Flashcards in Condition-specific AX Deck (102):
T/F Patients with diabetic ketoacidosis should not be anesthetized. Should emergency surgery be necessary, regular insulin, aggressive fluid replacement, as well as potassium and dextrose supplementation are required before anesthesia.
Up to how many weeks is a dog or cat considered a neonate? What about a calf or foal? Up to how many weeks is a dog considered pedaitric?
Muffin, the 9 year old Standard poodle, has an insulinoma. Which drug class can you give to promote gluconeogenesis? Which one could you give to inhibit insulin release?
Glucocorticoids - promote gluconeogenesis
Diazoxide- inhibits insulin release
During surgery, Muffin the poodle with insulinoma you are unable to maintain her BG with dextrose and glucocorticoids. Which drug that promotes gluconeogenesis and glycogenolysis can you give?
One disadvantage of IPPV is that it causes (increased/decreased?) blood pressure.
T/F Diabetic patients should never be fasted prior to surgery so that they can receive a normal AM dose of insulin before the surgery.
False, routine fasting (8-12 hours) is warranted and HALF of the normal insulin dose should be given.
Cookie is a 10 year old boxer with an insulinoma. His BG intra-operatively is 70mg/dl. What do you do?
Nothing, this is a normal BG for a patient with an insulinoma. As long as the BG is over 50mg/dl no action is necessary.
Water should never be withheld from patients with __________ or _________
T/F: In patients with hypothyroidism tachycardia, hyperthermia, and hyperventilation may be more likely.
(Bradycardia, hypothermia, hypoventillation)
Spazz the cat is hyperthyroid. Suddenly his heart rate and blood pressure spikes, his heart rate becomes irregular he has a fever. What is this called and what caused it?
You want to avoid giving drugs to Spazz, the hyperthyroid cat, that increase heart rate, myocardial work, and oxygen consumption. You also want to avoid drugs that cause significant CV changes. The same drugs should be avoided in patients with phenochromocytoma. Which of the following drugs do you want to avoid?
Dexmedetomidine & xylazine (all alpha-2's)
Atropine pre-med (routine use)
What class of drugs should be avoided in patients with diabetes mellitus? Why?
Alpha-2 agonists (xyalizine, dexdemetomidine)
Cause hyperglycemia (by inhibiting insulin release or stimulating glucagon release)
Why should you use short-acting drugs or those that can be reversed in patients with DM?
So you can feed them ASAP (resume normal feeding and insulin schedule)
Spazz the hyperthryoid cat needs BP support intra-operatively. What drug should you use?
T/F: Analgesia in younger patients is less crucial since their nervous system is not fully developed yet.
False, important in patients of any age.
Pain experienced as a neonate may cause altered pain perception for life.
Serum iCa should be decreased in hyperparathyroid patients before anesthesia. This is because chronic hypercalcemia can lead to ______ _______.
T/F To maintain BG in DM patients, D5W (5% dextrose in water) should be used as needed intraoperatively.
False, 1-5% dextrose in balanced electrolyte solution.
For bolus use fluids without dextrose.
What is the normal BG range you want to maintain with DM patients? How often should you check the BG intra-operatively? How often post-op?
q30-60min (depending on initial values)
q1-2 hours until patient is eating
What electrolye do you want to check before induction in patients who have Diabetes insipidus? What level do you want to maintain?
What can you use to treat a common post-op complication in hyperparathyroid patients? What is this complication?
What are the signs of adrenal insufficiency that you should monitor post-op in dogs with Addision's?
Which drug should you avoid with dogs who have Addision's disease as well as septic patients? Why?
Causes adrenocortical supression
Sodium in a patient with DI should not be increased or decreased faster than ____mEq/L per hour. This is done to prevent fatal ____ _______.
Brain hemorrhage (central pontine myelinolysis, aka osmotic demyelination syndrome)
Which shorting-acting injectable beta blocker used for tachyarrythmias is most commonly used in patients with pheochromocytoma?
A 1 month-old puppy will have a (lower/higher?) blood pressure under anesthesia. An awake 1 month-old puppy will have a BP around (50/100/150?) mmHg.
T/F: Most patients with hemoabdomen require less inhalant anesthesia, so the vaporizer should be turned down to 0.25-1% iso (1-2% sevo) or less.
What is the definition of colic?
T/F: Fetal drug metabolism is fast which is why drug dosages must be drastically adjusted.
False, drug metabolism is slow due to immature hepatic microsomal enzyme system
A patient with DI should be given hypotonic fluids intra-operatively as needed. Which 2 of the following are hypotonic fluids?
0.45% NaCl + 2.5% dextrose
0.45% NaCl + 2.5% dextrose
Which monitoring device will reveal the your Cushinoid patient has developed pulmonary embolism (PTE)? What will you see?
An exponential decrease in ETCO2, a sharp drop in ETCO2
A pregnant bitch's cardiac output _____ 30-50%
What form of blood pressure monitoring provides accurate systolic, diastolic and mean pressure values and allows for the evaluation of a pulse pressure wave?
Invasive (direct) blood pressure
Match the terms with their definition:
-Functional Residual Capacity
Maximum expelled volume after maximum inspiration
Remaining gas in lung after maximum expiration
Remaining gas in lung after normal expiration
Normal breath volume
Tidal Volume: Normal breath volume
Functional Residual Capacity: Remaining gas in lung after normal expiration
Vital Capacity: Maximum expelled volume after maximum inspiration
Residual Volume: Remaining gas in lung after maximum expiration
Blood pressure in dogs with Cushing's disease should be kept (higher/lower?) than normal during anesthesia.
Higher (due to loss of autoregulatory control at the tissue level)
Which long-acting alpha antagonist can be used pre-operatively in patients with pheochromocytoma to stabilize blood pressure and heart rate?
What class of local anesthetic is more likely to accumulate because it is metabolized by hepatic microsoal enzymes? What are some examples of these local anesthetics?
Foals are normally delivered less than ___ minutes after membrane rupture. After about ____ minutes almost no foals survive birth.
A ___ epidural is common in small animals, while a ____ epidural is more common in cows.
Once a pheochromocytoma is removed, an acute drop in catecholamines may occur. What drugs can you use to treat the hypotension and bradycardia this causes?
T/F: Dyspnic patients should not be sedated.
False, light sedation is indicated (such as torb +/- benzo or low dose ace)
Which sedatives are not recommended in young patients? What can you use for sedation that helps maintain respiratory and CV function?
Phenothiazines and alpha-2 agonists
Diffusion rate is proporational to tissue area, partial pressure difference an solubility of the gas in the tissue. Diffusion is inversely proportional to tissue thickness and the square root of molecular weight. What law is this?
T/F: Pregnant patients have a decreased epidural space and an increase in the cranial spread of epidural drugs. This is why epidural drug volume should be decreased by approximately 1/3.
T/F: Burprenorphine is a good choice for analgesia +/- sedation in young patients because it has a short DOA and is easily reversible.
False, long DO and poorly reversible.
Which class of sedatives increases uterine pressure and decreases O2 delivery to the fetus? What species, when pregnant, is it still commonly used in?
T/F: You should induce emesis in patients with megaesophagus prior to surgery to reduce the likelihood of reflux.
False, avoid vomiting.
What is the reduced fluid rate used for cardiac patients under anesthesia?
If an opioid was administered to the mother before she gave birth, how do you reverse it in the babies?
1-2 drops of naloxone sublingually
Rapid induction and control of airways is important in patients who have megaesophagus. Which drug should you avoid?
In which of the following cases is it indicated to give anticholinergics with the premed?
An 8 week old puppy being anesthetized for wound repair.
A 2 year old hyperthyroid dog having dental extractions.
A 1 year old horse with borderline high blood pressure who is being castrated.
8 week old puppy
T/F: Most NSAIDs are approved for use in dogs >5 weeks of age. They are a good class of drug to use to control pain in young dogs since opiates are too strong.
False, not recommended because of their immature hepatic and renal function.
Also, carprofen is approved for dogs >6 weeks but other NSAIDs are only approved for dogs over 4-6 months of age.
A geriatric animal are those that are older than ___% of expected life span.
In an equine patient with moderate to severe hypocalcemia, what can you administer pre-op?
T/F: An ECG gives no information about contraction, it only represents electrical activity.
Logoregional block and sedation are commonly used when delivering ruminants. What blocks are used in small ruminants? Large ruminants?
Small: Line block, LS-epidural
Large: Paravertebral block, Inverted "L" block
Geriatric animals have less responsive ___ receptors, which means a limited ability to increase ____ rate.
Splenic disease often causes _____ arrythmias which can be treated with _____.
Which induction agent can be used safely in large animals but use in small animals is controversial and may contribute to mortality in canine neonates?
Which fluid type is not appropriate for a patient with CHF?
Which sedative is most appropriate for ancient crabby cats? Which should be avoided?
Dexdomitor and ketamine
MAC is (lower/higher?) during pregnancy.
Which of the following treatments would be most appropriate for local anesthetic toxicity?
Based on recent clinical studies, which induction agent is safe an effective for C-section in dogs?
What 2 drug classes are combined commonly for epidural anesthesia?
Local anesthetic (or A-2 agonist) + Opioid
(Often bupivacaine + morphine in small animals, detomidine + morphine in horses)
In patients with GI disease, reperfusion of compromised tissue causes the release of ______ ______ which may cause severe vasodilation, hypotension, decreased inotropy, and ventricular arrhythmias.
Serial measurement of which prognostic indicator is warranted anesthesia in patients with GDV? What are normal lactate values in a dog?
Which of these is not a balanced replacement crystalloid?
Is gastric trocharization appropriate for GDV patients? If yes, would you preform it before induction, at induction, or intra-operatively?
Yes, before induction to support BP and ventilation as well as improve patient comfort.
T/F: In GDV patients, a lidocaine bolus or CRI should be considered even if there are no or minimal VPCs.
In patients with CHF, which fluids are most appropriate for increasing vascular volume; Colloids, crystalloids or blood products?
Prior to colic surgery, a horse weighing 450-500kg should be given a bolus of how much of which type of fluid before induction?
Pre-oxygenating and limiting stress are important for animals with: Colic, HCM, or hypothyroidism?
T/F Oxygen diffuses 20 times more rapidly than carbon dioxide.
CO2 is more soluble with a similar molecular weight.
Before induction, patients who are in shock should have a heart rate less than ____ and systolic BP more than ___.
Hypoxemia is defined as a PaO2 < ___mmHg, which corresponds to a SpO2 of ___%.
In a horse with colic, hyperlactatemia is a sign of what?
Poor perfusion +/- GIT ischemia
VPCs should be treated if HR >180, R on T phenomenon is occurring, the VPCs are multiform, or if they are causing ______
What are the 5 causes of hypoxemia?
2. Anatomic R-L shunt
3. Low inspired O2 (FiO2)
4. Diffusion impairment
5. V/Q mismatch
What type of fluid therapy is indicated intra-operatively for a hypotensive horse in surgery for colic?
Hypertonic saline and colloids
Other than pre-operative atropine, which drugs should be avoided in shock patients as well as those with mitral valve disease?
Phenothiazines (VD, incr BP)
A-2 agonsts (++VC, bradyC, decr CO)
Propofol (VD, decr contractility)
Why are opioids and benzos good drugs to use in shock and overall sick patients?
They are reversible and have minimal CV effects.
T/F: As long as the blood pressure is stable, a dog with mitral valve disease can be anesthetized before pulmonary edema has been resolved. Diuretics, ACE inhibitors and pimobendan can then be used during the procedure to resolve the edema.
False, patients with CHF should be stable. These drugs should be given before the animal is anesthetized.
Which medication(s) should be avoided in a dog with CHF the morning of the surgery?
All others should be given normally
T/F: Ketamine can be used in patients with mitral valve disease as long as they do not have pre-existing tachycardia or A-fib.
At the time of PDA occlusion diastolic BP will increase dramatically often resulting in _____ ______, known as Branham's sign. This is treated with ______.
Patients with 3rd degree AV block require a method for pacing while anesthetized. Why is this and what are the non-invasive pacers that can be used? Where are the pacemakers placed if they are placed surgically?
Transcutaneous (pacing pads)
Temporary transvenous pacing
Surgically: Trans-diaphragmatic or in jugular vein with fluoroscopic guidance
Hypoventilation is defined by PaCO2 >___mmHg and will result if breathing room air (FiO2= ___) but not if breathing ___% O2.
This ratio is used to objectively measure oxygenating ability. V/Q mismatch is the most common cause of the ratio dipping <500 (100/0.21). What is this fraction
Arterial O2 to Fractional inspired O2 (PaO2:FiO2)
An anemic patient may have a normal PaO2 but marked tissue hypoxia. What must you increase to resolve this and what can you give to do this?
RBCs or synthetic Hb
T/F: Body temperature affects ventilation.
Which 2 of the following drugs cause potentially significant respiratory depression?
The others cause minimal respiratory depression.
When placing a pacemaker, drugs that cause vagal stimulation, bradycardia or hypotension should be avoided. What drugs are these?
Pure mu agonists
Can anticholinergics be used when placing a pacemaker?
Yes, but they probably won't be effective.
Which type of arrhythmia is normal in horses?
2nd degree AV block
T/F: Lidocaine can be used to treat ventricular escape beats, like those that occur in a 3rd degree AV block.
False, lidocaine can suppress the ventricular beat and lead to arrests. Escape beats are not the same thing as VPCs.
What is the ECG rhythm called where QRS complexes arise from the ventricles in a wide, bizarre pattern and without a P wave? The rate is usually 100-140bpm. This rhythm will not respond to lidocaine.
Accelerated idioventricular rhythm (AIR)
What are the arrest rhythms on ECG?
Pulseless ventricular tachycardia
Pulseless electrical activity
IPPV decreases _____ but may increase it if resolving areas of atelectasis.
Pre-op bloodwork for DM patients should be a CBC and chemistry including ______.