Monitoring during anesthesia (Tenenbaum) Flashcards
1
Q
Most important thing about monitoring before procedure
A
- physical exam
- heart
- lungs
- pulses
- Know normals for that patient
2
Q
What is monitored?
A
- CNS
- CVS
- Respiratory
- Renal
- Temp
- Other (case dep)
3
Q
CNS
A
- eye
- palpebra
- crneal
- nystagmus
- lacrimation
- jaw tone
- anal reflex
- pedal reflex
4
Q
signs to monitor for good plane of anesthesia
A
- position of eye
- movement
- muscle tone
- certiain reflexes
- response to sx stimulation
- nystagmus (horse)
- Shivering
- eye reflexes present or absent
5
Q
Light Plane of Anesthesia
A
- central eye position
- cessation limb movements
- muscle tone remains
-
response to surgical stimulation
- movement
- breating/hemodynamic response
- Nystagmus (horse)
- eye reflexes present
- shivering
- moist cornea
6
Q
Medium plane of anesthesia
A
- No spontaneous movement
- no reflex movement
- no change in hemodynamic or breathing in response to surgical stim
- moderate muscle tone
- dec in tidal volume
- no palpebral reflex
- no shivering
- ventromedial rotation of the eye
- small pupil aperture
- moist corneas
7
Q
deep plane of anesthesia
A
- dec in tidal volume
- abdominal breathing may be noted
- eyes fixed centrally
- no pedal reflexes
- no spontanous or reflex movement
- bradycardia/hypotension and worsening hemodynamic function
- no palpebral and corneal reflex
- dilated pupil
- dry cornea
8
Q
Cardiovascular system
A
- maintain perfusion to body organs
- maintain normal rhythm and rate
- use clinical skills as well as a specific equipment to monitor
- heart rate
- blood pressure
9
Q
Mucous membranes
normal
white/pale
cyanosis
red/bright pink
A
- normal: pale pink/pink
- white/pale: anemia, vasoconstriction, lack of circulating fluid
- cyanosis: lung disease, dec in oxygen flow to breathing circuit, endobronchial intubation
- red/bright pink: hypercapnia
10
Q
Palpation of pulse
SA
A
- lingual artery
- femoral artery
- digital artery
11
Q
pulse in LA
A
- facial artery
- transverse facial artery
- digital artery artery
12
Q
Esophageal stethoscope
A
- can evaluate rhythm, rate
- can’t evaluate adequacy of circulation
- can be annoying to anesthetist
13
Q
ECG
A
- good for
- heart rate and rhythm
- not good for
- evaluating cardiac function
- heart disease
14
Q
Common arrhythmias
A
- Sinus tachycardia
- Sinus bradycardia
- second degree AV block
- VPCs
15
Q
mean blood pressure should be maintained at
A
- above 60 mmHg
- above 70 mmHg in horses
- to prevent post-op myopathies
16
Q
main organs we want to perfuse
A
- heart
- brain
- kidneys
17
Q
Direct BP
A
- provides real time beat by beat pressure monitoring
- invasive
- aseptic technique
- hematoma common
18
Q
Indirect BP measuring
A
- sphymomanometry
- size of cuff: width => should be about 40% circumference of limb
- big width: underestmates BP
- small width: overestimates blood pressure
- too tight: underestimates BP
- too loose: overestimates BP
- Systolic should be > 80
19
Q
Oscillometric method
A
- cuff inflated to a pressure and it’s slowly released
- go by the mean
- MAP > 60mmHg
20
Q
Cardiac output
A
- invasive method (thermodilution)
- not used routinely
- Requires special and expensive equipment
- CO = HR times stroke volume
*something about injecting cold saline and measuring the temp change of the heart….WTF?!
21
Q
Pulse oximetry
A
- arterial oxygen saturation
- heart rate monitoring
- placed on tongue, ears, digits
22
Q
Pulse oximetry measures
A
- light absorption of two different wavelengths at fast intervals during pulsations
23
Q
Pulse oximetry detects
A
- reduced hemoglobin and oxyhemoglobin
24
Q
Pulse oximetry
percent of saturated hemoglobin calculated based on
A
- algorithms and displayed on screen
25
Pulse ox is sensitive to
* movement, cold, vasoconstriction
26
Pulse ox should be maintained
at \> 95%
27
At what percent do you consider patient to be hypoxemic
\< 90%
- corresponds to 60 mmHg
- blood gas is only way to be sure
28
Central venous pressure
* assess fluid status of patient
* pressure within the thoracic vena cava
29
Decreased CVP
hypovolemia
30
Inc CVP
fluid overload
31
Normal CVP
SA:
LA:
SA: 2-7 cm H2O
LA: 15-25 cm H2O
32
Urine output dependant on
cardiac output, blood volume, and renal function
33
Normal urine output
1-2 ml/kg/hr
34
Clinical skills of respiratory system
* monitor resp rate
* check excursions
* abdominal efort
* tidal volume
* mm color
35
normal resp rate for a dog
10-30 bpm
36
Normal tidal volume
10-15 mL/kg
37
Lots of dead space can accidentally cause a patient to be
extubated
38
Blood gas analysis measures levels of
oxygenation and carbon dioxide in arterial blood
39
Blood gas analysis provides
acid-base status
40
Blood gas analysis can also measure
electrolytes/glucose/lactate
41
Blood gas analysis not required in ........but almost necessary in .........
SA
LA
42
Capnography measures
the end tidal carbon dioxide and inspired carbon dioxide tension
43
Capnography is connected
between the patient and the breathing system
44
Capnography useful to measure
* hypoventilation
* hyperventilation
* apnea
* disconnection
* rebreathing
* obstruction
* embolism
45
Capnography provides information on (3 things)
1. Adequacy of ventilation
2. Cardiovascular system
3. Patients metabolism
46
Phase 1 of capnogram
* Phase 1: inspiratory baseline
* inspiration of fresh gas
* baseline should stay at the level that corresponds to zero conc (mmHg) of CO2
47
Phase 2 of capnogram
* phase 2: expiratory upstroke
* this phase occurse shortly after inspiration ends
* caused by rapid washing out of fresh gas in anatomic space, then replacement by CO2 - rich alveolar gas
* upstroke should be steep
48
phase 3 of capnogram
* phase 3: expiratory plateau
* represents continuous exhalation
* this line will be perfectly horizontal if ventilation and perfusion were perfectly matched
* CO2 conc will be constant throughout the exhalation phase
* Ventilation and perfusion not perfectly matched
* CO2 slowly increases as gas from lung areas with lower ratio of ventilation to perfusion reaches sampling site
49
phase 4 of capnogram
* phase 4: Inspiratory downstroke
* occurs shortly after the expiration ends
* represents rapid washing out of CO2 by fresh gas as inspiration starts
* downstroke should be steep
50
Pulse ox and respiratory system
* lower oxygen tension means lower arterial oxygen saturation
* will see low saturation with pulmonary embolism
51
Should maintain a body temp greater than
94 deg F
52
Hypothermia anesthetic complications
* decrease in anesthetic requirements
* non-response to anticholinergics
* prolonged recovery
* cardiopulmonary depression
53
Hyperthermia
* should be avoided
* rule out malignant hyperthermia
* esp pink pigs
54
Normal end tidal CO2
35-45 mmHg
