Ch. 5 - Anesthetic Monitoring

Front 1

What is the best indicator of patient well-being?

Back 1

Vital signs

Front 2

Monitoring Parameters:

Vital Signs (8)

Back 2

1. heart rate

2. heart rhythm

3. respiratory rate and depth

4. mucous membrane color

5. CRT

6. pulse strength

7. blood pressure

8. body temperature

Front 3

Monitoring Parameters:

Reflexes are indicators of ______________ ________.

Back 3

Anesthetic depth

Front 4

Monitoring Parameters:

Involuntary reflexes: (6)

Back 4

1. palpebral

2. corneal

3. pedal

4. swallowing

5. laryngeal

6. papillary light reflex

Front 5

Monitoring Parameters:

Reflexes may be affected by: (3)

Back 5

1. drugs

2. disease

3. individual response variatioH

Front 6

How many Stages of Anesthesia are there?

Back 6

4 stages

Front 7

Which two stages of anesthesia do we try to jump over and why?

Back 7

Stages I & II

get past the excitement and movement

Front 8

What happens in Stage 1 of Anesthesia? (8)

Back 8

• body movement
• fear
• excitement
• disorientation
• struggling
• urination
• defecation
• increased HR & RR

Front 9

Stage 1 of Anesthesia ends with what?

Back 9

recumbency / loss of ability to stand

Front 10

Stage II of Anesthesia - what is it referred to as?

Back 10

The "excitement" stage

Front 11

Stage II of Anesthesia is characterized by: (7)

Back 11

• vocalization
• irregular breathing
• struggling
• paddling
• increased HR & RR
• dilated pupils
• muscle tone
• reflexes present

*actions are not under conscious control

Front 12

Stage II of Anesthesia ends with what?

Back 12

muscle relaxation

decreased RR

decreased reflex activity

Front 13

Stage III of Anesthesia is the period of _______________ ___________________.

Back 13

surgical anesthesia

Front 14

Stage II of Anesthesia is divided into how many PLANES?

Back 14

Four planes

Front 15

Plane 1 of Stage III of Anesthesia: is it adequate for surgery?

Back 15

NO

Front 16

Plane 1 of Stage III of Anesthesia:

Characteristics of:

Back 16

1. no involuntary limb movement

2. eyeballs start to rotate ventrally

3. decreased pupillary light reflex

4. other reflexes still present but decreased response

Front 17

What can we do in Plane 1 of Stage III of Anesthesia ?

Back 17

intubate

Front 18

In what Plane / Stage do we intubate?

Back 18

Stage III, Plane 1

Front 19

What is the suitable stage / plane for most surgical procedures (where we want to be and stay?)

Back 19

Stage III, Plane II

(Stage 3, Plane 2)

Front 20

Plane 2 of Stage III of Anesthesia:

characterized by: (8)

Back 20

1. regular and shallow breathing

2. decreased RR

3. mildly decreased HR

4. mildly decreased BP

5. relaxed muscle tone

6. no swallowing reflex

7. no pedal reflex

8. ventromedial eye rotation

Front 21

In Stage III, Plane 2, surgical stimulation may produce:

Back 21

1. mild increase in HR, BP, RR

Front 22

in Stage III, Plane 2, patient remains __________ and _____________.

Back 22

unconscious and immobile

Front 23

Stage III, Plane 3 is known as what kind of anesthesia?

Back 23

DEEP anesthesia (too deep)

Front 24

Is Stage III, Plane 3 acceptable for most anesthetic procedures?

Back 24

NO

Front 25

What is Stage III, Plane 3 characterized by?

Back 25

1. low HR and RR

2. decreased tidal volume

3. reduced pulse strength

4. increased CRT

5. poor - to - absent pupillary light reflex

***reflexes are totally absent - muscle tone is VERY RELAXED

Front 26

Stage III, Plane 4 =

Back 26

early anesthetic overdose

Front 27

Stage III, Plane 4 is characterized by:

Back 27

1. no jaw tone at all

2. abdominal breathing

3. fully dilated pupils

4. absence of all reflexes

5. marked depression of CV system

6. pale MM

7. increased CRT

8. flaccid muscle tone

Front 28

Stage IV Anesthesia =

Back 28

overdose

Front 29

Stage IV Anesthesia is characterized by:

Back 29

1. patient has stopped breathing

2. circulatory collapse

3. death

Front 30

What should you do in Stage IV Anesthesia?

Back 30

resuscitate immediately to save patient

Front 31

Stage III: What plane is known as "medium," optimal for most surgical procedures?

Back 31

Stage III, Plane II

Front 32

Stage III: What plane is known as "light" - not suitable for surgery

Back 32

Plane I

Front 33

Stage III: What plane is known as "deep" (excessive depth)

Back 33

Plane 3

Front 34

4 Objectives of Surgical Anesthesia:

Back 34

1. patient does not move

2. patient is not aware

3. patient does not feel pain

4. patient has no memory of procedure

Front 35

Assessing vital signs:

3 Physical methods:

Back 35

1. touch

2. vision

3. hearing

Front 36

Assessing vital signs:

5 mechanical instruments:

Back 36

1. pulse ox

2. capnograph

3. ECG

4. BP monitor

5. Doppler blood flow monitor

Front 37

Monitoring Patient Safety:

Vital sign groupings: 3 major categories:

Back 37

1. circulation

2. oxygenation

3. ventilation

Front 38

Monitoring Patient Safety:

Vital Signs:

Circulation (5)

Back 38

1. HR & rhythm

2. pulse strength

3. CRT

4. MM color

5. BP

Front 39

Monitoring Patient Safety:

Vital Signs:

Oxygenation: (5)

Back 39

1. MM color

2. CRT

3. Hgb saturation

4. inspired O2

5. arterial blood O2

Front 40

Monitoring Patient Safety:

Vital Signs:

Ventilation (5)

Back 40

1. RR rate & depth

2. breath sounds

3. end-expired CO2 levels

4. arterial CO2

5. blood pH

Front 41

Why do we give a breath? (2)

Back 41

1. expand lungs

2. make sure patient as a good breath of O2

Front 42

Lower blood volume has what effect on heart rate?

Back 42

Increases HR

(Heart tries harder to push blood through to oxygenate body)

Front 43

If you can feel a pedal pulse the BP should be at least _________.

Back 43

60 (MAP)

Front 44

Indicators of Circulation: Heart Rate

Physical Assessment: (2)

Back 44

1. palpation of pulses

2. ausculatation with stethoscope (more difficult in recumbent, anesthetized animals)

Front 45

Indicators of Circulation: Heart Rate

Mechanical Assessment: (3)

Back 45

1. ECG

2. BP monitor (doppler or oscillometric)

3. intra-arterial line / transducer

Front 46

Indicators of Circulation: Heart Rate

Bradycardia: why might it happen (4)

Back 46

1. depressant effect of most anesthetics

2. drugs (alpha2-agonists & opioids)

3. excessive anesthetic depth

4. adverse effects of drugs

Front 47

Indicators of Circulation: Heart Rate

Tachycardia: why might it happen? (6)

Back 47

1. anticholinergics & cyclohexamines

2. inadequate anesthetic depth

3. pain

4. hypotension

5. blood loss / shock

6. hypoxemia & hypercapnea (too much CO2)

Front 48

Are sinus arrhythmia normal to see in cats?

Back 48

NO - not normal in cats!

Front 49

Indicators of Circulation: Heart Rhythm

Which lung should be up if the patient is in lateral recumbency?

Back 49

BEST LUNG ALWAYS UP

Front 50

Indicators of Circulation: Heart Rhythm

What can be used to detect 1st or 2nd degree heart block?

Back 50

ECG

Front 51

Indicators of Circulation: Heart Rhythm

What things cause arrhythmias?

(2 main categories)

Back 51

1. drugs

2. disease / medical state

Front 52

Name 4 classifications of drugs that could cause cardiac arrhythmia:

Back 52

1. barbituates

2. anticholinergics

3. cyclohexamines

4. alpha 2 agonists

Front 53

Name 5 diseases / medical states that could cause cardiac arrhythmia:

Back 53

1. hypoxia

2. hypercarbia (high level of CO2 in blood)

3. heart disease

4. trama

5. GVD

Front 54

Instruments used to monitor HR & Rhythm:

(2)

Back 54

1. esophageal stethoscope

2. ECG

Front 55

What does ECG measure?

Back 55

electrical activity of the heart

Front 56

Cardiac arrhythmias are usual within the first 10 minutes of initial use of what type of drug?

Back 56

barbituates

Front 57

Cardiac Conduction System:

Commonly encountered Cardiac Arrhythmias:

Back 57

Sinus arrhythmia

Front 58

Sinus arrhythmias coordinate HR with what?

Back 58

respirations

Front 59

Sinus arrhythmias are abnormal in what species?

Back 59

cats

Front 60

TRUE OR FALSE:

Sinus bradycardia is common during anesthesia when there is excessive anesthetic depth and/or drug reactions

Back 60

TRUE

Front 61

How can you potentially correct a sinus bradycardia? (2)

Back 61

1. anticholinergics

2. reversal agent

Front 62

Sinus tachycardia might happen as a result of what 3 things?

Back 62

1. inadequate anesthetic depth

2. drug reaction

3. surgical stimulation

Front 63

Cardiac Arrhythmias:

1st Degree A-V Heart Block has a prolonged ____________ interval

Back 63

P-R

Front 64

Cardiac Arrhythmias:

2nd Degree A-V Heart Block has occasional missing __________ complexes.

Back 64

QRS

Front 65

Cardiac Arrhythmias:

3rd Degree A-V Heart Block has randomly irregular ____________ intervals

Back 65

P-R

Front 66

Which degree A-V heart block is blood not being moved effectively?

Back 66

3rd degree

Front 67

In an A-V heart block, the __________ is not getting to the heart.

Back 67

message

Front 68

PEA stands for...

Back 68

Pulseless Electrical Activity

Front 69

PEA occurs when the heart is not contracting, but ________________ is normal.

Back 69

ECG

Front 70

PEA: definition

Back 70

Cessation of heart contractions and/or palpable pulse in the presence of normal or nearly normal ECG

Front 71

PEA (Pulseless Electrical Activity) is associated with ________ __________.

Back 71

Cardiac arrest

(mechanical activity of the heart)

Front 72

Anesthetist must do both _____________ monitoring and ____________ monitoring.

Back 72

physical

ECG

Front 73

Indicators of Circulation:

Why might there be a delay in CRT time? (8)

Back 73

1. patient is cold / low body temp

2. low BP

3. too deep

4. heart problem

(5. dehydration)

6. shock

7. blood loss

8. epinephrine release

Front 74

CRT indicates ________________________________.

Back 74

peripheral tissue blood perfusion

Front 75

Indicators of Circulation:

Blood pressure - is an indicator of _________ _______________.

Back 75

tissue perfusion

Front 76

Factors involved in blood pressure: (5)

Back 76

• Stroke volume
• Heart Rate
• Vascular Resistance
• Arterial compliance (elasticity)
• Blood Volume

Front 77

Systolic pressure is produced by _____________ of the __________ _____________.

Back 77

contraction

left ventricle

Front 78

Diastolic pressure is the pressure that remains in the arteries when the heart is in the _____________ __________ between _____________.

Back 78

resting phase

contractions

Front 79

Can all BP monitoring instruments measure systolic pressure?

Back 79

YES

Front 80

Can all BP monitoring instruments measure Diastolic pressure?

Back 80

NO

Front 81

Hypertension can damage delicate tissue in the: (3)

Back 81

1. kidneys

2. lungs

3. retina

Front 82

What is the best indicator of blood perfusion to the internal organs?

Back 82

MAP (mean arterial pressure)

Front 83

Indicators of Circulation:

Pulse Strength is used as a rough indicator of _________ _______________.

Back 83

blood pressure

Front 84

Pulse strength is typically ___________ in anesthetized animals.

Back 84

lowered

Front 85

Pulse strength is a ____________ interpretation.

Back 85

subjective

Front 86

Direct BP readings are obtained via an ________________ ______________ inserted into an ____________.

Back 86

indwelling catheter

artery

Front 87

Direct BP readings are most commonly used with what species?

Back 87

horses

Front 88

What type of BP reading provides continuous reading throughout the cardiac cycle and is the most accurate?

Back 88

Direct

Front 89

Indirect BP readings are obtained by using an ________________ _____________ and ________.

Back 89

external sensor

cuff

Front 90

Name 3 types of indirect BP reading equipment:

Back 90

1. Doppler ultra sound

2. Osciollometric

3. Sphygmomanometer

Front 91

What type of BP reading is common at referral hospitals for prolonged surgeries?

Back 91

Central venous pressure

Front 92

Central venous pressure assesses ______________________________________ and __________ __________.

Back 92

blood return to the heart

heart function

Front 93

Central venous pressure usually uses a catheter from the ____________ vein into the ___________ ________ _________.

Back 93

jugular

anterior vena cava

Front 94

Indicators of Oxygenation:

MM Color: should be _________

3 places you can measure:

Back 94

pink

1. gums

2. conjunctiva

3. anus

Front 95

MM color provides a rough assessment of ___________________ and ___________ ______________.

Back 95

oxygenation

tissue perfusion

Front 96

The goal is to have oxygenation of at least ______%.

Back 96

95%

Front 97

Pale MM indicate: (2)

Back 97

1. anemia

2. poor capillary perfusion

Front 98

Cyanotic membranes indicate: (3)

Back 98

1. respiratory arrest

2. O2 deprivation

3. pulmonary disease

Front 99

MM color is affected by: (3)

Back 99

1. body temperature

2. vascular resistance

3. gum disease

Front 100

Physiology of O2 Transport:

Most O2 is carried by ____________.

Back 100

hemoglobin

Front 101

100% O2 saturation means:

Back 101

all available Hgb - binding sites are filled with O2

Front 102

Indicators of Oxygenation:

Measuring Blood O2:

Partial Pressure (PaO2) measures ________________ O2 dissolved in ____________.

Back 102

unbound

plasma

Front 103

PaO2 is highest in ___________ blood.

Lowest in __________ blood.

Back 103

highest in arterial

lowest in venous

Front 104

As PaO2 decreases, SaO2 _______________.

Back 104

also decreases

(but not at the same rate / not as rapidly)

Front 105

Indicators of Oxygenation Saturation:

TRUE OR FALSE:

When a patient is breathing pure O2 from anesthetic machine the % saturation will increase.

Back 105

FALSE

The amount of DISSOLVED O2 will increase, not necessarily the % saturation.

Front 106

Indicators of Oxygenation:

Blood gas analyzers measure __________ ____________.

Back 106

partial pressure

Front 107

Pulse Oximeters measure ___________ _____________.

Back 107

Oxygen saturation

Front 108

What measures partial pressure of O2?

Back 108

Blood gas analyzer

Front 109

What measures O2 saturation?

Back 109

Pulse oximeter

Front 110

Pulse oximeter measures what 2 things?

Back 110

1. O2 saturation

2. heart rate

Front 111

O2 Saturation:

>________% is normal in patient breathing pure O2.

<_________% saturation for >_________ seconds is a medical emergency

Back 111

95%

85% / 30 seconds

Front 112

Pulse Oximeter can also be used in exam room to look at ______________ _____________. (Example, on cats)

Back 112

vascular efficacy

Front 113

Two types of probes used in pulse oximetry:

Back 113

1. transmission probe

2. reflective probe

Front 114

What type of pulse ox probe is better to use in horses?

Back 114

reflective

Front 115

Name 2 places you can put a pulse ox probe (on a small animal)

Back 115

1. tongue

2. in between toes

Front 116

If you lose your Pulse Ox reading or get a LOW reading, what are the 1st three things to do?

Back 116

1. reposition probe

2. check ventilation (is bag / drape moving?)

3. check circulation

Front 117

Ventilation vs. Respiration

What is ventilation?

Back 117

The movement of GAS in and out of the alveoli.

Front 118

What is respiration?

Back 118

The tissue using the O2 and exchanging the CO2.

Front 119

Respiratory Rate = _____________

Back 119

# of breaths per minute (bpm)

Front 120

2 ways to physical monitor RR:

2 ways to mechanically monitor RR:

Back 120

1. watch bag fill

2. watch chest wall movements

----------------------------

1. apnea monitor

2. capnograph

Front 121

Tachypnea during anesthetic procedure may result from: (4)

Back 121

1. hypercapnea (too much CO2in blood)

2. pulmonary disease

3. mild surgical stimulus

4. progression from moderate to LIGHT anesthesia

Front 122

Tidal Volume = ________________________________.

Back 122

the amount of air inhaled during a breath

Front 123

Patients under anesthesia tend to

a) hyperventilate

b) hypoventilate

Back 123

HYPO ventilate (Shallow Breathing)

(risk of becoming acidotic due to CO2 accumulation)

Front 124

Hypoventilation can lead to _________________.

(the collapse of the ____________.)

Back 124

atelectasis

lungs

Front 125

In HYPERventilation you would see ______________ tidal volume.

Back 125

elevated

Front 126

A patient might start hyperventilating if they are _______________.

Back 126

painful

Front 127

The risk of HYPERventilation is________________.

Back 127

losing too much CO2 and becoming alkalotic.

Front 128

Respiratory character refers to the____________________________________

Back 128

effort required to breathe

Front 129

abdominal breathing is referred to as (acronym)

Back 129

COPD

Front 130

Examples of respiratory character (2)

Back 130

1. dyspnea

2. apneustic pattern

Front 131

Respiratory character can be measured by: (2 ways)

Back 131

1. visually - watching chest (time between inspiration / expiration

2. listening - harsh noises, whistles, squeaks

Front 132

What piece of equipment warns that the patient hasn't taken a breath in a preset time period?

Back 132

Apnea monitor

Front 133

A capnograph measures _____________________.

Back 133

End tidal CO2

Front 134

End tidal CO2: normal shape on monitor should be a:

Back 134

"flattened mountain"

Front 135

Capnogram:

Inspiration = CO2 is _________mmHg

Expiration = CO2 is __________mmHg

Back 135

0

35-45

Front 136

Abnormal CO2 levels are most commonly due to changes in ________________.

Back 136

ventilation

Front 137

With hyperventilation you will see a gradual _________________ in ETCO2 value.

Back 137

decrease

Front 138

With hypoventilation you will see a gradual ________________ in ETCO2 value.

Back 138

increase

Front 139

The #1 thing that affects pH is _______________.

Back 139

ventilation

Front 140

What else might affect pH?

Back 140

Fluids

Front 141

Capnogram abnormalities unrelated to ventilation or equipment problems: (4)

Back 141

1. cardiac arrest

2. hypotension

3. hypothermia

4. hyperthermia

Front 142

CO2 levels and Acid-Base Status:

Anesthetized patients may become mildly ______________.

Back 142

acidotic

Front 143

CO2 levels and Acid-Base Status:

How can you determine if a patient's acidosis is respiratory or metabolic?

Back 143

compare blood pH to PaCO2

Front 144

PaO2 should be ____________x the inspired O2 concentration (room air rate)

Back 144

5 times

Front 145

Room air is 21% O2, so PaO2 should be ________.

Back 145

100mmHg

Front 146

Pure O2 is 100% O2, so PaO2 should be ________.

Back 146

500mmHg

Front 147

Hypoxemia in the absence of disease is commonly seen in what anesthetized species?

Back 147

horses

Front 148

Indicators of Body Temp:

Reasons why an animal would get cold under Anesthesia: (4)

Back 148

1. shaving & cleaning surgery site

2. temp of fluids

3. opening abdomen to air

4. can't shiver under anesthesia

5. vasodilation caused by pre & anesthetics

Front 149

How to minimize / manage Heat Loss during anesthesia? (6)

Back 149

1. warm IV fluids

2. avoid cold prep / Sx / Tx rooms

3. barrier between patient and table top

4. circulating warm water blanket

5. forced warm air blanket

6. heating lamps

Front 150

Heating animals: avoid using _____________ _______.

Back 150

heating pads (will burn them)

Front 151

Hyperthermia is not normal, but when it happens is most often seen during or just before ______________.

Back 151

recovery

Front 152

Management of hyperthermia: (5)

Back 152

1. cool fluids IV, IP, or rectally

2. fans

3. ice or alcohol application

4. reversal agents

5. increase flow rate of O2 in non-rebreathing systems

Front 153

Malignant Hyperthermia is most commonly seen in what species?

What causes it?

Back 153

pigs

genetic defect

Front 154

Clinical signs of malignant hyperthermia (4)

Back 154

1. patient becomes hot and stiff

2. ears turn red

4. increased CO2 production

5. tachyarrhythmias

Front 155

How to treat malignant hyperthermia: (3)

Back 155

1. stop Ax immediately and give 100% O2

2. use cooling methods

3. treat with dantrolene

Front 156

Reflexes:

What is used to determine when to pull the trach tube?

Back 156

swallowing reflex

Front 157

What is the palpebral reflex?

Back 157

blink reflex

Front 158

Slow palpebral reflex in horses indicates ______________________________.

Back 158

adequate surgical anesthetic depth

Front 159

Checking a corneal reflex is done by _______________________________ and is most useful in ______________ animals.

Back 159

dropping a drop of sterile saline or artificial tears into eye

large

Front 160

Corneal reflex is used primarily to determine if a large animal patient is _______ ___________.

Back 160

too deep