Chapter 9 - Powerpoint Condensed

Question 1

True or False: Any time saved by skipping steps in surgical patient preparation is often offset managing problems that could’ve been prevented

Answer 1

True

Question 2

What 4 components make up a basic Anesthetic Protocol?

Answer 2

• Includes calculated dosages, routes and order of administration
• calculated, checked and re-checked doses, oxygen flow rates and fluid administration rates
• use patient minimum database, physical status and procedure to influence protocol
• modified protocol for ill, pediatric or otherwise compromised animals

Question 3

What are some examples of physiological abnormalities that need to be corrected before anesthesia?

Answer 3

Dehydration, Hypotension and Anemia

Question 4

A bolus drug must be given ______ enough to produce a short-term stage 3 plane 1 anesthesia to intubate (slowly or quickly)

Answer 4

quickly

Question 5

True or false: The quicker we can get intubation completed and move to inhalant anesthesia for maintenance, the faster the recovery will be and the safer the process will be

Answer 5

True

Question 6

When giving anesthetic induction agents by ______ administration, the anesthetic depth will increase, peak and then gradually decrease

Answer 6

IM

Question 7

True or False: Once an IM injection has been given for induction, the anesthetist has little control over changes in depth. If the depth is too light we can add more, but if the depth is excessive there is nothing to be done until the patient comes out naturally

Answer 7

True

Question 8

IM induction is not ideal in ______ patients

Answer 8

geriatric

Question 9

The technique used for short procedures (less than 10 mins) requiring general anesthesia typically includes:

Answer 9

IV injection and an Ultra-Short-Acting Agent such as Propofol or Etomidate

Question 10

TIVA stands for ________ and meanst the patient is induced “to effect” and given additional boluses every ___ to ___ minutes as needed to maintain surgical anesthesia

Answer 10

Total Intravenous Anesthesia, 3-5 mins

Question 11

The most commonly used agent for TIVA techniques is:

Answer 11

Propofol

Question 12

What are 3 factors that may slow down the rate at which a patient is induced via Mask?

Answer 12

Patients respiration, Agent used and carrier gas flow rate, type and volume of breathing circuit

Question 13

Sometimes during a struggle in induction via Mask, the animal will ____

Answer 13

Breath hold

Question 14

True or False: The best technique for masking an animal for induction is introducing the mask quickly with a high flow rate to knock them out as quick as possible

Answer 14

False. A struggle will happen and breath holding will occur. The best way is to introduce the mask slowly with Oxygen only at first, then introduce anesthetic at 0.5% increments over 10-15 seconds each. Then turn it up high to pass the excitatory stage quickly

Question 15

The most commonly used method of inducing and maintaining anesthesia in small animals includes:

Answer 15

IV induction and Inhalant maintenance

Question 16

What equipment needs to be checked in preparation BEFORE induction begins?

Answer 16

Intubation equipment, syringes/needles/fluids, heating equipment, anesthetic machine, crash cart with emergency drugs

Question 17

True or False: It is best to give the entire calculated dose of anesthetic induction IV

Answer 17

False. It is best to give about half, and try and intubate, if patient isnt ready then give the rest to effect

Question 18

What is titration?

Answer 18

IV drugs given as a series of bolus injections and discontinued when desired effect is reached

Question 19

With mask induction, it is hard to monitor what 3 parameters through the mask?

Answer 19

CRT, MM and Ocular indicators of anesthetic depth

Question 20

True or False: It is appropriate to mask an un-sedated patient down for induction

Answer 20

False. This will produce a struggle and cause the release of epinephrine, and further struggle will come to induction and recovery. Use only on calm or sedated patients

Question 21

What are the disadvantages of induction via Chamber?

Answer 21

Stress, trauma, vomiting, airway blockage
Hard to monitor patient
Exposes personnel to waste anesthetic gasses

Question 22

True or False: The dose required for IM induction is generally about half the dose needed for IV induction

Answer 22

False. It is twice the corresponding dose.

Question 23

True or false: When IM induction drugs peaks and the patient is still too light, an additional drug must be administered to get the patient to the point of intubation

Answer 23

True

Question 24

The ET tube conducts anesthetic gas directly from oral cavity to trachea and by passes the ____ and ____

Answer 24

nares and pharynx

Question 25

ET tubes help decrease anatomic dead space therefore reducing the risk of _______

Answer 25

atelectasis

Question 26

What equipment is needed for ET intubation? (8)

Answer 26

1. 3 ET tubes of slightly different diameters 2. 2 foot length of IV tubing or rolled gauze to secure the ET tube in place 3. Gauze sponge to grasp the tongue 4. 12 mL syringe to inflate the cuff 5. Stylette for narrow diameter tubes 6. Lidocaine spray to control laryngospasm in cats 7. Laryngoscope with appropriate blade and a light source 8. Lubricant for the end of the tube

Question 27

Ideally, you should choose an ET tube size so that the length extends from the tip of the nose to the _____

Answer 27

thoracic inlet

Question 28

When selecting the appropriate diameter of ET tube, it must be small enough not to cause _____ injury and large enough to provide a _____ with an inflated cuff

Answer 28

Tracheal, seal

Question 29

It is best to check the ET tube cuffs for leaks by:

Answer 29

Inflating them 10 minutes prior to intubation and ensuring they are still inflated

Question 30

When the ET tube is placed correctly, the tube will begin to _______ from within, then the patient is placed in ______ recumbency

Answer 30

Fog, lateral

Question 31

What are 3 ways you can confirm correct ET tube placement?

Answer 31

Watch the reservoir bag, unidirectional valve motion, patient coughs during intubation, fogging of tube during exhalation

Question 32

You should inflate the ET tube cuff until leaking just ceases at a breathing circuit pressure of _______

Answer 32

20 cm of water

Question 33

Laryngospasm is common in cats, swine and small ruminants and it makes intubation very difficult, which could lead to ____ or ______

Answer 33

Cyanosis or hypoxemia

Question 34

Forcing the ET tube into the Glottis can cause life-threatening complications including:

Answer 34

Tracheal rupture, pneumothorax and pneumomedistinum

Question 35

Despite all precautions, some intubated patients will develop minor tracheal irritation. Owners should be warned that it is common for animals to _____ for 1-2 days after anesthesia

Answer 35

Cough

Question 36

An alternatvive to ET intubation is ______

Answer 36

Supraglotic Airway Devices (SAD)

Question 37

What are the advantages of using SAD's instead of ET tubes?

Answer 37

Increases efficacy of anesthetic gas delivery, redused anatomical dead space, reduced risk of laryngeal trauma

Question 38

True or False: When rotating an intubated patient, it is best practice to temporarily disconnect the ET tube from the anesthetic machine

Answer 38

True. Rolling or twisting an animal while it is still connected to the circuit may cause ET tube to twist or collapse, resulting in airway obstruction or lacerated trachea

Question 39

_______ should be instilled into th eyes of an anesthetized patient every 2-3 hours to increase patient comfort

Answer 39

Artificial tears or corneal lubricant

Question 40

True or false: Patient breed can influence the length and quality of the recovery period

Answer 40

true

Question 41

If a patient in the recovery stage is shivering even while under heating elements, the anesthetist can administer _______

Answer 41

direct oxygen

Question 42

True or false: During extubation it is best to remove the tube straight out and slightly upward

Answer 42

False. It is best to remove the tube in the same arch that it went in

Question 43

True or False: Remove the IV catheter as soon as the vaporizer is shut off and anesthetic is discontinued

Answer 43

False. Leave IV catheter in until patient is FULLY awake in case of emergency

Question 44

The _______ stage of anesthesia is often the most dangerous even for healthy animals

Answer 44

recovery

Question 45

After dental cleaning, oral surgery or any other procedure in which blood or other fluids are present in the oral cavity, what is the best way to remove the ET tube?

Answer 45

Leave the cuff slightly inflated during removal to sweep out fluid and prevent it from entering airway

Question 46

A recovering patient should be turned every 10-15 mins to prevent _______

Answer 46

Hypostatic congestion: Pooling of blood in the dependent lung and tissues

Question 47

What is a laryngospasm?

Answer 47

Reflex closure of the glottis in response to contact with object/substance

Question 48

2 ways to prevent Laryngospasm are to wait for the glottis to open before intubating and _________

Answer 48

spray with lidocaine