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Day 3 - anaesthesia Flashcards

1
Q

Risk factors of an.

A

Age
Type of surgery (fracture and colic)
Body position
Premedication (use acepromacine!)
Duration
Time of an

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2
Q

Provide .. to anaesthesia

A
  1. Free airway (intubation)
  2. O2 supply
  3. IPPV (intermittent positive pressure ventilation)
  4. Venous access-catheter
  5. CPR=Cardio-Pulmonary Resuscitation
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3
Q

Prior to sedation; give .. (4)

A

Antimicrobials
Anti-inflammatories
IV. Catheter in jugular vein
Flushing the oral cavity with tap water

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4
Q

Drugs for premedication (4)

A

Phenothiaxines (Acepromazine)
Alpha2 adrenergic drug
Opioids (never alone, cause excitement)
Benzodiazepines (young foals)

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5
Q

Combinations of premedications (4)

A

o Alpha2- agonists
o Alpha2agonists + Phenothiazine/opioid
o Phenothiazine + alpha2- agonist/ + opioid
o Benzodiazepine (neonates)

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6
Q

Drugs for induction

A

Ketamine
Guaiphenesin (GGE)
Barbiturates (thiopental – best choice (short acting))
Propofol

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7
Q

Example of premedication (4)

A
  1. Ketamine + Diazepam
  2. GGe: + Ketamin or + thiopental
  3. Tiletamine + zolazepam, not narcotic drug
  4. Propofol
  5. Inhalational anestetics (foal)
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8
Q

Maintanance of an (3)

LEARN THE INFO

A

TIVA (total intravenous anesthesia)
Inhalational anesthesia
PIVA (Partial intravenous anesthesia) (balanced an.)

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9
Q

TIVA advantages/disadv

A

ADV:
* Less depression on cardioresp.
* TIVA stress < inhalation anesthesia
* Good analgesia
* Less complication/mortality
* Nice recovery
* Min. tissue toxicity
DISADV.:
* drug accumulation, infusion pump is needed
* Methods of drug delivery:
o Intermittent injection (bolus)
o Drip technique (infusion/syringe pump) – continus infusion

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10
Q

TIVA 2 groups

A

1ST GROUP: SHORT ANESTHESIA (<30 MINS)
Alpha2-agonist (1/4 dose) + dissociative anesthesia (1/2 dose) –> 5-10 min
Thiopental
2ND GROUP: MID LONG ANESTHESIA (30-60 MINS)
Hypoxia can develop, give extra O2, Boluses/CRI (continuous rate infusion)

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11
Q

TIVA combinations (3)

A
  • Triple drip in CRI
  • GGE 5% + xylazine + ketamine
  • Ketamine + Xylazine + diazepam
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12
Q

Inhalation an
- Adv/disadv
- Drugs

A

ADV:
* Depth can be changed rapidly
* Can be monitored
* Min. drug accumulation
* Elimination is ventilation dependent
DISADV:
* Pollution
* Cardiorespiratory depression
* Min. analgesia
* Expensive
* Recovery is not as good as TIVA

MAC- minimal alveolar concentration
1. Isoflurane (MAC: 1.31%)
2. Sevoflurane (MAC: 2.31%)
3. Desflurane (MAC: 7.6%)

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13
Q

PIVA
Combined use of inhalational and intravenous anesthesia

Adv/disadv

A

ADV.
* Cardiorespiratory depression decrease (MAC decr.)
* Analgesia increase
* Organ toxicity decrease
* Movement decrease
* Recovery increase
* Mortality decrease
* Muscle-relaxing effects of inhalational anesthesia

DISADV.
* Pollution
* Cardiovascular depression ßinhalation drugs
* Equipment: IV + inhalation drugs
* Long procedures
IV drugs accumulation

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14
Q

PIVA - drugs (5)

A
  1. Ketamine
  2. Alpha2-agonist:
    - medetomidine
    - Romifidine
    - Xylazine
  3. Ketamine + alpha2-agonists
  4. Lidocaine – colic patients in continuous iv drip
  5. Lidocane + ketamine - approx. 60% - colic patients
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15
Q

Fluid loss - replacement

A

Replace fluid loss: 5-10 ml/kg/h

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16
Q

Methods to decrease surgical stress (3)

A
  • Increase tissue perfusion: avoid hypotension, hypovolemia (circulatory system)
  • Local anesthesia: prevent nociceptive signals to CNS
  • Butorphanol: decrease cortisol response
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17
Q

Recovery

A

Use of part-dose of alpha2-agonists in recovery, keep in lateral recumbency, dark, quiet box, urethral catheters

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18
Q

Complications and emergencies (8)

A
  1. Cardiopulmonary resuscitation
  2. Anaphylaxis
  3. Intraoperative hypotension
  4. Hypoxemia and hypoxia
  5. Hypercapnia
  6. Postoperative myopathy
  7. Postoperative neuropathy
  8. Postoperative laryngeal oedema
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19
Q

Resuscitation drugs (4)

A

Vasoconstriction - epinephrine
Positive ionotrop - dobutamine
Vagolytic - atropine
Ventricular tachycardia - lidocain

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20
Q

Treatment of anaphylaxis

A

IPPV
Ventilate with O2
Fluid therapy
Give: epinephrine, bronchodialator, corticosteroids, antihistamines
Check ABP, ECG

21
Q

Treatment of intraoperative hypotension

A
  • Hypotension
  • Poor tissue perfusion
  • Postop myopathy
  • Spinal cord ischemia
  • Cerebral necrosis
  • Myocardial dysfunction
  • Treatment
    Infusion: electrolyte/colloid/hypertonic
    + inotrope: dobutamin
22
Q

Preoperative evaluation - important things - ana of foals

A

-Auscultation on heart
-Congenital cardiac
-Heart murmur
-Colostrum intake
-Blood glucose
-Substitute glucose

23
Q

Effects of hypothermia - ana of foals

A

-MAC ̄
-Bradycardia – decreased CO
-Tissue perfusion ̄, metabolism ̄, bleeding time ­
-Delayed recovery, increased O2 consumption (shivering)

24
Q

ana of foals - sedation

A

-Diazepam, midazolam
-Prevent: hypothermia, hypoglycemia!!
-Provide extra O2!!!
-Butorphanol
-Benzodiazepines: diazepam/diazolam – Safest combo! -Exact dose, careful IV injection, dilute!
a2 agonists: (over 4 weeks, not so sick)
-xylazine
-detomidine
-medetomidine
-romifidine

25
Induction with inhalation - ana foals
not recommended
26
Induction with IV - ana foals
Light plane anesthesia/short (eg. joint lavage): -Ketamine + diazepam Deep plane an./long -Ketamine + diazepam +/- a2 agonist -Propofol (apnea, minimal analgesia)
27
Ana geriatic horse - sedation
Acepromacine, Xylazine, butorphanol
28
Age restrictive diseases - ana (4)
RAO Cushing syndrome Aortic valve insufficiency Hypothyroidism
29
Ana of colic horses - preop
-Hypovolemic shock -Abdominal pain-shock -Endotoxemic shock 1. Stomach tube 2. Rapid fluid therapy -Isotonic fluids -Hypertonic saline -Colloids -Acid-base correction: metabolic acidosis (mixed)
30
Ana of colic horses - sedation, analgesia
-a2 agonist: xylazine -NSAIDs (antiendotox-flunixin, analgesic) -Opioids: with a2 agonist combo -Phenotiazines contraindicated!! Don’t for shock patients! Anti-endotoxin: polymixin B, anti-endotoxin serum, flunixin, DMSO AB: b-lactam (penicillin) + aminoglycoside (gentamicin) before induction
31
Ana of preggo - maintanance
inhalation, isoflurane
32
ANESTHESIA AND HYPERKALEMIC PERIODIC PARALYSIS
Hyperkaema Tachy/bradycardia ECG changes Hypotension Muscle tremor Hypercapnia Normothermia Tx: Ca-gluconate inf., Dextrose inf., insulin (K+) ̄ IV
33
ana of cardiovascular horse
-Hypovolemic shock (severe hemorrhage) -Endotoxemia, sepsis (colic) -Profound electrolyte imbalance -Stabilize prior to an.! -Low doses of sedatives, pre-emptive analgesic drugs Induction: GGE/benzodiazepins + ketamine Balance an., monitoring: ABP, ECG, blood gas
34
IPPV -increase volume -increase pressure
Volume increase – injury to lung Pressure increase – less injury to lung
35
Tidal volume
10 ml/kg for a 500kg horse 5 liter
36
O2 consumption
Average: 5ml/kg/minute for a 500kg horse 2,5 liter/minute
37
Monitoring during general anaesthesia
Physical signs ECG Blood pressure Pulse- oximetry Capnography Blood gas analysis (additional) Other (eg. EEG, not often)
38
Depths og anaesthesia (3)
1. Stadium analgesiae 2. Stadium excitationis 3. Stadium tolerantiae
39
Leads of ECG
o Positive electrode on the left thorax, caudal to the olecranon o Negative electrode on the right thorax, caudal to the olecranon o Neutral electrode to the loose skin about the junction of the neck
40
HR of horses
* Normal: 35 – 45/min * Bradycardia: < 25/min * Tachycardia: > 55/min
41
Causes of bradycardia
* Drugs: alfa2 agonist, opioid agonist, overdose of any anesthetics * Increased vagal tone: ETT, abdominal nociception, traction of ocular muscles, high blood pressure * Metabolic: hypothermia, end-stage hypoxemia, hyperkalaemia * Heart disease
42
Causes of tachycardia
* Light level of anesthesia: nociceptive response during surgery * Drugs: ketamine, parasympatholytics, sympathomimetics * Metabolic: hypovolemia, hypoxia, hypercapnia, hyperthermia, postoperative pain * Endocrine disorders: pheochromocytoma, hyperthyreoidosis * Heart disease
43
Hypotension - causes and consequences
Causes: o Hypovolemia o ̄ cardiac output o Vasodilatation Consequences o Compromised cerebral and coronary perfusion
44
Hypertension - causes and consequences
Causes: o Vasoconstriction Consequences (acute): o Edema and bleeding in organs (brain, lungs)
45
Capnography
* Non invasive * Monitoring the cardiopulmomary system * Lot of information: o Carbon dioxide content of exhaled gas o End tidal carbon dioxide partial pressure/concentration o Respiratory status o Ventilation o Perfusion o Metabolism Normal EtCO2: 35- 45 mmHg
46
ALPHA2 ADRENERGIC RECEPTOR AGONIST
Sedative effect, muscle relaxation, analgesia (visceral). Side effect: peripheral vasoconstriction, reflex bradycardia, bradyarrythmias. Xylasine Detemodine Romifidine
47
NSAIDS
Anti-inflammatory, Antipyretic, Painkiller Side effects o GI ulcer, GI bleeding o Nephrotoxic o Hepatotoxic o Antithrombotic effect o Chondrotoxic - Ketoprofen (foal) - Flunixin melgumine (Visceral pain, inflammation, potent COX inhibitor, tissue irritant) - Phenylbutazone: Orthopaedic pain, muscle and skeletal disorders. SE: Gi problems, tissue necrosis - Meloxicam, foals - Firocoxib - Diclofenac
48
NMDA RECEPTOR ANTAGONISTS
Ketamin Anaesthetic and maintenance, analgesic properties Increased heart rate, cardiac output, arterial blood pressure
49
Opioids
Excitement, agitation, increased locomotor activity, BUT calming. In combo w/ alpha2-a. - Butorphanol: in combo - Buprenorphine: In combo - Morphine - Methadone - Fentanyl

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