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152 Cards in this Set
- Front
- Back
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What is the definition of anesthesia?
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Loss of sensation
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What is general anesthesia?
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Loss of consciousness and loss of sensation
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True/false: Local anesthesia provides analgesia and anesthesia to a limited area
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True
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Name two dissociative anesthetics
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Ketamine
Teletamine |
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What general drug classes provide analgesia?
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Opioids
Dissociative anesthetics Alpha 2 agonists |
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True/false: With neuroleptanalgesia, an animal may seem unconscious but with stimulation will become aware.
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True
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When should you optimally do a pre-anesthetic evaluation?
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1-7 days prior to anesthesia; often is done the same day though
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Is there such a thing as safe anesthesia?
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NO, only safe ANESTHETISTS
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What is the minimal amount of time you should fast an animal pre-op? What is the optimal amount of time?
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6 hrs
8-12 hrs preferred |
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Why might you not fast a young or very small patient prior to surgery?
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Due to hypoglycemia
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Why shouldn't you give regularly administered meds between pre-med and induction?
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Because it can be retained in esophagus or pharynx
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Which of the following can cause additive effects when mixed with anesthetics: Aminoglycosides, Barbiturates, Corticosteroids, Digitalis.
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Barbiturates
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Which causes an increased depressant effect of anesthesia which is severe, aminoglycosides or B-adrenergic agonists (propranolol)?
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B-adrenergic agonists
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Which may impair ventilation and have renal concerns when mixed with anesthesia, aminoglycosides or Ca channel blockers?
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Aminoglycosides
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H2 blockers and NSAIDS are enzyme inducers or enzyme inhibitors?
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Enzyme inhibitors, which means they prolong the activity of other drugs
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Barbiturates and benzodiazepines are enzyme inducers or enzyme inhibitors?
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Enzyme inducers
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What is the minimum data base of bloodwork performed pre-op?
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PCV, TP, BUN
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What is normal PCV?
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>27-30
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True/false: Pre-op bloodwork varies with patient (based on age, presentation and dz process).
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TRUE
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Subtle changes in renal and hepatic function are normal, but if > ___x, you should investivate.
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2
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What effect does increased potassium have on the heart?
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Bradycardia and arrest
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What effect does decreased potassium have on the heart?
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Irritated myocardium
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You are presented with a normal, healthy dog for OHE who has no systemic diseases. What ASA classification is this?
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ASA 1
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You are presented with a dog who was HBC. What ASA classification is this?
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ASA 5
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Which ASA classification covers mild systemic disease (obesity, simple fracture, compensated heart dz)?
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ASA 2
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Which ASA classification covers severe systemic disease that is under control (hepatic/renal)?
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ASA 3
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Which ASA classification covers severe systemic dz that is not under control and is a threat to life (shock, hepatic/renal, fever)?
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ASA 4
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What designation can be added to ASA classifications to denoted that it is an emergency?
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E
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How should you dose an obese patient who is >25% over normal body weight?
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Dose based on lean BW - remember, obese animal has brain of normal weight!
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Do you need to use the anesthesia machine with chemical restraint?
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No, in fact, lack of an anesthesia machine is a reson for doing chemical restraint
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What are some disadvantages of using chemical restraint?
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All-or-nothing
Prolonged recovery No airway control Monitoring overlooked |
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Describe good induction:
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Quiet, quick
Rapid control of airways |
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What is the most common way to induce anesthesia?
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IV (either bolus or titration)
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When might you use IM anesthetic induction?
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Wild animal
Fractious animal |
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On what animal might you use a nasotracheal tube?
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Foal under sedation
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What are some disadvantages of using chemical restraint?
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All-or-nothing
Prolonged recovery No airway control Monitoring overlooked |
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Describe good induction:
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Quiet, quick
Rapid control of airways |
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What is the most common way to induce anesthesia?
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IV (either bolus or titration)
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When might you use IM anesthetic induction?
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Wild animal
Fractious animal |
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On what animal might you use a nasotracheal tube?
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Foal under sedation
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When should you intubate?
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When anesthetic depth is 2/3 of stage 3
Regular breathing Normal pupil size Relaxed 3rd eyelid Rotated eyeball Decreased palpebral reflex Decreased laryngeal reflex |
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Which reflex goes first, the lateral or medial palpebral?
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Lateral
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What is the most reliable way to insure that the ET tube is in the trachea?
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Visualize tube between arytenoids
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After induction, what is one of the most important things to check?
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Palpate pulse
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What are some common complications associated with induction?
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Apnea
Excitement Hypoxemia Regurgitation Laryngospams |
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What are the three phases of recovery?
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Emergence
Early recovery Late recovery |
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Which stage of recovery is characterized as the period between discontinuation of anesthesia and extubation?
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Emergence
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Which stage of recovery is characterized by an ambulatory animal that is still under the influence of sedatives?
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Early recovery
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What stage of recovery = FULL recovery?
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Late recovery
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Describe a good recovery.
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Quiet, fast control of airway
Appropriate analgesia |
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If you give an epidural, what do you have to remember during recovery?
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Express the animal's bladder
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Why should you disconnect the patient before moving?
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Prevent tracheal tear
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When should you extubate?
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Mouth and nose clean
Regular breathing Well oxygenated Swallowing reflex |
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How do you handle extubation in brachycephalics?
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Leave tube in until they reject it
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Where should you be positioned to extubate an animal?
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Behind it
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What is the most important monitoring tool on/in the patient?
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Esophageal stethescope
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Why is an esophageal stethescope important?
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Tells HR and rhythm
Whether it is ALIVE or NOT |
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What does an ECG reflect?
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Electrical activity of the heart
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What should you use for arrhythmia diagnosis?
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ECG
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Does ECG provide indication of CO?
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NO
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What lead should you focus on when doing an ECG?
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Lead II
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What is the equation for MAP?
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MAP = CO x SVR
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Systolic pressure should be:
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90-100 mmHg
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MAP should be:
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70-90 mmHg
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What are the two indirect methods of measuring indirect arterial BP?
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Doppler flow
Oscillometer |
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Which provides you with more information, Doppler flow or Oscillometer?
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Oscillometer, not only does systolic BP, but also does HR, diastolic and MAP
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You should use indirect arterial BP measurements (doppler and oscillimeter) on larger or small patients?
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Small patients
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Which provides a measure of systolic BP only, Doppler or Oscillimeter?
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Doppler
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Which one gives automatic trends of BP and is easier to use, Doppler or Oscillimeter?
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Oscillimeter
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What is the gold standard for arterial BP measurement?
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Direct BP (IV cath in peripheral artery)
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True/false: Direct BP measurement only gives systolic BP information.
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False, gives continuous information on systolic, diastolic and MAP
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How can you measure how the heart handles venous return?
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Central venous pressure (cath in right jugular that measures luminal pressure of cranial vena cava or right atrium)
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Name some things that can interfere with the Pulse-Ox.
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Hair
Pigmentation Vasoconstriction Decreased perfusion Motion |
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Which produces a waveform, capnograph or capnometer?
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Capnograph
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What is the optimal end tidal CO2 measurement provided by either a capnograph or capnometry?
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35-45 mmHg
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CO2 increases or decreases with expiration?
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Increases
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What is the gold standard for ventilatory status determination?
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Arterial blood gas
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How can you monitor renal physiology?
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Urine production - 1-2 mL/kg/hr
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True/false: General anesthesia includes unconsciousness, analgesia, muscle relaxation and absence of reflex responses.
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TRUE
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What stage of anesthesia does this describe: Voluntary movement, awake/asleep/sedated, includes the initial admin of induction agent to unconsciousness.
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Stage 1
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During which stage of anesthesia might you have voluntary motor activity, cough, laryngeal reflexes, salivation and vomition?
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Stage 1
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During which stage of anesthesia is there delirium with involuntary movement, loss of consciousness, exaggerated reflexes and jaw tone?
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Stage 2
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Surgical anesthesia is achieved in which anesthetic stage?
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Stage 3
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Eyeball movement, unconscious, reduced muscle tone, normal HR and RR, loss of laryngeal response but intact palpebral reflexes. The above describe what plane of stage 3 anesthesia?
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Light
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Describe the medium plane of stage 3 anesthesia.
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Stable pulse and RR
Palpebral reflexes sluggish Eye partially obscured by 3rd eyelid Adequate for most surgical procedures |
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Decreased intercostal muscle function, decreased Vt, increased RR, a centered and dilated pupil with no palpebral reflex describes what stage of anesthesia?
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Deep plane, stage 3
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What stage of anesthesia causes extreme CNS depression, a barely detectable BP, shock and widely dilated pupils that don't respond to light?
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Stage 4 - WE DON'T WANT THIS
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What cranial nerves are related to the palpebral reflexes?
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5 and 7
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What cranial nerves are related to PLR?
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2 and 3
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True/false: Ear flicks in cats are reliable signs of anesthetic depth.
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False
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True/false: HR, RR, BP and mm color are the most reliable signs of anesthetic depth.
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False
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True/false: PLR, eyeball position and palpebral reflexes are unreliable signs of anesthetic depth.
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False
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What is metabolic scaling?
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Decreased metabolic rate per kg in larger animals (so mouse requires more anesthetic per kg than does an elephant)
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True/false: Pre-medications help decrease anesthetic requirements, decrease qirway secretions and help suppress/induce vomiting.
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TRUE
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What two pre-med drugs are considered anticholinergics?
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Atropine
Glycopyrrolate |
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Which crosses the BBB, atropine or glycopyrrolate?
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Atropine
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Which is a competative antagonist of Ach at muscarinic receptors, atropine, diazepam, or ace?
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Atropine (anticholinergic)
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True/false: anticholinergics are reversible
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TRUE
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What is atropine's affect on HR?
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Increases it
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Do anticholinergics provide analgesia?
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NO
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What are the general effects of atropine?
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Decrease SLUD
Increase HR Bronchodilation Mydriasis |
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What is mydriasis?
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Pupil dilation
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What are the four uses of acepromazine?
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Excellent sedative
Antiemetic Antihistamine Antiarrhythmic |
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Which drug blocks dopamine receptors in CNS, serotonin and alpha 1 receptors, diazepam, metatomadine or ace?
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Ace
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Does ace (and other phenothiazines) provide analgesia?
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NO
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True/false: Ace is synergystic with opiods.
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TRUE
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Why might atropine cause colic in a horse?
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Decreases secretions and causes GI stasis
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What two drugs cause relaxation of the retractor penis muscle?
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Ace and Xylazine
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Why might you not want to use Ace in a hypovolemic animal who has anemia or shock?
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Because it causes vasodilation as well as decreases PCV, TP and platelet function
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Is Ace reversible or irreversible?
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Irreversible
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High doses of Ace can cause what?
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Hypotension
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True/false: The use of Ace will allow you to decrease your MAC.
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TRUE
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Which causes better sedation, Ace or diazepam?
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Ace
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Which is an anticonvulsant, Ace or diazepam?
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Diazepam
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What is the mechanism of action of benzodiazepines?
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Bind to GABAa receptors and increase affinity
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What is the reversal agent for benzodiazepines?
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Flumazenil
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Which would be better to use in a patient with heart and respiratory problems, Diazepam or Xylazine?
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Diazepam - benzodiazepines have very minimal CV and respiratory effects
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True/false: Diazepam may cause paradoxical excitement.
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True
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Name two benzodiazepines.
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Diazepam
Midazolam |
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Which class of drugs can cause facial edema in horses and emesis in cats?
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Alpha-2 agonists
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What are the physiologic changes associated with alpha-2 agonists?
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Decreased CO, RR, Vt, HR
Sedation Analgesia Muscle relaxation |
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Put the alpha-2 agonists in order of increases alpha-2 affinity.
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Xylazine
Romifidine Meditomadine Dexmeditomadine |
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Who is more sensitive to xylazine, a cow or a dog?
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Cow
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Who is more sensitive to xylazine, a horse or a pig?
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Horse
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True/false: With xylazine, there is arousal with auditory stimuli.
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True
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Which has more predictable sedation and analgesia, medetomidine or xylazine?
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Medetomidine
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Which has to be used off-label in cats, medetomidine or dexmedetomidine?
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Medetomidine
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Is romifidine approved for large or small animals?
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Large only
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Detomidine is used in which animals?
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Horses and cows
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What are some contraindications for use of alpha-2 agonists?
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Arrhythmias, hypotension, shock, urinary tract obstruction
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What is the reversal agent for Medetomidine and Dexmeditomidine?
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Antipemazole
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Which is more selective for alpha-2, antipemazole or yohimbine?
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antipemazole
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What are the full agonist opioids?
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Morphine, oxymorphone, hydromorphone, fentanyl
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What is the partial agonist opioid?
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Buprenorphine
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What is the agonist-antagonist opioid?
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Butorphenol
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Opioids cause presynaptic inhibition of which receptors?
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Ach, Dopa, NE, Substance P
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What is the full antagonist opioid?
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Naloxone
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True/false: You can see excitation/dysphoria with high doses of opioids.
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True
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True/false: Opioids can cause nausea and vomiting.
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True
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naproxen
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Analgesics
Drug Class: NSAID Brand: Naprosyn Use: anti-inflammatory, analgesic |
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Which can cause histamine release, morphine, oxymorphone, or hydromorphone?
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Morphine
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Which causes less vomiting, morphine or oxy/hydromorphone?
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Oxy/hydromorphone
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True/false: Both morphine and fentanyl provide excellent analgesia.
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True
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Which of the opioids has the most rapid onset and shortest duration?
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Fentanyl
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Does Fentanyl cause a histamine release?
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NO
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Which two opioids cause less respiratory depression?
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Buprenorphine
Butorphanol |
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Which allows for better sedation, buprenorphine or butorphanol?
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Butorphanol
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Why is Butorphanol highly used in equine patients?
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Because there are less GI side effects
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True/false: Naloxone shoud be given slowly IM or IV and reverses everything, including analgesia.
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True
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Which drug that we talked about lowers the seizure threshold and can cause hypotension?
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Ace
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You have an animal present to you that was HBC and is shocky. You want to give him Ace as a pre-med. Should you?
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No - It decreases PCV, TP and platelet function and it causes hypotension, so definitely shouldn't use it in an already hypotensive shocky animal.
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What does the ASA classification system help us with?
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Determining patient risk factors for anesthesia (there are of course other risk factors to take into consideration)
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