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RUSVM Anesthesiology > Anestheitc Induction > Flashcards

Anestheitc Induction Flashcards

1
Q

What is the induction of anesthesia?

A

Transition from a conscious state to unconsciousness

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2
Q

What are the top priorities when inducing anesthesia?

A

Rapidly secure airways and give oxygen

Maintain cardiovascular function

Induce/maintain anesthesia

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3
Q

Why is induction in an inhalation agent via mask not recommended?

A

Breath hold- longer uptake

Longer to induce and intubation-> chance of aspiration

Slow induction-> can resist handling in excitement phase, stressful and chance for injury

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4
Q

Propofol, etomidate, alphaxalone and thiopental all work on what receptor?

A

GABA agonist

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5
Q

What is the most common injectable anesthetic in small animals?

A

Propofol

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6
Q

T/F: propofol can only be used IV

A

True

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7
Q

What effects does propoffol have on the CV system?

A

Vasodilation and hypotension

not ideal in hemodynamically unstable patient

High dose- may have neg inotropic effect

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8
Q

What effect does propofol have on the respiratory system?

A

Strong depression -apnea possible

Decrease RR
Decreases tidal volume

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9
Q

What effect does propofol have on the CNS

A

Decrease cerebral metabolic O2 consumption

Cause cerebral vasoconstriction

Reduced ICP and volume

Can terminate or induce seizure :O

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10
Q

T/F: propofol has an analgesic effect

A

FALSE

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11
Q

How can we keep intracranial pressure low during anesthesia?

A

Choose your drugs wisely

Increase ICP. -> ketamine and inhalants

Decrease ICP-> all other injectable (propofol, etomidate, alfaxalone)

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12
Q

What things should you avoid to keep ICP low?

A 
Hypercapnia or hypoxia 
Hypertension 
Coughing/vomiting 
Head down position
Jugular vein compression
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13
Q

What are special considerations if you use propofol in cats?

A

Slower metabolism
Recovery may be delayed

Pain during IV (small veins0

Repeated admin- hemolysis and heinz body anemia

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14
Q

What is the most common induction agent in small animals?

A

Propofol

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15
Q

What is the most common component of TIVA in small animals

A

Propofol

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16
Q

What is the drug of choice for C-section?

A

Propofol

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17
Q

When is propofol contraindicated?

A

Hemodynamically unstable patients

-hypovolemia and negative inotropic effect

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18
Q

What are the CV effects of alfaxalone?

A

Minimal when given at low doses

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19
Q

T/F: alfaxalone causes a dose dependent respiratory depression

A

True

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20
Q

T/F: alfaxalone causes good muscle relaxation and analgesia

A

False

Good muscle relaxation
No analgesia

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21
Q

What is the onset and duration of alfaxalone ?

A

Rapid onset and short duration

22
Q

Which is better as a CRI, propofol and alfaxalone?

A

Alfaxalone -> no accumulation

23
Q

What are the routes of admin for alfaxalone

A

IM and IV

24
Q

Alfaxan is an new formulation of alfaxalone, which benefit does it provide over old formations life Saffan?

A

No histamine release

25
Q

What is the number one choice for induction of hemodynamically unstable patients?

A

Etomidate - almost no C effects

26
Q

T/F: etomidate provides no analgesia

A

True

27
Q

How is etomidate administered?

A

IV

Formulated in propylene glycol/lipid emulsion -> painful if give IM

28
Q

How is etomidate metabolized?

A

Hepatic and plasma esterases

-> short duration of action (5-10mins)

29
Q

T/F: like alfaxalone, etomidate is a good drug for CRI?

A

False

Contraindicated CRI because of

  • adrenal suppression
  • propylene glycol accumulation
30
Q

What effect does etomidate have on ICP?

A

Similar to propofol

Decrease ICP and decrease metabolic demand of O2

31
Q

What opioid could you pair etomidate with to decrease vomiting as a side effect?

A

Fentanyl -> crosses BBB to inhibit vomiting

32
Q

What type of onset and distribution does thiopental have?

A

Fast onset, short duration

Fast redistribution -> rapid recover

But slow distribution - accumulation after repeated doses

33
Q

In what order of compartments does thiopental distribute?

A

Vessel rich group (CNS)-> rapid induction of anesthesia

Muscle group-> redistribution here leads to rapid recovery

Fat group

34
Q

Where is thiopental metabolized?

A

Liver

**very slow!
Redistribution from muscles and fat is slow -> bad recovery with repeated doses or CRI

35
Q

Can etomidate be used for C-sections

A

Nope

36
Q

What effects does thiopental have on the CV system>

A 
Negative inotropy (more than propofol)
Vasodilation (less than propofol)

Arrhythmogenic
Reflex tachycardia

37
Q

What effects does thiopental have on the CNS and respiratory system?

A

Similar to propofol

decrease ICP

Respiratory depression
-better muscle relaxation and does not cause twitching

38
Q

Which drug is a dissociative anesthetic?

A

Ketamine

39
Q

T/F: ketamine has an analgesic effect

A

True

NMDA antagonist

40
Q

Can ketamine be used on its own to induce anesthesia?

A

Nope

Causes catatonic state and catalepsy
—> use with benzodiazepine or a2 agonist

41
Q

How can ketamine be administered?

A

IM or IV

42
Q

Ketamine causes a catatonic state, how does this relate to monitoring anesthetic depth?

A
  • eyes remain open
  • pupils dilated
  • palpebral reflex or active
  • nystagmus
  • swallowing reflex intact
  • increased muscle tone

—> must use other signs to mentor anesthetic depth

43
Q

What is the MOA of ketamine?

A

NMDA antagonist

-> anesthetic and analgesic effects

44
Q

What are the CV effects of ketamine?

A

Indirect: Catecholamine release -> increase HR and contractility

Direct: negative inotropic

  • if catecholamines are depleted, negative inotropic effect may dominate
45
Q

What effects does ketamine have on the respiratory system?

A

Less resp depression

Apneustic breathing - breath hold at full inspiration

Bronchodilation

46
Q

What are the CNS effects of ketamine?

A

Cerebral vasodilation: increase intracerebral volume and pressure

Increase O2 requirement

47
Q

T/F: ketamine is the drug of choice for induction of anesthesia during ocular surgery

A

FALSE

Contraindicated!
Intraocular pressure increases -> may cause rupture with corneal damage

48
Q

How is ketamine metabolized?

A

To active metabolite in liver
Norketamine excreted in urine

*cats-> minimally metabolized, mostly directly excreted in kidney—> caution if renal function is reduced

49
Q

When is ketamine indicated?

A

Most risk patients tolerated in small doses

Asthma

Initial phase of hypovolemia shock

Chemical immobilizing of aggressive animals (good with a2 agonsit)

50
Q

When is ketamine contraindicated?

A

Brain trauma or tumor (increased ICP)

Eye injury

HCM and other heart disease

Seizure

Hepatic and renal insufficiency

51
Q

What is in telazol?

A

Tiletamine (like ketamine) and zolazepam (benzo)

52
Q

When is telazol useful?

A

Aggressive small or wild animals

Longer acting
Formulated as powder and can be diluted as needed

RUSVM Anesthesiology (32 decks)

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