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48 Cards in this Set
- Front
- Back
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List the Vital signs that must be monitored during anesthesia (6) |
- heart rate/rhythm - respiratory rate/depth - mucous membrane colour/CRT - pulse strength - body temperature - blood pressure |
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T/F: Trends are better indicators of anesthetic depth & condition than static observations |
True |
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T/F: It is easier & usually more successful to deal with an anticipated anaesthetic problem than one already in progress. |
True |
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T/F: No one monitoring parameter is sufficient in assessing anaesthetic depth/condition. |
True |
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Describe stage 1 of anesthesia. What signs would indicate this stage? What indicates the end of this stage? |
- Stage 1 is a period of voluntary movement. - Fear, excitement, disorientation, struggling, urination, defecation, increased heart and respiratory rate - Ends with loss of ability to stand and recumbency |
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Describe stage 2 of anesthesia. What signs would indicate this stage? What indicates the end of this stage? |
- Stage 2 is a period of involuntary movement. - Irregular breathing, vocalization, struggling, paddling, increased heart and respiratory rate, pupils dilated, muscle tone marked, reflexes present - Ends with muscle relaxation, decreased respiratory rate, and decreased reflex activity. |
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Give 2 reasons why we try to get through stage 2 as quickly as possible. |
1. To prevent injury to the animal and the restrainer 2. Because the more the patient is effected by this stage, the harder it becomes to get them to stage 3. |
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What is the laryngeal reflex? |
The reflex that mediates coughing in response to irritation of the larynx |
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How does each stage effect respiratory rate? |
Stage 1: Resp rate increased. Stage 2: Irregular. Stage 3 Plane 1: High end of normal rate. S3P2: Moderate rate, may be shallow. S3P3: Low rate possibly below normal, shallow. S3P4: Jerky. Stage 4: Apnea. |
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How does each stage effect cardiovascular function? |
Stage 1: Heart rate Increased. Stage 2: Rate often increased. Stage 3 plane 1: Strong pulse, rate high end of normal. S3P2: Moderate rate. S3P3: Heart rate low end of normal, CRT increased, weaker pulse. S3P4: Rate below normal, increased CRT, pale mucous membranes. Stage 4: Cardiovascular collapse. |
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What is the pedal reflex? |
When you pinch the web of skin between the toes of the animal, they will withdraw their leg. |
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What is the palpebral reflex? |
The eyelids close when they are touched |
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What do we do during S3P1? What do we not do? Why not? |
- We insert the endotracheal tube so the patient can be connected to a gas anesthetic machine - We do not begin any surgical procedures because the patient will still have a physical response to painful stimuli (some movement; increased HR & RR) |
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What happens to the animal's reflexes during S3P1? |
Palpebral and pedal reflexes are present; laryngeal reflex is not. |
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What is the swallowing reflex? |
The reflex is initiated by touch receptors in the pharynx as a bolus of food is pushed to the back of the mouth by the tongue, or by stimulation of the palate (palatal reflex). |
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The loss of which 2 reflexes marks the entry into S3P2? |
Pedal reflex and swallowing reflex |
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Which plane is optimal for most surgical procedures? |
Stage 3 Plane 2 |
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In which plane does ventromedial eye rotation occur? |
Stage 3 Plane 2 |
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What are 3 different ways you can identify S3P3? |
- Usually all reflexes are completely abolished in this plane - Eyeballs are central with moderately dilated pupils - Skeletal muscle tone is so relaxed that no resistance occurs when the jaw is opened |
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In which plane does tidal volume of respiration become a concern? |
Tidal volume decreases during S3P3, meaning manual or mechanical ventilation may be necessary. |
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Give an alternate name for each stage/plane of anesthesia (except plane 1). |
Stage 2: Excitement stage S3P1: Light anesthesia S3P2: Moderate anesthesia S3P3: Deep anesthesia S3P4: Early anesthesia overdose Stage 4: Anesthesia overdose |
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How can S3P4 be identified? |
Abdominal breathing, fully dilated pupils, all reflexes absent, marked depression of cardiovascular system, pale mucous membranes, increased CRT, flaccid muscle tone |
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How can Stage 4 be identified? |
Apnea, circulatory collapse, and death |
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List the 4 objectives of anesthetic anesthesia |
1. Patient doesn't move 2. Patient isn't aware 3. Patient doesn't feel pain 4. Patient has no memory of the procedure |
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Relating to cardiac function, what signs do we need to physically (without a machine) monitor during anesthesia? How do we monitor them? |
- Heart rate via auscultation - Heart rhythm via auscultation - Pulse via palpation - Mucous membrane colour - CRT |
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Relating to cardiac function, what signs do we need to mechanically (with a machine) monitor during anesthesia? |
- ECG - Blood pressure |
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What is an ECG and why is it used? |
An electrocardiogram measures the electrical patterns of the heart for the purpose of identifying arrhythmias, and differentiating them as normal/abnormal; dangerous/harmless; etc. |
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Describe a sinus arrhythmia in detail. In which species is a sinus arrhythmia abnormal? |
A sinus arrhythmia is when the heart rate is coordinated with respiration. This means the heart rate decreases during expiration, and increases during inspiration. It is abnormal in cats. |
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What are the common causes of bradycardia during anesthesia and how are they treated? |
- Caused by excessive anesthetic depth and/or drug reactions - Treated with reversal agents or anticholinergics |
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What are the common causes of tachycardia during anesthesia and how are they treated? |
- Caused by inadequate anesthetic depth, drug reactions, and surgical stimulation - Treatment depends on the cause |
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What is this an example of? |
Sinus arrhythmia |
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What is the difference between systolic pressure and diastolic pressure? |
Systolic is the pressure that's created when the contraction of the left ventricle propels blood through the systemic arteries, whereas diastolic is the pressure that remains in the arteries when the heart is in its resting phase. |
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What is MAP? |
Mean arterial pressure. It is the average blood pressure throughout the cardiac cycle and is the most important blood pressure value to consider. |
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What is the minimum MAP required to supply body tissue with adequate perfusion? |
60mmHg |
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When observing blood pressure, why is it important to monitor trends rather than a single value? |
Blood pressure can be difficult to measure accurately because it changes rapidly and is subject to many influences. |
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How does pulse strength relate to blood pressure? |
Pulse strength is determined by the difference between systolic and diastolic pressure |
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Why is it important to palpate the pulse strength both prior to and during anesthesia? |
By doing so, the anesthetist can detect a change in the pulse strength that may indicate a drop in blood pressure |
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What is the difference between a direct blood pressure monitor and an indirect blood pressure monitor? |
Direct is when a sensor is actually placed inside an artery (common in large animal practice) whereas indirect is where a sensor is placed somewhere on the outside of the body. |
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Explain the doppler method of reading blood pressure |
An inflatable cuff is placed around the peripheral limb, proximal to a light sensor attached to the skin. As the cuff is inflated and deflated, the sensor detects the resulting change in blood flow, which allows the technician to determine systolic pressure. |
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Explain the oscillometric method of reading blood pressure |
An inflatable cuff with sensors inside is placed around the peripheral limb. These sensors detect changes in pressure as the cuff is inflated and deflated, and uses that information to automatically calculate systolic, diastolic, and mean arterial pressures. |
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Explain hemoglobin saturation. |
Hemoglobin has 4 oxygen binding sites. If each binding site is full, that means each molecule of hemoglobin can carry 4 molecules of oxygen. If this is the case, the hemoglobin is said to be 100% saturated. |
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Explain partial pressure of oxygen. How is it measured? |
Partial pressure measures the oxygen that's dissolved in plasma, unbound to hemoglobin. It's measured in mmHg. |
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Explain percent oxygen saturation. |
Percent oxygen saturation measures the percentage of the total number of hemoglobin binding sites occupied by oxygen molecules. |
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What are the following abbreviations: Pao2 = ? Pvo2 = ? Sao2 = ? Svo2 = ? |
Pao2 = Partial pressure of oxygen in arterial blood Pvo2 = Partial pressure of oxygen in venous blood Sao2 = Arterial oxygen saturation Svo2 = Venous oxygen saturation |
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Why is it that Po2 and So2 are different depending on where they are measured? What would the differences be? |
Po2 and So2 will be highest in the arterial side of the system close to where they picked up oxygen from the lungs. As the blood moves throughout the body and oxygen gets used up by body tissue, both Po2 and So2 will decrease. |
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Explain the relationship between partial pressure and oxygen saturation. |
In order for oxygen to have the ability to bind to hemoglobin, there must first be a certain amount of dissolved oxygen in the blood. Because of this, Po2 and So2 tend to increase along side each other. |
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Explain why a slight difference in Po2, despite it carrying a very negligible percentage of blood oxygen, can still have a major effect on the blood oxygen content overall. |
The decrease of Po2 has a reverse exponential effect on So2, starting off slow and becoming more drastic. So hypothetically speaking if Po2 was at 500mmHg and dropped to 100, that could cause only a 2% drop in So2. However, if it were to drop again to 60mmHg, that could have a much more detrimental effect of up to 20% on So2. |
