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81 Cards in this Set

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Are cats pretty much just small dogs?
No! different handling and response to drugs
What is a common side effect of anesthesia in dogs and cats?
Hypothermia, as body mass gets smaller the more prone to hypothermia
Much of case 'management' in small animals occurs before the patient is anesthetized such as ____, _____ and ______.
Drugs
Techniques
Be prepared
What are 2 components of preparing a small animal patient for anesthesia?
Fasting & stabilization
What are the 5 components of the anesthetic plan for small animals?
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
What are 2 reasons there are minimal requirements for preanesthetic preparation of small animals?
-not as prone to regurgitation
-rapid gastric emptying
How long should you withhold food and water from a small animal before anesthesia?
Food: 6 hours (main reason is to reduce risk of regurgitation & aspiration)
Water: 1-2 hours
-neonates not routinely fasted
What are the 5 sedatives that can be used for small animal premedication?
1) Acepromazine
2) Dexmedetomidine
3) Xylazine
4) Midazolam
5) Diazepam
What are the general agents used for sedation in small animals?
Sedative +/- opioid +/- anticholinergic
What are 7 opioids that can be used for small animal premedication?
1) Morphine
2) Butorphanol
3) Hydromorphone
4) Buprenorphine
5) Oxymorphone
6) Fentanyl
7) Meperidine
What is used for aggressive/ difficult to manage small animals?
Can add ketamine or telazol
-tank induction w/ inhalant in fractious cats
What are 5 premedication considerations of small animals?
1) Patient preanesthetic assessment
2) Drug pharmacology
3) Personal knowledge & experience
4) Personnel, drugs & equipment available
5) Procedure to be performed
What are 4 properties of a small animal premedication should be taken into consideration?
1) Does it decrease anxiety/stress
2) Sedation/chemical restraint
3) autonomic reflex
4) decrease anesthetic requirements
What are the 3 sedatives used in small animal anesthesia?
1) Acepromazine
2) Diazepam & midazolam
3) Dexmedetomidine & xylazine
What is the tranquilization, onset and duration of acepromazine?
Mild-moderate tranquilization
Slow onset, long duration
What are the side effects of acepromazine?
Mild CV effects
-vasodilation & hypotension
Are the minor tranquilizers (diazepam & midazolam) reversible?
Yes
What type of sedation does dexmedetomidine & xylazine provide? Duration? Onset?
Dependable moderate-marked sedation
Rapid onset, duration dose dependent
What are the side effects of dexmedetomidine & xylazine?
Significant CV effects
-hypertension, bradycardia
What are the 6 side effects of opioids?
1) Vomiting, defecation
2) Panting
3) sedation/dysphoria
4) Bradycardia
5) Pyloric sphincter contraction
6) Hyperthermia
Compare the duration and effects of atropine and glycopyrrolate.
Atropine shorter acting and more profound effects
Are anticholinergics routinely used in small animals?
Controversial
Tachycardia may be detrimental to some patients
When is intravenous catheterization used in small animals?
For all anesthetic procedures
-administration of anesthetic agents
-fluid administration
-emergency drugs
What are the 2 most common sites for intravenous catheterization in cats and dogs?
1) Cephalic
2) saphenous
-lateral-dog
-medial-cat
What are 3 less common sites of IV catheterization in dogs and cats?
1) Jugular
2) Ear
3) Tongue
The drug/method selection used for induction in small animals is based on what 6 factors?
1) Side-effect profile
2) Administration options
3) Equipment
4) Cost
5) Recovery characteristics
6) Personal preference/familiarity w/ drugs & procedures
What are the 4 advantages of intravenous anesthetics?
1) Rapid loss of consciousness
2) Less patient stress (?)
3) Rapid control of airway
4) Less risk of injury to patient or staff (?)
What is a disadvantage of IV anesthetics?
Metabolism of drugs require for recovery
______ is the slowest, least controlled method of induction used for small animals.
Tank inductions
Why are tank inductions a bigger risk for the staff?
Considerable environmental contamination w/ inhalant anesthetic
What setting should you use for the O2 flow & vaporizer setting for tank induction?
Highest O2 flow & vaporizer setting possible
What size of mask do you want to use for induction?
Smallest size mask with tight seal
Do you want mild, moderate or heavy sedation for mask induction?
Heavy
What are the two techniques of mask induction?
Start low turn up vaporizer slowly
Pedal to the metal
What are the 2 most common IV induction agents used in small animal anesthesia?
1) Propofol
2) Ketamine/ diazepam
What are the 4 less common IV induction agents used in small animal anesthesia?
1) Telazol
-tieltamine/zolazepam
2) Ketamine/ midazolam
3) Etomidate
4) Neuroleptanalgesic
-opioid + tranquilizer
Is propofol cumulative? controlled?
No, no
What are the cardiorespiratory depression effects of ketamine/ diazepam?
Minimal, relatively broad therapeutic index
What is a downfall of ketamine/ diazepam for induction agents?
Less muscle relaxation, reflex activity remains
-Poorest intubation quality
What are 2 advantages of ketamine/ diazepam?
1) inexpensive
2) fairly rapid recovery, less desirable quality though
What are 3 disadvantages of etomidate?
1) Expensive!!
2) Relatively poor induction quality
3) Adrenocortical suppression
When is etomidate the drug of choice in small animals?
Patient with severe cardiac disease
What is the purpose of using adjuncts such as diazepam or lidocaine or opioids during small animal anesthesia?
Used to decrease dose of induction drugs
When should adjuncts be administered during anesthetic protocol?
Immediately preceding other induction drugs
What is neuroleptanalgesia?
Combination of opioid + tranquilizer
When is neuroleptanalgesia used for induction in small animals?
Occasionally used for induction in severely depressed or compromised dogs
-minimal cardiovascular depression
What combination is usually used for neuroleptanalgesic induction?
Usually diazepam/ midazolam + mu opioid agonist
-fentanyl
-hydromorphone
-oxymorphone
When are IV anesthetics used for maintenance?
Short procedures <30-45 minutes
-can get expensive
What are 4 things to consider when using intravenous anesthetics for maintenance?
1) Airway protection
2) O2 supplementation
3) Ventilatory support
4) Adequate monitoring & vigilance
What are 2 drugs used IV for anesthetic maintenance?
Propofol
Ketamine/ diazepam
What are 4 factors to consider when trying to select an inhalant for small animals?
1) Cost
2) Vaporizers available
3) Case load
4) Method of administration
-closed circuit
-semi-closed/ semi-open circuit
-non-rebreathing circuit
When do you want to use a non-rebreathing circuit for small animals?
Patients <5-7 kg
What fresh gas flow rate do you want to use with non-rebreathing circuits?
200-300 mLs/kg/min
When do you use rebreathing circuits (circle, 'Y', Universal F)?
Patients > 5 kg
What do you want to use for the induction flow rate with rebreathing circuits? Maintenance?
Induction: 100-150 mLs/kg/min
Maintenance: 30-50 mLs/kg/min
In a closed system flow rate =_______.
Metabolic O2 consumption
What are 3 reasons we use non-rebreathing circuits in patients < 5 kg?
1) Higher oxygen flow rates --> increased cost
2) Less resistance to breathing
-no valves
-no CO2 absorbent
3) Less dead space (?)
True or false. Patients less than 5 kg absolutely cannot be maintained on a circle circuit.
False, may do fine on a circle, pediatric circle systems are available
Why is it so important to use the largest diameter tube that comfortably fits your patient?
Tube is the LARGEST source of airflow resistance
Are high volume/ low pressure cuffs or low volume/ high pressure cuffs preferred in small animal anesthesia?
High volume/ low pressure cuffs
What tubes are preferred for small animal intubation?
Clear tubes preferable
Why do you want to try to avoid touching the epiglottis when performing endotracheal intubation on a small animal?
Can get laryngospasms especially in cats
What small animal do we want to use lidocaine in?
Cats
-reduce laryngospasm, give it time to work
What do you want the pressure to be in the endotracheal tube cuff?
20 cm H2O to prevent leak
How big of a reservoir bag do you want to use in small animals?
5-6 x tidal volume
-tidal volume= 10-20 mLs/kg
-if in doubt use larger size
What are 2 types of fluids used for supportive care in small animal anesthesia?
1) Crystalloids
2) Colloids
What are some external heating sources?
Circulating warm water blankets, heat lamps, electric blankets, hot water bottles, rice socks
-Use with caution- patient burns possible
What drugs are used for cardiovascular support in small animals?
Sympathomimetics
-dopamine
-dobutamine
anticholinergics
-atropine
-glycopyrrolate
What are 3 emergency drugs used in small animal anesthesia?
1) Atropine
2) Epinephrine
3) Lidocaine
What are 2 ways to check the CNS status of a small animal under anesthesia?
Reflexes, jaw tone
What are the 3 ways to monitor the cardiovascular system of small animals?
Rate, rhythm (ECG)
Blood pressure (doppler, oscillometric, direct)
Hemoglobin saturation tells us about __________.
oxygenation
Capnography tells us about _______.
Ventilation
Why is it important to avoid hypothermia in small animals?
If shivering when waking up then oxygen demands increase and so respiratory depression + shivering--> hypoxia
What are 3 possible adverse events that occur during recovery from anesthesia?
1) Hypoxemia/ hypercapnia
2) Airway obstruction
3) Regurgitation/ aspiration
What is the goal of the anesthesiologists during recovery?
Smooth transition from unconsciousness to consciousness
What are the 4 steps to recovering a small animal from anesthesia?
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
What are 6 factors influencing small animal recovery?
1) Anesthetic drugs/ techniques used
2) Breed
3) Analgesia
4) Sedation
5) Environment
6) Patient comfort
-warmth
-position
-bandaging
-bladder size
During a rough recovery it can be hard to distinguish _____ from _____.
Pain or emergence delirium
-if in doubt treat for pain!!!!!!!!!!
What are 5 analgesics used in small animals post-op?
1) Opioids
2) NSAIDs (slow onset)
3) Ketamine (low dose)
4) Alpha2 adrenergic agonist
5) Local/regional anesthetic techniques
What are 2 things that can help with emergence delirium (dysphoria) during recovery?
1) Time
2) Tranquilizer/sedatives
-acepromazine
-alpha2 adrenergic agonist