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Anesthesia & Analgesia > Analgesia, Anesthetic Agents, And Special Techniques > Flashcards

Analgesia, Anesthetic Agents, And Special Techniques Flashcards

1
Q

Agonist

A

Bind and stimulate receptors

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2
Q

Partial Agonist

A

Bind and partially stimulate receptors

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3
Q

Agonist-antagonist

A

Stimulate one receptor and blocks another

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4
Q

Antagonist

A

Bind partially to a stimulator blocking effects of agonist

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5
Q

List anesthetics and adjuncts that can be reversed

A

Flumazenil-> benzodiazepines (uncommon to use)
Alpha-2 Antagonist (Atipamezole, Yohimbine)-> short DoA (redoes); avoid when anticholinergics given
Naloxone, Butorphanol-> Opioid -> given as emergency/revive neonates; rare adverse effect (correct dose)

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6
Q

Dose dependent

A

Magnitude of effect (adverse, desired) of anesthesia and adjunct is based on dose given

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7
Q

Preanesthetic:
Anticholinergics/Parasympatholitics (Atropine, Glycopyrrolate)

A

Indication: minimize bradycardia, respiratory, salivary, GI, lacrimal secretion; bronchodilator
MoA: block acetylcholine receptors
Route: SQ, IM (common), IV, IT (emergency)
Onset: 1-5 min, peak 5-20 min
DoA: 60-90 min (Atropine), 2-3 hrs (Glyco)
AE: tachycardia, arrhythmia, mydriasis, inhibit intestinal peristaltis = colic, bloat

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8
Q

Preanesthetic:
Phenothiazine (Acepromazine)

A

Indication: sedation/calming, reduce seizure threshold, anti-arrhythmic, antiemetic, antihistamine
MoA: Depress reticular activating center of brain; metabolized by liveth, cross placenta
Route: IM (dogs), IV (horse)
Onset: 15 min, peak 30-60 min
DoA: 4-8 hours (SA), 1-3 (LA)
AE: tachycardia/bradycardia, hypotension, decreased PCV

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9
Q

Preanesthetic:
Benzodiazepine (Diazepam/Valium, Midazolam) Class IV

A

Indication: anti-anxiety/calming, anticonvulsant, skeletal muscle relaxant
MoA: increase activity of Gaba = depressing CNS
Route: IV, IM (Midazolam only)
Onset: 15 min
DoA: 1-4 hr
AE: Disorientation/excitement (dogs), dysphoria/aggression (cats), pain IM site, ataxia (LA)

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10
Q

Preanesthetic:
Alpha-2 Agonist (Dexmedetomine, Xylazine)

A

Indication: Sedation, Analgesia, Muscle relaxant
MoA: Stimulate receptor of SNS ↓ release of norepinephrine, metabolized by liver, excreted urine
Route: IV, IM
Onset: 5-15min (IV), 15-30(IM) DoA: 1-4hr
AE: Aggitation/aggression, hypertension/bradycardia hypotension, respiratory depression, vomiting, hyperglycemia, hypothermia, polyuria

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11
Q

Preanesthetic:
Opioids

A

Indication: analgesia, sedation/CNS depression
MoA: bind/partially bind/displaces µ, κ receptors
Route: IV, IM, SQ, rectal, oral, transdermal, local
Onset: varies
DoA: most <30 min
AE: CNS stimulation/dysphoria (cats), bradycardia/respiratory depression, panting, hypothermia (dogs), hyperthermia (cats), V/D, ileus

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12
Q

Preanesthetic:
Neuroleptanalgesia

A

Indication: Opioid & Tranquilizier (acepromazine, alpha2agonist, benzodiazepine) for profund analgesia & sedation used for debilitated dogs minor procedure
Route: IM, slow IV
AE: Can cause excitement in cats, mania in young dogs; bradycardia fast infusion (intubate & assist ventilation)

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13
Q

Preanesthetic:
Propofol

A

Indication: Sedation/short-term GA*, muscle relaxation, antiemetic, ↓ intracranial & ocular pressure
MoA: ↑ action of GABA to depress CNS
Route: IV CRI or repeat boluses (over 1-2min, q 3-5)
Onset: 30-60sec
DoA: 2-5min, recover 20-30min
AE: Tansient excitement/tremor (induction), bradycardia, ↓ cardiac output, hypotension, respiratory depression/apnea (rapid injection)

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14
Q

Injectable Anesthesia:
Alfaxalone

A

Indication: Sedation/short-term GA*, muscle relaxation, minimal cardiovascular depression
MoA: Bind to GABA receptors (similar to Propofol)
Route: IV, IM (cats)
Onset: varies
DoA: most <30min
AE: Tachycardia, hypotension (+inhalant), respiratory depression/apnea (rapid IV), excitement (recovery)

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15
Q

Explain the effect of protein binding, lipid solubility, and redistribution on the pharmacokinetics and pharmacodynamics of injectable anesthetics.

A

Propofol macroemulsion large particles scatter light (cloudy/milky) from milk fat, glycerin, oil
• Lipid soluble = 1-5% unbonded passes through brain (more potent if hypoproteinemic)
• 95-99% bounded to plasma proteins
• Diffuses heart, kidney, liver (rich in vessels) → muscle → fat once blood concentrate ↓
• Metabolized by liver, excreted by urine (1-2hrs)

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16
Q

Injectable Anesthetic:
Barbiturates (not commonly used)
Class III

A

Indication: GA for lab animals, epilepticus/intractable seizures, euthanasia solution
Use as IV injectable replaced by propofol, alfaxalone & inhalants

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17
Q

Injectable Anesthesia:
Dissociative
Ketamine, Benzodiazepine, Ketamine+Diazepam/Midazolam
Class III

A

Indication: Catelepsy (unresponsive, muscle rigidity), somatic analgesia
MoA: Inhibit NMDA receptors = prevent windup
Route: SQ, IV, IM
Onset: 1-2min IV, 10min IM DoA: 20-30min
AE: intact reflexes, stimuli sensitivity, nystagmus (cats), apneustic respiration, ↑ HR, cardiac output, MAP, intracranial & ocular pressure, tissue irritation

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18
Q

Nitrous Oxide (N2O)

A

Indication: Speeds induction & recovery, additional analgesia (with added agents), MAC reducing = reduces cardiopulmonary & respiratory AE
Seldom use as Iso & Sevo already produce rapid induction & recoveries

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19
Q

Define vapor pressure and how this property affects action and use of inhalants.

A

Amount of pressure excreted by gaseous form of substance when gas & liquid is in equilibrium

Tendency to evaporate in vaporizer – based on agent & room temperature

Available inhalants are volatite (evaporates readily) so uses agent specific precision vaporizer*

*Isoflurane stored in nonprecision Stevens vaporizer specifically made for it

20
Q

Define partion coefficient (BGPC) and how this property affects action and use of inhalants.

A

Solubility of inhalant anesthetic in blood compared to alveolar gas

Inhalants ↓ BGPC = faster induction, response to change in vaporizer setting, recovery
↑ BGPC = highly soluble in blood & tissue

21
Q

Define minimum alveolar concentration (MAC) and how this property affects action and use of inhalants.

A

Average setting used to produced anesthesia
(↓ MAC = more potent)

Estimated vaporizer setting: 1x MAC = light stage III
1.5 x MAC = surgical anesthesia
(Iso Maintainenance ~1.5-2.5% Sevo ~2.5-4%)
*Setting based on age, metabolic activity, body temperature, patient condition (dz, obese, pregnant)

22
Q

Inhalant Anesthetic:
Isoflurane, Sevoflurane, Desflurane

A
  1. Isoflurane: most common induction/maintenance
    VP: 240mmHg
    BGPC: 1.46
    MAC: 1.3-1.63
  2. Sevoflurane: less irritating, minimal odor, costly
    VP: 160mmHg
    BGPC: 0.68
    MAC: 2.3-2.5
  3. Desflurane: pungent, induce breath holding, sympathethic storm (transient ↑ HR, BP – humans)
    VP: 700mmHg
    BGPC: 0.42
    MAC: 7.2-9.8
    - special vaporizer to prevent boiling
    - ‘one breath anesthesia’, least potent
23
Q

Describe the uptake, distribution, and elimination of the commonly used inhalation anesthetic agents.

A

MoA of inhalants: Unknown, may inhibit nerve cell function in brain & spinal cord

Uptake of inhalants: Fresh gas diffuse in alveolar membrane → blood based

Distribution: Induce – diffuse in vascularized organs (↑ alveoli ↓ blood), enter brain, diffuse back to alveoli when vaporizer discontinued (↑ blood ↓ alveoli)

Eliminated by lungs, minimal liver metabolism

24
Q

Analeptic (CNS Stimulant):
Doxapram

A

Indication: Induce respiration, recovery in emergency, reverse effects of inhalants & barbiturates

Route: IV, PO/sublingual/umbilical vein - neonates
Onset: 2 minutes (IV)

AE: Wide margin of safety; hyperventilation, hypertension, arrhythmia, lowers seizure threshold, can cause CNS damage (provide O2 support)

25
Q

List the advantages and disadvantages associated with the use of local anesthetic agents.

A

Low cardiovascular/respiratory toxicity, inexpensive, analgesia, doesn’t cross placenta, minimal recovery

Common in LA (standing sedation) but used in conjuncton with GA for SA, no reversal, cause arrhythmia, myocardial depression (overdose)

26
Q

Lidocaine 2%
Bupivacaine 0.5%

A

MoA: Blocks sodium channels so sensory & motor neurons cannot depolarize

Onset: 1-5min (L), 10-20min (B)
DoA: 1-2hr (L), 4-6h (B)
Add epinephrine to Lidocaine to prolong DoA

27
Q

Explain the risks involved and the adverse effects that may be seen with the use of local anesthetic agents.

A
  • Affect motor neurons (CNS to periphery) = paresis (weakness) & paralysis (loss of voluntarily movement)
  • Paresthesia: ‘tingling’ sensation
  • Allergic reaction – hives, anaphylaxis
  • Tissue irritant, loss of function (direct nerve inj)
  • Systemic toxicity (IV w/out torniquet, large SQ)
  • Sympathethic blockade (loss of sensation to SNS) – vasodilation/hypotension, hypertension
28
Q

Use of local anesthesia:
Topical

A

EMLA cream (Lidocaine + Prilocaine) – for IV catheter placement, occlusive dressing; not to be applied eyes, broken skin/accessible to patient

Splash block: place in open wound – spray, gauzed with anesthetic & saline

29
Q

Use of local anesthesia:
Infiltration

A

Inject under aseptic skin & in proximity of a nerve for analgesia & anesthesia to area (for skin biopsy, mass removal, minor lacerations) – onset 3-5min

Ineffective – deep tissue (muscle), scar/fibrous or inflamed tissue

30
Q

Use of local anesthesia:
Outline the methods for performing a nerve block and a line block, and list clinical situations in veterinary practice un which these blocks are used.

A

Inject in close proximity of nerve – dental, intercostal (chest)

Line block – continuous line in SQ/ID proximal to target area (horse, cattle)

Ring block – block an encircled area (digit)

31
Q

Use of local anesthesia:
Intraarticular

A

Inject (diluted Bupivacaine) into stifle joint

32
Q

Use of local anesthesia:
Regional

A

Inject into major nerve plexus/in proximity to spinal cord - blocks nerve impulse to & from large area

Paravertebral – T13 to L2 (C-section)
Epidural
IV (Bier Block) <1hr local anesthesia to extremity (amputation)

33
Q

Use of local anesthesia:
Epidural

A

Epidural block sensation in abdomen, pelvis, tail – temporary immobility, analgesia (tail amputation), debilitated animals (cannot tolerate GA)

Insert needle perpendicular within spinal canal

34
Q

Explain the difference between assisted and controlled ventilation

A

Assisted Ventilation: ↑ amount of gas delivery (fresh gas), patient initiate inhalation

Controlled Ventilation: deliver all air patient require, patient does not make spontaneous respiratory efforts

Positive pressure ventilation (PPV): assisted and control ventilation - delivering of oxygen & anesthetic gas to patient’s lung; evaluated w/ SPO2 & ETCO2

35
Q

Ventilation in awake vs. anesthetized animal

A
  • Ventilation – movement of air in & out lung
  • Active phase (inhalantion) - triggered by respiratory center in the brain & ↑ PACO2 >40mmHg, intercostal muscle push ribcage outward, diaphragm flatten
  • Passive phase (exhalation) - relaxation of diaphragm & intercostal muscle ↑ PACO2 triggering another inspiration, 2x longer
  • Anesthetics ↓ responsiveness of respiratory center to CO2 (less inhalation), relax intercostal & diaphragm (↓ VT, RR, RMV)
36
Q

Describe the techniques of manual (periodic, intermittent) ventilation and their application to anesthesia.

A

Manual ventilation lungs filled O2 from ↑ pressure entering lungs as reservoir bag is squeezed, passive exhalation

Periodic bagging (1-2 breaths q 2-10min): close popoff valve, compress RV ≤20 cm H2O

Intermittent ventilation (bagging throughout procedure): close pop off valve, open every 2-3 breaths

37
Q

Describe the techniques of mechanical ventilation and their application to anesthesia.

A

Ventilator provides intermittent ventilation – for thoracotomy/lengthy operations/LA

Patient intubated, monitor vitals & anesthestic depth

Risk of controlled ventilation – excess airway = ruptured aleveoli, ↓ cardiac output, hyperventilation, excess anesthetic depth

38
Q

List the indications for the use of neuromuscular blocking agents and the hazards associated with their use.

A

Skleletal muscle paralyzing agents – mechanical ventilation (prevents spontaneous inspiration), orthopedic, opthalmic, C section

Always administer patient unconcious, give slow IV/CRI, ↑ inhalant potency

Can make assessing depth difficult (depress blink reflex), hypothermia (↓ muscle tone)

39
Q

Describe the differences between the 2 classes of neuromuscular blocking agents, including mode of action and reversibility.

A

MoA: interrupt normal transmission of impulses from motor neurons

Depolorazing agents – muscle twitch & paralysis
Onset: 20 sec, short DoA
AE: Hyperkalemia, cardiac arrhythmia

Nondepolarizing – blocks receptors
AE: histamine release, hypo/hypertension, tachycardia

40
Q

Pure µ agonist opioid:
Morphine, Hydromorphone, Methadone, Fentanyl (Class II)

A

Indication: Analgesia (moderate to severe), Sedation/CNS depression

MoA: Bind μ receptors
Route: IV, IM, SQ, Epidural/Regional
Onset: varies
DoA: most <30min

AE: bradycardia/respiratory depression, panting, hypersensitivity, vomiting (less likely Methadone), CNS hypersensitivity (Methadone)

41
Q

Pure µ agonist opioid:
Buprenorphine (Class III)

A

Indication: Analgesia (mild/moderate), prolonged sedation

MoA: Bind μ receptors - less potent

Route: IV, IM, SQ, Epidural/Regional, Oral (cats)
Onset: 15min IV
DoA: 6-12hr IM

AE: respiratory depression – reversed with Doxapram

42
Q

µ Agonist-antagonist Opioid:
Butorphanol (Class III)

A

Indication: Analgesia (mild/moderate visceral pain), reverse respiratory depression/sedation of μ agonist

MoA: Blocks μ, stimulate κ receptors

Route: IV, IM, SQ
DoA: 1hr IM

AE: high dose – respiratory depression (ceiling effect), hypotension, bradycardia, panting, vomiting, histamine release

43
Q

Describe the uses for and procedure for application of fentanyl transdermal patch.

A

For use in post op patient (orthopedic, abdominal), trauma, cancer

Sized patch has Fentanyl reservoir enclosed in plastic applied to aseptic & clip skin

44
Q

Mechanism of action, use, and adverse effects of NSAIDs

A

Indication: Analgesia (all somatic, some visceral), anti-inflammatory, antipyretic

MoA: Inhibit synthesis of prostaglandin (involved in pain & inflammation) by inactivating COX enzyme

Route: Oral, injectable
Onset: 30-60min DoA: varies by species

AE: liver damage, GI ulceration, renal toxicity, impaired platelet aggregation

45
Q

List other analgesic agents

A
  • Tramadol: at home analgesia (activity µ)
  • Tranquilizers potentiate effect of opioids
  • Gabapentin – neuropathic & allodynia
  • Amantadine – analgesic adjunct for neuropathic pain
  • Corticosteroids – anti-inflammatory
  • Antidepressants/anti-anxiety - combined for neurogenic (cancer pain)
  • Alpha2 agonist (short term)
  • Dissociative (prevents windup)
46
Q

Describe nursing care that relieves discomfort in hospitalized patients.

A
  • Padded, clean, kennel
  • Quiet area
  • Avoid putting cats in bottom row cages
  • Respositioning, eye drops
  • Gentle handling & owner visitins
  • Nutritional intervention

Anesthesia & Analgesia (5 decks)

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