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Anesthesia & Analgesia > Anesthesia of the Dog & Cat > Flashcards

Anesthesia of the Dog & Cat Flashcards

(52 cards)

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1
Q

What are the 5 steps of anesthesia?

A
  1. pre-anesthetic evaluation & patient preparation
  2. pre-anesthetic medication
  3. anesthetic induction
  4. maintenance & monitoring
  5. recovery
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2
Q

What does patient assessment entail?

A
  • full physical exam
  • medical history
  • basic hematology
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3
Q

What should you take into consideration in a full physical exam while assessing a patient for anesthesia?

A
  • age
  • temperament (pre-hospital: gabapentin, trazadone…)
  • breed (brachycephalic, greyhounds…)
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4
Q

What should you take into consideration in a medical history while assessing a patient for anesthesia?

A
  • past problems, previous adverse drug responses
  • anesthetic events
  • present problems - medication
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5
Q

What should you take into consideration in basic hematology while assessing a patient for anesthesia?

A

PCV, TP, BUN, Gluc

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6
Q

What assessment & diagnostic tests should you do when assessing an older/sick patient for anesthesia?

A
  • CBC, serum chemistry, u/a advisable (in older or ill patients or on the basis of the physical exam & history)
  • radiograph thorax (trauma, respiratory problems)
  • ECG, echocardiography (murmurs, arrhythmias)
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7
Q

With older or sick patients when should you delay anesthesia until?

A
  • further assessment is performed
  • patient is stabilized
  • anesthetic risk is established
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8
Q

What should you communicate to a client prior to anesthesia?

A
  • anesthetic risk
  • set expectations
  • patient preparation starts at home
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9
Q

What are prehospital anxiety drugs & how are they given?

A
  • trazadone & gabapentin
  • PO, 2 hours prior to drop off
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10
Q

What are the categories in the ASA physical status classification?

A
  • ASA 1: normal healthy patient
  • ASA 2: mild systemic disease - no functional limitations
  • ASA 3: severe systemic disease - definite functional limitation
  • ASA 4: severe systemic disease that is a constant threat to life
  • ASA 5: moribund, not expected to survive w/o operation
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11
Q

What are the rules for food & water prior to anesthesia?

A
  • allow free access to water (esp in older animals & those w/ increased fluid requirements)
  • recommend fasting before anesthesia (young animals require shorter fasting times - hypoglycemia; 6-16 wks: 4 hrs; older than 16 wks: 6-8 hrs)
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12
Q

What information is important for anesthesia protocol?

A
  • physical exam
  • age
  • temperament
  • surgical procedure
  • clinical setting
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13
Q

What 4 types of drugs should be included in an anesthetic protocol?

A
  • premed: sedative + opioid
  • induction
  • maintenance: inhalant +/- opioid +/- local anesthetic
  • post operative pain management: NSAID, opioid
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14
Q

What are the aims of premedication?

A
  • sedation & anxiolysis (fear free)
  • facilitate animal handling
  • balanced anesthetic technique
  • analgesia
  • smooth & quiet recovery
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15
Q

What can you use for a premedication?

A

Opioid (hydromorphone, methadone, butorphanol, buprenorphine) + sedative (acepromazine, dexmedetomidine, midazolam) +/- anticholinergic (atropine, glycopyrrolate)
- do not co-administer an anticholinergic w/ dexmedetomidine

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16
Q

What is the premedication protocol for calm dogs (ASA 1-2)?

A
  • Acepromazine + hydromorphone
    OR
  • dexmedetomidine + hydromorphone
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17
Q

What is the premedication protocol for excited, agitated dogs (ASA 1-2)?

A
  • acepromazine + dexmedetomidine + hydromorphone
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18
Q

What is the premedication protocol for aggressive dogs (ASA 1-2)?

A
  • acepromazine + dexmedetomidine + hydromorphone + ketamine
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19
Q

What is the premedication protocol for cats (ASA 1-2)?

A

dexmedetomidine + hydromorphone

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20
Q

What do you use for the heavy sedation of cats?

A
  1. Kitty magic (Dexmedetomidine + ketamine + butorphanol (opioid))
  2. dexmedetomidine + midazolam + butorphanol
  3. alfaxalone + butorphanol + midazolam
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21
Q

What should you remember about heavy sedation (kitty magic) of cats?

Study These Flashcards
A
  • for more reliable sedation used a ketamine-based protocol
  • provides general anesthesia for invasive short procedures
  • monitor patient!
  • provide life support
22
Q

Karl, 6 m male DSH was given Midazolam, Butorphanol, Isoflurane as needed, & lidocaine intra-testicular block for castration. What is wrong here?

Study These Flashcards
A
  • midazolam can cause excitement in young, healthy animals
  • on these meds Karl is excited, hyperactive, & unrestrainable
23
Q

young cat given midazolam + butorphanol causing excitement & o will be back in 2 hours to pick him up, which drug can we use to sedate him? a) reverse midazolam w/ flumazenil b) dexmedetomidine c) ketamine d) alfaxalone e) acepromazine ?

Study These Flashcards
A

topped up w/ dexmedetomidine & then place catheter to proceed w/ induction

a) will get rid of side effect but he will not be sedated enough to perform neuter
c) would need high dose of ketamine to override midazolam & this is heavy sedation for such a quick procedure
d) again would need a higher dose
e) not a great sedative in cats & takes 1/2 hr to work

24
Q

What is on the pre-induction part of the anesthetic safety checklist?

Study These Flashcards
A
  • patient NAME, owner CONSENT & PROCEDURE confirmed
  • IV CANNULA placed & patent
  • AIRWAY EQUIPMENT available & functioning
  • ET CUFFS checked
  • ANESTHETIC MACHINE checked today
  • adequate OXYGEN for proposed procedure
  • BREATHING SYSTEM connected, leak free, & APL VALVE OPEN
  • person assigned to MONITOR patient
  • RISKS identified & COMMUNICATED
  • EMERGENCY INTERVENTIONS available
25
What is on the pre-procedure - time out part of the anesthetic safety checklist?
- patient NAME & PROCEDURE confirmed - DEPTH of anesthesia appropriate - SAFETY CONCERNS COMMUNICATED
26
What is on the recovery part of the anesthetic safety checklist?
- SAFETY CONCERNS COMMUNICATED (airway, breathing, circulation (fluid balance), body temperature, & pain) - ASSESSMENT & INTERVENTION PLAN confirmed - ANALGESIC PLAN confirmed - person assigned to MONITOR patient
27
What is included in the equipment check prior to anesthetic induction?
- ensure ET tubes/intubation aids are readily available - monitoring equipment - anesthesia machine (select appropriate breathing system, perform leak test, check: oxygen, inhalant, CO2 absorbent, waste scavenging)
28
How do you prepare a patient for anesthetic induction?
- venous access - catheter placement - stabilize hemodynamically instable patients - check HR, pulse quality, & respiratory rate - connect monitoring equipment (appropriate for disease condition) - pre-oxygenation: reduces risk of hypoxemia - quiet enviro
29
How do you induce anesthesia in a dog and drugs used?
- propofol, alfaxalone, ketamine/diazepam - administer to effect
30
What do we not want to do to induce anesthesia in dogs anymore?
mask induction w/ isoflurane or sevoflurane
31
How do you induce anesthesia in a cat and drugs used?
- propofol, alfaxalone, ketamine/diazepam - administer to effect
32
What do we not want to do to induce anesthesia in cats anymore?
mask/chamber induction w/ isoflurane or sevoflurane
33
What are the ABCs of Anesthesia Induction?
1. Airway (intubation, secure tube, inflate cuff) 2. Breathing (auscultation for bilateral lung sounds while manually ventilating, check for spontaneous ventilation) 3. Circulation (auscultation of heartbeat) 4. Depth & Drugs (assess depth of anesthesia, turn on vaporizer) 5. Equipment (blood pressure, eye lube very last on list (lube prior to induction)) 6. Fluids
34
What should you check on an ET tube prior to use?
- check tube for patency - check cuff for leaks
35
What should you remember about ET tube intubation?
- have multiple ET tube sizes available - laryngoscope, tie, cuff syringe - pre-measure ET tube length (incisor teeth to thoracic inlet)
36
What is the technique to intubate a dog?
- can be performed in sternal, lateral, or dorsal - apply slight coating of lube (improves cuff's ability to seal) - open the dog's mouth, pull tongue forward gently - straighten head & neck, extend tongue - put tip of laryngoscope blade on base of tongue, NOT on epiglottis - insert ET tube under visualization - inflate cuff while checking for leaks - secure tube
37
How do you intubate a cat?
- more difficult than dog: small oropharynx & prone to laryngospasm - local anesthetic (lidocaine) useful to prevent laryngospasm (lidocaine spray or lidocaine neat 2%)
38
How do you confirm endotracheal intubation?
- direct visualization (use laryngoscope) - rebreathing bag - chest excursions - palpation of ONE trachea below the larynx - capnograph - GOLD STANDARD: auscultation of both sides of the animal's chest during manual ventilation
39
What does A stand for in the ABCs of anesthesia induction?
Airway establishment - intubation - securing the ET tube - inflation of the ET tube cuff - confirmation of endotracheal intubation
40
What does D stand for in the ABCs of anesthesia induction?
Depth & Drugs - check depth of anesthesia (eye position, palpebral reflex, jaw tone) - based on patient's depth, turn on vaporizer
41
What does E stand for in the ABCs of anesthesia induction?
Equipment - apply monitoring equipment - doppler 1st: audible signal - monitor blood pressure - assess patient - adjust vaporizer setting
42
What does F stand for in the ABCs of anesthesia induction?
Fluids - correction of normal ongoing fluid losses - support of cardiovascular function - countering of potential negative physiologic effects - maintaining patent IV catheter
43
What fluid rate should be used during anesthesia?
New guidelines: - Cats: 3 mL/kg/hr - Dogs: 5 mL/kg/hr old way of 10 mL/kg/hr is NOT evidence based
44
What is important about the recovery/postoperative period?
- CRITICAL PHASE OF ANESTHESIA - 47% (dogs) & 60% (cats) of all anesthetic related deaths are w/in 1st 3 hours of recovery - continued monitoring & patient support is important
45
What should you remember about extubation in small animals?
- after dental surgery check the oral cavity for fluid - dont untie the tube until patient has reached the final recovery spot - ET-tube cuff should not be deflated until just before extubation
46
When do you extubate dogs?
on return of swallowing reflex
47
When do you extubate cats?
- cats need to be extubated sooner than dogs - on return of good palpebral reflex or ear flick reflex - prone to laryngospasm or laryngeal edema
48
What is the optimal recovery time?
w/in 10 to 30 mins of the end of the anesthesia
49
What are common complications during anesthetic recovery?
- emergence delirium - dysphoria - pain - delayed recovery
50
During recovery, when should patients be closely observed until?
until they are alert, normothermic, & ambulatory
51
How can you ensure patient comfort during anesthetic recovery?
- limit environmental stress (noise, bright lights) - prevent hypothermia - prevent urinary bladder distension - assess pain & provide adequate pain management
52
How can you provide supportive care during anesthetic recovery?
- oxygen - fluids - heating - eye lube

Anesthesia & Analgesia (30 decks)

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