Study Questions 1.10 Supportive Care

Front 1

What are the 5 main supportive care?

Back 1

Ventilation
Fluid therapy
Pharmacological support of blood pressure
Passive warming
Eye care (lubrication)

Front 2

What are the 3 methods of ventilation?
Describe them

Back 2

Methods
IPPV: manual, mechanical
PEEP
IPPV
Positive pressure at mouth drives gas into alveoli and expands lung

Front 3

Ventilation: Indications 3

Back 3

High CO2

Hypoxaemia

Difficulty maintaining anaesthesia

Front 4

How do you correct increased Co2?

Back 4

Benefit of IPPV:
Improve tidal volume and/or rate →improved removal of CO2 from alveoli

Indication for ventilation:
ET > 60 mmHg; PaCO2 > 65 mmHg

All causes of Inadequate alveolar ventilation respond to IPPV (manual or mechanical)

Front 5

What is the advantages of using IPPV to fix hypoaxemia?

Back 5

Benefits of IPPV
i) Improve oxygen delivery
ii) Increase oxygen available for exchange (remove CO2)

Front 6

What are the limitations of usinf IPPV for treating hypoxaemia?

Back 6

Limitation of IPPV alone
Abnormal lung collapses easily → smaller volume

Smaller lung volumes require greater pressure change to inflate

Normal lung more easily inflated

THUS IPPV works predominantly on normal lung = minimal increase in O2

Front 7

What are the 2 benefits of using PEEP?

Back 7

Benefits of PEEP
Prevent alveolar collapse at end expiration

Helps re-inflate collapsed lung → increase area available for gas exchange

Front 8

How does IPPV fix the Inability to maintain anaesthesia ?

Back 8

IPPV: improves delivery of gas to alveoli.

Front 9

What are the adverse effects of ventilation?

Back 9

Pulmonary:
lung injury


Cardiovascular:
interference with venous return

Front 10

What is the result of pulmonary injury to normal llung?

Back 10

excessive pressure → alveolar rupture → pneumothorax

Front 11

What is the consequences of pulmonary injury to abnormal lung?

Back 11

Preferential delivery to normal lung

Normal tidal volumes and pressure delivered to smaller area of lung can cause further damage

Front 12

What is the result of repeated overdistension of normal lung?

Back 12

Fibrosis
Increased vessel permeability
oedema

Front 13

Ventilation: Ways of Limiting adverse effects on normal lung? 3

Back 13

Normal lungs
Use least amount of positive pressure to inflate lungs

Allow sufficient expiratory time for venous return to heart

Maintain normal blood volume

Front 14

Ventilation: Ways of Limiting adverse effects on lung pathology that are abnormal.

Back 14

In the presence of lung pathology:

Use smaller tidal volumes (5 ml/kg) and higher RR
→ limits over-distension of normal lung

Front 15

What are the Indications for fluids during anaesthesia?

Back 15

Indications for fluids during anaesthesia
Animals may not drink adequately in peri-operative period
Fill vascular space
Replace losses: respiratory, surgical

Front 16

List 5 points about IV administeration of fluids.

Back 16

Intravenous:
Preferred route
Fluids delivered directly into vascular system
Rapid effect
Rapid delivery of other medication

Front 17

List 2 points about subcut administeration of fluids.

Back 17

Subcutaneous:
Limited to animals that can not be catheterised
e.g. Pocket pets
Absorption delayed in anaesthetised animals due to poor peripheral circulation

Front 18

List the use of gravity in administering fluids to large and small animals?

Back 18

Gravity
Simple
Most commonly used in horses and other large animals
Risk of volume overload in v. small animals

Front 19

What are teh 3 benefits of using a fluid pump?

Back 19

Infusion pump
Accurate administration
Preferred method in animals at risk of fluid overload
e.g. 1 small animals
e.g. 2 Heart disease

Front 20

What are the 2 indications for using Pharmacological support in administering fluids?

Back 20

Indications
1. ↓BP unresponsive to reduced anaesthetic depth and fluids
2. Difficult to administer large volumes quickly e.g. Hypotensive horse

Front 21

List the 4 most common drugs used as pharmalogical supports?

Back 21

Dopamine
Dobutamine
Phenylephrine

Ephedrine

Front 22

How is dopamine used?

Back 22

Administration
Most common agent used in small animals
Short acting →→Intravenous infusion
Dose of administration: 1-20 mcg/kg/min
Recommended maximum dose:
Dogs 20 mcg/kg/min
Cats 10 mcg/kg/min

Front 23

What are the side effects of dopamine?

Back 23

1.Tachycardia
2.Arrhythmias
3. Excessive/prolonged VC→ renal ischaemia
4. Excessive / Prolonged VC
→ GIT ischaemia

5. Suppress immune system

Front 24

How do you llimit the side effects of dopamine?

Back 24

Limiting incidence of adverse affects

Titrate to minimum dose for adequate BP

Correct cause of low BP asap.

Front 25

What ar ethe side effect od dobutamine?

Back 25

1.Tachycardia
2.Arrhythmias
3. Seizures/twitches
in cats
4.?? constriction
of vessels in GIT

Front 26

What are the clinical indications of Phenylephrine?

Back 26

Clinical use
Less frequently used in small animals and horses
Short acting: infusion required

Front 27

Clinical use of Ephedrine?

Back 27

Clinical use
Mainly used in horses
Can be used in small animals
Long acting: given as bolus 0.03-0.06 mg/kg IV

Front 28

How do you protect the eyes?

Back 28

Lubrication
Prevent dessication

Protect from disinfects used around head