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Anaesthesia > Clinical Monitoring During Anaesthesia - Capnography > Flashcards

Clinical Monitoring During Anaesthesia - Capnography Flashcards

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1
Q

Why monitor anaesthesia?

A
  • to prevent P responses to Sx stimulation
  • to detect abnormalities before they turn into major complications
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2
Q

by ensuring tissue perfusion & oxygenation, we can…

A
  • prevent worsening of subclin dz & improve P outcome
  • reduce morbidity & mortality assoc’d w/ anaesthesia
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3
Q

When is the highest risk period for patients surrounding anaesthesia?

A

during the recovery period

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4
Q

When monitoring anaesthesia, what do you specifically monitor?

A
  1. CV system
  2. resp system
  3. depth of anaesthesia
  4. body temp
  5. fluid balance
  6. anaesthetic equipment
  7. recovery
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5
Q

What reflexes in the dog/cat are monitored during anaesthesia?

A
  • flexor withdrawal/pedal
  • palpebral
  • position of the eye
  • eye mvmt
  • ear flick (cat)
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6
Q

How do you determine in small animals adequate anaesthetic depth?

A
  • HR, RR, BP stable
  • Neg flexor withdrawal reflex
  • Eyes: no palpebral reflex, ventral rotation, no nystagmus
  • minimal jaw tone
  • no movement
  • neg ear flick
  • pink MM
  • CRT <2 sec
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7
Q

How do you know an animal is too light

A
  • eye central
  • increased HR/BP/RR
  • increased jaw tone
    +/- palpebral
    +/- pale mm
    Nystagmus in horses (VERY LIGHT)
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8
Q

how do you know an animal is too deep?

A
  • eye central
  • decreased HR, BP, RR
  • no palpebral, jaw tone
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9
Q

When monitoring and determining depth of anaesthesia, you notice a central eye. Your patient was given ketamine as part of its premed IM and was maintained on CRI of ketamine. Is this normal?

A

Ketamine will result in a central eye so this cannot be used to determine depth.
This does NOT occur & of concern if used as an induction agent (duration of action 10-20 mins)

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10
Q

A respiratory monitor

A

“bleeps” each time the P breathes but DOES NOT tell you anything about efficiency of respirations/ventilation/etc.

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11
Q

If an animal is hypothermic in recovery and shivering, it will

A

increase Oxygen demand by 400% so need about 85% Oxygen to not become hypoxaemic

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12
Q

Why are IV fluids administered?

A

inhalants & maintenance w/ propofol/alfaxalone –> vasodilation occurs, circ blood vol is not enough –> relative hypovolaemia

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13
Q

What does capnograph measure?

A

End-tidal (Et) & inhaled (Fi) CO2

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14
Q

Normal Et value

A

4.6-6 kPa (35-45 mmHg)

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15
Q

Normal Fi value

A

0 –> do NOT want any inhalation of CO2 in most conditions

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16
Q

capnographs produce a wave form which is useful to

Study These Flashcards
A

diagnose respiratory problems

17
Q

CO2 is an end-product of…

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A

metabolism, then sent to lungs for exhalation

18
Q

Levels of CO2 depend on…

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A

cell metabolic rate, perfusion of lungs, ventilation
& can be used to diagnose issues w/ breathing system

19
Q

Capnography monitors…

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A

ventilation, circulation, metabolism

20
Q

End-tidal or exhaled CO2 equates w/

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A

alveolar & arterial CO2
UNLESS VQ mismatch or other issues

21
Q

Increased inspired CO2 (Fi) indicates

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A

equipment is faulty

22
Q

capnography provides range of info including:

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A
  • CO2 production (metabolism)
  • pulmonary perfusion & CO
  • alveolar ventilation
  • breathing system & other equipment issues
  • efficiency of CPR
  • warns of impending cardiac arrest
23
Q

when looking at a capnograph, how do you determine hypercapnia is occurring? Clinically, what is happening physiologically in the patient?

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A

EtCO2 > 6kPa
ventilation is not keeping up w/ expelling CO2 at the appropriate rate –> build up of CO2

24
Q

What is the most common cause of hypercapnia?

Study These Flashcards
A

decreased alveolar ventilation due to: too deep anaesthesia, geriatric, obesity, pregnancy, space-occupying masses, muscle weakness, laparoscopy, endoscopy (expansion of abd contents), pain

25
What is the 2nd most common cause of hypercapnia
Equipment failure causing rebreathing of CO2 --> exhausted soda lime, dysfxning unidirectional valves, too low FGF, equipment dead space
26
What are other causes of hypercapnia aside from the most common ones?
increased metabolic rate --> hyperthermia, hyperthyroidism, seizures, etc
27
What are the 4 main causes of hypocapnia?
- decreased metabolism - decreased perfusion - increased alveolar ventilation - equipment problems
28
Remember: if you suspect that the hypocapnia seen on a capnograph is due to decreased cardiac output, it is...
an emergency
29
Explain the 4 phases of a capnograph trace?
I: exhaling anatomical dead space gas, no CO2 II: alveolar air w/ CO2 joins dead space air III: exhaling only alveolar gas 0: inhalation, normal CO2 drops & majority should be 0 CO2 during this time; if not, then is inhaling CO2
30
What kind of trace is this?
Normal capnograph trace
31
What kind of trace is this? Is it normal or abnormal?
Cardiogenic oscillations Normal trace
32
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
abnormal hypoventilation P hypoventilated so hypercarbic
33
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
Abnormal Bronchoconstriction or partial airway obstruction/kink Expiration difficult/restricted leading to accumulation of CO2
34
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
Patient fighting the ventilator Abnormal Patient is trying to inhale in the middle of ventilation
35
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
Rapidly decreasing EtCO2 Abnormal indicates cardiac arrest, rapidly failing cardiac output; OR leak in cuff or breathing system not connected
36
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
Leaky ETT Cuff Abnormal when exhaling, the CO2 majority exits into the room around the tube, so lower EtCO2 than what is being exhaled
37
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
Abnormal Rebreathing of CO2 in a circle system due to leaky valves leaky valve so circle fails which is unidirectional flow of gas, then can no longer airflow properly so P breathing in CO2 when not reaching baseline during inspiration = massive rebreathing of CO2
38
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
Rebreathing of CO2 in a non-rebreathing system abnormal insufficient FGF on non-rebreathing Gap on baseline = rebreathing CO2
39
What kind of trace is this? Is it normal or abnormal? What is happening to the patient?
Oesophageal intubation abnormal breathing, not no CO2; if you see this and know p is breathing, you intubated in the wrong tube and need to reintubate

Anaesthesia (23 decks)

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