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93 Cards in this Set

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What are arguably the two most commonly used alpha-2 agents in equine anesthesia?
Xylazine and detomidine
What are indications where acepromazine should not be used in the horse?
Excitable animal
Shock or anemia is present
Cachexia
Hypotension
How should your alpha-2 agonist dose be modified in older horses? In draft horses? In quarter horses?
Older horses and draft horses are more susceptible (reduce dose);
quarter horses (use normal dose)
When should alpha-2 agonists be avoided in horse premeds?
Shock or anemia
Cachexia
Hypotension
(pretty much like ace)
What are the alpha-2 reversal agents?
Yohimbine
Tolazoline
Atipamezole
What is the generic recipe for neuroleptanalgesia in the horse (bonus points if you can name specific drugs)?
Tranquilizer + Analgesic
(usually xylazine or romifidine + butorphanol)
In which of the following animals should preanesthetic fasting NOT be implemented?
a) horse
b) cow
c) goat
d) cat
e) 2 wk old puppy
f) llama
not puppy since it is a neonate
Which of the following is/are unacceptable induction protocol drug combinations in the horse?
a) Thiopental alone
b) Ketamine followed by Guaifeniesen
c) Thiopental + Guaifeniesen
d) Xylazine followed by Ketamine
e) Xylazine + Ketamine + Guaifeniesen
b) Ketamine followed by Guaifeniesen (should be Guaifeniesen FIRST)
e) Xylazine + Ketamine + Guaifeniesen (this is a MAINTENANCE mixture)
Which type of laryngoscope blade is commonly used for equine intubation?
NONE -- blind intubation is usually used!
A period of tachypnea followed by apnea is known as...
Which species does this generally occur?
Biot's Breathing occurs in 24-30% of foals
What is the normal MAP range for a horse?
75 - 100 mmHg
What is the normal respiration rate in an anesthetized horse? A foal?
Horse (4-10)
Foal (6-20)
Describe the desired CNS reflexes that are desired in an anesthetized horse?
Ocular reflex (should MAINTAIN a slow palpebral reflex)
What points should be protected during horse anesthesia?
Coronary band
Eye
Brachial plexus
Nose roll prevents laryngeal hemiplegia
What is the most important factor in preventing myopathy in the horse?
Maintenance of perfusion pressure
What are common options for cardiovascular support in the horse with low perfusion pressure?
Dobutamine
Ephedrine
Calcium gluconate
What can prevent soft palate displacement during equine extubation?
Get horse to swallow
What are causes of difficult jugular venipuncture in camelids?
Thick skin
Close jugular/carotid proximity
Jugular valves
Regurgitation is common in which of the following animals?
a) Camelids
b) Horses
c) Oxen
d) Sheep and goats
e) Pigs
a) Camelids
b) Oxen
d) Sheep/Goats
e) Pigs
Which of the following is NOT commonly used in camelid sedation protocols?
a) Xylazine
b) Medetomidine
c) Butorphanol
d) Acepromazine
e) Nalbuphine
d) Acepromazine
Which of the following is NOT an acceptable mode of chemical restraint in the camelid?
a) Xylazine IM followed by Ketamine IM 15-20 min later
b) Xylazine + Ketamine given together IM
c) Xylazine alone (IM or IV)
d) Medetomidine IM
e) Romifidine IV
a) Xylazine IM followed by Ketamine IM 15-20 min later
(Ketamine should be IV)
What are the components of "Keatmine Stun"? Which animal(s) is this associated with?
Ketamine + Xylazine + Burorphanol (pretty much same as BKX but with more xylazine and butorphanol)
Associated w/Camelids
What are the relative proportions of BKX?
10mg butorphanol
100mg xylazine
1000mg ketamine
What can often help when catheterizing a camelid?
Using a needle or scalpel to incise the skin first
Which animal has the highest rate of syncope during anesthesia?
a) horse
b) cow
c) llama
d) sheep
e) fainting goat
Probably a fainting goat but in reality, LLAMAS have a high degree of syncope
Which of the following are acceptable induction regimens in camelids?
a) Thiopental alone (IV)
b) Thiopental + Guaifensen (IV)
c) Ketamine + Guaifensen (IV)
d) Propofol (IV)
e) Xylazine followed by Ketamine (IV)
ALL are acceptable!
What is triple-drip? How do the proportions differ between the camelid, horse, and ruminant?
Triple drip = Xylazine, Ketamine, Guaifensen
(Use less xylazine in camelids, even less in ruminant)
Which method describes intubation of the camelid?
a) Orotracheal
b) Blind nasotracheal
c) Nasotracheal w/laryngoscope
d) a and b only
e) all of the above
e) all of the above
Which structures must be avoided during nasotracheal intubation of a llama? What are some complications of this?
Avoid middle meatus, pharyngeal diverticulum (epistaxis is a complication)
In which animal is atropine a common part of the preanesthetic preparation?
Camelids
What are normal heart rates of camelids?
60-90 bpm (w/atropine)
28-40 bpm (w/xylazine)
100-125 bpm (juvenile w/atropine)
What is a good MAP range for camelids? How about respiratory rate?
75-90 mm Hg
10-25 bpm (adults)
20-30 bpm (juveniles)
When should the ET tube be removed from camelids?
It should remain in-place as long as possible!
What is the common injection site for epidural anesthesia in camelids? What are common drugs used for epidurals?
Sacrocaudal joint
Use xylazine or pretty much anything ending in -caine
Which pre-anesthetic drug is NEVER used in bulls?
Acepromazine
Place the following in order of greatest to least sensitivity to alpha-2 agonists:
Sheep
Pig
Calf
Goat
Llama
Horse
Goat (most sensitive)
Calf
Sheep
Llama
Horse
Pig (least sensitive)
What are two side-effects of using xylazine in ruminants?
Hypoxemia
Oxytocin-like effects
Xylazine + Butorphanol is commonly used as neuroleptanalgesia in which of the following animals?
a) camelids
b) pigs
c) horses
d) ruminants
ALL OF THE ABOVE
T or F:
Ruminants should undergo a preanesthetic fasting period of 8-24 hrs to prevent regurgitation.
False!
Fasting only prevents BLOAT in ruminants
T or F:
Orotracheal intubation is blind in cattle but can be done with a laryngoscope in most other ruminants.
True
What are normal MAP values for cattle? Sheep/goats?
Cattle (90-120 mm Hg)
Sheep/Goats (70-90 mm Hg)
A palpebral response is NOT desired during anesthesia in which of the following animals?
a) horse
b) cow
c) camelid
d) dog
e) cat
b) cow
d) dog
e) cat
Which drug is used in swine for sedation that isn't used in any other large animal/ruminant/camelid?
Azaperone
Which 3-drug combination (technically a 4-drug combo) is used in chemical restraint of swine?
TKX (Tiletamine, Zolazepam, Ketamine, Xylazine)
What additional technique must be used when intubating swine?
Lidocaine on arytenoids
Which physical anesthetic monitoring characteristics are the most important in swine anesthesia?
a) palpebral reflex
b) Heart rate
c) Corneal reflex
d) Movement
HR and movement (response to pain); ocular reflexes are worthless
Name the condition that causes anesthetic complications in the following animals:
Horses
Dobermans
Sighthounds
Boxers
Pigs
Horses (HYPP)
Dobies (Von Willebrand's Dz)
Sighthounds (Thiobarbiturates)
Boxers (Cardiac dz; Acepromazine)
Pigs (Malignant hyperthermia)
What are complications associated with animals at either extreme of body condition scoring?
low score = cachexic (poor anesthetic candidate)
high score = fat (frequently overdosed)
Which of the following has the least impact on changing anesthetic protocols?
a) Body condition score
b) Age of patient
c) Preanesthetic labwork
d) Patient temperament
c) Preanesthetic labwork (recent paper showed that labwork had little impact on protocol change)
What is the ASA status of a patient awaiting a TPLO? Of a patient with pulmonic stenosis?
TPLO = ASA - 1
Stenosis = ASA - 3
What are the 8 main steps to patient anesthesia? (hint - remember what you did for the dog anesthesia lab)
Physical exam
Calculate doses
Premedicate
Set-up machine
Place catheters
Intubate
Maintenance
Recover
What drugs were used for pre-anesthetic in the dog lab? For induction?
Pre (Ace + Hydromorphone)
Induction (Propofol)
What are two main differences between cats and dogs with regard to anesthesia?
Cats more prone to hypothermia (small size)
Decreased hepatic capability alters pharmacokinetics
What is a good premed drug combo for an aggressive dog?
Dexmedetomadine + Telazol
What is a possible complication to hydromorphone use in cats?
Hyperthermia
What are procedural indications for anticholinergic use in small animals?
Endoscopy
Opthalmic procedures
Describe the premedication used for a geriatric dog with a fractured mandible.
Benzodiazepine + opioid
(eg: midazolam + hydromorphone);
also nerve blocks
Describe the premeds used for a juvenile english bulldog in for ovariohysterectomy.
Butorphanol or low-dose hydromorphone
Which long-lasting opioid works really well in cats?
Buprenorphine
Which anesthetic drug should usually be avoided in geriatric cats?
Ketamine (renal excretion)
What are the two major (common) options for IV induction in small animals?
Propofol
Ket/Val
When properly placed and properly sized, where should the ET connection be located in relation to the patient's anatomy?
At tip of the nose
How does intubation of cats differ from dogs?
Need lidocaine for arytenoids in cats
What are some adjuncts that can be used during IV induction of small animals?
Diazepam/midazolam
Lidocaine
Opioids
What is a great physical monitoring parameter for anesthetic depth in small animals?
Jaw tone
Which dog breeds generally have poor recoveries? What can be done for this?
Curly-tailed breeds (give acepromazine)
What are some advantages to using local anesthesia IN CONCERT with general anesthesia?
Reduces necessary amt of other meds (general anesthetics, post op pain meds)
Prevents wind-up
Minimizes negative effects of other anesthetic drugs (due to decreased amounts)
What are the three general sites of action for local anesthetics? Generally speaking of mechanisms here...
Inhibit transduction (locally)
Inhibit transmission
Modulation of spinal pathways
Chemically speaking, what are the three parts to a local anesthetic?
Hydrophilic part
Lipophilic part
Intermediate chain
What is the general MOA for local anesthetics?
Binds to receptor site in Na channel, which inactivates the Na channel and prevents depolarization.
What are cardiovascular signs of local anesthetic toxicity?
Hypotension, bradycardia, dysarrthymias
What is a rough estimate for total volume of lidocaine to administer? Bupivicaine?
<0.5ml/kg for both
What effect does the addition of bicarbonate to a local anesthetic injection have?
a) Prolong block duration, increase intensity of block
b) Hasten block onset, decrease pain of injection
c) Local vasoconstrictor
d) Part of multimodal analgesia
b) Hasten block onset, decrease pain of injectio
What effect does the addition of epinephrine to a local anesthetic injection have?
a) Prolong block duration, increase intensity of block
b) Hasten block onset, decrease pain of injection
c) Local vasoconstrictor
d) Part of multimodal analgesia
c) Local vasoconstrictor
Which nerves are affected in a brachial plexus block?
Musculocutaneous
Median
Radial
Axillary
Ulnar
What tool can ensure the precision of local blocks?
Peripheral nerve stimulator
Which block is useful in onychectomies? Which nerves are blocked?
4-point block (distal foot block)
Superficial radial n.
Dorsal br. of ulnar n.
Median n.
Palmar br. of ulnar n.
T or F:
Blocking at the mandibular foramen and/or the infraorbital foramen blocks M4 to I1 on the side of administration.
False! This only describes blocking at the mandibular foramen! At the infraorbital foramen you block PM3 to I1.
Give some examples of non-drug anti-pain therapies.
Acupuncture
Ultrasound
Heat/cold therapy
Massage
"Laser"
Electromagnetic treatments
What are the major classes of therapeutic anti-pain drugs?
NSAIDs
Opioids
Alpha-2 agonists
NMDA blockers
Local anesthetics
What is the difference between anesthesia and analgesia?
Anesthesia blocks PERCEPTION of painful stimuli
Analgesia increases TOLERANCE to pain
Which is safer, COX1/COX2 balanced NSAIDs or COX2 selective NSAIDs?
BALANCED NSAIDs are safer overall (less nephrotoxicity, less hepatotoxicity, and better analgesia overall)
What are feline concerns when using NSAID therapy?
Hepatic metabolism is variable
Nephrotoxicity in animals w/kidney dz
What are benefeits of neutraceuticals? Disadvantages?
Benefits (positive effect on cartilage matrix, enhance hyluronic acid, inhibit catabolisis in joints)
Disadvantages (no FDA regulation, commonly below potency levels)
What is the range of duration for butorphanol effectiveness in cats?
15min to 8 hours!!!
This newer drug has an unknown MOA and is used very early in human pain management and shows promise in veterinary pain management.
Gabapentin
This drug (NOT ketamine) is a NMDA antagonist and an antiviral. It also may increase DA release.
Amantidine
T or F:
Pain should be considered a vital sign.
yup
Choose pathological or physiological pain...
...reaction to injury.
physiological
Choose pathological or physiological pain...
...requires a high-threshold input.
physiological
Choose pathological or physiological pain...
...altered nerve pathways require a low-threshold input.
pathological
Choose pathological or physiological pain...
...no protective function.
pathological
What are five factors to evaluate for pain? AAARP
Attitude
Appetite
Activity
Responses
Physiological parameters