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Sem 1: A&S Aneasthesia > Monitoring Aneasthesia > Flashcards

Monitoring Aneasthesia Flashcards

1
Q

why should we monitor anaesthesia?

A

anesthesia depresses many homeostatic mechanisms
- hypothermia
- hypoventilation
- hypotension
- reduced cardiac output
monitor and manage

manage depth and plane

monitor analgesia need

are compromised patients tolerating the procedure?

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2
Q

why is a pre-anesthetic assessment useful?

A

provides baseline value
see whether changes/adaption are needed
identifies any problems prior to anesthetic

have done by person monitoring
- learn the patient

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3
Q

what is basic monitoring?

A

you monitoring

examples
- reflexes
- respiratory
- CV - pulse/MMs/CRT/HR etc

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4
Q

what is intermediate monitoring?

A

the use of additional equipment for more readings

examples
- ECG
- capnograph
- blood pressure
- pulse-ox
- glucometer
- lactate testing

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5
Q

what is advanced monitoring?

A

additional tests if any concerns/complications

eg PCV and TS checks if hemorrhaged

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6
Q

how is the neurological system impacted under GA?
how do we monitor this?

A

reduction of consciousness
immobility

check with reflexes
to define plane of anaesthesia

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7
Q

how is the CV system impacted under GA?
how do we monitor this?

A

anaesthtic agents effect
- autonomic function
- vascular tone
- heart rate and contractibility

monitor these with
- BP
- ECG
- Pulse/heart rate
- MMs

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8
Q

what considerations need to be made when monitoring heart rate?

A

affected by pain/bleeding

pulse palpitation - tells us perfusion but doesn’t mean good BP
ECG - doesn’t mean heart working
SPO2 - affected by alpha-2 drugs (vasoconstriction)

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9
Q

what can impact mucus membrane colour?

A

blue/grey = cyanosis
- hypoxic

pale
- anaemic
- vasodilation

pinker
- vasoconstriction

yellow = jaundice
- issue with liver

cherry red
- toxicity
- carbon monoxide

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10
Q

how to check for perfusion?

A

MM
CRT
HR
Pulse Quality
Extremity temperature

lactate
- high = lack of perfusion

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11
Q

what is pulse oximetry?

what do we need to consider when using?

A

read pulse rate
- ensure PR = HR
reads saturation of hemoglobin
- can still be anemic (just less hemoglobin travel)

place on gums, tongue, ear etc
- effected by hair/dirt/pigments
- move regularly as pressure on tissues with decreases perfusion

carbon monoxide/ toxictity patients
- detects bright red MMs
- reads as good hemoglobin
- will still be hypoxic

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12
Q

reasons for bad perfusion/saturation?

A
  1. hypoventilation
    - lighten anesthetic and give IPPV
  2. insufficient FiO2
    - increase oxygen delivery
  3. ventilation:perfusion mismatch
    - treat cause
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13
Q

what is electrocardiography?

A

measure electrical activity of the heart
- not cardiac output
- doesn’t mean patient is alive - carries on after heart stops

detects arrhythmias/abnormalities

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14
Q

things to consider when using an ECG?

A

positioning
- right = right fore
- yellow = left fore
- green = back left

heart rate can be double or triple counted
- or sometimes not at all - common with brachys and cats

continue checking pulse

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15
Q

what features on a normal ECG?

A

P wave
- atrial depolarisation
- should be followed by atrial contraction

QRS complex
- ventricular depolarisation
- should be followed by ventricular contraction

T wave
- ventricular repolarisation

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16
Q

how to interpret an ECG

A

morphology
- can you identify all parts of complex?

uniformity
- do they all look the same
- if not: narrow and wide or wide and bizarre?

regular or irregular
- if irregular: regularly (sinus arrhythmia) or irregularly (atrial fibrillation)?

output
- is there a palpable pulse for each complex?

17
Q

types of sinus rythms?

A

sinus rhythm
- normal

sinus tachycardia/ brachycardia
- can be normal - patient/drug dependent

sinus arrhythmia
- variable intervals
- regular pattern
- associated with breathing
- not normal in cats

18
Q

types of bradyarrythmias?

A

AV blocks - disconnect between SA node and AV node

type 1 = delay between P wave and QRS

type 2 = some P wave conduction, some missed

type 3 = complete disconnection
- causes ventricular escape rhythm - lethargic/collapse
- needs pacemaker

alpha-2 can cause block
- give atropine

19
Q

types of tachyarrythmias?

A

Ventricular tachycardia
- more than 3 wide and bizarre complexes in a row
- HR over 260
- heart not going back to baseline - no time to refill
- poor perfusion and hypoxia
- convert with lidocaine bolus

atrial fibrillation
- P wave absent
- irregular and fast rhythm of atria
- defibrillation or cardiac meds

20
Q

types of death rhythms

A

asystole
- no electrical activity

pulseless electrical activity (PEA)
- electrical activity with n cardiac output
- can look normal

pulseless ventricular tachycardia
- wide and bizarre complexes - HR over 180
- very strong v-tack so no cardiac output or pulses
- fix with defib

ventricular fibrillation
- no cardiac output or pulses
- heart is quivering
- start CPR and fix with defib

21
Q

What can blood pressure tell us?

A

indicates cardiac output and tissue perfusion
but increased vascular tone will increase blood pressure but not always perfusion

a MAP over 60 allows autoregulation
- maintain blood flow to brain and kidneys

MAP <60 = hypotension
- can go lower with neonates/pediatrics
- if mild correct with fluids
- if severe (below 45) get diagnosis and management

MAP >110 = hypertension
- often pain
- could be renal disease, hyperthyroidism or hyperadrenocorticism - geriatrics

22
Q

how to solve hypotension?

A

flow chart to fix

  1. lost fluid/hypovolemic shock?
    - IVFT
  2. bradycardia?
    - reverse alpha-2s
  3. vasodilation?
    - reduce inhalant - give agent
  4. reduced venous return?
    - obese, pregnant, ascites
    - change positioning or deflate stomach
  5. poor cardiac contractility?
    - cardiac drugs
23
Q

types of blood pressure monitoring equipment?

A

doppler
- cuff 40% limb width
- gives HR and BP reading
- note trends

Oscillometrics
- not ideal if brady/tachycardic, arrhythmias or hypo/hypertensive
- make sure accurate - matches HR

direct arterial
- arterial catheter - fluid line with transducer
- continuous monitoring - good if unstable
- very accurate
- but more cost, equipment and risks

24
Q

what do we check for when monitoring the respiratory system?

A

resp pattern, effort and rate

manual inflation of lungs
- check lung compliance
- forceful = compromised

thoracic auscultation
- crackles - edema
- wheezes - bronchoconstriction
- dullness - pleural effusion

25
Q

what can a capnograph tell us?

A

measure end tidal CO2
- expired CO2
- indicates cardiac output and perfusion

normocapnia = 35-45

26
Q

stages of a capnograph waveform?

A

phase 1 = inspiratory baseline

phase = expiratory upstroke

phase 3 = expiratory plateau
- point of reading

phase 4 = expiratory downstroke

must return to 0
- otherwise rebreathing
- breathing in expired CO2

27
Q

how to manage abnormal capnographs?

A

patient stopped breathing
- give IPPV - likely apneic phase
- check if arrest - pulse?

patient rebreathing CO2
- increase FGF/O2
- change/check soda-lime and bag

‘fin-like’ shape = ET tube partially obstructed
- mucus production
- suction or change tube

28
Q

reasons for hypo/hypercapnia?

A

hypocapnia = <35
hyperventilation (main)
- light anesthesia
- pain
reduced CO2 production
- hypothermia - reduces perfusion
- hypotension - more alveolar dead space
- pulmonary thromboembolism
equipment
- sampling error from leaks
- inflate cuff and leak test

hypercapnia = >45
hypoventilation (main)
- too deep
- obesity, pregnancy, ascites
- positioning
- underlying disease
increased CO2 production
- hyperthermia
- pain
- shivering
- seizures
increased inspired CO2
- rebreathing
- dead space
- exhausted sodalime

29
Q

reason for sudden drop in CO2 when monitoring?

A

equipment disconnection
- calibration

oesophageal intubation

apneoa

cardiac arrest

30
Q

reasons for changes in temperature under GA?

A

low temp
- no CNS response to change
- no ability to shiver
- skin prep solutions - esp. spirit
- loss of heat from body cavity - eg abdomen surgery

high temp
- unable to pant
- vasoconstrictors reduce peripheral heat loss
- common with brachys and double-couted/fluffy breeds

31
Q

why is hypothermia a problem?

A

increased post-op infections

reduced coagulation
- increase hemorrhage

altered drug metabolism
- prolonged recovery

shivering
- increased O2 consumption
- so increased CO2 production

32
Q

why manage urinary output under GA?

A

reducing urine production avoids hypotension
- hypotension reduces renal blood supply and function

Sem 1: A&S Aneasthesia (11 decks)

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