Anesthesia Final Review: Janet Flashcards Preview

Anesthesia -Scott Newman & Janet King > Anesthesia Final Review: Janet > Flashcards

Flashcards in Anesthesia Final Review: Janet Deck (161):
1

What is the surgical fluid rate and how often do we record this on the anesthesia form?

10mls/kg/hr
every 15 min.

2

What is the hypotensive fluid rate?

3-5mls/kg as a bolus
or double surgery fluids (20ml/kg/hr) for 15min.

3

Rebreathing system requirement and steps

>7kg
1.attach Y tubing
2.attach res. bag
3.scavenge
4.open pop-off

4

Non-rebreathing system requirement and steps

<7kg
1.attach fresh gas to outlet port on vaporizer
2.scavenge directly to scavenge system
3.pop off open

5

O2 flow rates & minimum rate

>7kg= 30ml/kg/min
<7kg=200ml/kg/min
Never less than 500mls/min

6

Equation for finding how much O2 you have in your tank

psi X 0.3= liters of O2

7

CO2 absorbing granules should be used no more than ____ or until they ____.

6-8hours
Turn blue/become brittle

8

2 Types of scavenge systems

Passive or Active

9

____ scavenges can be used for up to ____ or until weight gain of ____.

Passive
12 hours
50grams

10

Steps to pressure checking system.

Set up rebreathing system
Cover Y tubing
Close pop-off
Inflate res. bag
Build pressure to 20cm H2O on manometer

11

When pressure checking the pressure manometer should not fall ____ in ____.

Should not fall more than 5 cm in 30 seconds

12

How to calculate res. bag size

60mls/kg (round up to next whole liter)

13

How do you measure for length of ET tube?

Tip of nose to thoracic inlet

14

When intubating cats, you may need what 2 things to help?

Lidocaine lube and stylet

15

Esophageal stethoscope is measured from ___ to ____

tip of nose to mid-sternum

16

The esophageal stethoscope measures ___ and should be recorded every ___.

HR, every 5 min.

17

Class 1 anesthetic risk

EXCELLENT
Elective procedure only
Normal healthy patient

18

Class 2 anesthetic risk

GOOD
Brachy/sighthound
Slight to mild dz.
Well controlled dz.
Simple fracture

19

Class 3 anesthetic risk

FAIR
Moderate systemic dz.
1 or more controlled dz.
Moderate dehydration/fever
Moderate fracture

20

Class 4 anesthetic risk

POOR
Surgery must be done to save life of patient
Severe systemic dz/dehyrdation/fever

21

Class 5 anesthetic risk

GUARDED
Close to death
Patient not expected to live with or without surgery

22

PA Physical exam should consist of what 6 values?

T
P
R
Weight
MM/CRT
Body condition

23

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

24

Why is patient history a good thing to have?

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