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107 Cards in this Set

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Anesthesia - Intro, depth, and monitoring
Anesthesia - Intro, depth, and monitoring
What are the short term effects of exposure to waste anesthetic gases? How do they resolve?
neurological effects that resolve when no longer exposed to the gases
What are some long term effects of exposure to waste anesthetic gases?
reproductive disorders, renal and hepatic damage, bone marrow abnormalities, chronic nervous system disfunction
How is exposure to waste gases reduced?
scavenging devices, perform prev maint on equip, alter/improve anesthetic techniques/protocols
What are two hazards of compresed gas cylinders?
Fire hazard, hazard of suddenly released pressure.
Define anesthesia
loss of feeling or sensation
Define local anesthesia
acts where applied, no effect on brain
Define general anesthesia
complete unconsciousness
Define analgesia
reflief from pain
Define opioids
*Synthetic* morphine derivative drugs that produce sedation and pain relief
Define opiates
*Natural* morphine derivative drugs that produce sedation and pain relief
Define narcotic
opioid or opiate that induces physical dependence and addiction
Define neuroleptanalgesia
combination of narcotic w/ a tranquilizer
Define preanesthesia
any drug given w/i 1 hour prior to induction
Define induction
admin of fast-acting drugs (usually IV) to cause loss of consciousness
Define maintenance
admin of drugs to keep pt under anesthesia
Define surgical anesthesia
depth of anesthesia under which surgical procedures can be safely and effectively performed (enough muscle relaxation) w/o pain to the pt
Define tranquilizaton/sedation
a state of calmness associated w/ some CNS depression
What are 6 general reasons for using anesthesia?
Restraint, examination, manipulation, general surgery, seizure control, euthanasia
What are 5 goals of anesthesia?
relax skeletal muscles, decrease protective reflexes, induce deep sleep, produce amnesia, and provide analgesia
When checking to see if anesthesia goals were met one checks for signs of pain - what are 5 of these signs?
inc heart rate, inc resp rate, gross movement, vocalization, abdominal pressing
What is balanced anesthesia? How common is this technique?
The practice of combining a general anesthetic w/ other drugs to minimize the neg effects of the general anesthetic - it is the most common anesthesia technique
Does balanced anesthesia increase or decrease the amount of gen anesthetic needed?
decrease
What are four general considerations re: the pt to receive anesthesia?
species variations, breed variations, indiv variation, and anesthetic risk
What is species variation?
the same anesthetic drug may have different effects in different species
What is breed variation?
same drug may have different effect in different breeds
What dogs are vy sensitive to barbituates?
sighthounds
Do smaller breeds need a greater or lesser amt of anesthetic per pound of body wt in comparison to larger breeds? Why?
greater amount because they have a higher metabolic rate
Why do you leave brachycephalic breeds inubated as long as possible during recovery?
They have a long soft palate and are suceptible to laryngospasm
What can cause individual variation?
poor condition, age, reproductive status, disposition
Define "normal" anesthetic classification of risk
animal is normal, apparently healthy
Define "moderate" anesthetic classification of risk
organ abnormality which does not affect overall health
Define "poor" anesthetic classification of risk
organ abnormality that does affect overall health - liver/kidney failure, pancreatitis
Define "grave" anesthetic classification of risk
organ abnormailty that makes anesthesia life threatening
What are the two most important vital signs to look at when assessing the pts depth of anesthesia?
resp rate and heart rate/rhythm/pulse
As defined by our surg text, what is the normal resp rate for a normal awake dog? Cat?
dog 10-30 rpm, cat 25-40 rpm
What is a normal resp rate for an anesthetized dog or cat?
8-20 rpm
a resp rate of less than __rpm may indicate that the anesthesia is too deep
less than 8 rpm
What is tidal volume? Does anesthesia increase or decrease?
volume of air inspired w/ ea breath - anesthesia decreases tidal volume
What is a normal pulse in an awake dog? Cat?
Dog: 70-140 bpm
Cat: 110-220 bpm
A pulse of less than __bpm in a dog may indicate bradycardia or that the pt is too deep. In cat?
<70 bpm in a dog
<100 bpm in a cat
Where are two spots to take a pulse from in an anesthetized pt?
femoral artery, lingual artery
What are 5 monitoring methods for pulse/heart rate in an anesthetized patient?
palpate, esophageal stethoscope, ECG, pulse ox, blood pressure monitor
Other than HR and RR, what are two other vitals that can be used to assess depth of anesthesia?
CRT and MM
What is a normal CRT?
< 2 seconds
What are some abnormal MM colors and what are they associated with?
blue/purple - cyanosis (dec O2)
brick red: endotoxic shock
pale white/grey: poor perfusion(shock)
What is a palpebral reflex? How is it tested?
Blinking - tested by touching the corner of the eye
What is a pinnal reflex? How is it tested?
ear/pinnae movement - lightly touch hair in ear canal or blow in canal
What is a pedal reflex? How is it tested?
movement of foot in response to sensation/pain - pich toes or between toes
What is a corneal reflex? How is it tested?
eye - touching cornea w/ sterile object and seeing if the pt blinks and withdraws eye into orbital fossa
How is jaw tone used to assess anesthetic depth?
pull down on mandible, want no resistance
What are two other patient responses that can be used to assess depth of anesthesia?
eye position, pupillary light response (PLR)
When is stage one anesthesia seen?
From start of anesthetic administration to loss of consciousness
If resp are reg, pupils are resp to light, eyes are central, and all reflexes are present, what stage of anesthesia is pt in?
Stage 1
What is stage 2 of anesthesia also called?
Excitatory stage
If resp is irreg w/ poss breath holding or hyperventalation, pupils are dilated, eyes are central w/ poss nystagmus, reflexes are present & poss exaggerated, tachycardia, chewing/yawning/vocalization, & vomitting &/or diarrhea are present - what stage?
Stage 2/excitatory stage
What is another name for stage 3 plane 1 anesthesia?
Restraint anesthesia
At what stage is a pt in if the following are present: regular resp w/ inc rate & depth, resp pupils, eye central moving toward VD, laryngeal reflex gone, losing palpebral, other reflexes present, HR regular & strong
Stage 3, plane 1
What is another name for Stage 3, plane 2 anesthesia?
surgical plane
What stage? RR reg rhythm & rate, dec tidal vol, pupils slightly dilated, eyes ventral-medial, reflexes - laryngeal, palpebral, & jaw tone gone, pedal diminished or absent, mild dec in blood pressure and HR
Stage 3, plane 2
What is another name for stage 3, plane 3?
Orthopedic plane
What stage? Resp slow & shallow, pupils moderately dilated, PLR dimished, eyes central or moving central, reflexes all diminished or absent, dec cardiac output, weak pulse, delayed CRT
Stage 3, plane 3
What is another name for stage 3, plane 4 anesthesia?
TOO DEEP!
What stage? resp - irreg, jerky, shallow, pupils dilated & fixed, eyes central, reflexes absent, pale MM, prolonged CRT, weak pulse, muscles flaccid
Stage 3, plane 4 - too deep
What is another name for Stage 4 anesthesia?
Terminal stage
What stage? resp arrest, cardiac arrest
Stage 4
At what stage may breath holding or hyperventiliation be seen?
Stage 2/Excitatory stage
At what stage may nystagmus &/or exaggerated reflexes be seen?
Stage 2/excitatory stage
At what stage may chewing, yawning, &/or vocalization be seen?
Stage 2/Excitatory stage
At what stage may vomiting or defecation be seen?
Stage 2/excitatory stage
At what stage may eyes in a ventral-medial position be seen?
Stage 3, plane 2/surgical plane
At what stage is the laryngeal reflex gone, the palpebral diminishing, and other present?
Stage 3, plane 1/restraint anesthesia
At what stage are the laryngeal & palpebral reflexes gone, jaw tone gone, and the pedal diminished or absent?
Stage 3, plane 2/surgical plane
At what stage is a mild decrease in HR and blood pressure seen?
Stage 3, plane 2/surgical plane
At what stage is a decreased tidal volume seen w/ regular resp rhythm & rate?
Stage 3, plane 2/surgical plane
At what stage are resp slow & shallow?
Stage 3, plane 3/orthopedic plne
At what stage are all reflexes diminished or absent?
Stage 3, plane 3/orthopedic plane
At what stage is there dec cardic output, weak pulse and delayed CRT?
Stage 3,plane 3/orthopedic plane
At what stage are the pupils moderately dilated and the PLR diminished?
Stage 3, plane 3/orthopedic plane
At what stage are resp irregular, jerky, &/or shallow?
Plane 4 - too deep
At what stage are the pupils dilated & fixed which indicates brain hypoxia?
Plane 4 - too deep
At what stage are all reflexes absent?
Plane 4 - too deep
At what stage is there pale mm, prolonged CRT, and a weak pulse?
Plane 4 - too deep
At what stage are muscles flaccid?
Plane 4 - too deep
What should the tech do if signs of plane 4 present?
Inform vet and lighten anesthesia by turning vaporizer off or down and ventilating at 8-12 rpm
When does cardiac arrest occur?
60-90 seconds after resp arrest
What does tech do to start emergency procedures?
turn off vaporizer, flush system 3x w/ pure O2, begin CPR, epinephrine
What does an analeptic agent do? Example of?
stimulates CNS and respiration - Doxapram
What kind of drug is Doxapram?
analeptic agent
What is an indication for Doxapram?
respiratory arrest
What does a catecholamine drug do? Example of?
stimulates sympathetic nervous system - epinephrine
What is an indication for epinephrine?
cardiac arrest
What is a counterindication for epinephrine?
when heart is still beating - can cause tachycardia & fatal arrhythmia
What are two commom emergency drugs? What are they ea used for?
Doxapram for rep arrest, epinephrine for cardiac arrest
What are two manual methods for monitoring the anesthetized patient?
visual & palpation
What are 5 mechanical methods for monitoring the anesthetized patient?
esophageal stethoscpe, ECG, Pulse Ox, Doppler blood pressure monitor, Capnography (CO2 monitor)
What are some respiratory signs of anesthetic overdose?
<8 rpm, irregular or exaggerated resps, decreased tidal volume
What are some cardiac signs of anesthetic overdose?
bradycardia, prolonged CRT, cyantotic MM, weak pulse
Hypothermia may be a sign of what?
anesthetic overdose
What are some pupilary signs of anesthetic overdose?
decreased PLR, dilated pupils
What are some reflex signs of anesthetic overdose?
greatly diminished or absent
Recovery from anesthesia requires elimination of the anesthetic drug(s) from the ___
brain
What are three ways that gases are eliminated from the brain?
exhalation, redistribution, and liver metabolism
The ___ the anesthetic period, the longer the recovery time.
longer
What route of anesthetic admin has the greatest recovery time? The shortest?
IM>IV>Inhalation
What are some signs of anesthetic recovery?
resp rate & depth increase, eyes rotate to next shallow stage, reflexes return in reverse order lost, shivering, tongue movement, chewing, movement, lifting of head, attempts to stand
It is very important to watch for ___ during anesthetic recovery
seizures