principles of clinical practice: anaesthesia and analgesia Flashcards
(183 cards)
1
Q
triple
A
medetomidine hydrochloride, ketamine, and torbugesic
2
Q
what want from anaesthesia
A
- unconcioussness
- analgesia
- muscle relaxation
3
Q
analgesia in anaesthesia is necessary to
A
- inhibit processing of pain in CNS
- antinociception
4
Q
central eye position in anaesthesia indicates
A
light or deep anaesthesia
5
Q
eye position in adequate anaesthesia
A
rotated
6
Q
palpebral reflex and anaesthesia
A
if there is one than anaesthesia is too light
7
Q
movement is absent in what anaesthesia
A
adequate and deep anaesthesia
8
Q
the cornea is dry when in anaesthesia
A
in deep anaesthesia
9
Q
likelyhood that healthy dog dies due to anaesthesia
A
1 in 1849
10
Q
likelyhood that healthy cat dies due to anaesthesia
A
1 in 895
11
Q
likelyhood that healthy rabbit dies due to anaesthesia
A
1 in 72
12
Q
likelyhood that healthy guinea pig dies due to anaesthesia
A
1 in 26
13
Q
stuff that can happen due to anaesthesia (6)
A
- muscle nerve damage
- cerebral hypoxia causing poor recovery
- peripheral nerve damage
- spinal cord damage
- blindness
- post anaesthetic cognitive dysfunction
14
Q
low albumin and anaesthetic
A
- means more free drug so the dose will have a greater effect
- risk of oedema developing
15
Q
kidney failure and anaesthetic
A
- will show as increased creatinine or urea
- causing acidaemia
- increased free drug conc
- also depresses myocardial contractility
- and shifts HbO2 curve to right so lower affinity to oxygen
16
Q
3 dangers of waste anaesthetic gas
A
- cancer
- miscarriage
- liver/kidney disease
17
Q
gas cylinder size usually attached to an anaesthetic machine
A
size E
18
Q
gas cylinder size normally attached to pipelines
A
size J
19
Q
oxygen cylinder colour
A
black cylinder with white on top
20
Q
nitrous oxide cylinder colour
A
blue
21
Q
air cylinder colour
A
grey cylinder with black/white quarters on top
22
Q
oxygen is stored at (pressure)
A
13700kPa or 137 bar
23
Q
nitrous oxide stored how
A
as liquid with gas on top at 4400kPa (4.4 bar)
24
Q
how tell how much nitrous oxide in cylinder
A
- weigh it
- molecular weight 44 so 1 mole is 44 g
- 1 mole of gas is 22.4 litres
25
pipeline system for gas end in valves called
schrader valves
26
max O2 concentration you get out of an O2 concentrator
95%
27
how read a flowmeter
- top of bobbin
| - middle of ball bearing
28
low resistance or draw-over vaporises define
are in the system and gas that flows through them is generated by the patient
29
emergency oxygen flush delivers O2 at a flow of
30-70 liters per minute
30
2 rebreathing systems
- circle
| - to-and-fro
31
minute volume define
volume of air inspired or expired in a minute
32
tidal volume define
volume of air inspired or expired in one breath
33
estimate tidal volume to be
10-15 ml/kg
34
magill fresh gas flow
equal to minute volume
35
fresh gas flow for IPPV magill
3 x minute volume
36
magill weight animal
over 10kg
37
lack types 3
- parallel
- mini
- co-axial
38
lack fresh gas flow
equal to minute volume
39
estimate of minute volume
200 ml/kg/min
40
IPPV flow rate lack
3 x minute volume
41
standard lack animal weight
over 10kg
42
mini lack animal weight
under 10kg
43
ayers T-piece flow rate
2.5 - 3 x minute volume
44
ayers T-piece animal weight
under 10 kg
45
bain appearance
co-axial T piece with inspiratory tube surrounded by expiratory tube
46
fresh gas flow rate bain
2.5-3 x minute volume
47
bain animal weight
10kg
48
using a circle fresh gas flow rate
- first 10-15 minutes use a higher fresh gas flow (100ml/kg/min)
- then reduce to 50ml/kg/min
49
when change carbon dioxide absorbers
when half of it has changed colour
50
anticholinergics action
block acetylcholine receptors of parasympathetic system
51
3 anticholinergics
- atropine
- glycopyrollate
- hyoscine
52
anticholinergics 5 side effects
- increase heart rate
- reduce salivation
- reduce gut motility
- dilate pupil of eye
- relax bronchi
53
3 tranquillisers and sedative agents groups
- phenothiazine
- 2-adrenoceptor agonists
- benzodiazepines
54
define maximal effect
- increaseing dose does not increase action only length
55
3 phenothiazines
- acepromazine
- chlorpromazine
- propionylpromazine
56
phenothiazines are (tranquiliser or sedative)
tranquiliser
57
phenothiazine action
- dopamine antagonist
- alpha 1 adrenoceptor antagonist
- antihistamine
- anticholinergic effects
58
acepromazine is a (2)
- antiemetic
| - vasodilator
59
butyrophenones sedative or tranquiliser
tranquiliser
60
butyrophenone action
- alpha 1 adrenoceptor blocker
| - dopamine antagonist
61
example 1 butypophenone
azaperone
62
5 alpha 2 adrenoceptor agonists
- xylazine
- medetomidine
- dexmedetomidine
- detomidine
- romfidine
63
alpha 2 adrenoceptor agonist actions
centrally to inhibit norepinephrine release
| - peripherally in post synaptic receptors
64
benzodiazepines actions
enhance affinity of GABAa receptor to GABA so enhancing inhibitory transmission
65
profofol metabolism
not all by the liver
66
alfaxalone anaesthesia is a (type)
steroid
67
alfaxalone given
i/v or i/m
68
ketamine is a
dissociative anaesthetic
69
ketamine given
i/v or i/m
70
ketamine pros
- some analgesic properties
| - no CVS depression
71
thiopentone metabolism
slowly
| it accumulates in body fat
72
thipentone given
i/v
| if extravascular then get skin necrosis
73
etomidate pros
good in sick animals as minimal CVS/resp depression
74
etomidate cons
immunosuppresive
75
endotracheal tube and occlusion in lung overcome
murpheys eye in end of tube
76
3 methods maintenance with i/v
- intermittent boluses
- continuous rate infusion (CRI)
- partial i/v anaesthesia (PIVA) uses some gas as well
77
intermittent bolus mainenance anaesthesia cons
swinging plane of anaesthesia
78
solubility inhalational anaesthetics
more soluble in blood the less concentrated it is in brain
79
blood:gas partition coefficient define
- number of parts of gas in blood vs alveolus
| - if high then means more soluble in blood
80
MAC define
- minimum alveolar concentration of gas required to prevent movment in response to pain in 50% of animals
81
isoflurane dog MAC
1.3
82
isoflurane MAC cat
1.6
83
isoflurane MAC horse
1.3
84
sevoflurane MAC dog
2.3
85
sevoflurane MAC cat
2.6
86
sevoflurane MAC horse
2.3
87
how much sevoflurane is metabolised
2%
88
% isoflurane metabolised
0.2%
89
sevoflurane metabolism theory
free fluoride ions released which are toxic to kidney
90
sevoflurane and older hot soda lime
react to make nephrotoxic compound
| newer ones dont do this
91
nitrous oxide MAC
200%
92
nitrous oxide use
- used for mild analgesic properties
- speeds up second gas used
- has to be stopped 10 min before end to help reduce diffusion hypoxia as it reduces lungs O2 partial pressure
93
in horse during anaesthesia what needed for good recovery
good muscle perfusion
94
horse systolic blood pressure
110
95
horse diastolic blood pressure
70
96
horse mean blood pressure
90
97
ABP monitoring indirect method how to
- use cuff that has width of 40% of circumference
- find pulse using doppler thing
- inflate cuff till doppler stops
- deflate cuff and when noise starts thats the systolic blood pressure
98
oscillometric method arterial blood pressure monitoring pros
- gives systolic mean and diastolic pressures automatically
99
direct method ABP motioring how to
- put in arterial catheter
| - measures everything with electronic transducer
100
pros of direct ABP measurment
- gives continuous blood pressure
| - allows blood gas samples to be taken
101
pulse oximetry measures
- haemoglobin O2 saturation
| - heart rate
102
pulse oximetry cons
- cant tell partial pressure O2
| - misreads carboxyhemoglobin and methemoglobin
103
capnography measures
end tidal CO2
104
end tidal CO2 is normally
35-45mmHg
105
in hyperventilation and cardiac arrest ETCO2
decreases
106
in hypoventialtion ETCO2
increases
107
define hypoawemia
low O2 in blood
108
hypercapnia define
high CO2 in blood
109
3 causes of hypercapnia
- hypoventilation
- rebreathing exhaled gas
- increased basal metabolic rate
110
hypercapnia causes 6 things
- tachycardia
- arrhythmias
- hypertension
- increased intracranial pressure
- CV depression
- respiratory acidosis
111
intrapleural pressure is always
negative
112
IPPV causes intrapleural pressure to
go above 0 throughout resp cycle
113
increased intrapleural pressure causes
- decreased venous return and so decreased cardiac output
114
dobutanine effect on heart
- inotrope
| - mild chronotroph
115
dobutamine actions
beta 1 receptors
116
increased intracranial pressure triggers what reflex
cushings reflex
117
rabbits prone to post op
post op ileus due to pain/stress
118
rabbit consider for anaesthetic
most rabbits have subclinical resp problem. assume that all rabbits have
119
indication of rabbit resp disease
nasal discharge
120
4 blood sample taking sites rabbit
- cephalic vein
- marginal ear vein
- lateral sephanous vein
- jugular
121
before inducing rabbit anaesthesia
- apply EMLA cream 1 hour before venepuncture
| - place an i/v catheter
122
2 common premeds used on rabbit
- hypnorm
| - medetomidine
123
EMLA cream is
mix of lidocaine and prilocaine
124
hypnorm is
mix of fentanyl and fluanisome
125
hypnorm cons
- resp depression
- poor muscle relaxant
- can induce ileus
126
alpha 2 agonist can be reversed with
atipamezole
127
intubating rabbit
spray larynx with anaesthetic
128
cons rabbit laryngeal mask
when cuff blown up can cut of circulation to tongue and make it go blue
129
3 commonly used unlicensed rabbit analgesic
```
opiods
- bupenorphine
- butorphanol
NSAIDs
- meloxicam
```
130
rats, mice, gerbil i/v access
lateral tail vein
131
guinea pig i/v access
medial metatarsal vein
132
healthy horse probability of anaesthetic death
1 in 110 horses
133
starvation time for horse pre op
8 hourse
134
starvation time pre laproscopy horse
48 hours
135
horses need what drug pre op
anti-tetnus
136
acepromazine is
long acting injectable premed
137
acepromazine actions
stabilizes cardiac membrane so reducing chances of adrenaline induced arrhythmia
138
alpha 2 adrenoceptor agonists action
sedation
139
analgesia in horse
- opiods
| - NSAIDs
140
ketamine in horses usually used with what as induction
alpha 2 agonists
141
guaiphensin action
muscle relaxant
142
guaiphensin in horse anaesthesia
- given before induction or with induction
143
horse and intubation
will always damage the horse trachea
144
isoflurane horse recovery
can be too fast need a sedative to improve quality
145
isoflurane halothane compare
iso is more respiratory depressant so may need IPPV
146
lateral recumbency horse position anaesthesia
- front bottom leg should be a bit in front
- back bottom leg should be a bit behind
- head should be raised slightly
147
hypotension and horse anaesthetic
minimum blood pressure usually 30-45 minutes post induction, it improves normally due to an increase in systemic vascular resistance and so causes poor perfusion to extremities
148
tx hypotension (4)
- decreases anesthetic
- give large volume crystalloids
- inotropic agents
- hypercarbia (increase CO2)
149
hypercarbia define
increase of CO2 in blood
150
hypercarbia anaesthetic horse
- increases as horse is recumbent
| - causes increased cardiac output and blood flow and muscle tremours
151
tx horse hypercarbia
IPPV
152
hypoxaemia anaesthetic horse
occurs in large horses in dorsal recumbency
153
how to external cardiac massage a horse
jump on it landing on its chest with your knees
154
major cause equine death post anaesthesia
equine post-anaesthetic myopathy
155
equine post-anaesthetic myopathy due to
poor perfusion through weight and hypotension
156
how to position a horse post anaesthetic
- left lateral recumbency if has been in dorsal
| - if been in lateral you can leave to reduce chances of hypoxia or swap sides to improve muscle perfusion
157
3 consideration ruminant anaesthesia
- bloat
- salivation
- regurgitation
158
bloat and the heart
reduces venous return
159
IV sites cows
- tail vein
- jugular
- milk vein if desperate
160
sedation in ruminants done with
alpha2 agonists
161
alpha 2 agonists and ruminants 4 side effects
- pulmonary oedema
- reduces eructation and swallowing
- urine production
- urethral flow issues
- uterine contraction
162
3 local anesthetic licensed large animals
- procaine
- benzocaine
- tetracaine
163
2 types paravertebral block
- proximal
| - distal
164
proximal paravertebral block where
- T13
- L1
- L2
165
distal paravertebral block where
at lateral processes of
- L1
- L2
- L4
166
caudal epidurals where
where dip made when tail lifted up and down
167
what caudal epidural block of
rectum and more depending on dose
168
2 induction agents cow
- xylazine
| - ketamine
169
best combo anaesthetic for LA
ketamine and diazepam
170
when extubate ET tube LA
when animal can support its own head
171
halothane and small ruminants
can be hepatotoxic
172
camelids develop what with stress
third compartment stomach ulcers
173
pigs i/v injections
can use ear veins
174
pigs and intubation
hard as have small cricothyroid junction and marked laryngeal reflexes
175
how to intubate a pig
put in going down, rotate 180 and push round then rotate 180 again
176
define malignant hyperthermia
muscles contract producing a lot of heat
177
tx malignant hyperthermia
switch to dantrolene though it is expensive
178
prevention malignant hyperthermia
can do a test
179
pigs and anaesthetic risk (3)
- malignant hyperthermia
- hypothermia
- obstruction
180
1ml of blood weighs
1.2 g
181
dog has how much blood
80ml/kg
182
how long does mrphine last
4 hours
183
an overinflated ET tube can cause
tracheal rupture and generalised emphysema
