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CVNT > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

pre-op assessment

A
  • full history
  • owner questioning
  • previous reaction to drugs
  • confirm pre-op fasting times
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2
Q

pre-op fasting advantages/disadvantages

A
  • reduces GOR, regurgitation, aspiration
  • prolonged starvation can increase risk of GOR
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3
Q

routes of admin for induction

A

injectable (IV / IM)
inhalant (face mask / induction)

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4
Q

options for airway management

A

mask
laryngeal (LMA)
supraglottic device (V-gel)
ETT

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5
Q

complications during induction

A
  • lack of airway patency
  • aspiration/regurgitation
  • hypothermia
  • post-induction apnoea
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6
Q

FGF calculation

A

(BW x TV) x RR x CF
Min vol x RR x CF

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7
Q

dosage calculation

A

weight x dose/strength

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8
Q

2nd gas effect

A

2 gases in alveoli, nitrous diffuses into blood first as it has a bigger conc gradient. this concentrates the second gas which can then also diffuse into blood

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9
Q

equine catheter placement

A

left jugular vein

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10
Q

equine anaesthetic technique

A

ensure 5 point stance

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11
Q

how to perform a pre-anaesthetic assessment

A
  • full history
  • owner questioning (temperament)
  • previous reactions to drugs/anaesthetics
  • full clinical examination
  • confirm pre-op fasting times
  • procedure
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12
Q

ASA classification

A

ASA I- normal, healthy patient
ASA II- mild systemic disease
ASA III- systemic disease, well compensated or controlled by treatment
ASA IV- severe uncompensated systemic disease
ASA V- unlikely to survive 24hrs

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13
Q

pre-op fasting goal

A

the reduce volume of the stomach contents to prevent GOR/regurgitation and aspiration

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14
Q

pre-op fasting recommendations

A

cats- 6-8hrs
dogs- 8-10hrs
rabbits/small furries- no starvation, withhold food 30 mins before
- prolonged starvation can increase GOR

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15
Q

informed consent facts

A
  • legal document to be stored on patient record
  • must ensure owner understands what has been signed
  • give copy of consent form to owner
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16
Q

communication to owner

A
  • give realistic time frames for communication
  • keep communication open
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17
Q

oxygen cylinder storage

A
  • molybdenum steel
  • well ventilated fire-proof room
  • store full and empty cylinders seperately
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18
Q

cylinder yolk

A

screw that attaches to cyclinder
- contains a bodok seal providing a gas-tight seal
- allows unidirectional flows
- pin index safety system- prevents the cylinder being attached to the wrong inlet

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19
Q

pin index safety system

A

yolk on the anaesthetic machine has 2 protuding pins
- aligned with holes on the corresponding gas cylinder
- prevents the wrong one being attached to the wrong inlet

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20
Q

anaesthetic pipelines

A
  • pipelines connect the anaesthetic machine to schrader sockets which attach to main source
  • schrader probes- unique diameter index
    -non-interchangeable screw thread- unique profile of each nut and probe for each gas
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21
Q

pressure regulator

A
  • cylinder pressure needs to be reduced to a safe level (400kPa)
  • smooths any fluctuations of pressure from gas supply
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22
Q

pressure gauges

A
  • indicates the pressure of gas in kPa
  • cyliner pressure is proportional to vol of gas contained in it
  • as cyclinder empties, pressure gauge drops
  • shows when the cylinder needs to be changed
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23
Q

O2 failure alarm

A
  • should sound when the supply drops below 200kPa
  • should cut out nitrous oxide delivery
  • not all machines will make audible noise (warning message instead)
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24
Q

hypoxic guard

A
  • not present in all machines
  • O2 and N2O control valves are mechanically linked
    • maintains min ratio
  • prevents hypoxic micture being delivered to patient
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25
Q

check valve/non-return pressure relief safety valve

A
  • positioned downstream of vaporiser
  • prevents backflow of gas back into machine
  • protects machine not patient
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25
Q

check valve/non-return pressure relief safety valve

A
  • positioned downstream of vaporiser
  • prevents backflow of gas back into machine
  • protects machine not patient
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26
Q

flowmeter/rotameter

A
  • measures the flow of a specific gas passing through
    3 parts:
    1. flow control valve- allows adjustment of gas flow
    2. tepered transparent tube- visual scale
    3. bobbin- floats as gas passes around (higher flow= higher bobbin)
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27
Q

vaporizers

A
  • found on back bar of machine
  • downstream of flowmeter
  • contains volatile agent/liquid anaesthetic
  • as gas passes through, it picks up vapour to pass to patient
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28
Q

common gas outlet

A
  • attachment of breathing system
  • delivers gas/es and anaesthetic agent to patient
  • if obstructed the pressure relief safety valve should open
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29
Q

calibrated vaporizers

A
  • gas enters and splits into:
    1. bypass channel (avoids liquid anaesthetic)
    2. into chamber (above liquid anaesthetic)

TEC- temp compensation mechanism
- wicks- increase surface area for evaporation of anaesthetic
- baffles- direct incoming gas down closer to surface of liquid

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30
Q

O2 flush

A
  • supplies oxygen at 400kPa and 35-75L/min
  • bypasses flowmeters and vaporizer
  • use can cause barotrauma
  • dilution of anaesthetic gases
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31
Q

scavenging definition

A
  • removal of environmental contaminants
  • waste anaesthetic volatile agents
    two types:
    1. active
    2. passive
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32
Q

active scavenging

A
  • waste gases are drawn outside the building by a fan and vent system
  • requires an air break to prevent negative pressure applied to patients breathing system (prevents air being sucked out of patient)
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33
Q

passive scavenging

A
  • waste gas is pushed by patients expiratoru effort into tubing either:
    1. tubing leading out of the building (increases difficulty to exhale due to increased resistance)
    2. tubing leading to a canister containing active charcoal (doesnt absorb N2O)
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34
Q

advantages and disadvantages of passive scavenging

A

advantages:
- versatile
disadvantages:
- canister needs to be weighed regularly

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35
Q

oxygen concentrators

A
  • takes in air and purifies it
  • used for at home patients requiring oxygen
  • uses a moleccular sieve containing zeolite which removes nitrogen leaving the air 87-95% O2
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36
Q

liquid O2 supply

A
  • to be kept at -183 degrees
  • passed through a vaporiser and turned into a gas before being piped inside the building
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37
Q

patient saftey features on anaesthetic machines

A
  • pin index system
  • ratio regulators
  • nitrous oxide cut-out
  • O2 failure alarm
  • reserve oxygen cylinders
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38
Q

dead space

A

volume of gas that doesnt eliminate CO2

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39
Q

tidal volume

A

volume of gas entering the lung with each inspiration

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40
Q

minute volume

A

volume of gas entering the lungs within a minute

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41
Q

functions of a breathing system

A
  • provide O2 +/- anaesthetic agent
  • enable IPPV or spontaneous ventilation
  • enable scavenging of expired gases
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42
Q

non-rebreathing system components

A
  • attachment to ET tube
  • inspiratory and expiratory tubes
  • APL valve
  • reservoir bag
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43
Q

rebreathing system components: circle

A
  • soda lime canister
  • tubing to ET tube, scavenging
  • reservoir bag
  • unidirectional valve
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44
Q

reservoir bag

A

should be 3-6 X tidal volume

45
Q

breathing system tubing

A

coaxial (one tube lies within the other) or parallel
- parallel may increase drag but have less resistance
- beware of inner hose disconnection with coaxial systems

46
Q

soda lime function

A
  • absorbs CO2
  • changes colour when exhausted (needs changing)
  • water and heat produced
47
Q

non-rebreathing system examples

A
  • T-piece, bain, lack, magill
  • FGF removes expired CO2
48
Q

non-rebreathing system advantages and disadvantages

A

advantages:
- low resistance and lightweight
- some suitable for IPPV (T-piece and bain)
- cheap
disadvantages:
- higher FGF
- heat and moisture lost, expensive, increased pollution risk)

49
Q

circle advantages and disadvantages

A

advantages:
- lower FGF
- lower pollution risk, heat and moisture retained
- suitable for IPPV
- higher resistance

50
Q

minute vol calculation

A

tidal vol x resp rate

51
Q

tidal volume calculation

A

use 10mL/kg as starting point

52
Q

FGF calculation

A

minute volume x circuit factor

53
Q

minimum FGF in the circle

A

metabolic oxygen consumption
large animals: 5mL/kg
small animals: 10mL/kg

54
Q

main characteristics of T-piece

A
  • <10kg
  • circuit factor= 2-3
  • suitable for IPPV
  • low resistance and dead space
  • 2 tubes= slight drag
55
Q

characteristics of a bain

A
  • > 8-10kg
  • circuit factor= 2-3
  • suitable for IPPV
  • low drag and dead space
  • coaxial
55
Q

characteristics of a lack

A
  • > 10kg
  • circuit factor= 0.8-1
  • unsuitable for IPPV
  • moderate drag, resistance and dead space
56
Q

characteristics of a circle

A
  • variety of sizes
  • > 15-20kg
  • unidirectional valves, soda lime canister, APL valve= resistance
  • FGF set at more than metabolic oxygen requirement
57
Q

what happens when APL valve is left closed

A
  • reservoir bag distends
  • reduced thoracic movements
  • possibly leaking around ET tube cuff
  • tachycardia, hypoxia
  • potential for pneumothorax/pneumomediastinum (rupture of lung or trachea)
58
Q

effects of excessive resistance

A
  • altered resp rate/pattern
  • decreased tidal volume
  • hypoventilation and hypercapnia
  • hypoxia
59
Q

effects of excessive dead space

A

breathing system too long
- increases PaCO2
- increases work of breathing as minute vol needs to increase to maintain normal levels of PaCO2

60
Q

when is preforming procedures under sedation is appropriate in SA practice

A

procedures that aren’t invasive or painful that just require the animal to be still:
- radiography
- minor procedures such as wound re-dressing, de-matting

61
Q

when should dogs and rabbits be extubated

A
  • watch for signs that laryngeal reflexes are returning (swallowing)
  • watch for spontaneous movement/other reflexes
62
Q

when should cats be extubated

A
  • when ear flick and blink return
  • extubate before laryngeal reflexes return
  • danger of laryngospasm if left too long
63
Q

when should horses be extubated

A
  • return of laryngeal reflexes
64
Q

complication with pain/grimace scales

A
  • pain can be hard to measure in prey species using grimace scale
65
Q

what should be on an anaesthetic record

A
  • TPR, pulse ox, drug doses, start and finish time
  • every 5 mins
66
Q

reflexes that are used to measure depth of anaesthesia- stage 3, plane 1:

A
  • steady respiration
  • pinch reflex
  • no limb movement
  • eye in ventro-medial position
67
Q

stage 3 plane 2 measuring depth of anaesthesia

A
  • eye ventromedial
  • absent palpebral reflex
  • muscles relaxed
  • HR and tidal volume decrease
68
Q

stage 3 plane 3 depth of anaesthesia

A
  • eye becomes central, dilated
  • HR and BP low
69
Q

absent palpebral reflex and eyes ventromedial

A

adequate anaesthesia

70
Q

palpebral reflex and central eyes

A

too light

71
Q

no palpebral reflex and eyes central

A

too deep

72
Q

how does anaesthesia affect hypothermia

A
  • vasodilation increases heat loss
  • thermoregulation is interfered with, reduced metabolic rate and heat produced
73
Q

why is monitoring so important during anaesthesia?

A
  • adverse affects of medication
  • depth of anaesthesia
74
Q

advantages of BP doppler

A
  • inexpensive
  • efficient
  • quick results
75
Q

disadvantages of oscillometric BP

A
  • more expensive
  • systolic, diastolic, mean
  • interference, movement
76
Q

advantages and disadvantages of direct BP

A
  • gold standard, beat by beat info
  • useful for long procedures
  • arteries bleed
  • aseptic
  • invasive
77
Q

types of capnography

A

sidestream
- not real time, needs FGF
mainstream
- real time, expensive

78
Q

high end tidal CO2 causes

A
  • hypoventilation
  • reduced tidal volue
79
Q

low end tidal CO2 causes

A
  • hyperventilation
  • low CO
  • hypothermia
  • leak in sample line, breathing system
80
Q

high INCO2

A
  • too low fresh gas flow
  • too much dead space
  • exhausted absorbant
81
Q

advantages of capnography

A
  • non invasive
  • easy to set up and use
  • effective way of monitoring
82
Q

disadvantages of capnography

A
  • dead space
  • requires ET tube
83
Q

limitations of pulse oximetry

A
  • false readings
  • doesn’t work on pigmented skin
  • doesn’t work well in anaemia, poor perfusion
84
Q

methods for maintaining anaesthesia

A
  1. TIVA
  2. injection
  3. gaseous
85
Q

isoflurane, does it meet ideal agent requirements?

A
  • irritant to MM
  • peripheral vasodilation
  • no analgesia
  • rapid uptake and elimination
86
Q

sevoflurane, does it meet ideal agent requirements?

A
  • non irritant to MM
  • poor analgesia
  • high MAC
  • rapid uptake and elimination
87
Q

disadvantages of inhalational maintenance

A
  • requires equipment and facilities
  • mainly done in hosp environment
  • personnel risks
88
Q

disadvantages of injectable maintenance

A
  • difficult to control depth
  • unstable plane of anaesthesia if using bolus
  • careful dosing needed
89
Q

disadvantages of TIVA

A
  • IV access essential
  • long recovery after prolonged infusion
  • tricky calculations
90
Q

advantages of inhalational maintenance

A
  • easy to admin
  • suitable for most patients
  • easy to adjust depth
91
Q

advantages of injectable maintenance

A
  • available in field
  • admin by nurse
92
Q

what to do during tachycardia during anaesthesia

A
  • check for muscle tone, increased resp rate
    • increase anaesthesia
  • can be due to inadequate resp, hypovolaemia, drug action
93
Q

what to do during brachycardia during anaesthesia

A
  • check eye position, reflexes
    • too deeply anaesthetised (turn down)
  • hypothermic (check temp)
  • drug action
94
Q

managing hypotension during anaesthesia

A
  • turn down anaesthesia
  • IV crystalloid bolus
  • replace blood loss if applicable
95
Q

why do accidents and emergencies occur during anaesthesia?

A
  • sick animal- sstabilise before procedure
  • human error- checklists, communication
  • equipment failure- check
  • inadequate prep/monitoring
96
Q

common human errors

A
  • leaving APL valve closed
  • drug admin errors
  • airway management errors
  • errors positioning
  • inadequate eye protection
97
Q

leaving APL valve closed

A
  • reservoir bag distends
  • reduced thoracic movements
  • leaking around ET cuff
  • tachycardia
98
Q

airway management errors

A
  • failed intubation
  • traumatic intubation
  • tracheal rupture
99
Q

positioning errors

A
  • pain
  • comprimised ventilation
  • comprimised CV function
  • EPAM (equine post anaesthetic myopathy)
100
Q

eye protection errors

A
  • sedation reduces tear formation
  • bland opthalmic ointment
  • can lead to corneal ulceration
101
Q

mechanisms of resp failure

A
  • depression of resp centre in brain
  • impaired movement of thoracic cage (sandbags)
  • impaired lung movement (pleural effusion)
  • airway obstruction
101
Q

mechanisms of resp failure

A
  • depression of resp centre in brain
  • impaired movement of thoracic cage (sandbags)
  • impaired lung movement (pleural effusion)
  • airway obstruction
102
Q

increased risks of anaesthesia in exotics

A
  • size (difficult to weigh/examine)
  • lack of equipment
  • mouth anatomy (ability to intubate, obligate nasal breather)
  • physiology (high metabolism, O2 consumption)
  • temp (high SA:vol= heat loss)
  • CVS (size of vessels, HR)
  • GI (hind gut fermenter=gut stasis issue)
  • species specific concerns
103
Q

exotic species specific concerns

A

ferret: hyperoestrogenism
rabbit: liver torsion
poor husbandry (lack of knowledge)

104
Q

Bird anaesthesia concerns

A
  • hide illness
  • stress of restraint
  • complete racheal rings (do not cuff)
  • movement of sternum essential to breathing
105
Q

reptile/snake special considerations

A
  • zoonosis
  • husbandry= humidity, UV, light
  • poikilothermic/ectothermic
  • breath holding
  • 3 chamber heart (shunt can cause poor gas uptake)
  • avoid cuffed ET tube
106
Q

tortoise special considerations

A
  • respiration is produced by muscle movement of limbs
  • low MAP
107
Q

how long should guinea pigs and ferrets be starved before anaesthesia?

A

guinea pigs= 0-4hrs
ferrets= 6hrs

108
Q

monitoring anaesthesia in exotics

A

reflexes (righting, withdrawal, jaw tone)
pulse oximetry
capnography
ECG

CVNT (7 decks)

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