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Anesthesia Flashcards

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1
Q

An internal pressure regulator on the anesthesia machine reduces the carrier gas pressure from that in the tank or wall outlet to _____ pounds per square inch (PSI).

A

50

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2
Q

Respiratory acidosis occurs when hypoventilation causes ________ or an __________ in the blood PaCO2. The compensatory response to this condition is increased renal excretion of ______ which results in ___________ extracellular HCO3−.

A

hypercapnia, or an increase
H+
increased

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3
Q

What is a possible cause of transudative pericardial effusion?

A
  • Congestive heart failure
  • Peritoneopericardial diaphragmatic hernia
  • Hypoalbuminemia
  • Increased vascular permeability

Other causes include .

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4
Q

Define exudative pericardial effusion based on total protein and total nucleated cell count.

A

Total protein >2.5 g/dL; total nucleated cell count >5000 cells/µL

Exudate results from infectious or noninfectious pericarditis.

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5
Q

What are some infectious agents that can cause exudative pericardial effusion?

A

Bacterial, fungal, or viral

Examples include feline infectious peritonitis and feline cardiomyopathy.

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6
Q

Which fungal agent is noted to cause pericarditis in dogs in the southwestern United States?

A

Coccidioides immitis

Fungal pericarditis is unusual, but this agent is an exception.

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7
Q

What is a suspected cause of bacterial pericardial effusion in dogs?

A

Grass awn migration

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8
Q

List some causes of hemorrhagic pericardial effusion.

A
  • Trauma
  • Neoplasia
  • Anticoagulant intoxication
  • Rupture of the left atrium secondary to mitral valve disease

These conditions can lead to bleeding into the pericardial space.

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9
Q

What is the formula for Respiratory Minute Volume (MV)?

A

Respiratory Rate x Tidal Volume

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10
Q

What is the estimated tidal volume in mL/kg?

A

15 mL/kg

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11
Q

What is the recommended gas flow rate for a nonrebreathing system in relation to Minute Volume (MV)?

A

At least 3 times MV

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12
Q

What are possible complications of epidural injections?

A
  • Injection of local anesthetic into the vertebral sinuses
  • Respiratory depression and paralysis and dogs and cats caused by drug overdose
  • Temperature may fall in small animals because they are unable to shiver

These complications highlight the risks associated with epidural anesthesia.

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13
Q

What respiratory issues can occur in dogs and cats due to drug overdose?

A

Respiratory depression and paralysis

This condition is serious and can lead to inadequate breathing.

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14
Q

The drug must migrate to _______ to produce complete respiratory paralysis from blockade of the phrenic nerves.

A

approximately C5 or C7

Phrenic Nerve C5, C6, C7

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15
Q

What physiological change may occur in small animals due to inability to shiver?

A

Temperature may fall

This can lead to hypothermia in susceptible animals.

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16
Q

What nerve blockade is responsible for respiratory paralysis?

A

Phrenic nerves

The phrenic nerves are crucial for diaphragm function and breathing.

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17
Q

Injection of local anesthetic into the vertebral sinuses can lead to:

A
  • Vomiting
  • Tremors
  • Decreased blood pressure caused by peripheral vasodilation
  • Convulsions
  • Paralysis
  • Lack of intended effect
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18
Q

What increases with ventilation perfusion mismatch (V/Q)?

A

Increased ventilation and decreased perfusion

Balance between air reaching the lungs (ventilation) and how much blood flows through the lungs (perfusion).

Oxygen in, carbon dioxide out

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19
Q

What is the function of one-way valves in an anesthesia machine?

A

Prevent immediate rebreathing of exhaled gas

One-way valves ensure that exhaled gases do not return to the patient, thus maintaining the integrity of the anesthetic circuit.

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20
Q
A
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21
Q

What surface does a reverse-cutting needle have the cutting surface on?

A

Convex surface

Reverse-cutting needles create a unique triangular hole.

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22
Q

What shape does the hole created by a reverse-cutting needle have?

A

Triangular hole

The triangular hole has a flat edge.

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23
Q

The flat edge of the hole created by a reverse-cutting needle is _______ to the incision.

A

Parallel

This design helps in reducing tissue trauma.

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24
Q

What is the tidal volume (TV) setting range for mechanical ventilators?

A

10-20 mL/kg

Tidal volume refers to the amount of air delivered to the lungs with each breath.

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25
Recommended Chlorhex duration ____ minutes. vs. Alcohol-based hand rub solutions have similar efficacy w/in ____ minutes. Gold standard!
3-5 minutes 1.5-2 minutes
26
What is the recommended respiratory rate (RR) for mechanical ventilators?
8-12 breaths per minute ## Footnote This rate helps ensure adequate ventilation without causing respiratory alkalosis.
27
What is the recommended respiratory rate (RR) for mechanical ventilators?
8-12 breaths per minute ## Footnote This rate helps ensure adequate ventilation without causing respiratory alkalosis.
28
What is the peak inspiratory pressure (PIP) range for mechanical ventilators?
10-20 cm H2O ## Footnote PIP is the maximum pressure applied to the airways during inhalation.
29
What is the typical inspiratory/expiratory (I/E) ratio for mechanical ventilation?
1:2 ## Footnote This ratio helps maintain optimal gas exchange during mechanical ventilation.
30
What does CO2 react with to form carbonic acid on the surface of granules? ## Footnote Soda Lime
Water ## Footnote This reaction is crucial for the function of Soda Lime in absorbing CO2.
31
When should Soda Lime be changed? ## Footnote Soda Lime
Whenever rebreathing of CO2 by patient is observed on capnograph ## Footnote This indicates that the granules are no longer effectively removing CO2.
32
What happens to Soda Lime granules at higher fresh gas flow? ## Footnote Soda Lime
Granules may lose water to evaporation ## Footnote This can make them less effective for CO2 removal.
33
Fill in the blank: CO2 reacts with water to form _______ on the surface of granules. ## Footnote Soda Lime
[carbonic acid]
34
True or False: Minimal regeneration of Soda Lime occurs over time. ## Footnote Soda Lime
True ## Footnote This suggests that Soda Lime has a limited lifespan and needs to be monitored.
35
What is the consequence of using Soda Lime granules that have lost water? ## Footnote Soda Lime
They become less effective for CO2 removal ## Footnote Maintaining adequate hydration of the granules is essential for their function.
36
What is the relationship between fresh gas flow and the effectiveness of Soda Lime? ## Footnote Soda Lime
Higher fresh gas flow can lead to reduced effectiveness due to evaporation of water ## Footnote This highlights the importance of managing gas flow rates in anesthesia.
37
What does a rebreathing system allow? ## Footnote Rebreathing System
Rebreathing of exhaled gases minus CO2 ## Footnote This system recycles gases that have been exhaled, excluding carbon dioxide.
38
What does the amount of rebreathing in a rebreathing system depend on? ## Footnote Rebreathing System
Fresh gas flow rate ## Footnote The rate at which fresh gas is supplied affects how much exhaled gas is rebreathed.
39
What do nonrebreathing systems rely on? ## Footnote Nonrebreathing System
Relatively HIGH fresh gas flow rates to remove CO2 ## Footnote Nonrebreathing systems require higher flow rates to ensure that carbon dioxide is effectively removed from the gas mixture.
40
Are Touhy needles: * uninsulated or insulated * curved or straight at the tip * sharp or not sharp
* Uninsulated or insulated * Curved at the distal tip * Not as sharp
41
Touhy needles are used for?
epidural or perineural catheters
42
Name the Pain Nerves
A-alpha - proprioception A-beta - touch A-delta - pain (mechanical and thermal) C - pain (mechanical, thermal, chemical) Unmyelinated
43
How/where to block thoracic limb cat?
Brachial plexus C6-T1 VENTRAL BRANCHES
44
What are the ventral branches of the brachial plexus?
Suprascapular, subscapular, axillary, musculocutaneous, radial, median, ulnar nerves ## Footnote The specific spinal levels for each nerve are: Suprascapular + subscapular (C6-7), axillary + musculocutaneous (C6-8), radial (C6-T2), median (C7-T1), ulnar (C8-T2)
45
What is Regional or Nerve Block Anesthesia?
Injection of LRA (local regonal anesthesia) adjacent to a peripheral nerve to temporarily block conduction. ## Footnote This results in the temporary interruption of sensory afferent and/or motor efferent activity.
46
What are the major landmarks for brachial plexus block?
Scapulohumeral joint, acromion, greater tubercle, jugular vein ## Footnote These landmarks are critical for proper needle placement during the procedure.
47
Where is the puncture site located for brachial plexus block?
Cranial to the acromion and medial to the subscapularis muscle
48
What is the direction of needle advancement during brachial plexus block?
Medial to the scapula in a caudal direction ## Footnote This technique helps ensure proper placement of the anesthetic agent.
49
Fill in the blank: The spinal levels for the axillary and musculocutaneous nerves are _______.
C6-8
50
True or False: The radial nerve spans from C6 to T2.
True
51
The phases of end-tidal capnograph waveform?
Phase 1: Inspiratory **Baseline** Phase 2 : **Rise** (expiratory upstroke) Phase 3 : Alveolar **Plateau** Phase 4 : inspiratory downstroke
52
What happens to the capnograph waveform with hypoventilation?
Elevated plateau | Increase in horizontal portion, which is elevation of plateau (phase 3)
53
# Wit What happens to the capnograph waveform with rebreathing CO2?
Elevated baseline (phase 1)
54
What happens to the capnograph waveform with hyperventilation?
Decrease plateau
55
What is the difference from PCO2 vs PaCO2?
**PCO2** refers to the partial pressure of carbon dioxide, while **PaCO2** specifically indicates the partial pressure of carbon dioxide in arterial blood
56
What happens with drugs in a hypoproteinemic patient?
* Increased amount of circulating free drug * Propofol: much smaller dose needed for effect * Opioids and benzos need much smaller dose * Inhalants are not affected
57
What type of neuromuscular blocker is Atracurium?
Nondepolarizing Neuromuscular blocker ## Footnote Blocks acetylcholine (Ach) at the neuromuscular junction (NMJ)
58
What are the cardiovascular effects of Atracurium at normal doses?
Minimal cardiovascular effects ## Footnote Large doses can stimulate histamine release
59
Is Atracurium safe for patients with hepatic and renal diseases?
Yes ## Footnote It is indicated for use in patients with these conditions
60
Does Atracurium provide analgesia or sedation?
No ## Footnote It does not provide pain relief or sedation
61
What is the onset time for Atracurium when administered intravenously?
3-5 minutes ## Footnote It takes this time to achieve initial effects
62
How long does the central eye position last after Atracurium administration?
20 to 30 minutes ## Footnote This duration is important for surgical procedures. Its a neuromuscular blocking agent. Known to cause histamine release (possible various adverse drug reactions).
63
Is reversal of Atracurium blockade usually necessary? What drug is used to reverse?
**Rarely necessary** **Neostigmine** (an acetylcholinesterase inhibitor) ## Footnote Due to its relatively low dose and short duration of action
64
What effect does Atracurium have on intraocular pressure?
Prevents increases in intraocular pressure ## Footnote This is due to extraocular muscle contraction
65
What type of neuromuscular blocker is Succinylcholine?
Depolarizing ## Footnote It mimics acetylcholine at the NMJ
66
What is a notable side effect of Succinylcholine?
Triggers malignant hyperthermia ## Footnote It can also cause reported muscular pain following administration
67
What is the mechanism of action (MOA) of Edrophonium?
Inhibits acetylcholinesterases ## Footnote This increases acetylcholine at the NMJ. Used for myasthenia gravis (MG)
68
What can Endrophium potentially cause?
Cholinergic crisis ## Footnote This is a result of increased acetylcholine levels. Characterized by excessive acetylcholine (ACh) accumulation, leading to symptoms like muscle weakness, salivation, and respiratory distress.
69
Which drugs are inhibitors of acetylcholinesterase?
Neostigmine & Edrophonium ## Footnote These drugs increase levels of acetylcholine at the NMJ
70
What does ASA stand for in the context of physical status classification?
American Society of Anesthesiologists
71
What is ASA level 1 classified as?
Normal healthy patients
72
Provide examples of ASA level 1.
* No discernible disease * Animals entered for ovariohysterectomy * Ear trim * Caudectomy * Castration
73
What is ASA level 2 classified as?
Patients with mild systemic disease
74
Provide examples of ASA level 2.
* Skin tumor * Fracture without shock * Uncomplicated hernia * Cryptorchidectomy * Localized infection * Compensated cardiac disease
75
What is ASA level 3 classified as?
Patients with severe systemic disease
76
Provide examples of ASA level 3.
* Fever * Dehydration * Anemia * Cachexia * Moderate hypovolemia
77
What is ASA level 4 classified as?
Patients with severe systemic disease that is a constant threat to life
78
Provide examples of ASA level 4.
* Uremia * Toxemia * Severe dehydration and hypovolemia * Anemia * Cardiac decompensation * Emaciation * High fever
79
What is ASA level 5 classified as?
Moribund patients not with or without operation
80
Provide examples of ASA level 5.
* Extreme shock and dehydration * Terminal expected to survive 1 day malignancy or infection * Severe trauma
81
What ASA level for: * Hx of CHF ____ * Current failure ____ * Renal failure ____
* Hx of CHF = 3 * Current failure = 4 * Renal failure = 3
82
What is the function of soda lime in a rebreathing system?
Incorporates a CO2 absorbent to remove CO2 from the system and allow exhaled gases to be safely inhaled again
83
What are the main components of soda lime?
Combination of sodium hydroxide, potassium hydroxide, water, calcium hydroxide
84
What is the primary component of soda lime?
Na(OH)2 - sodium hydroxide
85
What type of reaction occurs in soda lime and what are its products?
Exothermic reaction producing H2O, Na2CO3, and heat
86
What is the intermediate compound formed during the reaction in soda lime?
Carbonic acid
87
What materials are included in soda lime to give hardness to the granules?
Silica and kieselguhr
88
What is the optimal moisture content required in soda lime for CO2 absorption?
14-19% H2O
89
What are the two types of regulation of vapor output in vaporizers?
* Variable bypass (MC) * Measured flow ## Footnote Variable bypass is more common, while measured flow is rare.
90
List the methods of vaporization used in vaporizers.
* Flow-over (MC) * Bubble-through * Direct injection ## Footnote These methods describe how the vapor is generated and delivered.
91
What are the two locations where vaporizers can be placed in the circuit?
* Out of circuit (MC) * Rarely integrated ## Footnote The placement affects how the vapor is utilized in the system.
92
What is a unique feature of Desfluorane vaporization?
Externally warmed vaporizer with gas phase injected into carrier gas ## Footnote This specificity distinguishes Desfluorane from other agents.
93
True or False: Measured flow vaporizers are more common than variable bypass vaporizers.
False ## Footnote Variable bypass is the more common type.
94
What is the primary purpose of rebreathing systems?
To remove CO2 from the system and allow exhaled gases to be safely inhaled again ## Footnote This is achieved using a CO2 absorbent like soda lime.
95
What type of patients are rebreathing systems reserved for?
Patients >5kg ## Footnote This indicates that rebreathing systems are not typically used for smaller patients.
96
What is the function of one-way valves in rebreathing systems?
To prevent immediate rebreathing of exhaled gas ## Footnote This enables unidirectional flow of gases.
97
What components are incorporated in rebreathing systems?
* CO2 absorbent (e.g., soda lime) * One-way valves * Reservoir bag * Pressure gauge * Pop-off valve * Breathing tubes ## Footnote These components work together to facilitate safe gas exchange and ventilation.
98
Fill in the blank: Rebreathing systems incorporate a _______ to remove CO2 from the system.
CO2 absorbent ## Footnote Soda lime is a common type of CO2 absorbent used.
99
True or False: Rebreathing systems allow for immediate rebreathing of exhaled gases.
False ## Footnote One-way valves prevent immediate rebreathing.
100
What is the role of the reservoir bag in rebreathing systems?
To allow positive pressure ventilation ## Footnote This helps in delivering the necessary airflow to the patient.
101
What is the significance of the pop-off valve in rebreathing systems?
To prevent overpressure in the system ## Footnote It ensures safety by allowing excess gas to escape.
102
Adjustable pressure‐limiting (APL) valve = “pop-off”
* Releases anesthetic gases into the scavenging system * Provide pressure control in the breathing circuit during manual ventilation
103
What is the actual name of the “pop-off”?
Adjustable pressure‐limiting (APL) valve
104
Fill in the Blank: Internal pressure regulator on ax machine reduces the carrier gas pressure from that in the tank or wall outlet to ____ PSI.
50 PSI
105
Fill in the Blank: Oxygen tanks are ____ in color in the US.
Green
106
The green tanks come in E and H. What are there PSI and volume?
E (mini sized tanks) 1900 PSI - 660 L H (full sized tanks) 2200 PSI - 6900 L
107
What is the purpose of a non-rebreathing system?
Prevents rebreathing of CO2 by using high fresh gas flow rates ## Footnote High fresh gas flow rates are essential to ensure that CO2 does not accumulate in the breathing circuit.
108
What is the required gas flow rate for a non-rebreathing system?
150-300 ml/kg/min ## Footnote This range is necessary to effectively prevent CO2 rebreathing.
109
What is the minimum fresh gas flow rate in relation to minute respiratory volume?
At least 3 times the minute respiratory volume ## Footnote Minute volume (MV) is calculated as MV = RR x TV, where TV is approximately 15 ml/kg.
110
What is the approximate tidal volume (TV) in ml/kg?
~15 ml/kg ## Footnote Tidal volume is the amount of air inhaled or exhaled in a single breath.
111
For which weight range does a non-rebreathing system work best?
Less than 3-5 kg ## Footnote Non-rebreathing systems are particularly effective for smaller patients.
112
What is the reservoir bag capacity for rebreathing systems?
5-10 times the tidal volume (10-20 mL/kg) ## Footnote The reservoir bag size is crucial for accommodating the patient's breathing needs.
113
What substance is used in rebreathing systems to absorb CO2?
Soda lime ## Footnote Soda lime is a common absorbent used in rebreathing systems to eliminate CO2 from the exhaled gases.
114
Place the local anesthestic in order of chrondrotoxic levels (less to greatest)? Mepivacaine, Bupivacaine, Ropivacaine
Ropivacaine < Mepivacaine< Bupivacaine ## Footnote Repeated administration leads to Chondromalacia
115
What is the dosage of Glyco for IV administration?
0.01 mg/kg IV, 0.005 mg/kg IV ## Footnote Glyco is administered intravenously at these specific dosages.
116
Does Glyco cross the blood-brain barrier (BBB) or placenta?
No, Glyco is poorly lipid soluble and does not cross the BBB or placenta ## Footnote This characteristic differentiates it from atropine.
117
How does the onset time of Glyco compare to that of atropine?
Glyco has a slower onset (5 min IV) compared to atropine (1 min) ## Footnote This indicates that atropine acts more quickly than Glyco.
118
How long do cardiovascular effects last with Glyco compared to atropine?
CV effects last for approximately 1 hour longer with Glyco ## Footnote This suggests that Glyco has a prolonged effect on cardiovascular parameters.
119
How does the potency of Glyco compare to atropine?
Glyco is 4 times more potent than atropine (0.04 mg/kg CPA or half dose anesth) ## Footnote This means a smaller dose of Glyco is required to achieve similar effects.
120
What are the central nervous system (CNS) effects of Glyco?
Glyco has no CNS or ocular effects ## Footnote In contrast, atropine can cross the BBB and cause mild sedation.
121
What is one effect of Glyco on gastric pH?
Increases gastric pH by increasing gastric acid secretions ## Footnote Atropine does not have this effect.
122
What is a shared effect of Glyco and atropine?
Both decrease GI motility ## Footnote This indicates that both agents can affect gastrointestinal function.
123
What effect do both Glyco and atropine have on lower esophageal tone?
Both reduce lower esophageal tone ## Footnote This can lead to increased gastroesophageal reflux.
124
What is a contraindication for the use of Glyco?
Not for use due to reflex brady from alpha 2 agonists ## Footnote This indicates that Glyco should be avoided in specific clinical situations.
125
What can epinephrine do to local block?
* Local: Prolong lidocaine by up to 3h * Epidurals increase duration, rostral spread, faster onset
126
What is the onset time of Lidocaine when administered subcutaneously (SQ)?
~5 minutes
127
What is the duration of action for Lidocaine?
45 to 60 minutes
128
In what forms can Lidocaine be used?
* Nerve block * Epidural * IV * SQ
129
What effect does Lidocaine have on MAC?
Decreases MAC
130
What is one of the uses of IV Lidocaine?
* Preventing postoperative ileus * Stimulates GI motility
131
What is a 'Bier block'?
IV regional anesthesia
132
How is a Bier block performed?
* Apply esmarch bandage to exsanguinate the limb * Place tourniquet * Give lidocaine IV distal
133
What is the toxic dose of Lidocaine for cats?
greater than 6 mg/kg
134
What is the toxic dose of Lidocaine for dogs?
greater than 8 mg/kg
135
What are some initial signs of Lidocaine toxicity?
* Vomiting * Ileus * Nausea * Regurge
136
What are the CNS effects of Lidocaine toxicity?
* Dull mentation * Seizures
137
What cardiac issues can Lidocaine toxicity cause?
* Decreased contractility * Arrhythmia * Death
138
What is the duration of action of Bupivacaine?
6-8 hours ## Footnote Bupivacaine has a longer duration due to its lipophilicity.
139
What is the onset time for Bupivacaine?
Up to 45 minutes ## Footnote The onset time is affected by pKa and protein binding.
140
Is Bupivacaine safe for intravenous administration?
No ## Footnote Bupivacaine is never given IV due to risk of cardiotoxicity.
141
What is the potential consequence of accidental IV administration of Bupivacaine?
Cardiac arrest ## Footnote Intralipid may help in case of accidental IV administration.
142
What routes can Bupivacaine be safely administered?
SQ, epidurally, or in chest tube ## Footnote These routes avoid the risks associated with IV administration.
143
What is the toxic dose of Bupivacaine for cats?
>2 mg/kg ## Footnote Dosage above this can lead to toxicity in cats.
144
What is the toxic dose of Bupivacaine for dogs?
>4 mg/kg ## Footnote Dosage above this can lead to toxicity in dogs.
145
How does the potency of Bupivacaine compare to Lidocaine?
4x as potent ## Footnote Bupivacaine is significantly more potent than lidocaine.
146
Dopamine's MOA
alpha/ beta adrenergic ## Footnote - Low dose→ Vasodilation (dopaminergic activity) - Intermediate dose → B receptors → ↑ Cardiac contractility & HR - High dose → primarily alpha → Vasoconstriction - Alpha and beta adrenergic receptors are crucial components of the sympathetic nervous system, mediating various physiological responses like vasoconstriction (alpha) and vasodilation/cardiac stimulation (beta)
147
Dopamine counteracts ____ during anesthesia.
Can use dopamine to counteract **vasodilation (hypotension)** due to local anesthesia.
148
Is dopamine inotropic or chronotropic?
High doses of dopamine produce both inotropic and chronotropic effects. ## Footnote Inotropic affects = cardaic force/ strength Chronotrpic affects = HR (fast/slow)
149
Fill in the Blank: NMDA (N-methyl-D-aspartate) receptors are ____ receptors that mediate excitatory neurotransmission.
glutamate receptor
150
Fill in the Blank: GABA (gamma-aminobutyric acid) is the primary ____ neurotransmitter in the brain
inhibitory neurotransmitter
151
Discuss adrenergic and dopaminergic receptor distributions, effects, and mechanisms of action
152
What is the mechanism of action (MOA) of Dobutamine?
- Stimulates beta-1 receptors in the heart, leading to increased heart rate (positive chronotropy) and contractility (positive inotropy). Leads to increased cardiac output and stroke volume. - Weaker effects and less pronouced on beta-2 receptors, which can cause vasodilation, and alpha-1 receptors, which can cause vasoconstriction.
153
What is the primary effect of Dobutamine on cardiac contractility?
Strong increase in cardiac contractility
154
Does Dobutamine cause norepinephrine release?
Does NOT cause NE release (like Dopamine)
155
What potential side effect may Dobutamine induce in cats?
May induce seizures in cats
156
What type of chronotropic effect does B1 have?
Positive Chronotrope leading to ↑HR (mild) and inotrophic affect (contractility)
157
Mechanism of Action of Vasopressin?
Antidiuretic Hormone | H- ormone that plays a crucial role in regulating water balance and bloo ## Footnote ADH is also known as Arginine Vasopressin (AVP)
158
What type of receptors does vasopressin act on as a vasopressor?
Nonadrenergic V1 receptors
159
In what situation may vasopressin be necessary to maintain blood pressure?
Vasoplegic shock associated with sepsis
160
What is the typical dosage range for vasopressin to maintain blood pressure?
0.1 to 1.0 mU/kg/min
161
What triggers the release of vasopressin during hypovolemia?
Decrease in blood pressure or blood volume ## Footnote Low-pressure stretch receptors and baroreceptors are stimulated and trigger the release
162
What are the two main effects of vasopressin in conditions of low blood volume?
* Increases water retention * Exerts a powerful vasoconstrictor effect
163
What is desmopressin?
A synthetic analogue of vasopressin ## Footnote DDAVP
164
What effect does desmopressin have on von Willebrand factor (vWf)?
Causes subendothelial vWf release ## Footnote DDAVP
165
Can Doxapram trigger an abnormal glottis to open?
No ## Footnote May be administered to highlight laryngeal function but some dogs will develop severe glottic constriction, resulting in upper airway obstruction
166
What is Doxapram?
A central nervous stimulant
167
What effect does Doxapram have on respiratory rate?
Increases respiratory rate ## Footnote Increases tidal volume
168
Which part of the brain does Doxapram increase electrical activity in?
Inspiratory and expiratory centers of the medulla ## Footnote Can stimulate respiration by reflex activitation of cartotid and aortic chemoreceptors
169
What is the approach used for the Maxillary N.?
* Infraorbital approach * Intraoral caudal * Ventral of the rostral Zygomatic arch ## Footnote A, Infraorbital. B, Maxillary. C, Ophthalmic. D, Mental. E, Mandibular alveolar.
170
Where is the mandibular foramen located in relation to the teeth?
Between M3 and angular process ## Footnote A, Infraorbital. B, Maxillary. C, Ophthalmic. D, Mental. E, Mandibular alveolar.
171
What is the location of the mental foramen for the Inferior alveolar n.?
Between K9 and PM1 at 45 degrees ## Footnote A, Infraorbital. B, Maxillary. C, Ophthalmic. D, Mental. E, Mandibular alveolar.
172
Why should you avoided alpha 2-agonist in patients with heart disease?
Alpha 2-agonists can **compromise cardiac output (CO) and myocardial oxygen (O2) delivery.**
173
Which cardiac condition should Ketamine not be used in?
hypertrophic cardiomyopathy (HCM) ## Footnote Ketamine can exacerbate symptoms in patients with HCM.
174
When can anticholinergics be used in patients with heart disease?
Should not be used, unless symptomatic bradyarrhythmia ## Footnote Anticholinergics can increase myocardial O2 demand due to potential tachyarrhythmias.
175
Should lidocaine CRI be used in patients with a 3rd degree block?
No
176
What drugs should be avoided with adrenal cases?
* Ketamine * Acepromazine: can cause α-antagonism = complicate sympathetic tone control * α2-agonist: decrease central sympathetic outflow for pheochromocytoma unpredictable effect ## Footnote µ-opioid and benzo are preferred
177
Drugs to avoid with respiratory cases?
Avoid Beta blockers (bronchoconstriction) ## Footnote Beta-blockers are a class of medications that block the effects of adrenaline (epinephrine) and noradrenaline (norepinephrine) on the body.
178
Drugs to avoid with renal cases?
* No NSAIDs * Ketamine, Benzos, Opioids, Acepromazine all of them renal excretion =prolong effects * Avoid ⍺-2s in obstructed cases bc ↑ urine output * No epidurals w/ severe uremia (PLT dysfunction)
179
Why would you avoid epidurals in uremic patients?
May have PLT dysfunction
180
Drugs to avoid with Septic cases?
* NO ACE OR ⍺-2s (CV changes) * Etomidate – adrenal suppression (if used give Dex SP)
181
What is malignant hyperthermia (MH)?
A rare, inherited disorder that causes a severe, life-threatening reaction to certain anesthetics and muscle relaxants used during surgery ## Footnote MH is characterized by a hypermetabolic state leading to various physiological disturbances.
182
What are the key symptoms of malignant hyperthermia?
Hypercarbia, hyperthermia, muscle rigidity, cardiac arrhythmias, and can lead to death ## Footnote These symptoms arise due to excessive calcium release and increased metabolic activity.
183
Which cellular defect is associated with malignant hyperthermia?
Defect in the Ryanodine Receptor (RYR1) ## Footnote This receptor is crucial for Ca induced Ca release in muscle cells.
184
What is the first sign of malignant hyperthermia?
Abrupt increase in CO2 from increased metabolism ## Footnote This is followed by an increase in temperature and heart rate.
185
What are the trigger agents for malignant hyperthermia?
Succinylcholine (depolarizing muscle relaxent) and Halothane (Sevoflurane, Isoflurane) ## Footnote These agents can provoke a hypermetabolic crisis in susceptible individuals.
186
What is the primary therapy for malignant hyperthermia?
D/C inhalants and administer IV Dantrolene ## Footnote Dantrolene stabilizes the sarcoplasmic reticulum membrane and decreases calcium release.
187
What does Dantrolene do in the context of malignant hyperthermia?
Stabilizes sarcoplasmic reticulum membrane and decreases calcium release ## Footnote This action helps to mitigate the severe muscle rigidity and metabolic crisis.
188
What is TIVA and how is it used in malignant hyperthermia?
Total Intravenous Anesthesia (TIVA) with propofol and oxygen delivery with a well-flushed system ## Footnote This technique avoids the use of inhalational agents that could trigger MH.
189
How can patients be pretreated for elective surgeries to prevent malignant hyperthermia?
Oral dantrolene for 1 week prior ## Footnote This pre-treatment can help reduce the risk of MH during anesthesia.
190
What should be assumed about relatives of individuals with malignant hyperthermia?
They may also have the disorder ## Footnote It is an inherited condition, so genetic counseling may be necessary.
191
What is Alfaxalone?
Steroid anesthetic which enhances GABA and glycine mediated CNS depression ## Footnote Alfaxalone is used for its anesthetic properties in veterinary medicine.
192
How is Alfaxalone administered?
Neutral solution can go IV or IM but only stored 6 hours ## Footnote Alfaxalone's stability limits its storage and usage timeframe.
193
How does Alfaxalone compare to propofol?
- Alfaxalone has less apnea compared to Propofol - Can use like propofol → rapid metabolism ## Footnote Both are used for inducing anesthesia but differ in their metabolic pathways.
194
What are the cardiovascular and respiratory effects of Alfaxalone?
Cardiac and respiratory depressive ## Footnote Use with caution in patients with pre-existing conditions affecting these systems.
195
What is the incidence of apnea with Alfaxalone compared to propofol?
Apnea, less than propofol ## Footnote This indicates a potentially safer profile in terms of respiratory depression.
196
What is the drug schedule classification of Alfaxalone?
Schedule IV ## Footnote This classification affects its regulation and use in clinical settings.
197
Fill in the Blank: Patients that have ____ should avoided using Alfaxalone?
DCM ## Footnote DCM refers to dilated cardiomyopathy, a condition that may be exacerbated by the drug's effects.
198
What is the primary route of metabolism for Propofol?
EXTRA-hepatic metabolism ## Footnote Metabolism occurs outside the liver.
199
Propofol is ____ acting and causes ____ and ____ if given as a bolus.
* Fast acting * Hypotension (secondary to vasodilation) and Apnea ## Footnote It has a rapid onset of effects.
200
True or False: Propofol causes oxidative damage to RBC in cats.
Yes, but the Oxidative damage to RBC is not clinically significant and does not lead to anemia.
201
True or False: Propofol cause spinal myoclonus?
True ## Footnote Spinal myoclonus, is a movement disorder characterized by sudden, brief, involuntary muscle jerks or twitches, involuntary muscle contractions (aka myoclonus) originating from the spinal cord, often involving specific segments.
202
What conditions can Propofol be used to treat?
Refractory status epilepticus and reduces intracranial pressure ## Footnote It is utilized in critical care situations.
203
Is Propofol considered a controlled substance in the United States?
Yes, in some states ## Footnote Regulations may vary by state.
204
What happens to the tissue when Propofol is administered perivascularly?
Nothing to the tissues. It does not cause tissue damage ## Footnote This route is safe for administration.
205
What is the potency of Methadone compared to morphine?
2x ## Footnote Methadone is a 𝜇 agonist and NMDA blocker, causing less excitatory response in cats.
206
What is the potency of Hydro compared to morphine?
8x ## Footnote Hydro is a 𝜇 agonist.
207
What is the potency of Oxymorphone compared to morphine?
10x ## Footnote Oxymorphone is a 𝜇 agonist.
208
What is the potency of Buprenorphine compared to morphine?
40x ## Footnote Buprenorphine is a Partial 𝜇 agonist.
209
What is the potency of Fentanyl compared to morphine?
100x ## Footnote Fentanyl is a 𝜇 agonist.
210
What is the potency of Meperidine compared to morphine?
10x less ## Footnote Meperidine is a 𝜇 agonist and causes more histamine release.
211
Does Buprenorphine has a plateau effect?
Yes. ## Footnote Ceiling effect, higher doses just last longer.
212
Methadone
A mu agonist and an NMDA receptor antagonist which causes fewer excitatory responses in cats ## Footnote Less excitatory effects in cat's vs dogs 2x as potent as morphine
213
What is the effect of a mixture of helium and oxygen (heliox) on respiratory effort?
It reduces respiratory effort by having lower resistance to flow than either room air or 100% oxygen. ## Footnote Increases tendency to laminar flow and reduces resistance to turbulent flow.
214
What is the ratio of helium to oxygen used?
70:30 ratio of helium to oxygen. ## Footnote Prevent fires caused by laser ignition
215
What are the three main types of one lung ventilation?
1. Double-lumen tubes (DLTs) 2. Bronchial blockers (BBs) 3. Single-lumen tubes (SLTs) ## Footnote Standard long ETT are less desirable
216
With DLT one lung ventilation what is a limiting factor?
Size DLTs limited to 5-20 kg ## Footnote Confirm placement with a bronchoscope +/- thorascopic assistance – then ventilate each lung field and listen
217
What is the purpose of a breathing/rebreathing bag?
Provides compliant reservoir of gas that changes volume with the patient’s inspiration/expiration
218
What is the ideal volume for a rebreathing bag?
10-20 mL/kg (5-10x tidal volume) ≈ Vmin ## Footnote 10-20 mL/kg
219
Why should a rebreathing bag not be too large?
It becomes difficult to observe the bag moving with breathing
220
What are the cardiovascular effects of opioids?
Minor direct effects ## Footnote Opioids primarily cause bradycardia through centrally mediated increased parasympathetic nervous system activity.
221
What can happen if a bolus of opioids is administered?
Bradycardia due to centrally mediated ↑ PSNS activity ## Footnote This effect can be blocked by anticholinergics.
222
Can opoids lead to histamine release?
Yes. ## Footnote IV use can cause vasodilation, tachycardia, and hypotension, especially with Meperidine and Morphine.
223
How much can opioid administration decrease MAC?
By 40-60% ## Footnote MAC stands for Minimum Alveolar Concentration, a measure of anesthetic potency.
224
Whether locals are administered in the central neuraxis (epidurally, intrathecally), or systemically all
- ** Inhibit K+ and Ca2+ channels** at the level of the dorsal horn of the spinal cord - **inhibit substance P binding** and evoked ↑ intracellular Ca2+ - **inhibit glutamatergic transmission** in the spinal dorsal horn neurons – reducing NMDA and neurokinin-mediated postsynaptic depolarization
225
What is the effect of low lipophilicity on the duration of action (DoA) of drugs?
Drugs with low lipophilicity have a longer duration of action (DoA) ## Footnote Example: Morphine is cited as a drug with low lipophilicity.
226
How does lipid solubility and protein binding affect systemic absorption of drugs?
Greater lipid solubility and protein binding result in lower systemic absorption ## Footnote This implies that drugs that are more lipid-soluble and strongly bound to proteins may not be absorbed as effectively into the systemic circulation.
227
How do local anesthetics work?
1. Vasodilation occurs first → 2. Loss of sensation of temperature → 3. Loss of sensation of sharp pain → 4. Loss of sensation of light touch → 5. Loss of motor activity
228
Fill in the Blank: ____ opioids, when given epidurally, have a slower onset of analgesia and a longer duration of effectiveness compared to more lipophilic opioids.
lipophilic opioids
229
Fill in the Blank: Lipophilic opioids, when given epidurally, have a ____ onset of analgesia and a ____ duration of effectiveness compared to more lipophilic opioids.
Slower onset Longer duration
230
What can epidural anesthesia cause?
Sympathetic blockade and hypotension ## Footnote This means the sympathetic nervous system's function is impaired, leading to low blood pressure.
231
What should be given to offset hypotension caused by epidural anesthesia?
IV fluids ## Footnote Administering intravenous fluids helps to increase blood volume and blood pressure.
232
Giving a large volume with a long-lasting local anesthetic can lead to?
Result in paralysis of the intercostal nerves, leading to impaired respiration ## Footnote Intercostal nerves are responsible for the movement of the chest wall.
233
What medication can be used to counteract vasodilation due to local anesthesia?
Dopamine ## Footnote Dopamine can help restore vascular tone and improve blood pressure.
234
What is the perferred benzodiazepine for dogs with hepatic dysfunction?
Midazolam ## Footnote MOA- enhance GABA - gamma-aminobutyric acid (inhibitory neurotransmitter)
235
Where do epidural injections go?
Epidural Space ## Footnote The procedure involves palpating the wings of the ilium and the dorsal spinous processes of L7 and S1, and advancing through supraspinous and interspinous ligaments.
236
What is the order of lipophilicity for the following drugs: Buprenorphine, Fentanyl, Hydro, Morphine?
Buprenorphine > Fentanyl > Hydro > Morphine ## Footnote This ranking indicates the relative solubility of these drugs in lipids.
237
Why is morphine preferred for epidural analgesia?
Because of its relatively low lipophilicity ## Footnote Morphine provides analgesia for 12 to 24 hours by this route.
238
True or False: Fentanyl is commonly used in epidurals.
False ## Footnote Fentanyl is very lipid soluble and not used in epidurals.
239
Contraindications for a epidurals?
C – coagulopathy H – hypotension, hypovolemia I – infection, inflammation N – neoplasia A – anatomical abnormality
240
Adverse effect of epidurals?
- neural damage or neurotoxicity, - infection, - subarachnoid, spinal, or subdural injection, - IV injection, - hypotension, - bradycardia, - Horner’s syndrome, - resp depression, - total spinal anesthesia, - toxicity, - urinary retention ## Footnote Thoracic breathing – if a large volume is use affecting diaphragm (Paralysis)
241
Ketamine MOA?
- Acts on NMDA, opioid, monoaminergic, and muscarinic receptors - Noncompetitive antagonists at NMDA R - Act at mu, delta, and kappa opioid Rs ## Footnote Also interact with votlage gated Ca channels
242
243
True or False: Ketamine safe to use w/ epidural.
True ## Footnote Better somatic (vs. visceral) pain control
244
Does Ketamine have better somatic pain control or visceral pain control?
Better Somatic pain control
245
Tramadol
- Weak µ agonist - Analgesic properties through inhibition of reuptake of Serotonin and NE (adrenergic receptor effects within CNS) ## Footnote Motablized in liver and excreted renally. Is 30% excrete unchanged in kidneys.
246
What percent of the Tramadol is excreted unchanged via the kidney's?
30%
247
MAC of isoflurane, sevoflurane and desflurane?
## Footnote "MAC" (Minimum Alveolar Concentration) is the minimum alveolar concentration of an inhaled anesthetic required to prevent movement in response to a standardized noxious stimulus in 50% of patients
248
What begins Stage III of anesthesia?
Cessation of muscular movement and onset of regular pattern of breathing ## Footnote This stage is crucial for surgical procedures.
249
What is the goal plane for anesthesia?
Plane 2 ## Footnote Plane 3 is also acceptable but indicates a deeper level of anesthesia.
250
At what plane does the palpebral reflex disappear?
Plane 2 (light-medium) ## Footnote The palpebral reflex is an important indicator of anesthesia depth.
251
At what plane does the pupillary light reflex (PLR) disappear?
Plane 3 (deep medium) ## Footnote Loss of PLR indicates a deeper level of anesthesia.
252
Fill in the blank: Stage III of anesthesia is characterized by _______.
cessation of muscular movement ## Footnote This is a key feature that allows for surgical intervention.
253
True or False: Plane 3 of anesthesia is considered too deep for surgical procedures.
False ## Footnote Plane 3 is acceptable but indicates a deeper level of anesthesia.
254
What does end-tidal CO2 provide an estimate of?
Arterial CO2
255
What is required to deliver CO2 to the alveoli?
Perfusion of the alveoli
256
How can end-tidal CO2 monitoring be used in clinical settings?
To indicate changes in pulmonary perfusion and cardiac output
257
What are the three factors associated with end-tidal CO2 monitoring?
* Ventilation * Leak * Arrest ## Footnote Consider this: * CO2 Production * Alveolar Ventilation * Pulmonary perfusion * Apparatus malfunctioning (Leak) * Arrest
258
End-tidal CO2 is typically ____ mmHg less than PaCO2.
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