Anesthetizing for dzs (Shih) Flashcards
1
Q
Upper airway dz patients considerations
A
- prone to hypoxia
- distress (catecholamine)
- prone to obstruction
- pulmonary edema
2
Q
TX for pulmonary edema
A
- furosemide
- open trachea
- don’t give lots of fluids
- give some O2
3
Q
With pulmonary disease if possible
A
- correct underlying dz before sx
- AB
- furosemide
- etc
4
Q
propofol decresases
A
ciliary moveoment in airways
5
Q
Pulmonary dz
concerns
A
- hypoventilation & hypoxia
- most drugs decrease ventilation
- change in compliance
- increase pulmonary resistance
- accumulate secretion
6
Q
Pulm dz
Pre-op assessment
A
- Hx and Rx
- Chest radiographs
- Pulse Ox, Blood gas
- Exercise tolerance: 60 second walk
7
Q
Pulm dz
Drugs
A
- premed: low sedation
- induction
- avoid increase in O2 demand
- avoid apnea
- pre-oxygenate (5 min)
8
Q
Anesthesia plan for Pulm Dz
A
2 phase: SLOW then FAST
- pre-oxygenate (5 min)
- low dose opioid (butorph or meth)
- Cerenia
- THEN induction Propofol and FAST FAST FAST
- inflate cuff
- rapid sequence induction
9
Q
Pulm Dz
Monitoring and recovery
A
- monitor
- capnograph
- pulse ox
- blood gas
- recovery
- low stress, high O2: nasal delivery as good as O2 cage
- patient position (patient confort)
10
Q
Worst thing to do for a HCM (heart dz patient)
A
tachycardia
11
Q
HCM in cats
A
- most commonly dx cardiac dz in cats
- stiff ventricle, poor diastolic function
- left ventricle outflow tract obstruction (LVOT)
- 15% of HCM cats have no clinical signs
12
Q
Outflow obstruction
A
- Worst LVOT
- Tachycardia
- inc contractility
- vasodilation
*
13
Q
Dexmedetomidine worst drug ever for heart dz except…..
A
- HCM cats
- causes bradycardia
14
Q
Ketamine plus HCM
A
gonna break your heart…LOL
15
Q
Dexmedetomidine + HCM
A
Let me give your heart a break!
16
Q
HCM cat anesthetic plan
A
- Pre oxygenate
- place IV catheter
- Reduce stress
17
Q
Old evil cat give
A
alfaxalone IM
18
Q
Anesthesia for HCM cat
A
- Dexmedetomidine and butorphanol
- etomidate
- propofol and midazolam
- fentanyl
19
Q
Recovery of HCM cat
A
- recovery in calm environment
- monitor BP & HR q 1 hr
- STRESS IS YOUR ENEMY
20
Q
Goal in mitral valve disease
A
- maximize foward flow
- vasodilation is better
- some tachycardia ok
- Preoxygenate
- low volume fluid therapy
21
Q
Drugs for mitral valve regurge
A
- acepromazine and butorphanol atropine
- Etomidate or alfaxalone
- ketamine midazolam or propofol midazolam
- dec inhalents if possible
22
Q
HCM summary
A
- mild decrease in HR and mild vasoconstriction decreases risk of LVOT
23
Q
Mitral regurg summary
A
- mild increase in heart rate and mild vasodilation improves cardiac performance
24
Q
Dogs with porto systemic shunts have no
A
- protein
- can’t metabolize drugs
- can’t break down ammonias
25
Solution for liver shunt dogs
* give 30% less normal dose
* use drugs that don't need the liver
26
liver disease concerns
* low metabolism
* dec protein production
* oncotic
* clotting
* free fraction drugs
* decrease glucose store
* hypoxia
27
Liver disease
Labwork
* **chemistry profile**
* US, neuro exam
* clotting factors
\*low protein = oncotic, clotting, free fraction drugs
28
Liver dz drug considerations
* use drugs that are reversible
* use short acting drugs
* use drugs that don't need liver for metabolism
29
Drugs for liver dz patients
* opioids, midazolam
* propofol
* remifentanyl + isoflurane
* Fluid: FFP, Hetastarch, Glucose
30
Liver failure/PSS summary
* propofol is a good induction agent
31
Brain dz concerns
* intra crania pressure (ICP)
* drugs
* positioning
* vomiting, cough, gag
* CO2, O2, BP
32
Brain disease drug considerations
* avoid drugs that cause
* vomiting
* sedation
* hypoventilation
* inc ICP
* ketamine
* halothane
33
Summary for brain neoplasia
Bad induction agent would be KETAMINE
34
Brain disease drug considerations
* Low dose opioid IV
* Thiopental, diazepam
* Isoflurane or sevoflurane
* both cause vasodilation and inc ICP
* if very sick Shih uses just propofol drip
