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Flashcards in Patient Evaluation Deck (35):
1

Pre-anesthetic patient evaluation

1. Signalment/general appearance
2. History
3. Physical exam and accurate weight
4. Risk assessment
3. Pre-anesthetic workup (blood work, radiology, etc)
4. Preparation

2

What weight should you use for obese patients to calculate drug dosages?

Estimated ideal weight

3

IV drugs should always be given to....

Effect

4

Anesthetic concerns for overweight/obese animals

1. Increased CO
2. Decreased lung and chest wall compliance
3. Decreased functional residual capacity- respiratory depression, mechanical ventilation often necessary

5

Evaluation of thin/cachectic animals

Evaluate and treat any underlying disease prior to anesthetic induction

6

Concerns of IV anesthetics in underweight animals

Drugs stay in VRG longer (titrate to effect)
Prone to severe hypothermia

7

Concerns with very small animals

1. Severe hypothermia
2. Must get accurate weight to avoid overdose of drugs and fluids
3. Difficult to access under drapes
4. Prone to hypoglycemia

8

Concerns with giant breeds

1. Profound response to sedatives (lower MBR)
2. Smaller body surface area to body weight ratio (BSA dosages should be reduced)
3. Senescence occurs earlier and have lower life expectancy

9

Concerns with neonates

1. Increased sensitivity to drug effects
2. Hypothermia
3. Hypoglycemia

10

Concerns with geriatrics

1. Decreased organ reserves
2. Sub-clinical organ function

11

T/F: Hyper or aggressive animals typically take higher dosages of drugs to achieve the same effect.

True

12

Concerns with brachiocephalic animals

1. Elongated soft palate
2. Everted saccules
3. Obstructed nares
4. High vagal tone- predisposes to bradycardia

13

Concerns with greyhouds

1. Susceptible to stress hyperthermia
2. Low body fat
3. Avoid thiobarbituates (decreased ability to metabolize)
4. Sensitive to propofol

14

Concerns with herding breeds (collies)

MDRI mutation- increased sensitivity to invermectins, acepromazine, butorphenol

15

Breeds with predisposition to Cardiomyopathies

Boxers, doberman pincher, giant breeds, maine coons

16

Cardiac/renal disease medications

Potentiate anesthesia related C/V depression

Angiotensin converting enzyme inhibitors, Beta or Ca channel blockers

17

What drug should you avoid with angiotensin converting enzyme inhibitors?

Acepromazine

18

What drug interacts with SSRIs Tricyclics and MAO inhibitors

Tramadol, some opiods

19

What drug increases metabolism of other similar drugs?

Phenobarbital- increases P450 metabolism

20

Why is it important to review anesthesia records?

To find any previous potentially drug related problems and avoid those drugs or try to alleviate

21

Should a physical exam always be performed the day of the anesthetic procedure?

Yes- helps determine ASA physical status and if any changes have occurred

22

Is the ASA risk assessment scale subjective or objective?

Somewhat subjective but based on set standards

23

ASA category I

Normal healthy patient

Likely will not require any invasive monitoring, extra IV catheters, different/special drug protocols/contradindications

24

ASA category II

Mild systemic disease but well compensated or uncomplicated injury

Likely will not require any invasive monitoring, extra IV catheters, different/special drug protocols/contradindications

25

ASA category III

Moderate systemic disease requiring medical management but stable physiologically

Likely not be managed with the same protocol or dosages and management

26

ASA category IV

Severe systemic disease that is a constant threat to life

Likely not be managed with the same protocol or dosages and management

27

ASA category V

Moribund; not expected to survive with or without surgery

28

ASA category E

Emergency

Patients usually otherwise classified as III, IV, or V

29

Is pre-anesthetic bloodwork a good predictor of risk?

No, it rarely alters anesthetic protocols

30

Fasting time

12hr fast, free access to water

May be longer for endoscopy or GI surgery

31

What patients should receive supplemental glucose?

Neonates and pediatrics Up to 4-6hr prior

32

Diabetic pre-anesthetic protocols

Adjustment of insulin dose (usually half) and early morning procedures

33

Should exotics/pocket pets be fasted?

No

34

Why should patients be fasted?

Reduce risk for vomiting/regurgitation- aspiration pneumonia

35

Does fasting decrease incidence regurgitation or reflux?

NO- just reduces material