Anaesthesiology pastq Surgery 1

Question 1

Anaesthesia: breed dispositions?

1. Greyhound
2. Dobermann
3. Staffie/greyhound/haflinger

Answer 1

1. NO thiopental (no fatty tissue for redistribution), recumbency.
2. DCMP, blood clotting disorder
3. sensitive to alpha 2 agonists

Question 2

Anaesthesia: breed dispositions?

1. Boxer
2. Brachycephalic breeds
3. Large breeds and individuals:
4. Warmblood type and individuals

Answer 2

1. No phenothiazine. Causes hypotension
2. pre-oxygenation, short induction, fast intubation, late extubation
3. Sensitive to hypoxia
4. decreased effect of sedatives, higher metabolic rate

Question 3

Positive effects of premedication?

Answer 3

1. Decreased pain, stress, fear, accident risk
2. Decreased anaesthetic dosage, side effects, material expenditure and costs
3. Elimination of excitation stage, balanced anaesthesia

Question 4

What is true according to induction?

Answer 4

IV access (vein cannulation) – reasons; drug admin, fluid therapy, emergencies
Small animals: v. cephalica + saphena (v. jugularis). Induction using injectable (or inhalants):
anaesthetics with moderate (or NO) side effects, rapid onset, short duration or counter-actable. The
patient reaches an unconscious, indubitable status. Endotracheal tube introduction.

Question 5

Elderly patients

Answer 5

Lengthened circulation time (delayed anaesthetic effect), decrease water content of cells, increased
fat content and lower compensation capacity

Question 6

Stages of narcosis:

Answer 6

1. Analgesia = induction phase
2. Exitationis = excitatory phase
3. Tolerantiae = surgical narcosis (divided into: superficial, surgical tolerance and deep)
4. Asphyxiae = overdose, asphyxia (suffocation)

Question 7

Antagonists:

1. Opioids
2. Alfa2
3. Benzo

Answer 7

1. Opioids/morph – Naloxone (also Naltrexone)
2. Alpha2 – Atipamezole (also Yohimbine)
3. Benzodiazepine – Flumazenil

Question 8

What is the definition of recovery?

Answer 8

Ending anaesthetic administration (elimination)

Extubation (after the return of swallowing and coughing reflexes)

Question 9

Capnograph:

Answer 9

Capnograph = graphic display of values on time chart. CO2 determination in air exhaled. Supervise
respiratory frequency, etCO2 and inhalant anaesthetic conconcentration, circuit pressure and tidal
minute volume (et = end tidal).
1. End tidal CO2 level correlates with arterial CO2 press (paCO2): paCO2 > etCO2.
2. Small animals: 5mmHg difference.
3. Horse: 5-20 mmHg difference.
4. Can be measured from sideflow or mainflow

Question 10

Mixing circuit vaporizer:

Answer 10

Most inhalational anaesthetics are liquid (volatile): converted to gas state in vaporizer, can be
precisely admin
Vaporizing: temperature dependent (stronger at higher temp), requires energy (takes in heat from
environment), different anaesthetics – different gas pressure (requires purpose-built vaporizers)

Question 11

Mixing system vaporizer:

Answer 11

Anaesthetic administration of modern vaporizers is not influenced by: flow rate, surrounding
environmental temperature, air pressure, temperature fluctuations during vaporizing, press
fluctuations during respiration or ventilation
Vaporizers can be classed as two main types: Injectable or variable-bypass.

Question 12

Pain:

Answer 12

Complex, multidimensional negative experience (subjective). No linear correlation btw degree of
pathological changes and intensity of pain. Pain sensation strengthened by fear and stress. Parallel
nociceptive effects add up (superposition)

Question 13

Characteristics of pain:

Answer 13

1. Physiological (to prevent injury), pathological (due to actual injury)
2. Origin: organic (somatic, visceral, neuropathic), psychogenic
3. Intensity (strength)
4. Duration of sensation: acute or chronic
5. Localization (unusually sensitive: tooth pulp, cornea, serous membrane, head, thorax,
   perineum, periosteum)
6. Modality (quality): mechanical, heat, chemical

Question 14

Pathological pain:

Answer 14

1. Hyperalgesia: small pain provocation, result in large pain sensation
2. Allodynia: no pain provocation, but pain sensation occurs

Question 15

Values: pulse-oxymetry and capnometry:

Answer 15

Ideal SpO2 value = 100%.
Normal: 100-97% (measure 02 saturation % of Hb). <90% = hypoxia
CO2 determination in air exhaled from endotracheal tube or nose.
Normal: etCO2 = 35-45 mmHg. Concentration: V%

Question 16

Anaesthesia, foals?

Answer 16

Sedation/premedication: Benzodiazepine (diazepam, midazolam) in neonates
Alpha-2 agonist (Xylazine, Detomidine, Medetomidine, Romifidine)
Induction:
„ Light: inhalations or IV (Ketamine + Diazepam)
„ Deep: Ketamine + Diazepam + alpha-2 agonist, or Propofol.
Maintenance:
„ Inhalation
„ PIVA: Isoflurane + Ketamine + Lidocaine
„ TIVA (total IV anesthetics)

Question 17

Can cattle and horse get the same drugs?

Answer 17

yes

Question 18

Premedication:

Answer 18

1. Acepromazine + Butorphanol
2. Medetomidine + Butorphanol
3. Medetomidine + Ketamine + Butorphanol
4. Midazolam + Butorphanol
5. Diazepam + Butorphanol
6. Fentanyl

Question 19

Induction:

Answer 19

Propofol IV, Ketamine + Diazepam IV
Ultra-short barbiturates, steroids (and inhalational) are also useful for induction
Inhalational: Isoflurane, Sevoflurane
Total IV: Propofol + Fentanyl

Question 20

What is the most dangerous with anaesthesia on horse?

Answer 20

That the horse is recumbent on back for so long, the danger in laying down and waking/getting up

Question 21

ASA (American society of Anaesthesiologists) – risk categories?

Answer 21

ASA 1: Healthy, symptom free. And/or: 6 weeks – 5 years
ASA 2: Mild systemic disease, no functional disorder apparent. And/or: 6 weeks – 5-8 years
ASA 3: Severe systemic disease with visible functional impairment, but not life threatening. And/or: 8-
10 years
ASA 4: Severe systemic disease, constant threat to patients life. And/or: 0-3 days, over 10 years
ASA 5: Moribund status, patient likely to die within 24 hours, with or without surgery
E (emergency): No time for classification (CEPOD 1).

Question 22

Induction drugs?

Answer 22

NMDA (N-methyl D-aspartate) agonist, phenyl thiazine
Ketamine + Midazolam
Tiletamine + Solezopan
Guaiphenesin (gge)
Propofol

Question 23

Pre-operative antibiotics procedures?

Answer 23

Indicated in orthopaedic surgery

30 min prior to surgery, single dose to reach sufficient tissue levels, second dose lasting for 3 hours

Question 24

When to use Antibiotics?

Answer 24

Surgery > 90 min, implantation, infections, orthopaedics, oesophageal, dirty surgery’s like faecal or
urine contamination etc

Question 25

Anaesthesia of young/ paediatric patients

Answer 25

Heart: immature innervation, low min volume, weak vasomotor, low BP Lung: decreased alveolar surface area, increased respiratory rate and min tidal volume.

Question 26

Anaesthesia of old/geriatric patients

Answer 26

Avoid Ketamine and alpha 2 agonists Decreased respiration, venous reflux from abdominal organs Heart: decreased min volume and BP Lengthened circulation time (delayed anaesthetic effect)

Question 27

O2 level?

Answer 27

97-100%

Question 28

Consequence of pCO2 < 60 mmHg

Answer 28

Cyanosis, brain damage

Question 29

What is not an effect of NSAIDs?

Answer 29

Increase intra ocular pressure

Question 30

Intubation is difficult in?

Answer 30

More difficult in cattle than horses

Question 31

Liver patients contraindicated meds?

Answer 31

``` No ketamine in dogs No diazepam No methoxyflurane No Halothane Fentanyl is recommended Opioids glucuronic conjugation is delayed or rebound ```

Question 32

Drug when spinal injury?

Answer 32

Methylprednisolone

Question 33

Which part is not included in the anaesthesia machine? Mixing system or pulseoximeter?

Answer 33

Pulsoximeter

Question 34

Pulseoxymetry, influenced by:

Answer 34

Bilirubineamia, environmental temperature, peripheral circulation, hypovolaemia, poor tissue perfusion, hypotension, shock, vasoconstriction, movement, direct pressure on the sensor, hair, pigment, thick tissue, carbohaemoglobin (measure as oxyhaemoglobin) and methaemoglobinaemia

Question 35

What is not good for preoperative analgesia?

Answer 35

Fenotiazine and Butorphanone derivatives | NSAIDs, opioids, α2-agonists, dissociative anesthetics and local anesthetics are used.

Question 36

Intraoperative anaesthesia uses only?

Answer 36

Maintenance inhalational drugs, Isoflurane and Sevoflurane

Question 37

In patients with decreased kidney perfusion we can give?

Answer 37

Propofol and inhalation anaesthetic. No alpha2 agonist

Question 38

Ketamine not given in patients with?

Answer 38

Heart problems, glaucoma , head trauma patients and hyperthyroidism

Question 39

Swine Anaesthesia

Answer 39

Susceptible to ventricular arrhythmias, fragile pulmonary tissue, stress sensitive, anaesthesia very risky.

Question 40

Pain management (Which is FALSE) - a: preemptive (prophylactic analgesia) - b: multimodal (multiple aproch) analgesia - c: no gap should appear during therapy - d: not important in small animals but in adults

Answer 40

D

Question 41

Praeoperative anlalgetics (which is FALSE) - a: local - b: phenothiazine, butryrophen derivatives - c: opioids + NSAID´s - d: alpha2agonists + NMDA antagonists

Answer 41

B

Question 42

Antagonisis (which is FALSE) - a: diazepam – flumazenil - b: propofol – dantrolen - c: fentaly - naloxon - d: dexmedetomidine – atipamezole

Answer 42

B

Question 43

Physical characteristics of young patients (which is FALSE) - a: immature vegetative innervation of heart, weak vasomotiric funktion - b. small alveolar surface, high o2 demand - c. blood-brain barrier is less permeable puppys untill 4 weeks of age require higher doses - d. fragile fluid haemostasis; immature glomerular filtration until 2 weeks, immature tubular funktion until 6 week

Answer 43

C

Question 44

Physical characteristics of old patients (Which is FALSE) - a: increased vital capacity, resp. Frequency and compliance - b: small compensation reseve of heart an circulatuion - c: decreased glomerular flitration rate - d: decreased pararenal function

Answer 44

A

Question 45

Which statement is false -a: Phenothiazine should be used with care in stallions -b: Phenothiazines are not usabel in shock patient -c: Midazolam is an adequate drug to trat tetanus in horses -d: Phenothiazines are given most frequently to colic horse to reduce visceral pain

Answer 45

D

Question 46

Which statement is false -a: ACP given to a horse i. M in the premedication decreases the intrapoerative mortality rate -b: Anesthetized foals without premedication have greater intrapoerative mortality risk -c: inhalalational anesthesia induces greater stress response than i.v. Anesthesis (TIVA) -d: More postoperative complications can be manifested using balance anesthesia (PIVA)

Answer 46

D

Question 47

Which statement is false? - a. Inhalalational anesthetic drugs usually decrease the arterial blood pressure - b. the shorter the time of anesthesia, the fewer complications can maifest intraor postoperatively - c. Propofol has shorter context- sensitive half-life than short acting barbiturate - d. Only the indirect measurement of the arterial blood pressure is abailable in anesthetised horses

Answer 47

D

Question 48

ACP... (Which is FALSE) -a: recommended for young, healthy, restless, aggressive patients -b: has antiarrhytmic effect and decreases the threshold to seizures -c: use higher doses because lower doses notably elongate the duration of action -d: depression of the thermoregulation center can lead to hypo/hyperthermia

Answer 48

C

Question 49

Propofol (which is FALSE) -a: recomended for induction and maintenace; has good hypnotic and muscle relaxant effect -b: general dose: 0,5 mg/ bwkg i.v (it is 5mg/bwkg) -c: has short duration of action, wide therapeutic range, is not cummulative, may be redoses or continiously applicated -d: resp. Depression may evolve in case of high doses or rappid application

Answer 49

B

Question 50

Mixing systhem of anaesthetic mashine (whcich is FALSE) - a: absorband canister with sodaline - b: gas source, pressure reducing valve, mannometer - c: flowmeter - d: vaporiser

Answer 50

A

Question 51

Parameters of ventilation (which is FALSE) - a. respiratory volume: 10-15 ml/bwkg , frequency: 10-15/ min - b. PEEP: not used routinely (also correct in lecture notes) - c. EtCO2: 35- 45 mmHg/ spO2: 100-97 % - d. inhalalation : exhalation Time ratio: 2/1 – 8/1

Answer 51

D

Question 52

``` Which statement is false - a. The main advantages of balanced anaesthesia (PIVA) are the decrease in cardio-respiratory depression and increase of analgesia (true) - b. Lidocaine administered iv. to an anaesthesised horse increases the risk to postoperative... […ileus??? → Wrong: reduces the risk of PO- Ileus!]? - c. Ketamine, lidocaine, alpha2agonists can be given in balanced anaesthesia (PIVA) in horses (true) - d. lidocaine administered iv. helps to prevent ishemic and reperfusion injuries in horses (true) ```

Answer 52

B

Question 53

which is false - a. Ketamine can not be given to a standing horse to relive the pain - b. lidocaine can be given to a standing horse to relive the pain (true) - c. lidocaine adminitered i.v. can have adverse effect to the CNS of a horse (true) - d. neurophathy can develop due to inadequat positioning during anaesthesia (true)

Answer 53

A

Question 54

Which is false - a. neonatal foals will be expected to have higher? mac for inhalational aneastehics than adults (false) [neonatal foals lower doses, BUT older foals higher doses!!!]) - b. Hyperkalemic pariodic paralysis can accure in sertain horse beeds during general anaesthesia (true HYPP in quarter horses) - c. alpha2agonists are not used in the premedication of sick neonatal foals (true) - d. it is important to prevent hypotermia and hyperglycaemia in the anaesthetised neonatal (To increase body temp.→increased metabolic rate→ hypoxemia, hypoglycemia can develop earlier than in adults.)

Answer 54

A

Question 55

which statement is false concerning bovine anaesthesia? - a. for premedication benzodiazepine can be used (benzodiazepines poor effect,not approved) - b. regional i.v anaesthesia can be favourable in certain limb surgery (true) - c. intubation of cattels is more difficult than....…that of horses? (true) - d. cattels regurate mostly in dorals reccumbency (Under general an. Should be intubated!! Danger of aspiration, left lateral recumbency have lower incidence of regurgitation, mostly in dorsal recumbency.)

Answer 55

A

Question 56

which statement is false -a. inhalational anaesthetic drugs usually decrease the arterial blood pressure -b: the shorter the time of anesthesia, the fewer complications can manifest intraor postoperatively -c: propofol has shorter context- sensitive half- live than short- acting barbiturates -d: only the indirect measremet of the arterial boold pressure is availavle in anesthetises horse (false)

Answer 56

D

Question 57

Pain (which is FALSE) -a: complex, multidimensional negative experience -b: Pain sensation is not influenced by fear and stress -c: the is no linear correlation between the level of pathological changes and intensity of pain -d: parallel nociceptive effects add up

Answer 57

B

Question 58

Recovery (choose wrong answer) -a: stop application of anastehtic durgs or use antagonists -b: remove intratracheal tube, after the return of swallowing relex -c: if there is no dangerous amount of fluid in the oral cavity remove the tube with inflated cuff -d: monitoring of the patient is recomended in the complete recovery period

Answer 58

C

Question 59

Stadium analgesiae (choose wrong answer) - a: maximal pupildialtion no cornial tensoin - b: transition towards an unconcious state - c: increasing imobilisation - d: coughing reflex is present, intubation is not possible

Answer 59

A