Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/157

Click to flip

157 Cards in this Set

  • Front
  • Back
What are the 4 purposes of monitoring anesthesia?
1) Assess depth of anesthesia
2) Assess response to anesthesia
3) Verify performance of equipment
4) Improve safety
In general, what variables of anesthesia do you want to monitor?
Variables that respond quickly to change in anesthetic depth
When monitoring you are assessing normal VS abnormal values for what 2 things?
1) Vital signs in that specie
2) Responses to anesthetic drug administration
What are the 3 organ systems being monitored during anesthesia? What do you assess for each system?
1) CNS
-assess depth of anesthesia
2) Cardiovascular
-assess adequacy of perfusion
3) Respiratory
-Assess ventilation/ oxygenation
How do we assess ventilation?
By monitoring how well the animal is eliminating CO2
What are 10 parameters that we monitor during anesthesia regarding the cardiovascular system?
1) HR
2) ECG
3) Pulse rate
4) Pulse pressure
5) Membrane color
6) Perfusion time
7) BP
8) Pulse oximetry
9) Central venous pressure
10) CO
What are 3 methods used to monitor the HR?
1) Auscultation w/ stethescope, if thorax accessible, or esophageal stethoscope
2) Palpate peripheral pulse
3) Monitor ECG
-lets you know rate & rhythm
What are 2 types of leads used to monitor the ECG?
Lead II
Base-apex lead
Compare the heart rate of larger breeds and smaller breeds.
Larger breeds are slower
Smaller breeds are faster
Do juveniles have a faster or slower heart rate?
Faster
True or false. Heart rate is usually unaffected by premedication and anesthesia depth during small animal surgery.
False, affected by premedicants used and depth of anesthesia can affect HR (insufficient anesthesia= increased HR)
e.g. Dexmetatomidine & opioids slow HR
What are 6 arteries that can be paplpated to measure the pulse in canine/felines?
1) Dorsal pedal
2) Femoral
3) Lingual
4) Coccygeal
5) Metacarpal
6) Metatarsal
What is the normal heart rate of dogs under anesthesia?
65-180 beats / minute
-alpha2 will slow HR to 40 or 50 so he'll use a lower dose
What is the normal heart rate of a cat under anesthesia?
100-220 beats/minute
-alpha2 will slow HR to 40 or 50 so he'll use a lower dose
When does the depth of anesthesia affect HR in SMALL ANIMALS?
Usually won't decrease as depth of anesthesia increases, but can increase if depth of anesthesia is insufficient
Out of horses, ruminants, camelids and swine, which has the slowest HR?
Horses
How does the HR fluctuate with anesthesia in LARGE ANIMAL surgery?
HR may decrease as depth increases (except in horses)
What are 6 arteries that can be palpated to measure the pulse in a horse?
1) Facial
2) Digital
3) Radial
4) Dorsal metatarsal
5) Transverse facial
6) Caudal auricular
What is the normal heart rate of an adult horse under anesthesia? Juveniles?
Adults: 30-50 beats/min
Juveniles: 50-70 beats/min
What are 4 arteries that can be palpated to measure the HR in ruminants?
1) Common digital
2) Caudal auricular
3) Saphenous
4) Radial
What is the normal HR of an adult ruminant under anesthesia? Juvenile?
Adult: 70-100 beats/min
Juveniles: 80-120 beats/min
What are 4 arteries you can palpate to measure the HR in a camelid?
1) Common digital
2) Caudal auricular
3) Radial
4) Saphenous
*Same as ruminants
What is the normal HR for an adult camelid under anesthesia? Juveniles?
Adults: 60-90 beats/min (w/ atropine)
28-40 beats/min (w/ alpha2)
Juveniles: 90-125 beats/min
What are the 3 arteries that can be palpated to measure the heart rate in swine?
1) Radial
2) Caudal auricular
3) Saphenous
What is the normal HR for adult swine under anesthesia? Juveniles?
Adults: 60-90 beats/min
Juveniles: 90-125 beats/min
What are the 3 characteristics of the pulse that you should analyze?
Strength, rate, rhythm
What determines the pulse pressure?
Difference b/w systolic and diastolic pressure
e.g. 120/90 mmHg palpates similar to 90/60 mmHg
True or false. Pulse strength gives a pretty accurate quantitative estimate of BP.
False, not accurate
When examining a pressure wave, what is a dicrotic notch? Is it a good thing?
Blood is ejected from aorta and then blood starts to flow backwards towards the heart, then the valves closes and blood hits the valve and squirts forward again
-it appears as the second bump on graph
What is the only difference b/w the arteries palpated to estimate HR and pulse strength among all the species (as in which arteries can be palpated)?
All of them are the same, but in swine you can also palpate the dorsal pedal artery to estimate pulse strength
What color should mucous membranes be?
Pink, not pale or cyanotic
What is required for an animal to be ABLE to have cyanotic mucous membranes?
Requires AT LEAST 5 g of hemoglobin
Perfusion time is an indicator of ______.
Blood pressure
When you blanche a gum, what is a normal capillary refill time?
<2 seconds
-be careful, "perfusion time" can be close to normal after death bc just squish blood out and it flows back
What instrumentation is used to assess the electrical activity of the heart?
Electrocardiography (ECG)
Electrocardiography allows continuous audible assessment of the _____ and _____ of the heart.
Rate & rhythm
What are 2 downfalls of electrocardiography?
1) May not correlate w/ mechanical activity
2) Artifacts can be common
What type of leads are most commonly used for electrocardiography?
Lead II
Modified base-apex lead
What are 2 locations where you can put the left arm lead of an ECG?
Left thorax
Base of heart
Where do you put the right arm lead when using electrocardiography in animals?
Right thorax
Where do you put the left leg lead when performing electrocardiography?
Patient's head or throat
-Change lead selector to find one that will be accurate
What are 2 measuring devices used for arterial catheterization?
1) Aneroid manometer
-instrument used to measure pressure
2) Long fluid administration set
What are the 4 electrical instruments used for direct blood pressure?
1) Transducer
2) Amplifier
3) Display
4) Anderoid manometer
-or long fluid administration set
When directly measuring blood pressure with arterial catheterization is is ________, continuous and inaudible.
Accurate
Direct blood pressure measurements can be altered by position of the ________.
Transducer
What are 4 sites used for arterial catheterization?
1) Dorsal pedal
2) Coccygeal
3) Femoral
4) Lingual
-All these are also used to check pulse
What are 5 sites used for arterial catheterization in horses?
1) Facial
2) Transverse facial
3) Dorsal metatarsal
4) Digital
5) Caudal auricular
-All these are also used to check pulse
What are 4 sites used for arterial catheterization in ruminants and camelids?
1) Common digital
2) Caudal auricular
3) Saphenous
4) Radial
What are 3 sites used for arterial catheterization in swine?
1) Caudal auricular
2) Saphenous
3) Radial
What are 2 methods used to indirectly measure blood pressure?
1) Doppler
-Return to flow principle
2) Oscillometric technic
-Cardell series & others OR petmap
What does the Doppler measure?
Determines blood flow & determines systolic pressure
-Value nearer mean pressure in cats/small dogs
Dopplers produce a continuous audible signal of ______ and ______, but not ________.
Continuous audible signal of RATE and RHYTHM, but not PRESSURE.
What are 3 parameters that we can control that can cause errors in a Doppler reading?
1) Faulty probe placement
2) Incorrect cuff size
3) Rapid cuff deflation
What are 4 physiologic parameters of the patient that can result in errors in a Doppler reading?
1) Hypotension
2) Hypovolemia
3) Bradycardia
4) Hypothermia
What are 4 arteries that the crystal can be placed on when using a Doppler?
1) Metacarpal
2) Metatarsal
3) Dorsal pedal
4) Tail (less often)
What does the Doppler measure?
Determines blood flow & determines systolic pressure
-Value nearer mean pressure in cats/small dogs
Dopplers produce a continuous audible signal of ______ and ______, but not ________.
Continuous audible signal of RATE and RHYTHM, but not PRESSURE.
What are 3 parameters that we can control that can cause errors in a Doppler reading?
1) Faulty probe placement
2) Incorrect cuff size
3) Rapid cuff deflation
What are 4 physiologic parameters of the patient that can result in errors in a Doppler reading?
1) Hypotension
2) Hypovolemia
3) Bradycardia
4) Hypothermia
What are 4 arteries that the crystal can be placed on when using a Doppler?
1) Metacarpal
2) Metatarsal
3) Dorsal pedal
4) Tail (less often)
What are 4 arteries the crystal can be placed on when using a doppler on a horse?
1) Tail
2) Dorsal metatarsal
3) Digital
4) Radial
What are 3 arterial the crystal probe of a Doppler can be placed on in a camelid, ruminant or swine?
1) Tail
2) Common digital
3) Radial
Do you want to place the crystal distal or proximal to the cuff when using a Doppler?
Proximal to crystal
How do you know what size of a cuff to use when measuring blood pressure with a Doppler?
Cuff diameter should be 40% of circumference of limb
What are the benefits of the Cardell series and others?
Accurate over a wider range of heart rates and patient sizes.
What are 5 errors/physiologic changes that can result in inaccurate blood pressure measurements when using a Cardell series?
1) Hypotension
2) Hypovolemia
3) Hypothermia
4) Bradycardia
5) Wrong cuff
**What does the cardell measure?
Determines mean arterial pressure and calculates systolic and diastolic pressure and HR
When does the cardell take measurements (at what intervals)?
Some will cycle at user-determined intervals, automated, very convenient and usually accurate
True or false. Non-invasive blood pressure is a continuous method, that is not audible and can be inaccurate.
False, It is inaudible and can be inaccurate, but not continuous
What are 3 locations that the cardell series can be used on to take the blood pressure of a small animal?
1) Metatarsus
2) Antebrachium
3) Tail
What are 4 sites you can use for a Cardell series to measure blood pressure in a horse?
1) Tail
2) Dorsal metatarsal
3) Digital
4) Radial
What are 3 sites blood pressure can be taken using a Cardell series in a ruminant, camelid and swine?
1) Tail
2) Common digital
3) Radial
What is the normal blood pressure (systolic, diastolic and MAP) of a dog?
Systolic: 80-120 mmHg
Diastolic: 40-80 mmHg
Mean: 60-100 mmHg
What is the normal blood pressure of a cat?
Systolic: 80-150 mmHg
Diastolic: 40-80 mmHg
Mean: 60-120 mmHg
What is the normal blood pressure a horse?
Systolic: 95-120 mmHg
Diastolic: 65-90 mmHg
Mean: 75-100 mmHg
Why do horses require a higher mean arterial pressure compared to other species?
When animal is down and putting weight on the muscles and if too deep then the driving pressure to force open those capillaries is diminished so get areas of ischemia and if get enough muscle damage then horse can't stand afterward
-Keep MAP> 75 to prevent myopathy
What is the normal blood pressure of sheep, goat, camelids and swine?
Systolic: 80-100 mmHg
Diastolic: 50-70 mmHg
Mean: 60-80 mmHg
What is the normal blood pressure of cattle?
Systolic: 120-150 mmHg
Diastolic: 75-100 mmHg
Mean: 90-120 mmHg
Why are indirect blood pressure readings inaccurate with camelids?
Because on cannon bone its just bone so the algorithms aren't designed for this
Is pulse oximetry invasive? continuous? audible?
Noninvasive
Continuous
Audible
How does pulse oximetry measure hemoglobin saturation?
Utilizes red & infrared light to determine hemoglobin saturation
What does pulse oximetry display?
Waveform & heart rate
What is the normal percent saturation of hemoglobin?
SpO2> 95%
Why is pulse oximetry useful during anesthesia?
Detects hypoxemia before cyanosis is present
What are 4 sources of error when using pulse oximetry?
1) Motion
2) Ambient light
3) Vasoconstriction
-hypothermia, hypovolemia, drug induced
4) Dyshemoglobinemia
What is the primary site used to get pulse oximetry readings?
Tongue
What are some alternate sites used for pulse oximetry (not tongue)?
Nares in some species, paw, ear, prepuce, vulva
-*alternate locations need white skin
-achilles tendon less dependable
What does the central venous pressure assess?
Venous return to right atrium/ heart's ability to pump
What is a normal central venous pressure?
5-10 cm H2O for most species
-Normal can be 20-30 cm H20 in equines in lateral recumbency
True or false. Central venous pressure can be a big help during anesthesia.
False, little use during anesthesia
What are 4 ways to monitor/measure cardiac output?
1) Thermodilution
2) Dye dilution
3) Lithium dilution
4) Ultrasound techniques
True or false. Cardiac output is not commonly monitored in clinical cases.
True
What is dye dilution?
Inject dye into right atrium or anterior vena cava and then measure concentration and calculate out dilution
-but background concentrations kept increasing w/ time
What is thermodilution?
Inject saline and then measure temperature, use pulmonary arterial catheter
What is lithium dilution?
Don't need a pulmonary arterial catheter like you do w/ thermodilution, just inject lithium and then push button and blood is aspirated out of artery and then computer tells you concentration and CO
What are 3 ways to monitor the respiratory system (without electronic equipment)?
1) Auscultation
2) Observation of chest excursions
3) Observe breathing pattern
-movement of rebreathing bag, chest wall, abdomen
What are 4 parameters that are measured to monitor the respiratory system?
1) Tidal volume
2) Capnography
3) Blood gas analysis
4) Rate
Abdominal breathing is common in what 3 situations/animals?
1) large animals
2) Neonates
3) When obstruction or lung disease is present
How is respiratory rate affected by anesthetic depth?
Rate tends to decrease as anesthetic depth increases
What is the normal respiratory rate in a dog?
8-15 breaths/min
What is the normal respiratory rate of a cat?
10-20 breaths/min
How does panting affect anesthesia intake?
results in less effective ventilation
What is the normal respiratory rate of horses?
6-8 breaths/ min
What is the normal respiratory rate of a ruminant?
25-40 breaths/min
What is the normal respiratory rate of a camelid?
10-20 breaths/min
What is the normal respiratory of swine?
10-20 breaths/min
______ "pant" under anesthesia.
Ruminants
How do you assess tidal volume?
Watching rebreathing bag, not very precise
-rebreathing bag should move in sync with chest
How is tidal volume affected by anesthetic depth?
Tends to decrease as anesthetic depth increases
How do you measure tidal volume?
Spirometer
- but tidal volume changes rapidly so can't really measure it
What is the normal tidal volume in canines/felines?
8-10 mL/kg
What is the normal tidal volume of a horse?
8-12 mL/kg
What is the tidal volume of a ruminant?
5-8 mL/kg
How does the tidal volume vary between the ventilator and the volume the animal naturally breathes in?
Ventilator is higher amount
What is one way to assess ventilation during anesthesia?
Capnography- measures CO2 in expired gas
-CO2 goes up the less the animal breathes
How does the depth of anesthesia affect CO2 levels?
PCo2 will increase as depth of anesthesia increases or with increased doses of opioids
What can be used to detect equipment malfunction? what types of malfunction?
Capnography
-Recognizes airway disconnection, apnea, abnormal breathing patterns and cardiac arrest (blood flow ceases and no CO2 returns to lungs so decreases very quickly)
How does partial pressure of end tidal carbon dioxide vary from partial pressures of arterial CO2?
PetCO2 < PaCO2 by 10-15 torr
What is the normal partial pressure of end tidal CO2?
40-75 torr (spon Vent)
30-35 torr (IPPV)
What is the normal fractional concentration of inspired O2? inspired CO2?
FIO2= 50-90%
FICO2< 2 torr
What does it mean if the fractional concentration of inspired CO2 increases?
Sodalyme is running out
What are 3 things that can be analyzed using blood gas analysis?
1) Acid-base status
2) Adequacy of ventilation & oxygenation
3) Many assess electrolytes, lactate, glucose
What is the normal PaCO2 for large animals using Spon Vent? Small animals?
Large animals: 60-75 torr
Small animals: 40-60 torr
-both using spon vent
What is the normal PaCO2 using IPPV ?
40-45 torr
What is the normal PaO2 in small animals? Large animals?
Small animals: 400-500 torr
Large animals: > 200 torr
What is a normal pH?
7.35-7.45
What are 6 ways to check the CNS status of a patient under anesthesia?
1) Muscle relaxation/ jaw tone
2) Ocular reflexes/ eye position
3) Lacrimation
4) Laryngeal/ swallowing reflex
5) Response to pain/ pedal reflex (to assess response to pain or surgical stimulus)
6) Ear flick/ whisker reflex
How do you assess muscle relaxation? What animals is it useful in?
By jaw tone
-Useful reflex in dogs and cats
-some tone should be present
What does a lack of jaw tone in a dog or cat imply?
Depth of anesthesia can be decreased
How can you monitor the ocular reflexes in a dog?
Globe begins centrally then as gets deeper in anesthesia the eye moves rostral-ventral ("rolled in")
How do you monitor the ocular reflexes in a bovine?
As depth of anesthesia increases the globe roles ventrally, then as anesthesia levels out the globe moves dorsally to the center
What is the palpebral reflex?
Lids close when touched or lid margins brushed
Palpebral reflexes are slow to absent in what animal?
Horses
What does it mean if the palpebral reflex is present in any animal other than a horse?
Means insufficient anesthesia
What is the corneal reflex? Should it be present during anesthesia?
Lids should close when cornea is touched, should be present
What is a nystagmus?
Medial-lateral oscillations of eye
What does the presence of nystagmus in a HORSE imply?
Anesthesia is too light
-best accuracy in horses, other species not dependable
How is pupillary dilation/ constriction affected by anesthesia?
-Pupil may dilate slightly during induction (excitement) then may constrict
-pupils dilate at increasing depth
Lacrimation is an indirect indicator of _______ pressure, which is useful in horses.
Perfusion pressure
When is the swallowing reflex present during anesthesia?
Lost early and regained just prior to return of consciousness
-can be present in ruminants at adequate depth of anesthesia
Why should the swallowing reflex be present at the time of extubation?
To prevent aspiration
What is the laryngeal reflex?
Closure of arytenoid cartilages due to tactile stimulation
-can make intubation difficult
Laryngeal reflex is more common in what 4 animals?
Cats, goats, sheep & swine
What is the cause of laryngospasm in cats?
A sustained laryngeal reflex
How do we assess an animal's response to pain? How is this helpful for monitoring anesthesia?
Pedal reflex: pinch pad or digit, lack of withdrawal when depth adequate
What does the ear flick/ whisker reflex indicate?
Inadequate anesthetic depth
What does increased heart rate, respiratory rate, and blood pressure indicate?
Insufficient depth
How do we perform anesthetic agent analysis?
Measures end tidal agent concentration to provide an estimate of dose, interpretation affected by premedication, local anesthesia
Most surgeries are done at _____-_____ MAC, if the animal is premedicated ____-_____ MAC is used and if an epidural is in place _____-____ MAC is usually required.
1.25-1.5 MAC
1.0-1.25 (w/ premed)
<1 MAC (epidural)
What are 5 ways to asses fluid balance?
1) Hematocrit or hemoglobin
2) Electrolytes (Na, K, Cl, Ca)
3) Plasma total solids or serum total protein
4) Glucose, lactate
5) Urine production
What are 2 ways to monitor body temperature during surgery?
1) Clinical thermometer
2) Esophageal or rectal probe
What does increased heart rate, respiratory rate, and blood pressure indicate?
Insufficient depth
How do we perform anesthetic agent analysis?
Measures end tidal agent concentration to provide an estimate of dose, interpretation affected by premedication, local anesthesia
Most surgeries are done at _____-_____ MAC, if the animal is premedicated ____-_____ MAC is used and if an epidural is in place _____-____ MAC is usually required.
1.25-1.5 MAC
1.0-1.25 (w/ premed)
<1 MAC (epidural)
What are 5 ways to asses fluid balance?
1) Hematocrit or hemoglobin
2) Electrolytes (Na, K, Cl, Ca)
3) Plasma total solids or serum total protein
4) Glucose, lactate
5) Urine production
What are 2 ways to monitor body temperature during surgery?
1) Clinical thermometer
2) Esophageal or rectal probe
What are 4 risks that increase in a patient that's hypothermic?
1) Arrhythmias
2) Blunts response to chronotropes
3) Delays recovery
4) Increases risk of infection at surgical site