Exam 3 Flashcards
(95 cards)
1
Q
concerns for rums under anesthesia
A
salivation
regurgitation/aspiration - fast, extubate w/ cuff inflated
bloat - decreases lung vol
hypoventilation, V/Q mismatch - ventilate
size - myo/neuropathies
temperament - more sotic, suited for standing procedures
2
Q
how do you pad a ruminant under anesthesia?
A
larynx higher than oral cavity and rumen
3
Q
What’s important for injections in rum
A
if IM - neck or shoulder (protect meat)
pilot hole through tough skin
4
Q
Xylazine and ruminants
A
- recumbency concern for standing procedure
- sensitivity: goat>sheep>cattle>EQine
- 3rd trimester abortion - avoid in pregos
- avoid in sheep (resp issues)
- reverse w/ tolazoline or yohimbine
5
Q
Benzos and ruminants
A
good for calves, small rum
alpha 2’s for adult cows preferred
minimal cv depression
6
Q
Opioids and Induction agents used in rum
A
Morphine, butorphanol
Ketamine (+xylazine + diazepam), guaifenesin
propofol = apnea risk
7
Q
Ket-stun
A
special drug combo for standing sedation ~45 min
Butorphanol, Xylazine, Ketamine
8
Q
Rum characteristics under anesthesia
A
eyes - jelly bean sized pupils, rotated ventrally and medially
hypertensive
9
Q
where do you place a catheter in an SAC?
A
high on neck - further from carotid but thicker skin requires pilot hole
10
Q
concerns for SAC and anesthesia
A
salivation, regurge, aspiration - fast bloat intubation - laryngospasm position - nose to sky, larynx high recovery - obligate nasal breathers, soft palate displacement
11
Q
Concerns for pigs and anesthesia
A
- size variation = dose variation
- venous access hard - ears, IM injection in neck
- short necks, diverticular = difficult intubation
- malignant hyperthermia
12
Q
sedation vs. chemical restraint
A
sedation - calm, awake, but arousable
restraint - progress from sedation, tranquilization
13
Q
Acepromazine
A
- calming in 30 min
- no analgesia
- hypotension, maybe worsens seizures, paraphimosis in stallions
14
Q
Benzo’s (Midaz and Diza)
A
- midaz preferred (water soluble, absorbs via IM/SQ)
- reversed by flumazenil
- good adjunct b/c CV safe, amensic but alone causes excitement
15
Q
Alpha 2 agonists (Xylazine, Dexmetdetomidine, Detomidine, Romifidine)
A
- analgesic, heavy sedation, m relaxation
- bradycardia, AV block - only give to healthy animals
- GI effects, sudden arousal
- reversible
16
Q
Opioids
A
- not sedative in EQ, don’t use
- morphine most sedating, fentanyl least
- CV safe
- dysphoria, panting
17
Q
Ketamine/Telazol
A
can enhance sedation, give light anesthesia
telazol for fractious pets
18
Q
Propofol or alfaxalone
A
heavy sedation to general anesthesia
give supp oxygen
19
Q
Concerns when anesthetizing a pregnant patient
A
maternal safety
effects on neonate, oxygen delivery to fetus
risk of abortion
20
Q
CV changes during pregnancy
A
- Increased blood vol (plasma) based on fetus #
- Increased CO (both SV, HR) but decreased SVR to maintain BP
- delayed baroreceptor compensatory response
21
Q
What is the concern w/ hypotension during pregnancy
A
- uteroplacental perfusion is pressure dependent
- hypotension = decreased perfusion to fetus
22
Q
respiratory changes during pregnancy
A
- pregnancy displaces diaphragm = decreased TLC, FRC = increased risk of hypoxia (preoxygenate!)
- increased progesterone = increased sensitivity to PaCO2 = compensatory ventilation sooner = increased o2 consumption
23
Q
Other physiologic changes during pregnancy
A
- decreased anesthetic requirement (d/t progesterone, GABA, hormones)
- increased sensitivity to drugs (overdose risk)
- higher regurge/aspiration risk
24
Q
fetal phys during pregnancy
A
- affected by drugs that can cross bbb
- decreased hepatic enz = longer drug effect
- fetal blood supply has lower PaO2, higher hgb affinity
- blood goes to liver first - drugs partially metabolized
25
Recommendations for anesthetizing preggos
- correct blood vol deficits ahead
- maintain BP
- preoxygenate
- rapidly secure airway
- minimize drug doses & time under
26
Premed for preggos
SA - opioids, anticholinergics
LA - alpha 2 agonists
Rum/camelid - benzos (propofol) or not used
27
Induction for preggos
IV (over IA) w/ 15 mins for redistribution
SA - propofol, alfaxalone
LA - ketamine +/- propofol
28
Maintenance for preggos
low dose IA (minimized neonate depression)
mechanical ventilation
avoid nitrous oxide
29
Post-op pain for preggos
Line/incision block - esp. if C-section
| Morphine epidural, systemic opioids, or NSAIDs - but time against nursing
30
How to resuscitate a neonate
- Ideally 1 person per baby
- Remove membranes, clear oropharynx secretions
- anatognistic drugs sublingual or umbilical v.
- rub chest vigorously to stim respiration
- supp oxygen, heat
- maybe Doxapram to increase breathing, not start it initially
31
Concerns for neonates based on their phys
- fewer liver enz = decreased metabolic capacity
- reduced glycogen stores = hypoglycemia risk
- greater SA to bw ratio = heat loss risk
- immature symp NS = lower BP, lower contractility & CO
- weak muscles = decreased FRC, more thoraicic compliance
32
Concerns when anesthetizing neonates
- decreased ability to metabolize drugs
- hypoglycemia
- hypothermia
- bradycardia, hypotension
- hypoventilation
33
What kind of drugs do you use to anesthetize neonates
short acting, reversible - IA's, propofol, opioids
| Ephedrine if BP drops
34
What's key about shock and trauma patients
Likely in or about to be in compensatory shock - will crash if anesthetize now - STABILIZE FIRST
35
Types of thoracic injuries seen w/ trauma
lung contusions
pneumothorax
myocardial contusion
diaphragmatic hernia
36
Lung contusions
- common
- take 12-24 hrs to appear
- prone to atelectasis (lung collapse), hypoxemia/hypoventilation
- give PPV, but increased risk of barotrauma
37
Pneumothorax
- common, can be open or closed form
| - risk of atelectasis, hypoxemia, tension pneumothorax
38
What's the concern w/ tension pneumothorax
some air leaks out w/ each breath --> builds up cavity P --> lung compression = decreased venous return, SV/CO, hypotension --> CV collapse
39
Signs of tension pneumothorax during anesthesia
- decreased lung compliance
- sudden decrease in BP (b/c decreased venous return)
- stop PPV, do emergency thoracocentesis
40
What's the concern about myocardial contusions
- arrhythmias, which may be worsened under anesthesia
- ECG!
- avoid arrhythmogenic drugs - alpha 2's, thiopental, halothane
41
What's the concern about diaphragmatic hernia
abdomen in chest compression lungs
| decreased FRC --> atelectasis, hypoxemia
42
Ruptured bladder
common
urine leaks into abdomen
azotemia, electrolytes - hyponatremia/chloremia, hyperkalemia
43
What's the concern w/ ruptured bladder causing hyperkalemia?
- raises resting membrane potential - triggers systole more often
- can --> arrhythmias (V fib, asystole), bradycardia
44
How to treat hyperkalemia
- give CA to resolve conduction, not hyperkalemia
- drain urine (catheter)
- NaHCO3, insulin or dextrose to normalize K
45
What are the concerns w/ head trauma
Increased ICP
| Anesthesia could alter blood flow to brain
46
Signs of increased ICP
decreased mentation
small pupils
Cushing's response - hypertension, bradycardia
sometimes altered breathing
47
Head trauma and anesthesia
- intubation can spike ICP (b/c cough, give lidocaine)
- low dose drugs to minimize cerebral autoreg effects
- PPV to maintain PaCO2
- avoid ketamine, alpha 2's b/c increase ICP
48
Lab values to keep track of in an anesthetized trauma patient
Hgb
Acid/base
electrolytes - K, Ca
Oxygenation/ventilation parameters
49
Common drug combos for trauma anesthesia induction
Fentanyl + midaz/diaz
Etomidate + midaz/diaz - most CV/resp sparing, use for cats
Avoid ketamine in head traumas b/c increase ICP
Propofol/alfaxalone - decrease ICP but hypotension, apnea are concerns
50
What breeds are actually sensitive to anesthesia?
- greyhounds and thiobarbiturates - delayed recover d/t liver metab
- collies and MDR1/p-glycoprotein - Ace, torb
- boxers and acepromazine (anecdotal collapse)
- brachycephalics
51
T/F: opioids always cause excitation/dysphoria in cats
False, only high dose, not clinical doses
| but only use to treat for pain in cats, not to sedate
52
T/F: Butorphanol is an excellent analgesic
False: only treats mild pain, short acting (1-2 hrs)
53
T/F: Hydromorphone and Morphine are equally efficacious at providing analgesia
True, but potency varies
Hydro - lower dose needed than morphine to achieve same effects
Fentanyl more potent than hydro or morphine
54
T/F: alpha 2 agonists have severe CV effects
True, even for low doses
| Dexmedetomidine can decrease CO up to 50%
55
T/F: Propofol is the safest induction drug
False, actually very similar to thiopental in CV and resp effects
56
T/F: Iso is better than Sevo
False - clinically very similar
| Sevo has slightly faster induction/recovery b/c lower solubility
57
T/F: Pulse quality does not indicate BP and tissue perfusion
True - only indicates systole/diastole differen
58
T/F: hypotension is a concern for any anesthetized patient
True
59
What are the clinical signs of hypotension in an anesthetized patient
There are none - must measure!
60
T/F: Bradycardia means patient is too deep
False
| Common causes: hypothermia, vagal stimulation, opioids, alpha 2's
61
What spp doesn't have an epiglottis
birds, reptiles
62
Spp w/ an apical bronchus to R cranial lung lobe
rum, pigs
63
Spp where ocular signs have little significance as an indicator of depth of anesthesia
llamas
EQ - nystagmus and palpebral
rum - ventral/medially rotates eyes
64
Spp w/ complete tracheal rings
birds, some reptiles
65
Spp w/ a ventral laryngeal diverticulum impacting intubation
pigs
66
Spp w/ dive reflex
marine mammals, sea turtles/reptiles, diving birds
67
Spp w/ sensitivity/lack of sensitivity to xylazine
rum most sensitive (low dose), pigs unsensitive (high dose)
68
Spp in which a respiratory sinus arrhythmia is normal
dogs
69
Spp that may be hypertensive during anesthesia
cattle, maybe wild ruminants
70
Spp susceptible to malignant hyperthermia
pigs
71
Spp that could vocalize w/ an ET tube in place
birds
72
What drug do you avoid in a cat w/ hyperthyroid and concurrent hypertrophic cardiomyopathy?
Ketamine
73
What drug class treats tachyarrhythmias assoc'd w/ hyperthyroidism in cats/
beta blockers
74
Key pre-op management for anesthetizing an Addison doggo
glucocorticoid supp
75
Hyperkalemia can manifest in what ECG change?
absence of P waves
76
What drug has potential to increase blood glu?
Dexmedetomidine
77
FS dog w/ diabetes, mod mitral valve murmur getting a dental w/ possible extractions. drug plan?
Torb, atropine, etomidate, midazolam, iso
78
What is the goal of neuroanesthesia
prevent increasing ICP
79
how do you not increase ICP during anesthesia?
- Decrease cerebral metabolic rate by maintaining approp anesthetic depth
- maintain low to normal paCO2, prevent hypoxemia
- maintain MAP to prevent ischemia
- maintain acid/base status
maintain mild hypothermia - avoid hyperthermia, low metabolic rate
80
What can you do if there is an increase in ICP during anesthesia?
- decrease ECF via mannitol or furosemide
| - glucocorticoids contraindicated for traumatic brain injury
81
Clin signs of head trauma
```
papilledema, anisocoria, strabismus
changed mentation
abnormal resp
opisthotonus
Cushing's reflex to ICP: bradycardia and hypertension
```
82
What is the one drug that doesn't decrease CMR (cerebral metabolic rate) and CBF (cerebral blood flow)?
Ketamine
| increases CMR, slightly decreases CBF
83
What is the concern w/ IA's and neuroanesthesia?
CNS vasodilation as higher doses - avoid by using low dose, balanced anesthesia
84
Concerns for spinal cord neuro procedures
long
| concern for hypothermia, drug accum
85
Spinal imaging and horses
weakness, ataxia
| minimize alpha 2's - use ketamine, benzo, propofol
86
What's important about post-op care for neuro patients?
neuro status may worsen after surgery d/t increased anxiety, pain
Want calm recovery! Sedate - phenothiazine, low dose alpha 2
87
Between kidneys and liver, which once can regenerate?
Hepatocytes are regenerative to a point
| kidney can't regenerate nephrons
88
Additional concerns for animals w/ renal dz
anemia
hypertension
electrolyte abnormalities
stage of renal dz
89
Prepping a renal dz patient
- prevent hypovolemia (anesthetics reduce GFR)
- recheck electrolytes
- correct anemia
90
Anesthesia drugs to avoid for a renal patient
- avoid Ace, alpha 2's b/c decrease CO
- maybe avoid ketamine - metabolized in kidneys in cats
- maybe avoid sevo - make nephrotoxic compound
- maybe avoid NSAID's for post-op pain - alter PG synth which alters renal blood flow
91
What's the concern w/ lidocaine in renal or heptic dz patients?
cleared slowly in general, risk of buildup in dz'd patients - use low doses
92
Concern for cats w/ urethral blockage & post-renal azotemia
hyperkalemia, acidemia
Give Ca, bicarb, insulin/dextrose before anesthesia
expect post-op diuresis - don't let them dehydrate
93
Prepping a hepatic dz patient
- prevent hypovolemia
- treat hepatic sequelae
- treat coagulopathies
- avoid hypoxemia
94
what's a good pre-med choice for liver dz patients?
Opioids - minimally metabolized, reversible, little CV effects
Avoid alpha 2's, ace b/c CV effects and metabolized by liver
95
What IA is contraindicated for liver dz?
Halothane
