what is it?
2. has similar effects and side effects to what?
3. how is it given? why is it not given another way?
4. short or long acting?

Back 335

Stresnil
1. butyrophenone
2. similar effects/side-effects to ace
3. IM only; IV causes excitement
4. short acting tranquilliser

Front 336

Pig: how are alpha2s given?

--the two mostly used alpha2s

Back 336

in combination w/ketamine (have a very limited effect on their own, but very good w/ketamine)

--xylazine, medetomidine

Front 337

Pig: name the 3 different xylazine combinations used for introduction and maintenance of GA

--name two agents used alone

Back 337

-xylazine - tiletamine-ketamine
-xylazine-ketamine - butorphanol
-guaifenesin-ketamine-xylazine
--thiopentone
--propofol

Front 338

which spp are prone to laryngospasm?

--how do you correct this?

Back 338

pigs and cats

--lidocaine spray

Front 339

Pig: possible structural problems w/intubation

Back 339

-larynx and trachea set at an angle
-soft palate is long and soft
-large ventral saccules
-long narrow trachea
-apical lung lobe has separate bronchus, can be occluded by ET tube

Front 340

Pig: why do you need to be careful not to obstruct the nostrils?

Back 340

they are obligate nasal breathers

Front 341

Pig: which inhalational agents are used with pigs?

Back 341

all

Front 342

Pig: which breed does NOT get malignant hyperthermia?

Back 342

pot-bellied pigs

Front 343

Pig: why is epidural anesthesia easier than in most spp?

--which drugs do you use?

Back 343

pigs have an open epidural space

--lidocaine and morphine

Front 344

Pig: procedure for anesthetizing potbellied pigs

Back 344

1. intranasal midazolam
2. use long needles
3. always intubate and supplement oxygen
4a. medetomidine plus ketamine im
4b. tiletamine/xylazine
4c. tiletamine/xylazine/ketamine
5. reverse alpha2 agonist at end of procedure

Front 345

Pig: malignant hyperthermia (MH)
1. what is it
2. what can trigger it (non drugs)
3. which drugs/agents can trigger it

Back 345

1. genetic disorder associated with defective gene for ryanidine
2. stress, transport, several drugs
3. can be induced by all inhalational agents primarily halothane and succinylcholine)

Front 346

Pig: CS of malignant hyperthermia

Back 346

Peracute tachycardia, hypercapnia, muscle rigidity, hyperthermia…death

Front 347

Pig: how do you detect MH?

Back 347

-increase in temperature (‘pink’ pigs go very red)
-‘toes’ spread (Increase in jaw tone)
-very rapid respiration.
-increase in ET CO2 (Use up CO2 absorbent)

Front 348

Pig: tx for MH

Back 348

-stop inhalant and switch to totally new machine
-non-rebreathing system if there
-rapid body cooling, ice cold fluids
-administer Dantrolene

Front 349

Pig: what can you give prophylactically for MH?

Back 349

Dantrolene (oral, as IV is expensive)
OR
a muscle relaxant which works directly on ryanodine receptor to block calcium release

Front 350

2 things that could cause fire and explosions

Back 350

Oxygen supports combustion (so DON'T use oil)
Overheated ‘soda lime’

Front 351

how to prevent sloughing and abscess after SQ thiopentone injection

Back 351

tx at the time of accidental inj w/large volumes (1 Litre) of saline plus hyaluronidase would prevent this

Front 352

T/F aim to pass the ET tube before regurgitation takes place

Back 352

TRUE

Front 353

regurgitation could cause ___ in rum

Back 353

esophageal obstruction

Front 354

in horses w/colic, what do you want to do before anesthetic induction?

Back 354

empty stomach

Front 355

how do you treat the inhalation of stomach contents?

--which spp is particularly susceptible

Back 355

clear airway --> suction --> bronchial lavage --> antibiotics/corticosteroids

--horses (and man)

Front 356

ABC stands for...

Back 356

Airway
Breathing
Circulation

Front 357

how to dx airway obstruction

Back 357

-type of breathing (effort)
-air movement at nostrils: mouth: ET tube
-movement of rebreathing bag
response to treatment/removal of cause

Front 358

common causes of obstruction while under anesthesia: non-intubated

Back 358

Laryngeal obstruction
Soft palate (brachycephalics)
Nasal obstruction
tongue

Front 359

common causes of obstruction while under anesthesia: intubated

Back 359

-kinked ET tube
-over-distended cuff
-blocked circuits: faulty valves
-esophageal intubation, endobronchial intubation

Front 360

what does endobronchial intubation cause

--CS

Back 360

causes a 'shunt (blood passes through non-aerated lung)

--hypercarbia
--high inspired concentrations of inhalation agent required

Front 361

esophageal intubation is most likely found in what spp?

--how do you detect it?

Back 361

cat or very small dog

--Capnogram, limited (but some) movement of rebreathing bag, inhalation agent seems ineffective

Front 362

one way to secure an airway ONLY in a dog and cat

Back 362

pull tongue forward, hard

Front 363

what happens to CO2 and O2 in respiratory arrest?

Back 363

patient becomes hypercapnic (stops breathing so can't get rid of CO2) and hypoxic (not breathing in O2)

Front 364

what is different about respiratory inadequacy (than a full arrest)?

Back 364

oxygen deficiency can be compensated by increasing the inspired oxygen concentration, so the patient may be hypercapnic but not necessarily hypoxic

Front 365

define: hypoventilation

Back 365

ventilation inadequate to remove CO2. Thus patient will be hypercarbic (high PaCO2)

Front 366

define: hypoxemia

Back 366

low arterial PaO2 with Hb not fully saturated

Front 367

if it is not caused by hypoventilation, what will hypoxia do?

--what does this cause?

Back 367

stimulate breathing

--therefore, the hypoxic animal may then hyperventilate

Front 368

how do you dx hypoventilation?

what will you see?

Back 368

-capnogram and/or arterial blood gas analysis (not easy w/o these)
-bright pink mucous membranes (hypercarbia)
-cynotic mucous membranes (hypoxia)

Front 369

how do you dx hypoxemia?

Back 369

-colour of mucous membranes
-pulse oximeter
(need adequate peripheral circulation and Hb for both!!)
-animal hyperventilating
-may not show under anesthesia
-arterial blood gas analysis

Front 370

causes of hypoxemia

Back 370

-low inspired oxygen
-oxygen cylinder running out!
-severe hypoventilation/respiratory arrest
-pulmonary pathology

Front 371

what is IPPV and what do you have to be careful of?

Back 371

Intermittent Positive Pressure Ventilation

--blowing up the stomach

Front 372

agent used to start ventilation in neonates?
--what does it do?
---how is it administered?
----when do you use this in animals besides neonates?

Back 372

Doxapram
--general CNS stimulation
---IV, via mucous membranes, intra-tracheal
----ONLY if there is no other method of ventilation

Front 373

for all circulatory emergencies, what do you want to do?

Back 373

treat the cause

Front 374

common causes of circulatory failure under anesthesia

Back 374

-inadequate circulating volume
-inadequate cardiac output

Front 375

reasons for inadequate circulating volume

Back 375

Pre-operative hypovolaemia
Blood loss
Vasodilatation from anaesthetic drugs

Front 376

reasons for inadequate cardiac output

Back 376

Inadequate circulating volume
Depression by anaesthetic agents
Cardiac rate and rhythm (drug induced bradycardia)
High peripheral resistance

Front 377

common causes of tachyarrhythmias under anesthesia

Back 377

-hypercapnia
-hypoxia
-electrolyte imbalances
-adrenaline/epinephrine (halothane sensitizes, acepromazine protects)

Front 378

common causes of bracyarrhythmias under anesthesia

Back 378

-vagal reflex
-electrolyte imbalances
-drugs used in anaesthesia (high dose opioids, alpha2 adrenoceptor agonists)

Front 379

T/F Reflex vagal bradycardia/cardiac arrest under anaesthesia is an "all or nothing" reflex, meaning either no effect or cardiac arrest

Back 379

true: all or nothing

Front 380

what are some high risk areas of surgical stimulation of reflex bradycardia/cardiac arrest under anesthesia?
--how do you protect/treat it?

Back 380

-eye, end of nose, larynx, around vagal trunk high risk
--with anti-cholinergic drugs (atropine, glycopyrollate etc)

Front 381

problem w/noticing cardiac arrest under anesthesia

Back 381

animals may breath for some time after the heart stops

Front 382

resuscitation routine for cardiac arrest under anesthesia

Back 382

1. tell surgeon, call help
2. check airway, (intubate if not already) stop anesthetic administration, IPPV with O2
3. external cardiac massage - external (judge efficacy), internal (if necessary)
4. remove cause
5. drug/shock therapy to restart heart

Front 383

resuscitation routine in cardiac arrest under anesthesia in a horse (heart in asystole)

Back 383

1. stages 1 and 2 as for all animals.
2. external cardiac massage
3. ensure effective circulation prior to drugs
4. ephedrine/atropine IV then continue massage

Front 384

CPCR stands for:

Back 384

cerebro-cardiopulmonary resuscitation

Front 385

Evidence based classification of CPr procedure:
1. Class I
2. Class IIa
3. Class IIb
4. Class III
5. Indeterminate class

Back 385

1. excellent evidence, definitely helpful
2. good to very good evidence, acceptable, probably helpful, standard of care
3. fair to good evidence, acceptable, possibly helpful, optional or alternative care
4. unacceptable, no proven benefit, may be harmful
5. insufficient evidence, no harm, no benefit.

Front 386

One important changed made to how CPCR is performed in veterinary medicine

Back 386

avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival

Front 387

CPCR: cannot have more than ___ between chest compressions
--how long should they resume between defibrillator shocks?

Back 387

no > 10sec
-- approx 2 minutes

Front 388

Define: cardiorespiratory arrest

Back 388

abrupt, unexpected cessation of spontaneous and effective ventilation and systemic perfusion (circulation)

Front 389

it is important to differentiate between cardiorespiratory arrest and what other 2 things?

Back 389

-cardiorespiratory arrest
(note: respiration can continue for some minutes after cardiac arrest)
-respiratory arrest: loss of effective, spontaneous ventilation
pulseless electrical activity (PEA)

Front 390

things that can cause cardiorespiratory arrest

Back 390

-vagally mediated cardiac arrest/ vasovagal syncope
-trauma
-systemic and metabolic disease
-respiratory disease
-cardiac disease
-acid-base and electrolyte abnormalities: (hyperkalemia (urethral obstruction, renal failure), hypocalcemia, hypermagnasemia, hypoglycemia

Front 391

high risk patients intra-operatively

Back 391

anaesthetic overdose
hypothermia
hypoxia
hypercarbia
hypotension/hypovolaemia

Front 392

changes in respiratory rate, depth, or pattern can indicate what?

Back 392

that cardiac arrest has already occurred

Front 393

will find no palpable pulse if systolic pressure is ?

--will find no heart sounds if systolic pressure is ?

Back 393

<60mmHg

-- <50mmHg

Front 394

clinical signs of cardiac arrest

Back 394

-no palpable pulse or heart sounds
-central eye - pupillary dilation (really shows in the dog)
-absence of observable ventilation
-cyanosis (may be late to show)
-very slow capillary re-fill (get some re-fill from the venous side.)

Front 395

signs of cardiac arrest (electrical monitoring

Back 395

-EKG
-direct blood pressure - will still read low, but no pulse pressure
-pulse oximeter - no signal
-no doppler signal
-NIBP fails
-capnograph - low, and falling ET CO2

Front 396

Problem w/using EKG to determine cardiac arrest

--reason for a capnograph

Back 396

10% of cardiac arrests are from electromechanical dissasociation (so just bc you have an ECG reading, doesn’t mean it’s alive)
--if you have a decent end tidal CO2, IT’S ALIVE!!

Front 397

what are the 3 stages of CPR?

Back 397

-Basic life support
-Advanced life support
-Prolonged life support

Front 398

the ABCs of Basic life support

Back 398

A – ASSISTANCE and establish an Airway
B - Breathing support (also Blood)
C - CHEST COMPRESSIONS and Circulatory support

Front 399

effective CPR requires how many people?

Back 399

4-5 assistants

Front 400

first thing you do:

Back 400

-immediate intubation/tracheostomy
-100% oxygen (turn off anesthetic) --> if no spontaneous ventilation ventilate 10 - 15 times/minute
-continuous with chest compressions (most important !! )

Front 401

what does the C stand for in the ABCs of basic life support?

Back 401

Compressions
get your Circulation going!!
Connect ECG
Catheters
Calm

Front 402

what position should the animal be in for closed chest compressions?

--how are they performed (location, rate, etc)

Back 402

right lateral recumbency
--4th - 5th intercostal space
--at least 80 - 120/minute
--interpose abdominal compressions
--high ratio of chest compressions:ventilations
--without interruption

Front 403

what does it mean if the pupils constrict

Back 403

it means you're winning!!

Front 404

What is the cardiac pump theory and when is it used?

Back 404

used in animals <15kg
-Strength of chest compressions is transmitted directly to the heart
-More effective means of generating cardiac output

Front 405

What is the thoracic pump theory and when is it used?

Back 405

used in animals >15kg
-Forward flow is achieved through changes in intrathoracic pressure
-Less effective generation of cardiac output

Front 406

Limitations of closed chest compressions
1. produces ___ of the normal CO
2. cerebral and myocardial flow are ___ pre-arrest values
3. renal and hepatic blood flow during CPR is ____ of pre-arrest values

Back 406

1. up to 20%
2. less than 5%
3. 1% to 5% of pre-arrest values

Front 407

During CPR, what determines the efficacy of organ perfusion?

Back 407

force, rate, and duration of chest compression

Front 408

All methods will fail if...?

Back 408

there is no venous return

Front 409

when should open chest compressions start?

Back 409

w.i 2-5 minutes of starting CPR

Front 410

what will PETCO2 monitor during CPR?

Back 410

non-invasive way of estimating blood flow (and meaningful perfusion) through the lungs

Front 411

when and animals has a peak ETCO2 of ___ it is unlikely to be resuscitated
1. dog
2. cat

Back 411

1. < 15 mm Hg
2. < 20 mm Hg

Front 412

most helpful cranial nerve reflex during CPCR

Back 412

pupil size

Front 413

the thing to remember about ECG

Back 413

it only provides information about electrical activity, not functional output

Front 414

what are the 4 ECG rhythms that means something during CPCR?

Back 414

-asystole (flat)
-ventricular tachycardia
-ventricular fibrillation
-electro-mechanical dissociation (beautiful ECG but everything else being measured says no circulation – ex capnograph)

Front 415

the DEF of Advanced Life Support

Back 415

D -- Diagnosis and Drugs
E -- Electrocardiography
F -- Fibrillation control

Front 416

what is the ONLY drug that has received the Class I recommendation for treatment for CPCR?

Back 416

atropine (for bradycardia)

Front 417

what is the most common arrest rhythm in dogs?

Back 417

electromechanical dissociation (though asystole is a close second)

Front 418

how should we administer drugs during CPR?

Back 418

intravenous
intra-osseous
intra-tracheal
(intra-cardiac is NOT recommended)

Front 419

though shock doses of fluids are recommended for CPCR, what do we need to be careful of?
--what type do we want to consider?

Back 419

they can impair myocardial and cerebral perfusion

--colloids and hypertonic saline

Front 420

most important drug used in CPR

Back 420

oxygen!

Front 421

list of drugs used for CPR

Back 421

epinephrine
atropine
lidocaine
vasopressin
antagonist drugs

Front 422

epinephrine aka

-when is it indicated?

--what does it do?

Back 422

adrenaline

-in almost all cases of cardiac arrest
--acts as a vasopressor and positive chronotrop

Front 423

contraindications of epinephrine

Back 423

-ventricular tachycardia & fibrillation
presence of drugs that increase ADRENERGIC drug effects (xylazine, halothane, etc) --> incr ventricular fibrillation

Front 424

what type of drug is epinephrine?

--what receptors does epinephrine act on during CPCR?

Back 424

mixed alpha and beta agonist

--alpha, beta1, and beta2

Front 425

epinephrine: it's effects on:
1. alpha receptors
2. beta1 receptors
3. beta2 receptors

Back 425

1. vasoconstriction
2. increased contractility
3. bronchodilation, skeletal muscle vasodilation, increased HR

Front 426

epinephrine: other effects

Back 426

-Increased myocardial and cerebral perfusion
-Increased arrhythmogenicity

Front 427

epinephrine:
1. when do alpha effects predominate?
2. when do beta effects predominate?

Back 427

1. at high doses (vasoconstriction)
2. at low doses (inotropy, chronotropy)

Front 428

why do we keep doing CPCR when we first give epinephrine?

--benefit and problem w/high dose

Back 428

need to get the drug to the coronary vessels

--improves cerebral blood flow but incr refibrillation rate and decr survival rate (has been assoc w/myocardial dysfn and neuro outcomes)

Front 429

adverse effects of epinephrine

Back 429

-Increased myocardial oxygen demand/ consumption
-Increased lactate production
-Increased intrapulmonary shunting
-Increased likelihood of fibrillation

Front 430

what kind of drug is atropine and when is it indicated?

Back 430

-antimuscarinic parasympatholytic drug
--To decr an increased vagal tone
--Bradyarrythmias

Front 431

Atropine: what types of things is it used for when decr vagal tone?

Back 431

light anesthetic depth/awake intubation
retching/vomiting
ocular manipulations
concurrent opioid use

Front 432

Atropine: what types of bradyarrhythmias is it used for?

Back 432

-Sinus bradycardia
-Sinus arrest, slow pulseless electrical activity
-2nd degree AV block

Front 433

Vasopressin: when is it indicated and what does it do?

Back 433

-Ultra-potent vasoconstrictor
-improves cerebral and myocardial blood flow
-particularly indicated in sepsis, systemic inflammatory response syndrome

Front 434

Vasopressin:
currently recommended to replace or be given adjunct to what in CPCR therapy?

Back 434

adrenaline

Front 435

rare cardiac arrhythmia in dogs

Back 435

ventricular tachycardia

Front 436

what is the only way to convert a ventricular fibrillation to a perfusing rhythm

Back 436

defibrillation

Front 437

CPCR indications for lidocaine

Back 437

-beneficial for ventricular arrhythmias following resuscitation
-no proof of efficacy w/cardiac arrest
-ventricular tachycardia (if underlying SA nodal rhythm)
-may be an effective “free radical scavenger !!

Front 438

Ventricular tachycardia
1. if you give a lidocaine bolus and it's effective, what do you do?
2. if a lidocaine bolus is NOT effective, then what do you do?
3. what may replace lidocaine as tha anti-arrhythmic of choice?

Back 438

1. give lidocaine infusion
2. give procaine IV
3. Amiodarone

Front 439

reversal agents for different anesthetics:
1. opioids
2. xylazine
3. medetomidine
4. midazolam

Back 439

1. naloxone
2. yohimbine
3. atipamezol
4. flumazenil

Front 440

On the antero-lateral aspect of the upper arm, 3 cun inferior to the axillary fold and 6 cun superior to Lu-5, in the depression between the lateral border of the biceps brachii muscle and the shaft of the humerus.

Back 440

Lu-3

Hint 440

Sky Window
Balances above & below - goiter
Affects Po- sadness, weeping, disorientation, forgetfulness, somnolence, insomnia, delerious speech
Cools, clears, calms (heavenly attributes)

Found to increase oxygen
Enhance athletic performance – needle just prior to event

Front 441

defibrillation is the only means of what?

Back 441

converting ventricular fibrillation to a perfusing rhythm

Front 442

what is mannitol used for in follow-up and post-resuscitation?

Back 442

to decr the chance of cerebral edema

Front 443

the GHI of Prolonged Life Support

Back 443

G -- Gauging a patient's response.
H -- Hopeful measures for the brain
I -- Intensive care

Front 444

what effects does progesterone during pregnancy have on
1. the MAC of inhalational agents
2. body temperature
3. everything else in the body?

Back 444

1. decr MAC
2. thermogenic, increases body temperature
3. dilation/relaxation

Front 445

pregnancy: what do you have to be aware of when giving an epidural?

--effect of pregnancy of CO

Back 445

distended epidural veins

--incr </= 50% thru incr of stroke volume

Front 446

pregnancy: respiratory changes

Back 446

-incr oxygen consumption
-altered sensitivity of chemoreceptors to PaCO2
-↓↓ FRC (fnal residual capacity) and ↓↓ RV (reserve volume)
-reduced oxygen reserves
-incr risk of hypoxia
-incr risk of regurgitation/aspiration

Front 447

pregnancy: if not doing a C-section, what drug is the worst for sx?

Back 447

xylazine

Front 448

C-section: what can happen to the dam when it is in dorsal recumbency w/the heavy pressure of the uterus (before it's taken out)? the uterus can...

Back 448

-press on lungs - V/Q mismatch - ‘apparent ‘slow uptake of isoflurane
-press on vena cava --> reduced venous return to heart --> low CO --> low arterial BP

Front 449

C-section: what can help take the pressure of the uterus off the dam in dorsal recumbency?

Back 449

Use a ‘wedge’ to have dam positioned just ‘off’ the straight

Front 450

C-section: in healthy animals, what will premed do?

--which 2 types of drugs do you avoid?

Back 450

reduce anxiety, stress and improve uterine perfusion

--alpha2s and benzodiazepines

Front 451

C-section: what drugs would you use to premed?
--what would you do if the puppy is respiratory depressed?
---why not benzodiazepines?

Back 451

-prefer fentanyl or meperidine (low doses)
--antagonize opiate
---slowly eliminated from puppies --> puppy depression

Front 452

C-section: restrictions for using N2O and why?

Back 452

-stop immediately after induction bc crosses placental membrane and can cause diffusion hypoxia in baby post-partum

Front 453

C-section: what's a good injectable induction agent to use?

Back 453

propofol/etomidate

Front 454

C-section: what can be done for analgesia?

Back 454

-pre-emptive administration of NSAIDs
-low dose opioids (delay until babies delivered)
-lumbosacral extradural

Front 455

C-section: if a drug crosses the blood brain barrier...?

Back 455

it will cross the placenta

Front 456

Pyometra: anticipated problems

Back 456

-SHOCK
-anemia
-hypovolemia, toxemia, septicemia
-glomerulonephritis
-risk of vomiting at induction --> aspiration pneumonia
-reduced FRC
-hypoalbuminemia
-CNS depression
-insulin resistance

Front 457

What agents would you use for a Caslick's sx on a mare?

Back 457

ACP plus butorphanol (avoid xylazine)

Front 458

best agent for mare C-section

Back 458

romifidine

Front 459

C-section: in a cow, why do you use a caudal epidural?

Back 459

so it stops straining

Front 460

Avian: birds have a high metabolic rate, so that means what about oxygen?

Back 460

they have limited oxygen reserves

Front 461

Avian: compare w/mammals
1. stroke volume
2. heart size
3. CO
4. resting MAP

Back 461

1. higher
2. larger
3. higher
4. higher

Front 462

Avian: what can disturb the high, efficient CVS

--what can this lead to?

Back 462

posture and anesthetic agents

--depressed venous return in dorsal recumbency and hypotension

Front 463

Avian: the cardiorespiratory stress response occurs in what type of birds?
--when can this occur
---what's the problem with it?

Back 463

diving birds and ducks
--from stress before or during GA
---can cause cardiopulmonary depression and incr anesthetic risk

Front 464

Avian:
1. how could you diminish the dive response?
2. how could you virtually abolish the dive response?

Back 464

1. pre-med
2. pre-oxygenate

Front 465

Avian: name the functional components of ventilation in the avian respiratory system

Back 465

conduction airways
air sacs
thoracic skeleton
muscles of ventilation

Front 466

Avian: name the functional components of gas exchange in the avian respiratory system
--what is the basic unit for gas exchange?

Back 466

the parabronchi
--basic unit for gas exchange is the parabronchus (NOT the alveolus)

Front 467

Avian: respiratory system: what do fowl have in comparison to all other birds

Back 467

-All birds have paleopulmonobronchi
-fowl have neopulmonobronchi

Front 468

Avian: they are missing ___, which makes breathing ___

Back 468

a diaphragm
--active process (both inspiration and expiration)

Front 469

Avian: tracheas are long and wide, which is compensated by ?

Back 469

larger tidal volume and relatively low RR

Front 470

Avian: you can perform mechanical ventilation thru?

Back 470

air sac cannulation

Front 471

Avian: the big thing to remember about the "rigid lung"

Back 471

it does NOT contribute to gas exchange and does not affect anesthetic gas concentration, but it can be a reservoir

Front 472

Avian: why is gas exchange more efficient than in mammals?

Back 472

bc of the countercurrent mechanism between gas and blood flow

Front 473

Avian: changes in depth of anesthesia occur ___ and hypoxia has a ____ impact than in mammals

Back 473

faster; larger

Front 474

Avian: how should doses by calculated?

Back 474

by body mass index/body surface area rather than gram weight

Front 475

Avian: dorsal recumbency severely impairs what?

Back 475

venous return

Front 476

Avian: premedications... for cage birds

Back 476

Not always necessary
-but can use benzodiazepines and butorphanol

Front 477

Avian: Induction of cage birds
1. inhalational vs injectable
2. mask induction and intubation are?
3. what is mandatory?
4. type of system used

Back 477

1. Inhalationals are better
2. are generally very easy
3. IPPV is mandatory
4. low-resistance non-rebreathing systems

Front 478

Avian: premedication of ratites (ex ostrichs)

Back 478

benzodiazepines
butorphanol
medetomidine

Front 479

Avian: induction of ratites

Back 479

-IM/IV ketamine and medetomidine
-propofol

Front 480

Avian: where do you give fluids?

Back 480

-indwelling IV in the medial metatarsal, jugular, ulnar
-intraosseous in the ulna or tibiotarsus

Front 481

Avian: when doing analgesia, birds have which type of receptors?

--so which drug should be used?

Back 481

-kappa instead of mu

--use butorphanol (carpofen and meloxican)

Front 482

Avian: anesthesia
1. eye position
2. which reflexes do you test?

Back 482

1. always central
2. pupillary diameter, corneal, PLR, withdrawal (toe pinch/wattle pinch/cloacal pinch)

Front 483

Reptile: their response to anesthetic drug depends on what?

Back 483

temperature (they're ectothermic)

Front 484

Reptile:
1. what type of heart do they have?
2. left atrium empties into ?
3. right atrium empties into ?

Back 484

1. three-chambered
2. cavum arteriosum
3. cavum venosum

Front 485

Reptiles: compare total lung volume and gas exchange area w/mammals

--which lung is either vestigial or absent?

Back 485

total lung volume is larger
gas exchange area is smaller

--left lung

Front 486

Reptiles: what makes their respiratory system similar to a bird's?

Back 486

they have no (functional) diaphgram

Front 487

Reptiles: injection routes

Back 487

-Hindlimb IM injection
-Coccygeal veins – dorsal and ventral veins
-Cervical sinus on the dorsolateral surface of the neck

Front 488

Reptiles: which drugs work well?

--why is premed generally a waste of time?

Back 488

benzodiazepines

--prolonged clearance of parental drugs

Front 489

Reptiles: choice of drugs for injection induction

Back 489

propofol, telazol, medetomidine + ketamine

Front 490

Tiny beasts: metabolic rate in small animals

Back 490

high

Front 491

Tiny beasts:
1. why is apnea more rapidly fatal in these guys?
2. problem w/starvation and water deprivation

Back 491

1. bc they have low reserves
2. can cause hypoglycemia and dehydration

Front 492

Tiny beasts: what does it mean when you find black/reddish brown discharge around eyes and nose?

Back 492

non-specific response to stress or illness

Front 493

Tiny beasts:
1. what can you use for premed? what does it do?
2. which animal can this be ineffective in? so what do you use instead?

Back 493

1. Atropine - reduces salivation (reduce bronchial secretions); can also use opiods
2. atropine is ineffective in rabbits - use glycopyrrolate

Front 494

Tiny beasts: which spp is stressed by inhalational induction and what can you do to fix this?

Back 494

rabbits

--premed w/benzodiazepine/ ACP/ opioid/medetomidine

Front 495

Tiny beasts: what is the optimal way to induce tiny animals?

Back 495

induction chamber - administer 100% oxygen for 2-3 minutes, then introduce inhalational agent (sevo or haloflurane - NOT isoflurane)

Front 496

Tiny beasts:
1. vein used in rabbits; in larger rodents
2. 2 other commonly used injectable sites

Back 496

1. auricular vein; tail vein
2. Intraperitoneal, IM

Front 497

Tiny beasts:
1. which drug is ineffective if given alone?
2. Rabbits are more sensitive to what combination?

Back 497

1. Ketamine (rodents are highly resistant)
2. ketamine/medetomidine/benzodiazepine

Front 498

Tiny beasts: what two pieces of monitoring equipment should be used?

Back 498

pulse-ox and doppler

Front 499

Tiny beasts: what should you supplement post-op?

Back 499

glucose

Front 500

Rabbits: there are many protocols. what is one very common one?

Back 500

Medetomidine + Ketamine + Buprenorphine (or butorphanol) mixed in the same syringe
-given IM of SC
-still must give oxygen

Front 501

an animal is considered neonatal until:
1. dog and cat
2. foal

Back 501

1. 6 weeks
2. 1 month

Front 502

an animal is considered pediatric until:
1. dog and cat
2. foal and ruminant

Back 502

1. 12 weeks
2. 6 weeks

Front 503

comparison between pediatric and adult:
1. O2 consumption
2. minute volume and respiratory rate
3. pulmonary reserve
4. uptake of inhalational agent

Back 503

1. high (2 - 3 x adult)
2. high (high respiratory rate)
3. minimal pulmonary reserve
4. high in comparison

Front 504

Pediatric: what is the danger in respiratory physiology?

Back 504

lower FRC and high closing volume --> danger of alveolar collapse

Front 505

Pediatric: CV system
1. resting CO
2. stroke volume
3. heart rate
4. myocardium
5. what determines CO? why?

Back 505

1. high
2. low (fixed)
3. relatively high labile HR
4. poorly compliant myocardium
5. heart rate is major determinant of cardiac output since stroke volume is fixed (CO = HR x SV)

Front 506

Pediatrics: T/F become tachycardic is easy.

Back 506

False: becoming bradycardic is easy bc parasympathetic dominance --> high resting vagal tone

Front 507

Pediatrics: explain why distribution and metabolism of agents is different bc of:
1. total protein
2. renal and hepatic fn

Back 507

1. Low albumin/total protein --> incr free portion of highly bound anesthetic drugs
2. Immature renal and hepatic function --> prolonged clearance and altered excretion

Front 508

Pediatrics: explain why distribution and metabolism of agents is different bc of:
1. fluid balance and body fat
2. blood-brain barrier

Back 508

1. --> altered drug distribution
2. may be 5 - 6 x more permeable --> ‘more sensitive’ to anesthetics

Front 509

Pediatrics: anesthetic requirements in neonates and what happens when they become pediatric?

Back 509

-LOW in neonates, but then incr rapidly so are high in paediatric patients

Front 510

fluid requirements in
1. adults
2. pediatrics
3. why are they so different?

Back 510

1. 40 – 60 ml/kg/day
2. 80 – 100 ml/kg/day
3. higher rate of water turnover in pediatric and thus higher fluid requirements

Front 511

Pediatrics: any rise in HCT over the first month usually means what?

Back 511

it is a significant indicator of dehydration

Front 512

Pediatrics: hypothermia will induce ?

Back 512

bradycardia

Front 513

Neonates can rapidly become...

Back 513

hypothermic, hypoglycaemic, dehydrated, hypoxic, and die’

Front 514

Pediatrics: what do you need to be careful to maintain when using fluids?

Back 514

normoglycaemia and normovolaemia

Front 515

Pediatrics: risk of foal death ____ w/age

Back 515

decreases

Front 516

Pediatrics: in foals, when will you see...
1. ruptured bladder present
2. retained meconium present
3. orthopedic growth problems present

Back 516

1. 0.5-3days
2. 2-3 days
3. 1 week and up

Front 517

Pediatrics: what is the cardinal rule when anesthetizing a foal?

Back 517

sedate mom and keep with the foal until anesthetized !!

Front 518

Pediatrics: foal: what do you use to sedate?

Back 518

ace IM or romifidine IM and IV

Front 519

Pediatrics: the renal system in foals is...

Back 519

fully developed at birth

Front 520

Pediatrics: problem w/pre-op fasting?

--is it needed?

Back 520

can cause severe hypoglycemia

--no but if you do it, keep it short

Front 521

Pediatrics: foal:
1. why are benzodiazepines good to use?
2. which ones?
3. when will they cause excitement?

Back 521

1. good sedation in neonates
-minimal cardiovascular depression
-some respiratory depression
2. Diazepam or Midazolam (sedation or induction)
3. w/hepatic damage bc they have an extensive hepatic metabolism

Front 522

Pediatrics: foal: which drugs do you want to avoid bc of their dramatic CV effects? what about these drugs can neonates not cope with?

Back 522

alpha2 agonists

--bradycardia

Front 523

Pediatrics: foal: which opioids can be used? what do you have to be careful not to cause?

Back 523

all

--bradycardia (careful w/dose)

Front 524

Pediatrics: NSAIDS in foals are commonly given w/?

--what do we have to be careful of?

Back 524

GI protectants

--toxic effect in foals bc extensive hepatic metabolism

Front 525

Pediatrics: foal:
1. drug of choice for IV injection
2. which drugs should we avoid? why?

Back 525

1. Ketamine - NOT protein bound, via sympathetic stimulation --> stimulates CV system incl HR.
2. Thiopental (slow recovery, no fat for redistribution, immature enzymes)

Front 526

Pediatrics: foal: drug of choice for inhalational anesthesia

Back 526

sevoflurane

Front 527

Pediatrics: foal:
in foals less than 2 weeks old, use what induction/maintenance agents?

Back 527

-Sevoflurane (or iso)
-diazepam/midazolam if needed for intubation
-Sevo or Iso maintenance
-Opioids +/- NSAIDS

Front 528

Pediatrics: foal:
in foals 2-12 weeks old, use what induction/maintenance agents?

Back 528

-might premed - acepromazine
-induction:ketamine & diazepam or midazolam (same syryinge)
-nasal tube is can't intubate
Isoflurane or sevoflurane maintenance
-analgesia: opioids +/- NSAIDS w/gastro-protectants

Front 529

Pediatrics: foal:
in foals over 12 weeks, use what induction/maintenance agents?

Back 529

Treat as adults!!
ACP
Xylazine
Ketamine/ benzodiazepine
Isoflurane

Front 530

Pediatrics: in young foals, what happens to the anesthesia?
--why?

Back 530

tend to get "swinging" anesthesia, from light-deep-light

--low MAC, rapid uptake
--no fat reservoir

Front 531

Pediatrics: foal: what type of circuit do you use?

Back 531

small animal circle or large animal circle with reduced carbon dioxide absorbent

Front 532

Pediatrics: foal: how do you treat hypotension?

Back 532

the same as you would in adults:
-reduce inhalational agent
-fluid bolus (crystalloid or colloid)
-treat bradycardia (anticholinergics, Atipamezole)
-dobutamine or NE

Front 533

Pediatrics: puppies/kittens: premed drugs

Back 533

-benzodiazepines
-opioids w/o bradycardia (ex meperidine)
-tiny doses ACP only in older
-sometimes anticholinergic agents

Front 534

Pediatrics: pup/kit: induction and maintenance
1. make sure you:
2. what drug for mask induction?
3. what drug for IV induction?
4. advantage of low ketamine dose
5. avoid which drugs?

Back 534

1. Pre-oxygenate!
2. sevoflurane
3. propofol or etomidate
4. NOT protein bound
5. barbiturates

Front 535

pediatrics: pup/kit: analgesia
1. avoid which drugs?
2. Carprofen is licensed for what age?
3. Meloxicam is licensed for what age?
4. NSAID licensed for kittens under 12 weeks

Back 535

1. avoid most NSAIDs
2. puppies > 6 weeks old
3. dogs > 6 months old and calves over 1 week old
4. none

Front 536

Pediatrics: farm

what drugs are used for disbudding goat kids?

Back 536

lidocaine, procaine
--iso by mask in food animals

Front 537

Geriatric: CV consequences of old age

Back 537

-reduced cardiac reserve
-chronic valvular disease, hypertrophic cardiomyopathy
-incr peripheral vasoconstriction assoc with autonomic inefficiency
-reduced hemopoietic efficacy

Front 538

Geriatric: respiratory consequences of old age

Back 538

-reduced efficiency of gas exchange
-impaired respiratory muscle fn
-pulmonary fibrosis
-more dead space
-↑risk of respiratory obstruction
-greater proportion of tidal ventilation at lung volumes below closing volume (air trapping, V/Q mismatching, reduced PaO2 )

Front 539

Geriatric: organ function consequences of old age

Back 539

-reduced renal and hepatic reserves
-reduced drug clearance - GFR
-reduced efficacy of fluid and electrolyte loading
-impaired perfusion
-decreased hepatic mass
-decreased hepatic perfusion
-decreased skeletal muscle mass
-increased fat

Front 540

Geriatric: what happens to MAC of inhaled anesthetics as the animal ages?

Back 540

progressively decreases by 30% from young adult values with increasing age

Front 541

Geriatric: minimum reduction of ___ GFR

Back 541

50%

Front 542

Geriatric: premed drugs

Back 542

less sedation is required:
-opioids
-benzodiazepines or very low dose of acepromazine

Front 543

Geriatric: what do you do to improve ventilatory reserve?

Back 543

pre-oxygenate for 2-5 minutes

Front 544

Geriatric: how do you medicate an old horse?

Back 544

like any adult horse, except for low doses of ace