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Anaesthesia - SA Flashcards

1
Q

desc the basic ASA grading

A 
I - normal healthy
II - mild systemic dz
III - severe systemic dz
IV - severe dz, constant threat to life
V - moribund, expected to die wo sx
E - emergency
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2
Q

what are the basic aims of pre-anaesth assessment

A

to establish how suitable the patient is

any deviation that the GA will effect or create

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3
Q

should you take pre-op bloods

A

yes- baseline, defence in court if dies, predict complications, O reassurance, baseline for individual
no - cost, acquiring, are they necessary

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4
Q

what are the recocm for food/water with-holdin

A

feed wet food - quicker digested
starve 8hrs, withold water when brought in
if starve any more = inc chance of regurg

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5
Q

what considerations need to be made before dosing calculated

A

weight - obese animals dont need that much
body SA better method
breed - some more sensititive
other dz - eg if hypotensive DONT give ACP
hx

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6
Q

what sedatives/pre-op meds are there

A
  • ACP
  • A2 agonist
  • BZD
  • Opioids
  • Ketamine
  • Alfaxalone
  • Azaparone
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7
Q

what is the diff bw sedation and pre-med

A 
premed= calm
sedation = for procedures (eg needs more)
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8
Q

whya re sedative risks high

A

no airway control

poorer monitoring

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9
Q

desc the perfect sedative

A 
many admin routes
wo SE
quick and good DoA
any spp
reasonable volume
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10
Q

desc features of ACP

A

ONset - 30m
DoA - 4-8hrs
analgesia? NO
uses - bonfire night (NOT an anxiolytic); horses with pre-med
effects - vasodil (blocked a1 adrenoR) - so keep warm!; reduced sympathetic tone (can help some symp-induced arrhythmias); muscle relaxation; reduces PCV; anti-spasmodic and anti-emetic

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11
Q

desc the features of an A2 agonist

A

onset - 10m
DoA - short
analgesia? YES - centrally acting, activates desc inhib and good + opioids
uses - sedation (LA are ++ sensitive to touch though, watch out! - hence why w ketamine normally)
effects -
- severe CV: reduced symp tone, vasocon, reflex bradycardia, hypOtension, look grey-ish
- resp: depressed
- other: muscle relaxation; diuresis (consider in blocked cats etc); hyperglycaemia (reduced insulin prod and response); mydriasis; CI - pregn
reversal = atipamezole (antiseden) - NOT iv or crazy cats. reverses analgesia too.

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12
Q

name 4 types of a2 agonists and their basic properties

A
  1. xylazine - fastes/quickest. most relaxation + visceral analgesia. colic +
  2. detomidine - horses IM, most potent
  3. medetomidine - good sed++
  4. romifidine - longest DoA, weakest
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13
Q

what are the basic properties of BZ (benzodiazepines)

A

examples - Diazepam and midazolam - neither licensed in vet spp
uses - anti-convulsant, sedation (but may cause excitement). co-induction agent (aim to lower other drug doses and utilise the muscle relaxant property)
good bits - minor vasodil (keep warmer), CV or resp depression = ++recom for neonates and geriatric patients and muscle relaxation

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14
Q

desc the basics of opioids

A

uses - sedative, analgesic

effects - minimal CV depression; sign resp depression tho

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15
Q

name 4 types of opioid

A
  1. buprenorphine - 6hrs DOA, good for sx (feisty cats++)
  2. butorphenol - 1-2hrs DOA, best sedation (eg for xray)
  3. methadone - 4hrs DOA, quick, good sed + analgesia, not emetic (cats++)
  4. morphine - 4hrs DOA, need to be glucorinated (sorry cats)
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16
Q

desc the basic propertes of phencyclidine - ketamine

A

uses - induction agents + BZ - choice in LA; or in combos (ket, medatom and opioid) - SA, analgesia++

properties - dissociative, painful IM (pH-4)

effect - inc muscle tone, analgesic in v low doses. good for aggressive animals, apneustic breathing (min vol maintained tho), noise hypersensitivity, active CN reflexes (protect cornea)

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17
Q

what are the properties of propofol

A

DoA - short
uses - induction, maintenance, can titrate up to req effect
effects - CV - depression, hypotension; resp - depression and apnoea. indicated for cerebro-protection ++
properties - IV only as need high conc.
analgesia? NONE
metab by glucorinidation + hydroxylation - can give cats induction but not CRI
SE - heinz-body anaemia (C), CI in pancreatitis

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18
Q

what is a dog and cats circulating volume

A

d - 90mls

c - 60ml

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19
Q

what is pain

A

processing and perception of nociception

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20
Q

what is nociception

A

noxious stimulus received and relayed to CNS, but not cortex

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21
Q

name the 4 types of sensory perception and what sensory receptors sense it in the dermis

A
  • pressure - meissner corpuscle
  • vibrations - pacinian corpuscles
  • stretch - ruffini endings
  • light touch - merkel disls
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22
Q

what is allodynia

A

pain from light touch

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23
Q

what is hyper-algesia

A

inc sensitivity to pain

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24
Q

desc the difference bw somatic pain R and visceral pain R

A

somatic - many, widespread, small and precise
visceral - few each with large area. sensitive to distention, ischaemia or inflm. stimulus proportional to size of area, not severity

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25
what duration classes as chronic pain
>3mths
26
what does neuroplasticity mean
CNS and PNS can adapt to a pain event both fct'ally and anatomically. results in allodynia, and hyperalgesia
27
state the 4 stages of pain signal transmission
transduction modification transmission perception
28
what is peripheral sensitisation
+++ inflm mediators, nociceptors threshold is reduced. this signals 'silent/redundant' nociceptors to become active (c-fibres and Ad fibres) since there is apparent tissue injury. Anything that inc cAMP, induces hyperalgesia (bradykinins, SubP - vasodil, NA, aa's)
29
how do NSAIDs work
MoA - targets transduction (inflm) and modulation (CNS), blocks effect of PG synth due to COX blocked (1 = constitutive; 2 = inducible)
30
where else is cox2 seen which means its not great to be blocking all the time?
cns, kidney, eye, repro constitutively
31
name the 2 pain fibres and 1 proprioception fibre
pain - c-fibres; Ad | proprioception = Ab
32
dec basic pain transmission
PNS --> CNS (either Ad synap in laminae I+V; C synap in lmainae II+III, with interneurones to V) 2nd order go to brain in one of many tracts (spinothalamic etc..) and may have 'inter-neuroned' with a reflex arc 3rd order go to organ to perceive pain, eg cortex
33
describe what the following process and perceieve: - RAS - thalamus - cingulate gyrus - amygdala - hippocamp - locus coerulus - cortex
- RAS - motivation - thalamus - sensory - cingulate gyrus - behav - amygdala - anxiety - hippocamp - memory - locus coerulus - behav - cortex - perception
34
how are nerve transmissions modulated
amplify or suppress the signal that reaches the SC by: - inhib neurones - desc inhib - gate control - central sensitisation
35
what is the majot difference in NT bw inhib and excitatory neurones
inhib - inc Cl- = hyperpol (stim by GABA-a and glycine) | excitat - inc Na+ and Ca++ (stim by glutamate and aspartate)
36
desc the gate control theory
pain fibres inhibit the inhibitory interneurones )eg they get thru) mechanoR/proprioceptive fibres stimulate the inhib interneurones and do not go to be transmitted as pain
37
which tract does pain travel in
spinothalamic
38
which tract does mechanical stim pass in
dorsal
39
desc descending inhibition
as sensory stim come into the dorsal h - synapses at opiate-R. serotonin and NA from the brain descend and inhibit the synapse to continue the transmission of the pain perceptio all happens in peri-aque-ductal grey
40
desc some ways that maladaptive pain can ensue
chronic neuropathic - nerve injury leading to ectopic charges, allodynia, hyperalgesia complex regional - hyperresponsiveness, symp dysfct mech and proprioceptive sprouting and synapsing in the lamninae II, III..
41
why is pre-empt analgesia impt
cant develop hyperalgesia
42
where can pain be targeted:
topical to affect R/free nerve endings prev activation of silent nociceptors (stop inflm mediators) specifc targets = PGE2, ATP, Subs P, Histamine, Serotonin, bradykinine
43
how does paracetamol work
not sure, but stimulates desc inhibitory pathway, inhibit re-uptake of endo-cannabinoids, inhibis PGE2 d++, cats - NO
44
what is central sensitisation
lots of NTs means that 2ry order neurones are now reactive - causing pain to be felt for a very large, unnecessary area (2ry hyperalg and allodynia)
45
which R are seen on 2ry O neurone mainly in central sensitisation
NDMA - this req both glutamate and glycine to bind - this is why ketamine/methadone so useful for bad pain - blocks NDMA
46
what are your drugs of choice for chronic pain
``` NSAIDs paracet + codeine gabapentine NMDA antag (ket, methad, amantadine) SSRI - amitryptaline TCA - anti-D ```
47
what is the purpose of induction
to induce drugs to cause loss of consciousness
48
what is the pro/con for inhalation or injectabes
inhalation - IV not req, longer, stressful - bad smell and mask, irritant, pollution inj - smooth, no pollution, need accurate kg, usually Cv and Resp depressants, good to have IV access, maintainance poss by CRI
49
what are the differences bw SA and LA and injection speed
SA slow so can titrate to just the right amount | LA (horse) - rapid or might become excitable and dangerous
50
what is the ideal induction agent
``` painless well distributed cheap high tx index (safe) smooth action and recovery ```
51
where do injectable agents act
Gaba-a R nACh-R Glycine-R
52
desc the properties of barbituates
uses - induction, PTS, top-up bolus in LA / SA with high ICP analgesia? NO CI - vasodil, CV/resp depression
53
desc the properties neuro-steroids - alfaxalone
use - induction, maintenance, sedation properties - muscle relaxation - twitch when recovering; IM or IV, rapidly metabolised so okay for CRI effects - CV - vasodil and tachycardia; resp - depression analgesia? NO
54
what family of drugs does tiletamine belong to, and what are its properties
phencyclidine (ketamines) uses - wild animal GA properties - twitches and tremors; longer acting than ketamine; IV or IM effects - CV - tachycardia, arrhythmias; resp - depression; brain - excitatory, inc ICP and IOP
55
desc the properties of etomidate
uses - induction (partic if CV dz) properties - no analgesia, 2 x IV prep, Gaba-a R target, minimal CV or resp depression effect - muscle stiffness, cerebro-protective, rapidly metabolised BUT suppresses the stress response so dont give CRI or will get addisonian crisis
56
which animals are better without a cuff on an ETT OR having a low P high vol one (long and thin)
rabbits and cats with entire tracheal rings
57
what is the bevel and the murphey eyes for
bevel - reduced chance of obstruction | murphy - just in case it does
58
which are at high risk of laryngeospasm
rabits and cats | sheep and goats
59
state two methods of intubation for the horse
blind - such long oral cavity and big tongue | naso-tracheal intubation = foals and oral sx
60
desc the techn with ETTing ruminants
salivate a lot and regurg - so keep head up blind ETT - need it to be a lateral gag or manual palpation can use a smaller stomach tube first then put ET over top
61
what is the problem with ETT pigs
larynx = 90degrees so got to rotate a few times to navigate
62
how do you know you correctly ETT
``` visualise simult breathing with res bag capnograph suggests so cant feel the oesophagus feel air coming out of ETT ```
63
why does atalectasis occur
poor perfusion of ventilated upper lung fields, and opposite of others = collpase. horses in D-rucumbancy +
64
why isnt IPPV always a good thing
creating positive p not the 'natural' negative p as pushing the air in, therefore blood not forced into the heart can causes lung trauma and activate the RAAS the pressure squashes the CrVC
65
what is TIVA
total intravenous anaesthesia (sod inhalation, this is easy) watch out for cumulative effects
66
what does MAC stand for
minimal alv conc = 50% of patients dont respond to nox stim. inversely related to potency
67
desc what low solubility inhalations agents are/do
hard to get into the blood, very easy/quick to leave. suitable for induction as quick recovery
68
what are the major differences bw sevo and isoflurorane
iso - most resp depression sevo - v low solubility, only D both vasodil and have no analgesia
69
do we use inhalation in horses
not much - they are very sensitive to 'their MAC' levels RE- resp depression - so risky as they wont spontaneously ventilate!
70
why is nitrous oxide partic bad in ruminants
they are so gassy - and NO wants to get out into being a gas ASAP so can cause bloat/pneumothorax!
71
what are the 6 most important things for all GAs
1. IV 2. O2 supply 3. ETT 4. monitoring equip 5. recording 6. emergency drugs
72
what are 3 principle reasons for tachycardia GA
- hypovolaemia - either genuine (from RBCs hiding in the spleen) OR from vasodilator used (ACP) - too light - shit analgesia
73
when measuring the alveolar partial pressures (PaCO2) & end tidal CO2 pressure, what should it be
C+D = 35-45mmHg H = 60mmHg + (and thats fine..) if high = hypOvent; low = hypERvent
74
what should be expected of the BP once a bolus of fluids is given
stress relaxation = BP drops!
75
name some causes of hypoxaemia
``` inadeq O2 blocked ETT hypovent circulatory shut down crap gas exchange (as in atelectic horses..) inc O2 requirements ```
76
what partial p should the pulse oximeter show
60mmHg+
77
if a patient becomes very bradycardic and has been given A2 agonist - what should you do
PARTIALLY reverse it (atipamezol) | swiftly replace - anaglesia, muscle relaxant and sedation!!
78
what does a chnage in SV indicate about the heart under GA
rhythm changing
79
what is the best indicateor of good perfusion
mean arterial BP of 80mmHg
80
when is mm cyanosis visible
at 75% saturation, so use a capnograph too
81
what are the ideal CNS signs of good GA
``` no movement no spinal reflexes remain consciousness muscle relaxed amnesia corneal reflex still present no PLR or jaw tone ```
82
other than hot hands and blankets - how else can animals be kept warm
use co-axial bain | warms inspired flow by the external expired gases
83
when might an oesophageal stethoscope be useful
when peripheral puse cant be felt and thorax sx
84
what are the 2 types of indirect blood pressure monitors
doppler - over rtery in paw - listen for rtn of whoosh. only systolic BP oscillometric - like at home, need larger animals. can do all BPs (diastolic, mean and systolic)
85
what is direct arterial BP monitoring
gold std | cannulate dorsal metacarpal/tarsal or facial (H) and attach P-transducer. risk of thrombus, haem+ and infection..
86
what are 3 main ways to ammend hypOtensions
IVFT +ve inotropes (best in H) vasopressors (vasocon) also try changing position, lighten GA and IPPV (H)
87
how can central venous pressure be measured and why bother
via jug vein (like pacemaker..) go in to the RA | to assess level of cardiac dx and volaemia
88
what is the differnece bw capnometry and capnograph
capnometry - no trace, just measures ETCO2 (35-45) capnograph - traces. can ID rebreathing if doesnt return to 0 at inspiration, hypOvent and if CO2 decreases-v poor perfusion!
89
roughly - what % of deaths occur in recovery
40-60%
90
how common in hypOthermia
30% d and 70% cats
91
what causes hypothermia
``` drugs - vasodil clipping, sx scrub, open body cavity metal table if cold - lower MAC required! muscle twitches +/or shivering uses O2 ```
92
what is the diff bw seizures and emergence dilirium
seizures are silent, with random movement
93
how do you reduce the risk of hypoxaemia
only extubate when fully breathing alone give o2 extend their neck and position well
94
give some spp examples of recovery issues
D+C - gastric reflux/regurg C - tracheal rupture or blindness (cerebral ischaemia) Cattle - regug, bloat H - colic, myopathy, neuropathy and fracture P - hyperthermia

VSCI300 MOD (32 decks)

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