Anesthesia and Disease

Question 1

upper airway disease

Answer 1

prone to hypoxia

distress (catecholamine)

prone to obstruction

(pulmonary edema)

=preoxygenate for ~ 5 minutes to reach max level

Question 2

pulmonary disease

Answer 2

• chest trauma-pneumothorax
• upper airway obstruction
• pneumonia/pulmonary edema
• correct underlying disease!!
• hypoventilation and hypoxia
• most drugs decrease ventilation
• change in compliance
• increase in pulmonary resistance
• accumulate secretions

Question 3

pre-operative assessment for pulmonary disease

Answer 3

hx and rx

chest radiographs

pulse ox (awake), blood gas

exercise intolerance (60 second walk)

Question 4

how to manage pulmonary disease for anesthesia

Answer 4

• premedication- low sedation (slow)
• pre-oxygenate for ~ 5 minutes
• induction (fast)
  
  • avoid increase in O2 demand and apnea
  • inflate cuff, rapid sequence induction
• low dose opioid, propofol
• monitor with capnograph, pulse ox, and blood gas
• recovery: low stress, high O2, positioning

Question 5

during anesthesia, what would be worse for a patient with HCM?

vasoconstriction

vasodilation

bradycardia

tachycardia

Answer 5

tachycardia

Question 6

anesthesia for a cat with HCM

Answer 6

• HCM is most common heart disease in cats
  
  • 15% don’t show clinical signs
• stiff ventricle and poor diastolic function
• left ventricle outflow tract obstruction (LVO)
  
  • avoid tachycardia, increasing contractility and vasodilation
• atropine, opioids, etomidate

Question 7

pre-anesthetic care for HCM patient

Answer 7

• pre-oxygenate
• place IV catheter
• reduce stress!

Question 8

recovery for HCM patient after anesthesia

Answer 8

• recovery in calm environment
• monitor BP and HR for about an hour (if cat is compliant)

Question 9

anesthesia and cardiac disease (mitral valve disease)

Answer 9

• premedication, pre-oxygenate
• induction
  
  • avoid bradycardia and vasoconstriction
• fluid therapy-low volume
• reduce stress!
• opioids, dex, etomidate

Question 10

for HCM cats, a mild __________ in HR and mild ___________ decrease risk of LVOT

Answer 10

decrease

vasoconstriction

Question 11

for MR dogs, a mild _________ in HR and mild _____________ improve cardiac performance

Answer 11

increase

vasodilation

Question 12

liver disease and anesthesia

Answer 12

• portosystemic shunt (PSS) or intoxication
• low metabolism
• decease protein production
• decrease glucose stores
• hypoxia

Question 13

pre-operative assessment for liver disease

Answer 13

u/s

neuro exam

chemistry profile (protein!!)

clotting factors

Question 14

type of anesthetic drugs to use with liver disease

Answer 14

• use drugs that are reversible, short acting and don’t need liver for metabolism
• opioids, midazolam
• propofol***
• remifentanyl + isoflurane
• fluids: fresh frozen plasma (FFP), hetastarch, glucose

Question 15

brain disease and anesthesia

Answer 15

• head trauma, brain mass
• concerns
  
  • seizures
  • intracranial pressure (ICP)
    
    • drugs, positioning, vomiting, cough gag, CO2, O2, BP

Question 16

pre-operative assessment for brain disease

Answer 16

• hx, rx
• hydration status, electrolyte panel
• Cushing’s reflex: low HR, high BP

Question 17

what type of drugs to avoid with brain disease:

Answer 17

drugs that cause: vomiting, sedation (hypoventilation), increased ICP (ketamine, halothane)

Question 18

types of anesthetic drugs to use with brain disease

Answer 18

• low dose opioid IV
• thiopental, diazepam
• isoflurane or sevoflurane (vasodilation)
• ketamine is the only induction with analgesic properties