Revision Flashcards
1
Q
At which point is it considered appropriate to extubate a Feline patient?
A
- When the Ear flick is evident
- But before
- Gag reflex returns
2
Q
Identify the main route of excretion of Isoflurane and Sevoflurane from the patients body?
A
Mainly excreted via the Respiratory tract
3
Q
Explain why hypothermia must be avoided in the recovery period
A
Delays recovery by:
1. Reducing immune system and Clotting function
1. The act of shivering leads to increased oxygen consumption > which can result in Hypoxaemia
4
Q
List the 6 methods of warming post-operative patients
A
- Blankets
- Bubble wrap
- Metallic blankets
- Heat pads
- Bair huggers
-
Incubators
(Dependent on the patient)
5
Q
Describe 5 ways Oxygen can be provided to patients during the Recovery period
A
- Oxygen tent/Kennel
- Mask
- Flow-by
- Nasal catheter
- Tracheostomy tube
6
Q
List the 13 responsibilities of the RVN during the Recovery period
A
- Maintain regular observations every 5 mins
- Remain diligent + remember risks of complications
- Observe, monitor + record TPRs
- Ensure airway remains patent
- Ensure adequate ventilation, to avoid Hypoxia + provide O2
- Monitor return of cranial nerve reflexes + return of conciousness
- Extubate patient - once appropriate level of gag reflex is present (Considering Cats v Brachycephalics)
- Avoid Hypothermia by keeping patient warm + monitoring temp
- Monitor signs of pain
- Monitor wound for signs of infection, complications or interference
- Monitor urination, defecation, eating + drinking prior to discharge
- Keep patient comfortable, padded bedding for recumbent patients + turn Q2hr (Avoid Hypostatic pneumonia)
- Report any pain + abnormalties to VS
7
Q
Name the 5 classes of Pre-Meds
A
- Phenothiazines
- Anti-mucarinics
- Alpha-2-agonists
- Alpha-2-Antagonists
- Benzodiazepines
8
Q
Name the 10 classes of drugs used in General Anaesthesia
A
- Barbiturates
- Phenol Derivatives
- Dissociative Anaesthetics
- Steroid Anaesthetics
- Opioid - Full Agonists
- Opioid - Partial
- Opioid - Antagonist
- NSAIDs
- Anti-depressant
- Anti-Convulsants
9
Q
Name the 3 classes of drugs used in Analgesia
A
- NSAIDs
- Anti-Depressants
- Anti-Convulsants
10
Q
Name the 3 classes of Neuro-Muscular Blocking Agents
A
- Depolarising muscle relaxants
- Non-Depolarising muscle relaxants
- Non-Depolarising muscle relaxant Antagonists
11
Q
Name the class of drugs used for Local Anaesthesia
A
Local Anaesthetics!
12
Q
Name the Phenothiazine used for Pre-Med
A
Acepromazine
13
Q
Name the 2 Anti-muscarinics used for Pre-Med
A
- Atropine
- Glycopyrrolate
13
Q
Name the 3 Alpha-2-Agonist used for Pre-Med
A
- Medetomidine
- Dexmedatone
- Xylazine
14
Q
Name the Alpha-2-Antagonist used for Pre-Med
A
Atipamezole
15
Q
Name the 2 Benzodiazepines used for Pre-Med
A
- Diazepam
- Midazolam
16
Q
Name the Barbiturate used for General Anaesthesia
A
Pentobarbitone
17
Q
Name the infamous Phenol derivative used for General Anaesthesia
A
Propofol!
18
Q
Name the Dissociative anaesthetic used for General Anaesthesia
A
Ketamine!
19
Q
Name the Steroid Anaesthetic used for General Anaesthesia
A
Alphaxolone
20
Q
Name the 5 Full agonist-Opioids used for Analgesia
A
- Morphine
- Pethidine
- Fentanyl
- Methadone
- Tramadol
21
Q
Name the 2 Partial agonist-Opioids used for Analgesia
A
- Butorphanol
- Buprenorphine
22
Q
Name the Antagonist-Opioids used for Analgesia
A
Naloxone
23
Q
Name the 3 NSAIDs used for Analgesia
A
- Meloxicam
- Carprofen
- Robenacoxib
24
Name the **Anti-depressant** used for **Analgesia**
Amytriptyline
25
Name the **Anti-convulsant** used for **Analgesia**
Gabapentin
26
Name the **Depolarising Muscle Relaxant** used for **Neuro-Muscular Blocking Agents**
**Suxa**methonium
27
Name the 3 **Non-Depolarising** Muscle Relaxants used for **Neuro-Muscular Blocking Agents**
1. **Pancu**ronium
2. **Atracu**rium
3. **Vecu**ronium
28
Name the **Non-Depolarising** Muscle Relaxant **Ant**agonist used for **Neuro-Muscular Blocking Agents**
Neostigmine
29
Name the 3 **Local Anaesthetics** used for **Local Anaesthesia**
1. **Ligno**caine
2. **Bupiva**caine
3. **Mepiva**caine
30
Name the 9 **Emergency drugs** that should be in the **Crash box**
1. Adrenaline/Epinephrine
2. Lignocaine
3. Atropine
4. **Naloxone**
5. Diazepam
6. **Frusemide**
7. **Atipamezole**
8. **Doxapram**
9. **Sodium bicarbonate**
31
Where **liver disease** exists in the anaesthetised patient, you are likely to see?
A) Quicker recovery from faster drug metabolism
B) Slower recovery from slower drug metabolism
C) An increase in drug excretion time
D) An decrease in the half-life of drugs
B) **Slower recovery** from slower drug metabolism
32
The **area** of the **nervous system** that is concerned with the **control of the heart rate** is the:
A) Peripheral nervous system
B) Voluntary nervous system
C) Visceral nervous system
D) Autonomic nervous system
D) **Autonomic** nervous system
33
**Pain** is caused by **inflammatory chemicals** that are **released** from:
A) The spinal cord
B) Nerve endings
C) Damaged cells
D) The medulla oblongata
C) Damaged cells
34
A **forced intake** of **breath** **above** the **tidal volume** is known as:
A) Functional reserve capacity
B) Inspiratory reserve capacity
C) Inspiratory capacity
D) Residual volume
B) Inspiratory **reserve capacity**
35
**Hypercapnia** can be described as:
A) Low levels of blood calcium
B) Low levels of blood carbon dioxide
C) High levels of blood carbon dioxide
D) High levels of blood potassium
C) High levels of blood **carbon dioxide**
36
**Triad** of anaesthesia for **surgical anaesthesia** is **balance** between:
A) Sedation, analgesia, reduced systemic vascular resistance
B) Oxygenation, analgesia and narcosis
C) Analgesia, muscle relaxation, narcosis
D) Muscle relaxation, tranquilisation, analgesia
C) **Analgesia**, **muscle relaxation**, **narcosis**
37
During **deep** anaesthesia:
A) Pupils are dilated
B) The eyeball is ventromedial
C) A palpebral reflex is present
D) A pedal reflex is present
A) Pupils are dilated
38
A **dog** under anaesthesia has just **lost** his **palpebral reflex**; this would **indicate** a **level** of anaesthesia of stage:
A) I
B) II
C) III
D) IV
C) III
39
The **thorax muscles** are **paralysed**, the **eye** is **central** and **only** the **corneal reflex exists** – these **physical indicators indicate** a **level** of anaesthesia of stage:
A) I
B) II
C) III
D) IV
D) IV
40
An **ECG** will monitor the:
A) Electrical activity of the heart
B) Strength of the heart contractions
C) Saturation of oxygen percentage
D) pH of the blood
A) Electrical activity of the heart
41
When using a **pulse oximeter** on an **anaesthetised** patient, **normal saturation** would read:
A) 99%
B) 90%
C) 89%
D) 75%
A) 99%
42
**Capnography** measures carbon dioxide via:
A) Blood samples
B) Rectal probes
C) Venous catheterisation
D) Expired gases
D) Expired gases
43
What is the approximate **tidal volume** of a **25 Kg** dog?
A) 25 ml
B) 250 ml
C) 2500 ml
D) 25000 ml
B) 250 ml
## Footnote
Remember TMF!
1. BW(kg) x TV
= 25kg x (> 10kg = 10ml)
= 250 ml
44
A cat has a **Minute Volume** of **800mls**.
When using an **Ayres T Piece**, the **Fresh Gas Flow** would be:
A) 800mls/min
B) 1200 mls/min
C) 2400mls/min
D) 8000mls/min
C) **2400**mls/min
## Footnote
Remember TMF!
1.MV = 800mls.
2. FGF
TV x (CF = 2.5-3)
= 800ml x 2.5-3
= 2000 - 2,400ml
45
A **20kg** dog is to be anaestehtised using a **Lack** circuit.
It has a **respiratory rate** of **22bpm**.
The **fresh gas flow** for this dog will be:
A) 440mls/min
B) 6.5ltrs/min
C) 13ltrs/min
D) 20ltrs/min
B) 6.5ltrs/min
## Footnote
1. TV
Bw(kg) x CF
= **20kg x 1-1.5**
= 20 - 30 ml
2. FGF
= RR x TV
= **22bpm x 20-30ml**
= 440-660 ltrs/min
= 660 ltrs/min = 6.5 **ltrs/min**
46
In an anaesthetic **emergency**, which of the following **actions** has **highest priority**?
A) Stopping any haemorrhage
B) Calling the Veterinary Surgeon
C) Massaging the heart
D) Ensuring a patent airway
D) Ensuring a patent airway
47
Within a ‘**Crash Box**’, **atropine** would be included to use in cases of:
A) Arrhythmia
B) Oedema
C) Metabolic acidosis
D) Narcotic overdose
A) Arrhythmia
48
Which of the following is **cyanosis** suggestive of.
A) Hypercapnia
B) Hypoxaemia
C) Anaemia
D) Haemolysis.
B) Hypoxaemia
49
**TIVA** stands for:
A) Total intravenous anaesthesia
B) Total intravascular anaesthesia
C) Trans-intravenous anaesthesia
D) Trans-intravascular anaesthesia
A) Total intravenous anaesthesia
50
**Acepromazine** is an example of a:
A) Anticholinergic
B) Benzodoazepine
C) Phenothiazine
D) Alpha-2-agonist
C) Phenothiazine
51
An example of a **partial** **narcotic** (opioid) **agonist** is:
A) Morphine
B) Pethidine
C) Buprenorphine
D) Fentanyl
C) Buprenorphine
52
The **type** of anaesthesia that is **delivered** **without** the **use of a needle and syringe** is known as:
A) Topical
B) Infiltration
C) Regional
D) Spinal
A) Topical
53
A drug that can be used as a **tranquilliser** **or** a **sedative**, **dependent on the dose**, is:
A) Acepromazine
B) Atropine
C) Diazepam
D) Ketamine
A) Acepromazine
54
Which of the following statements is **NOT accurate** about **Nitrous Oxide**?
A) It is non-irritant
B) It is a colourless gas
C) It is explosive
D) A reducing valve is essential in its use
C) It is explosive
55
An example of **NSAID** **analgesic agent** is:
A) Isoflurane
B) Buprenorphine
C) Methadone
D) Meloxicam
D) Meloxicam
56
**Suxamethonium** is a:
A) Alpha 2 antagonist
B) A depolarising muscle relaxant
C) A non-depolarising muscle relaxant
D) A narcotic analgesic
B) A **depolarising** muscle relaxant
57
Which of the following agent is **chemically reversible**?
A) Halothane
B) Propofol
C) Acetylpromazine
D) Medetomidine
D) Medetomidine
58
A **side effect** of **Acepromazine** could be:
A) Hypertension
B) Hypotension
C) Emesis
D) Epileptic control
B) Hypotension
59
**Alpha 2 agonist** drugs can **reduce** the anaesthetic **induction** dose by:
A) 2%
B) 5%
B) 10%
D) 50%
D) 50%
60
The **length** of an **ET tube** is **calculated** by **measuring** from the:
A) Incisors to 14th rib
B) Incisors to the spine of scapula
C) Molars to the spine of scapula
D) Molars to xiphisternum
B) **Incisors** to the **spine of scapula**
61
It is **accurate** to say that:
A) A Humphrey ADE circuit is a non-re-breathing circuit only
B) It is unsafe to use nitrous oxide with a closed circuit
C) A re-breathing circuit will always deliver an accurate inhalation agent dose
D) Soda lime will have a cooling effect on inhaled gases
B) It is **unsafe** to use **nitrous oxide** with a **closed circuit**
62
The **Humphrey ADE circuit** is designed to:
A) Only be used for animals under 10kg
B) Only be used for animals over 10kg
C) Use very low flow rates
D) Be used separately from a respirator
C) Use very low flow rates
63
The veterinary surgeon wishes to anaesthetize a **12kg** dog that may have a **ruptured diaphragm**. The circuit of choice would be a/an:
A) Ayres T Piece
B) Bain’s
C) Co-axial Lack
D) Circle system
B) Bain’s
64
A positive **benefit** of using a **Bain**’s circuit is that:
A) Low circuit factors reduce gas costs
B) Low circuit factors reduce pollution risks
C) It can be used on animals between 7-40kg
D) The inspired air is warmed by expired air
D) The inspired air is warmed by expired air
65
The **substance** **in soda lime** that helps to **reduce** the **dust content** is:
A) Sodium hydroxide
B) Calcium hydroxide
C) Silicates
D) Chemical pH indicator
C) Silicates
66
The **reason** to **set a high initial flow rate** when using a **re-breathing circuit** is to **expel**:
A) Nitrogen
B) Water vapour
C) Excessive heat
D) Carbon dioxide
A) Nitrogen
67
The **ball** **in** the **flow meter** should be **read from** the:
A) Top
B) Bottom
C) Diameter
D) Grooves
C) Diameter
68
The **contents** of the **nitrous oxide cylinder** are **measured via** the:
A) Pressure gauge reading
B) Flow meter reading
C) Weight of the cylinder
D) Reducing valve measurement
C) Weight of the cylinder
69
Which of the following is **not an advantage** of using **ACP**?
A) Anti-arrhythmic effect
B) Anti- emetic effect
C) Spasmolytic effect
D) Analgesic effect
D) Analgesic effect
* ACP has **no analgesic properties**
* Hence it is **often combined with opiods**
* As these drugs **work synergistically** to provide **better sedation**
70
Which of the following drugs is an **alpha-2 adrenoceptor** **ant**agonist?
A) Naloxone
B) Atipamezole
C) Dexmedetomidine
D) Butorphanol
B) Atipamezole
* Alpha 2 adrenoceptor agonists such as **Medetomidine** and **Dexmedetomidine**
* Are **antagonised** by **atipamezole**
71
Which patients are **particularly sensitive** to the effects of **ACP**?
A) Rabbits
B) Small dogs
C) Cats
D) Large dogs
D) Large dogs
* Large dogs require a **relatively lower dose** of ACP
* Whilst **smaller** animals tend to be **more resistant** to its effects.
72
Which of the following **opioids** is a **partial** **agonist**?
A) Buprenorphine
B) Methadone
C) Pethidine
D) Fentanyl
A) Buprenorphine
* Buprenorphine is a **partial agonist**
* Often **incorporated** in to a **premedicant regime**
* Where **mild > moderate pain** may be anticipated
* It has a **duration** of **action** of **4-6 hrs**
73
Which of the following statements describe the **action** of **Dexmedetomidine**?
A) Causes peripheral vasodilation and provides analgesia
B) Causes peripheral vasoconstriction and provides analgesia
C) Causes respiratory stimulation and provides analgesia
D) Causes cardiovascular stimulation and provides analgesia
B) Causes **peripheral** vaso**constriction** and provides **analgesia**
* Dexmedetomidine is an alpha 2 **adrenoceptor** **agonist** drug
* It provides **reliable sedation** + analgesia
* Its effects on the cardiovascular system include **bradycardia** and **vasoconstriction**
* Therefore has a **depressant effect** rather than a stimulatory one
74
Which of the following drugs is a **Benzodiazepine**?
A) Glycopyrrolate
B) Alfentanil
C) Midazolam
D) Atipamezole
C) Midazolam
* Midazolam is a benzodiazepine that can be **used** as a **premedicant alone**
* Or **combined with opioids** for **very sick or debilitated patients**
* It has a **high safety profile**
* However is an **unreliable sedative** in **healthy** animals
* It can be used to **manage seizures** in an **intraoperative emergency situation**
75
Which of the following is a **local anaesthetic** drug?
A) Naloxone
B) Morphine
C) Glycopyrrolate
D) Bupivicaine
D) Bupivicaine
* Bupivicaine is an **agent** that can be used for **local blocks** or **tissue infiltration**
* Has a **longer duration of action** **than Lidocaine**
76
Which of the following is **not** an **effect** of **Atropine**?
A) Bradycardia
B) Pupillary dilation
C) Tachycardia
D) Gastro intestinal ileus
A) Bradycardia
* Atropine is an **anti-muscarinic drug** which means that it **reverses or counteracts the effects** of the **parasympathetic nervous system**
* It is **not commonly used as a premedicant**
* However may be used in **brachycephalic** patients
* It is more commonly found as part of the **crash kit**
* Where it can be used to **treat** **bradycardia**
* Or in **Cardiac Arrest** **alongside** **Adrenaline**
77
An opioid **overdose** may be **reversed** with:
A) ACP
B) Atipamezole
C) Lignocaine
D) Naloxone
D) **Naloxone**
* Naloxone is an **opioid** **ant**agonist
* That may be used in cases of opioid **overdose**
* **Or**
* **Inappropriately deep anaesthesia**
* Where the patient has **received opioids**
78
A **Mandibular** **nerve block** is an example of:
A) Topical anaesthesia
B) General anaesthesia
C) Epidural anaesthesia
D) Regional anaesthesia
D) Regional anaesthesia
* This is a regional local anaesthetic **technique**
* Where **sensation to a particular area** of the body is **blocked**
* In this case a **manibular** nerve block is used for
* **Oral/dental surgery**
79
**ACP** takes approximately **how long to take effect** after **I/M** injection?
A) 5-10 min
B) 10-15 mins
C) 30-40 mins
D) 60-90 mins
C) 30-40 mins
* ACP is **relatively slow** to **take effect**
* Has a **long duration of action**
* Which can **lead to slower recoveries** in some patients
80
Which of the following drugs can be **combined** in a **pre-med**?
A) Methadone and pethidine
B) Methadone and burprenorphine
C) Morphine and burprenorphine
D) Morphine and midazolam
D) Morphine and midazolam
* All of the others are **2 opiods combined**
81
Which of the following drugs should **not** be **administered** **intramuscularly**?
A) Methadone
B) Diazepam
C) ACP
D) Butorphanol
B) Diazepam
* Diazepam is **irritant intramuscularly**
* **Painful** when given by this route
* It can however be given:
1. **IV**
1. **Rectally**
1. **Orally** (Tablet form)
82
Which of the following would **provide** the **most reliable sedation** in an **aggressive** dog?
A) Acp and opioid
B) Alpha 2 agonist and opioid
C) Benzodiazepine and opioid
D) Anti muscarinic and opioid
B) Alpha 2 agonist and opioid
* Alpha-2-Agonists provides the **Most potent** and **reliable** **sedation**
83
**Define** the **triad** of **anaesthesia**
&
**Explain 3 reasons** for the **provision** of anaesthesia
* Anaesthesia is a **state of controlled and reversible unconsciousness**
Characterised by:
1. **Lack of** **pain sensation** (analgesia)
1. Lack of **memory** ( amnesia)
1. Relatively **depressed reflex responses**
**Reasons** for anaesthesia include;
1. **Humanitarian** – **prevent awareness** of pain
1. **Practical** – **immobilisation** of patient
1. **Legal** – ***''Protection of Animals Act 1964''***
84
# 6 marks, 2 for each type!
Describe the following **types** of **anaesthesia**.
Include in your answer **1 advantage** + **1 disadvantage** of each type.
1) **General**
* Anaesthesia may be **induced** + **maintained** by **injectable** or **inhalational**
* **IM** + **IV** are **most common** admin routes
* **Advantages** = **Convenient**, **rapid loss** of consciousness, **facilitates surgical field**.
* **Disadvantages** = **Stressful restraint**, technical **skill req**
2) **Topical**
* **Desensitisation** produced only **at or near** the **site** of **application**.
* **Advantages** = little or **no cardiovascular depression**, **inexpensive**, **easy to do**
* **Disadvantages** = used for **minor procedures** only
3) **Local**
* Produces **reversible block of nerve impulse conduction**.
* **Advantages** = **consciousness retained**, good for **superficial surgery**
* **Disadvantages** = used for **minor** procedures only, **possible wound breakdown**
85
List **7 cranial nerve reflexes** that are **commonly monitore**d during anaesthesia
&
**Explain** their **typical changes** in each of the following planes:
1. Light
2. Surgical
3. Overdose
1. **Palpebral** reflex
2. **Jaw tone**
3. **Corneal** reflex
4. **Pedal** reflex
5. **Ear flick**
6. **Pupillary light** reflex
7. **Eye position**
**Light** plane =
* Pupils = **Dilated**
* Eye position = **Central**
* Palpebral + Pedal reflexes = **Brisk**
* Jaw + Muscle tone = **Some**
**Surgical** plane =
* Pupil = **Constricted**
* Eye = Rolls **Ventromedial**
* Palpebral = **Absent**
* Pedal = **Absent/sluggish**
* Jaw tone = Absent
**Overdose** plane =
* Pupil = **Dilated**
* Eye = Central
* Palpebral = Absent
* Pedal + Jaw tone = **Absent**
* Corneal reflex = Absent
86
Describe the typical changes in **Cranial Nerve Reflexes**, during a **Light plane** of Anaesthesia
1. Pupils = **Dilated**
1. Eye position = **Central**
1. Palpebral + Pedal reflexes = **Brisk**
1. Jaw + Muscle tone = **Some**
87
Describe the typical changes in **Cranial Nerve Reflexes**, during a **Surgical plane** of Anaesthesia
1. Pupil = **Constricted**
1. Eye = Rolls **Ventromedial**
1. Palpebral = **Absent**
1. Pedal = **Absent/sluggish**
1. Jaw tone = Absent
88
Describe the typical changes in **Cranial Nerve Reflexes**, during a **Overdose plane** of Anaesthesia
1. Pupil = **Dilated**
1. Eye = Central
1. Palpebral = Absent
1. Pedal + Jaw tone = **Absent**
1. Corneal reflex = Absent
89
# (Include in your answer any legal requirements)
**Explain** the **purpose** of the anaesthetic **consent form**
&
**Describe** what is **meant** by ‘**informed owner consent**'.
1. The **purpose** of the consent form is to **record the clients agreement to treatment** **based on knowledge of what is involved** and the **likely consequences**
2. The **client** may be the **owner** or **someone acting with their authority**
3. **No one under the age of 16 should sign** the form
4. **Before being asked to sign** the **client** should have the **opportunity to read** + **understand** + **ask any questions** they may have regarding the procedure
5. RCVS advises that **client are given a copy** of the consent form
90
A 2 yr old Labrador is booked in for a **Dew claw Removal**.
The patient has been **premedicated** with **ACP** and **Buprenorphine**
Describe the **5 aims** of **premeds**.
1. To **calm** the patient
2. **Reduce anxiety**
3. Reduce **amount** of **induction agent**
4. Reduce amount of **maintenance agent**
5. Provide **analgesia**
91
# 5. ...
A 2 yr old Labrador is booked in for a **Dew claw Removal**.
The patient has been **premedicated** with **ACP** and **Buprenorphine**
Describe the **role** of the **RVN** in the **induction** of anaesthesia.
1. Assist with **restraint** of patient – **IV catheter placement**
2. **IV induction** – restrain + **reassure** patient
3. **Assist** with **ET intubation** – **connect** to **anaesthetic machine**
4. **Monitor** **Resp**, **HR**, **CRT** + **Temp** closely, may **connect patient to monitoring equipment**
5. Monitor **level** of **consciousness**
92
# (You may include items/equipment in your answer)
Describe 2 anaesthetic **monitoring techniques** used to **assess** **Cardiovascular** **System** status
* **Observation**:
1. Colour of MM
2. CRT
* **Palpate pulse**:
1. Femoral
1. **Sublingual**
1. **Carpal**
1. **Auscultate heart**
* **Equipment**:
1. **Pulse oximeter**
1. **Oesophageal stethoscope**
1. ECG
93
# 10 steps...
**Explain** the **procedure** **you would carry out** in the following anaesthetic **emergency** situation
If a Patient went into **Respiratory Arrest**
1. **Inform VS** immediately + **shout for help**
2. Ensure the **airway is patent + intubated**
3. **Turn off** anaesthetic **vaporiser + flush O2** (**ensuring** patient **briefly disconnected** **prior to flush**)
4. Put Patient on **100% O2**
5. **Monitor pulse** to ***ensure no cardiac arrest***
6. **Start** manual (or automatic) **IPPV** **10 > breaths per/min**
7. **Continue** until vital **signs improve**
8. Provide **IV fluids + drugs** - *under direction of VS*
9. **Once** vital signs have **improved** - **Stop IPPV briefly** to **see if spontaneous respiration occurs**.
10. If not continue bagging!
94
# 5 steps...
**Explain** the **procedure** **you would carry out** in the following anaesthetic **emergency** situation
If a Patient went into **Tachycardia**
1. **Inform VS**
2. **Establish cause**
* **Inadequate depth** of anaesthesia so evaluate **in relation to surgery**
* Or
* May be due to **compensatory mechanism**/**response to Hypotension** + be **critical** in **preventing** ***Hypoxia*** + ***Hypotension***.
3. Liase with surgeon
4. Be **aware** that **Tachycardia** may **encourage Arrhythmias**
5. **Drugs** may be used to **reduce HR** **or** **increase depth** of anaesthesia - as determined by VS
95
List **4 Emergency drugs** that may be **used** in an **Anaesthetic emergency**
&
**Explain** the **action** of **each** drug
1. **Adrenaline**
* ***Cardiac stimulant***
* It **increases rate + force** of **myocardial contractions**
* Used in Cardiac **Arrest**
2. **Doxapram**
* ***Respiratory + CNS stimulant***
* Used in ***Respiratory Arrest*** or **Neonates**
3. **Atipamazole**
* ***Alpha 2 antagonist***
* Used if ***poor recovery*** from eg. **Medetomidine** to ***reverse the effects*** of the alpha 2 **agonist**
4. **Atropine**
* ***Anticholinergic***
* Used to ***reduce excess*** **vagal tone** + treat **bradycardia**
5. **Diazepam**
* ***Benzodiazepine*** with ***anti-epleptic activity***
* Used to treat **seizures**
6. **Frusemide**
* ***Diuretic*** + treatment of ***Acute Pulmonary Oedema***
96
List **7 pieces** of **equipment** that can be used in an **Anaesthetic Emergency**
1. **Defribillator**
2. **Ambu bag**
3. IV Catheter
4. Laryngoscope
5. ET tube
6. **Suction machine**
7. O2 supply
97
Describe the **monitoring techniques** you would **carry out** for a patient **in** the **recovery phase**
Following **repair** of a **Complex Pelvic Fracture**.
1. **Vital signs**, Inc:
* Body temp
* Pain levels
* Cranial nerve reflexes
* Return of consciousness
2.**Extubation**
3.**Observe**:
* IV fluids
* Urination
* Defaecation
* Status of wound
4. **Findings** should be **recorded + communicated** with staff as req
98
**List 5 signs** an animal should **show** on **smooth recovery** from anaesthesia
1. **Return** of **cranial nerve reflexes**:
* Palpebral reflex
* Jaw tone
* **Swallowing** reflex
2. **TPR**:
* Pulse
* Respiration
* Body temp
* ***All returning to normal ranges***
3. **No signs** of **pain or Dysphoria** eg. *Vocalisation*, *thrashing* etc.
99
**Describe** the 4 **Cardiovascular** + **Respiratory effects** of **Propofol** **post- induction**
1. **Myocardial** **depression**
2. Vaso**dilation**
3. Brady**cardia**
4. **Respiratory depression** > may cause ***Apnoea***
100
Name **2 Muscle Relaxants** and **state** for each one whether they are **Depolarising** or **Non**-Depolarising
**Depolarising**
1. ***Suxameth***onium
**Non**-depolarising
1. ***Atrac***urium
2. ***Vecur***onium
101
Name
6
**Opioids**
&
State which are **Full** + which are **Partial** agonists.
1. **Morphine** = Full
2. **Pethidine** = Full
3. **Methadone** = Full
4. **Fentanyl** = Full
5. ***Buprenorphine*** = Partial
6. ***Butorphanol*** = Partial
102
Name the **1 Steroid** Anaesthetic
Alfaxalone
103
# 6 steps..
**Describe the checks** that should be made
on a **Parallel Lack** ***Non-Rebreathing circuit***
**prior** to its **use** on a patient
1. Check all **tubing** is **clean** + **free from contamination**, **no kinks** or **cracks**
2. Check that **all connections** are **secure**
3. Ensure that the **APL valve + reservoir bag** are **connected** to the **correct ports**
4. **Connect** to **anaesthetic machine** + perform a **leak test** on the circuit
5. Ensure that the **APL valve is left** in the **open** position
6. The **circuit** is **connected** to **scavenging** system
104
There are 2 methods available to measure **Arterial Blood Pressure.**
Explain **how** ***Direct*** BP Monitoring is **carried out** + the **equipment** that is **used**.
**Direct** Blood Pressure Monitoring
1. Involves placing a **cannula into** a **peripheral artery** (the ***Dorsal Pedal Artery*** is often used)
2. Cannula is **connected** to the **transducer**, which **converts** the **pressure signal from** the **artery into** an **electrical signal**
3. Then **to** an **electronic monitor**, providing a **display** of the **arterial** blood **pressure trace** + values for:
* Systolic
* **Mean**
* Diastolic pressure
105
Name **3 types** of pressure does **Direct** Blood Pressure Monitoring monitor?
1. Systole/**Systolic**
2. **Mean**
3. Diastole/**Diastolic**
106
There are 2 methods available to measure **Arterial Blood Pressure.**
Explain **how** ***In-direct*** BP Monitoring is **carried out** + the **equipment** that is **used**.
There are 2 = Doppler + Oscillometric.
1. **Doppler Ultrasonic Flow** method:
* Involves **positioning** a **small probe**, which **emits** an **ultrasonic beam**
* **Over** a **peripheral artery** (***Tail*** or ***paw***)
* Apply an **ultrasound coupling gel** **between** the **probe** **+ skin**
* **As blood flows** along the vessel + under the probe, a ‘**whooshing’ noise** is **emitted** by monitor
* If an **Inflatable cuff** is **connected** to an **Aneroid Manometer**, is placed further up the appendage + **inflated**, it will **occlude** the **artery** + the **noise will disappear**
* If the cuff is then **slowly deflated**, the **sound will recur** at **Systolic** arterial pressure, which can be **read off** the **manometer**.
2. **Oscillometric** method:
* Involves **connecting a cuff system** to an **electronic monitor**
* The **cuff** is placed **over** a **peripheral artery**
* Then the **machine automatically inflates the cuff** to **occlude** the artery
* Before **slowly releasing** the **pressure**
* **As** the cuff **deflates**, the **machine detects oscillations** in the artery - as the blood begins to **flow back through**
* These **oscillations begin** at **Systolic** pressure
* **Reaching** a **max** at **Mean** arterial pressure
* And gradually **disappear** at **Diastolic** pressure
107
What are the **Advantages** + **Disadvantages** of **measuring** **Arterial** blood pressure by the **Direct** method?
**Advantages**
1. Gives more **accurate + continuous** b**eat to beat** info than other methods
**Disadvantages**
1. Technical **skill** is required to **place** an **Intra-Arterial catheter**
2. **Small risk** of **Ischaemic damage + Haematoma formation** around the catheter **site**
108
What are the **2 types** of **probe** that can be used with **Pulse Oximeters**?
1. **Transmittance** probes
* **2-sided** probes
* With **LED emitters** on **1-side**
* **Photodetectors** on the **other**
2. **Reflectance** probes
* **1-sided** probe
* With L**EDs + reflectors** **adjacent** to each other
109
Describe the **sites of attachment** for both **Transmittance + Reflectance probes**
**Transmittance** probes
* Most common
* **Clip on** to the patient
* **Attached** to **non-pigmented hairless areas**
* Such as the tongue, interdigital spaces + pinna
**Reflectance** probes
* Less common
* Used **in** the **rectum** of **very small patients**
* Or occasionally **wrapped around digits**
110
What would be the ‘**normal**’ SpO2 reading expected in a an **anaesthetised** patient?
Above 95%
**Ideally**, **above 98%** SpO2
111
**Explain why** the use of **Alpha-2-Adrenoceptor Agonists** in the **pre-med protocol**, may affect a **Pulse Oximeter reading**?
* Animals premedicated with Alpha-2-Adrenoceptor Agonists
* Such as:
1. **Xylazine**
1. **Medetomidine**
1. **Romifidine**
* Develop **intense Peripheral Vasoconstriction**
* So, in these cases, **pulse oximeters** may be **unable to detect a reading**
112
Explain why **bright ambient lighting** can **effect** the **reading** on a **Pulse Oximeter**
* If the light is too bright
* It can **overwhelm the light from** the **LEDs**
* **In** the **probe**
113
Describe the **correct placement** of an **Oesophageal Stethoscope**
1. The device is **placed into** the **oesophagus** **until** it ***overlies the Heart***
1. **Until** the **Cardiac + Respiratory sounds** can then be **detected**
1. **By attaching the proximal end** to an **ordinary stethoscope**
1. From which the **bell part** has been **removed**
114
A **capnograph** is a valuable piece of anaesthetic monitoring equipment that is **connected between** the **ET tube** + Breathing **circuit**
1. **What** **does** this piece of equipment **measure**?
2. **What** are the ‘**normal’ values** for a **dog** in **mmHg**?
1. Capnographs measure the **concentration of carbon dioxide in end-tidal expired gas**, ETCO2.
* They produce a **graphical + numerical value display**
2. Normal ETCO2 for the dog ranges from **35-45 mmHg**
115
Describe the **difference** between a **Mainstream + Sidestream** Capnography
1. **Mainstream** analysers
* Measure CO2 **directly at the site** of the **probe**.
1. **Sidestream** analysers
* **Continually divert a small sample** of gas from the **airway** > **main body of** the **machine**.
**Mainstream** analysers have a **more rapid response rate**, **but** they are **bulkier than sidestream** versions.
116
Describe why the Capnograph trace ***'Failure to return to baseline between breaths'*** may occur?
Rebreathing
117
Describe why the Capnograph trace ***'Progressive reduction in ETCO2 over consecutive breaths'*** may occur?
1. **Pulmonary embolism**
Or
2. ***Reduced*** **Cardiac Output**
118
Describe why the Capnograph trace ***'Slow upstroke phase'*** may occur?
Can be due to **any form** of ***Respiratory Obstruction***, such as:
1. **Kinked** **ET** tube
Or
1. **Bronchospasm**
119
Describe why the Capnograph trace ***'Camel hump on trace plateau'*** may occur?
1. A ‘**Camel Hump**’ = due to a **Paventilation**
1. The **dips** in the **Alveolar Plateau** = due to the animal **attempting** to **take spontaneous breaths**
120
An ECG can be used to monitor Electrical Activity in the heart.
List **3 common causes** of **Anaesthetic related Arrhythmias**.
1. **Inadequate** Anaesthesia/**Analgesia**
2. **Hypoxaemia**
3. Hyper**capnia**
4. Hypo**tension**
5. Hyper/Hypo**thermia**
6. **Electrolyte abnormalities**
121
ACP stands for:
A) Acetorphenothiazine
B) Acetylpromazine
B) Acetylphenozine
B) Acetylpromazine
122
Alpha-2-**agonists** provide:
A) Sedation
B) Sedation + Analgesia
C) Analgesia
B) Sedation + Analgesia
123
True or False?
**After administering Local Anaesthesia**, sensations will **return** in the **following order**:
Pain > Cold > Warmth > Touch Pressure
False, its the other way round!
**Touch** **Pressure** > **Warmth** > **Cold** > **Pain**
124
True or false?
Patients receiving **neuromuscular blocking agents** will require **Artificial Ventilation**.
True
125
True or False?
A **geriatric** patient with **no** diagnosed conditions would be a class **III** (3) ASA Risk.
False.
It would be class **II** (2).
126
True or False?
Minute Volume = Tidal Volume x Respiratory Rate.
(MV = TV x RR)
True
127
True or False?
Alpha-2-**Adrenoceptor** **Agonists** **cannot** be **reversed**.
False.
They are **reversed by** **Antisedan**.
128
True or False?
**Epidural** anaesthesia **allows** for **mixing** of **product** with **Cerebrospinal** fluid.
False.
Drug **circulates between**
***Vertebrae*** + ***Dura matter***.
129
True or False?
**NBA**s **block** ***release*** of **Acetylcholine**.
True
130
True or False.
**Phenothiazines** have a **wide** margin of **cardiovascular safety**.
True
131
Who am I?
1. I provide **analgesia**.
1. I can be given **IM**, **IV** or **SC**.
1. I may cause a **bradycardia reaction**, but it can be **managed** with administration of **Anticholinergic**.
1. Administration of me **prior to induction** of anaesthetic may **reduce** the **effectiveness** of **Full agonists** administered **during** anaesthesia.
A) Atropine
B) Diazepam
C) Buprenorphine
D) Medetomidine
C) Buprenorphine
132
With the **use** of **Local Anaesthetic**, **sensations disappear** in which following order:
A) Pain, warmth, touch, cold, pressure
B) Pressure, touch, warmth, cold, pain
C) Pressure, pain, cold, warmth, touch
D) Pain, cold, warmth, touch, pressure
D) Pain, cold, warmth, touch, pressure
133
True or false.
**Hypertension** may occur after administration of Local Anaesthetics + **Muscle relaxants**.
False.
**Hypotension** can occur
134
Which **type** of **muscle** do **Neuromuscular Blockades** work on?
A) Skeletal
B) Smooth
C) Cardiac
A) Skeletal
135
Identify a **disadvantage** of **ACP**:
1. Hypotension
1. Hypertension
Or
1. Spasmolytic
1. Hypotension
136
True or False.
**ACP** can cause **syncope**, especially in Boxers.
True!
137
**Buprenorphine** is a Schedule **3** drug.
Yes or No?
Yes
138
True or False.
**Phenothiazines** are **Neurolepts** that can produce **sedation**.
True
139
True or False.
The **addition** of an **opioid** to a **neuroleptic** produces a substance that is known as '**Neuroleptanalgesia**'.
True
140
Which of these is a **Non**-Depolarising NBA?
A) Acetylcholine
B) Suxamethonium
C) Pancuronium
C) Pancuronium
141
Are patients required to fast during the pre-anaesthetic period?
Yes, depending on the species
142
How many ASA classifications are there?
5
143
Does **ACP** provide analgesia?
No
144
Are Morphine, Methadone, Buprenorphine and Fentanyl **all** Opioid analgesics?
Yes
145
Are Tranquilisers and Sedatives the same thing?
No
146
True or False.
The following **techniques** are for Local Anaesthesia:
* Topical
* Regional
* IVFT
False
147
True or False.
The following about anaesthesia.
*"Anaesthesia is defined as a state of controlled and reversible unconsciousness which is characterised by lack of memory, pain sensation, and relatively depressed reflex responses."*
True
148
True or False.
Lignocaine and Bupivacaine are Local Anaesthetic drugs.
True
149
True or False.
**Non**-depolarising agents **cannot** be **reversed**.
False
150
Is the following statement true or false?
*''**Neuromuscular Blocking Agent** disadvantages include **Hyperthermia**, patients require **IPPV**, and anaesthetic **depth is difficult to assess**.''*
False
151
What order do sensations **disappear**?
A) Pain, warmth, pressure, cold, touch
B) Warmth, pressure, touch, cold, pain
C) Pain, cold, warmth, touch, pressure
D)Pressure, warmth, touch, cold, pai
C) Pain, cold, warmth, touch, pressure
152
Can Local Anaesthetic cause temporary/permanent **loss of function**?
Yes
153
Is **Hypo**thermia a side effect of **NBA**s?
Yes
154
Is it easy to **asses** anaesthetic **depth** in patients with NBAs?
No
155
In what **order** are **skeletal muscles** affected?
A) Facial/neck > Tail/limbs/abdo > Intercostal/diaphragmatic
B) Tail/limbs/abdo > Inter/diaphragmatic > Facial/neck
C) Inter/diaphragmatic > Facial/neck > Tail/limbs/abdo
A) Facial/neck >
Tail/limbs/abdo > Intercostal/diaphragmatic
156
True or False.
Alpha-2-Adrenoceptor **agonists** **bind** alpha-2 **receptors** in the brain + spinal cord.
True
157
True or False.
Providing a patient with an appropriate **pre-med** **reduces how smooth** they will **recover** after anaesthesia.
False
158
Benzodiazepines:
A) Are safe
B) Good for muscle relaxation
C) Have anti-epileptic action
D) Can provide appetite stimulation in cats
E) All of the above
E) All of the above
159
True or False.
Opioids are an analgesia.
True
160
True or False.
Anti-muscarinics **decrease** Parasympathetic **tone** by **blocking** transmission via Acetylcholine.
True
161
Under ASA, what **class** is an animals with **pre-existing systemic disease** that is a **threat to life** e.g. Severe dehydration
Class IV – High risk
162
About an animal that is **healthy** and has **no underlying conditions**?
Class I - Minimal risk
163
Define ‘Antagonist’
A substance which **interferes with** or **inhibits** the **physiological action** of **another** drug
164
What is **likely** to have **cause** **Aspiration Pneumonia** in the anaesthetised patient?
Those that have **not** been **starved** appropriately pre anaesthetic
165
Define ‘Anaesthesia'
A **state** of **controlled and reversible unconsciousness** **characterized by** **lack of pain** sensation (analgesia) and relatively **depressed reflex responses**
166
How do we usually ‘**maintain**’ anaesthesia, once a patient has been **induced**?
Usually via an **inhalation** agent
167
Name **3 risks** to us, as staff, during the provision of anaesthesia to a veterinary patient
1. **Equipment** (High pressure gas cylinders can explode)
2. **Patient inflicted injuries** (Accidental self-injection of drugs)
3. **Risk of exposure** to anaesthetic **agents** + **Nitrous Oxide**
168
Define ‘Tidal Volume’
The **volume** of **gas** either breathed **in or out** during **1 resting breath**
169
Define ‘Hypotension’
Low blood pressure
170
What is the relevance of **Urea**, **Creatine**, Phosphorus Biochemistry, Blood sampling?
Measures **Kidney function**!
171
What **type** of pain is this Multi-modal pain management plan for?
**Chronic** pain, associated with **OA** + **DJD**
172
What **type** of pain is this Multi-modal pain management plan for?
**Acute** pain for a **dental** patient!
173
What **type** of pain is this Multi-modal pain management plan for?
**Chronic** pain in a **Cancer** patient
174
What are the **contraindications** of **Opioids**?
A) Severe liver failure
B) Severe liver and kidney failure
C) Chronic liver and kidney failure
D) Improved liver and kidney function
B) Severe liver and kidney failure
175
What is the generic name for **Comfortan**?
A) Meloxicam
B) Medetomidine
C) Methadone
C) Methadone
176
True or False.
**Full** agonists are used to treat **Mild** > **Moderate** pain.
False.
They are for Moderate > Severe pain.
177
What drug category is **Meloxicam**
A) Opioid
B) Local anaesthetic
C) NSAIDs
C) NSAIDs
178
What does NSAID stand for?
A) Numbing spinal anti-inflammatory drug
B) Non-steroidal anti-inflammatory drug
C) Non-systemic anti-incoagulant drug
D) Non-systemic anti-inflammatory drug
B) Non-steroidal anti-inflammatory drug
179
Is **Acupuncture** more often used for Chronic or Acute pain?
Chronic
180
What drug is used to treat **convulsions** and **neuropathic** pain?
A) Gabapentin
B) Ketamine
C) Xylazine
D) Curcumin
A) Gabapentin
181
What are the possible **side effects** of NSAIDS?
A) GI irritation + ulceration
B) Renal failure
C) Liver toxicity
D) Blood imbalances
A) A, B and D
B) A, C and D
C) All of the above
C) All of the above
182
True or false.
Can Fentanyl be administered via **CRI**?
True
183
What procedures is **Buprenorphine** commonly used for?
A) Superficial surgeries and stitch ups
B) Neutering
C) Amputation and orthopaedic procedures
A) Superficial surgeries and stitch ups
184
Where on the Nervous System do **Opioids** act?
Peripherally or Centrally?
**Both**
Peripherally + Centrally!
185
Is **Morphine** a Full or Partial agonist?
**Full** Opioid Agonist
186
Which of the following **Opioids** is administered by **CRI**:
A) Methadone
B) Buprenorphine
C) Fentanyl
C) Fentanyl
187
True or False.
NSAIDS are suitable for animals **under** the age of **6 weeks**.
False
188
True or False.
**Acupuncture** is most often used in patients with acute pain
False.
Acupunture is used for Chronic pain.
189
How is **Ketamine** given when used for analgesic purposes?
A) S/C
B) I/M
C) IV
D) Infusion
D) Infusion
190
Which drug can be administered to **reverse** analgesia provided by **Alpha 2 Agonists**?
A) Medetomidine
B) Atipamezole
C) Xylazine
D) Amitriptyline
B) Atipamezole
191
What do NSAIDS **inhibit**?
They **inhibit** the inflammatory mediators in the pain pathway, also known as **Prostaglandins**
192
What **species** Is **Methadone** **licensed** for?
A) Dogs
B) Cats
C) Rabbits
D) Dogs and cat
D) Dogs and cat
193
What **type** of pain would **Buprenorphine** be used to treat?
A) Moderate > Severe pain
B) Pain associated with Major Orthopaedic and Soft Tissue surgery
C) Mild > Moderate pain
C) Mild > Moderate pain
194
What is the difference between Full + Partial Agonists?
Give 1 example of each.
1. **Full** agonist, such as **Methadone**, **fully** binds with the Nociceptors, to its full potential + used for **Moderate** > **Severe** pain.
1. **Partial** agonist, such as **Buprenorphine**, **partially** binds with the Nociceptors + used for **Mild** > **Moderate** pain.
195
How can **Methadone** be administered?
A) IV
B) SC
C) IM
D) All of the above
D) All of the above
196
List 2 **side effects** of **Opioids**
1. **Hyperexcitement** in **Cats**, where no pain exists
2. Depressed cough reflex
3. Respiratory depression
197
What is the generic name for Metacam?
Meloxicam
198
True or False.
You should avoid NSAIDs if the patient has pre-existing renal disease.
True
199
List the **3** types of **Local Anaesthetics**
1. Lignocaine
2. **Bupivi**caine
3. **Mepivi**caine
200
**Gabapentin** is a:
A) Anti-coagulant
B) Anti-convulsant
C) Anti-histamine
D) Anti-biotic
B) Anti-convulsant
201
How must **Ketamine** be **delivered** for the purposes of **Analgesia**?
**Bolus** or **very low** rate **infusion**
202
Is Acupuncture a form of pain relief?
Yes
203
Do Alpha-2-Adrenoreceptor Agonists have a sedative effect?
Yes, some do.
204
Should Ketamine be given at a **high** dose rate where used **purely** for **analgesia**?
No
205
Are **Benzodiazepines** used to control **muscle spasms**?
Yes, as they are Anti-muscarinics
206
Name 2 commonly used **Full** Agonists.
1. Methadone
2. Fentanyl
207
What are **contraindications** of using **Steroids**?
Advanced **Respiratory**, **Kidney** + **Liver failure**
208
NSAIDS **inhibit** the **production** of **inflammatory mediators** via the **inhibition** of ***COX enzymes***.
Give an example of an inflammatory mediator.
Prostaglandins
209
Give 5 examples of NSAIDs
1. Meloxicam
2. Carprofen
3. **Robenacoxib**
4. **Aspirin**
5. **Phenybutazone**
210
Name **3 Adverse Effects** that could occur when giving a patient **NSAID**s
1. GI ulceration + irritation
2. Blood imbalances
3. Liver toxcity
211
When should you **avoid** giving a patient **NSAID**s
1. **Dehydration**
2. Liver + Kidney failure
3. Using other Steriods or NSAIDs
212
What forms does the Local Anaesthetic **Lignocaine** come in?
1. Spray
2. Gel
3. Injection
213
What **type** of pain may Gabapentin be used for?
**Neuropathic** pain
214
What dose is **Ketamine** administered at?
5-10 ug/kg
215
What **animal** is **Amitriptyline** most useful in when a **flare up** occurs?
Cats
216
True or False.
Alpha-2-adrenoreceptor agonists can be given alongside opioids to gain a synergistic benefit as an analgesia.
True
217
What section of the pain pathway does **Local Anaesthetics** **block** to prevent the pain?
Transmission + Transduction
218
True or False.
**Acupuncture** is used to **complement pharmaceutical measures** in painful patients.
True
219
True or False.
Fentanyl isn't a potent full agonist.
False.
It is a potent, full agonist.
220
True or False.
You should avoid or take extreme care using an NSAID when there is dehydration, **hypotensive**/**shock**, pre-existing renal disease, liver disease or animals already on **corticosteroids** or other NSAIDS.
True
221
What drug helps reduce muscle spasms, and is **useful** on a **short-term** basis?
A) Amitriptyline
B) Benzodiazipines
C) Neutroceuticals
D) Gabapentin
B) Benzodiazipines
222
True or False.
**Medetomidine** is a NSAID.
False.
Medetomidine is a Alpha-2-Adrenoceptor Agonist.
223
What **Opioid** is commonly used where **Moderate** > **Severe** pain is anticipated, e.g. a Bitch spay
Buprenorphine
224
What are the side effects of NSAIDs, A or B?
A) Hyper excitement & seizures in cats, respiratory distress, depressed cough reflex
B) Gastrointestinal irritation and ulceration, renal failure, liver toxicity
B) Gastrointestinal irritation and ulceration, renal failure, liver toxicit
225
Which one is NOT an admission route for lignocaine?
A) Injection
B) Gel
C) Ingestion
D) Spray
C) Ingestion
226
What species has an **increased susceptibility** to some NSAIDs
A) Dogs
B) Rabbits
C) Cats
D) Horses
C) Cats
227
What is a side effect of **Opioids**? Select one.
A) Hyper excitement and seizures in cats
B) Vomiting
C) Diarrhoea
B) Vomiting
228
What variation of NSAID is considered safer for the gut?
A) COX-1 Selective
B) COX-2 Selective
B) COX-2 Selective
229
Name one type of Surgery **Methadone** is commonly used in.
1. Major Orthopaedic surgery
1. Fracture repair
230
How is **Buprenorphine** given in **Cats**?
A) I/M
B) I/V
C) OTM
C) OTM
231
What is the dosage amounts for **Ketamine**?
A) 1-2ug/kg
B) 5 -10ug/Kg
C) 6-12ug/kg
B) 5 -10ug/kg
232
True or False.
Gabapentin is used to treat Neuropathic pain in adult animals only.
True
233
True or False.
Is this the definition of a full or partial agonist?
Opioids are used to treat Moderate > Severe pain, which can be topped up.
Full Opioid Agonist
234
True or False.
**Buprenorphine** reaches an analgesic plateau.
True
235
Which of the following is **NOT** a side effect of **Fentanyl**?
A) Depressed cough reflex
B) Incontinence
C) Seizures
D) Respiratory depression
B) Incontinence
236
What class of drug has the classifications COX 1 and COX 2?
NSAIDs
237
What Local Anaesthetic is used in **Equine Nerve Blocks**?
Mepivicaine
238
True or False.
Local Anaesthetics **partially** block **conduction** of **Nociceptive** impulses.
True
239
What class of drugs are **Dopamine receptor ant**agonists?
Phenothiazines
240
What is the Intra-**thecal** route?
* Spinal route
* Used for spinal anaesthesia (LA)
* Inj into subarachnoid space
* To mix w/CSF (L5/6)
* Rarely used in VP
241
List 10 routes to admin LA
1. Intra-pleural - via chest drain - Bupivicaine
2. Intra-spinal
3. IV
4. Splash blocks
5. Anti-arrhythmic - Lignocaine IV
6. Topical
7. SC infiltration (can be ring!)
8. Nerve blocks
9. Intra-articular
10. Epidural
242
Would you see more dribble if anaesthesia was inadequate?
More
243
If anaesthesia was inadequate would you see hypo- or hypertension?
Hypertension
244
What would you see on your capnograph if anaesthesia was inadequate?
Inc in CO2
245
How do non- depolarising drugs work?
They block Acetylcholine
246
What type of NMBA is pancuronium?
Non-polarising
247
How long should you leave between giving a **NMBA** and **Neostigmine**?
20 mins
248
What type of NMBA is **Suxamethonium**?
Depolarising
249
What is the antagonist
for **depolarising**
muscle relaxants?
1. There **isn't** one
1. They are **broken down** by ***Cholinesterase***
250
What are NMBAs?
* NeuroMuscular
* Muscle
* Relaxants
1. Used for absloute relaxation
2. Do **NOT** **cross** the ***blood-brain-barrier***
3. Have **no** **action** on ***smooth*** or ***cardiac*** muscle
4. **Neither** ***anaesthetics*** or ***analgesics***
251
Explain how muscles + nerve interact, to provide a contraction?
1. **Electrical impulses** **cause** the chemical messenger, ***Acetylcholine*** to **release**
2. Acetylcholine **receptors react**
3. **Muscle** cell **membranes** **DEPOLARISE**
4. Membranes **-ve** + the **interior** is **+**ve
5. Muscle **contracts**
252
Name the 2 types of NMBAs
1. Depolarising
2. Non-depolarsing (relaxing)
253
What do **De**polarising NMBA's do?
1. **Act like** ***Acetylcholine***
2. Cause **depolarisation** by **breaking down** ***Cholinesterase***
3. Causing **PARALYSIS**
There are ***no antagonists***!!
254
Name a Depolarsing NMBA
Suxamethonium
255
How long does Suxamethonium last for?
3-5 mins
256
If Suxamethonium only last 3-5 mins, what can it facilitate?
**Intubation**
(Normally in Cats, humans + Pigs)
257
What do **Non**-depolarising NMBA's do?
1. **Block** **receptors**
2. Stops ***Acetylcholine*** ***reaching*** the **receptors**
3. Causing **FLACCID** paralysis
258
True or False.
Non-depolarising NMBAs last longer than Depolarising ones.
True
259
Name the 5 **Antagonists** for Non-depolarising NMBAs.
1. ***Neostigmine***
2. **Endrophonium**
3. **Pancuronium**
4. **Atra**curium
5. **Vecur**onium
260
Give the **onset** + **duration** of action **times** for the **Non**-depolarising ***Antagonists*** for **Pancuronium**.
1. Onset = 30-90 sec
2. Lasts = 30-50 min
261
Give the **onset** + **duration** of action **times** for the **Non**-depolarising ***Antagonists*** for **Atracurium**.
1. Onset = 3-5 mins
2. Lasts = 20-40 mins
262
Give the **onset** + **duration** of action **times** for the **Non**-depolarising ***Antagonists*** for **Vecuronium**.
1. Onset = 2-4 mins
2. Lasts = 20-30 mins
263
Why should you wait 20 mins between admin of Non-polarising NMBAs + admin of the reversal agent, markedly, Neostigmine?
* As it **stimulates** the **Vagal Nerve** + pNS
* Causing **salivation**
264
How should admin Neostigmine?
1. **Wait 20 mins** between admin of Non-polarising NMBA to prevent salivation
2. **Mix** w/**Atropine** in **syringe**
3. Give small ax **IV**
4. Admin 1-2 mins after ventilation has stopped, for 10-15 sec
5. If no spontaenous respration occurs - restart IPPV
6. Try unaided respiration 1-2mins later
7. Further doses can then be given Q 3-5 mins
265
When should you **only** use Non-depolarising + Depolarising NMBAs?
* **Anaesthetised** px's
* Anaesthetist MUST ensure the px is unconciousness
* When:
1. **Eyelids** are **OPEN**
1. Eye is **CENTRAL**
1. **NO corneal + palpebral** reflexes
Signs of Overdose ^^
266
Explain the term **Diffusion Hypoxia**
1. Due to the fact that **nitrous oxide** has **low solubility in blood**
1. At the **end** of **anaesthesia** when administration of N2O ceases
1. The N2O **present** **in blood diffuses back into** the **alveoli**
1. And ‘**dilutes**’ the alveolar **air** so **less O2** is **available**
1. If the animal is breathing room air hypoxia may occur as a result of this
1. This effect is **mitigated** by **ensuring** that patients **receiving** N2O
1. **Have 10 minutes** of **pure oxygen** after cessation of nitrous administration
267
Explain why nitrous oxide might be administered alongside oxygen as part of an inhalational anaesthetic protocol?
For which patients should nitrous oxide be used with caution?
1. Used to provide **analgesia**
2. Because it **has** an ***anaesthetic sparing effect*** meaning **lower doses** of **volatile** agents are generally **required**
3. It is mixed at a **2:1 ratio** with **oxygen**.
4. As it **accumulates** in **gas filled spaces**
5. It should be used with **caution** in patients with:
* **GDV**
* Intestinal **obstruction**
* **Pneumo**thorax
* **Middle** ear disease
268
Compare Isoflurane to Sevoflurane
Iso
1. More **potent**
2. Lower MAC
3. Lower dial req - as higher potency
4. **Slower induction + recovery** times
5. Slower **changes** in **depth**
6. **Irritant** to airways
Sevo
1. Less potent
2. **Higher MAC**
3. **Higher dial** req - as lower potency
4. Faster induction + recovery times
5. Higher changes in depth
6. Less irritant to airways
7. **Odourless**
8. **Costs** more
9. **Reacts** w/**Soda Lime**, producing the **nephrotoxic Compound A**
269
Name 3 inhalational volatile agents
1. Isoflurane
2. Sevoflurane
3. **Desflurane**
270
True or False.
1. Volatile agents are delivered by carrier gases, such as O2.
2. Level of agents is determined by a dial on the vapouriser.
3. All agents cause some degree of respiratory + cardiovascular depression.
4. Agents are extreamely hazardous to patients, if overdosed.
5. They provide analgesia.
All are True, apart from 5.
Volatile agents do **NOT** provide Analgesia.
271
What volatile agent has the **highest** blood gas solubility?
Isoflurane
272
What volatile agent has the **lowest** blood gas solubility?
Desflurane
273
What volatile agent has the **highest** MAC value in **Dogs**?
Desflurane
274
What volatile agent has the **highest** MAC value in **Cats**?
Desflurane
275
What volatile agent has the **lowest** MAC value in **Dogs**?
Isoflurane
276
What volatile agent has the **lowest** MAC value in **Cats**?
Isoflurane
277
If **Desflurane** has a **lower** blood gas solubility, does this mean it will work faster or slower?
Faster
278
What does **MAC** stand for when speaking about Volatile agents?
+
What is it?
* **Mean**
* **Alveolar**
* **Concentration**
&
1. It is the **measure** of **anaesthetic potency**
2. Quantity of anaesthetic required to immobilise 50% of patients
3. Agents with **lower** MAC values - are **more potent**
279
What is Blood Gas Solubility?
1. The ratio that indicates the **amount** of **volatile agent** that is **dissolved** **in** the **blood**
1. **Compared** to the **gaseous form** - at equibilbrium
1. Ratio of 1 = 1 part blood : 1 part gaseous
2. Ratio of 0.5 = 1 part blood : 2 parts gaseous
3. Ratio of 3 = 2 part blood : 1 part gaseous
280
Why do volatile agents with higher gas solubility take **longer** to work?
Because they can **build up** a **reservoir** in the **plasma**
281
True or False.
Desflurane has been used in veterinary patients however it is unlicensed.
True
282
What are **Barbiturate** anaesthetics?
1. The 1st veterinary anaesthetics
2. Known as **Thiopentone** + **Methohexitone**
3. They are ***no longer licensed***
4. **Pentobarbitone** is the only 1 used, only as an **Anticonvulsant** or **Euthansaia**
283
Name the 2 Barbiturate anaesethetics that are no longer licensed for use in the UK
1. Thiopentone
2. Methohexitone
284
Name the **Barbiturate** anaesthesic that is used as an **Anti**-**convulsant** + for **Euthanasia**.
Pentobarbitone
*(Otherwise known as Phenobarbitol)*
285
Name the 4 Ketamine Neuroleptanalgesic mixtures you can use to reduce muscle hypertonicity
1. ACP
2. Diazepam
3. Xylazine
4. Medetomidine
286
Name the 4 Opioid Neuroleptanalgesic mixtures you can use
1. Acetylpromazine + Buprenorphine
2. Medetomidine + Butorphanol
287
What are **Neurileptanalgesics**?
&
Provide 2 examples.
1. **Tranquillsers** combined w/**analgesics**
2. ***Benzodiazepine*** + Ketamine
OR
3. ***Alpha-2-Agonists*** + Ketamine
288
What is Propofol?
1. A **water-soluble** **Phenol derivative**
2. Milky, white, oil emulsion
3. Causes **rapid loss of consciousness**
4. **Rapid recovery** - metabolised by Liver
5. Useful for TIVA techniques
6. Some have **preservative** ***Bacteriostat***
289
True or False.
Propofol can cause mild pain on Inj.
True
290
Name the Pros + Cons of using Propofol
**Pros**
1. **Rapid** **metabolism** + recovery
2. No hangover - if single dose
3. **Non-cumulative** effect
4. Can be **used** as part of **TIVA protocol**
5. **Non-irritant peri-vascularly**
**Cons**
1. Possible **apnoea** **if inj too fast** - takes 1 min in vein > brain!
2. Possible **Hypotension** + **Bradycardia**
3. Can cause **twitching**, ***spontaenous muscle acitivity*** + **excitable** recoveries
291
What is Alfaxalone?
1. **Steriod** anaesthetic
2. Used in Dogs, Cats + Rabbits
3. **Clear** solution
4. In Multi-dose bottle
292
True or False.
Ketamine is painful if given IM.
True
293
True or False.
Ketamine's dissociative anaesthesia effects maintains protective airway reflexes, eyes remain open + pupils dilated.
True
294
Why must Ketmine be used in combo with other drugs, in Dogs?
1. Because it can make them **stiff**
2. **Hard** to **tell** what **state** they are **in**
295
Can Ketamine provide analgesia?
Yes
296
# (Top-up)
Can you titrate IM drugs?
No
297
What is TIVA?
**Total**
Intravenous
Anaesthetsia
298
Why is TIVA so desirable?
1. Because it provides an alternative to gaseous anaesthesia
1. **Avoiding effects** of **inhalation** agents
299
When is most TIVA useful?
When inhalational delivery of ana would compromise access for surgery
300
What 2 things do you need for TIVA?
Good **airway** + **O2 supply**
301
How an you provide TIVA?
**CRI** + **Syringe driver**
302
How are anaesthetic drugs Metabolised + Excreted?
1. Metabolised in **Liver**
2. Where they **convert** from ***lipid > water soluble molecules***
2. Go to **Kidneys**
2. Excreted as **bile** (small ax) or **urine** (If lipid)
303
Name a rapidly metbolised anaesthetic drug
Propofol
304
What is GA characterised by?
* State of **controlled** + **reversible** unconsciousness (Narcosis)
* Characterised by:
1. **Lack** of **pain** = **analgesia**
2. Lack of **memory** = **amnesia** (narcosis)
3. Depressed reflex responses (**Muscle relaxation**)
Know as the **TRIAD** of anaesthesia
305
What is the **TRIAD** of anaesthesia?
1. Lack of pain (analgesia)
2. Lack of memory (amnesia)
3. Depressed reflex responses (muscle relaxation)
306
What is **Balanced** anaesthesia?
1. Use of drugs in **combination**
Examples:
* **Pre-med** of ***Sedative + Analgesic***
* **Analgesic** ***during***/after surgery
* **Maintained** w/***inhalational*** agent - to provide narcosis
307
What are the 2 types of anaesthetics?
1. Injectable (parenteral)
2. Inhalational
308
What are the effects of IV anaestheic agents dependent on?
**Concentration** in **Plasma**
309
What 3 things does the route of admin effect?
1. **Speed** of **onset** of ana
2. Ana **duration**
3. **Peak** effect
310
How are drugs distrubuted in the body?
1. **Brain** **recieves** ***high concentration*** of **drug** after IV
2. **Unconsciousness** occurs when ***critical*** **concentration** is **reached**
3. Over time, less perfused organs - like ***skeletal muscle*** - start to **take up** drug
4. Resulting in ***reduction*** in **plasma levels**
5. **Creating** ***diffusion gradient*** + ***promoting*** drug **levels** to ***move*** from **brain** > ***plasma***
6. This is when **consciouness** **returns** (brain levels **below** the critical level)
311
What is the difference between:
A) Neurolept
B) Narcotic
C) Sedative
D) Traquilliser/Ataractic
A) **Neurolept** = state of **apathy + mental detachment** - conscious!!
B) **Narcotic** = **drug induced stupor** - by insensibility + ***paralysis***
C) **Sedative** = CNS depression - **drowsy**, lethargic, ***lost consciousness***
D) **Traquilliser**/Ataractic = **calms** + reduces anxiety - conscious!!, major tranquillsers = neurolept
312
