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104 Cards in this Set
- Front
- Back
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Neuromuscular Blocker Effects |
Paralyze only skeletal muscle, not visceral smooth musle No effect on CNS |
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Neuromuscular Blocker Precautions |
Administer after general anesthesia Must intubate and ventilate Monitor for hypotheria Lubricate eyes |
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Succinylcholine |
Depolarizin muscle paralyzer Muscle twitching, followed by paralysis Fast onset, short duration No reversing agent |
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Local Anesthesia Action |
Prevent sensory nerve transmission No effect on brain |
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Topical LA |
Skin Eyes MM |
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Infiltration LA |
Injected SC around site Most common |
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Nerve Blocks LA |
Near (not into) specific nerve Blocks sensation from area distal to injection site |
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Line or Ring Blocks LA |
Continuous line or ring of drug injected proximal to body part |
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Intra-articular LA |
Injected into joint |
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Regional Anesthesia LA |
Injected where major nerves exit spinal cord |
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Epidural LA |
Placed into epidural space Dorsally through lubrosacral space |
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Local Anesthesia Precatuions |
Infiltration may cause inflammation Injection into a nerve may cause temporary or permanent damage If reaches brain in high conc. - seizures, death |
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Potentation |
One drug increases effectiveness of another drug |
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Lidocaine |
LA Most common |
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Bupivicaine |
LA Slower onset, longer duration |
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Mepivicaine |
LA horses less tissue reaction |
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Procaine |
LA Bovine |
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Proparacaine |
LA Ophthalmic topical |
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Why treat pain |
Painful to humans --> painful to animals Owner concern New general anesthetics --> little to no post op sedation or analgesia Decreased movement due to pain no longer seen as protective Survival rates and recovery times improve |
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Goal of Pain Management |
Allow patient to move, eat, sleep w/o undue discomfort Focus on first 1-3 days after routine surgery Longer if severe trauma or epecially painful surgery |
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Sensory Neurons |
A delta fibers (shart, discrete pain, fast transmission) C fibers (dull, aching pain, slow transmission) |
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Somatic Pain |
Skin, SQ, muscles, bones, joints Both A delta and C fibers involved |
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Visceral Pain |
Internal organs Primarily C fibers only |
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Adaptive Pain |
normal response to tissue damage |
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Maladaptive pain |
changes in the CNS from chronic, unmanaged pain that causes the CNS to be more, rather than less sensitive |
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Allodynia |
Pain from a stimulus that does not normally cause pain |
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Hyperesthesia |
Increased sensitivity to a stimulus that is normally painful |
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Referred pain |
Felt in a body part other than the cause |
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Neuropatic pain |
due to direct damage to peripheral nerves or spinal cord |
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Indicators of Pain |
Decreased activity Restlessness Limping Increased HR & RR Abnormal body posture Depression Vocalization Trembling/shaking Licking/chewing |
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Opioid Drugs (moderate to severe pain) |
Morphine, hydromorphone, oxymorphone, fentanyl |
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Opioid Drugs (mild to moderate pain) |
Meperidine, Butorphanol, Nalbuphine, Buprinorphine |
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NSAIDs |
Work at the tissue level to prevent prostaglandin production |
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Advantages of NSAIDs |
Oral Not controlled Litte Resp/Caridiovascular effects No sedation Anti-inflammatory |
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Contraindicatons of NSAIDs |
Dehydrated or hypotensive patient Liver or kidney disfunction Corticosteroids GI disorders |
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NSAIDs (drugs) |
Carprofen Meloxicam Asprin Firocoxib Deracoxib |
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Local Anesthetics |
Pre-emptive use only Short duration Potential for toxicity |
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Alpha-2 Agonists |
Short duration Profound sedative effect Serious side effects |
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Ketamine |
Useful in trauma at low dose Little resp/cardiovascular effect Contraindications: head trauma, cardiac or renal disease |
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Tranquilizers |
No direct analgesic effect Calm patients, allow opioids to work |
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Constant Rate Infusions |
Prevents hills and valleys Allows patient to recieve effective pain control while decreasing side effects |
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Non-Pharmacologic Intervention (lifestyle change) |
Weight loss Increasing mobility Easy access to litter box Soft padded bedding Gentle handling Decrease stress |
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Non-pharmacologic Intervention (Complementary medicine) |
Acupuncture Chiropractic Neutraceuticals |
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Balanced Anesthesia |
Using drugs from more than one class of analgesia to maximize effectiveness and minimize side effects |
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Geriatric |
Reached 75% of life expectancy Poor response to stress Reduce anesthetic doses Allow for more time to take effect Recovery may be prolonged |
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Pediatric |
3 months or younger hypoglycemia a problem high risk of hypothermia, overhydration reduce dosages inhalation preferred |
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Brachycephalic |
High vagal tone airway obstruction a problem (preoxygenate, induce rapidly, delay extubation) |
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Sighthounds |
avoid barbiturates |
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Obese |
preoxygenate dose according to ideal weight induce rapidly assist ventilation if necessary delay extubation |
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Cesarean |
Preoxygenate IV fluids lowest effective dose of anesthetic Neonates: oxygen by mask, aropine for bradycardia, reversing agents) |
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Hypovolemic shock |
Decrease in circulating blood volume due to loss of fluid (hemorrhage, vomiting, diarrhea, burns) |
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Vasculogenic shock |
vascular space is increased, leading to loss in blood pressure (sepsis, anaphylaxis, drug overdose) |
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Cardiogenic shock |
failure of cardiac output (dysrhythmias, valvular insufficiency, heart muscle problems) |
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Obstructive shock |
restriction in blood flow (GDV, pneumothorax, cardiac tamponade) |
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Signs of Shock |
Tachycardia Hypotension Tachypnea Hypothermia Weakness, restlessness, depression Reduced urine output Coma and pupil dilation Leads to cardiopulmonary arrest |
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Treatment of Shock |
Rapid IV fluids warm patient dopamine or dobutamine (Increase contraction of heart muscle) Lidocaine or propranolol (arrythmias) Antibiotics for sepsis |
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Patient does not stay anesthetized |
Avoid by proper machine checkout, confirm placement of intubation, measure endo tube & check cuff |
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Patient too deep |
Signs: Dilated pupils, no reflexes, bradycardia, hypoventilation Causes: Equipment, patient Treat or avoid by: proper checkout, turn down vaporizer, ventilate, warm patient, reversal drugs |
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Respiratory Depression |
Signs: Reduced RR, Reduced TV, Cyanosis Causes: too deep, anesthetic drugs, positioning, CNS or metabolic disease Treatment: lighten plane, correct positioning, doxapram |
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Abnormal breathing patterns |
Signs: increased effort, cyanosis, unusual sounds, tachypnea Causes: too deep, misplaced ET, Obstruction, disease of resp. system Treatment: check popoff valve, assess depth, ventilate |
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Bradycardia |
Signs: <60 bpm in dogs, <100 bpm in cats Causes: Too deep, increased vagal tone, hypothermia, metabolic problems, late stages of hypoxia Treatment: Lighten anesthetic plane, support ventilatin, keep warm, administer anticholinergic |
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Tachycardia |
Signs: Dogs (LG >120bpm, MD >140bpm, Sm >150bpm), Cats >220bpm Causes: too light, hypotension, hypovolemia, shock, drug induced, hyperthermia Treatment: Adjust depth, Proide adequate fluids, support ventilatin, check temp |
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Cardiac Dysrhythmias |
Signs: Irregular HR, pressure, sounds, hypotension, abnormal ECG Causes: Too light or too deep, anesthetic drugs, electrolyte or acid-base balance, surgical manipulation Prevention: Presurgical PE or labwork, correct hydration & metabolic imbalances before anesthesia, Knowledge of drug actions, fluids, anesthetic depth monitoring Treatment:Assess & adjust depth, ventilation, fluids, lidocaine |
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Cardiac Arrest |
Signs: resp arrest, no pulse or heart sounds, fixed, dilated pupils, lack of bleeding, blue/gray tissues Causes: inadequate ventilation, anesthetic overdose, hypothermia, acidosis Treatment: CPR, Epinephrine |
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Vomiting |
Active stomach contractions (pumping stoamch) |
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Regurgiation |
Passive reflux from esophagus or stomach |
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Vomiting/Regurgitation |
Causes: drugs, light anesthesia, feeding before anesthesia, stress, surgical manipulation Prevention: Fast 12 hours before anesthesia, avoid stress, Ace Treatment: place in sternal, keep mouth open, tilt head down |
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Signs of Aspiration |
Cyanosis Bronchospasm (wheezing, can't breathe in) Apnea or Tachypnea |
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Treatment of Aspiration |
Suction airway Administer oxygen Broad-spectrum antibiotics Coupage |
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Malignant Hyperthermia |
Hypermetabolic state induced by drugs; uncontrolled increase in temp, metabolic crisis; may lead to death |
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Predisposing Factors of Malignant Hyperthermia |
Genetic Infection Drugs (ketamine, anticholinergics, inhalantion drugs) Environmental stress and excitement |
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Early signs of Malignant hyperthermia |
Hyperventilation, tachypnea Elevated temp Skin & MM flushed (cyanosis) Tachycardia and dysrhythmias Muscle rigidity |
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Late signs of Malignant hyperthermia |
Muscle rigidity Core body temp: 108-110 Severe metabolic acidosis Hemolysis Acute renal failure Hypoglycemia |
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Treatment of Malignant Hyperthermia |
Remove triggering agents IV fluids Cool body Oxygen Diuretics Corticosteroids |
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Horse Injectables |
Given IV in jugular (right side opposite of esophagus) in case of tissue reaction Avoid carotid artery |
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Dedation and standing chemical restraint |
Used for minor surgery Patient may be aroused from sedation by pain or other stimulation |
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Equine Sedation (alone or in combination) |
Acepromazine Xylazine Detomidine |
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Equine Field Anesthesia |
Using injectables to achieve light general anesthesia with recumbency Usually xylazine followed by ketamine Site: flat, good footing, clean. free from hazards, noise and traffic |
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Guaifenesin |
Muscle relaxant used in horses Smooths induction and recovery Light restraint |
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Diazepam |
Anticonvulsant used in horses Mild sedation & relaxation Given w/ ketamine in same syringe |
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Butorphanol |
Increase analgesia and duration of sedation in horses |
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Monitoring Depth (equine) |
Monitor pulse, respiration, muscle tension Strong palpebral and corneal reflexes present Spontaneous eyelid movement and nystagmus often present |
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Inhalant Anesthesia (equine) |
Procedures longer than 30 minutes or requiring dorsal recumbency |
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Anesthetic Equipment (equine) |
Mechanical ventilator necessary <300 lbs: SA machine with 5L bag >300 lbs: 15-30L bag; larger hoses and valves; 24-30mm inside diameter ET |
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Equine Intubation |
Blind technique Confirm by breath sounds from tube |
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Post-Procedural myopathy |
Concern in horses 6+ inches of padding Prevent extreme abduciton of limbs |
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Equine BP monitoring |
Catheter in metatarsal, facial or auricular artery Normal MAP = 70-80 mmHg |
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Equine capnography |
Normal range = 35-45 mmHg |
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Anesthesia for foals |
May be induced with injectables Very young - induction by nasotracheal tube ET for maintenance |
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Bovine Surgery |
Most done standing w/ combination of sedation, local analgesia and physical restraint |
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Special Considerations for Bovine General Anesthesia |
Bloat, regurgitation, aspiration, copius salivation |
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Regurgitation |
Cuffed ET tube necessary Keep head and mouth lower than neck in lateral |
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Bloat |
Fast for 48 hrs before anesthesia
Place in sternal Trocarization |
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Sedation and Standing Chemical Restraint (bovine) |
Xylazine - most common - cattle very sensitive - may become recumbant Acepromazine |
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General Anesthesia (bovine) |
Sedation usually not necessary Recoveries not rough |
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Bovine Induction Agent |
Ketamine Telazol Thiopental |
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Bovine Maintenance Drugs |
Triple drip of Guaifenesin/Ketamine/Xylazine Inhalants - intubation by palpation or blind |
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Anesthesia for Calves |
Induction: IM xylazine and ketamine; Mask or nasotracheal tube Maintenance: Oral tracheal intubation, SA anesthetic machine |
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Small Ruminant Anesthesia |
Same concerns as for cattle Use SA xylazine Induce w/ IV xylazine/ketamine + diazepam SA anesthetic machine |
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Swine Anesthesia Chalenges |
Few accessible veins Thick body fat requires 1.5" needle for IM Difficult to restrain Difficult intubation Malignant hyperthermia/Porcine Stress Syndrome |
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Swine IM Induction |
Site:caudal to ear, 2" off midline Drugs: opioid/tranquilizer +/- ketamine |
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Local Anesthesia Large Animals |
Lidocaine most common |
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Local Anesthesia LA Toxic Reactions |
CNS effects (restlessness, twitching, seizures, unconsiousness) Ciruclatory effects (bradycardia, hypotension) Toxicity reduced by limiting total dose and adding vasoconstrictors to delay absorption |
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Administration of Large Animal Local Anesthesia |
Topical opthalmic "Inverted L" inflitration into paralumbar fossa for abdominal inscisions in cattle Nerve blocks Regional nerve blocks where nerves exit spinal cord IV regional anesthesia Caudal epidural for tail and perineal region |
