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MOD (year 3) > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

why should a cuffed endotracheal tube be used to intubate dogs, cats, ruminants?

A

at risk of regurgitation

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2
Q

what does IPPV stand for?

A

intermitent positive pressure ventilation

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3
Q

what does ASA stand for?

A

American society of anaesthesiologists

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4
Q

what is the ASA status of the patient for?

A

attempt to classify the risk of anaesthesia according to an animals physiological status (not surgical risk)

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5
Q

what are the aims of anaesthesia?

A

unconsciousness
analgesia
muscle relaxation
(autonomic stability)

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6
Q

why is balanced anaesthesia needed?

A

no agents provide analgesia, unconsciousness and muscle relaxation

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7
Q

what is balanced anaesthesia?

A

anaesthesia from two or more agents/methods of anaesthesia

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8
Q

what are the benefits of balance anaesthesia?

A

reduction of dose/side effects

post-operative analgesia

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9
Q

what type of procedures is sedation used for?

A

non-invasive

non-painful

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10
Q

what is sedation used for?

A 
relieve patient anxiety
facilitate handling
provide analgesia
provide muscle relaxation
enable procedures
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11
Q

what is premedication used for?

A

smooth induction, maintenance, recovery of GA

reduce dose of induction/maintenance agent

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12
Q

what must drugs used via the cascade for food producing animals have?

A

maximum residue limit (withdrawal period)

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13
Q

what can be given to an anxious horse pre-appointment?

A

acepromazine or detomidine oral gel

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14
Q

what can be given to an anxious dog/cat pre-appointment?

A

gabapentin or trazadone

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15
Q

what are examples of opioids?

A 
butorphanol
buprenorphine
methadone
fentanyl 
(morphone)
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16
Q

what is an example of a phenothiazine?

A

acepromazine

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17
Q

what are examples of alpha 2 receptor agonists?

A 
xylazine
detomidine
romifidine
medetomidine 
dexmedetomidine
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18
Q

what are examples of benzodiazepines?

A

diazepam

midazolam

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19
Q

what are some adjuncts for sedation?

A

ketamine
alfaxalone
propofol
physical restraint

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20
Q

what patients are opioids good at sedating?

A

very painful/sick animals

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21
Q

what is the main side effect of opioids?

A

respiratory depression

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22
Q

what cases can acepromazine be used for?

A

mitral valve disease
BOAS patients
laryngeal paralysis

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23
Q

what are the main side effects of acepromazine?

A

vasodilation

unreliable

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24
Q

what is acepromazine often used in combination with?

A

alpha 2 agonists (acepromazine for calming effect)

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25
Q

what situations is acepromazine not suitable for?

A 
very young animals
hepatic impairment
haemorrhage
hypotension
sepsis
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26
Q

what are the disadvantages of acepromazine?

A

no analgesia
not reversible
long duration
moderate MAC sparing

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27
Q

what are the side effects of alpha 2 agonists?

A

peripheral vasoconstriction (reflex bradycardia)
reduce cardiac contractility
increase urine production

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28
Q

how reliable is alpha 2 agonist sedation?

A

very

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29
Q

what are the advantages of alpha 2 agonists?

A

analgesia
reversible (atipamezole)
duration depends on drug/dose
large MAC sparing

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30
Q

what are alpha 2 agonists not suitable for?

A

mitral valve disease
very young animals
if bradycardia would be a problem
urinary obstruction

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31
Q

what animals are benzodiazepines useful for?

A

very young, old and sick

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32
Q

how reliable is benzodiazepine sedation?

A

poor

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33
Q

what animals are benzodiazepines not suitable for?

A

farm animals

portosystemic shunts

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34
Q

what are the advantages of benzodiazepines?

A

reversible (flumazenil)

duration depends on dose

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35
Q

what are the disadvantages of benzodiazepines?

A

no analgesia

moderate MAC sparing

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36
Q

what can be used to sedate food producing animals?

A

butorphanol
xyalzine
detomidine

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37
Q

what drug are ruminants very sensitive to?

A

xylazine

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38
Q

when giving a horse opioids and alpha 2 agonists, what should be given first?

A

alpha 2 agonist (stops pacing)

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39
Q

what equine cases should acepromazine not be used in?

A

colic (vasodilation)

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40
Q

what small animal cases is acepromazine useful for?

A

long duration that require calming

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41
Q

what are possible agents used for induction?

A 
propofol
alfaxalone
ketamine
tiletamine
pentobarbital
thiopental
etomidate
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42
Q

what are possible co-induction agents?

A

ketamine
benzodiazepines
guaifenesin
opioids

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43
Q

what species considerations need to be considered when inducing cats?

A

mask subclinical disease well
don’t tolerate restraint
variable temperament

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44
Q

what species considerations need to be considered when inducing horses?

A

don’t like being recumbent

flight animals

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45
Q

what are the possible inhalation maintenance agents?

A

isoflurane

sevoflurane

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46
Q

what are possible injectable maintenance agents?

A

propofol
alfaxalone
ketamine

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47
Q

what is TIVA?

A

total intravenous anaesthesia

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48
Q

what is MAC?

A

minimal alveolar concentration

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49
Q

how can the plane of anaesthesia be assessed using the eye?

A

pupil size
eye position
palpebral reflex

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50
Q

what are adjuncts for maintain of anaesthesia?

A

multimodal analgesia
locoregional technique
PIVA
monitoring

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51
Q

what is PIVA?

A

partial intravenous anaesthesia

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52
Q

what are the ways the airway can be managed?

A

face mask
endotracheal tubes
supraglottic airway devices (LMA, V-gel)

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53
Q

what are two types of supraglottic airway devices?

A

LMA (laryngeal mask airway)

V-gel

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54
Q

where do supraglottic devices sit?

A

don’t go into trachea (sit over larynx)

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55
Q

what can be used in cases when emergency airway access is needed?

A

urinary catheter
stomach tube (guide ETT)
tracheostomy

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56
Q

what is pain?

A

unpleasant sensory/emotional experience associated with actual/potential tissue damage

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57
Q

what is nociception?

A

relay of noxious stimuli from the periphery to the CNS

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58
Q

what is the difference between pain and nociception?

A

pain is when the nociceptive input is processed and perceived

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59
Q

what are the types of acute pain?

A

somatic
visceral
neuropathic

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60
Q

what causes visceral pain?

A

chemical, thermal, mechanical stimuli to bone, skin, muscle… (localised)

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61
Q

what causes visceral pain?

A

inflammation, ischaemia or distention of viscera (diffuse)

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62
Q

what is neuropathic pain?

A

lesions within the nervous system (localised/diffuse)

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63
Q

what is hyperalgesia?

A

exaggerated pain sensation in response to noxious stimuli

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64
Q

what is allodynia?

A

perception of pain to a normally non-noxious stimuli

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65
Q

what is peripheral sensitisation?

A

increased responsiveness of nociceptors (reduced activation threshold)

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66
Q

what causes peripheral sensitisation?

A

tissue damage and inflammation

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67
Q

what does peripheral sensitisation cause at the site of injury?

A

hyperalgesia and allodynia

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68
Q

what is central sensitisation?

A

increased efficiency of nociceptive signal transmission that can persist after cessation of nociceptive input

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69
Q

what is central sensitisation due to?

A

prolonged/repeated nociceptive input

70
Q

why is acute pain associated with behavioural changes?

A

minimise damage

optimise tissue healing

71
Q

what are the 4 stages of the nociceptive pathway?

A

transduction
transmission
modulation
perception

72
Q

what drug types are available for acute pain?

A 
NSAIDs
Opioids
Paracetamol
Local anaesthetics
Alpha 2 agonists
NMDA antagonists
73
Q

what do NSAIDs inhibit?

A

COX enzyme

74
Q

what stages of the nociceptive pathway do NSAIDs effect?

A

transduction, modulation, perception

75
Q

what stages of the nociceptive pathway do opioids effect?

A

modulation, perception, transduction

76
Q

what receptors do opioids effect?

A

mu

77
Q

what opioids are full mu agonists?

A

pethidine
morphine
methadone
fentanyl

78
Q

what opioid is a partial mu agonist?

A

buprenorphine

79
Q

what opioid is a mu antagonist and kappa agonist?

A

butorphanol

80
Q

what is generally the first choice opioid in small animals?

A

methadone

81
Q

what opioid should not be administered IV?

A

pethidine

82
Q

what are the mechanisms of action of tramadol?

A

weak mu receptor agonist
inhibit serotonin and noradrenaline reuptake
alpha 2 agonist

83
Q

what are the side effects of tramadol?

A

salivation, vomiting, seizures

84
Q

what stage of the nociceptive pathway does paracetamol effect?

A

modulation

85
Q

what is the mode of action of local anaesthetics?

A

sodium channel blockers

86
Q

what stage of the nociceptive pathway do local anaesthetics effect?

A

transmission (true analgesics)

87
Q

what stages of the nociceptive pathway do NMDA antagonists effect?

A

modulation, perception

88
Q

what is the mode of action of gabapentinoids?

A

calcium channel blockers

89
Q

what stages of the nociceptive pathway do gabapentinoids effect?

A

modulation, perception

90
Q

what is an example of a NK-1 antagonist?

A

maropitant

91
Q

what is a multidimensional composite pain scale used for dogs?

A

Glasgow composite measure canine pain scale

92
Q

what is a multidimensional composite pain scale used for cats?

A

Glasgow feline composite measure pain scale

93
Q

chronic pain can cause changes to central pain processing, what are these?

A

hyperalgesia

allodynia

94
Q

what are the types of chronic pain?

A 
nociceptive/inflammatory
neuropathic
neoplastic
mixed
referred
myofascial
95
Q

what is referred chronic pain?

A

pain that is projected from the source to a distant site (makes identification difficult)

96
Q

what causes myofascial trigger points?

A

general wear/tear of muscles (damage to motor end plates)

97
Q

what muscles are commonly effected by myofascial pain?

A

postural (neck, shoulders, lumbar spine)

98
Q

what implications are associated with chronic pain?

A 
sensory
emotional
cognitive (conditioned responses)
motor
welfare
99
Q

what can be used to assess lameness associated with chronic pain?

A

force plate analysis

100
Q

how is the majority of chronic pain assessed?

A

owner questionnaires

101
Q

what are the steps in a chronic pain consult?

A 
identify owners concerns
identify problem
assess degree of pain
classify pain components
identify source of pain
identify aims of management 
devise treatment 
implement plan
102
Q

what does PLATTER stand for?

A 
plan
anticipate
treat
evaluate
return
(management of chronic pain)
103
Q

what does ABCDE stand for in regards to treating chronic pain?

A 
analgesia
bodyweight
control of complications and comfort
disease modification
exercise
104
Q

what are some possible analgesic interventions for chronic pain?

A 
acupuncture
physiotherapy
hydrotherapy
laser therapy
transcutaneous electrical nerve stimulation
105
Q

what drugs are commonly used for nociceptive/inflammatory pain?

A

NSAIDs

106
Q

what should be monitored in animals on long term NSAIDs?

A

serum biochemistry and urinalysis (check for side effects)

107
Q

what is the mode of action of grapiprant?

A

prostaglandin receptor antagonist

108
Q

what drugs can be used to treat chronic pain?

A 
NSAIDs
grapiprant 
paracetamol
tramadol
NMDA antagonist
gabapentin 
tricyclic antidepressants
109
Q

what are the side effects of longterm NMDA antagonist use?

A

GI signs
agitation
restlessness

110
Q

how does acupuncture work?

A

needles cause local vasodilation and nerve growth factors stimulate wound healing

111
Q

what is physiotherapy used for?

A

muscle strengthening

myofascial pain

112
Q

how does laser therapy for chronic pain work?

A

reduces pro-inflammatory mediator and cytokines

113
Q

what can exacerbate pain/inflammation in obese animals?

A

adipokines

114
Q

what can be used to treat chronic pain in food producing animals?

A

NSAIDs
paracetamol
ketamine

115
Q

why is anaesthesia monitored?

A 
maintain physiology
maintain anaesthetic depth
prevent pain
safety 
legal implication
116
Q

how is the CNS monitored during anaesthesia?

A 
reflexes (palpebral, corneal)
anal tone 
eye position/movement
lacrimation
autonomic tone (sweating...)
muscle tone (jaw...)
movement 
response to surgery
117
Q

where do small animals eyes rotate in an adequate plane of anaesthesia?

A

ventromedially

118
Q

what is the HR of a horse?

A

20-40bpm

119
Q

what is the HR of a dog?

A

50-100bpm

120
Q

what is the HR of a cat?

A

80-160bpm

121
Q

what is the respiratory rate of a horse?

A

4-10bpm

122
Q

what is the respiratory rate of a dog?

A

10-20bpm

123
Q

what is the respiratory rate of a cat?

A

15-30bpm

124
Q

what is an oesophageal stethoscope used for?

A

auscultating heart/lungs even if animal is covered by drapes

125
Q

what does an ECG monitor?

A

electrical activity of the heart

126
Q

what is arterial blood pressure used to monitor?

A

indication of cardiac output and perfusion

127
Q

what are the three values given for arterial blood pressure?

A

systolic pressure
diastolic pressure
mean pressure

128
Q

what is normal systolic arterial blood pressure?

A

80-140mmHg

129
Q

what is normal diastolic arterial blood pressure?

A

50-90mmHg

130
Q

what is normal mean arterial blood pressure?

A

60-90mmHg

131
Q

what are the two ways of monitoring arterial blood pressure?

A

invasive (gold standard)

non-invasive

132
Q

what does pulse oximetry measure?

A

% saturation of haemoglobin with oxygen

133
Q

what is normal haemoglobin oxygen saturation?

A

> 95%

134
Q

what are the limitations of pulse oximetry?

A 
hypoperfusion 
bright lights
movement
anaemia
probe can blanch capillary bed
135
Q

what does capnography measure?

A

end tidal CO2

136
Q

what is normal end tidal CO2?

A

35-45mmHg

137
Q

what can capnography tell you? (other than CO2)

A

correct ETT placement

confirms cardiac output indicates problem with breathing system

138
Q

what are the three common complications of anaesthesia? (Hs)

A

hypotension
hypothermia
hypoventilation

139
Q

what figure should mean arterial blood pressure stay above during surgery?

A

> 60mmHg

140
Q

what can cause hypotension during surgery?

A

reduced cardiac output (reduced stroke volume and HR)

reduced systemic vascular resistance

141
Q

what are the steps for treating hypotension under anaesthesia?

A 
check cuff (repeat reading)
check plane of anaesthesia
check HR
give fluid
drugs 
change position
142
Q

what drugs can be given to treat hypotension during anaesthesia?

A

vasoconstrictors

positive inotropes

143
Q

what are the main organs/tissues are we concerned about being damaged during hypotension from anaesthesia?

A

acute kidney injury

myopathy

144
Q

why does hypothermia occur under anaesthesia?

A

increase heat loss
reduced heat production
no behaviour responses (shivering)
alterations to hypothalamic function

145
Q

what are the consequences of hypothermia?

A

arrhythmias
coagulopathies
reduced immune function and drug metabolism

146
Q

what can hypoventilation cause?

A

hypercapnia

hypoxaemia

147
Q

when should hypercapnia be treated?

A

end tidal CO2 >60mmHg

148
Q

how is hypercapnia treated?

A

increase minute ventilation - lighten plane and mechanical ventilation

149
Q

when should hypoxaemia be treated?

A

saturation O2 <90%

150
Q

how can hypoxaemia be treated?

A 
increase oxygen delivery
mechanical ventilation
increase gas exchange (bronchodilators)
check ETT blockage 
fluids
151
Q

what can cause bradycardia under anaesthesia?

A

increased parasympathetic system activation (drugs)
hypothermia
disease (hyperkalaemia)

152
Q

what can cause tachycardia during anaesthesia?

A

increased sympathetic tone
hypovolaemia
hyperthermia
hypercapnia

153
Q

why is recovery phase of anaesthesia so dangerous?

A

physiological support reduced
monitoring is reduced
some problems manifest after a delay

154
Q

what are the most common recovery problems?

A

hypotension
hypothermia
emergence delirium
hypoxaemia

155
Q

what are the consequences of hypothermia in recovery?

A

reduced MAC requirement
shivering
delayed recovery
wound healing problems

156
Q

what is emergence delirium?

A

state of dissociated consciousness where the patient is incoherent, irritable and uncooperative

157
Q

what can be done to treat/prevent emergence delirium?

A

sedate/restrain
reduce stimulation, noise and light
analgesia

158
Q

what are the clinical signs of hypoxaemia?

A

cyanotic MM
tachypnoea
stertor/stridor
reduced consciousness

159
Q

when do you extubate an animal?

A

once they can protect their own airway (once swallowing)

160
Q

what issues are seen in dogs/cats during recovery?

A

gastric reflex/aspiration
tracheal tear (cats)
blindness (cats)

161
Q

what issues are seen in horses during recovery?

A

colic
myopathy/neuropathy
fracture

162
Q

what issues are seen in ruminants during recovery?

A

regurgitation/aspiration

bloat

163
Q

what issues are seen in pigs during recovery?

A

respiratory obstruction

hyperthermia

164
Q

what needs to be assessed in an emergency patient?

A

ABC
mentation
problems (prioritise)

165
Q

what basic diagnostic tests can be done on emergency cases?

A

PCV/TP, electrolytes, glucose
T-FAST, A-FAST
thoracic/abdominal radiographs

166
Q

how is fluid therapy given in emergency cases?

A

(bolus) - 10-20ml/kg of crystalloid over 10 minutes

167
Q

what are potential problems when anaesthetising emergency cases?

A

CV
respiratory
pain
temperature

168
Q

what drugs can be used to sedate emergency cases?

A 
alpha 2 agonists
acepromazine
benzodiazepines
ketamine 
opioids
169
Q

what alpha 2 agents would be most suitable for IM administration to a horse?

A

detomidine

170
Q

which opioid is good for very painful 3-4 hour procedures in a cat?

A

methadone

MOD (year 3) (45 decks)

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