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Anaesthesia > Formative Assessment > Flashcards

Formative Assessment Flashcards

1
Q

How long does ACP take to have an effect on the patient and for how long do its effects last?

A

30-40 mins to effect then

lasts 4-6hrs

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2
Q

Why is ACP contraindicated in shocked animals?

A

It causes vasodilation which leads to hypotension, this can be disastrous in shocked animals leading to cardiovascular collapse

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3
Q

Which combination of premedicant drugs is suggested as an appropriate for an ASA category 4 canine patient?

A

Benzodiazepine and opioid

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4
Q

Which category of patients tend to have a higher incidence of concurrent disease and reduced cardiovascular reserve functionality

A

Geriatrics

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5
Q

At what age is a puppy or kitten assumed to have normal liver function?

A

12 weeks

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6
Q

Which class of pre-medicant has a significant drug sparing effect?

A

Alpha 2 agonists

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7
Q

What are the normal expected heart rates in dogs and cats after administration of alpha 2 agonists?

A

Dog 45-60

Cat 100-115

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8
Q

Which pre-medicants can be used for their anti-convulsive effects?

A

Diazepam

Midazolam

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9
Q

Which opioids act on the OP3 receptors?

A

Morphine, methadone, fentanyl, pethidine

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10
Q

How long does buprenorphine take to effect the patient and how long do its effects last?

A

30-40 mins onset, duration 6 hrs

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11
Q

What effects do opioids have on the cardiovascular system?

A

Cause bradycardia due to vagal stimulation.

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12
Q

Explain the aims of using an anticholinergic drug such as atropine (note that this is not part of a standard premedication protocol in modern practice)

A

Reduce salivary and bronchial secretions

To block the effects of impulses in the vagal
nerves (eg, prevent the oculocardiac reflex)

To block the effects of drugs that stimulate the
parasympathetic nervous system, such as opioids

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13
Q

What is the name of the neurotransmitter that is released at the neuromuscular junction?

A

Acetylcholine

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14
Q

Explain the difference in mode of action between depolarizing and non-depolarizing MBAs

A

Depolarising – occupies ACh receptors causing an initial contraction.

Non-depolarising – there is no initial stimulation

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15
Q

Explain the use and potential side effects of suxamethonium

A

Rapid acting, used in intubation of cats.

Side effects include cardiovascular effects, malignant hyperthermia, increases intra ocular pressure

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16
Q

List 2 advantages of using non-depolarising muscle relaxants

A

They can be topped up

They can be reversed

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17
Q

According to the article which 2 non-depolarising MBAs are widely used in practice?

A

Atracurium

Vercuronium

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18
Q

List three types of monitoring equipment suggested for use when monitoring a patient under the influence of NBAs

A

ECG

BP monitor

Pulse oximeter

Capnography

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19
Q

List 3 potential side effects of using a MBA reversal agent such as edrophonium

A

Increased salivation

Bronchospasm

Bradycardia

Arrhythmias

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20
Q

During recovery from a procedure where MBAs are used, how should the animal be positioned to maximise efficient ventilation?

A

Sternal recumbency for full inflation of the lungs

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21
Q

General Anaesthesia - Describe, Advantage & Disadvantage

A

Anaesthesia may be induced and maintained by injectable or inhalational means.

Intramuscular or intravenous are the most commonly used injectable routes of administering general anaesthesia.

Advantages – convenient, rapid loss of consciousness, facilitates surgical field.

Disadvantages – stressful restraint, technical skill required.

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22
Q

Topical Anaesthesia - Describe, Advantage & Disadvantage

A

Desensitisation is produced only at or near the site of application.

Advantages – little or no cardiovascular depression, inexpensive, easy to do

Disadvantages – used for minor procedures only

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23
Q

Local Anaesthesia - Describe, Advantage & Disadvantage

A

Produces reversible block of nerve impulse conduction.

Advantages – consciousness retained, good for superficial surgery

Disadvantages – used for minor procedures only, possible wound breakdown

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24
Q

Explain the effects of anaesthesia on the body in each of the following stages of anaesthesia: Stage I

A

Pulse increased

resp rate increased

possible breath holding may occur depending on agent used.

Pupils dilate.

Hypereflexia.

Patient may vocalise

Salivate

urinate and defaecate.

25
Q

Explain the effects of anaesthesia on the body in each of the following stages of anaesthesia: Stage III, plane 3

A

Resp rate decreases

Tidal volume is decreased

a pause appears between inspiration and expiration,

HR and BP decrease

Eye position becomes central

Pupil diameter increased,

Abdo muscles relaxed.

26
Q

Explain the effects of anaesthesia on the body in each of the following stages of anaesthesia: Stage IV

A

Progressive respiratory failure leading to respiratory arrest.

Pulse may be rapid then slows becoming inpalpable.

Eye central, pupils dilated and cornea surface dry.

Cyanosis turning grey

CRT increased

27
Q

ASA Scale I

Physical description & patient example

A

Physical description- Normal healthy patient

Patient example- Young dog, elective OVH

28
Q

ASA Scale III

Physical description & patient example

A

Physical description- A patient with moderate to severe systemic disease

Patient example- Dog with heart murmur resulting in reduced exercise tolerance

29
Q

ASA Scale IV

Physical description & patient example

A

Physical description- Patient with severe systemic disease that is a constant threat to life

Patient example- Dog with cardiac arrhythmia resulting in severe circulatory compromise

30
Q

ASA Scale V

Physical description & patient example

A

Physical description- A moribund patient – not expected to survive without the procedure

Patient example- Dog with GDV

31
Q

Explain the purpose of the anaesthetic consent form and describe what is meant by ‘informed owner consent’ (4 marks)

A

The purpose of the consent form is to record the clients agreement to treatment based on knowledge of what is involved and the likely consequences.

The client may be the owner or someone acting with their authority.

(No one under the age of 16 should sign the form).

Before being asked to sign the client should have the opportunity to read and understand and ask any questions they may have regarding the procedure.

32
Q

A 2 yr old Labrador is booked in for a routine OVH. Describe the pre-anaesthetic assessment procedures (5)

A

A full clinical history – status of diagnosed chronic disease if applicable, current meds

Previous anaesthetic history

Temperament of patient, recent changes in food/water consumption

Vaccination status

Clinical examination – CNS, cardiovascular and respiratory status

Pre-op bloods – haematology and biochem

33
Q

A 2 yr old Labrador is booked in for a routine OVH. Describe the aims of premedication (5)

A

To calm the patient

Reduce anxiety

Reduce amount of induction agent

Reduce amount of maintenance agent

Provide analgesia

Aid smooth recovery

34
Q

A 2 yr old Labrador is booked in for a routine OVH.

Describe the induction procedure of general anaesthetic (intravenous) –

include in your answer monitoring procedures immediately post induction (5)

A

Assist with restraint of patient – i/v catheter in place.

i/v induction – restrain and reassure patient.

Within 20 seconds induction effective.

Assist with endotracheal intubation – connect to anaesthetic machine.

Monitor respiration heart rate CRT and temperature closely

35
Q

Describe 2 anaesthetic monitoring techniques used to assess cardiovascular system status (you may include items/equipment in your answer) (2)

A

Observation – colour of mucous membranes, CRT

Palpate pulse- femoral, sublingual, carpal. Auscultate heart.

Equipment – Pulse oximeter, oesophageal stethoscope, ECG

36
Q

Explain the procedure you would carry out with a patient in respiratory arrest (6)

A

Inform VS immediately/summon assistance

Turn off anaesthetic vaporiser and flush o2

Patient on 100% O2

Monitor pulse

Manual (or automatic) IPPV

37
Q

Explain the procedure you would carry out with a tachycardic patient (4)

A

Establish cause -

inadequate depth of anaesthesia so evaluate in relation to surgery OR may be due to compensatory mechanism/response to hypotension and be critical in preventing hypoxia and hypotension.

Liase with surgeon

Tachycardia may encourage arrhythmias

May require use of drugs to reduce heart rate or increase depth of anaesthesia

38
Q

List 4 emergency drugs that may be used in an anaesthetic emergency and explain the action of each drug (8)

A

Adrenaline – cardiac stimulant, increases rate and force of myocardial contractions
Doxapram – respiratory and CNS stimulant

Atipamazole – alpha2 antagonist – used if poor recovery from eg. Medetomidine

Atropine- anticholinergic, used to in excess vagal tone, to treat bradycardia

Diazepam – benzodiazepine used to treat seizures

Frusemide – diuretic, treatment of acute pulmonary oedema

39
Q

List items of equipment that may be used in an anaesthetic emergency (4)

A 
Defibrillator
Ambu bag
I/v catheter
Laryngoscope
Endotracheal tube
Suction machine
Oxygen supply
40
Q

Describe the monitoring techniques you would carry out for a patients in recovery from post-orthopaedic surgery (5)

A

vital signs

pain levels

cranial nerve reflexes

observe – i/v fluids, urination, defaecation, record findings

41
Q

Describe the monitoring techniques you would carry out for a patient recovering from respiratory arrest (whilst under general anaesthetic) (5)

A

constant monitoring of respiration

pulse oximetry if possible

concentrate on mm colour, cranial nerve reflexes

vital signs

TPR and record findings

42
Q

List 5 signs an animal should show on smooth recovery from anaesthesia

A

Return of cranial nerve reflexes – palpebral, jaw tone, swallowing

TPR – pulse respiration and body temperature returning to normal ranges

No signs of pain

43
Q

Name any 4 premedicants, stating which drug group they belong to , 1 advantage and 1 disadvantage of each drug.

(1mark for group, 1 mark for advantage and 1 mark for disadvantage)

A

Make table

44
Q

Describe the cardiovascular and respiratory effects of propofol post induction

A

Myocardial depression

Vasodilation and bradycardia

Respiratory depression, may cause apnoea post induction

45
Q

Describe one advantage and one disadvantage of the inhalational anaesthetic agent sevoflurane

A

Advantage –

non-irritant,
more rapid induction and recovery
preferred choice for induction by in halaltion method.
pleasant odour - well tolerated for mask induction

Disadvantage –

dose dependent cardiovascular and respiratory depression
unstable in presence of soda lime producing compound A which is nephrotoxic in rats

46
Q

Describe one advantage and one disadvantage of the inhalational anaesthetic agent Isoflurane

A

Advantage –

good muscle relaxation
good analgesic
rapid recovery
rapid induction

Disadvantage –

Hypotension
Pungent smell - poorly tolerated for mask induction
Potent respiratory depressant
irritant to the airways

47
Q

Describe one advantage and one disadvantage of the inhalational anaesthetic agent desflurane

A

Advantage –

lowest blood gas solubility - allowing rapid alterations in anaesthetic depth and fast recovery
rapidly excreted via lungs
well tolerated for mask induction

Disadvantage –
requires temperature controlled pressured vapouriser (expensive)
irritant to respiratory tract in high concentrations

48
Q

Name 2 muscle relaxants and state for each one whether they are depolarising or non-depolarising (2)

A

Suxamethonium (depolarising)

Atracurium, Vecuronium (non-depolarising)

49
Q

Name 4 opiods

A

Morphine

Pethidine

Buprenorphine

Butorphanol

Methadone

50
Q

Name one steroid anaesthetic

A

Alfaxalone

51
Q

Describe the correct storage requirements for buprenorphine

A

stored in locked and permanently secured cabinet – schedule 3

(do not need to keep a register)

52
Q

Describe the correct storage requirements for butorphanol

A

stored in cool dry place, shelf at room temperature

53
Q

Describe the correct storage requirements for propofol

A

stored in cool dry place, shelf at room temperature

54
Q

Why might nitrous oxide be administered alongside oxygen as part of an inhalational anaesthetic protocol?

A

Used to provide analgesia

Has an anaesthetic sparing effect meaning lower doses of volatile agents are generally required.

It is mixed at a 2:1 ratio with oxygen.

55
Q

Which patients should nitrous oxide be used with caution?

A

As it accumulates in gas filled spaces it should be used with caution in patients with GDV, intestinal obstruction, pneumothorax, middle ear disease.

56
Q

Explain the term diffusion hypoxia

A

N2O has low solubility in blood, at the end of anaesthesia when administration of N2O ceases the N2O present in blood

diffuses back into the alveoli and ‘dilutes’ the alveolar air so less O2 is available.

If the animal is breathing room air hypoxia may occur as a result of this.

This effect is mitigated by ensuring that patients receiving N2O have 10 minutes of pure oxygen after cessation of nitrous administration.

57
Q

Explain the term Minimum Alveolar Concentration

A

MAC is a measure of anaesthetic potency

Defined as the quantity of anaesthetic agent required to immobilise 50% of patients when under surgical stimulus.

The lower the MAC value the more potent the anaesthetic.

58
Q

Explain the term Blood Gas Solubility

A

Is a measure of how readily the volatile agent dissolves into plasma.

More soluble agents accumulate a reservoir in the blood and slowly move from plasma to the CNS meaning they have a slower onset and recovery time.

Agents with low blood gas solubility e.g. sevoflurane are taken up rapidly from plasma = faster onset and recovery.

Anaesthesia (9 decks)

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