Anesthesia Flashcards
(208 cards)
1
Q
What diameter of ET tubes is typically used in cats?
A
3-4.5 mm
2
Q
What diameter of ET tube is used in dogs?
A
1-2 kg starts at a 5 and then goes up 1-2 mm for every 2 kg of dog
3
Q
How do you measure the length of an ET tube?
A
Tip of nose to thoracic inlet
4
Q
What could an inappropriate length of ET tube cause?
A
Inappropriate length could result in hypoxia and hypoventilation
5
Q
How do you check ET tube placement?
A
- Observe condensation in tube
- Palpate neck area
- Observe air movement
- Auscultate lung sounds
- Observe capnograph
6
Q
How do you check for leaks?
A
Close pop off valve
Put thumb over tube
Fill reservoir bag with air
Apply positive pressure to reservoir bag and observe manometer up to 30 cm H2O
7
Q
What patients should you use lidocaine on and why?
A
Cats and rabbits to prevent laryngospasm
8
Q
What do feline tubes sometimes require that dogs dont?
A
Stylet because of the small size
9
Q
When can you extubate?
A
When gag reflex is intact and patient is swallowing. Cats you can also monitor for ear flicks.
10
Q
What is the gas supply?
A
compressed gas cylinder or central supply line
11
Q
What is the check valve?
A
Ensures one way flow of O2 at beginning of anesthesia machine
12
Q
What is the Pressure reducing valve?
A
Reduces pressure from tank to approximately 50 psi
13
Q
What is the pressure gauge?
A
Indicates cylinder pressure when valve is open
14
Q
What is the flow meter?
A
Measures rate of gas flow in L/min and further reduces pressure to approximately 15 psi
15
Q
What does the vaporizer do?
A
Converts liquid anesthetic to gasWh
16
Q
What are the types of breathing systems?
A
F circuit or bain system
17
Q
What do the unidirectional valves do?
A
Ensure a unidirectional flow of gas in the breathing system. 1 for inspiration and 1 for expiration
18
Q
What is the reservoir bag for?
A
Used to manually ventilate patient
19
Q
What does the pop off valve do?
A
Close for leak test or to fill the reservoir bag
20
Q
What does the CO2 absorber do?
A
Soda lime canister removes CO2 from expired gases
21
Q
What is the common gas outlet?
A
Where mix of gases exits machine into breathing system
22
Q
What is the oxygen flush valve?
A
Bypasses vaporizer to deliver pure oxygen
23
Q
What is the pressure manometer?
A
Measures the pressure in the breathing system
24
Q
What is the scavenging system?
A
Collects waste gas and delivers to activated charcoal or outside
25
What is the negative pressure relief valve?
Safety valve that opens to allow negative pressure to escape
26
What is the scavenger interface?
Opens to release air if scavenging system fails
27
What is the circuit alarm?
Sounds if pressure level is greater than 15 cm H2O
28
How do you calculate the volume of cylinders?
Multiply the available cylinder pressure in psi by conversion factor
29
What is the standard pressure in a full O2 cylinder?
2200 psi
30
How do you calculate the volume of a O2 cylinder?
Multiply psi by 0.3
31
When should you change an O2 cylinder
When pressure drops below 100
32
What is vapor pressure?
Pressure exerted by gas and varies by temperature
33
What is an additional measure on the anesthesia machine that can be used to monitor breath?
Unidirectional valves
34
What size patient for a 0.5 L reservoir bag?
0-6 kg
35
What size patient for a 1 L reservoir bag?
6-16 kg
36
What size patient for a 2 L bag?
16-35 kg
37
What size patient for a 3 L bag?
greater than 35 kg
38
What color do granules in soda lime container change?
blue or purple
39
When should you never use the oxygen flush valve?
bain system on a small patient
40
What should the manometer not exceed when providing assisted ventilation?
15-20 but in some dogs up to 30
41
What should the rate and pressure be on an anesthetic ventilator?
1:1 inspiration/expiration and no greater than 30 cm H2O
42
What should you do if a canine is spontaneously breathing?
ensure the pop off valve is closed
43
What is bypassed on a non-rebreathing system?
unidirectional valves, pop off valve, and soda lime canister
44
What systems are monitored with anesthetic monitoring?
1. CNS
2. Cardiovascular
3. Ventilation
4. Oxygenation
5. Fluids
6. Temperature
45
What do you use to measure CNS in anesthetic monitoring?
1. Eye Position
2. Palpebral Reflex
3. Corneal Reflex
4. Pupil size
5. Pedal Reflex
6. Jaw Tone
46
What do you use to measure Cardiovascular in anesthetic monitoring?
1. HR
2. Pulse Rate
3. Rhythm
4. BP
5. CRT
47
What do you use to measure ventilation in anesthetic monitoring?
1. Rate
2. Tidal Volume
3. Oxygenation
4. Capnography
5. Blood Gas Analysis
48
What is the normal eye position?
1. Central when too light or too deep
2. Rotate ventromedially during Stage 3, Plane 2
49
What is the normal palpebral reflex?
Disappears as patient gets deeper
50
What is the normal corneal reflex?
Should be present but will disappear with overdose
51
What is normal pupil size?
Constricted in light surgical plane. Dilates in non-surgical or deep surgical plane
52
What is normal pedal reflex?
Disappears with Surgical plane
53
What is normal jaw tone?
Disappears in light surgical plane
54
What is normal anesthetic HR?
Dogs 70-140 BPM
Cats 110-160 BPM
55
What should be noted with Heart rhythm in anesthetic monitoring?
Note arrythmias
56
What should be noted with pulse in anesthetic monitoring?
Pulse should match HR
57
What is the normal blood pressure in anesthesia monitoring?
Systolic 100-160 mmHG
Mean 80-120 mmHG
Diastolic 600-100 mmHG
58
What is normal CRT?
less than 2 seconds
59
What is the normal respiratory rate?
8-20 BPM
60
What is the normal tidal volume?
10-15 ml/kg
61
What is the normal oxygenation?
greater than 98 %
62
What is the normal capnography?
35-44 mmHg
63
How do you measure eye reflexes?
touch or tap
64
How do you measure eye position and pupil size?
Visualize
65
How do you measure jaw tone?
open mouth
66
How do you measure heart rate, pulse, and rhythm?
Palpation
Stethoscope
ECG
Doppler
67
How do you measure BP?
Palpate
MM Color
Indirect Monitor: Doppler or Oscillometric
Direct Monitor: Arterial line
68
How do you measure RR?
Visualize breaths on patient or anesthesia machine
Stethoscope
69
How do you measure respiratory depth?
Capnography
70
What causes abnormal CNS?
Depth of sx plane
Some drugs
71
What causes bradycardia? (10)
1. Drug effect
2. Anesthetic depth
3. End stage hypoxia
4. Hypertension
5. Vagal Nerve Stimulation
6. Hypothermia
7. Hyperkalemia
8. Myocardial Ischemia
9. Hypoxemia
10. Fluid Overload
72
What causes Tachycardia (9)?
1. Pain
2. Hypoxemia
3. Hypercarbia
4. Ischemia
5. Anaphylaxis
6. Anemia
7. Hypovolemia
8. Drug Effects
9. Fever
73
What causes hypotension?
1. Hypovolemia
2. Shock
3. Drug Effect
4. Depth of Anesthesia
74
What causes hypertension?
1. Pain
2. Hypercarbia
3. Fever
4. Drug Effect
75
What causes decreased CRT?
Hypovolemia
76
What causes tachypnea (7)?
1. Anesthetic Depth
2. Hypoxemia
3. Hypercapnea
4. Hyperthermia
5. Post Op Pain
6. Drug Induction
7. Individual Variation
77
What causes hypercapnea?
1. Excessive depth of anesthesia
2. Airway obstruction
3. Thoracic or Abdominal Restrictive dz
4. pulmonary dz
5. Dead space breathing
78
What causes Hypoxemia?
1. O2 flow too low
2. Breathing room air
4. Venous admixture
79
What causes hypothermia?
Thermoregulation fails or environmental losses
80
What causes hyperthermia?
1. Excessive heat application
2. Drug Interaction
3. Genetic defect such as malignant hyperthermia
81
How many stages of anesthesia are there?
4
82
What is the first stage of anesthesia?
Induction phase
83
What are the signs of stage 1?
1. Sensations become dull
2. Loss of pain
3. Normal pupils
4. Increased BP
5. Increased RR
6. Vomiting
7. Voluntary movement
84
What is stage 2 phase?
Excitement phase
85
What are the signs of stage 2 phase of anesthesia?
1. Struggling
2. Exaggerated reflexes
3. Dilated pupils
4. Irregular respiration
5. Vomiting
86
How many planes are in stage 3 of anesthesia?
4
87
What happens in stage 3, plane 1?
Eyeball begins to roll but reflexes are still present
88
What happens in stage 3, plane 2?
Ideal surgical plane
1. Respirations deep and regular
2. Fixed eyeball with sluggish pupillary reflex
3. Mild increase in RR and HR with pain
4. Peripheral reflexes absent
89
What happens in stage 3, plane 3?
1. RR decreases and breath no longer deep and regular
2. Pupils begin to dilate
3. Pulse fast and faint
4. Decrease in BP
5. No response to pain stimuli
90
What happens in stage 3, plane 4?
1. Progressive respiratory paralysis
2. Decreased tidal volume
3. Reflexes absent
4. Pupils dilated and not light responsive
5. Decreased HR
6. Decreased BP
7. Apnea
8. Pale mm and proglonged CRT
91
What happens in stage 4?
Apnea and cardia arrest
92
What is the goal of ventilation?
maintain near normal acid-base status and oxygenation and counteract CO2 retention
93
What are the reasons a patient will spontaneously breath?
1. Underventilation
2. Pain
3. Light anesthetic plane
94
What can overventilation cause?
ruptured alveoli
95
How is tension thorax indicated?
Increased pressure with chest expansion
96
What are the mechanisms that regulate pH?
1. Chemical
2. Respiratory System
3. Renal System
97
What is respiratory acidosis?
CO2 production is greater than CO2 excretion
98
How is respiratory acidosis indicated?
Increased CO2 levels
99
What is respiratory acidosis caused by?
depressed ventilation
100
What does respiratory acidosis cause?
Decreased pH
Increased cardiac output
Vasodilation
Ventricular arrythmias
101
How do you treat respiratory acidosis?
Increase ventilation and/or treat underlying disease
102
What is respiratory alkalosis?
CO2 excretion is greater than CO2 production
103
How is respiratory alkalosis indicated?
Decreased CO2 levels
104
What is respiratory alkalosis caused by?
excessive ventilation or spontaneous hyperventilation
105
What does respiratory alkalosis cause?
Increased pH
Tachycardia
ECG changes
106
What is the tx for respiratory alkalosis?
Decrease minute volume or tx cause of hyperventilation
107
What are they types of preanesthetic drugs?
1. Anticholinergics
2. Tranquilizers and Sedatives
3. Opioids
4. Neuroleptanalgesics
108
What are the types of injectable induction agents?
1. Barbiturates
2. Nonbarbiturates
3. Dissociatives
109
What are the inhalant anesthetics?
Isoflurane
Sevoflurane
Halothane
110
What are the types of anticholinergics?
Atropine and Glycopyrrolate
111
What are the indications for anticholinergics?
1. Prevent or tx bradycardia
2. Increase HR
3. Reduce salivary and tear secretions
4. Promote bronchodilation
5. Dilate Pupils
6. Reduce GI activity
112
What are the side effects of anticholinergics?
1. May initially produce sinus tachycardia
2. May produce thicker mucus
113
What are the contraindications for anticholinergics?
1. Preexisting cardiac dz
2. Geriatric pts
3. Constipation or ileus
4. Colic in horses
5. Bloat in ruminants
114
What are the 4 types of tranquilizers/sedatives?
1. Phenothiazines
2. Benzodiazepines
3. Butyrophenes
4. Alpha 2 Agonists
115
What are the three types of phenothiazenes?
1. Acepromazine
2. Chlorpromazine
3. Promazine
116
What are the 4 types of benzodiazepines?
1. Diazepam
2. Midazolam
3. Lorazepam
4. Zolazepam
117
What is the brand name for diazepam?
Valium
118
What is the brand name for midazolam?
Versed
119
What is the brand name for lorazepam?
Ativan
120
What are the 2 types of butyrophenes?
Azaperone and Droperidol
121
What is the brand name for azaperone?
Strensil
122
What is the brand name for Droperidol?
Inapsine
123
What are the 3 Alpha 2 Agonists?
Xylazine
Romifidine
Dexmedetomidine
124
What is the brand name for Xylazine?
Rompun
125
What is the brand name for Romifidine?
Sedivet
126
What is the brand name for Dexmedetomidine?
Dexdomitor
127
What reverses Xylazine?
Yohimbine
128
What reverses Dexmedetomidine?
Yohimbine and atipamezole
129
What is the brand name for atipamezole?
Antisedan
130
What are the indications for phenothiazines?
1. Skeletal muscle relaxation
2. Antiarrythmic
3. Antiemetic
4. Inhibit platelet aggregation
131
Do phenothiazines have analgesic properties?
No
132
What are the side effects of phenothiazines?
1. May lower seizure threshold
2. Hypothermia
3. Hypotension
4. May cause excitement
5. May produce penile protrusion
133
What are the contraindications for phenothiazines?
1. Shock
2. Dehydration
3. Epilepsy
4. Depressed patients
5. Caution with geriatric and pediatric
6. Avoid in breeding stallions
6. Boxers and dobermans are more sensitive
134
What are the indications for benzodiazepines?
1. Calming effect
2. Anticonvulsant
3. Enhance sedation
4. Reduce inhalant requirements
5. Ideal for older, depressed, or anxious patients
135
What are the side effects of benzodiazepines?
Bradycardia
Hypertension
136
What are the contraindications for benzodiazepines?
Poor hepatic function
Excitable animals
137
What drug do benzodiazepines combine well with?
Ketamine
138
What med can be combined with benzodiazepines for excitable animals?
Xylazine
139
What are the indications for butyrophenes?
1. Reduce anxiety
2. Antiemetic
3. Reduce movement and response to stimuli
4. Increase RR
140
What are the side effects of butyrophenes?
1. Hypotension
2. Bradycardia
3. Decreased cardiac output
4. Panting
5. Hypothermia
6. Produce salivation
141
What is the side effect of very high doses of butyrophenes?
Rigidity and seizures
142
What are the indications of alpha 2 agonists?
1. Produce calming effects
2. Provide profound sedation
3. Moderate analgesia
4. Muscle relaxation
5. Decreased need for anesthetic
143
What are the side effects of Alpha 2 Agonists?
1. Bradycardia, decreased cardiac output, and dysrhythmias
2. Initial increase in BP followed by decrease in BP
3. Peripheral vasoconstriction
4. Hypothermia
5. Depress swallowing reflex
6. Vomiting
7. Slight muscle tremors
8. Excitement
9. Reduced intestinal motility
10. Hyperglycemia and Glucosuria
144
What are the contraindications of Alpha 2 Agonists?
1. Cardio dz
2. Respiratory dz
3. Hepatic dz
4. Renal dz
5. Diabetes
6. Shock
7. GDV
145
What are specific things to remember about Atropine (4)?
1. Potent and fast acting
2. Will cross blood brain barrier
3. Will cross placental barrier
4. IV may cause ventricular arrythmias
146
What are specific things to remember about Glycopyrrolate?
1. Slower onset of action but longer duration
2. Will not cross blood brain barrier
3. Will not cross placental barrier
147
What are specific things to remember about diazepam?
Do not mix with other drugs when giving IV and do not administer IM
148
What are butyrophenes used for?
Swine and exotic animals
149
What is azaperone primarily used for?
Sedate and treat aggression in swine
150
What are important things to remember about Xylazine?
1. Most commonly used tranquilizer
2. Sedation lasts 1-2 hours
3. Analgesia lasts 30 minutes
4. Caution in ruminants because it may reduce oxygen exchange
151
What is romifidine used for?
Primarily horses
152
Why is romifidine used in horses?
More potent than xylazine and dexmedetomidine and it provides longer sedation
153
What are opioids used for?
Sedation
Analgesia
Dysphoria
Excitement
154
How are opioid classified?
Mu or Partial mu
155
What opioids are partial mu?
Bupernorphine and butorphanol
156
What are the indications for opioids?
1. Analgesia
2. Induction
3. Balanced anesthesia
4. CRIS for multimodal anesthesia
5. Preemptive pain control
157
158
What are the side effects of opioids (11)?
1. Bradycardia
2. Panting in dogs
3. Hypothermia
4. Hyperthermia in cats with hydromorphone
5. Nausea, Vomiting, defecation with morphine and hydro
6. Constipation
7. Cough suppression
8. Addiction
9. Salivation
10. Miosis in dogs and pigs
11. Mydriasis in cats and horses
12. Noise sensitivity
13. Sweating in horses
159
What are the contraindications of opioids?
1. Previous hx of excitement
2. GI obstruction because of vomiting
3. Diaphragmatic hernia because of vomiting
160
What are the 2 barbiturates used?
Pentobarbital and Thiopental
161
What is the difference between pentobarbital and thiopental?
Pentobarbital is short acting and thiopental is long acting
162
What are the indications for barbiturates?
1. Sedation
2. Anticonvulsant
3. General anesthesia
163
What are the side effects of barbiturates?
1. Non reversible
2. Respiratory and Cardiovascular depression
3. Free barbiturates will increase with hypoproteinemia because they are protein binding
164
What breeds should you avoid using thiopental in ?
Sight hounds
165
What is the recovery for barbiturates?
slow and rough
166
What can happen if you give thiopental perivascularly?
Can cause sloughing
167
What are the 5 types of non-barbiturates?
1. Propofol
2. Alfaxalone
3. Fentanyl
4. Etomidate
5. Guafenisin
168
What are the indications for propofol?
1. Sedation
2. Induction
3. Anesthesia maintenance
4. Anticonvulsant
5. Muscle relaxation
169
What type of drug is propofol?
Short acting hypnotic
170
Described induction and recovery with propofol?
Rapid induction and rapid recovery with no hangover
171
What are the side effects of propofol?
1. Transient apnea
2. Avoid in animals with hypotension
3. Transient excitement and muscle tremors
4. Crosses placental barrier
172
Why do you need to discard propofol after 6 hours?
Will support bacterial growth
173
Why is alfaxalone used?
Newest drug available
Little or no cardiovascular effects
Can be used with any preanesthesia
174
What are the side effects of alfaxalone?
1. No antimicrobial preservatives
2. Transient induction apnea
3. Respiratory depression
4. Cant be used with other IV drugs
5. Excitement or muscle twitching may occur
6. Safety not established with pregnancy
175
Describe Fentanyl
1. Primarily an analgesic
2. Can produce unconsciousness
3. Neuroleptanalgesic
4. Does not cause apnea or heart related complications
176
What are the indications for etomidate?
1. Very safe, short acting, rapid distribution
2. Produce CNS depression
3. Popular with animals with cardiac dz
4. Can be bolus or continuous
177
What are the side effects and contraindications of etomidate?
1. No analgesic properties
2. May cause V/D, nausea, excitement, and apnea
3. Mild respiratory distress
4. Produces excessive muscle rigidity and seizures in horses and cattle
5. Injection may be painful
178
Describe guafenesin
1. IV anesthesia
2. Muscle relaxant used in large animal
3. Induction and recovery excitement free
4. Minimal respiratory and cardiac effect
5. Excessive doses may cause apneustic effects and muscle rigidity
179
What are they types of dissociative anesthetics?
Ketamine and Tiletamine
180
What are the indications of dissociative anesthetics?
1. Analgesia and catalepsy
2. Selective superficial analgesia
3. Cardiac stimulation
4. Increase muscle rigidity
5. Apneustic breathing
6. Increase RR
7. Immobilization of patient
8. Amnesic
9. Open eyes with centrally dilated pupils and nystagmus
10. Can be administered via mouth
181
What are the side effects of Dissociative anesthetics?
1. Small % of cats will show convulsive behavior
2. Tissue irritation
3. Increase salivation and lacrimation
4. Increase intraocular pressure
5. Temporary personality changes
6. Excitement on recovery
182
What are the contraindications of dissociative anesthetics?
1. Many induce pulmonary edema or acute heart failure
2. Use with caution renal and hepatic dz
3. Never use as a sole agent in cats
4. Used alone in dogs maay cause seizures
5. Dont use glaucoma
6. Prolonged and unreliable recovery
183
What are important things to remember with ketamine?
1. Somatic analgesia
2. Combined with benzodiazepines for induction
3. Can be combined with midazolam and given IM
184
What makes up telazol?
Zolazepam and tiletamine
185
What are the types of inhalant anesthetics?
1. Isoflurane
2. Sevoflurane
3. Desflurane
186
What is vapor pressure?
measure of volatility of anesthetic liquid
187
How is potency of inhalant anesthetics determined?
Minimum alveolar concentration
188
What is Minimum alveolar concentration?
The amount of the drug that produces no response in 50% of patients exposed to painful stimuli
189
What makes inhalent anesthetics more potent?
lipid solubility
190
How are inhalant anesthetics distributed?
Absorbed from alveoli into the bloodstream
191
How are inhalant anesthetics excreted?
The lungs
192
What does uptake depend upon with inhalant anesthetics?
Concentration and solubility
193
What are the indications of inhalant anesthetics?
1. Produce general anesthesia and suitable in all species
2. Provide some analgesia and muscle relaxation
3. Minimal side effects
4. Rapid recoveries
5. Nonexplosive
6. Inexpensive
194
What is the MAC of Isoflurane?
1.2 % in dogs and 1.6% in cats
195
What is the MAC of sevoflurane?
2.4% in dogs and 2.6% in cats
196
What is the MAC of desflurane?
7.2% in dogs and 9.7% in cats
197
What color labels do inhalant anesthetics have?
Iso - Purple
Sevo - Yellow
Des - BLue
198
What are the indications for isoflurane?
1. Least expensive
2. More muscle relaxation
3. Malignant hyperthermia in pigs
199
What are the indications of sevoflurane?
1. Most expensive
2. Excellent choice for avians
3. Non pungent and non irritating
4. Less of a hangover
200
What are the indications of desflurane?
1. Pungent and airway irritation
2. Most rapid acting but may not have fast recovery
3. Malignant hyperthermia in many species
201
When can regurgitation happen in ruminant anesthesia?
Any plane
202
On a ventilator what should inspiration:expiration be?
1:1
203
What can hypothermia cause?
Tissue acidosis
204
What makes assessment of dehydration harder?
Low body fat
205
What is most appropriate suture to close an enterotomy?
Absorbable monofilament
206
What can dexmedetomidine cause specifically in cats?
vomiting
207
What is sterilization?
Removal of all microbes
208
