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