Final Exam Flashcards
(163 cards)
1
Q
What is placed first after the patient has been sedated?
A
endotracheal tube
2
Q
Name 5 parameters the Cardell patient monitoring machine measures:
A
blood pressure heart rate pulse ox temperature respiration rate
3
Q
Explain how to change a Baxter fluid pump from macro to micro
A
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
4
Q
What is the purpose of the “Blue bubble” or “Blue egg” in the surgery room and dental room?
A
Its purpose is to warm the intravenous fluids before they enter the patient. This reduces the risk of hypothermia
5
Q
Name the 5 sources of heat (thermal) support we may use for our patient during and after a surgical procedure
A
Cage warmers bair hugger warm towels rice socks Tpump with heating pad
6
Q
Name the 2 major reasons we will choose to use an anticholinergic such as atropine of glycopyrrolate in the dog during the preanesthetic period
A
prevents bradycardia
dries salivary secretions
7
Q
Name one contraindication for each of the following drugs: atropine sulfate acepromazine carprofen (rimadyl) xylazine (rompun)
A
- 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
8
Q
Acepromazine’s recommended dosage for IM administration in the dog in our labs is? Max is?
A
0.05 mg/lb. The volume is never to exceed 0.4 mL with IM administration.
9
Q
Atropine sulfate is administered at a dosage rate of? bottle concentration?
A
0.02 mg/lb in our labs. The label reads 0.54 mg/mL
10
Q
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?
A
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
11
Q
What is the surgical stage/plane of anesthesia, and how do you know that your patient has progressed to that level?
A
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.
12
Q
Describe how to check the following reflexes in your patient:
palpebral reflex
Pedal (withdrawal) reflex
Corneal reflex
A
- 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
13
Q
Name the most common method used to assess muscle tone of your patient during anesthetic induction
A
opening the jaws to assess jaw tone
14
Q
What is the eye location of a patient in moderate or surgical level of anesthesia?
A
eyes rotate medial vetrally
15
Q
When monitoring your anesthetized dog or cat patient, you need to notify the veterinarian if the respiratory rate drops
A
to 8 breaths/minute or lower
16
Q
Pale mucous membranes are an indication of
A
shock and anemia
17
Q
A prolonged capillary refill time indicates
A
poor tissue perfusion
18
Q
Name 2 vessels which may be used to assess pulse in the anesthetized dog or cat:
A
1-lingual artery under the tongue
2-femoral artery on the medial side of the hindlimbs
19
Q
define agonal breaths.
A
Respiratory “gasps” which occur when the diaphragm spasmodically contracts, but no physiologic exchange of gases is occurring in the lungs
20
Q
Name one way to confirm that the endotracheal tube is properly placed.
A
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
21
Q
The clipper blade that is generally used to prepare a small animal patient for surgery is the
A
No. 40 blade
22
Q
blades usually used for large animal surgery prep are
A
No. 10 or 30 blades
23
Q
Describe one good method of patient identification
A
Name bands and cage cards containing client and patient names
24
Q
Name 2 possible serious complications if food is not withheld in the dog prior to anesthesia
A
1-vomiting/nausea
2-aspiration
25
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.
26
What is a potential serious complication of fasting very young animals?
hypoglycemia
27
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
28
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.
29
Name 2 important clinical signs of dehydration.
1-dry/tacky mucus membranes
| 2-skin tenting
30
Name 2 important clinical signs of accidental overhydration of your patient.
1-excessive nasal discharge
| 2-swollen conjunctiva
31
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
32
What is the general recommended IV fluid flow rate during anesthetic/surgical procedures in the dog?
5mL/lb/hr
33
What is the total blood volume per pound of body weight in the dog?
40mL/lb
34
When using crystalloid fluids to replace blood loss, what amount is administered per mL of blood lost?
3mL/1mL blood lost
35
Name 2 commonly used types of crystalloid fluids
1-normal saline 0.9%
| 2-Lactated ringers solution (LRS)
36
Name 2 types of colloid fluids
1-Dextran and hetastarch (synthetic)
| 2-whole blood/plasma
37
Anticholinergics are used as preanesthetics for what beneficial reason?
decrease salivary secretions
38
The most commonly used anticholinergic drug as a preanesthetic agent is:
atropine sulfate
39
Atropine sulfate may be administered:
IM, IV, SQ
40
How does atropine sulfate generally affect the heart rate of a dog?
prevents bradycardia
41
Atropine sulfate causes
mydriasis
42
A contraindication for using atropine sulfate in the cat is
preexisting tachycardia
43
A usual advantage of glycopyrrolate over atropine is
that it does not cross the blood brain/ placental barriers
44
Chlorpromazine acts as
as an anti-emetic
45
Emesis is
act of vomiting
46
What drug decreases threshold to seizures
Acepromazine
47
Acepromazine is contraindicated in shock because
it may produce hypotension effects
48
The common trade name for diazepam is
Valium
49
A better choice of drug to use as a preanesthetic to calm a geriatric, debilitated patient is
diazepam
50
A common trade name for xylazine is
Rompun
51
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
52
A potential problem with using xylazine in cats is
it frequently causes vomiting as a side effect.
53
The partial antagonist (reversal agent) for xylazine is
yohimbine
54
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
55
Give 2 examples of narcotic analgesics:
morphine and buprinex
56
An analgesic is used for
pain control
57
The prototype narcotic analgesic that others are compared to the potency is
morphine
58
Butorphenol is used as a
narcotic analgesic and cough suppressant
59
Which 2 species of domestic animals are particularly susceptible to the excitatory effects of narcotic analgesics?
horses and cats
60
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
61
Naloxone is used as an
anesthetic reversal agent
62
Name one NSAID which may be administered as a pre-emptive analgesic in a surgical dog:
rimadyl
63
Name one narcotic analgesic that is provided in a skin patch form:
Fentanyl
64
List necessary tasks for preoperative preparation of the equine surgical patient:
remove shoes
set IV cath
physical exam
Shave and wipe area of interest
65
Name 2 possible major complications post operatively in the horse that had inadequate padding on the surgery table for a 5 hour procedure.
1-myopathies/neuropathies
| 2-cardiopulmonary compromise
66
Name one possible side effect of each of the following preanesthetics in the horse:
acepromazine
xylazine
acepromazine- hypotensive effects
| xylazine- bradycardia
67
For each of the following species, tell whether the body temp is more likely to increase or decrease during anesthesia pig, cat, dog
pig-increase
cat-decrease
dog-decrease
68
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
69
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
```
70
Name 3 frequently encountered problems associated with general anesthesia in cattle:
respiratory depression
bradycardia
bloat
71
Xylazine must be dosed at approximately ___the IV horse dose in cattle
1/10th
72
Name one common side effect of xylazine in cattle
bloat
73
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
74
When extubating a ruminant, the cuff of the endotracheal tube should be
be partially inflated
75
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
76
Name 2 possible complications from over inflation of an ET tube cuff:
lumen tube collapse
| necrosis of trachea
77
As a preanesthetic, atropine is not often used in ruminants for what 2 reasons?
bloat
| increased viscosity of salivary secretions
78
Name 2 possible causes of a prolonged CRT in pigs
dehydration
| hypotension
79
A respiratory stimulant drug is
doxapram
80
The species most prone to malignant hyperthermia is
pig
81
Rebreathing bag sizes used in horses are typically
15-30 liters
82
A bird must be able to freely move its____ to breathe properly during surgery
Thorax
83
____ and___ bones of the bird may be pneumatic
The humerus and femur
| and should not have intraosseous fluids administered in them
84
Uncuffed endotracheal tubes are recommended for use in
avian patients
85
how are ECG leads in the snake placed
cranial and caudal to the heart
86
is it acceptable to transfuse a cockatoo with pigeon blood
as long as it is only done once
87
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
88
The safest anesthetics to use in the bird are
isoflurane and sevoflurane administered via mask or endotracheal tube
89
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.
90
How do you treat an anesthetic overdose in the fish?
place the fish in a tank of water free of anesthetics; “swim the fish”
91
Which birds require personnel to wear eye protection?
long beaked birds such as herons
92
Which birds may disembowel personnel?
Ratites such as emus and ostriches
93
The most widely used fish anesthetic is
Finquel
94
What anesthetic gas may be used in reptiles and amphibians
Isoflurane
95
Chelonians generally______at the surgical plane of anesthesia
require respiratory support in the form of IPPV
96
Fasting prior to surgery is not recommended in
pet birds
97
Rabbits may produce ____ naturally
atropinase
98
Gerbils are generally predisposed to what?
seizure disorders, to the point that about 50% will seizure when handled or stressed
99
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
100
Two vessels used in the dog to monitor pulse rate and pressure are what?
femoral and digital arteries
101
```
Name one important consideration when anesthetizing for each patient type:
geriatric patient
pediatric patient
sighthound
obese animals
```
- 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
102
What is the appropriate IV drip set calibration to use in patients under 10 pounds?
60 gtt/mL
103
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
104
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
Increased
105
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
106
For C section procedures it is recommended that as much of the___ ___ as possible be done before anesthetizing the patient
preoperative preparation
107
What drug is considered safe to use for C section procedures
Propofol
108
what is common in the first 72 hours after chest trauma?
Cardiac arrhythmias
109
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
110
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
111
Name 4 possible causes of pale mucous membranes in the anesthetized patient
pre existing anemia
blood loss during surgery
hypotension/ vasodilation
pain
112
The first priority in the treatment of shock is generally what?
the administration of IV fluids
113
Respiratory arrest must be corrected within ___ minutes to avoid brain cell damage
4 minutes
114
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
115
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
116
Define Apneustic breathing
Patient is holding their breath
117
define apnea breathing
cessation of breathing
118
define bradycardia
decreased heart rate
119
define tachycardia
increased heart rate
120
Describe clinical signs that you would find in the cardiac arrest patient.
- pulse: absent
- heartbeat: absent
- mucous membrane color: gray or cyanotic
- pupils: blown and fixed; negative PLR
- respiration: absent
- ECG tracing: can be in asystole, ventricular fibrillation, or electromechanical dissociation
121
List the 6 major steps in cardiopulmonary resuscitation
```
Airway
Breathing
Circulation
Drugs
ECG
Fluids
```
122
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
123
The drug most commonly used for initial treatment of cardiac arrest (asystole) is
epinephrine
124
The drug most commonly used initially for seizures that occur in the post anesthetic period is
diazepam
125
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
126
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
127
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.
128
A decimal error in mathematical calculations of drug dosages minimally causes a __ fold error in the amount of drug administered.
10 fold error
129
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
130
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
131
Laryngospasm is most common in what species?
Cat
132
Telazol is made up of what 2 drugs?
Tiletimine and Zolazopam
133
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
134
Name the possible methods of arousal (waking up) from injectable anesthesia
- redistribution of the drug within the body
- liver metabolism
- renal excretion
135
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
136
A barbiturate commonly used as an anticonvulsant is
phenobarbital
137
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
138
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
139
Name one complication of injecting pentobarbital perivascularly.
patient can remain stuck in the stage II excitatory phase
140
Name 2 clinical uses for pentobarbital today:
1- euthanasia
| 2- treatment for stychhnine toxicity
141
Anesthetic agents which produce profound amnesia and dissociation from one’s environment are termed
dissociative agents (cyclohexamines)
142
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
- eyelids: open
143
Telazol can be given IM or IV. what are the doses?
`1mL/100lb IV, 1mL/30-45lb IM
144
Propofol has poor storage characteristics, which make it more likely to support ____ ____. How should it be handled?
- bacterial growth
- For this reason, it is recommended that the drug vials be handled aseptically and that unused product be stored by refrigeration.
145
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
146
The most common undesired effect on the patient during induction with propofol is
apnea
147
A muscle relaxant used in combination to induce anesthesia in large animals such as horses is what? How is it given?
Guafenisen.
| It is always given IV
148
How do inhalation agents reach the brain from the anesthesia machine?
anesthetic liquid -> vaporized with oxygen -> air passageways -> alveoli -> blood stream -> brain
149
Which 2 older gas anesthetic agents with significant elimination from the body by liver metabolism?
halothane and methoxyflurane
150
A measure of the distribution of the inhalation agent between the blood and gas phases in the body is termed
solubility coefficient
151
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
152
Depth of anesthesia may be changed most rapidly with what inhalation gas?
sevoflurane
153
Halothane most commonly has ___ ___ associated with administration
cardiac arrhythmias
154
Name Anesthetic agents from slowest to most rapid
methoxyflurane -> halothane -> isoflurane -> sevoflurane
155
what inhalation gas has a higher concentration for induction?
Sevoflurane
156
which inhalation gas is considered to have the least undesirable cardiac effect?
Isoflurane
157
Non rebreathing anesthetic systems are recommended for patients less than ___lb body weight
15
158
CO2 absorbent should be changed after___ hours of use
10 hours
159
Oxygen tanks should be changed when they have reached __ psi
500
160
Name 3 classes of drugs which may be used as pre anesthetics to produce calming or relaxation
Benzodiazepines
phenothiazines
opioids
161
2 ways to quickly check proper ET tube placement are what?
patient cough and fogging of tube
162
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
163
Why is Atropine seldomly used in the cow or horse?
because it makes their salivary secretions thick and “ropey”
