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101 Cards in this Set

  • Front
  • Back
what is the physical status of category I pre anesthetic patient and give examples
Normal, healthy...no disease, elevtive OHE
what is category II's physical status and give example
mild systemic disease....fracture with no shock
what is category III and give examples
fever, dehydration, anemia, cancer cachexia...severe systemic disease
what is category IV and give examples
uremia, toxemia, severe dehydration...SSD, constant threat to life
What is category V of preanesthetic patient status and give examples
Moribund, not expected to live
what are some different ways to monitor a patient during anesthesia
1. circulation 2. oxygenation 3 ventillation 4.
what are different methods used for monitoring circulation to ensure adequate tissue perfusion
1. palpate pulse 2. palpate heartbeat through wall 3. listen to heart with esoph stethescope 4. ECG 5. blood pressure monitor 5. invasive bp monitor
what are you looking for when you are monitoring oxygenation
you are ensuring adequate O2 concentration in patient's arterial blood
what are the methods for monitoring the oxygenation
1. observe MM color 2. pulse oximeter 3. oxygen analyzer on inspiratory limb of breathing circuit 4. blood gas analysis 5. hemoximetry
what are the methods of monitoring ventillation
1. observe thoracic wall mvmt 2. observe breathing bag movement 3. auscillation of breath sounds 4. audible resp monitor 5. respirometry 6. capnography 7. blood gas monitoring
what should be on an anesthetic record
all drugs given , dose, time, route 2. monitored variables on reg basis
what are variables commonly monitored in anesthetized patients
1. heart and breathing rates and sounds
2. pulse rate and character
3. depth and pattern of breath
4. capillary refill time and color of MM
5. ECG
6. arterial BP
7. arterial blood gas tensions and pH
8. acid base status
9. hemoglobin saturation(pulse ox)
10. exhaled CO2 concentration
11. cardiac output
how do you determine central nervous responses and depth of anesthesia?
-eyeball position
-pupillary size and responsiveness
-muscle relaxation
-jaw tone
-response to noxious stimuli
what are potential side effects of anesthetic drugs?
excessive hypotension
-bradycardia
-arryhthmias
-myocardial depression
-vasodilation/vasoconstriction
what does palpating the pulse tell you?
rhythm, rate, strength, stroke volume
what does the esophageal stethescope tell you?
the sounds reflect the pumping of blood and strength of contractions; allows assessment of heart rate and rhythm
what is category II's physical status and give example
mild systemic disease....fracture with no shock
what is category III and give examples
fever, dehydration, anemia, cancer cachexia...severe systemic disease
what is category IV and give examples
uremia, toxemia, severe dehydration...SSD, constant threat to life
What is category V of preanesthetic patient status and give examples
Moribund, not expected to live
what are some different ways to monitor a patient during anesthesia
1. circulation 2. oxygenation 3 ventillation 4.
what are different methods used for monitoring circulation to ensure adequate tissue perfusion
1. palpate pulse 2. palpate heartbeat through wall 3. listen to heart with esoph stethescope 4. ECG 5. blood pressure monitor 5. invasive bp monitor
what are you looking for when you are monitoring oxygenation
you are ensuring adequate O2 concentration in patient's arterial blood
what are the methods for monitoring the oxygenation
1. observe MM color 2. pulse oximeter 3. oxygen analyzer on inspiratory limb of breathing circuit 4. blood gas analysis 5. hemoximetry
what are the methods of monitoring ventillation
1. observe thoracic wall mvmt 2. observe breathing bag movement 3. auscillation of breath sounds 4. audible resp monitor 5. respirometry 6. capnography 7. blood gas monitoring
what should be on an anesthetic record
all drugs given , dose, time, route 2. monitored variables on reg basis
what are variables commonly monitored in anesthetized patients
1. heart and breathing rates and sounds
2. pulse rate and character
3. depth and pattern of breath
4. capillary refill time and color of MM
5. ECG
6. arterial BP
7. arterial blood gas tensions and pH
8. acid base status
9. hemoglobin saturation(pulse ox)
10. exhaled CO2 concentration
11. cardiac output
how do you determine central nervous responses and depth of anesthesia?
-eyeball position
-pupillary size and responsiveness
-muscle relaxation
-jaw tone
-response to noxious stimuli
what are potential side effects of anesthetic drugs?
excessive hypotension
-bradycardia
-arryhthmias
-myocardial depression
-vasodilation/vasoconstriction
what does palpating the pulse tell you?
rhythm, rate, strength, stroke volume
what does the esophageal stethescope tell you?
the sounds reflect the pumping of blood and strength of contractions; allows assessment of heart rate and rhythm
what does ECG tell us
rate and rhythm, intraop dysrythmias, ischemic events, electrolyte imbalances...can treat arrythmias before they happen
when do you treat an arrhythmia seen on ECG
impaired myocardial performace, cardiac output, or tissue perfusion...or if could progress to fatal rhythm
what is the formula for MAP
DBP + 1/3(SBP - DPB)
what value do you want your MAP above in anesthetized patients?
60mmHg in everyone but 70mmHg in horse
what is the direct/invasive way of measuring BP
cathetarization of artery, connect to ext line and connect to a manometer or transducer
which arteries are good to use in small animals
dorsal pedal in hind
-lingual
-femoral
which is good to use for direct measure of BP in horse
facial a
-lateral metatarsal
which artery is good to use for direct BP measure in a cow?
auricular
does the ECG tell if the heart is beating
no
what does it mean when the R waves start to get close to the T waves
could go into ventricular tachy or fibrillation
what might cause bradycardia
vagal tone
-medetomidine(drugs)
-hypothermia
-excessive anesthetic depth
-intracranial hypertension
what is the tx for bradycardia
-atropine
-warm up
-lighten anesthesia
-basically tx of underlying cause
what might be the cause of tachycardia?
-insuff depth of anesthesia
-sympathetic stimulation
-hypovolemia
-shock
-drugs
what is the tx of tachycardia during anesthesia
tx of underflying cause
how do you tx a PVC if trending:
lidocaine
why might looking at just the BP be misleading
because you can have normal BP with low CO or normal BP even when animal is going into shock because of the increase in CO to compensate for the vasodilation
what do transducers tell you
they give qualitative info about:
-contractility
-stroke volume
-vascular resistance
-DBP and SBP and MAP
what should the tubing connecting transducer to catheter be?
short and non compliant
what should you do before using a transducer
zero it at the level of the right atrium (placing lower will give falsely low readings)
what do noninvasive BP measure methods use?
pressure cuff-not as accurate-placement and size are important
how big should the cuff be
40% of the circiumference of the limb
what will happen to BP valvues if the cuff is too wide
underestimated
what type of noninvasive BP measurement is used in OR
oscillometric methods-
-connect cuff to device which senses pressure changes in cuff as result of arterial pulsation
when do the oscillometric cuffs give accurate results(what size animal)
small animals-but if too small or too low pressures will not work well
what pressure is most accurate with these cuffs
systolic
when do you know the systolic pressure displayed is credible
if the displayed HR is within 10% of value obtained by palpation, auscultation or ECG
why do you measure central venous pressure
gain info regarding cardiac function and circulating volume status
what is a normal MAP in an awake animal
100
what is an appropriate MAP under anesthesia in small animals
greater than 60
what about an appropriate MAP in a horse
greater than 70
what are causes of hypotension
hypovolemia
-sepsis
-shock
-excessive anesth depth
what is the treatment for hypotension under anesthesia
1st thing is lighten anesthesia
-increase fluid rate
-give colloid
-consider pressor agents(dopamine, dobutamine)
what are the causes of hypertension
insuff anesthesia/analgesia
-hypercapnea
-fever
-increased ICP
what is the tx for hypertension
tx underlying cause
where do you usually place the catheter for a central line to get CVP
cranial vena cava via jugular
what are normal CVP values
0-10
what does a low central venous pressure indicate
relative hypovolemia(need fluids)
what does a high central venous pressure indicate
relative hypervolemia(discontinue or slow fluids)
how can you estimate tidal volume and breathing rate
observe chest and reservoir bag
how is adequacy of alveolar ventillation determined
measure arterial CO2 in breathing circuit
what does measuring the CO2 waveform tell us
warn of airway obstruction and onset of malignant hyperthermia
what is the relationship between PaCO2 and minute volume of alveolar ventillation
inverse relationship...if ventillation doubles, the PaCO2 decreases by half
what does the fact that an end tidal volume CO2 exists tell you
that the tube is not in the esophagus
-there is good cardiac output
what does it mean if you end CO2 is high
hypoventillation
what does it mean if your end CO2 is low
hyperventillation
what is a normal PaCO2
35-45...happy if in small animals less than 60
what are some causes of apnea
exc depth of anesthesia
-recent ventillation
-hypothermia
-MS paralysis
-medullary edema
what is the tx for apnea
control ventillation
-tx underlying cause
what does a capnograph display
CO2 concentration in exhaled gas from ET tube as waveform
what does phase I on the capnograph show
dead space washout and inspired CO2
what does phase II on capnograph show
rapidly rising, first exhaled gas
what does phase III show on capnograph
alveolar plateau followed by sharp downstroke: inspiration and beginning of phase I
what is a mainstream capnograph
fits in breathing circuit(infrared device) between ET tube and breathing hoses
what are the advantages to the mainstream capnograph
no need to scavenge sampled gas
-no need to compensate for water vapor
-NO TIME DELAY
-convenient
what are the disadvantages to mainstream capnographs
bulky, fragile, heavy, expensive
-potential to be damaged
what is a sidestream capnograph
continously remove gas from circuit
-carry to monitor where sampled
what are adv to sidestream capnograph
less bulky
-does not pull on ET tube
what are disadvantages to sidestream capnographs
time delay
-sampled gas has to be scavenged
-erroneous at high fresh gas flows
-condensation damage machines
what does arterial oxygen tension measure
oxygenating efficiency of lung
how do you estimate arterial oxygen tesnsion
observe MM
-use pulse ox
what does pulse ox measure
hemoglobin saturation-percent saturation not amount of hemoglobin
do pulse oximeters give true meausre of blood oxygen content or tissue oxygenation
no
what are some cuases of tachypnea
insufficient anesthesia/analgesia
-hypoxia
-hypercapnea
what are some cuases of hypercapnea
always hypoventillation-due to:
-anesth depth,
-drugs
-position of patient
-Pickwickian syndrome
what cuases hypocapnea
hyperventillation:
-too light anesthetic
-iatrogenic
when do pulse ox's reflect decrease in oxygen tension
when the PaO2 reaches point where hemoglobin begins to desaturate
what is the point when hemoglobine begins to desaturate
60 mmHg
what does 90 SaO2 on pulse ox mean
the PaO2 is 60
what is the normal PaO2
above 80
what interferes with pulse strength
vasoconstriction
-presence of pressure cuffs
-restrictive bandages
-excessive pressure or tension on probe itself