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156 Cards in this Set
- Front
- Back
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When does the Pt enter the Maintenence/monitoring phase?
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After animal is induced
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What is the goal of maint & Monit?
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Insure significant & safe anesthetic depth for Sx or other diagnostic procedures.
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Why are vitals closely monitored during Maint & Monit?
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to make sure they stay within safe acceptable limits
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What do we monitor the HR & rhythm with during anesthesia?
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Esophageal Stethoscope
-measure tip of nose to mid-sternum to find appropriate length |
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What are some ways to monitor pulse during anesthesia?
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*sublingual
Digital dopplar |
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What is a normal bpm range for dogs and cats under anesthesia?
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60-120
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What is the lowest acceptable HR for a large dog under anesthesia?
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60 bpm
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What is the lowest acceptable HR for a small dog under anesthesia?
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70 bom
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What is the lowest acceptable range for a cat under anesthesia?
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100 bpm
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Pulse strength can indicate BP quality and pulses will disappear below _____mmHg.
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60 mmHg
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ECG measure electrical activity of the heart and what type of lead is typically done?
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Lead II, one of many types
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In Lead II, the P wave represents what?
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Atrial contraction/depolarization
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In lead II, the QRS wave represents what?
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Ventricular contraction/depolarization
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In lead II, the T wave represents what?
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Ventricular repolarization
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In regards to an ECG, what does 60 cycle interference refer to?
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electrical interference from cautery, warming blankets etc.
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Normal sinus rhythm means that there is a _______ for every _______.
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QRS complex
P wave |
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Respiratory sinus arrhythmia/dysrhythmia is a rhythm commonly seen in dogs that involves:
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-A regularly irregular rhythm that should match respiratory rate
-HR speeds up during inspiration -some Anti-cholinergics will decrease this irregularity |
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What are some concerns about sinus tachycardia?
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-Increases workload on the heart
-Can lead to cardiac arrest -can cause pulse deficit -can cause poor perfusion |
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What are some concerns about sinus bradycardia?
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If it becomes severe enough, it can lead to cardiac arrest
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What is considered sinus bradycardia in a large dog?
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<60bpm
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What is considered sinus bradycardia in a small dog?
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<70 bpm
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What is considered sinus bradycardia in a cat?
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< 100 bpm
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What does a First degree A-V block look like on an ECG and what is this a result of?
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*Prolonged P-R interval
------cannot diagnose in Sx, need specialist *Conduction is working but there is a delay between A & V contraction due to SLOWING of electrical conduction. *There is potential to have this progress to second degree AV block |
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What defines a Second degree heart block and what is this a result of?
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*Some P waves not followed by QRS complexes
-more/most common -Results from some electrical impulses getting through but not some are blocked. -Will see a lower HR |
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What defines a Third Degree heart block and what is this a result of?
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*Complete heart block
*Will see wide bizarre complexes *A & V contractions occur independently of each other-no communication between the 2=no rhythm. -slow HR, poor perfusion |
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What is the main Tx for third degree heart blocks?
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Pacemaker needs to be put in
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What is a PVC/VPC and what is it a result of?
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The electrical impulse that should be originating in Atrium is coming from somewhere in ventrical rather than the SA Node.
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What is commonly seen after a VCP/PVC?
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A compensatory pause w/o P waves
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What is a Unifocal PVC?
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A VPC that originates from same place in ventricle
**Better than Multifocal! |
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What are some possible anesthetically related causes of tachycardia?
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-Too light-excessive response to surgical stimulation
-Drugs-Atropine, Ketamine, Epinephrine -Hypoxia -hypotension -Blood loss/hemmorhage/anemia -Hyperthyroidism -Underlying cardiac disease |
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During M & M of anesthesia, what should you do if your Pt experiences hypotension?
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-Decrease vaporizer
-give a bolus of fluids Possibly give meds such as Ephedrine |
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During M & M of anesthesia, what should you do if your Pt experiences hemorrhage?
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Increase fluids
Possible transfusion |
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What are some possible causes of bradycardia?
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*TOO DEEP!
-Drugs_ *Alpha 2 agonists * Higher doses of opioids -Vagal nerves stimulation -Hypothermia -Hyperkalemia |
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What are some interventions for bradycardia?
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-Too deep? Decrease vaporizer
-Alpha-2's are REVERSIBLE -Anticholinergics to block vagal nerve stimulation -Warm up -Hyperkalemia-non-anesthetic interventions |
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What is the emergency drug of choice for bradycardia?
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Atropine which has a faster onset compared to Glyco IF Alpha 2 was not already given
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What are some possible causes of II and III degree heart blocks?
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-Excessive anesthetic depth
-Drugs-esp Alpha 2's -Electrolyte acid base imbalances such as hyperkalemia -Underlying cardiac disease. ***MYOCARDIAL HYPOXIA-very common cause |
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What are some possible Tx for II and III degree heart blocks that may be anesthetically related?
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-Depth related-adjust the vaporizer
-Reverse the Alpha-2's -Myocardial hypoxia-ventilate |
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What is the general rule for all arrythmia's?
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Ventilate
Turn down vaporizer as much as possible |
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What is the drug of choice for Tx of heart blocks?
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Atropine will fix II degree.
III degree will usually be noticed prior to Sx but Atropine will buy some time if it comes up during Sx till a pacemaker can be put in. |
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PVC/VPC can cause pulse deficits and some possible causes are?
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-Too deep
-Barbituates/halothane -Electrolyte acid base imbalances -hypercapnea-respir. acidosis -Underlying cardiac disease -Stress/Pain -GDV-almost always will cause this --Cardiac Trauma, bruising (HBC) -Myocardial hypoxia |
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What are some possible interventions for VPC/PVC's?
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-Decrease depth
-Hypercapnea-ventilate - |
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What are some possible treatments for PVC/VPC?
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-Lidocaine IV or CRI for excessive PVC's
defined as 3 or more in a row or more in 15 minutes |
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What are multifocal PVC's?
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PVC's that originate in different places within the ventricles (more of an issue than unifocal)
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What will be the reult of 3 or more VPC's in a row in regards to pulse quality?
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Pulses will not be palpable because perfusion is too low
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What is the definition of Ventricular tachycardia?
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Multiple VPC's in a row
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What is V-tach ALWAYS treated with?
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LIDOCAINE
-as well as ventilating and turning vaporizer down or off |
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How is ventricular fibrillation defined?
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-NO recognizable complexes
-Irregular -Little to no cardiac output due to weak uncoordinated contractions -CARDIAC ARREST IS IMMINENT! |
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What is the Tx for V-tach?
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Defibrillate Pt
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What is Asystole and what is its Tx?
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No electrical activity ----->no heart contractions
-CPCR! |
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What will you see on an ECG if hyperkalmia is present?
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T waves tall and spiked along with bradycardia
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What do Tall and wide T waves indicate?
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Can indicate Myocardial Infarction
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Rate and depth of respirations tend to decrease to what during anesthesia?
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8-30 RR average
TV decreases by 25% |
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Res bag that is too big is better than one that is too small because a Res bag that is too small will-
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-Increase pressure in breathing system
AND patient -Pt will have difficulty exhaling---->hypercapnia |
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Respirations should be smooth and regular. What are some commonly seen breathing changes seen with Ketamine and Propofol?
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Ketamine-apneustic breathing
Propofol-Transient apnea -give slowly to minimize -got hooked to O2 too quickly ----no vaporizer until regular breathing |
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How often should you ventilate a normal patient?
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Every 3-5 minutes
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How is hypoventilation defined?
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Decreased Respiration Rate and TV
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What are some causes of hypoventilation?
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-Too deep
-Animal is obese -Tilted Sx table-head down, butt up for Sx procedure puts pressure on diaphragm |
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How is hyperventilation defined?
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FAST RR and decreased TV
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What are some possible causes of Hyperventilation?
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-Too light/Sx stimulation response***First sign they are too light
-Metabolic Acidosis-too many H+ increases Ph---> DKA leads to ketones breaking down -Respiratory/lung disease |
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What are some ways to deal with hyperventilation?
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increase depth
Ventilating will help increase TV and improve oxygention |
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What is a commonly used drug that may cause hypothermia due to vasodialation?
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Ace
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What are some possible causes of hypothermia?
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-Ace and inhalents
-Decreased metabolic rate (less heat generated) -Metal tables -Room temp fluids -***OPEN body cavities*** -Shaving & alcohol -Neonates & geriatrics have a decreased ability to thermoregulate |
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Hypothermia can cause-
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-Can easily be Od'd because lower metabolism requires less anesthetic
-Prolongs recovery -Shivering - increases O2 demands by 600% |
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How can we prevent hypothermia in our anesthesia patients?
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-Warm IV fluids
-Circulating water blanket/table -Cover metal table w/blanket -Bair hugger-warm air blanket -Warmed rice bags -Warmed expired IV fluids -Warming frisbees -Covering paws |
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An Apnea monitor does what?
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Monitors amount of breathing/breaths
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Blood pressure monitoring refers typically to arterial pressure and is very important to monitor because_______
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Hypotension is common
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The 3 things that Blood pressure is determined by is?
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-Cardiac Output
-Vascular Resistance -Blood Volume |
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What is the pump part of BP?
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Pump is the Cardiac Output which is made up of HR * Stroke volume
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What is tube part of BP?
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Vascular resistance of circulation
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What is the fluid portion of BP?
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Blood volume
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The systolic portion of the blood pressure is the top # and refers to what?
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Ventricular contraction
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The diastolic is the bottom # and represents what?
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Ventricular relaxation
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Mean artiole pressure/MAP refers to
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Average pressure in arteries through the cycle of systole/diastole
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What number is the best to have since it represents quality of tissue perfusion?
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Mean arteriole pressure/MAP
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What is the normal range for Systole?
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100-160mmHg
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What is the normal range for Diastole?
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60-100mmHg
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What is the normal range of MAP?
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80-120mmHg
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What defines hypotension under anesthesia in regards to BP?
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Systolic- <80mmHg
Map <60mmHg |
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How does a Doppler probe work?
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By using ultrasound technology to convert pulse to an audible sound (whooshing noise)
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Where should a Doppler probe typically be placed?
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-Front leg-on metacarpal artery proximal to metacarpal pad
-Back leg on metatarsal artery -Tail-on coccygeal artery |
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What does the first whoosh heard when a BP cuff is released represent?
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The systolic pressure
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What does the a Doppler let you measure?
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Systolic BP
Pulse |
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What does a capnograph measure?
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End Tidal Co2 (ETCO2)
In tidal CO2 (INCO2) Respiratory Rate |
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What is the most common type of capnograph?
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Side stream-an adapter that sits between ET tube and O2 tube
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What does the Capnograph give an estimation of?
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Amount of CO2 dissolved in the blood
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Under anesthesia, INCO2 should be close to what?
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ZERO!
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Under anesthesia, ETCO2 should be between what and what?
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35-45mmHg
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Arterial blood gas analysis can tell us what?
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There are two sets of information that can be obtained from an ABG. The first is the blood acid-base balance, and the second is blood oxygenation. The measures of blood oxygenation are the oxygen (pO2) and the oxygen saturation (O2 sat). The dissolved oxygen in the blood is called the pO2 and is measured in mmHg. The second measure is the oxygen saturation, which represents the amount of hemoglobin sites with attached oxygen. Oxygen saturation is expressed as a percentage of the total sites that have hemoglobin. The O2 sat can be continually monitored non-invasively with pulse oximetry.
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Hypotension under anesthesia is defined as :
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systolic <80mmHg
MAP <60 mmHg |
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Hypotension causes inadequate perfusion to what organs of top concern ?
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**Kidneys are most sensitive to effects of poor perfusion
-Heart -Brain |
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What are some causes of hypotension in relation to anesthesia?
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-**Excessive anesthetic depth**
-Vasodialation -decreased CO -decreased HR -->Drugs cause vasodialation-Ace, Alpha2's, Inhalents -->Blood loss |
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What are 3 interventions for hypovolemia?
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-Turn down vaporizer-in 1/2% increments
-Bolus fluids -Drugs |
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What type of fluid is usually administered to our patients?
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Crystalloid-a balanced electrolyte solution that moves from blood vessels to tissues quickly.
(LRS, 0.9% Saline) |
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What rate are cystalloids typically administered?
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-10 mls/kg/hr Surgical fluids
for normal patients |
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What rate is a bolus of fluids typically given?
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1) 3-5 mls/kg
2) double surgical fluids- 20mls/kg and run for 15min's |
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How many times can you bolus an animal with cystalloids before deciding that it is not going to work?
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Twice--after that if it is not working, then it is not going to
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If the crystalloids are not working, what is a next possible fluid of choice to deal with hypotension?
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Colloids such as Hetastarch, blood products
These stay in blood vessels and do not go to the tissues, thus increasing blood volume. |
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Try to bolus an animal prior to anticipated blood loss. What are some of the bloodier surgeries where this may be a concern?
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-Amputations
-Splenectomy -Very large pregnant spay -large tumor removal C-Section |
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What does an Inotrope do?
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increases force of cardiac contraction
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What does a Chronotrope do?
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Increase HR
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What does a vasopressor do?
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blood vessel constriction
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What is 1 of the 3 common drugs used to treat hypotension and what is it's effects?
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----Dopamine +Inotrope, +chronotrope
-increases renal perfusion and urine output ( Save the Nephrons!) -Administered Micrograms per kg per minute -Diluted in bag of fluids -CRI, esp long anesthesias |
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What is the 2 of the 3 common drugs used to treat hypotension and what is it's effects?
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Dobutamine- + Inotrope, slightly lower amount of +Chronotrope
-Given in Micrograms per Kg per minute -CRI drip -Common in Equine |
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What is the 3rd of the 3 common drugs used to treat hypotension and what is it's effects?
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Ephedrine +Vasopressor, lower amount of INO and CHRONOTROPIC effects
-cheap, easy to give -great for short anesthesia's -can give up to 2 doses |
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What are the 2 ways to monitor BP indirectly?
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Doppler bp monitor
Oscillomter bp monitor |
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What are the 3 parts of the Doppler?
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Cuff
Probe Amplifier |
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When is the Doppler cuff put on and how do you measure for the right size?
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First'
-Width should be 40% of circumference of the limb or tail. -Too big is better than to small because too small gives artificallly high BP readings and we are more concerned about too slow |
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The probe of the Doppler should be placed how?
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With Ultrasound gel on concave side, with probe distal to cuff, place on top of appropriate artery
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What is the 3rd step of setting up a Doppler for monitoring anesthesia?
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Turn on the amplifier and be sure to hear the "whoosh, whoosh, whoosh" sound
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To measure the BP using a Doppler, inflate the BP cuff until there is no sound, then
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slowly release the pressure from the cuff until first woooshing sound is heard and this number is the Systolic portion of a BP measurement
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What animals does a doppler work best on?
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Long, straight legged dogs with little amounts of hair.
-Not very accurate in cats--some may add 14 mmHg to measurement |
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Oscillometer is BP monitors are attached to the Surgivet for computer monitoring of BP and this measures BP automatically by detecting
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oscillations within the cuff caused by pulsations of artery beneath cuff.
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A Doppler measures what 2 things?
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Systolic BP
Pulse |
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A Oscillometer BP monitor measures what 3 things?
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Systolic
MAP Pulse |
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What is one disadvantage of Oscillometer BP?
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May not be as accurate in small patients
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Direct arterial pressure is a second way to measure BP and is common in equine anesthesia. How does this method work?
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-More accurate but invasive
-An indwelling cath is placed in an artery which is then connected to a manometer or transducer by fluid filled tubing for continuous monitoring |
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What does decreased ET CO2 indicate?
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Decreased amounts of dissolved CO2 (pCO2) which leads to hypocapnia
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What are some possible causes and results of Decreased ETCO2?
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Causes
---Increased RR-hyperventilation --ET tube in Esophagus --Results may be: -Pulmonary arrest -Respiratory arrest |
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What does Increased ET CO2 indicate?
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Increased amounts of dissolved CO2 (pCO2) in blood--hypercapnia
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What can increased ET CO2 lead to and what may it be due to?
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Can lead to respiratory acidosis
-Due to respiratory depression causing hypoventilation (decreased RR & TV) |
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What is the best way to correct increased ET CO2?
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INCREASE VENTILATIONS
0r put on ventilator |
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What is something that may need to be done during anesthesia if you increase ventilations?
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Decrease vaporizer
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What is something that may need to be checked if increased respiration (INS CO2)?
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-Soda lime granules are exhausted
-RB or O2 flowr ate not high enough |
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What does Pulse Oximetry measure?
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-O2 Saturation (SaO2) which represents % of hgb saturated with oxygen
-pulse -How well lungs deliver O2 to the blood, indicating degree of oxygenation |
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How do Pulse Oximeters measure?
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They measure pulsatile signals across
perfused tissue using 2 different wavelengths of light. -Probe emits 2 wavelengths of light -red and infrared, which allows for differentiation between reduced hgb and oxygented hgb. Reduced absorbs more red light Oxygentated absorbs more infared |
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Pulse Oximeter only measures what type of blood?
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Arterial blood
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Where should the Pulse Ox probe be placed?
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-Should be attached to thin, hairless, non-pigmented area
--Usually the tongue -Lip, pinna, toe web, achilles tendon, vulvar fold -rectal probe |
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Anesthetized patients breathe 100% O2, so O2 sat of Hgb should be at least 95%. What defines Hypoxia when an animal is on O2?
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Borderline hypoxia- 90-95%
Hypoxia- O2 sats <90% **correct BEFORE it gets here!! |
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In regards to Pulse Oximetry, at what % will you start to see Cynosis?
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when O2 sats hit <85%
-Pulse Oximetry can detect hypoxia before it is visually evident |
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Reasons for decreased pulse oximeter readings?
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-Probe placement issues
-Over time probe pinches and causes decreased perfusion -Peripheral vasoconstriction-Alpha2's, cold tongue -ET tube issues-placement, kinked, plugged -O2 flow rate too low -Lung issues/disease VQ mismatch |
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What is a VQ mismatch?
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V refers to ventilation
Q refers to pulmonary perfusion, circulation from heart to R to L lung to heart. -fairly common - |
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What are some examples of VQ mismatch?
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Pulmonary thromboembolism-lacking in even perfusion but ventalation is ok
----Collapsed lung- -Perfusion ok -Ventilation not ok -end result is same-decreased O2 perfusion |
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What are some reasons heart reasons for VQ mismatches?
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Severe bradycardia & Arrhythmias will both affect perfusion to the lungs
-Septal defects-VSD, PDA |
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When does Recovery begin in relation to anesthesia?
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When anesthesia concentration begins to decrease in the brain.
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How are most inhalant drugs removed from the body?
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Exhaled
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How are most injectable drugs removed from the body?
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Metabolized by the liver
Kidney excretion Barbituates-are redistributed from the brain -->fat--->metabolised *some have reversal agents |
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Animals often survive Sx and anesthesia only to die during recovery. What are some reasons that this is a vulnerable time?
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-Off O2
-Disconnected from monitors |
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What are 3 things that increase chances of complications during recovery?
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-higher risk patient
-longer anesthesia -inexperienced anesthetist |
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What are some ways to improve recovery?
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-Allow them to breath O2 post inhalant shut off
-Deflate cuff, untie so you can extubate quickly |
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Respiratory complications are common in recovery, so we watch Respirations, MM, Color, CRT and pulses. What are some ways to help an animal in respiratory distress?
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-Reposition to sternal
-Extend head and neck -pulling out tongue may open airway if animal will allow it -O2 mask or flowby O2 -May need to reinduce and reintubate |
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During recovery, an animal may vomit and not be able to swalllow. What can we do to help keep them from aspirating?
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Hold them butt up to allow gravity to help.
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What are some other things that may help an animal during recovery?
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-Gentle stimulation, reassurance to gently wake them up
-Warm them back up, keep them warm ---->Temp up to 100 degrees F -Watch for licking & chewing and don't let it happen -give post-op analgesia |
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What are some Post-op hemorrhage indicators?
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-Hypothermia--they just do not warm up
-Depression-slow to get up and recover -Increased CRT, Pale MM -Increased HR, RR -Decreased BP |
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When does Recovery begin in relation to anesthesia?
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When anesthesia concentration begins to decrease in the brain.
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How are most inhalant drugs removed from the body?
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Exhaled
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How are most injectable drugs removed from the body?
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Metabolized by the liver
Kidney excretion Barbituates-are redistributed from the brain -->fat--->metabolised *some have reversal agents |
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Animals often survive Sx and anesthesia only to die during recovery. What are some reasons that this is a vulnerable time?
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-Off O2
-Disconnected from monitors |
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What are 3 things that increase chances of complications during recovery?
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-higher risk patient
-longer anesthesia -inexperienced anesthetist |
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What are some ways to improve recovery?
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-Allow them to breath O2 post inhalant shut off
-Deflate cuff, untie so you can extubate quickly |
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Respiratory complications are common in recovery, so we watch Respirations, MM, Color, CRT and pulses. What are some ways to help an animal in respiratory distress?
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-Reposition to sternal
-Extend head and neck -pulling out tongue may open airway if animal will allow it -O2 mask or flowby O2 -May need to reinduce and reintubate |
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During recovery, an animal may vomit and not be able to swalllow. What can we do to help keep them from aspirating?
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Hold them butt up to allow gravity to help.
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What are some other things that may help an animal during recovery?
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-Gentle stimulation, reassurance to gently wake them up
-Warm them back up, keep them warm ---->Temp up to 100 degrees F -Watch for licking & chewing and don't let it happen -give post-op analgesia |
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What are some Post-op hemorrhage indicators?
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-Hypothermia--they just do not warm up
-Depression-slow to get up and recover -Increased CRT, Pale MM -Increased HR, RR -Decreased BP |
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After doing a TPR on a Pt you suspect is hemorrhaging, what is the next thing you should do?
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PCV & TP
-hopefully was done prior to Sx so you can compare -TP will decrease first and more quickly -Can do a belly tap/Rad's to check for blood if it was an abdominal Sx |
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What are some concerns about Brachycephalic anesthesia?
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-Increased risk due to elongated soft palate which can lead to airway obstruction during post-exubation recovery
-Stenotic nares -Smaller tracheal diameter -Increased parasympathetic tone increases risk of bradycardia |
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How can we decrease anesthetic risk for brachycephalic animals?
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-Leave ET tube in as long as possible
-Give anti-cholinergics -Give tranq/seds to decrease anxiety -Pre-oxygenate before induction-flowby -IV induction followed by rapid and efficient intubation |
