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85 Cards in this Set

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Monitoring of anesthetic equipment (5)
Check for leaks

C02 absorbent is not exhausted

Varify power sources

Verify monitoring device readings

MM color, CPR, pulse
Perfusion
passage of oxygenated blood through body tissues
Shock
inadequate perfusion
Hypoxemia
Insufficient oxygenation of blood
(Pa02 < 60 mm Hg)
Hypoventilation
Reduced ventilation

Determined by increase of arterial CO2 levels

PaCO2 > 45mm Hg
Hypercarbia / hypercapnia
Increased arterial CO2 levels
Hypotension
Inadequate arterial blood pressure


Common sign of cardiovascular depression
Hypovolemia
Insufficient circulating blood volume.

Common cause of hypotension.

Fluid administration used as supportive measure.
Hypothermia
Abnormally low body temperature

2 - 3 degrees below normal

Sign of nervous system & cardiovascular depression
Ways to evaluate respiratory function (6)
respiratory rate
tidal volume
breathing patterns
Hb concentration
end-tidal CO2
arterial blood gases
What does pulse oximeter measure
% of Hb that is saturated with O2
What does the capnometer measure?
end-tidal carbon dioxide (ETCO2)
Manual ways of monitoring respiration (3)
esophageal stethascope

reservoir bag movement - observe movement, feel for resistance

MM, arterial blood @ sx site
Ways to evaluate cardiovascular function (7)
hr, heart sounds
temp
pulse quality and rate
mm color
CRT
blood pressure
urine output
Ways to monitor cardiovascular function (3)
ausculation
ECG
Pulse
Pulse quality
how pulse feels when palpated

strong, moderate, weak, thready
Pulse pressure
difference between systolic and diastolic arterial pressures
What do cherry red mm indicate?
Carbon monoxide poisoning
Response to hypothermia
decrease anesthetic concentration

decrease fresh gas flow to minimum requirements

ensure adequate circulation

insulate from cold surfaces; dry the body surface

apply warm blankets, pads
Response to tachycardia (4)
decrease anesthetic concentration

increase oxygen flow

increase rate of IV fluids

support ventilation
Response to bradycardia (4)
anticholiergics or alpha antagonist
decrease anesthetic concentration
support with 02 and fluids
may be transient
Response to hypotension (3)
lower anesthesia
administer fluids
keep warm
Response to hypercarbia / hypercapnia
increase ventilation
Reasons for hypercarbia / hypercapnia
1) Rebreathing circuits: expired soda lime or faulty unidirectional valves
2) Non-rebreathing circuits: inadequate flow rate
3) Excessive dead space, long ET tube
Response to hypoxemia
increase inspired O2 concentration and ensure adequate ventilation
Reasons for hypoxemia (2)
kinked/plugged ET tube
empty O2 tank
Response to excessive depth (3)
decrease vaporizer setting
increase O2 flow rate
ensure ventilation and circulatory support
Reasons for inadequate depth (5)
insufficient delivery of anesthetic to avleoli
breathing around ET tube/mask
vaporizer is empty, overfilled, malfunctioning
inadequate flow rate and vaporizer settings
inadequate uptake of anesthetic from alveoli into bloodstream
Reasons for excessive circuit pressure
closed pop-off valve
excessive O2 flow rate
occlusion of scavanger system
Checklist for inspection of anesthetic equipment (8)
1) sufficient O2 available
2) vaporizer filled
3) gas lines correctly connected
4) sufficient CO2 absorbent time available
5) scavenger system properly connected / functioning
6) cuff syringe available
7) attach breathing circuit, tubes, reservoir bag
8) check for leaks
How do you check for leaks? (8)
1) close pop-off valve
2) occlude patient end of breathing circuit
3) fill circuit w/ O2 to a pressure of 20cm H2O
4) turn O2 flow to 100ml/min (0.1 L/min)
5) if pressure increases, leaks are withing acceptable limits
6) if pressure drops, increase flow rate until pressure remains stable
7) Leaks exceeding 200ml/min (0.2L/min) should be corrected via machine maintenance
8) open pop-off valve while occluding Y-piece; pressure should drop to 0cm H2O
Why do anesthetic problems occur? (4)
human error
equipment failure
adverse effects of anesthetics
patient related factors
Which breeds are at highest risk? (5)
bulldog
pekingese
brachycephalics
weimaraner
jack russel
Types of human error (4)
failure to get good history
lack of knowledge of drugs/machines used
incorrect drug administration
personell in hurry, fatigue, careless
Problems with geriatric patients (4)
reduced organ function
poor response to stress
degenerative disorders
increased risk of hypothermia and overhydration
Ways to decrease risk in geriatric patients
IV fluids at reduced rate
select agents with minimal cardiovascular effect
allow longer time for preanesthetics
preoxygenate
reduce anesthesia
keep warm
Problems with pediatric patients (3)
increased risk of hypothermia and overhydration
inefficient secretion of drugs
difficult intubation and IV catheterization
Ways to decrease risk in pediatrics (6)
keep warm
careful w/ pre-op fasting
IV dextrose in LRS
cut ET tubes
dilute injectable drugs
lower doses
inhalent agents over IV
ket/val, no barbiturates
Problems with brachycephalics (2)
tendency toward airway obstruction
high vagal tone
Reducing risk in brachycephalics (5)
anticholinergics
preoxygenate
rapid IV induction
delay extubation
observe closely during recovery
Which anesthetic cannot be used on sighthounds?
barbiturates
Problems with obese animals (3)
accurate dosing difficult
poor anesthetic distribution
respiratory difficulties
shallow breathing results in hypercapnia
Decreasing risk in obese patients
dose according to ideal weight
rapid induction
preoxygenate
may need to bag
delay extubation
observe closely during recovery
Problems encountered in dam during cesarean
increased workload on heart
compromised respiration
tendency to vomit
risk of hemorrhage
Problems encountered with offspring during cesearian
Anesthetics may cross placenta, causing reduced respiratory and cardiovascular funciton.
Stragedies to decrease risk in cesarian sx - dam (5)
IV fluids
clip before induction
preoxygenate
lowest effective dose of anes
avoid pentobarbital, ket/val
Stragedies to decrease risk in cesarian sx - offspring
reversing agents, doxapram

administer O2 by face mask

atropine (bradycardia)
Problems with trauma patients (4)
cardiac arrhythmias, 12-72hrs post trauma, often cause of cardiac arrest after HBC

respiratory distress
shock & hemorrhage
internal injuries
Decreasing risk of trauma patients
thorough exam
thoracic xrays & ECG
stabilize before anes
Problems with cardiovascular disease (4)
compromised circulation
risk of overhydration
pulmonary edema
tendency to develop arrhythmias and tachycardia
Decreasing risk for patients with cardiovascular disease (4)
preoxygenate

avoid agents that effect heart (halothane, xylazine)

avoid overhydration

diuretics - alleviate pulmonary edema
Problems encountered in patients with respiratory disease (3)
poor oxygenation
respiratory arrest
patients anxious/difficult to restrain
Decreasing risk for patients with respiratory disease (7)
avoid stress
preoxygenate
no nitrous oxide
induce with IV anes
rapid intubation
control ventilation if needed
monitor closely during recovery
Problems encountered in patients with hepatic disease
delayed metabolism
decreased blood clotting
hypoproteinemia
dehydration
anemic / icteric
Decreasing risk in pateints with hepatic disease
pre anes blood tests
omit preanes meds
induce with iso or propofol
expect prolonged recovery
Problems in patients with renal disease (3)
delayed excretion of anes agents

electrolyte imbalances: hyperkalemia, hyperphosphatemia, metabolic acidosis

dehydration
Decreasing risk in patients with renal disease (5)
rehydrate before sx, keep H2O till last moment

reduce anes dosage

obtain renal function tests
& electrolyte values

caution with carprofen, acepromazine, xylazine, diazepam, etamine and barbiturates.

IV fluids during sx (urinary obstructions are special cases)
Problems in patients with urinary obstruction (5)
dehydration
acidosis
azotemia
hyperkalemia
bradycardia
Decreasing risk in patients with urinary obstruction (3)
avoid barbiturates & IV ket
treat hyperkalemia if present
Brachycephalic breeds (8)
Bulldogs
Pugs
Pekingese
Shih Tzu
Boxer
Shar-Pei
Boston Terrier
Bull Terrier
Brachycephalic syndrome (3)
hypoplastic trachea
elongated soft palate
stenotic nares (small lumen)
normal RR
dog 8-15 bpm
cat 12-18 bpm
normal HR
dog 70-120 bpm
cat 130-170 bpm
normal arterial blood pressure
dog 100 mm Hg (mean)
cat 120 mm Hg (systolic)
normal temp
100-102 F
RR requires tx
dog <8
cat <10
HR requires tx
dog <60 or >140

cat <110 or >200
blood pressure requires tx
dog <60
cat <100
temp requires tx
<98 or >103 F
critical rr
dog <4
cat <6
critical hr
dog <40 or >175
cat <100 or >225
critical blood pressure
dog <50
cat <80
critical temp
<95 or >104
If the pop-off valve is inadvertently left shut it will...
cause a significant rise of pressure within circuit
Brain damage may occur when there is inadequate oxygenation of the tissues for longer than ____ min
4
When a technician is performing CPR alone, the ratio of cardiac compressions to ventilation should be:
10:2
CPR should not be discontinued for longer than:
30 seconds
Signs that ET tube is malfunctioning (4)
reservoir bag is not moving

compression of reservoir bag does not result in the raising of the chest

animal is dyspneic

animal cannot be kept at adequate level of anesthesia
Signs that pop-off valve is closed or malfunctioning
reservoir bag distended with gas

patient has difficulty exhaling
Which patients are at risk of overhydration
cardiac disease & pediatrics
Why are brachycephalic dogs under anesthetic risk
excess tissure around oropharynx

increased vagal tone

disproportionally small trachea
Drugs that should be avoided with cardiovascular disease patients
halothane & xylazine
How much barbiturate does an animal with liver dysfunction & hypoprotenemia require for induction compared with normal dog
less barbiturate
Reasons for light plane of anesthesia
ET tube cuff not inflated
incorrect vaporizer setting
incorrect placement of ET tube
use of anesthetic w/ low MAC
Causes of tachypnea
Increased levels of arterial CO2

Light anesthesia