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POS 2 > Introduction to anaesthesia > Flashcards

Introduction to anaesthesia Flashcards

1
Q

What are reasons for anaesthesia?

A

restraint (capture of wild animals)
surgery
dx procedures
therapy
legal requirements

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2
Q

What is the definition of anaeWhthesia?

A

without sensation
loss of sensation to the entire or any part of the body, induced by drugs that depress the activity of the nervous system

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3
Q

What is the definition of analgesia?

A

absence of pain in response to a stimuli which would normally be painful

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4
Q

What is the definition of general anaesthesia?

A

drug-induced unconsciousness that is characterised by controlled but reversible depression of the central nervous system (CNS) in which ptx neither percieve or recall noxious stimuli

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5
Q

What is the definition of local/regional anaesthesia?

A

insensibility to pain in a larger, though limited, body area usually defined by the pattern of innervation of the affected nerves

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6
Q

What are the 3 components of GA?

A

unconsciousness (hypnosis)
analgesia (antinociception)
muscle relaxation

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7
Q

What are the 4 stages of the depth of anaesthesia?

A
  1. voluntary movement
  2. delirium or involuntary movement
  3. surgical anaesthesia
  4. extreme CNS depression
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8
Q

What do we consider balanced anaesthesia?

A

use of smaller doses of a combination of drugs to achieve the various components of anaesthesia = reducing the disadvantages of using large doses of any one drug
multi-modal approach to pain control

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9
Q

What are the side effects of anaesthesia on the CNS?

A

CNS depression: damping of reflexes
cardiovascular -> hypotension
respiratory -> hypoventilation
thermoregulatory -> hypothermia
postural -> reduced muscle tone

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10
Q

What are the side effects of anaesthesia on the CVS?

A

cardiovascular depression = hypotension
damping of reflexes
changes in vasomotor tone
myocardial depression

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11
Q

What are the side effects of anaesthesia on the respiratory system?

A

respiratory depression = hypoventilation (hypercapnia/hypoxaemia)
damping of reflexes
alveolar collapse
reduced functional residual capacity
ventilation/perfusion mismatch

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12
Q

What are the drug related side effects of anaesthesia?

A

specific drug effects
adverse drug reactions

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13
Q

What are the 3 steps of the preoperative assessment?

A
  1. Hx
  2. PE
  3. preanaesthetic blood tests
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14
Q

What can be seen in the preanaesthetic blood tests that cause concern to anaesthesia?

A

Anaemia (oxygen delivery)
hypoprotenemia (highly protein-bound drugs)
azotemia, renal dz (dehydration, depressed myocardial contractility, Hb oxygen dissociation curve shifted to R)

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15
Q

What are the important parts of the preop prep?

A

pre-anaesthetic assessment
owner consent
fasting (species specific)
miscellaneous (clipping, clean moth, anti-tetanus, ABs)
premeds (sedation, anxiolysis, analgesia)

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16
Q

What are the first steps prior to induction?

A

Premeds
Endotracheal intubation

17
Q

What are the main aspects of maintenance of anaesthesia?

A

Inhalation (gas)
total intravenous anaesthesia (TIVA)
monitoring

18
Q

What is the mortality risk of anaesthesia in humans, dogs, cats and rabbits?

A

humans: 0.01%
dogs: 0.17%
cats: 0.24%
rabbits: 0.73% (if sick 7.3%)
nonfatal complications tend to occur more frequently than mortal events

19
Q

What is the difference in mortality rate between GA and sedation?

A

GA is always much higher risk

20
Q

When is the risk of mortality higher (premed, induction, maintenance, recovery)?

A

recovery ++++
maintenance +++
induction +
after premed +/-

21
Q

Why is recovery the riskiest part of anaesthesia?

A

Animal goes from 70-100% O2 to room air (~20%)
extubation
reduced monitoring equipment
different personnel - handover

22
Q

What are the main systems causing mortality during anaesthesia?

A
  1. CVS (collapse, arrest)
  2. Resp
  3. Neuro
  4. Renal
  5. Unknown
23
Q

What are the main causes of mortality in pets in the UK?

A
  1. Euth due to worsening condition
  2. CVS
  3. Death outside clinical settings

majority of deaths still happening during anaesthesia maintenance/recovery period

24
Q

What are the main morbidity causes during anaesthesia causing failure of the animal to return to pre-operative state?

A

CVS and Resp compromise
regurgitation
peripheral nerve injury
myopathy
eye injury, loss of vision
acute kindey injury (AKI)

25
Q

What are the factors affecting anaesthetic risk?

A
  1. Ptx health
  2. urhency: elective vs emergency procedure
  3. surgery
  4. facilities available
  5. anaesthetict: protocol chosen, tiredness/vigilance
  6. duration of procedure
26
Q

How can we assess the risk of anaesthesia in ptx?

A

Examine patient
use ASA status (1-5)

27
Q

What are the 5 ASA grades?

A
  1. normal healthy animal w/ no underlying dz (elective)
  2. mild systemic dz or impairment (fracture, controlled diabetes mellitus)
  3. more severe systemic dz which is well compensated/controlled by tx (dehydration, liver dz, moderate cardiac dz)
  4. severe systemic dz, not compensated (shock, uncompensated cardiac dz)
  5. moribund, unlikely to survive w/ or w/o intervention (endotoxemia, MODS)
28
Q

What are all the steps to assessment of risk?

A

ptx exam
prep ptx
check all anaesthetic equipment before use
appropriate use of drugs
constant monitoring
intraoperative support
post-op care

29
Q

What are the environmental considerations of anaesthesia?

A

greenhouse gas emission
- utilise low fresh gas flow
- avoid high impact inhaled anaesthetics: dsflurane, nitrous oxide
- consider IV/regional techniques
- invest in WAG trapping/destroying technology

30
Q

What are the risk to the team exposed to anaesthetic drugs/gases?

A

no definite evidence that chronic exposure to traces causes long-term harm
possible risks: cancer, miscarriage, liver and kidney damage, immunosuppression, psychological disturbance

31
Q

How can we minimise exposure to anaesthetic drugs/gases?

A

use gas scavenging system
service all anaesthetic equipment regularly
avoid mask or chamber induction of anaesthesia
inflate ET tube cuff, preferably before turning vaporizer on
fill vaporizeers at end of day
cap empty bottles of anaesthetic before discarding
before disconnecting ptx, flush circuit w/ oxygen and dump the bag into scavenging system

32
Q

How can practices avoid/minimise anaesthetic gas exposure?

A

use scavenging systems properly
avoid nitrous oxide
improve room ventilation
pregnant staff exempt from filling vaporizers
keep away from recovery areas (often most polluted)
leave animals connected to circuit as long as possible
special facemasks
monitor envr. levels regularly

33
Q
A

POS 2 (10 decks)

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