Flashcards in Final Exam Deck (163):
What is placed first after the patient has been sedated?
Name 5 parameters the Cardell patient monitoring machine measures:
Explain how to change a Baxter fluid pump from macro to micro
1-press and hold down “Select” button
2-Press “On” button
3-Press “Select” button until “Macro” or “Micro” is lite up
4- Press “Run” button twice
What is the purpose of the “Blue bubble” or “Blue egg” in the surgery room and dental room?
Its purpose is to warm the intravenous fluids before they enter the patient. This reduces the risk of hypothermia
Name the 5 sources of heat (thermal) support we may use for our patient during and after a surgical procedure
Tpump with heating pad
Name the 2 major reasons we will choose to use an anticholinergic such as atropine of glycopyrrolate in the dog during the preanesthetic period
dries salivary secretions
Name one contraindication for each of the following drugs:
-atropine sulfate: patients with pre existing tachycardia
-acepromazine: patients with a history of seizures
-carprofen (rimadyl): liver toxicity in high doses
-xylazine (rompun): history of liver or kidney problems
Acepromazine’s recommended dosage for IM administration in the dog in our labs is? Max is?
0.05 mg/lb. The volume is never to exceed 0.4 mL with IM administration.
Atropine sulfate is administered at a dosage rate of? bottle concentration?
0.02 mg/lb in our labs. The label reads 0.54 mg/mL
A cat that has received ketamine/xyalazine is almost down to the surgical plane of anesthesia when it begins vomiting undigested food. What is your action to prevent serious complications in this cat?
Hang the cat’s head and forelimbs over the edge of the table to let gravity play its role in removing anymore vomit. Then use a bulb suction syringe to clear any remaining vomit from the mouth
What is the surgical stage/plane of anesthesia, and how do you know that your patient has progressed to that level?
Stage III, Plane 2
When the patient has reached this stage, little to no reflexes are present. The patient’s reaction to pain is very low or not present at all.
Describe how to check the following reflexes in your patient:
Pedal (withdrawal) reflex
-palpebral reflex: by tapping the medial and lateral canthus around the eyes. The patient will blink if the reflex is still active
- Pedal (withdrawal) reflex: pinching a toe. The patient will pull its limb in towards the body if the reflex is still active
-Corneal reflex: shining a light in the patient’s eye or touching the patient’s eye. The patient will blink if the reflex is still active
Name the most common method used to assess muscle tone of your patient during anesthetic induction
opening the jaws to assess jaw tone
What is the eye location of a patient in moderate or surgical level of anesthesia?
eyes rotate medial vetrally
When monitoring your anesthetized dog or cat patient, you need to notify the veterinarian if the respiratory rate drops
to 8 breaths/minute or lower
Pale mucous membranes are an indication of
shock and anemia
A prolonged capillary refill time indicates
poor tissue perfusion
Name 2 vessels which may be used to assess pulse in the anesthetized dog or cat:
1-lingual artery under the tongue
2-femoral artery on the medial side of the hindlimbs
define agonal breaths.
Respiratory “gasps” which occur when the diaphragm spasmodically contracts, but no physiologic exchange of gases is occurring in the lungs
Name one way to confirm that the endotracheal tube is properly placed.
The patient will cough and the expelled air will be felt through the end of the tube. It may even blow back the anesthetist’s hair
The clipper blade that is generally used to prepare a small animal patient for surgery is the
No. 40 blade
blades usually used for large animal surgery prep are
No. 10 or 30 blades
Describe one good method of patient identification
Name bands and cage cards containing client and patient names
Name 2 possible serious complications if food is not withheld in the dog prior to anesthesia
If a 4 yr old female poodle is presented for routine ovariohysterectomy, and is a known epileptic, which preanesthetic drug do we need to avoid using, and why?
We should avoid giving acepromazine because it lowers seizure threshold.
What is a potential serious complication of fasting very young animals?
If a patient scheduled for surgery is 8% dehydrated, what should be done if possible prior to surgery?
Place an IV catheter and begin administering fluids prior to surgery
Before administering anesthetic drugs to a patient, what paperwork should we require the owner to complete?
A signed document explaining all parts of the surgical procedure, including estimated cost.
Name 2 important clinical signs of dehydration.
1-dry/tacky mucus membranes
Name 2 important clinical signs of accidental overhydration of your patient.
1-excessive nasal discharge
Name 2 risks associated with IV catheterization and administration of IV fluids
1-infection of insertion site
2-introducing an air bubble into the catheter accidentally, resulting in possible air embolism
What is the general recommended IV fluid flow rate during anesthetic/surgical procedures in the dog?
What is the total blood volume per pound of body weight in the dog?
When using crystalloid fluids to replace blood loss, what amount is administered per mL of blood lost?
3mL/1mL blood lost
Name 2 commonly used types of crystalloid fluids
1-normal saline 0.9%
2-Lactated ringers solution (LRS)
Name 2 types of colloid fluids
1-Dextran and hetastarch (synthetic)
Anticholinergics are used as preanesthetics for what beneficial reason?
decrease salivary secretions
The most commonly used anticholinergic drug as a preanesthetic agent is:
Atropine sulfate may be administered:
IM, IV, SQ
How does atropine sulfate generally affect the heart rate of a dog?
Atropine sulfate causes
A contraindication for using atropine sulfate in the cat is
A usual advantage of glycopyrrolate over atropine is
that it does not cross the blood brain/ placental barriers
Chlorpromazine acts as
as an anti-emetic
act of vomiting
What drug decreases threshold to seizures
Acepromazine is contraindicated in shock because
it may produce hypotension effects
The common trade name for diazepam is
A better choice of drug to use as a preanesthetic to calm a geriatric, debilitated patient is
A common trade name for xylazine is
Briefly discuss species variation in dosing xylazine in horses versus cattle.
The dose for a cow is 1/5 to 1/10 the dose of a horse weighing the same amount
A potential problem with using xylazine in cats is
it frequently causes vomiting as a side effect.
The partial antagonist (reversal agent) for xylazine is
Why is xylazine contraindicated for use in pregnant cows in the third trimester?
xylazine can cause uterine contractions in the third trimester resulting in premature birth
Give 2 examples of narcotic analgesics:
morphine and buprinex
An analgesic is used for
The prototype narcotic analgesic that others are compared to the potency is
Butorphenol is used as a
narcotic analgesic and cough suppressant
Which 2 species of domestic animals are particularly susceptible to the excitatory effects of narcotic analgesics?
horses and cats
Name 2 rules that must be followed by hospital personnel in handling controlled substances:
1-the substances must remain in a double locked box
2-an accurate and up to date drug log should be kept recording dispensed doses
Naloxone is used as an
anesthetic reversal agent
Name one NSAID which may be administered as a pre-emptive analgesic in a surgical dog:
Name one narcotic analgesic that is provided in a skin patch form:
List necessary tasks for preoperative preparation of the equine surgical patient:
set IV cath
Shave and wipe area of interest
Name 2 possible major complications post operatively in the horse that had inadequate padding on the surgery table for a 5 hour procedure.
Name one possible side effect of each of the following preanesthetics in the horse:
acepromazine- hypotensive effects
For each of the following species, tell whether the body temp is more likely to increase or decrease during anesthesia pig, cat, dog
Describe how to pull a horse’s shoes prior to surgery.
File down tips of nails bent through the top of the hoof then pull nails and show from the bottom of the hoof
What are the recommendations for the length of time food should be withheld prior to anesthesia?
(pigs, large ruminants, goats/sheep, calves/lambs/kids, horse)
pigs: 12-24 hours
large ruminants: 24-36 hours
goats/sheep: 12-24 hours
calves/lambs/kids: 2-4 hours
horse: 24 hours
Name 3 frequently encountered problems associated with general anesthesia in cattle:
Xylazine must be dosed at approximately ___the IV horse dose in cattle
Name one common side effect of xylazine in cattle
Ocular reflexes are good indicators of the depth of anesthesia in cattle, what are they?
1. the corneal reflex should be active throughout anesthesia, and the palpebral reflex is depressed by gas anesthesia
When extubating a ruminant, the cuff of the endotracheal tube should be
be partially inflated
Name One method for placing the endotracheal tube in the cow is
by inserting your arm into the cow’s mouth, pulling down the epiglottis with hand while inserting the tube
Name 2 possible complications from over inflation of an ET tube cuff:
lumen tube collapse
necrosis of trachea
As a preanesthetic, atropine is not often used in ruminants for what 2 reasons?
increased viscosity of salivary secretions
Name 2 possible causes of a prolonged CRT in pigs
A respiratory stimulant drug is
The species most prone to malignant hyperthermia is
Rebreathing bag sizes used in horses are typically
A bird must be able to freely move its____ to breathe properly during surgery
____ and___ bones of the bird may be pneumatic
The humerus and femur
and should not have intraosseous fluids administered in them
Uncuffed endotracheal tubes are recommended for use in
how are ECG leads in the snake placed
cranial and caudal to the heart
is it acceptable to transfuse a cockatoo with pigeon blood
as long as it is only done once
What complications or factors do we need to consider when administering anesthesia for an abdominal surgical procedure in the bird, due to the fact that the diaphragm is incomplete?
The airsacs are easily compromised in the bird due to their “bellows” type breathing system
The safest anesthetics to use in the bird are
isoflurane and sevoflurane administered via mask or endotracheal tube
Describe proper care of birds during post op recovery.
It is advised to keep the bird wrapped in a towel until full recovery to prevent self injury. Never place a bird on a perch to recover.
How do you treat an anesthetic overdose in the fish?
place the fish in a tank of water free of anesthetics; “swim the fish”
Which birds require personnel to wear eye protection?
long beaked birds such as herons
Which birds may disembowel personnel?
Ratites such as emus and ostriches
The most widely used fish anesthetic is
What anesthetic gas may be used in reptiles and amphibians
Chelonians generally______at the surgical plane of anesthesia
require respiratory support in the form of IPPV
Fasting prior to surgery is not recommended in
Rabbits may produce ____ naturally
Gerbils are generally predisposed to what?
seizure disorders, to the point that about 50% will seizure when handled or stressed
Describe how to correct soft palate displacement when it causes you to be unable to visualize the larynx as you attempt to intubate a patient.
Use a mouth speculum to keep the mouth open. Use a laryngoscope to visualize and pull down the epiglottis to insert the ET tube. Use lidocaine gel if laryngospasm is a problem
Two vessels used in the dog to monitor pulse rate and pressure are what?
femoral and digital arteries
Name one important consideration when anesthetizing for each patient type:
-geriatric patient: risk of hypothermia due to decreased muscle mass
-pediatric patient: avoid injectable anesthetics because liver enzymes and passages are not fully developed until about 8 weeks of age
-sighthounds: avoid barbituates
-obese animals: dose at ideal body weight
What is the appropriate IV drip set calibration to use in patients under 10 pounds?
For anesthetizing a 3 week old puppy to repair a congenital umbilical hernia, what method is preferred?
mask with isoflurane, then intubate and maintain on isoflurane
A veterinary patient under 2 months of age is generally considered to be at ___(increased OR decreased) risk when anesthetized, compared with a mature animal
Name 3 anatomic characteristics in the brachycephalic dog that may impede respiratory air exchange
1- stenotic nares
2- elongated soft palate
3- everted laryngeal folds
For C section procedures it is recommended that as much of the___ ___ as possible be done before anesthetizing the patient
What drug is considered safe to use for C section procedures
what is common in the first 72 hours after chest trauma?
you must “bag” a patient during repair of a diaphragmatic hernia, explain how you would do so
pressure to approximately 20 cm H2O is applied every 5 seconds, with the pop off valve being closed. The anesthetic vaporizer setting must be adjusted lower than would be set for the patient that is ventilating itself
Name 4 possible causes to quickly check for if an animal on gas anesthesia will not stay anesthetized
1- cuff inflated
2- vaporizer on
3- tube properly inserted in the trachea
4- O2 on and full
Name 4 possible causes of pale mucous membranes in the anesthetized patient
pre existing anemia
blood loss during surgery
The first priority in the treatment of shock is generally what?
the administration of IV fluids
Respiratory arrest must be corrected within ___ minutes to avoid brain cell damage
List in order your steps in treatment of respiratory arrest
1- alert veterinarian
2- turn off vaporizer
3- intubate and bag with 100% oxygen every 5 seconds
Describe how to effectively manage the patient who temporarily ceases respiratory efforts immediately following anesthetic induction.
-monitor pulse ox, heart rate, CRT, and MM color
-bag the patient every 30 seconds for 1-2 minutes
-alert veterinarian if respiration does not pick up or if other vital signs begin dropping
Define Apneustic breathing
Patient is holding their breath
define apnea breathing
cessation of breathing
decreased heart rate
increased heart rate
Describe clinical signs that you would find in the cardiac arrest patient.
-mucous membrane color: gray or cyanotic
-pupils: blown and fixed; negative PLR
-ECG tracing: can be in asystole, ventricular fibrillation, or electromechanical dissociation
List the 6 major steps in cardiopulmonary resuscitation
How do assess whether or not cardiac compressions are being effective in CPR?
If a femoral pulse is felt then enough compression is happening. Also, MM will get pinker and CRT will return to <2 seconds
The drug most commonly used for initial treatment of cardiac arrest (asystole) is
The drug most commonly used initially for seizures that occur in the post anesthetic period is
Define the term electromechanical dissociation.
A QRS complex is shown on the ECG but no heart contraction is happening. The electrical stimulus is present but the heart is not obeying it
You are monitoring a canine patient undergoing an ovariohysterectomy. If the respiratory rate falls to 8 breaths/minutes or below you should consider what?
adjusting the vaporizer to a lower setting
If the anesthesia machine is assembles so that the F circuit breathing tubes are attached opposite the way intended to the anesthesia machine, what complications will the patient experience?
The patient will not be able to inhale oxygen, it will only be able to inhale its own CO2. This will lead to hypercapnia.
A decimal error in mathematical calculations of drug dosages minimally causes a __ fold error in the amount of drug administered.
10 fold error
What checks can you establish for yourself to ascertain that you administer the correct drug by the proper route with an accurate dosage measured and delivered?
-accurate patient weight
-check drug being used
-check concentration of the bottle
-check route of administration
-repeat calculations to avoid mathematical errors
-label syringe with patient’s name, dose, route, and drug name
A cat recovering from ketamine anesthesia suddenly begins a grand mal seizure. What drugs is the doctor likely to request and in what order?
a. first: diazepam
b. second, if the first drug is ineffective in stopping the seizure: phenobarbital
c. third alternative drug: resedate with general anesthesia
Laryngospasm is most common in what species?
Telazol is made up of what 2 drugs?
Tiletimine and Zolazopam
You notice your feline OHE patient, while anesthetized with isoflurane on a non rebreathing system on the surgery table, is cyanotic. How do you respond?
- alert the veterinarian
- turn off the vaporizer and bag with 100% oxygen every 5 seconds
- Check all connections on anesthesia machine
- Immediately disconnect the patient from the non rebreathing system , allowing the patient to breathe room air
-administer doxapram under the direction of the veterinarian
Name the possible methods of arousal (waking up) from injectable anesthesia
- redistribution of the drug within the body
- liver metabolism
- renal excretion
label these drugs as ultra short acting, short acting, intermediate acting, and long acting (methoxy, thiopental, pentobarbital, and phenobarbital)
Ultra short acting: methoxy
short acting: thiopental
intermediate acting: pentobarbital
long acting: phenobarbital
A barbiturate commonly used as an anticonvulsant is
When apnea occurs during anesthetic induction, you first priority should be to:
intubate quickly and begin giving the patient 100% oxygen; assess other vital signs
Concisely summarize the major concern/ problem or effect encountered with barbiturate anesthesia: (respiratory system, cardiac effect, hypoproteinemic animals, acidotic animals, and sighthounds)
-respiratory system: decreases respiration rate
-cardiac effect: decreases heart rate
-hypoproteinemic animals: low circulating protein levels creates and overdose effect from the anesthesia
-acidotic animals: greater effect in patients with low pH
-sighthounds: causes an overdose effect due to low body fat
Name one complication of injecting pentobarbital perivascularly.
patient can remain stuck in the stage II excitatory phase
Name 2 clinical uses for pentobarbital today:
2- treatment for stychhnine toxicity
Anesthetic agents which produce profound amnesia and dissociation from one’s environment are termed
dissociative agents (cyclohexamines)
Effects of Ketamine anesthesia in a cat:
-reflex responses: exaggerated:
-laryngeal reflex: present
-sensory stimuli: response
-muscle tone: increased
-peripheral analgesia: good
-visceral analgesia: poor
-heart rate: increased
Telazol can be given IM or IV. what are the doses?
`1mL/100lb IV, 1mL/30-45lb IM
Propofol has poor storage characteristics, which make it more likely to support ____ ____. How should it be handled?
- For this reason, it is recommended that the drug vials be handled aseptically and that unused product be stored by refrigeration.
It is considered acceptable to repeat dosing of propofol if needed for the desired anesthetic effect. Why?
Because propofol is metabolized very quickly in the body
The most common undesired effect on the patient during induction with propofol is
A muscle relaxant used in combination to induce anesthesia in large animals such as horses is what? How is it given?
It is always given IV
How do inhalation agents reach the brain from the anesthesia machine?
anesthetic liquid -> vaporized with oxygen -> air passageways -> alveoli -> blood stream -> brain
Which 2 older gas anesthetic agents with significant elimination from the body by liver metabolism?
halothane and methoxyflurane
A measure of the distribution of the inhalation agent between the blood and gas phases in the body is termed
Define minimum alveolar concentration (MAC):
this is the lowest amount of agent possible to produce a response in 50% of patients to a pain stimulus
Depth of anesthesia may be changed most rapidly with what inhalation gas?
Halothane most commonly has ___ ___ associated with administration
Name Anesthetic agents from slowest to most rapid
methoxyflurane -> halothane -> isoflurane -> sevoflurane
what inhalation gas has a higher concentration for induction?
which inhalation gas is considered to have the least undesirable cardiac effect?
Non rebreathing anesthetic systems are recommended for patients less than ___lb body weight
CO2 absorbent should be changed after___ hours of use
Oxygen tanks should be changed when they have reached __ psi
Name 3 classes of drugs which may be used as pre anesthetics to produce calming or relaxation
2 ways to quickly check proper ET tube placement are what?
patient cough and fogging of tube
If the pop valve is left in a closed position, what could happen?
pressure may rapidly rise in the anesthetic circuit. Closure of the pop off valve causes pressure on the patient’s lungs. This prevents the patient from breathing