Ch 21 + 22 Anaesthesia monitoring and conditions Flashcards

Question

monitoring equipment

Answer 1

Ga must maintain: - DO2 (CO and O2 content) - acid-base (ventilation) - narcosis, analgesia + muscle relax - temperature induction can casue apnea and hypoventilation 1.depth: (jaw/eye/hr/rr) 2.blood pressure BP is idirect measure of CO (therefore DO2) if BP <60mmhg, DO2 and tissue perfirsion likely insufficent to kidney and brain (prolonged hypotension result in reduce brain function and AKI) INDIRECT: less accurate/precise, affected by (cuff size, movement, position), dopppler or oscillometric DIRECT: arterial catherisation, complications (haemorrhage, thrombosis) 3. ECG (arrythmia, electrolyte imbalance) 4. ventilation drugs cause reduce ventilation > hyopventilation/hypercapnia (increase CO2) hypercapnia results in: resp. acidosis, vasodilation, increase ICP, arrythmias aveolar CO2 approx arterial CO2 ET-CO2: capnograph, WNL **35-65mmHg**, monitors vent as well as (extubation/leak, cardiac arrestm resus effort, CO2 rebreathing) PULSE-OX: estimates % of Hb that are saturated with O2, patient breathing 100% O2 should have spO2 100% . PaO2 checked if <98% inaccurate dt (vasoconstriction, reduced CO, anaemia, hypothermia, hypervolaemia) 5.CVP indection = rik of fluid overload (heart or kideny dz), hypavolaemic measure vascular volume (cr. vena cava via jugular) measure indirect arterial P with manometer (**0-5mmHg**)

Answer 2

* phase 0- inspiration, 0mm Hg * phase 1- start expiration, increase in waveform * phase 3- end expiration, CO2 peak * phase 4- just before inspiration, fresh gas 0 mmHg pulse ox: 100% inspired O2 =PaO2 500 mm Hg. Fall to less than 90 mm Hg to show a change in the pulse oximeter reading

Answer 3

act on 3 receptors (m, k, d) - µ-receptor regulates the majority of clinical effects, including analgesia and side effects - δ-receptor seems to primarily play a modulating role on the µ-receptor MOA: triggers influx of K+ and decrease in intracellular Ca++ > decreases substance P and glutamate which hyperpolarizes post synaptic cell > decreases pain signaling MAC sparing in GA pros: minimal CV effects SE: ileus, nausea/V+, regurgitation, excitment resp depression under GA reverseal: naloxone or butorphanol morphine (12-24hr epidural) methadone (3-4hr) hydromorphone fentanyl (CRI or transdermal) 40min bradycardia/apnea after bolus Tramadol: Codeine analogue with weak μ receptor, Analgesic effects due to serotonin and adrenergic receptor effects within the central nervous system buprenorphoine (partial agnoists) 4-6hr butorphanol (κ-receptor agonist; µ-receptor antagonist) 1/2-2hr

Answer 4

ii. Benzodiazepines: enhance the effects of GABA channels which is an inhibitory neurotransmitter within the CNS a. Cause muscle relaxation, narcosis, amnesia, no analgesia, anti convulsant b. Do not cause CV or respiratory depression c. Schedule III d. Reversal Flumazenil Diazepam a. Lasts 2 hours, adsorbs to plastic tubing and sensitive to light b. IV, IM, PO, rectal Midazolam a. Lasts 1 hour b. Breakdown products not effective (unlike diazepam), better for liver disease

Answer 5

1. Depresses dopamine in the reticular activating system 2. Lasts 4-6 hours, moderate sedation, some muscle relaxation 3. α-1 antagonist: hypotension, protects the heart from some arrhythmias

Answer 6

decrease norepinephrine release in the CNS - sedation, analgesia, muscle relaxation - some α1 activity causes vasocontriction, hypertension, arrhythmogenecity, and paradoxical excitation, hyperglycemia, diuresis, and respiratory depression - Can see reflex bradycardia and subsequent hypotension Xylazine a. α2: α1 = 160:1, lasts 12-20 mins b. Initial hypertension followed by hypotension, induces vomiting in cats c. 44x increase in cardiac arrest in dogs; 92X increase in complications Medetomidine a. α2: α1 = 1600:1, lasts 60-90 mins b. hypertension and reflex bradycardia, can cause arousal and aggression c. analgesia and sedation d. Cats: minimal hypertension although HR, CO, SV decrease e. profound depression of cardiac output > healthy animals only Dexmedetomidine a. Same as previous except twice as potent, may cause less sedation and last slightly shorter

Answer 7

Propofol: agonism of GABA receptors - Works in 30-60 seconds - Rapidly redistributed and metabolized, safe for patients with liver disease - Vasodilation/hypotension and occasionally compensatory tachycardia, apnea - Preoxygenation prolongs effect - Oxidative damage to red blood cells in cats ketamine - Antagonism of NMDA receptors - dissociation between higher brain functions and unconscious functions - Muscle rigidity common so often given with benzo for induction - May induce salivation - can increase myocardial work, increases intracranial and intraocular pressure - In patients with shock it decreases CO - Renal elimination - May decrease dorsal horn windup responsible for hyperalgesia Alphaxalone - Steroid anesthetic enhancing GABA and glycine CNS depression - Depresses CO but no clinical respiratory depression

Answer 8

Minimum alveolar concentration (MAC): concentration (vol/vol percent) required to prevent purposeful movement in response to standard painful stimulus in 50% of normal patients. Surgical stimulus more intense MAC iso: 1.3-1.7 sevo: 2.1-3.1 isoflurane, sevoflurane having 0.2%, 2% of their total amount being metabolized by the liver. Side effects: hypotension due to decreased CO and SVR, respiratory depressant, increased intracranial pressure, disrupted thermoregulation, malignant hyperthermia

Answer 9

Lidocaine/bupivacaine MOA: Dose and activity dependent blockade of fast sodium channels on afferent nerves Lido: lipophilic, fast onset (5mins), lasts 45-60mins, Bupiv: higher lipid solubility, lasts 6-8 hours, takes 45 mins to exert effect, cardio toxic IV associated with chondrotoxicity Can be used in thoracostomy tubes (1.5mg/kg q6-8) Anticholinergic Agents: atropine, glycopyrrolate Parasympatholytics: minimize vagal tone which decreases HR and BP

Answer 10

* Many anesthetics impair vascular tone and CO -> low BP * CO can be low because 1. low preload (hypotension) 2. poor contractility 3. excessive afterload (severe vasoconstriction) Inhalent anesthetics and propofol o Tx with positive inotropic drug * **Dobutamine** (5-10mcg/kg/min) or **dopamine** (5-12mcg/kg/min) * B-adrenergic agonists, Chronotropic effect on heart Opioids -> vagally induced bradycardia o Tx symptomatic (**atropine, glycol**) Vasodilation -> relative hypovolemia Tx 1. Usually responsive to **fluid** boluses * Isotonic crystalloids (5-15ml/kg bolus) or isotonic colloid (2.5-5ml/kg bolus) 2. **Decrease inhalant**, use other adjunct drugs such as fentanyl 3. Reverse vasodilation a-Adrenergic vasopressors **phenylephrine** (0.5-1.5mcg/kg/min)

Answer 11

aimed at preserving cardiac output and systemic O2 delivery RAAS activated -> increased BP and increased intravascular fluid retention and hypervolemia HCM: diastolic dysfunction DCM: systolic dysfunction, reduce contractility MVD: regurgitant fraction, decreasing forward CO, spectrum of presentation PDA o Branham reflex * Associated w ligation of PDAs * Reflexive decrease in HR after ligation of ductus arteriosus due to an abrupt increase in afterload consdierations: echo before sx pre-O2 reduce stress reduce IVFT dt overload risk give medication except ACEI premed: opiod +/- benzo NOT (ACP/ketamine/medetomadine/atropine) induction: propofol or alfaxan (will cuase vasodilation) +/- benzo to reduce doses maint: ideally low MAC + mutimodal agens (fentanyl CRI, nerve blocks) positive ionotropes to increase BP procainamide for ventricular arrythmia

Answer 12

thyroid - carcinoma removal > monitor for laryngeal paralysis - avoid ketamine in hyperthyroid diabete mellitus - 1/2 insulin dose morning - monitor Glu q 1hr during sx (dextrose on hand) insulinoma - BG q 30min - May use glucagon (5-13ng/kg/min) to help normalize BG after prolonged hypoglycemia, but may also drive insulin release Adrenal gland - phaechormocytoma have inc risk arrythmia/tachycardia, - a-adrenergic blockade drugs (phenoxybenzamine) for ~1wk before anesthesia - increased risk infection - PU may lead to hypovoalemia - adrenelectomy: peri-op pred - haemorrhage risk > blood type/x-match - * Nitroprusside for hyerptension * Lidocaine for arrhythmias premed: opiod + benzo (no ACP)

Answer 13

1. Upper airway disease- difficult to intubate 2. Pleural space disease- decreased residual capacity and tidal volume; rapid hypoxia after premeds a. Thoracoscopy- may require higher resp rates b. Chronic chylothorax- fibrosing pleuritis; monitor peak airway pressures (<10cm H2O) 3. Lower airway- asthma, bronchoconstriction, expiratory dyspnea and hyperinflated lungs; use bronchodilators 4. Parenchymal disease- V/Q mismatch, hypoxemia, dyspnea, not usually hypercapneic pre-op: rads/stabilise, blood gas (hypercapnia/hypoxia) consdierations: pre-oxygenate, BOAS (no opiod, antiemetics/gastric protectants, vagal tone, delay extubate) difficulty entubation (have tracheostomy ready) premed: ketamine/benzo + ACP (monitor for hypovent) induction: propofol (short actig + fast) ideal for BOAS maint: Thoracotomy Bupivicaine 1.5mg/kg q8 locally; LS epidural- 0.2mg/kg morphine diluted to 0.3mL/kg volume Likely to need PPV and PEEP TIVA- fentanyl + propofol Reexpansion pulmonary edema start with peak pressure of 10cm H2O, slow inc Post op O2 at 100mL/kg/min via nasal cannulas = 40% FIO2 Combine sedation and analgesia for smooth recovery monitor: ETCO2 + PaCO2 (ventilation) SPO2 (oxygenation) + PaO2 (Hypoxaemia)

Answer 14

Evaluate function by: - Albumin, total bili, glucose, BUN, and cholesterol - Pre- and post-prandial bile acids - Coagulation profile (If coagulopathic, FFP at 10ml/kg starting dose) * Hepatic encephalopathy d/t shunts, microvascular dysplasia, or hepatic failure * Decreased oncotic pressure from failure to produce proteins (albumin) > Normal oncotic pressure = 18-22mmHg > reduce Blood volume consdierations 1. Ascites - Increased pressure on diaphragm - decreased functional residual capacity and ETV - Ascites at equilibrium with intravascular > rapid removal > hypovolemia 2. hypoglycaemia 3. prolonged drug effect diazepam: sedative effects prolonged midazolam: less, choice with hepatic disease 4. reduced protien/decrease drug bound thus less dose > Opioids, benzos, and Propofol bind to albumin > less drug required or increased sensitivity 5.Biliary tree manipulation > increased vagal tone so have anticholinergics, pressors ready 6. blood type Premed: hydromorphone (do not require P450 microsomal enzymes) or fentanyl + Midazolam - ½ regular dose starting point; pre-oxygenate Induction: propofol (extra-hepatic metab) Maintenance: inhalants (minimal hepatic metab) > Remi-fentanyl CRI in addition to inhalant due to metabolism by plasma esterases and not hepatic biotransformation

Answer 15

Chronic renal failure - 75% nephron dysfunction before visible on chemistry - dehydration (polyuria, polydipsia) - hypokalemia - metabolic acidosis - muscle wasting - anemia (PCV < 20% result in reduced DO2) Acute renal failure - Vomiting, lethargy, overhydration, - hyperkalemia - metabolic acidosis consdierations: - 24 hr IVFT prior to anesthesia if elective - NSAIDs contraindicated - hypertensive or hypotensive (monitor BP) - Caution with ketamine, benzos, opioids, and acepromazine - Hyperkalemia (calcium gluconate 50-150mg/kg IV slowly, insulin, Glucose) - monitor UO Premed: opioids + acepromazine produces an effective neuroleptanalgesic effect Induction: propofol * Avoid ketamine unless obstruction rapidly resolved Maintenance: inhalants * Urine output decreased - Mannitol 0.5g/kg IV – free rad scavenger can reduce swelling of renal epithelial cells and flush renal tubules - Furosemide 0.2-2mg/kg IV or CRI 0.66mg/kg/hr

Answer 16

1. Inadequate oxygen delivery to tissues 2. Distributive shock (relative hypovolemia) > Compensatory shock – increased CO > Decompensatory shock - cardiovascular collapse consdierations - Relative adrenal insufficiency - inability to generate SVR Premed: frequently not necessary Avoid acepromazine and alpha 2 agonists Induction: neurolept combo  Hydro 0.2mg/kg + diazepam 0.5mg/kg + ketamine 2mg/kg  Propofol 0.25-1mg/kg Maintenance: multimodal  Fentanyl CRI 5-60mcg/kg/hr  Ketamine or lidocaine

Answer 17

maximum allowable intraabdominal pressure (IAP) is **14 cm H2O** - above this threshold, renal blood flow, AKI - increased intrathoracic pressure + hypoventilation (exacerbated by Trendelenburg (head-down) positioning) - increased CO2 absorption may increase ETCO2 and PACO2 - reduce venous return and therefore BP o Clinical signs of an air embolus include a sudden drop in the ETCO2 tracing, as well as a drop in blood pressure o Therapy for air embolism: - CPR (drive the air from the right ventricle > lungs) - placing the patient in left lateral recumbency

Answer 18

* Cesarean Section (C-Section) o only anesthetic drug that has been shown to adversely affect neonate survival is xylazine * Neonatal Patients - heart rate is an important determinant of cardiac output - anticholinergics are recommended - sensitive to the resp depressant effects of opioids and inhalant anesthetics - food withheld 2 to 4 hours - dextrose (2.5% to 5%) may be necessary - poorly developed liver function and renal concentrating ability consdier drugs full or partial opioid agonist + midazolam induction with propofol, maintenance with isoflurane

Answer 19

consdierations: potent opiod local anaesthetic bloskcs MAC sparing/multimodal - total ear canal ablation or limb amputation, a soaker catheter can be fashioned bupivicaine + morphine (0.1mg/kg) total volume 0.2 mL/kg - procedures below the elbow are suited for local anesthesia using a brachial plexus block - hindlimbs, lumbosacral epidural analgesia is  0.2 mL/kg should be adequate for analgesia of the hindlimbs  0.3 mL/kg can be used to provide adjunctive analgesia for abdominal or thoracic procedures | dexmedetomidine (0.01 to 0.02 mg/kg) and an opioid, monitor V+ and resp

Answer 20

reduce nociception, stress resposne, GA, and post op opiod Humans: reduced hospitalisation without increase morbidity loss of resistance and hanging drop technique are the most commonly used. The sensitivity and specificity of loss of resistance to predict a success of extradural injections were 63 and 90% respectively complications - hypoventilation (if travel too high) - intrathecal/intraparenchymal - hypotension > vasodilation - hypothermia > vasodilation - urinary retension - muscle relax > increase hip lux? - neuro damage(sciatic neuropraxia) - infection

Answer 21

1.**hypothermia**: due to reduce hypthalamic regulation + vasodilation can result in: pronlonged recovery, reduce immmune, alterned drug metab, prolonged healing TX: warm peripherals 2.**hypoxaemia** causes: R>L shunt, V/Q mismatch, hypoventilation (during recovery) V/Q most common, result in venous admixture (Interruption of pulmonary blood flow, or areas of lung collapse from disease or atelectasis) TX: IPPV, increase O2 3.**hypotension** (pressor and inotrope) 4.**hypercapnia** PaCO2 >85mmHg sympathetic stim wanes and bradycardia, ventricular arrhythmias, hypotension, narcosis, circulatory collapse ETCO2 essential (+/- PaCO2) machine cause: exhausted soda lime, iadequate O2 flow patient cuases: hypoventilation (reduce RR or TV) Tidal Volume = 8-12 mL/kg 5.**malignant hyperthermia** Inherited condition (deficit in ryanodine receptor – involved in calcium release in muscle) extreme hypermetabolic state during GA hypercarbia hyperthermia muscle rigidity can lead to arrhythmias and death Dx: abrupt increase ETCO2 with inc HR and temp TX: TIVA, dantrolene 6.**cardiac arrest** Prolonged cardiac ischemia dt hypotension, anemia, hypoxemia ETCO2 ID cardiac arrest (no ECG) Tx: CPR (compressions, No more than 12 breaths per minute, atropine 0.05mg/kg, adrenaline 0.01mg/kg, V-fib > electrical defibrillation 7.**tracheal tears** cause pneumothorax, pneumomediastinum, subcut emphysema more common in cats dt ETT cuff 8.**reflux** cause esophagitis (stricture risk) to prevent aspiration > suction, check pH +/-lavage metoclopramide CRI, omeprazole

Answer 22

distinct stages in the transmission of nociceptive information and distinct anatomic nociceptive pathways - Nociceptors represent the free endings of primary sensory neurons. - primary afferent nerve fibers two main types: unmyelinated C fibers and myelinated A‐δ fibers. - Unmyelinated C fibers, activated by intense stimuli, conduct impulses slowly (~0.5 m/s), . they contribute to the ‘slow burn’ sensation of pain - myelinated A‐δ fibers conduct noxious impulses more quickly and contribute to the rapid ‘stab’ of the acute pain response. Activation of specific receptors and ion channels (present in most tissues and organs) in peripheral unmyelinated nerve endings by chemical, mechanical, or thermal stimuli causes the initiation of action potentials that propagate the stimulus along the axons of primary afferent nerve fibers - synapse with sites in the dorsal horn of the spinal cord. - This triggers the release of neurotransmitters, (glutamate and substance P) which activate neurons located in the spinal cord. - The primary afferent fibers: the A‐δ fibers synapse in lamina I and V (spinothalamic) of the spinal cord and the C fibers largely in lamina II, also known as the substantia gelatinosa. - second‐order neurons project to various areas in the brain: periaqueductal gray (PAG) region MIDBRAIN via spinothalamic tract and thalamus via spinothalamic tracts, and to the reticular formation - Descending axons of serotonergic and noradrenergic neurons from the brain synapse with inhibitory inter‐neurons in the spinal cord to modify their function - in pain states, this effect may be blunted and there may be local disinhibition - - The reticular activating system (in the brainstem) plays a key role in integrating information and both the subjective responses to pain - The cerebral cortex is the seat of conscious experience of pain; it exerts top‐down control and can modulate the sensation of pain. pathophys - widely recognized that peripheral tissue damage results in increased activation - Electrical activity of primary afferent neurons is primarily governed by the expression and function of ion channels that define the resting membrane potential, action potential initiation, and transmitter release from their terminals in the dorsal horn - voltage‐gated sodium channels, potassium and calcium channels, leak channels, and ligand‐gated ion channels - Many analgesic drugs in current use have a spinal site of action, highlighting the spinal cord’s pivotal role in pain processing. Nociceptive inputs can trigger a prolonged increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization - mechanisms of central sensitization have been studied and involve a range of excitatory and inhibitory interneurons, Nmethyl‐ d‐aspartate receptor activation, and descending influences from the brainstem, which can be both inhibitory and excitatory in nature. Prolonged firing of C fiber nociceptors causes release of glutamate from within the dorsal horn of the spinal cord enhances the excitability of neurons, resulting in increased pain sensitivity.

Answer 23

- epidural space to block sensory and motor spinal nerve roots in the thoracic, abdominal, pelvic, and lower extremity areas. - Epidural anesthesia can reduce the opioid requirement during and after a procedure, lowering the incidence of associated adverse effects. - postoperative pain management as part of a multimodal approach cranial spread anticipated (i.e. large volume): - avoid the use of a long-lasting local anesthetic because this could result in paralysis of the intercostal nerves and could impair respiration. - Patient positioning may also influence the cranial spread hould be preservative-free and handled using aseptic technique to prevent the introduction of bacteria and subsequent epidural empyema. lidocaine cause a rapid onset of analgesia, they do not last as long as bupivacaine, which can provide up to 6 hours of analgesia. The trade-off for the extended duration of action of bupivacaine is the delay in time to effect, which can be as long as 45 to 60 minutes. presence of local anesthetic in the epidural space interrupts the flow of nociceptive information in the spinal cord spreads out of the central canal and anesthetizes ganglia of the sympathetic chain, uncontrolled vasodilation may result from loss of sympathetic tone.

Answer 24

extending the hind limbs cranially yielded an increase of close to 100% on the cranial-caudal distance from the dorsal facets of the lumbosacral space The sacrococcygeal intervertebral space may also be used for epidural delivery of drugs, which is beneficial, especially in cats (perineum) assist in epidural space identification, the two most commonly used are the “hanging drop” and loss of resistance (LOR) Distribution after epidural administration is not always bilaterally homogeneous,

Answer 25

prosepective Omeprazole administered the evening and 3 hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.

Answer 26

robenacoxib: composite pain score higher at 24hr, more dogs required rescue analgesia - meloxicam more effective for pain relief

Answer 27

CBPI developed and validated in dogs with multiple joint OA receiving a systemic analgesic (non-steroidal anti-inflammatory, NSAID) Quality of life variety are reported in the literature, with reference to chronic pain, most are not validated Gait analysis objective outcome measure that directly measures the function of the patient > directly ascribed to pain and pain relief where pain is causing the alteration in function (i.e. not mechanical). when the biases that influence analysis are well controlled, can be both precise and accurate. However, evaluation of clinical studies suggests there is room to improve in quality control and data evaluation, interpretation and reporting. Overall, natural variability in ground reaction forces 5.0% or 10.0% is rare. Thus, changes in ground reaction forces of this amount are clinically important when associated with intervention because they rarely occur spontaneously.

Answer 28

Local anaesthetics inhibit membrane depolarisation, nerve excitation and conduction primarily by blocking inward Na+ currents through voltage-gated Na+ channels bupivicaine: should be used for any type of abdominal surgery such as intestinal foreign body removal, enterotomy, splenectomy, etc. IP and incisional anaesthesia are simple, safe and cost-effective adjunct methods to reduce pain after abdominal surgery in companion animals and are not limited by geographical drug availability. However, readers should be aware that some of our recommendations were based on a consensus and low-level of evidence provided by the current literature

Answer 29

Glasgow feline/Canine composite measure pain scale Feline Grimace Scale for acute pain assessment. owner reported CBPI, COI and LOAD sufficient evidence to support validity

Answer 30

Prospective, randomized, controlled clinical trial with a blinded observer. Animals: Forty-six client-owned\ Conclusion: Postoperative signs of pain after surgical treatment of intervertebral disc herniation (IVDH) were reduced when dogs received perioperative pregabalin rather than opioids alone.

Answer 31

Experimental study. Sample population: Canine cadavers (n = 8) weighing between 20.2 and 37.4 kg. Advancement of a left-sided Robertshaw double-lumen endobronchial tube (DLT) and the EZ-blocker (EZ) were evaluated Clinical significance: Fluoroscopy-assisted placement of EZ and DLT is a useful alternative to bronchoscopy-assisted placement of these OLV devices.

Answer 32

- reports of efficacy variable – some support in ortho procedures over bupivacaine/saline no additional efficacy reported in soft tissue/abdominal sx - increased rate of incisional/injection-site inflammation Rahn 2023 – effect of liposomal bupivacaine on opioid use and sx-site complications after GI-FB sx - liposomal bupivacaine – labelled for up to 72hr analgesia - liposomal bupivacaine → lower post-op fentanyl use and rates, time in ICU and hospital - wound complications: 7/65 (10.8%) LB vs 4/140 (2.9%) control

Answer 33

- CPSP present after TPLO in 41% - assessed by Helsinki Chronic Pain Index

Answer 34

These results indicate that grapiprant was non-inferior to robenacoxib for mitigating postsurgical pain in cats after OVH performed via ventral celiotomy Grapiprant selective prostaglandin E2 (PGE2) receptor antagonist, and therefore its mechanism of action is distinct from the cyclooxy- genase (COX) inhibitors. The EP4 receptor is one of four binding sites for PGE2. By only targeting the EP4 receptor, production of the homeostatic prostanoids, such as PGE2 is not reduced to the extent seen with the more traditional NSAIDs

Answer 35

prospective, 17 dogs Two doses of methadone at either 0.25 or 0.5 mg/kg administered via subcutaneous injections pre-operatively and 4 hours later, along with 4.4 mg/kg carprofen subcutaneously 8 hours after the first methadone dose appear to provide sufficient pain control for up to 12 hours in dogs undergoing tibial plateau levelling osteotomy. can use lower dose of methadone.

Answer 36

BLIS or saline surgical incision infiltration Use of BLIS for exploratory laparotomy did not provide improved pain control over postoperative opioid administration alone. Patients that received BLIS had no increase in short-term complications. does not increase the chance of surgical site infection

Answer 37

Placement was possible at the first attempt in 136 cats, at the second attempt in eight cats In about 7% of the cases, replacement of the device was required due to mispositioning or dislocation

Answer 38

Controlled laboratory study. in vitro toxicity of preservative-free bupivacaine concentration dependent - clinically relevant concentrations may not → chondrotoxicity in vitro - liposomal encapsulated bupivacaine → time-dependent chondrotoxicity - not recommended for intra-articular use

Answer 39

0.5% levo-/bupivacaine + morphine/buprenorphine - success = low fentanyl CRI requirement, no additional analgesic infusions/opioids for 3hr - success rate: 88.7% - complications: intra-op: hypercapnia (75.2%), hypotension (46.1%), hypothermia (27.7%) regurgitation (6.3%) short-term (<24hr): urinary retention (17.8%), sciatic neurapraxia (5.8%) vomiting/regurg/diarrhoea (8.2%) post-op: hip luxation 3/206 (1.5%) at 48hr (2) and 72hr (1) cannot categorically rule out that some of them were intrathecal,

Ch 21 + 22 Anaesthesia monitoring and conditions Flashcards

(63 cards)