Flashcards in Anesthesia Final Review: Janet Deck (161):
What is the surgical fluid rate and how often do we record this on the anesthesia form?
every 15 min.
What is the hypotensive fluid rate?
3-5mls/kg as a bolus
or double surgery fluids (20ml/kg/hr) for 15min.
Rebreathing system requirement and steps
1.attach Y tubing
2.attach res. bag
Non-rebreathing system requirement and steps
1.attach fresh gas to outlet port on vaporizer
2.scavenge directly to scavenge system
3.pop off open
O2 flow rates & minimum rate
Never less than 500mls/min
Equation for finding how much O2 you have in your tank
psi X 0.3= liters of O2
CO2 absorbing granules should be used no more than ____ or until they ____.
Turn blue/become brittle
2 Types of scavenge systems
Passive or Active
____ scavenges can be used for up to ____ or until weight gain of ____.
Steps to pressure checking system.
Set up rebreathing system
Cover Y tubing
Inflate res. bag
Build pressure to 20cm H2O on manometer
When pressure checking the pressure manometer should not fall ____ in ____.
Should not fall more than 5 cm in 30 seconds
How to calculate res. bag size
60mls/kg (round up to next whole liter)
How do you measure for length of ET tube?
Tip of nose to thoracic inlet
When intubating cats, you may need what 2 things to help?
Lidocaine lube and stylet
Esophageal stethoscope is measured from ___ to ____
tip of nose to mid-sternum
The esophageal stethoscope measures ___ and should be recorded every ___.
HR, every 5 min.
Class 1 anesthetic risk
Elective procedure only
Normal healthy patient
Class 2 anesthetic risk
Slight to mild dz.
Well controlled dz.
Class 3 anesthetic risk
Moderate systemic dz.
1 or more controlled dz.
Class 4 anesthetic risk
Surgery must be done to save life of patient
Severe systemic dz/dehyrdation/fever
Class 5 anesthetic risk
Close to death
Patient not expected to live with or without surgery
PA Physical exam should consist of what 6 values?
What 2 PA physical exam values are important to know before surgery?
Temperature-- fever may indicate infection and hypothermia pt. will not need as much GA
Weight-- accuracy is important for doses
Why is patient history a good thing to have?
Duration of problem-- sooner= better
Concurrent diseases-- fix first
Anesthesia history-- any previous issues?
Which 2 breeds are at a higher anesthetic risk?
Brachycephalics and sighthounds
An obese patient should be dosed based on their ____ and an anorexic patent should be dosed based on their ____.
An aggressive patient would be at a higher risk due to ____.
Increased stress and inability to get PA info
What is the bare minimum PA lab work?
PCV & TP (red top tube)
What 4 things does a blood chemistry include?
PCV diagnoses ____ and evaluates ___ and gives you____ status
O2 carrying capacity
TP gives you ____ status, ____, and ____.
___ will always drop before ___.
TP drops before PCV
Name the anticholinergics
Anticholinergics block function of ____ & the ____ nerve.
Main side effects of anticholinergics
Decreased salivary secretions
Decreased lacrimal secretions
Mydriasis in cats
Increased heart rate
What is the MAIN reason for use of anticholinergics?
Increases heart rate and prevents bradycardia
Commonly used for emergency HR increaser
Less likely to cause tachycardia
You should NOT use anticholinergics if your patient is ___.
2 types of tranquilizers
Phenothiazine & Benzodiazepine
Vasodilation (decreased BP)
Acepromazine is most commonly used for its ____ properties, but it also prevents ____ and is a ____.
Maximum dose = 3grams in ____.
Acepromazine usually lasts ____ hours, but up to ___ in some.
Name the Benzodiazepine tranquilizers
Zolazepam- in Telazol
What is the Benzo tranquilizer reversal agent?
Benzodiazepine tranquilizers are used for ___ but have no ____. They are also a ____ and appetite stimulant in cats.
Calming & antianxiety
Diazepam is given ____ and is best as a _____.
(Benzodiazepine tranq) Valium
Midazolam is ___ so it can be mixed with other drugs easily and its route is ____.
(Benzodiazepine tranq) Versed
IM or SQ
Zolazepam is combined with ____ in ____. It can be used as a sole agent for ____ procedures or ____.
Tiletamine in Telazol
Which tranquilizers are not usually used alone due to possible excitement & minimal sedation?
Name the 3 Alpha-2 agonists (sedatives)
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
Xylazine is reversed with ____.
And is mainly used in ____ patients.
Young, healthy patients
Medetomidine (____) is reversed with ____ and is dosed by ____.
Dexmedetomidine (____) is reversed with ____.
____ are given BEFORE giving Alpha-2s to prevent adverse cardio effects
What are the most effect drugs for pain?
What is the most common side effect of opioids?
Respiratory side effects
What are opioids reversed with?
Naloxone HCl (Narcan)
Morphine is a ____ and has a ___ duration.
Given ____ only.
Pure agonist opioid
4 hour duration (4+ in cats)
Hydromorphone is a ____ opioid and has a ____ duration. It is also less likely to cause ____.
Pure agonist opioid
4 hour duration
Oxymorphone is a ____ opioid, has a ____ duration, and is more expensive.
Pure agonist opioid
Fentanyl has a ____ duration and is a ____ opioid.
Pure agonist opioid
Fentanyl & Fentanyl patch brand name
Butorphanol is a ____ opioid and provides some ____ and analgesia. It has a ____ duration.
1-4 hour duration
Buprenorphine is a ____ ____ opioid and provides analgesia for ____ pain. Has a ____ duration and can be given ____ in cats
Partial agonist opioid
What are some common PA neuroleptoanalgesics
Acepromazine & Butorphanol
Diazepam & Hydromorphone
Versed & Fentanyl
What are 2 types of barbiturates and their main use?
Pentobarbitol- euthanasia agent
Cyclohexamines (are/are not) controlled and (are/are not) reversible.
ARE NOT reversible
Cyclohexamines mode of action?
CNS stimulation (disrupts/scrambles nervous system pathways)
What are some side effects of cyclohexamines?
Lowers seizure threshold
Increased sensitivity to sound/light
Hallucinations during recovery
Tachycardia and increased BP
____ have the side effect of apneustic respirations & Propofol a side effect of ____ respirations.
What are the 4 benefits of ET intubation
Decrease gas exposure to personnel
What does ET ID mean?
ET internal diameter-- measured in mm
What are some possible complications with over-inflation of the ET tube cuff?
Compression of the lumen
Tearing/rupture of the trachea
What are some tools to assist with intubation?
Lidocaine on vocal folds (felines)
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
Cyclohexamines cause an ___ in heart rate so ____ should be used instead of ____.
Glyco instead of Atropine
(milder on heart)
Cyclohexamines have what effect on the eyes?
Nystagmus in cats
Open, dilated & central
How are cyclohexamines metabolized?
Cats= excreted by kidneys
What is the most common induction agent used?
IV vs. IM ketamine
IV= faster onset and recovery, decreased dose, no tissue irritation
IM= longer duration, common in fractious/wild animals
Duration of IV & IM ketamine
IV= 3-10 min.
IM= Dog: 20-30 Cat:30-60min.
Ketamine-Diazepam should be given ____ only because ____ is not water soluble.
Tiletamine is a newer ____ found in ____.
Propofol is a common ____ _____ and can be used as sole agent for short procedure.
IV induction agent
(but is metabolized quickly)
What is the main cardiovascular effect of Propofol & how can this be minimized?
Hypotension immediately after injection-- Vasodilation
Give IV fluids to minimize
When giving Propofol you should pre-oxygenate due to the ____.
Duration & complete recovery time of Propofol
Complete recovery= 20-30min.
Etomidate has ___ analgesia & (is/is not) controlled
What is the best choice induction agent for high risk patients?
Etomidate is given ___ and may cause ____.
pain/irritation-- give with fluids
What is GGE & who is it commonly used in?
Muscle relaxant in large animals
What can be used in sick/debilitated patients as an induction agent that CAN NOT be used as induction in normal healthy patients?
Color for ISO & SEVO
3 Physical properties of inhalant anesthetics
Vapor pressure measures what?
The tendency of anesthetic to go from liquid to gas
High vapor pressure want to ____.
Be a gas
Solubility provides info on ____.
Speed of induction, depth change, and recovery
Low solubility = ____ gas
High solubility = ____ gas.
List the gases from low solubility to high solubility
Inhalants with low solubility allow for ___ in stages/planes of anesthesia & ____ recovery.
What does MAC stand for?
Minimum Alveolar Concentration
What is MAC?
The minimum alveolar concentration of a gas that produces no response to surgical stimulation in 50% of patients
MAC gives an indication of ____
The higher the MAC, the ___ the gas.
List the gases from low to high MAC
Methoxyflurane- most potent
Sevoflurane- least potent
Halothane has ____ vapor pressure
Isoflurane has ____ vapor pressure & ___ solubility
High vapor pressure
Isoflurane has rapid ____ & ____.
Changes in depth & rapid recovery
Induction & maintenance % Iso & Sevo
Iso= induction-2.5% maint-1.5-2.5%
Sevo= induction-4% maint-2.5-4%
Effects of Iso
0.2% metabolized by liver
Excellent muscle relaxation
Effects of Sevo
Moderate muscle relaxation
Sevo vapor pressure, solubility, & MAC
High vapor pressure
Lowest solubility (fastest gas)
Highest MAC-- least potent higher vaporizer settings
Sevo has less ____ than Iso
What is the main benefit of induction chambers?
Little physical restraint
Route of PA drugs
IM or SQ
Induction agents are given ____ and this is to ____
have the ability to intubate patient
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
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
What 5 vitals are recorded every 5 min?
What 2 things are recorded every 15min?
What should ALWAYS be monitored during anesthesia?
Jaw tone etc...
A ___ is used to monitor electrical activity of the heart
You should ventilate at least once every ____ during anesthesia to prevent what 2 things?
Atelectasis & hypercapnia
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
Heart rate under anesthesia usually ranges between ____rpm
What are some causes of tachycardia
Too light-- increase gas
Bradycardia values under anesthesia
Large dog= <100bpm
Causes of bradycardia
Too deep-- decrease gas
Vagal stimulation-- Atropine
2 reasons for prolonged CRT or pale MM
2.Decreased tissue vasoconstriction
Cyanosis = _____.
What is the intervention?
Check ET tube placement/plugs/kinks
Increase ventilations & maybe flow rate
Respiratory rates usually range between ____ under anesthesia
Hypoventilation = decreased ____ & ____
RR & Tidal volume
Causes of hypoventilation
--Increase ventilations for all--may need to decrease gas
Hyperventilation = ____.
Too light-- increase gas
What is the most common causes of arrhythmias?
Increase ventilations and turn down gas
What are some signs that your patient is too light?
Increased HR, RR, BP
Tight jaw tone
What should you do if your patient starts waking up?
Turn up vaporizer and ventilate & or give more induction IV drug
What are some signs that your patient is too deep?
Shallow respirations <8rpm
All reflexes absent
Slack muscle tone
Systolic BP and Pulse
Systolic, Diastolic, & MAP
Causes of hypotension
Too deep-- decrease gas
Drugs (vasodilation) --increase fluids
Blood loss-- Dopamine, Dobutamine, Ephedrine
ETCO2 should range between ____
InspCO2 should range between ____
Decreased ETCO2 causes
Hyperventilation-- increase depth or give more induction drug
Tube in esophagus-- fix it!
Cardiopulmonary/Resp. arrest-- ventilate/CPR
Increased ETCO2 causes are usually due to ____. so you should ____.
respiratory depression causing hypoventilation
Increased ETCO2 can lead to ____.
Decreased ETCO2 can lead to ____.
If you have a increased InspCO2 you should ____
Check for expired soda lime granules (RB)
Increase O2 flow rate (NRB)
Pulse Ox measures
O2 saturation of Hgb (% of Hgb saturated with O2)
Pulse Ox values should be around ____ under anesthesia because ____.
They are breathing 100% oxygen
Borderline hypoxia =
Cyanosis becomes apparent when O2 sat fall below __.
Cyanosis apparent <85%
Causes of decreased O2 sats.
ET tube placement/plug/kinked
O2 tank empty
O2 flow rate too low
Intervention= GET OXYGEN TO PATIENT!
During the maintenance phase, monitor as many parameters as possible and turn down gas percents in ____ when at a good anesthetic level.
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)
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