Anesthesia Equipment And Safety Flashcards
(98 cards)
1
Q
List 2 North American professional organizations that offer specialization in anesthesia and analgesia and summarize the aims of each.
A
- Academy of Veterinary Technicians in Anesthesia and Analgesia (AVTAA)
- promote interest in the discipline of vet anesthesia - American College of Veterinary Anesthesia and Analgesia (ACVAA)
- define and promote the highest standards of clinical practice of vet anesthesia and analgesia and to define criteria used to designate vet with advanced training as specialists in the clinical practice of vet anesthesiology
2
Q
Anesthesia
A
Loss of sensation
3
Q
General anesthesia
A
Reversible state of unconsciousness, loss of sensation, immobility, and muscle relaxation even if presented with painful stimulus
4
Q
Surgical anesthesia
A
General anesthesia with sufficient analgesia and muscle relaxation (Plane 2, medium anesthetic depth)
5
Q
Local anesthesia
A
Disruption of sensory neurons nerve impulse = loss of sensation in a small area of the body by administering local anesthetic agent in area of interest (infiltration)
Sensory neurons - transmit nerve impulse from periphery to CNS after sensing pain/heat or cold/pressure
6
Q
Topical anesthesia
A
Loss of sensation to a localized area by administering anesthesia directly to skin/body surface
Ex. Spray lidocaine in open wound
7
Q
Regional anesthesia
A
Loss of sensation in a limited area of the body by administering agent in proximity to sensory nerve
Ex. Lidocaine/Bupivacaine Injection (Epidural)
8
Q
Epidural
A
Loss of sensation in pelvis, hindquarters (hind legs, quadriceps)
Ex. Lidocaine/Bupivacaine Injection
9
Q
Sedation
A
Drug induced CNS depression and drowsiness varying from light to deep intensity (unconscious, unaware, arousal with noxious stimulus)
Ex. Neurolept analgesia
10
Q
Tranquilization
A
Drug induced state of calm where patient is reluctant to move, unconcerned but aware of surrounding (conscious)
Ex. Trazodone, Acepromazine
11
Q
Hypnosis
A
Drug-induced sleep-like state impairing ability to response to stimuli; need proper arousal for sufficient stimulation
Ex. Propofol
12
Q
Narcosis
A
Narcotics induced sleep which patient is not easily aroused
Ex. Opioid
13
Q
What are the advantages of multimodal/balance anesthesia
A
Administer multiple anesthetics in smaller quantities - synergistic effects, minimize adverse effects
Maximizes/maintain pain control and other positive effects (muscle relaxation)
14
Q
Therapeutic Index (TI)
A
Dose range which a medication is effective without unwanted adverse effects
Anesthetics have low TI = narrow margin that can be safely administered
15
Q
List common indications for anesthesia.
A
Performing surgery, dentistry, diagnostics, wound care, transport, restraint of aggressive patients
16
Q
What are the challenges and risks with anesthesia?
A
Pulmonary and cardiac function affected by anesthesia: decreased cardiac output, hypothermia, hypoventilation, hypoxemia/hypercapnia, hypotension
constantly check vital signs, monitoring equipment, and patient
17
Q
List the qualities and abilities of a successful veterinary anesthetist.
A
High level of knowledge
Competency
Commitment
Acceptance of responsibility on the part of the anesthetist
18
Q
What is the role of a VT in communication and why do you need to communicate effectively?
A
Link between patient, client, DVM
Patient advocate
Educate clients
Relay accurate info to DVM
19
Q
Why should a preoperative patient evaluation occur?
A
Gathered info could lead to factors complicating anesthesia affecting DVM’s decision to change protocol/delay procedure
20
Q
List the parts of a minimum patient database.
A
Patient history
Signalment
Physical exam
Preanesthetic diagnostics
21
Q
How can a patient’s signalment (species, breed, age, sex, reproductive status) influence the anesthetic procedure and pain management?
A
Sensitivity to drugs (cats to opioids)
Difficult intubation (bracycephalic)
Slow metabolism, recovery (neonates)
Estrous cycle and pregnancy status (drugs cross placental barrier)
22
Q
How would you gather a patient’s history?
A
Ask open-ended, non-leading questions
Eating, drinking, defecation, urine, behavior, vomiting, regurgitation, coughing, sneezing (duration, volume/severity, frequency, and appearance)
Medications/vaccine status/preexisting medical history
23
Q
What factors influence anesthetic procedures or pain management?
A
Dehydration - ↑ hypotension, poor tissue perfusion
Anemia - hypoxemia
Bruising - clotting disorder
Respiratory/Cardiovascular dz- anesthetic complications
Enlarged liver, small kidneys - ↓ metabolism, inability to excrete anesthetic agents
Ear mites/infection, fleas, overgrown nails, impacted anal glands - co-treated during surgery
Physical abnormalities - retained testicle = complex case
24
Q
List the abnormalities associated with signlament critetia.
A
Eating - hyporexia/anorexia
Drinking - polydipsia/hypodipsia/adipsia
Defecation - tenesmus (frequent defecation)/diarrhea
Urine - pollakiuria/polyuria/oliguria/anuria
Behavior - pain/exercise/intolerance/syncope
25
What is the rationale for obtaining an owner consent form? What needs to be discussed with the owner?
Law – obtain client’s consent
Correct patient
Cost estimate
Discuss procedure risks, fasting & CPR status
Extra Label Drug Use
Contact information
26
What are the normal vital signs for dogs?
Psys(mmHg): 90-140
HR(bpm): 60-180
Respiratory Rate: 10-30, pant
Heart Rhythm: NSR/SA
Temp: 100-102.5°F
SPO2: 95-100%
MAP: 70-100 mmHg
MM: pink, pale pink, pigmented
CRT: <2 sec
ETCO2: 35-45 mmHg (<55 mmHg anesthetized)
<5% dehydrated (skin turgor, MM, enopthalmos)
27
What are the normal vital signs for cats?
Psys(mmHg): 80-140
HR: 120-240 bpm
Respiratory Rate: 15-30
Heart Rhythm: NSR
Temp: 100-102.5°F
SPO2: 95-100%
MAP: 70-100 mmHg
MM: pink, pale pink, pigmented
CRT: <2 sec
ETCO2: 35-45 mmHg (<55 mmHg anesthetized)
<5% dehydrated (skin turgor, MM, enopthalmos)
28
How can a patient's body weight affect selection of anesthesia?
Dose of anesthesia = based on lean body weight/exclude fat
Cachexia – sensitivity to barbiturates, risk of hypothermia
Obesity – compromised cardiovascular system & functional lung volume
29
What are some tasks during preanesthetic preparation?
1. Obtain sample & run diagnostics
Minimum diagnostics: PCV/TP, BUN, ALT
2. Stabilize conditions – dehydration, anemia
3. Place an IV cather
4. Know fasting status & administer prescribed premedication
30
What are the 5 patient physical status classifications as specified by the American Society of Anesthesiologists?
PS1 - Minimal risks/Normal,healthy pt criteria/OVH (elective) conditions
PS2 - Low risks/ Mild systemic disease criteria/Conditions-Neonates, Mild Dehydration
PS3 - Moderate risks/severe systemic disease criteria/ Conditions-Anemia, Organ disease, dehydrated
PS4 - High risks/ Severe life-threatening disease criteria/ conditions- Hemorrhage, pyometra
PS5 - Extreme risks/ Moribund – life saving operation criteria/ Conditions- Pulmonary embolus, GDV
31
What is the recommended withholding time for food and water for various species?
Dogs and cats: 8-12 hours (food)/2-4 hours (water)
Horses: 8-12 hours (food)/0-2 hours (water)
Cattle: 24-48 hours (food)/8-12 hours (water)
Small ruminants: 12-18 hours (food)/8-12 hours (water)
Neonates and pediatric patients: none for both
32
Why would an IV catheter be advisable for anesthetized patients?
- Maintain blood volume & pressure
- Rapid drug administration
- CRI: slow continuous infusion by syringe pump to maintain drug/anesthesia effect
- Administer vesicants – damaging to tissue when injected perivascularly
33
Why is fluid administration indicated for anesthetic procedures? How does anesthesia affect blood homeostasis?
Anesthetic agents cause
• Negative inotropy - ↓ force of muscle contractions (bradycardia, ↓ cardiac output)
• Vasodilation – vessels relax ↑ intravascular volume (hypotension, decrease tissue perfusion)
IV fluids ↑ circulation blood volume & cardiac output
Dehydration depletes ECF fluid
Hemorrhage depletes IV fluid
34
Perform an infusion rate calculation.
lb x 1kg/2.2lb x mL/(kg/hr) x 1hr/60min x 1min/60sec x gtt/mL
Macrodrip Set = 10-15gtt/mL
(>100mL/h, >10-20kg patients)
Microdrip Set = 60gtt/mL
(<100mL/h, <10-20kg)
35
Replacement Fluid
↑ Na⁺ and Cl⁻ (replace fluid in ECF = ideal for dehydration)
36
Maintenance fluid
↓ Na⁺ and Cl⁻, ↑ K⁺ (maintain fluid balance longer period, similar to TBW)
37
Balanced
Osmolarity similar to ECF
38
Isotonic
Hypertonic
Hypotonic
Isotonic: osmolarity similar to plasma
Hyper: > plasma osmolarity (cell shrink)
Hypo: < plasma osmolarity (cell swell)
39
Crystalloids (LRS, Norm-R, Plasmalyte, NS, D5W)
Fluid composed of water, small solutes (electrolytes), +/- dextrose & buffers routinely used for healthy anesthetized patients
40
Isotonic Replacement Solution (LRS, Plasmalyte, Norm-R)
- Water, electrolytes, ± dextrose & buffers
- Routinely used for anesthetized patients
- Standard Rate: 10mL/kg/h for first hour then 3-5 mL/kg/h
41
Normal Saline (0.9% Sodium Chloride)
- Flush cavities, catheters, blood transfusion (Addisonian patient)
- More acidic than isotonic replacement & maintenance fluids
- Can cause hypokalemia if not supplemented
42
Dextrose (D5W)
- Mixed with isotonic replacement solution
- Rapidly metabolized as CO₂ & H₂O
- For treatment of hypoglycemia, diabetes
- Contraindicated for shock/hemorrhage
43
Hypertonic Saline (7.2% NaCl)
- Treatment of hypovolemic shock (↓ plasma)
- Temporary treatment for hemorrhage
- Treat ↑ intracranial pressure, hyponatremia
- 4-5 mL/kg (dogs) & 2-4 mL/kg (cats) given slowly (> 5 minutes) to prevent hypotension, bradycardia
44
Colloids (Vet Starch: synthetic, blood products)
Treatment
- Hypotension, shock
- Severe anemia (pRBC)
- Hypoproteinemia, coagulation disorder, thrombocytopenia (low platelet)
Can cause volume overload, reaction, coagulation disorder
45
What are signs and patients at risk for volume overload?
Patients
<5kg, cats, history of cardiac/renal disease
Signs
Ocular & nasal discharge
Swelling of conjunctiva
Subcutaneous edema
↑ lung sounds, RR, dyspnea
46
What is hemodilation and patients at risk?
Dilution of plasma proteins and RBC seen in anemic and hypiproteinemic patients
47
What is the advantage of endotracheal intubation?
Administer O2 & inhalant anesthetics
Maintain open airway
CPR
48
Describe the function and use of anesthetic masks.
Plastic/rubber; rubber gasket to create seal
Indication: Anesthesia induction & maintenance, rapidly delivery of oxygen
Use exclusively for small mammals
Contraindiction: Doesn’t maintain open airway, protect from pulmonary aspiration & allow for manual ventilation
49
Describe the function and use of each component of an anesthetic chamber.
Clear acrylic/plastic box with removable top; ports deliver fresh gas & remove WAG
Indication: Induce general anesthesia in small animals that cannot be physically restrained
Contraindiction: Requires close monitoring of patient, ↑ WAG exposure
50
Describe the basic operation of an anesthetic machine.
Liquid anesthetic vaporized in carrier gas delivered to a patient by breathing circuit
- Controlled oxygen flow rate
- Precise concentration of iso/sevoflurane
- Remove CO2 /exhaled gas by scavenging system.
- When recirculate gas - filter CO2 out
51
What are the four basic anesthetic machine systems?
1. Compressed gas supply
2. Anesthetic vaporizer – vaporizes liquid inhalant mixing it with carrier gas
3. Breathing circuit – delivers fresh gas, remove CO2 (rebreathing & non-rebreathing)
4. Scavenging system – remove WAG
52
Trace the flow of oxygen through an anesthetic machine and patient breathing circuit for a rebreathing circuit.
Rebreathing (>7kg)
1. Tank (tank pressure gauge 2,200psi)
2. Pressure reducing valve (line pressure gauge 50psi)
3. Flowmeter (15psi, adjust 0-4L/min) → Vaporizer inlet port
4. Vaporizer → Vaporizer outlet port → Fresh gas inlet
5. Inspiratory Unidirectional Valve → Inspiratory Tube →
Y piece → ETT
6. ETT → Y-piece → Expiratory Tube → Expiratory Unidirectional Valve
7. CO2 canister → Pop-off valve/pressure manometer → Reservoir bag
8. Fresh gas inlet & Scavenger (CO2 gas)
53
Trace the flow of oxygen through an anesthetic machine and patient breathing circuit for a non-rebreathing circuit.
Non-rebreathing (<7kg)
1. Tank (tank pressure gauge 2,200psi)
2. Pressure reducing valve (line pressure gauge 50psi)
3. Flowmeter (15psi, adjust 0-4L/min) → Vaporizer inlet port
4. Vaporizer → Vaporizer outlet port
5. ETT (fresh gas inhaled by patient)
Bain Coxial Circuit – various Mapleson classification
6. Fresh gas inlet → ETT
7. ETT → RB & pressure manometer → Overflow valve
8. Scavenger
54
Explain the use of the oxygen supply of an anesthetic machine, including safety concerns associated with compressed gas cylinders.
- Ensure oxygen supply is on (START OF DAY)
- Close valve (E tank), purge gas line (END)
Safety
- Flammable carrier gas
- Turning on E tank, ensure attached to yoke
- Support tank when standing
- Safety measures in place - color coded, PISS
55
Describe the function and use of each component of a compressed gas cylinder/oxygen tank.
Contains carrier gas (O2 / N2O – rarely used)
- Small E Tank: attaches to fitted yoke (safety)
- Large H Tank: chained to wall
Valves control flow: "Righty tighty, lefty loosey"
56
Describe the function and use of a tank pressure guage (B).
Indicates amount of gas in task (2200 psi – full)
LE = PSI x 0.3 (660L – full)
LH = PSI x 3 (6600L – full)
Change tank when <500psi (150L)
57
Describe the function and use of the pressure reducing valve (C).
Reduced pressure of gas leaving tank 40-50 psi carried through source lines
58
Describe the function and use of the line pressure guage.
Indicates pressure in intermediate pressure gas line (40-50 psi when O2 on)
Will continue to register pressure until line is purged (depress oxygen flush valves/turn flowmeter to high rate of flow until gas is vented)
59
Describe the function and use of flowmeters.
Reduce pressure to 15psi
Control flow rate 0-4L/min, read ‘center’ of ball
60
Describe the function and use of oxygen/fast flush valve.
Quickly infuse oxygen in breathing circuit
• Rapidly fill reservoir bag, deliver oxygen to ill patient, dilute out anesthetic gas using short burst
• Only use in nonbreathing system when pop-off valve is OPEN = ↑ pressure to lungs, atelectasis(partial/collapsed lung)
61
Describe the function and use of a vaporizer.
Holds liquid anesthetic added in a controlled amount into carrier gas entering from the flowmeter to vaporizer inlet port
Fresh gas exits through vaporizer outlet port → fresh gas inlet (breathing circuit entrance)
62
Non-precision vaporizer
Vaporizer in circuit (VIC)
Uncommonly used – used on discontinued inhalants (Methoxyflurane) with low vapor pressure that does not readily evaporate
VIC – carrier gas O2 enters breathing circuit, bypassing vaporizer
63
Precision vaporizer
Vaporizer out of circuit (VOC)
Used with high-vapor-pressure anesthetics, each vaporizer must be filled with the specificied inhalant calibrated for it
VOC – O2 from flowmeter passes to vaporizer before entering breathing circuit
64
Identify factors that affect anesthetic vaporizer output.
Temperature: hotter room ↑ vaporized anesthetic than indicated in dial = patient receives more (newer vaporizer compensates for change)
Gas flow rate: ↑ O2 flow rate = ↑ anesthetic in uncompensated vaporizer. >10L/<250mL
RR/RD: affects VIC/nonprecision vaporizer
Back pressure: ↑ pressure at vaporizer outlet port manual bagging & flushing O2 valve
65
Explain differences between a rebreathing and a non-rebreathing system with regard to equipment, gas flow, advantages, disadvantages, and indications for use.
66
Explain the advantages and disadvantages of closed and semi-closed rebreathing systems.
Closed/Total Rebreathing – LA anesthesia
• Pop-off valve nearly/completely closed
• Low flow rate, CO2 buildup, ↑ pressure
• Same volume added that is consumed by patient (difficult to achieve, requires constant monitoring)
Semi-closed rebreathing – commonly used in SA anesthesia
• Pop-off valve partially open
• More oxygen than patient requirement
67
Describe the function and use of unidirectional inspiratory and expiratory valve.
Attachment for corrugated breathing tube – attached together at Y piece to connect to ETT
Controls gas flow to circular path
Used to monitor respiration – valves will flatter for inspiratory valve only during inhalation & vise versa
68
Describe the function and use of air intake/negative pressure relief valve.
SAFETY MECHANISM - admits room air into in the circuit during negative pressure = inability of lungs to fill with air → hypoxemia
Can be incorporated on top of inspiratory valve
69
Describe the function and use of the CO2 canister.
"Scrub" CO2 from the gas coming from expiratory unidirectional valve before returning expiratory gases to the patient
Change every 6-8 hours or when 30-50% of granules changed color (violet, off-white) or brittle
Capnograph will read close to 0mmHg during inhalation when granules changed
70
Describe the function and use of the pop-off valve (pressure relief, overflow, adjustable pressure valve)
Allows fresh gas to exit to scavenger
SAFETY MECHANISM – partially open to prevent buildup of pressure in system
Closed during manual ventilation/bagging
71
Describe the function and use of the reservoir/rebreathing bag.
Reservoir for expired air that patient can rebreathe
Monitor respiration – partially deflate (inspiration), expand (exhalation)
Monitor ETT placed in trachea – move synchronously
Provide manual ventilation
72
Describe the function and use of the pressure manometer.
Measure pressure in breathing circuit = pressure in patients lungs
0-2cm H₂O – open pop off valve, spontaneous breathing
20 cm H₂O/15mmHg (SA) – normal assisted ventilation
30-35 cm H₂O – GDV, open chest
73
State the sizing guidelines for reservoir and corrugated breathing tube.
Breathing Tube
• Pediatric (15mm diameter): 2.5-7kg
• SA (22mm): >7kg
• LA (50 mm): >20kg
Reservoir bag (50mL/kg = bag size in mL, round ↑)
• 500 mL ≤3kg
• 1L 4-7kg
• 2L 8-15kg
• 3L 16-50kg
• 5L 51-150kg
74
Explain the procedure that should be followed to prepare an anesthetic machine for use.
75
Explain the impact of oxygen flow rates on anesthetic concentration within the breathing circuit, changes in anesthetic depth, patient safety, and waste gas production.
Based on VT 10mL/kg x RR 10-20bpm, circuit, anesthetic period, mask/chamber
RSC – more economical, Δ depth slower, air warmed & humidified, vent WAG based on O2 flow rate
76
List oxygen flow rates for each common domestic species, breathing system, and period of an anesthetic event.
N-R (semi-open): 100-200mL/kg/min
N-R (open): 300-400mL/kg/min
RSC induction, recovery: 50-100mL/kg/min (max 5L/min)
RSC induction maintenance: 20-40mL/kg/min – low flow
Mask: 1-3L/min (≤10kg), 3-5L/min (>10kg)
Chamber: 5L/min
77
Performing anesthetic machine maintenance.
Adjust pressure reducing valve (40-50psi)
Flowmeter: do not overtight when closing
Vaporizer – serviced; emptying q 6-12hr old inhalants
Hoses: check holes, defects
Unidirectional valve: diassemble & clean
Pop-off valve: check periodically still operational
RB, breathing tube, Y-piece: disconnect & clean each part
78
Performing anesthetic machine leak test.
Low pressure system test (non-rebreathing): test lines between flowmeter & Y-piece
1. Turn on oxygen tank
2. Close pop-off valve & occlude Y-piece
3. Turn on flowmeter to 3-5L/min, use oxygen flush valve to fill RV. Pressure manoter = 30 cmH2O
4. Turn off flowmeter, pressure manometer should rop
79
Identify recommended exposure limits (RELs) for waste anesthetic gases.
National Institute for Occupational Safety & Health (NIOSH) <2ppm (Isoflurane, Sevoflurane), <0.5 (with N2O)
OSHA no limit, ensure NIOSH standards met
80
List the factors that affect waste gas levels in a veterinary hospital.
↑ Waste Anesthetic Gas (WAG)
Duration – longer procedures
O2 flow rate – higher flow rate
Improperly maintained/leaking anesthetic machine
No scavenger
Mask/chamber induction & maintenance
Improperly ventilated room(15-21 air change/hour) Spills
81
Describe the short-term and long-term effects of waste anesthetic gas on persons working in health care environments.
Short Term
Fatigue, Headache, Nausea, Drowsiness
Long term
Reproduction, kidney/liver/CNS & bone marrow disorder – toxic metabolites
82
Describe procedures and practices used to minimize waste gas release.
Compare and contrast active and passive scavenging systems and describe the four components of a scavenging system.
Scavenging system remove >90% WAG – attaches to popoff/overflow valve
Active: suction from vacuum draw gas into scavenger (more costly, maintenance)
Passive: positive pressure ‘push’ gas into activated charcoal canister (weigh & date; +50g, >12h= dispose)
83
Explain how waste anesthetic gases are monitored.
Check periodically/concerns for increased levels/odors, pregnant anesthesists
Occupational hygienist check ventilation & scavenger
Measure air samples with infrared spectrometer
Passive dosimeter – comes uncapped, worn, capped after exposure & returned to OSHA for analysis
84
Identify hazards associated with use of compressed gas cylinders.
Describe proper procedures for handling, storing, and transporting compressed gas cylinders.
Gas cylinders = fire hazard, pressurized
- Turn on cylinders when connected to anesthesia machine, wearing PPE (goggles), turning valve slowly
- Store upright position
- Move cylinders using dolly, secured before release
- Label tanks, separating empty & full
85
Identify hazards from potent injectable agents.
Outline the precautions necessary for handling potentially hazardous injectable agents.
Skin, eye, oral exposure from inhalants & injectables
(sedation/disorientation, respiratory depression)
- PPE (gloves, goggles)
- Carefully load (Luer lock, tight needle)
- Avoid needle sticks, recapping
- Use sharps container to dispose
- When exposed provide immediate first aid, call emergency hotline
86
Pain
Aversive sensory & emotional experience that elicit protective motor action (biting), avoidance (fear) & alters species-specific traits (social behavior)
87
Nociception
CNS & PNS processing a noxious stimuli (chemical, thermal, mechanical that can cause tissue damage) activating nociceptors and their pathways
88
List the main steps of the pain pathway.
1. Transduction: nociceptors process noxious stimuli (depolarization of pain neurons)
2. Transmission: conduction of sensory impulses through the spinal cord
3. Modulation: neurons amplify (send to brain)/suppressing (release of local endogenous opioids) impulse
4. Perception: brain process pain → reaction (withdrawal, vocalization, aggression)
89
Physiologic pain
Adaptive pain
Acute pain
Protective sensation occurring when there is actual/possible tissue injury (avoiding fire)
Promotes survival to prevent further injury/promote healing
Immediately occurs when tissue is damaged resolving once tissue is healed
90
Pathological pain
Maladaptive pain
Chronic pain
Prolonged & exaggerated pain Malfunction/damaged nociception from constant noxious stimualtion – mediators released ↓ pain threshold ↑ sensitivity
No function, just causes suffering & difficult to treat
Pain after tissue healed (weeks-years) or tissue not healing (cancer)
91
Pain Origin:
Inflammatory pain
Neuropathic pain
Visceral pain
Somatic pain (superficial/deep)
Idiopathic pain
- Occurs at site of tissue injury from release of chemical mediators
- Injury to nervous system (nerve damage)
- Organ pain (pleuritis)
- Musculoskeletal pain (skin, bones)
- Unidentifiable cause of pain
92
Analgesia
Preemptive Anesthesia
Use of pharmaceuticals to relive/avoid pain
Analgesia is usually provided prior to an anticipated painful procedure to prevent windup & reduce requirement for post-op analgesics
93
List the consequences of untreated pain.
- Catabolism
- Distress (extreme stress)
- Immune Suppression
- Inflammation = Delayed Wound Healing
↑ anesthetic risk = increase dose
- Neuroendocrine change (release corisol)
↑ myocardial consumption = arrhythmia
↑ morbidity, mortality
94
How does primary and secondary analgesia develop?
As an aftermath of pathologic pain
- Peripheral Hypersensitivity: ↑ sensitivity to pain (painful to touch fractured wrist)
- CNS Hypersensitivity/Windup: manifestation of allodynia area close to site of tissue injury is
painful if stimulated with a non-noxious stimulus (touching forearm of fractured wrist)
95
What are symptoms that may indicate an animal is painful? (Physiological)
Cardiovascular: hypertension, tachycardia, tachyarrhythmia, peripheral vasoconstriction (pale mucosae)
Respiratory: tachypnea, shallow breathing (abdominal or thoracic guarding), exaggerated abdominal component, panting (dogs), open-mouth breathing (cats)
Ophthalmic: mydriasis
96
What are symptoms that may indicate an animal is painful? (Behavior)
- Hiding, seeking attention, stoic, staring
- Change in gait, limping, exericse intolerance
- Uncomfortable, prayer position
- Vocalizing, aggression
- Glazed, squinting (cats)
- Unkempt apperance
97
List common surgical and medical conditions that are considered to be painful.
Medical Conditions: arthritis, cancer, cystitis, pancreatitis, peritonitis, pleuritis
Surgical Conditions: spinal surgery, fracture repair, total hip replacement, joint surgery, ear surgery, dental extractions, rhinotomy or sinus surgery, trauma, eye surgery, thoracotomy, gastric dilation-volvulus, colon tension, pyometra
98
Examples of pain assessment tools.
- Descriptive scale (mild, moderate, severe)
- Visual analogue number line (no pain – worst)
- Numeric (0=no pain, 1=mild..) CSU pain scale
- Categorical numerical scale - assign numerical value to categories, ↑ score = more painful
- Validated scale – descriptors assigned points with high scores requiring analgesia
