Anesthesia Final Review: Janet Flashcards
1
Q
What is the surgical fluid rate and how often do we record this on the anesthesia form?
A
10mls/kg/hr
every 15 min.
2
Q
What is the hypotensive fluid rate?
A
3-5mls/kg as a bolus
or double surgery fluids (20ml/kg/hr) for 15min.
3
Q
Rebreathing system requirement and steps
A
> 7kg
- attach Y tubing
- attach res. bag
- scavenge
- open pop-off
4
Q
Non-rebreathing system requirement and steps
A
<7kg
- attach fresh gas to outlet port on vaporizer
- scavenge directly to scavenge system
- pop off open
5
Q
O2 flow rates & minimum rate
A
> 7kg= 30ml/kg/min
<7kg=200ml/kg/min
Never less than 500mls/min
6
Q
Equation for finding how much O2 you have in your tank
A
psi X 0.3= liters of O2
7
Q
CO2 absorbing granules should be used no more than ____ or until they ____.
A
6-8hours
Turn blue/become brittle
8
Q
2 Types of scavenge systems
A
Passive or Active
9
Q
____ scavenges can be used for up to ____ or until weight gain of ____.
A
Passive
12 hours
50grams
10
Q
Steps to pressure checking system.
A
Set up rebreathing system Cover Y tubing Close pop-off Inflate res. bag Build pressure to 20cm H2O on manometer
11
Q
When pressure checking the pressure manometer should not fall ____ in ____.
A
Should not fall more than 5 cm in 30 seconds
12
Q
How to calculate res. bag size
A
60mls/kg (round up to next whole liter)
13
Q
How do you measure for length of ET tube?
A
Tip of nose to thoracic inlet
14
Q
When intubating cats, you may need what 2 things to help?
A
Lidocaine lube and stylet
15
Q
Esophageal stethoscope is measured from ___ to ____
A
tip of nose to mid-sternum
16
Q
The esophageal stethoscope measures ___ and should be recorded every ___.
A
HR, every 5 min.
17
Q
Class 1 anesthetic risk
A
EXCELLENT
Elective procedure only
Normal healthy patient
18
Q
Class 2 anesthetic risk
A
GOOD Brachy/sighthound Slight to mild dz. Well controlled dz. Simple fracture
19
Q
Class 3 anesthetic risk
A
FAIR Moderate systemic dz. 1 or more controlled dz. Moderate dehydration/fever Moderate fracture
20
Q
Class 4 anesthetic risk
A
POOR
Surgery must be done to save life of patient
Severe systemic dz/dehyrdation/fever
21
Q
Class 5 anesthetic risk
A
GUARDED
Close to death
Patient not expected to live with or without surgery
22
Q
PA Physical exam should consist of what 6 values?
A
T P R Weight MM/CRT Body condition
23
Q
What 2 PA physical exam values are important to know before surgery?
A
Temperature– fever may indicate infection and hypothermia pt. will not need as much GA
Weight– accuracy is important for doses
24
Q
Why is patient history a good thing to have?
A
Duration of problem– sooner= better
Concurrent diseases– fix first
Anesthesia history– any previous issues?
25
Which 2 breeds are at a higher anesthetic risk?
Brachycephalics and sighthounds
26
An obese patient should be dosed based on their ____ and an anorexic patent should be dosed based on their ____.
Ideal weight
| True weight
27
An aggressive patient would be at a higher risk due to ____.
Increased stress and inability to get PA info
28
What is the bare minimum PA lab work?
PCV & TP (red top tube)
29
What 4 things does a blood chemistry include?
GLU
BUN/Creat
ALT/Alk.Phos
TP
30
PCV diagnoses ____ and evaluates ___ and gives you____ status
Anemia
O2 carrying capacity
Hydration
31
TP gives you ____ status, ____, and ____.
Hydration status
Blood loss
Liver info
32
___ will always drop before ___.
TP drops before PCV
33
Name the anticholinergics
Atropine
| Glycopyrrolate
34
Anticholinergics block function of ____ & the ____ nerve.
acetylcholine
| vagus nerve
35
Main side effects of anticholinergics
```
SLURED<3
Decreased salivary secretions
Decreased lacrimal secretions
Mydriasis in cats
Increased heart rate
```
36
What is the MAIN reason for use of anticholinergics?
Prevent bradycardia
37
```
Atropine Sulfate:
Brand name
Family
Duration
Common use
```
```
Atropine
Anticholinergic
60-90min.
Increases heart rate and prevents bradycardia
Commonly used for emergency HR increaser
```
38
```
Glycopyrrolate
Brand name
Family
Duration
Common use
```
Robinul-V
Anticholinergic
4 hours
Less likely to cause tachycardia
39
You should NOT use anticholinergics if your patient is ___.
Tachycardic
has CHF
Hyperthyroid
40
2 types of tranquilizers
Phenothiazine & Benzodiazepine
41
Phenothiazine tranquilizer:
Brand name
Side effects
Route
Acepromazine (Promace)
Vasodilation (decreased BP)
NOT reversible
PO,SQ,IM,IV
42
Acepromazine is most commonly used for its ____ properties, but it also prevents ____ and is a ____.
Calming/Relaxing
Vomiting
Antiarrythmic
43
Maximum dose = 3grams in ____.
Acepromazine
44
Acepromazine usually lasts ____ hours, but up to ___ in some.
4-8hours
| 24hours
45
Name the Benzodiazepine tranquilizers
Diazepam- Valium
Midazolam- Versed
Zolazepam- in Telazol
46
What is the Benzo tranquilizer reversal agent?
Flumazenil
47
Benzodiazepine tranquilizers are used for ___ but have no ____. They are also a ____ and appetite stimulant in cats.
Calming & antianxiety
Analgesia
Anticonvulsant
48
Diazepam is given ____ and is best as a _____.
(Benzodiazepine tranq) Valium
IV, slowly
Combo drug
49
Midazolam is ___ so it can be mixed with other drugs easily and its route is ____.
(Benzodiazepine tranq) Versed
Water soluble
IM or SQ
50
Zolazepam is combined with ____ in ____. It can be used as a sole agent for ____ procedures or ____.
(Benzodiazepine tranq)
Tiletamine in Telazol
Short
Induction agent
51
Which tranquilizers are not usually used alone due to possible excitement & minimal sedation?
Benzodiazepine tranquilizers
52
Name the 3 Alpha-2 agonists (sedatives)
Xylazine- Rompun
Medetomidine- Domitor
Dexmedetomidine- Dexdomitor
53
Alpha-2s (are/are not) controlled. They produce ____, _____, & _____. But they also cause ____ and ____ causing pale MM and decrease in temp.
are NOT controlled
Analgesia, sedation & muscle relaxation
Vomiting
Peripheral vasoconstriction
54
Xylazine is reversed with ____.
| And is mainly used in ____ patients.
Alpha-2 (Rompun)
Yohimbine (Yobine)
Young, healthy patients
55
Medetomidine (____) is reversed with ____ and is dosed by ____.
Alpha-2 (Domitor)
Atipamezole (Antisedan)
Weight chart
56
Dexmedetomidine (____) is reversed with ____.
Alpha-2 (Dexdomitor)
| Atipamezole (Antisedan)
57
____ are given BEFORE giving Alpha-2s to prevent adverse cardio effects
Anticholinergics
58
What are the most effect drugs for pain?
Opioids
59
What is the most common side effect of opioids?
Respiratory side effects
Vomiting
CNS depression
60
What are opioids reversed with?
Naloxone HCl (Narcan)
61
Morphine is a ____ and has a ___ duration.
| Given ____ only.
(Duramorph)
Pure agonist opioid
4 hour duration (4+ in cats)
IM/SQ
62
Hydromorphone is a ____ opioid and has a ____ duration. It is also less likely to cause ____.
(Dilaudid)
Pure agonist opioid
4 hour duration
Vomiting
63
Oxymorphone is a ____ opioid, has a ____ duration, and is more expensive.
(Numorphan)
Pure agonist opioid
3-4 hour
64
Fentanyl has a ____ duration and is a ____ opioid.
30min.
| Pure agonist opioid
65
Fentanyl & Fentanyl patch brand name
Sublimaze
| Duragesic
66
Butorphanol is a ____ opioid and provides some ____ and analgesia. It has a ____ duration.
(Torbugesic)
Mixed opioid
some sedation
1-4 hour duration
67
Buprenorphine is a ____ ____ opioid and provides analgesia for ____ pain. Has a ____ duration and can be given ____ in cats
Partial agonist opioid
mild-moderate
6-8 hour
OTM
68
What are some common PA neuroleptoanalgesics
Acepromazine & Butorphanol
Diazepam & Hydromorphone
Versed & Fentanyl
69
What are 2 types of barbiturates and their main use?
Phenobarbitol- anticonvulsant
| Pentobarbitol- euthanasia agent
70
Cyclohexamines (are/are not) controlled and (are/are not) reversible.
ARE controlled
| ARE NOT reversible
71
Cyclohexamines mode of action?
CNS stimulation (disrupts/scrambles nervous system pathways)
72
What are some side effects of cyclohexamines?
Lowers seizure threshold
Increased sensitivity to sound/light
Hallucinations during recovery
Tachycardia and increased BP
73
____ have the side effect of apneustic respirations & Propofol a side effect of ____ respirations.
Cyclohexamines
| Transient apneustic
74
What are the 4 benefits of ET intubation
Establish airway
Prevents aspiration
IPPV
Decrease gas exposure to personnel
75
What does ET ID mean?
ET internal diameter-- measured in mm
76
What are some possible complications with over-inflation of the ET tube cuff?
Compression of the lumen
Pressure necrosis
Tearing/rupture of the trachea
77
What are some tools to assist with intubation?
Stylet (felines)
Lidocaine on vocal folds (felines)
Laryngoscope
78
What are 3 reasons why Benzodiazepines & Cyclohexamines are a good combo drug?
Cyclohexamines & Benzodiazepines
1. Decreased seizure thresh.-- Benzos are an anticonvusant
2. Rough recovery-- Smoother with Benzo
3. Catalepsy-- muscle relaxaion from Benzos
79
Cyclohexamines cause an ___ in heart rate so ____ should be used instead of ____.
Increase
Glyco instead of Atropine
(milder on heart)
80
Cyclohexamines have what effect on the eyes?
Nystagmus in cats
| Open, dilated & central
81
How are cyclohexamines metabolized?
```
Dogs= liver
Cats= excreted by kidneys
```
82
What is the most common induction agent used?
Ketamine
83
IV vs. IM ketamine
IV= faster onset and recovery, decreased dose, no tissue irritation
IM= longer duration, common in fractious/wild animals
84
Duration of IV & IM ketamine
```
IV= 3-10 min.
IM= Dog: 20-30 Cat:30-60min.
```
85
Ketamine-Diazepam should be given ____ only because ____ is not water soluble.
IV
| Diazepam
86
Tiletamine is a newer ____ found in ____.
dissociative
| Telazol
87
Propofol is a common ____ _____ and can be used as sole agent for short procedure.
IV induction agent
88
Propofol:
Controlled?
Analgesia?
Reversible?
NO
NO
& NO
(but is metabolized quickly)
89
What is the main cardiovascular effect of Propofol & how can this be minimized?
Hypotension immediately after injection-- Vasodilation
| Give IV fluids to minimize
90
When giving Propofol you should pre-oxygenate due to the ____.
transient apnea
91
Duration & complete recovery time of Propofol
Duration= 5-10min.
| Complete recovery= 20-30min.
92
Etomidate has ___ analgesia & (is/is not) controlled
NO
| NOT CONTROLLED
93
What is the best choice induction agent for high risk patients?
Etomidate
94
Etomidate is given ___ and may cause ____.
IV
| pain/irritation-- give with fluids
95
What is GGE & who is it commonly used in?
Guaifenesin
| Muscle relaxant in large animals
96
What can be used in sick/debilitated patients as an induction agent that CAN NOT be used as induction in normal healthy patients?
Neuroleptanalgesics
97
Color for ISO & SEVO
```
Iso= Purple
Sevo= Yellow
```
98
3 Physical properties of inhalant anesthetics
Vapor pressure
Solubility
MAC value
99
Vapor pressure measures what?
The tendency of anesthetic to go from liquid to gas
100
High vapor pressure want to ____.
Be a gas
| Evaporate easily
101
Solubility provides info on ____.
Speed of induction, depth change, and recovery
102
Low solubility = ____ gas
| High solubility = ____ gas.
```
Low= fast
High= slow
```
103
List the gases from low solubility to high solubility
Sevoflurane-fastest
Iso
Halo
Methoxyflurane-slowest
104
Inhalants with low solubility allow for ___ in stages/planes of anesthesia & ____ recovery.
Quick changes
| rapid
105
What does MAC stand for?
Minimum Alveolar Concentration
106
What is MAC?
The minimum alveolar concentration of a gas that produces no response to surgical stimulation in 50% of patients
107
MAC gives an indication of ____
Potency
108
The higher the MAC, the ___ the gas.
Less potent
109
List the gases from low to high MAC
Methoxyflurane- most potent
Halothane
Isoflurane
Sevoflurane- least potent
110
Halothane has ____ vapor pressure
High
111
Isoflurane has ____ vapor pressure & ___ solubility
High vapor pressure
| Low solubility
112
Isoflurane has rapid ____ & ____.
Changes in depth & rapid recovery
113
Induction & maintenance % Iso & Sevo
```
Iso= induction-2.5% maint-1.5-2.5%
Sevo= induction-4% maint-2.5-4%
```
114
Effects of Iso
Cardiovascular depression
Respiratory depression
0.2% metabolized by liver
Excellent muscle relaxation
115
Effects of Sevo
3% metabolized
Cardiovascular depression
Respiratory depression
Moderate muscle relaxation
116
Sevo vapor pressure, solubility, & MAC
High vapor pressure
Lowest solubility (fastest gas)
Highest MAC-- least potent higher vaporizer settings
117
Sevo has less ____ than Iso
pungent odor
118
What is the main benefit of induction chambers?
Little physical restraint
119
Route of PA drugs
IM or SQ
120
Induction agents are given ____ and this is to ____
to effect
| have the ability to intubate patient
121
List how you would hook up patient after intubating
Turn on oxygen
Attach breathing system to ET tube
Watch for respirations
Once patient is breathing, turn on gas
122
After hooking up patient to the anesthesia machine what are the following steps?
```
Pass esophageal stethoscope & obtain HR
Watch res. bag and obtain RR
(record on anesthesia for every 5min.)
Ventilate & listen for leaky ET tube
Inflate cuff if necessary
Lube eyes & record as comment on anesthesia form
```
123
What 5 vitals are recorded every 5 min?
```
Heart Rate
Resp. Rate
Blood Pressure
O2 saturation
ETCO2
```
124
What 2 things are recorded every 15min?
Fluids
| Temperature
125
What should ALWAYS be monitored during anesthesia?
CRT/MM color
Palpebral
Eye placement
Jaw tone etc...
126
A ___ is used to monitor electrical activity of the heart
ECG
127
You should ventilate at least once every ____ during anesthesia to prevent what 2 things?
5 min.
| Atelectasis & hypercapnia
128
How do you ventilate a patient?
```
Close pop off
Squeeze res bag
Watch manometer & never exceed 20cmH2O
or until you feel resistance
Open pop off
```
129
Heart rate under anesthesia usually ranges between ____rpm
60-120bpm
130
What are some causes of tachycardia
```
Too light-- increase gas
Pain-- opioids
Sx stimulation
Hypoxia
Hypotension
Anemia
Hypovolemia
Cardiac Dz.
```
131
Bradycardia values under anesthesia
Large dog= <100bpm
132
Causes of bradycardia
```
Too deep-- decrease gas
Drugs-- reversal
Vagal stimulation-- Atropine
Hypothermia
Hyperkalemia
```
133
2 reasons for prolonged CRT or pale MM
1. Peripheral vasoconstriction
- alpha-2s
- hypothermia
- pain
2. Decreased tissue vasoconstriction
- Too deep
- Hypotension
- Bradycardia
- Heart failure
134
Cyanosis = _____.
| What is the intervention?
Hypoxia
Check RR
Check ET tube placement/plugs/kinks
Increase ventilations & maybe flow rate
135
Respiratory rates usually range between ____ under anesthesia
8-30rpm
136
Hypoventilation = decreased ____ & ____
RR & Tidal volume
137
Causes of hypoventilation
Too deep
Obese patient
Tilted table
--Increase ventilations for all--may need to decrease gas
138
Hyperventilation = ____.
| Causes
```
Increased RR
Too light-- increase gas
Surgical stimulation
Pain-- analgesics
Hypercapnia
```
139
What is the most common causes of arrhythmias?
Hypoxia
| Increase ventilations and turn down gas
140
What are some signs that your patient is too light?
```
Increased HR, RR, BP
Patient movement
Palpebral
Eyes central
Tight jaw tone
```
141
What should you do if your patient starts waking up?
Turn up vaporizer and ventilate & or give more induction IV drug
142
What are some signs that your patient is too deep?
```
Shallow respirations <8rpm
Pale/cyanotic MM
Increased CRT
Bradycardia
Weak/absent pulse
Hypotension
All reflexes absent
Slack muscle tone
```
143
Doppler measures
Systolic BP and Pulse
144
Oscillometric measures
Systolic, Diastolic, & MAP
145
Normal systolic=
Normal diastolic=
Normal MAP=
```
Systolic= 100-160mmHg
Diastolic= 60-100mmHg
MAP= 80-120mmHg
```
146
Hypotensive systolic=
| Hypotensive MAP=
Systolic= <60mmHg
147
Causes of hypotension
Too deep-- decrease gas
Drugs (vasodilation) --increase fluids
Blood loss-- Dopamine, Dobutamine, Ephedrine
148
Capnograph measures
ETCO2
Insp.CO2
RR
149
ETCO2 should range between ____
| InspCO2 should range between ____
35-45mmHg
| 0-5mmHg
150
Decreased ETCO2 causes
Hyperventilation-- increase depth or give more induction drug
Tube in esophagus-- fix it!
Cardiopulmonary/Resp. arrest-- ventilate/CPR
151
Increased ETCO2 causes are usually due to ____. so you should ____.
respiratory depression causing hypoventilation
| INCREASE VENTILATIONS!
152
Increased ETCO2 can lead to ____.
| Decreased ETCO2 can lead to ____.
Respiratory alkalosis
| Respiratory acidosis
153
If you have a increased InspCO2 you should ____
Check for expired soda lime granules (RB)
| Increase O2 flow rate (NRB)
154
Pulse Ox measures
O2 saturation of Hgb (% of Hgb saturated with O2)
| Pulse
155
Pulse Ox values should be around ____ under anesthesia because ____.
98-100%
| They are breathing 100% oxygen
156
Borderline hypoxia =
| Cyanosis becomes apparent when O2 sat fall below __.
90-95%
| Cyanosis apparent <85%
157
Causes of decreased O2 sats.
```
Probe problems
Peripheral vasoconstriction
ET tube placement/plug/kinked
O2 tank empty
O2 flow rate too low
Bradycardia
VQ mismatch
```
Intervention= GET OXYGEN TO PATIENT!
158
During the maintenance phase, monitor as many parameters as possible and turn down gas percents in ____ when at a good anesthetic level.
0.5% increments
159
What could be wrong if your patient is not staying anesthetized?
ET tube not in trachea
Cuff may need to be inflated (gas can leak around)
Oxygen may be off or rate not high enough to carry gas
Vaporizer may need more liquid
Machine may be hooked up wrong
O2 flush valve being used too often (delivering 100% Oxygen)
160
End of procedure steps:
Turn off vaporizer
Try to allow patient to breathe 100% O2 for up to 5min.
Disconnect patient from machine
Turn off oxygen
Be ready to deflate cuff on ET tube
Extubate after 2 good, successive swallows
Continue to monitor during recovery
161
What is closely monitored during recovery?
Temperature
MM color/CRT
Pulse
RR
