Lecture 13 10/22/24

Question 1

What are the complications of swine anesthesia that arise due to genetics?

Answer 1

-Porcine Stress Syndrome
-Pale-Soft-Exudative Pork
-Malignant Hyperthermia

Question 2

Which type of pig is considered susceptible to malignant hyperthermia?

Answer 2

meat breeds

Question 3

What are the special considerations taken into account with swine anesthesia?

Answer 3

-very intelligent
-social behavior
-feeding schedule/temp fluctuations
-drug residues in meat
-personnel safety

Question 4

What are the characteristics of fasting in swine?

Answer 4

-omnivorous monogastric animals
-12 hrs of fasting in adults
-3 hrs of fasting in juveniles
-1 hr of fasting in neonates
-maropitant/cerenia used for vomiting

Question 5

What history is typically obtained from an owner?

Answer 5

-behavior
-food intake

Question 6

What are the characteristics of a swine physical exam?

Answer 6

-begin with visual observations of mentation and ambulation
-move to hands-on exam to best of ability
-stress levels will affect vitals

Question 7

What is important regarding the age of swine undergoing anesthesia?

Answer 7

the rise in pigs as pets has led to more geriatric swine undergoing anesthesia

Question 8

Which drugs can be used for oral tranquilization in swine?

Answer 8

-gabapentin
-trazodone
-clonazepam

Question 9

How can a pig’s stress be reduced in hospital?

Answer 9

-allowing time for animal to acclimate to hospital environment
-food enrichment/distraction

Question 10

What are the characteristics of physical restraint in swine?

Answer 10

-poorly tolerated
-aggressive physical restraint not recommended
-want to minimize stress from handling
-minimizing stress reduces exertion hyperthermia

Question 11

Which techniques can be used to physically restrain a pig?

Answer 11

-towel wrap
-board
-snout twisting w/ snare
-cart

Question 12

Which aspects of pig anatomy and physiology pose a challenge to anesthesia?

Answer 12

-thick adipose tissue layer
-poor venous and arterial access
-laryngeal conformation
-tracheal bronchus
-small tidal volume and chest compliance
-no sweat glands

Question 13

Which drug administration routes are used in pigs?

Answer 13

-PO
-IM
-intranasal
-intra-testicular
-intra-osseous

Question 14

Which veins are used in pigs?

Answer 14

IV drug admin:
-external jug.
-cranial vena cava
sample blood:
-cranial vena cava
-tarsal vein
small catheters:
-caudal auricular vein
-cephalic vein

Question 15

Which sedatives are used in swine?

Answer 15

-midazolam
-xylazine
-butorphanol
-alfaxalone
-ketamine
-tiletamine/zolazepam combo.

Question 16

What are the characteristics of mask induction?

Answer 16

-done to pre-oxygenate, facilitate intubation, or bring pig into unconsciousness
-need a deep mask to accomodate long snout
-high flow and high vaporizer setting

Question 17

Which induction agents are used in swine?

Answer 17

-midazolam
-alfaxalone
-ketamine
-propofol
-tiletamine/zolazepam combo.

Question 18

Which challenges complicate swine intubation?

Answer 18

-large epiglottis
-redundant tissues in the larynx
-target is small and far, with small opening between maxilla and jaw
-obtuse angle to overcome
-prone to laryngospasm
-possible to perforate posterior floor of larynx

Question 19

Which supplies are needed for swine intubation?

Answer 19

-long blade laryngoscope
-mouth speculum
-extended neck
-lidocaine splash
-regular or long ET tube
-soft stylet

Question 20

What is the ideal ET tube position in the pig and why?

Answer 20

-cranial to 2nd intercostal space
-prevents tracheal bronchus exclusion and endobronchial intubation

Question 21

Which injectable combinations are used to maintain swine anesthesia?

Answer 21

-guaifenesin/ketamine/xylazine
-telazol/xylazine/ketamine

Question 22

Which injectable medications are used for PIVA?

Answer 22

-lidocaine
-ketamine
-fentanyl

Question 23

Which inhalant medications are used to maintain swine anesthesia?

Answer 23

-isoflurane
-sevoflurane
-desflurane

Question 24

What is important about swine MAC?

Answer 24

it is higher than all animals except cats for all inhalant drugs

Question 25

What are the characteristics of swine positioning during anesthesia?

Answer 25

-done to prevent neuromyopathy -padding used -limbs flexed and relaxed

Question 26

What is monitored during swine anesthesia?

Answer 26

-depth of anesthesia (jaw tone preferred) -pulse-ox -ECG -blood pressure

Question 27

What are the characteristics of ventilation in swine anesthesia?

Answer 27

-prone to hypoventilation -mechanical ventilation recommended if available -small animal machine set up used

Question 28

Which drugs are used for blood pressure management in swine?

Answer 28

-dobutamine -dopamine -ephedrine -phenylephrine -vasopressin -norepinephrine

Question 29

What are the characteristics of swine temperature regulation under anesthesia?

Answer 29

-no hair cover; more prone to hypothermia -cannot sweat; must avoid hyperthermia -bair hugger and heated blanket used until animal is warm; removed before elevated temp. can begin

Question 30

What is malignant hyperthermia?

Answer 30

-genetic, hyper-metabolic syndrome in humans and swine -associated with PSS and PSEP syndromes -single amino acid mutation on Ryanodine Receptor Type 1

Question 31

What are the triggers for malignant hyperthermia?

Answer 31

-rough handling/stress -high ambient temp. -vigorous exercise/strain -transportation -inhalant drugs -succinylcholine

Question 32

What is the pathophysiology of malignant hyperthermia?

Answer 32

-excess of Ca efflux from sarcoplasmic reticulum -cannot regulate efflux due to mutation -results in over-activation of excitement-contraction coupling -muscle contracture and release of heat occurs -insaturation of anaerobic metabolism

Question 33

What are the clinical signs of malignant hyperthermia?

Answer 33

-hyperthermia -hypercarbia -tachypnea/dyspnea -tachycardia -cardiac arrhythmias -hypotension -acid-base and electrolyte disorders -muscle rigidity -blanched or reddened areas of skin -skin and mucus membrane cyanosis -coagulopathy -shock -SIRS -death

Question 34

Which changes on bloodwork are consistent with malignant hyperthermia?

Answer 34

-hyperkalemia -hypercalcemia -hyperphosphatemia -hypermagnesemia -severe lactic acidosis

Question 35

What are the treatment steps for malignant hyperthermia?

Answer 35

-discontinue inhalant -change breathing circuit and rebreathing bag -continue 100% O2 admin. -actively cool -dantrolene -NaHCO3 -treat hypotension -treat hyperkalemia -treat arrhythmias

Question 36

What is the outcome of malignant hyperthermia?

Answer 36

often fatal

Question 37

What can be done in pigs suspected to be at risk for malignant hyperthermia?

Answer 37

pre-treat with dantrolene the night before and morning of anesthesia

Question 38

What is the modern method for screening for malignant hyperthermia?

Answer 38

RYR1 qPCR-HRM assay from EDTA blood sample

Question 39

What are the characteristics of swine recovery from anesthesia?

Answer 39

-keep IV access as long as possible -prolonged recovery typical -hypothermia risk -mutilation risk if re-introduced to pen mates -noisy breathing should be investigated immediately

Question 40

What are the possible post-extubation complications in swine?

Answer 40

-laryngospasm -laryngeal edema -hematoma -soft palate engaged in larynx -resp. depression resulting in apnea, resp. distress, and edema

Question 41

When should extubation be attempted?

Answer 41

when there are signs of swallowing/chewing/coughing/shivering