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Anesthesia Exam 3 > Misconceptions in Anesthesia > Flashcards

Misconceptions in Anesthesia Flashcards

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1
Q

T/F: many breeds are “sensitive” to anesthesia

A

false: very few breed-specific anesthetic idiosyncrasies. more likely that the patient had some sort of disease process going on that they didn’t know about before anesthesia

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2
Q

what drugs are contraindicated in greyhounds?

A

thiobarbiturates
- delayed recovery (3-4x longer)
- mostly decreased liver metabolism
- thiopental used to be common induction agent.
greyhounds metabolize drugs in a slower pathway

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2
Q

what electrolyte imbalance do greyhounds get?

A

hyperkalemia
- progressive increase in K+ levels
- often subclinical but can be life-threatening
- duration of anesthesia >2 hr
- etiology unknown

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2
Q

what do you want to check in greyhounds before and during anesthesia?

A

K+ levels
don’t want duration of anesthesia over 2 hrs

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3
Q

why do greyhounds get hyperkalemia under anesthesia?

A

we don’t know

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3
Q

what species should not be administered thiobarbiturates?

A

greyhounds
delayed recovery (3-4x longer)
- mostly decreased liver metabolism
- thiopental used to be common induction agent.
greyhounds metabolize drugs in a slower pathway

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4
Q

what is delayed post-operative hemorrhage?

A
  • bleeding disorder caused by mutant DEPOH gene
  • common in greyhounds, wolfhounds, other sighthounds
  • hours to days post sx: variable severity
  • hyperfibrinolysis: anti fibrinolytic drugs
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4
Q

when does delayed post operative hemorrhage disorder happen?

A

hours to days post surgery: variable severity

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5
Q

how do you treat delayed post operative hemorrhage?

A

anti fibrinolytic drugs

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5
Q

how long is the max time for anesthesia in greyhounds before you get concerned about hyperkalemia?

A

> 2 hours

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6
Q

collies, shelties, aussies, whippets are all predisposed to what condition? what causes this?

A
  • MDR1 mutation: multi drug resistance mutation (esp in COLLIES!!)
  • they have non-functional P-glycoprotein: its function is to clear drugs from CSF. in these mutations, don’t have enough of P glycoprotein and get accumulation of drug.
  • acepromazine and butorphanol have very significant and prolonged effects on them.
  • every time you see a Collie or other susceptible breed, ask about previous anesthesia or other prolonged recoveries, if tested, etc
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6
Q

patients with a mutant DEPOH gene are prone to what condition?

A

delayed post operative hemorrhage

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6
Q

greyhounds, wolfhounds and other sighthounds are all prone to what complication after surgery?

A

delayed post operative hemoorhage: bleeding disorder caused by mutant DEPOH gene

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6
Q

what drugs should you likely not use in patients with the MDR1 mutation?

A

acepromazine, butorphanol

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7
Q

what blood issues does delayed post operative hemorrhage cause?

A

hyperfibrinolysis

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8
Q

MDR1 mutation

A
  • collies 70%, also shelties, aussies, whippets
  • non functional P glycoprotein doesn’t clear drugs from CSF, get excessive CNS exposure from drugs
  • acepromazine and butorphanol especially have prolonged effects
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8
Q

T/F: the MDR1 mutation is mainly caused in dogs

A

false, happens in cats too

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9
Q

what are the strong benefits of using opioids?

A
  • excellent analgesia
  • great CV stability/minimal depression
  • potent anesthetic sparing effect
  • reversible!
    allows us to drop the other amount of drugs that we use
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9
Q

an owner checks in with her 7 year old Collie for a routine dental. what do you ask her about?

A
  • previous anesthesia history
  • prolonged recoveries?
  • has she been tested for MDR1

likely won’t use acepromazine or butorphanol in this patient

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9
Q

acepromazine in boxers?

A
  • collapse, anecdotal reports
  • increased vagal response? boxers would collapse after given ace
  • induces bradycardia
  • genetics? british/european lines
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9
Q

MDR1 mutation in cats?

A

yes- neurotoxicity with eprinomectin
- homozygous for MDR-1 mutation
- mostly non-purebred maine coons?)
- no anesthesia related information yet
- flea/tick meds caused adverse events and death

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10
Q

in what breeds is it recommended to not use acepromazine in?

A

boxers

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10
Q

what breeds often provide the most issues with anesthesia?

A

bracycephalics
- upper airway obstruction
- challenging intubation and recovery
- prone to regurgitation and aspiration
- extubation: wait until they are actively objecting the ETT

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10
Q

what is the biggest anesthetic issue with brachycephalic breeds?

A

extubation: have such a bad airway and can organize their airway to where they cough the ETT out. keep tube as long as possible

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10
when do you take the ETT out in a bulldog or other brachycephalic breed?
when they are actively objecting the tube
11
T/F: opioids cause serious adverse effects
false, are extremely safe
11
is respiratory depression from opioids worse in humans or in animals?
people
12
when do you see adverse effects of opioid use?
- rarely serious - vomit and defecation seen commonly after pre-medication - opioid dependent: morphine > methadone - less likely when animal is painful. if they are not painful, more likely to see side effects. if they are truely painful, then you are less likely to see the side effects
12
what cardiovascular effects do opioids have?
bradycardia: easily treated/prevented
12
when is significant respiratory depression seen with opioid use?
when they are combined with other anesthetics: ex opioid added to CRI with inhaled anesthetic. PPV
13
what is more likely to cause adverse effects like vomit and defecating: morphine or methadone?
morphine
14
what adverse effects are seen with opioids? when?
- vomit/defecation usually seen after pre medication - opioid dependent: morphine > methadone - hypothermia, hyperthermia in cats. easily corrected
15
are you more likely to see adverse effects of opioids when a patient is painful or non painful
non painful. if they are truely painful then will not see side effects
16
aside from vomiting and defecation, what adverse affects can be seen with opioids?
- hypothermia - hyperthermia in cats: well described with hydromorphone having hyperthermia in recovery period - easily corrected - dysphoria in recovery: need to either sedate or reverse
17
your tech rushes into the lab area saying a cat that had been sedated using hydromorphone is having temperature abnormalities. what are you expecting to see the thermometer read as?
hyperthermia
18
what do you do for a patient who is dysphoric following administration of opioids?
sedate or reverse
19
T/F: butorphanol provides great pain relief
false - only indicated to treat mild pain - not as efficacious as pure μ-agonists: ceiling effect - short duration (1-2 hr maximum) - nice to use as combo for sedation because it works synergistically with other drugs, and doesn't have as many adverse effects - is short, doesn't last long, and only so much analgesia obtained
20
T/F: butorphanol is a kappa agonist and a mu antagonist
true: is an opioid agonist-antagonist
21
butorphanol is only indicated to treat what kind of pain?
mild pain not as efficacious as pure mu agonists - short duration: 1-2 hrs max
22
your associate vet sedated a patient for a spay and used butorphanol as their analgesic of choice. you remind her that her spay better not take more than ________ hours. why?
butorphanol has a short duration of 1-2 hours maximum
23
T/F: hydromorphone is more potent than morphine, and thus must be a better analgesic
false. potency is a DOSE thing. - both drugs are equally efficacious (similar analgesia) - potency = smaller dose to achieve same effect - pure μ agonists differ in potency but nOT in efficacy
24
pure μ agonists differ in ________ but NOT in ________
potency, efficacy
25
fentanyl, hydromorphone, and morphine are all examples of
pure μ agonists listed in order of most potent to least potent
26
list these pure μ agonists in order of most potent to least potent: fentanyl, morphine, hydromorphone
fentanyl > hydromorphone > morphine
27
what is more potent, morphine or fentanyl? which one is more efficacious?
fentanyl is more potent, both have the same efficacy
28
what has higher efficacy, morphine or butorphanol?
morphine: is a pure μ agonist. butorphanol is a agonist-antagonist
29
T/F: even very low doses of alpha 2 agonists can cause severe CV depression
true
30
how severely does dexmedetomidine affect CV system?
- good sedation! - 1 μg/kg decreases CO by 50%>!!! PAY ATTENTION TO PATIENT SELECTION!!
31
T/F: injectable anesthesia is safer than inhaled
true
32
why is injectable anesthesia safer than inhaled?
- mask has many side effects - slow: non-secured airway - struggling/excitation: inhaled anesthetics smell! sedate with IV catheter first ^ increases catecholamines = risk of arrythmia - depth for intubation > maintenance. greater CV depression
33
T/F: the depth for induction of inhaled anesthetics is much greater than you have for injectables
true
34
what is safer, alfaxolone or propofol?
- clinically very similar - alfaxolone may have better CV profile, but hypotension still possible
35
T/F: alfaxolone has a better CV profile than propofol
true
36
T/F: propofol has a better respiratory profile than alfaxolone
false, resp depression/apnea is similar. need to administer slowly and preoxygenate!
37
what has better recovery, alfaxolone or propofol?
propofol: extrahepatic metabolism leads to rapid smooth recovery
38
what common induction agent can be given IM?
alfaxolone! gives options! cats, exotic species
39
T/F: sevoflurane is better than isoflurane
false: clinically not significantly different - similiar CV and resp depression - dose dependent, no myocardium sensitization
40
what has lower solubility, sevoflurane or isoflurane? what does this mean?
lower: sevoflurane. faster induction/recovery
41
what is a potential downside to using sevoflurane?
potentially toxic by-products: fluoride, compound A. low fresh gas flow should be avoided with Sevo
42
how reliable is an ECG to tell you how the heart is working for a patient under anesthesia?
- ECG can appear normal even when heart is not pumping effectively or at all!! - electrical conduction x mechanical pump - "pulseless electrical activity" or "electromechanical dissociation" - useful for detection of arrhythmias
43
how do anesthetics affect cardio?
decrease myocardial contractility, which decreases cardiac output
44
what is an ECG on an anesthetized patient useful for?
detection of arrhythmias
45
why is pulse not a good indicator of blood pressure and tissue perfusion?
pulse only dictates the difference between systolic and diastolic blood pressures - strong palpable pulse means a big difference between systolic and diastolic blood pressure, and does NOT rule out hypotensions?
46
T/F: you can be confident your patient is not hypotensive if you feel a strong palpable pulse
false!! ex! PDA!! a strong palpable pulse only tells you that there is a big difference between systolic and diastolic pressures
47
PDA animals may have normal pulse but be hypotensive. why is this
PDA has low blood pressure: decreased diastolic but normal to increased diastolic. this leads to strong bounding pulses, but MAP is usually low
48
how common is hypotensiveness during anesthesia?
super common- not just old and sick!! - 32% of all anesthetized patients at CSU experience hypotension, 28% of all elective OVH patients get hpotensive
49
many young and healthy patients get hypotensive during anesthesia. how do you combat this?
- decrease anesthetic depth - bolus IV fluids - inotropes (12%)
50
how can you tell if a patient is hypotensive?
measure it!! hypotensive animals can appear clinically normal
51
most patients will recover from anesthesia without "obvious" problems. is this good?
not necessarily- renal ischemia and other damage may be undetected. 75% of nephrons must be dead before BUN or creatinine increase
52
why is anesthesia critical for patients with dental disease?
- very risky, mostly older patients with coexisting diseases - careful preanesthetic evaluation! PE and BW - adequate support with fluids and oxygen and monitoring
53
what does bradycardia signify for your patient who is under anesthesia?
many causes, and deep planes of IA are usually not associated with bradycardia - hypothermia - vagal stimulation - opioids, alpha 2 agonists
54
what are the most common causes of bradycardia?
- hypothermia - vagal stimulation - opioids, alpha 2 agonists
55
T/F: deep planes of IA are not usually associated with bradycardia
true
56
how does oxygenation affect recovery of patients?
- has no effect - prevents hypoxemia! - remove IA from breathing circuit, bc even after you turn off vaporizer it has gas inhalant in it - empty bag and refill with O2 - maintain ventilation to eliminate IA
57
why might an animal at room air appear to "breathe better"?
hypoxic drive!! an animal taking big, deep breaths after anesthesia is HYPOXIC and is trying to get more air!!
58
what might slow recovery?
- sedative drugs and analgesics - slow not necessarily bad! - hypothermia: slow metabolism and drug elimination. try to maintain them warm!! - hypotension and hypovolemia decrease drug clearance

Anesthesia Exam 3 (7 decks)

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