Anesthesiology Choosing An Anesthetic Protocol: Dogs & Cats

Front 1

Are cats pretty much just small dogs?

Back 1

No! different handling and response to drugs

Front 2

What is a common side effect of anesthesia in dogs and cats?

Back 2

Hypothermia, as body mass gets smaller the more prone to hypothermia

Front 3

Much of case 'management' in small animals occurs before the patient is anesthetized such as ____, _____ and ______.

Back 3

Drugs
Techniques
Be prepared

Front 4

What are 2 components of preparing a small animal patient for anesthesia?

Back 4

Fasting & stabilization

Front 5

What are the 5 components of the anesthetic plan for small animals?

Back 5

1) Preanesthetic assessment
-history, PE, temperament
2) Patient preparation
3) Selection of appropriate drugs
-Premedication, induction, maintenance
4) Monitoring & supportive care
5) Recovery & post-procedure pain management

Front 6

What are 2 reasons there are minimal requirements for preanesthetic preparation of small animals?

Back 6

-not as prone to regurgitation
-rapid gastric emptying

Front 7

How long should you withhold food and water from a small animal before anesthesia?

Back 7

Food: 6 hours (main reason is to reduce risk of regurgitation & aspiration)
Water: 1-2 hours
-neonates not routinely fasted

Front 8

What are the 5 sedatives that can be used for small animal premedication?

Back 8

1) Acepromazine
2) Dexmedetomidine
3) Xylazine
4) Midazolam
5) Diazepam

Front 9

What are the general agents used for sedation in small animals?

Back 9

Sedative +/- opioid +/- anticholinergic

Front 10

What are 7 opioids that can be used for small animal premedication?

Back 10

1) Morphine
2) Butorphanol
3) Hydromorphone
4) Buprenorphine
5) Oxymorphone
6) Fentanyl
7) Meperidine

Front 11

What is used for aggressive/ difficult to manage small animals?

Back 11

Can add ketamine or telazol
-tank induction w/ inhalant in fractious cats

Front 12

What are 5 premedication considerations of small animals?

Back 12

1) Patient preanesthetic assessment
2) Drug pharmacology
3) Personal knowledge & experience
4) Personnel, drugs & equipment available
5) Procedure to be performed

Front 13

What are 4 properties of a small animal premedication should be taken into consideration?

Back 13

1) Does it decrease anxiety/stress
2) Sedation/chemical restraint
3) autonomic reflex
4) decrease anesthetic requirements

Front 14

What are the 3 sedatives used in small animal anesthesia?

Back 14

1) Acepromazine
2) Diazepam & midazolam
3) Dexmedetomidine & xylazine

Front 15

What is the tranquilization, onset and duration of acepromazine?

Back 15

Mild-moderate tranquilization
Slow onset, long duration

Front 16

What are the side effects of acepromazine?

Back 16

Mild CV effects
-vasodilation & hypotension

Front 17

Are the minor tranquilizers (diazepam & midazolam) reversible?

Back 17

Yes

Front 18

What type of sedation does dexmedetomidine & xylazine provide? Duration? Onset?

Back 18

Dependable moderate-marked sedation
Rapid onset, duration dose dependent

Front 19

What are the side effects of dexmedetomidine & xylazine?

Back 19

Significant CV effects
-hypertension, bradycardia

Front 20

What are the 6 side effects of opioids?

Back 20

1) Vomiting, defecation
2) Panting
3) sedation/dysphoria
4) Bradycardia
5) Pyloric sphincter contraction
6) Hyperthermia

Front 21

Compare the duration and effects of atropine and glycopyrrolate.

Back 21

Atropine shorter acting and more profound effects

Front 22

Are anticholinergics routinely used in small animals?

Back 22

Controversial
Tachycardia may be detrimental to some patients

Front 23

When is intravenous catheterization used in small animals?

Back 23

For all anesthetic procedures
-administration of anesthetic agents
-fluid administration
-emergency drugs

Front 24

What are the 2 most common sites for intravenous catheterization in cats and dogs?

Back 24

1) Cephalic
2) saphenous
-lateral-dog
-medial-cat

Front 25

What are 3 less common sites of IV catheterization in dogs and cats?

Back 25

1) Jugular
2) Ear
3) Tongue

Front 26

The drug/method selection used for induction in small animals is based on what 6 factors?

Back 26

1) Side-effect profile
2) Administration options
3) Equipment
4) Cost
5) Recovery characteristics
6) Personal preference/familiarity w/ drugs & procedures

Front 27

What are the 4 advantages of intravenous anesthetics?

Back 27

1) Rapid loss of consciousness
2) Less patient stress (?)
3) Rapid control of airway
4) Less risk of injury to patient or staff (?)

Front 28

What is a disadvantage of IV anesthetics?

Back 28

Metabolism of drugs require for recovery

Front 29

______ is the slowest, least controlled method of induction used for small animals.

Back 29

Tank inductions

Front 30

Why are tank inductions a bigger risk for the staff?

Back 30

Considerable environmental contamination w/ inhalant anesthetic

Front 31

What setting should you use for the O2 flow & vaporizer setting for tank induction?

Back 31

Highest O2 flow & vaporizer setting possible

Front 32

What size of mask do you want to use for induction?

Back 32

Smallest size mask with tight seal

Front 33

Do you want mild, moderate or heavy sedation for mask induction?

Back 33

Heavy

Front 34

What are the two techniques of mask induction?

Back 34

Start low turn up vaporizer slowly
Pedal to the metal

Front 35

What are the 2 most common IV induction agents used in small animal anesthesia?

Back 35

1) Propofol
2) Ketamine/ diazepam

Front 36

What are the 4 less common IV induction agents used in small animal anesthesia?

Back 36

1) Telazol
-tieltamine/zolazepam
2) Ketamine/ midazolam
3) Etomidate
4) Neuroleptanalgesic
-opioid + tranquilizer

Front 37

Is propofol cumulative? controlled?

Back 37

No, no

Front 38

What are the cardiorespiratory depression effects of ketamine/ diazepam?

Back 38

Minimal, relatively broad therapeutic index

Front 39

What is a downfall of ketamine/ diazepam for induction agents?

Back 39

Less muscle relaxation, reflex activity remains
-Poorest intubation quality

Front 40

What are 2 advantages of ketamine/ diazepam?

Back 40

1) inexpensive
2) fairly rapid recovery, less desirable quality though

Front 41

What are 3 disadvantages of etomidate?

Back 41

1) Expensive!!
2) Relatively poor induction quality
3) Adrenocortical suppression

Front 42

When is etomidate the drug of choice in small animals?

Back 42

Patient with severe cardiac disease

Front 43

What is the purpose of using adjuncts such as diazepam or lidocaine or opioids during small animal anesthesia?

Back 43

Used to decrease dose of induction drugs

Front 44

When should adjuncts be administered during anesthetic protocol?

Back 44

Immediately preceding other induction drugs

Front 45

What is neuroleptanalgesia?

Back 45

Combination of opioid + tranquilizer

Front 46

When is neuroleptanalgesia used for induction in small animals?

Back 46

Occasionally used for induction in severely depressed or compromised dogs
-minimal cardiovascular depression

Front 47

What combination is usually used for neuroleptanalgesic induction?

Back 47

Usually diazepam/ midazolam + mu opioid agonist
-fentanyl
-hydromorphone
-oxymorphone

Front 48

When are IV anesthetics used for maintenance?

Back 48

Short procedures <30-45 minutes
-can get expensive

Front 49

What are 4 things to consider when using intravenous anesthetics for maintenance?

Back 49

1) Airway protection
2) O2 supplementation
3) Ventilatory support
4) Adequate monitoring & vigilance

Front 50

What are 2 drugs used IV for anesthetic maintenance?

Back 50

Propofol
Ketamine/ diazepam

Front 51

What are 4 factors to consider when trying to select an inhalant for small animals?

Back 51

1) Cost
2) Vaporizers available
3) Case load
4) Method of administration
-closed circuit
-semi-closed/ semi-open circuit
-non-rebreathing circuit

Front 52

When do you want to use a non-rebreathing circuit for small animals?

Back 52

Patients <5-7 kg

Front 53

What fresh gas flow rate do you want to use with non-rebreathing circuits?

Back 53

200-300 mLs/kg/min

Front 54

When do you use rebreathing circuits (circle, 'Y', Universal F)?

Back 54

Patients > 5 kg

Front 55

What do you want to use for the induction flow rate with rebreathing circuits? Maintenance?

Back 55

Induction: 100-150 mLs/kg/min
Maintenance: 30-50 mLs/kg/min

Front 56

In a closed system flow rate =_______.

Back 56

Metabolic O2 consumption

Front 57

What are 3 reasons we use non-rebreathing circuits in patients < 5 kg?

Back 57

1) Higher oxygen flow rates --> increased cost
2) Less resistance to breathing
-no valves
-no CO2 absorbent
3) Less dead space (?)

Front 58

True or false. Patients less than 5 kg absolutely cannot be maintained on a circle circuit.

Back 58

False, may do fine on a circle, pediatric circle systems are available

Front 59

Why is it so important to use the largest diameter tube that comfortably fits your patient?

Back 59

Tube is the LARGEST source of airflow resistance

Front 60

Are high volume/ low pressure cuffs or low volume/ high pressure cuffs preferred in small animal anesthesia?

Back 60

High volume/ low pressure cuffs

Front 61

What tubes are preferred for small animal intubation?

Back 61

Clear tubes preferable

Front 62

Why do you want to try to avoid touching the epiglottis when performing endotracheal intubation on a small animal?

Back 62

Can get laryngospasms especially in cats

Front 63

What small animal do we want to use lidocaine in?

Back 63

Cats
-reduce laryngospasm, give it time to work

Front 64

What do you want the pressure to be in the endotracheal tube cuff?

Back 64

20 cm H2O to prevent leak

Front 65

How big of a reservoir bag do you want to use in small animals?

Back 65

5-6 x tidal volume
-tidal volume= 10-20 mLs/kg
-if in doubt use larger size

Front 66

What are 2 types of fluids used for supportive care in small animal anesthesia?

Back 66

1) Crystalloids
2) Colloids

Front 67

What are some external heating sources?

Back 67

Circulating warm water blankets, heat lamps, electric blankets, hot water bottles, rice socks
-Use with caution- patient burns possible

Front 68

What drugs are used for cardiovascular support in small animals?

Back 68

Sympathomimetics
-dopamine
-dobutamine
anticholinergics
-atropine
-glycopyrrolate

Front 69

What are 3 emergency drugs used in small animal anesthesia?

Back 69

1) Atropine
2) Epinephrine
3) Lidocaine

Front 70

What are 2 ways to check the CNS status of a small animal under anesthesia?

Back 70

Reflexes, jaw tone

Front 71

What are the 3 ways to monitor the cardiovascular system of small animals?

Back 71

Rate, rhythm (ECG)
Blood pressure (doppler, oscillometric, direct)

Front 72

Hemoglobin saturation tells us about __________.

Back 72

oxygenation

Front 73

Capnography tells us about _______.

Back 73

Ventilation

Front 74

Why is it important to avoid hypothermia in small animals?

Back 74

If shivering when waking up then oxygen demands increase and so respiratory depression + shivering--> hypoxia

Front 75

What are 3 possible adverse events that occur during recovery from anesthesia?

Back 75

1) Hypoxemia/ hypercapnia
2) Airway obstruction
3) Regurgitation/ aspiration

Front 76

What is the goal of the anesthesiologists during recovery?

Back 76

Smooth transition from unconsciousness to consciousness

Front 77

What are the 4 steps to recovering a small animal from anesthesia?

Back 77

1) Inhalant off, remove from ventilator
-support ventilation at slow rate if apneic
2) Increase O2 flow if using circle
-"wash out" residual inhalant
3) Leave patient attached to circle for 5-10 m
-scavenge residual inhalant
-Maintain O2 support
4) Extubate smoothly, gently
-Dogs: 1st or 2nd swallow
-cats: ear flick, tongue movement

Front 78

What are 6 factors influencing small animal recovery?

Back 78

1) Anesthetic drugs/ techniques used
2) Breed
3) Analgesia
4) Sedation
5) Environment
6) Patient comfort
-warmth
-position
-bandaging
-bladder size

Front 79

During a rough recovery it can be hard to distinguish _____ from _____.

Back 79

Pain or emergence delirium
-if in doubt treat for pain!!!!!!!!!!

Front 80

What are 5 analgesics used in small animals post-op?

Back 80

1) Opioids
2) NSAIDs (slow onset)
3) Ketamine (low dose)
4) Alpha2 adrenergic agonist
5) Local/regional anesthetic techniques

Front 81

What are 2 things that can help with emergence delirium (dysphoria) during recovery?

Back 81

1) Time
2) Tranquilizer/sedatives
-acepromazine
-alpha2 adrenergic agonist