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Anesthesia Flashcards

1
Q

ASA 1 and example

A

Healthy
Elective SX- spay/neuter

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2
Q

ASA II

A

Mild systemic disease
Mass removal, uncomplicated ortho procedure, well controlled diabetic

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3
Q

ASA III and example

A

Severe systemic disease
Cardiac dysfunction, poorly controlled DM, mild anemia, early renal disease

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4
Q

ASA IV and example

A

Severe disease this is constant life threat
Hemoabdomen, sepsis, FB, shock, hypovolemia

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5
Q

ASA V and example

A

Moribund patient who is not expected to survive without operations
MAssive trauma, multiorgan dysfunciton

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6
Q

What is the grimace scale

A

Discriminates painful vs nonpainful
five action units - eyes, ears, muzzle whiskers, head position in cats

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7
Q

What is the UNESP Botucatu MCPS

A

First pain scale to be validated for post-op pain in cats
Looks at 10 different variables
Recuse analgesia required if total >7/30

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8
Q

What is Glasgow

A

Pain scale for cats
Can be applied to any pain
Rescue analgesia >5/20

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9
Q

What is transduction

A

conversion of noxious stimulus into electrical energy by peripheral nociceptor
Mechanical pain to electrical

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10
Q

Transmission

A

impulse propagation from the site of the oral injury through the CN V

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11
Q

Modulation

A

When neurons from the pain fibers synapse with nociceptive neurons in the medulla

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12
Q

What is wind up pain

A

Peripheral sensitization remains untreated and the exacerbation of intensity of the nociception
Glutamate binds to NMDA = increase pain (this is why ketamine helps with wind up)

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13
Q

What analgesics affect transduction, transmission and modulation

A
  1. Transduction - local anesthetic, opiod, NSAID, Steroids
  2. Transmission - local anesthetics, Alpha2 Agonist
  3. Modulation - local anesthetic, alpha 2 agonist, opiods, NMDA antagonist, anticonvulsants, NSAID
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14
Q

How does hyperalgesia, analgesia, allodynia effect pain and the stimulus curve

A
  1. hyperalgesia - increase responsiveness, shift curve to the left
  2. Analgesia- decreases response, shiftst curve to the right and flattens it
  3. Allodynia - innocuous stimuli begin to elicit pain, shifts curve to the farthest left
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15
Q

What is the purpose of the anesthesia machine and circuit

A

safe delivery of inhalants and O2 with removal of CO2 and excess gases

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16
Q

What is normal tidal volume

A

10-15ml/kg

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17
Q

What is solubility (anesthetic gas)

A

Usually expressed as coefficient known as ostwalds coefficient
The greater blood gas partition coefficient = great solubility in the blood
increased solubility = longer induction recovery times

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18
Q

What is the most to least soluble anesthetic gases

A

Halothane>ISO>SEVO>Nitrous oxide>Desflurane

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19
Q

Inhalant effects on the body

A

CNS - depression via inhibitory GABA, NMDA, AMPA
Resp - depression
CV - Decrease CO, hypotension, vasodilation
Kidney - decrease renal BF
Liver - mild
Malignant hyperthermia

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20
Q

Minimum alveolar concentration

A

of inhalant: produces no response in 50% of animals exposed to noxious stimulus
1MAC = light anesthesia
1.5MAC = surgical
2MAC = deep
0.5MAC = awake

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21
Q

MAC of Sevo vs Iso

A

Sevo = 2.3
Iso = 1.3

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22
Q

What are the 4 stages of anesthesia

A

1 = induction to loss of consciousness
2 = excitement, spontaneous muscle movement
3 = end of spont muscle mvt and regular breathing
3a= light, regular breathing, pupil size normal, ventromedial, some response
3b= medium, shallow breathing, moderate pupil size, ventromedial, minimal palpebral, no response
3c= deep, jerky breathing, dilated and central pulse, decreased corneal reflex
4 = extreme CNS depression and respiratory arrest

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23
Q

How much of the body is water

A

55-60%

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24
Q

Blood volume is about how much? how to calculate transfusion

A

90ml/kg
ml of donor blood = recipient blood volume x desired PCV - active pcv/pcv of donor

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25
P wave seen on ECG
atrial depolarization
26
PR interval represents
atrial depolarization adn conduction of AV node
27
QRS complex represents
ventricular depolarization
28
TT represents on ECG
repolarization
29
AV block type 1: if r is far from P
30
second degree av block type 1: wenkenback: PR gets longer, longer, drops
31
Second degree av block type 2: mobitz: P waves dont produce QRS response. Intermittent QRS dropped
32
3rd degree av block: P and Q dont agree
33
Sinus arrhythmia
34
Ventricular enlargement alters QRS VPC
35
Ventricular enlargement alters QRS ventricular Tachy
36
Hypoventilation causes
increased CO2 Respiratory acidosis hypo-ventilating to increase bicarb
37
Hyperventilation causes
Decreased CO2 Respiratory alkalosis trying to decrease bicarb
38
What are the 4 phases of capnography
1 = dead space 2 = expiratory 3 = alveolar plateau 4 = Inspiratory
39
What is normal end tidal CO2
35-45mmHg >45 = hypoventilation
40
Normal
41
Hypoventilation
42
Obstruction
43
Check equipment
44
endotracheal cuff
45
hyperventilation
46
What happens with hyperkalemia
bradycardia peaked t waves prolonged PR Loss p waves Wide QRS
47
What happens with lidocaine toxicity
5- muscle twitching 10 - seizures 15- unconsciousness 20+ = seizure, coma, resp arrest, cv depression
48
Is MAC lower or higher for neonates
Lower
49
What are the 4 types of anaphylactic reactions
1 - immediate 2 - cytotoxic 3 - immune complex 4 - delayed
50
Atropine and glyco are what types of drugs
Anticholinergics Atropine - crosses BBB, can see av block, fast Glyco - doesnt cross BBB, slower, decrease saliva Both act on smooth muscle relaxation
51
What do adrenergic receptors do
improve cardiac output by increasing HR and SV Increase BP by vasoconstriction
52
What do the adrenergic receptors work on (A1, A2, B1, B2, B3)
Alpha = contraction Beta = relaxation A1= contract smooth muscle A2= nerve terminals B1= heart and kidney B2= smooth muscle relax B3= adipose tissue
53
What are the MOA for Norepi vs Epi
Epi = high affinity for beta receptors, increase CO Norepi = high affinity for alpha receptors, primarily used for hypotension due to decreased vascular resistance
54
Dopamine vs dobutamine
Dopamine = alpha and beta receptors, 5-20mcg/kg/min Dobutamine = beta receptors agonist, used for low CO, 10mcg/kg/min
55
what is CO
CO = SV + HR
56
What is naloxone, atipamezole, flumazenil reverse
naloxone = opiod atipamizole = alpha 2 agonist Flumazenil = Benzodiazepine
57
Maximum dose of Lidocaine/bupivicaine
Bup = 2mg/kg Lidocaine = 3-5mg/kg
58
Projection vs perception
Projection = dorsal horn to cortex Perception = realizing painful stimuli
59
Evaporation, conduction, convection, radiation loss
Evaporation = dissipatiton of heat via moistture to gas Conduction = transfer between 2 objections Convection = transfer within fluids Radiation = through electromagnetic waves
60
Half life
Time for plasma concentration to decrease by 50%
61
MOA of Nerve Block
Blocks NA channels 70% or 3 nodes of ranvier lipophilic, hyrdophilic joined by ester or amide linkage acidic environment causes longer onset due to ionization
62
Adverse effect of bupivicaine and other NB
cardiotoxic (more so bup) CNS issues Methemoglobinemia --tx methylene blue
63
Toxic dose of lidocaine vs bupivicaine
Lido = 10mg/kg Bupivicaine = 2mg/kg
64
IO blocks what
Desensitizes teeth, maxilla, incisive bone, upper lip, oral mucosa **extent depends on how caudal the needle is
65
MX NB blacks what
Desensitizes maxilla, incisive bone, palate, maxillary teeth, gingiva, oral mucosa, nasal mucosa (partially), skin
66
Inferior alveolar blocks what
Desensitizes mandibular body, mandibular teeth, surrounding oral mucosa, lower lip
67
Mental foramen (middle) blocks what
Desensitizes rostral lower lip & oral mucosa if the foramen is not entered Desensitizes incisor, canine, & most rostral premolar teeth if foramen is entered; desensitization is partial even then
68
Major Palatine block what
Desensitizes soft tissues & bone of hard palate rostral to the block on the ipsilateral side
69
What is the order from shortest to longest acting local anesthetics (lido, bup, mepiv, ropiv)
Lido = 2 hour Mepiv = 2-4 hr Bupiv = 4-6 hours Ropiv = 6+ hour
70
What are examples of alpha 2 adrenoreceptor agonist and their reversal
Dexmedetomine and medetomidine Reversal = atipamezole
71
What is an example of alpha 2 agonist and reversal
Xylazine Reversal - atipamezole Sedation, analgesia, muscle relaxant, decrease MAC
72
Example of Benzodiazepine and reversal
Diazepam and midazolam Reversal - flumazenile Anxiolytic/anticonvulsant - depresses thr limbic system through GABA
73
Example of Phenothiazine
Acepromazine Dopamine receptor agonist and is metabolized through the liver
74
Neuroactive steroid
Alfaxalone Inhibits GABA
75
Anticholinergic agents
Atropine and Glyco
76
Hypnotic alkyl phenol
Propofol interaction with GABA potentiating the gaba induced chloride
77
Ketamine
Interacts with multiple binding sites including NMDA & non-NMDA glutamate receptors, nicotinic & muscarinic cholinergic, monoaminergic & opioid receptors Inhibits voltage-dependent sodium & calcium channels
78
Cerenia
Antiemetic and prokinetic Maropitant is an NK-1 receptor antagonist that blocks the action of substance P in the central nervous system as well as at peripheral NK-1 receptors in the GI tract
79
Metoclopramide
Antiemetic MOA not well understood
80
what are the three classes of opiod receptors and MOA
Activity at opioid receptors located in the CNS & peripheral sites (ganglia & peripheral nerve endings) 3 classes of opioid receptors: Mu (MOP) Delta (DOP) Kappa (KOP)
81
What are the four classification of opiod and examples of each
1. Agonists High affinity for mu Morphine, pethidine, hydromorphone, methadone, fentanyl, sufentanil, alfentanil, remifentanil, codeine Tramadol is a weak mu agonist 2. Partial Agonists Do not have full intrinsic activity at the mu receptor Buprenorphine 3. Mixed Agonist-Antagonists Act as agonists at some receptors and antagonists at others Affinity & intrinsic activity at the receptor site may vary Butorphanol 4. Antagonists Reverse the effects of mu and kappa agonists because of their high affinity & low intrinsic activity Naloxone
82
What is the pathway of desensitization of nerve blocks
B are desensitized first, then C, then A-delta, then A-beta. A-alpha are the largest nerves, so motor is blocked last/not at all. Re-sensitization happens in reverse order

Basic Info (16 decks)

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