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RUSVM Anesthesiology > GI Disease > Flashcards

GI Disease Flashcards

1
Q

Reperfusion of compromised tissue causes the release of??

A

Inflammatory mediators

—> vasodilation and hypotension, decreased inotropy, and ventricular arrhythmia

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2
Q

Manipulation of the GI tract can cause _________ stimulation

A

Vagal

—>bradycardia

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3
Q

What is a dilation of esophagus with poor motility ?

A

Megaesophagus

Can be congenital
-mechanical or neurological

Or

Acquired idiopathic (most common)

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4
Q

What are concerns for anesthesia in a dog with megaesopgus?

A

Regurgitation and aspiration

Gastroesophageal reflux

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5
Q

How long do you fast dogs with megaesophagus??

A

5ish hours, avoid prolonged fast —> gastroesophageal reflux

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6
Q

In dogs with megaesophagus, we want to avoid vomiting and have rapid induction/control of airway. What would be good drug choices for this?

A

Avoid opioids causing vomiting
Acepromazine —> antiemetic effect?

Propofol and alfaxalone good for induction
AVOID ketamine

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7
Q

You are doing endoscopy on a patient. What will you consider for your drug choices??

A

Patients may have chronic disease —> hypoproteinemia , thin BCS

Debilitated patient ? —> avoid drug with significant CV effects

Upper GI studies —> have anticholinergic on hand incase of vagal simulation causing bradycardia

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8
Q

Exploratory abdominal surgery is usually due to chronic GI disease requiring a full thickness biopsy. What considerations will you have prior to surgery and precautions to take during the surgery?

A

SAME as endoscopy + check for liver disease and clotting times

Patients may have chronic disease —> hypoproteinemia , thin BCS

Debilitated patient ? —> avoid drug with significant CV effects

Upper GI studies —> have anticholinergic on hand incase of vagal simulation causing bradycardia

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9
Q

If you have an emergency abdominal exploratory surgery for hemoabdomen, what is the usual emergency presentation ?

A

Clinical signs: weakness and collapse

Hypovolemic shock —> hypotension and tachycardia, pale mucus membranes

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10
Q

Hemoabdomen is usually secondary to??

A

Splenic neoplasia (hemangiosarcoma) or benign splenic disease

—> both require emergency splenectomy to stop hemorrhage

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11
Q

How are you going to resuscitate an animal with hemoabdomen prior to surgery?

A

Fluids - balanced replacement crystalloids (LRS, plasmalyte A, or Norm-R)

Opioid analgesia

Avoid resuscitating to normal awake BP levels —> may disrupt clots
(Doppler at 9mmHg is reasonable)

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12
Q

Splenic disease often causes ventricular arrhythmias, what id your drug of choice for treatment?

A

Lidocaine

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13
Q

What would you the best choice for premed in hemoabdomen case?

A

Opioids (short acting-> fentanyl) and benzo (midazolam) IV

May include lidocaine for arrhythmia and MAC sparing /analgesic effect

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14
Q

What injectables can you used to decrease the dose of inhalant anesthesia? Why would you want to do this?

A

Fentanyl, hydromorphone, oxymporphone

Lidocaine

Ketamine

Inhalants have significant CV effects —> hypotension

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15
Q

T/F: Most patients with hemoabdomen require very little inhalant anesthesia

A

True

ISO 0.25-1%
Sevoflurane 1-2%

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16
Q

What monitoring equipment do you use in a hemoabdomen case?

A

DIRECT BP —> more accurate and can also evaluate pulse pressure

TPR
Indirect BP
ETCO2

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17
Q

MAP should be maintained above _______ in hemoabdomen

A

60 mmHg

18
Q

You have hypotension during your hemoabdomen surgery (oh no.. tragedy), what will you do to fix it?

A

If hypovolemia —> give fluids

If vasodilation or decreased inotropy —> DECREASE inhalant +/- CV drugs

19
Q

Post op splenectomy patients are very susceptible to ventricular arrhythmias, how do you deal?

A

Hospitalized for 24-48 hours post op

Lidocaine CRI

Continue analgesic

20
Q

What drugs do you used for a routine removal of a GI foreign body?

A

Opioids and benzodiazepines

Any induction drug will do

21
Q

What drugs would you avoid in a routine GI foreign body surgery? What additional drug would you avoid if patients was sick/septic

A

Acepromazine -non reversible
Dexmedetomidine —> strong CV effects

Sick/septic : also avoid propofol (CV effects) and etomidate (adrenal suppression)

22
Q

What would you use for premed and induction in a sick/septic patient with GI foreign body?

A

Opioid and benzo for premed, and again for induction

23
Q

You are doing an emergency cholecystectomy. How sensitive will your patient be o anestheric drugs?

A

Very sensitive —> SICK patients (rupture causing bile peritonitis)

Likely have hypotension- vasodilation and decreased inotropy due to inflammatory mediator release

24
Q

What drugs will you use during you emergency cholescytectomy??

A

MAC sparing techniques (opioid, benzo, ketamine, and lidocaine)

Vasopressor and inotrope for hypotension

25
Q

Mortality rates with GDV are primarily dependent on ??

A

Degree of gastric necrosis

Serial lactate measurements have been examined ANS a prognostic indicator

26
Q

GDV patient has hypovolemic shock. What is the game plan?

A

Give fluids

Combo replacement crystalloid and colloids

27
Q

What do you give GDV patients for analgesia??

A

Pure mu opioid

IV hydromorphone, oxymorphone, fentanyl

28
Q

The dilated and gas filled stomach in a GDV patient can cause what?

A

Decreased venous return —> hypovolemic shock

Pressure on diaphragm —> hypoventilation

29
Q

What can you do in your GDV patient prior to induction to help BP and ventilation?

A

Gastric trocharizaiton

Gastric tube can be passed once airway is protected with ET tube

30
Q

What drugs do you use in GDV procedure ?

A

CV sparing drugs (AVOID profofol or use at vEry low dose)

Routine use of lidocaine —> bolus then CRI

Opioid-benzo + low does alfaxalone/ketamine

31
Q

How are you monitoring your GDV patients?

A

Direct BP

ECG for ventricular arrhythmias
-consider lidocaine bolus

32
Q

You have intra-op hypotension in your GDV case. What do you do?

A

Turn down vaporizer

Add injectable for MAC sparing

Fluid bolus
Vasopressor/inotrope as needed

33
Q

You have high PCV and azotemia in your equine colic patient, what is going on?

A

Dehydration —> give fluids LARGE volume

Crystalloids 10-20L before induction

If rushed to surgery —> 10 L of crystalloid and 1L of hypertonic saline before induction

34
Q

Hyperlactatemia in your equine colic patient is a sign of??

A

Poor perfusion +/- GIT ischemia

35
Q

In equine colic cases, there is nearly always already an A2 agonsit, NSAID, +/- butorphanol on board from referring vet. What do you do for premed and induction?

A

May already be sedate

If not, premed with Xylazine and butorphanol

Induce with ketamine and diazepam

36
Q

What are you going to give for maintenance during equine colic surgery?

A

ISO/sevoflurane

Lidocaine CRI (MAC sparing and free radical scavenger)

Intermittent butorphanol for analgesia (q 1hr)

37
Q

How will you monitor your equine colic patient??

A

TPR, ETCO2, ECG

Direct BP —> all equine patients receiving inhalant anesthesia

Arterial blood gas (q 1 hr) —> PaO2, PaCO2, lactate and iCa

38
Q

What CV complication can arise from colic surgery?

A

Hypotension !!

Aggressive fluid therapy
Dobutamine, ephedrine, NE, dopamine, vasopressin

Ca gluconate (hypocalcemia causing poor contractility)

** hypotension can get significantly worse at time of reperfusion of ischemic gut—> inflammatory mediators***

39
Q

Hypoxemia is a common complication in equine surgery. What do you do?

A

High peak inspiration pressure to pen alveoli and decrease V/Q mismatch

Consider PEEP and recruitment maneuvers

40
Q

What is permissive hypercapnia?

A

PaCO2 can be tolerated up to 60-70mmHg
—> sympathetic stimulators effect

—> deceased negative effects of IPPV on cardiac output

41
Q

What are the complications for recovery in equine colic cases?

A

Exhausted from long colic and travel

Poor tissue O2 delivery during surgery/anesthetics —> poor muscle function

Hypocalcemia and hypokalemia —> muscle weakness

RUSVM Anesthesiology (32 decks)

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