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Year 1/2 > FTK 4: Large Animal Anesthesia > Flashcards

FTK 4: Large Animal Anesthesia Flashcards

1
Q

premedication options for horses? (3)

A

alpha-2 agonists, acepromazine, opioids

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2
Q

acepromazine in horses
goal?
administration?
method of action?
reversal agent?
risks?

A

PREMEDICATION

goal = to produce CALMING effect & NOT ANALGESIC, but can enhance other analgesic drugs’ activity

administration = PO, IV, IM

method of action = BLOCKS dopamine centrally & peripherally, causes adrenergic blockade that causes HYPOTENSION

reversal agent = none

risks = can cause PARAPHIMOSIS in stallions

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3
Q

alpha-2 agonists in horses
what types of drugs are these?
examples of drugs?
goals?
clinical signs it causes?
risks?

A

PREMEDICATION, THE MOST COMMON

phenothiazine tranquilizers

examples of drugs?
1. xylazine (LEAST alpha 2 to alpha 1 specific)
2. romifidine
3. detomidine
4. dexmedetomidine (MOST alpha 2 to alpha 1 specific)

goals?
RELIABLE sedation, sometimes can cause spontaneous reactions

clinical signs it causes?
hypotension
bradycardia
decreased GI motility

risks?
2nd degree AV block
SEIZURES if injected into carotid accidentally

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4
Q

opioids in horses
examples of common drugs?
risks?

A

examples?
1. butorphanol
2. morphine

risks?
dramatic excitatory reactions
GI stasis

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5
Q

what kind of pain does morphine treat MOST potently?

A

SUPERFICIAL pain, not as good with visceral pain

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6
Q

3 sites for IV administration in horse? what’s the most common?

A
  1. jugular vein (most common)
  2. cephalic vein
  3. lateral thoracic vein (over thorax)
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7
Q

4 goals of premedication in horses?

A
  1. analgesia
  2. muscle relaxation
  3. reduced amount of induction & maintenance anesthetic drugs
  4. improved quality of induction & recovery
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8
Q

what 3 things must be done prior to induction in horses?

A
  1. put on a SOFT halter
  2. rinse out mouth
  3. give adequate sedation (alpha-2 agonists, likely dexmedetomidine)
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9
Q

what 2 kinds of drugs are given PRIOR to induction in horses?

A

for SEDATION…
alpha-2 agonists like dexmedetomidine to help PREVENT excitatory reactions while inducing

for MUSCLE RELAXATION…
benzodiazepines (midazolam/diazepam) & guaifenesin

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10
Q

4 kinds of drugs used FOR induction in horses? (often given alone or not?)

A
  1. benzodiazepines (midazolam & diazepam)
  2. propofol
  3. ketamine
  4. guaifenesin

Often given IN CONJUNCTION

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11
Q

benzodiazepines in horses
2 examples?
pros?
cons?

A

examples = midazolam & diazepam
used as co-induction agents

pros?
1. reduces anesthetic drug requirements
2. minimal cardiovascular compromise
3. muscle relaxant

cons?
1. ataxia
2. long duration of action
3. can cause profound excitatory reactions

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12
Q

guaifenesin in horses
can be used as ____
= definition
something special about the product

A

INDUCTION agent

= centrally acting skeletal muscle relaxant

COMPOUNDED product

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13
Q

ketamine in horses
can be used as ____
= definition
effects when used alone?
often given with ___ & ___
reversal available?

A

INDUCTION agent

= dissociative NMDA receptor antagonist that acts as an indirect sympathomimetic

effects when used alone?
–> swallowing, nystagmus, laryngeal/eye reflexes, muscle rigidity, tearing

often given with MUSCLE RELAXANTS (benzodiazepines & guaifenesin) to prevent effects alone

NO REVERSAL AVAILABLE

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14
Q

what should we check for after induction but prior to tubing in horses?

A

PULSE QUALITY AND PRESENCE

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15
Q

what 3 things are needed for intubation in horses?

A
  1. ET tube
  2. cuffed syringe
  3. Bite block
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16
Q

3 steps for blind orotracheal intubation in horses? what might be needed?

A
  1. make sure HEAD AND NECK are extended, and pull tongue out to the side through the DIASTEMA
  2. Place bite block between incisors
  3. Advance ET tube through the oropharynx, larynx, then trachea

Might need an ENDOSCOPE for guidance

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17
Q

3 types of drugs & examples for MAINTENANCE of anesthesia in horses?

A
  1. INJECTABLES
    used for SHORT procedures like FIELD CASTRATIONS (30-45 minutes)
    - triple drip (guaifenesin/midazolam, acepromazine, xylazine)
    - multiple ketamine boluses CRI
    - propofol
  2. INHALANTS
    used for LONG procedures (45+ minutes)
    - isoflurane
    - desflurane
    - sevoflurane
  3. ADJUNCTIVE agents
    used in CONJUNCTION with inhalants or injectables to help LOWER anesthetic requirements; done via LOCOREGIONAL technique
    - alpha-2 agonists –> help reduce MAC for inhalant anesthetics
    - lidocaine CRI
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18
Q

what type of anesthesia machine is often used in LA medicine? what’s the average size in kg and tidal volume for a horse?

A

PISTOL-driven to ensure MORE ACCURATE TIDAL VOLUME DELIVERY

avg horse size = 450 kg
avg tidal volume = 7-8 L

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19
Q

what 5 clinical signs do we use as parameters during MONITORING for equine anesthesia?

A
  1. palpebral reflex
  2. corneal reflex
  3. eye position
  4. nystagmus
  5. lacrimation
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20
Q

TOO LIGHT vs. APPROPRIATE vs. TOO DEEP for 5 clinical signs during MONITORING for equine anesthesia

A

TOO LIGHT
palpebral reflex = brisk
corneal reflex = brisk
eye position = central
nystagmus = rapid
lacrimation = present

APPROPRIATE
palpebral reflex = slow
corneal reflex = present
eye position = VENTROMEDIAL
nystagmus = absent or slow
lacrimation = absent

TOO DEEP
palpebral reflex = absent
corneal reflex = absent
eye position = central
nystagmus = absent
lacrimation = absent

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21
Q

7 medical tools for EQUINE MONITORING

A
  1. ECG = HR & rhythm
  2. INVASIVE blood pressure via arterial catheter; **Non-invasive less accurate for adults but OK for minis/foals
  3. SpO2 (pulse ox for pulse)
  4. EXPIRED CO2 & inhalant concentration
  5. INSPIRED O2, CO2 & inhalant concentration
  6. Arterial blood gas for OXYGENATION
  7. Body temperature
22
Q

what type of lead placement is used for HORSES? name 3 locations

A

BASE-APEX lead placement

R arm = JUGULAR GROOVE or WITHERS
L arm = BEHIND ELBOW
L leg = INGUINAL AREA or PECTORAL MUSCLE

23
Q

4 arteries that can be used for INVASIVE BP in HORSES?

A
  1. transverse facial artery
  2. facial artery
  3. auricular artery
  4. lateral metatarsal artery
24
Q

equine RECOVERY from anesthesia

A

time at which there’s the HIGHEST CHANCE OF MORBIDITY & MORTALITY

need to give SEDATION via alpha-2 agonists + acepromazine to allow animal to REGAIN COORDINATION before trying to stand

can EXTUBATE once horse SWALLOWS

animal should go from LATERAL to STERNAL position

make sure REDUCED STIMULI –> put BLINDFOLD on eyes/ears

25
Q

5 different approaches to equine anesthesia recovery?

A
  1. UNASSISTED but SUPERVISED
  2. Head-and-tail rope
  3. Mat recovery
  4. Sling recovery
  5. Pool recovery
26
Q

5 different COMPLICATIONS that can arise in HORSES from anesthesia RECOVERY?

A
  1. MUSCULOSKELETAL
    - fractures
    - myopathy
  2. RESPIRATORY
    - obstruction
    - pulmonary edema
  3. OPHTHALMIC
    - corneal ulceration
  4. CARDIOVASCULAR
  5. NEUROPATHY
27
Q

4 main concerns for RUMINANTS while under anesthesia?

A
  1. SALIVATION –> high during anesthesia
  2. REGURGITATION –> can cause ASPIRATION, from RUMEN SHIFTING
  3. BLOAT –> esophageal opening CLOSED in recumbency, STOPS ERUCTATION
    **If rumen gets enlarged, can DECREASE CO
  4. HYPOVENTILATION –> worsens with bloat
28
Q

preanesthetic PREPARATION (3) in ADULT BOVIDS & CALVES/SMALL ruminants

A

(1) FOOD RESTRICTION = **IF ANIMAL IS EATING SOLID FOOD, THEN NEED TO RESTRICT!! WANT TO PREVENT REGURGITATION/ASPIRATION

ADULT bovids
- Feed = 24-28 hours
- Water = 6-12 hours
**Can auto-hydrate & auto-feed off of rumen, so need to decrease water and food components

CALVES/SMALL ruminants
- Feed = 12 hours
- Water = 6-8 hours

(2) PHYSICAL EXAM

(3) IV CATHETERIZATION
- USUALLY JUGULAR
- cephalic & auricular also options

29
Q

PREMEDICATIONS for RUMINANTS (adult bovids vs. calves/small ruminants)

A

adult bovids
1. ALPHA-2 AGONISTS –> CAUTION, ruminants are much more sensitive to them (1/10 of a horse dose, 1/20-1/30 of a swine dose)
2. ACEPROMAZINE

calves/small ruminants
1. BENZODIAZEPINES –> can usually use MIDAZOLAM alone
2. +/- OPIOIDS –> butorphanol or morphine

30
Q

why should we NOT give alpha-2 agonists to calves/small ruminants?

A

causes changes in their alveolar MACROPHAGES, leading to pulmonary edema, hypoxemia & death

31
Q

INDUCTION agents in RUMINANTS (all)

A

usually use both MUSCLE RELAXANTS & INJECTABLES

Muscle relaxants
1. BENZODIAZEPINES
2. GUAIFENESIN

INJECTABLES
1. KETAMINE
2. PROPOFOL

32
Q

CONCERNS for SMALL RUMINANTS during INDUCTION? (4)

A
  1. CANNOT OPEN MOUTH MUCH –> HARD TO INTUBATE
    - narrow intermandibular space
    - thick tongue base
  2. REGURGITATION/ASPIRATION –> need suction tool readily available
  3. SALIVATION
  4. HEAD/NECK MUST BE EXTENDED
33
Q

SMALL RUMINANT POSITIONING & INTUBATION

A

Positioning can be STERNAL OR LATERAL

Intubation = using DIRECT LARYNGOSCOPY, INSERT STYLE & pass ET TUBE OVER IT

34
Q

CONCERNS for RUMINANTS/CALVES during INDUCTION? (3)

A
  1. REGURGITATION/ASPIRATION
  2. SALIVATION
  3. POSITIONING
35
Q

ADULT BOVID INTUBATION & note about nasogastric tubes

A

often via DIGITAL PALPATION
- stick finger into oral cavity & over trachea/stylet, put ET tube over it and remove stylet

**nasogastric tubes may require stylets as well!

36
Q

CALF INTUBATION (position & method)

A

position = STERNAL recumbency

method = DIRECT LARYNGOSCOPY +/- stylet

37
Q

MAINTENANCE of anesthesia in ruminants? (2 types & examples)

A
  1. INJECTABLES
    - usually given CRI
    - KETAMINE
    - PROPOFOL
    - BENZODIAZEPINES
  2. INHALANTS
    - often given WITH INJECTABLE CRI to help REDUCE MAXIMUM DOSE OF INHALANT NEEDED because RUMINANTS ARE SENSITIVE
    - iso, sevo, des
38
Q

how do we know when RUMINANTS are at appropriate anesthetic depth?

A

eye will roll STRAIGHT VENTRALLY, so can ONLY SEE SCLERA

if CENTRAL, then TOO LIGHT or TOO DEEP

39
Q

tidal volume and RR in RUMINANTS vs. HORSES

A

Ruminants have LOWER tidal volume and HIGHER RR than horses

40
Q

parameters/equipment for ruminant anesthesia (8)

A
  1. ECG (HR & rhythm)
  2. BP –> USUALLY invasive, sometimes non-invasive
  3. Tidal volume
  4. RR
  5. Mucous membrane color
  6. CRT
  7. Body temperature
  8. SpO2
41
Q

POSITIONING for ruminants DURING anesthesia?

A

should be on PADDED MAT with HEAD DOWN so that SALIVA & REGURGITANT MATERIAL CAN DRAIN

42
Q

RECOVERY for ruminants (how they recover, in what position/why, extubation)

A
  1. usually recover QUIETLY & don’t try to MOVE PREMATURELY LIKE HORSES
  2. usually in STERNAL RECUMBENCY WITH HEAD DOWN so that ERUCTATION & LIQUID CAN LEAVE MOUTH (prevent aspiration)
  3. ET tube can be left in for O2 supplementation, EXTUBATION when CHEWING & SWALLOWING
43
Q

CAMELID ANESTHESIA (not much for this)
1. premedication
2. induction
3. intubation
4. maintenance/monitoring
5. recovery

A
  1. premedication = ALPHA-2 AGONISTS
  2. induction = depends HIGHLY ON BEHAVIOR
  3. intubation = DIFFICULT, has LONG SOFT PALATE & HIGH RISK OF REGURGITATION
  4. maintenance & monitoring = neck can be EASILY DAMAGED if in wrong position
  5. recovery = relatively smooth
44
Q

BEFORE surgery protocols for pigs (2)

A
  1. WITHHOLD FOOD/WATER because risk of VOMITING during perianesthetic period
    - stop feeding night before procedure, can still have water
  2. CAN try and give ANTI-EMESIS drugs prophylactically via AURICULAR catheter, but HARD because pigs are behavioral nightmares
45
Q

PREMEDICATIONS in pigs & how they’re all administered (3)
**note about BIG pigs

A

GIVEN IM!

  1. butorphanol (opioid)
  2. midazolam (benzodiazepine)
  3. dexmedetomidine (alpha-2 agonist)

*BIG pigs can use DETOMIDINE

46
Q

INDUCTION agents in pigs

A

INJECTABLES ARE MOST COMMON!
- ketamine or propofol

Can ALSO use inhalants via MASK

47
Q

SPECIFIC considerations in PIGS for anesthesia (7)

A
  1. EPIGLOTTIS sits on TOP of the soft palate, so we must DISPLACE SOFT PALATE to INTUBATE ORALLY
  2. prone to LARYNGOSPASMS
  3. larynx has VENTRAL FLOOR FORNIX/twist; must TWIST ET tube once past larynx
  4. tube can get stuck in PHARYNGEAL DIVERTICULUM
  5. NARROW mouth opening/oropharyngeal space
  6. THICK tongue also has DORSAL PROTRUSION, difficult for tubing
  7. ENDOBRONCHIAL INTUBATION POSSIBLE into RIGHT cranial lung lobe because it MOVES CRANIALLY
48
Q

MAINTENANCE & MONITORING of anesthesia for pigs

A

MAINTENANCE is based on INHALANT-BASED protocol + lidocaine CRI

MONITORING = ECG, SpO2, invasive or non-invasive BP, gas monitoring

49
Q

RECOVERY of anesthesia for pigs (3)

A

in STERNAL recumbency in a RECOVERY STALL

can EXTUBATE ONCE THEY FIRST SWALLOW –> **DO THIS RAPIDLY TO AVOID LARYNGOSPASMS

can REVERSE BENZODIAZEPINES/ALPHA-2 AGONISTS

50
Q

if a horse is TOO LIGHT, what would be the best combination to deepen? good alternative? what medication WOULDN’T be as effective?

A

KETAMINE will RELIABLY & QUICKLY DEEPEN!!
- provides ANALGESIA, PREVENTION OF PURPOSEFUL MOVEMENT while giving enough time to ALSO INCREASE INAHALANT/VOLATILE anesthetic
- **Alpha-2 agonists could be an alternative

Acepromazine can also deepen, but usually takes a long time to work

51
Q

at what point during anesthesia can we correct any FLUID disturbances, such as hyperkalemia or hyponatremia?

A

during PERIANESTHETIC period (during surgery)

52
Q

5 important factors for RECOVERY from MOST TO LEAST IMPORTANT

A
  1. ET tube placed properly w/ cuff INFLATED
  2. STERNAL recumbency
  3. Provision of OXYGEN supplementation
  4. Administration of flumazenil (premed)
  5. Heat support

Year 1/2 (139 decks)

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