Flashcards in Small Animal Medicine Deck (309):
What is the main reason for a Pre-GA Exam?
Determine the ability of the CV and Respiratory system to maintain O2 delivery and waste removal
T/F Smaller dogs and youngsters should decrease fasting time due to decreased glycogen stores & higher metabolic rates.
What are the parts of a signalment?
6) Reproductive status
Normal temperature for dog and cat.
______ can cause abortions
6 divisions of anesthetic risks- ASA classification of Patient Risk:
1) Class I-
2) Class II-
3) Class III-
4) Class IV-
5) Class V-
6) Class VI-
1) minimal risk, healthy animal with no underlying dz
2) slight risk (neonate or geriatric) mild systemic disease
3) moderate risk, moderate systemic disease and mild clinical signs
4) high risk, pre-existing systemic dz of severe nature
5) extreme risk, patient not expected to survive
6) patient will not recover
Atropine and Glycopyrrolate are what type of preanesthetics?
Name 2 tranquilizers/sedatives.
3) Alpha-2 agonists
How do anticholinergics work?
Block acetylcholine (vagus nerve) from parasympathetic on the muscarinic receptors
What's the difference between Benzodiazepines and Alpha-2 agonists?
Alpha-2 agonists can be reversed and give analgesia
What are 2 parts of the minimum database?
1) Patient history
2) Nature of procedure
3) Complete physical examination
4) Diagnostic tests
5) In consult with DVM, patient status and anesthetic risk
What are the three basic action of the anesthesia machine?
1) Deliver O2
2) Safe anesthesia concentration
3) Remove CO2
What are the basic components?
1) Compressed gas source
2) Anesthetic machine
3) Breathing circuit
What does the pressure gauge do?
Indicates the pressure of the gas remaining within the cylinder
What does the flow meter do?
1) Controls rate at which specific gas is delivered
2) Further reduces pressure to 15 psi
What is a Rotameter?
Ball or bobbin rising within graduated glass tube to height proportional to flow of gas in tube
The Oxygen Flush valve bypasses the _____ and is direct to common gas outlet or anesthetic circle
What does the O2 flush valve do?
Dilutes anesthetic gas in system
What does the vaporizer do?
Volatilizes liquids & inhaled anesthetics & delivers clinically useful concentrations of anesthetic vapor
If someone is color blind, how will they know where the oxygen tank and the nitrogen tank goes?
the Pin-index cylinders, for those connecting to the machine directly it has different positions for different gases
When should an O2 flush valve not be used?
1) should NEVER be used in closed breathing system without an open expiratory valve
2) should NEVER be used in a nonrebreather
3) should NEVER be used while the patient is connected
What's the difference between the rebreather vs the nonrebreather?
Rebreather: Eliminate CO2 by chemical removal and allows same gas to be rebreathed by patient
Nonrebreather: Eliminates CO2 by flushing of waste or exhaust system
What transfers gas from machine to patient
Used to increase visibility of larynx
State of controlled and reversible unconsciousness achieved through the use of injectable and/ or inhaled drugs and characterized by the absence of pain perception, memory, motor response to stimuli or reflex responses
What are the two routes of anesthesia?
injectable and inhalant
Advantages and disadvantages of inhalation anesthesia.
1) Advantages: Depth of anesthesia can be readily altered, Elimination occurs mainly through the lungs, Allows the constant delivery of 100% O2
2) Disadvantages: Requires an anesthetic machine, Induction is slow when used alone
What are the uses for an ET tube?
-Efficient delivery of gas
-Correct size improves efficiency by reducing anatomic dead space (portions of breathing passages containing air but no gas exchange)
-Inflated cuff decreases risk
ET placement Disadvantages:
-Increased vagal tone
-Using human tubes= can be too long which increases anatomic dead space
What stage of anesthesia is where the 4 planes occur?
Describe the 4 planes of anesthesia.
1) too light for surgical procedures
2) surgical plane
3) significant depression of all systems
Never use the _______ in animal appearing to be alive.
What does the Pulse oximeter do?
Estimates the saturation of hgb
What does the Pulse oximeter require? When will it not read accurately?
-Requires non-pigment motionless tissue
-Will not read accurately with vasoconstriction and anemia (PCV < 15%)
What are some indicators of ventilation?
-Tidal volume (Amount of air inhaled with each breath)
-Respiratory character (Effort required to breathe, the relative length of inhalation and exhalation)
-Apnea monitor (Sensor warns when patient has not taken a breath)
What does the Capnograph measure?
Measures the end tidal (ET) CO2
The Capnograph gives good assessments of depth of _______ and _______ but is not an adequate ventilation.
Describe the right patient positioning.
-Support during induction
-D/C from circuit when moving or rolling
-Ensure proper tube placement prior to prep
-Support anesthetic hoses
-Position patient as normal as possible
-Unilateral lung disease-good side up
-Artificial tears ointment q 90 min
The lower the ratio the _____ the induction
______ used as a standard of comparison for the potency of anesthetics
What does MAC stand for?
Minimum Alveolar Concentration
Low MAC value indicates a ____ anesthetic
What three factors decrease MAC
1) Severe hypotension
What is the only type of anesthetic gas that uses a non-precision vaporizer?
What does Doxapram do?
Inc. RR and depth reversing resp depression
If an anesthetic gas has low solubility what does that mean?
it has a fast induction
How can you ensure proper placement of an endotracheal tube?
-Watch reservoir bag movement
-Feel for air movement from tube connector
-Palpate the neck
-Cough or forcefully exhale
Reflex closure of the glottis is called?
Anticholinergic drugs such as atropine block the release of acteylcholine at the:
muscarinic receptors of the parasympathetic system
Doxapram is what class of drug?
What technique is not recommended for handling small dogs?
Small dog breeds have a higher incidence of __________ that should give you pause when determining restraint methods.
A neuroleptanalgestic is a combination of?
an opioid and a tranquilizer
T/F Most preanesthetics will not cross the placental barrier.
T/F It is recommended that atropine not be given to an animal that has tachycardia.
T/F High doses of opioids can cause bradycardia and respiratory depression.
What drug will precipitate out when mixed with other drugs or solutions?
An anesthetic agent that has a low blood-gas partition coefficient will result in ____ induction and recovery time.
As a rough guideline, to safely maintain a surgical plane of anesthesia, the vaporizer should be set at about:
a) 0.5 X MAC
b) 1 X MAC
c) 1.5 X MAC
d) 2 X MAC
c) 1.5 X MAC
Propofol sometimes causes transient apnea. To avoid this, the anesthetist should:
Titrate this drug in several boluses
A reservoir bag that is not moving well may indicate:
1) the ET tube is not in the trachea
2) the animal has a decreased tidal volume
3) there is a leak around the ET tube
Adverse effects common with isoflurane include:
depression of respiration
When the O2 tank is half full, the tank pressure gauge will read approximately:
The amount of O2 an animal is receiving is indicated by the
Flow meters that have a ball for reading the gauge should be read from the _____ of the ball
The flutter valves on an anesthetic machine help:
control the direction of movement of gases
The pop-off valve is part of the anesthetic machine and helps:
prevent excess gas pressure from building up within the breathing circuit
In small animal anesthesia, when the patient is bagged, the pressure manometer reading should not exceed:
20 cm H20
T/F Rebreathing systems, when used with standard small animal corrugated breathing tubes, are best reserved for animals weighing more than 7kg
The negative pressure relief valve is particularly important when:
there is a failure of O2 flow through the system
The tidal volume of an anesthetized animal is considered to be _____ mL/kg of body weight
A scavenging system is generally attached to
the pop-off valve
The anesthetist will know when the granules in the carbon dioxide absorber have been depleted because the:
1) granules will be brittle
2) granules may change color
3) granules may be hard
T/F With most injectable and inhalant anesthetics, there is generally a progressive depression of cardiovascular and respiratory function as the depth of anesthesia increases.
The plane of anesthesia most suitable for surgical procedures is generally considered to be:
Stage III, plane 2
T/F Analgesic Adjunt Agents may enhance effects of other classes of CNS depressant drugs
Anatomic dead space is considered to be the:
air within the trachea, pharynx, larynx, bronchi, and nasal passages
The minimum acceptable heart rate for an anesthetized large breed dog is ____ bpm
T/F If the ECG is normal, the heart must be beating normally.
In general, a respiratory rate of less than _____ breaths/min in an anesthetized dog should be reported to the veterinarian.
an increase in respiratory rate
T/F An animal that is in a surgical plane of anesthesia should not respond in any way to any procedure that is being done to it (ex pulling on viscera should not change heart beat)
Pulse oximetery allows accurate estimation of:
percent saturation of hemoglobin with oxygen
Pale mucuous membranes commonly indicate:
a. blood loss
c. decreased perfusion
a. blood loss
c. decreased perfusion
What is hypostatic pooling?
Pooling of blood in dependent lungs & tissues
When do you extubate?
coughing, swallowing, chewing on tube
Complications of Intubation:
-Vagal nerve stimulation (supresses cardiac)
-Difficulty, especially brachycephalics
-Chewing of tube and inhalation into trachea
Length of recovery depends on:
-age of animal
-type of drug used
What is the type of vaporizer found out of the circle?
T/F After a dental cleaning the cuff should be completely deflated prior to removal.
What is the first and last gas on?
Drugs may predispose horses to colic which ones? Why?
anticholinergics because they slow down the GI system
What can horses get if their head is not supported?
-Neuropathy (from compressed nerves-Radial and facial)
-Myopathy (from compressed muscles-Tying up)
What drug class is not used in ruminants? Why?
Anticholinergics not used because it does not reduce salivation it makes it thicker and ropy
You hold horses' heads ____ and ruminants heads' are _____
absence of pain SENSATION
What are some consequences of pain?
-Increased risk of infection
-Delayed wound healing
-Reduced food and water intake
Any drug used to induce a loss of sensation with or without unconsciousness
What is an adjunct?
any drug used (but not a true anesthetic) which can produce other desired effects such as sedation, reversal, muscle relaxation, analgesia, neuromuscular blockade or parasympathetic blockade
What are the time periods when anesthetic agents are given?
What is an agonist?
bind to and stimulate target tissue receptors
(most anesthetics and adjuncts)
What is an antagonists?
bind but do not stimulate receptors
(Apha-2 adrenergics and opioids), Given after agonist to “wake” patient
What is a partial agonist?
bind to and partially stimulate receptors
What is an agonist-antagonist?
bind to more that one receptor type and simultaneously stimulate and block at least one receptor
When should analgesia be provided?
Analgesia must be provided before, during and after procedure
What is windup?
accumulation of pain upon waking from previous procedure
T/F Anticholinergics prevents ptyalism(drooling), but will cause thick mucus (1o cats)
Water soluble drugs can usually be combined in same syringe. One exception is?
diazepam (non-water soluble) and ketamine
Allows visualization, illumination and manipulation of tongue and epiglottis
laryngoscope (Cough or visually-vocalization is impossible if in place)
Inflate the cuff with small increments of air if you over inflate you will get ___ _____
1) Check by placing __ cm of pressure and listening for air escape
2) Loud hiss needs ___ air
3) No hiss ____ slightly as may be adding too much pressure
4) Slight hiss cuff ___
5) Recheck ___ min as may need to add more due to muscle relaxation
Optimal size for the reservoir bag should be __ full, if overfull can rupture alveoli
Preanesthetics are any drug administered within an ____ of general anesthesia
What are the different types of preanesthetic classes?
2) Tranquilizers or sedatives
10-30 minutes prior to sx
IM or SQ
What are some reasons to administer preanesthetics?
-Calm or sedate a patient
-To produce smoother anesthetic inductions and recoveries
-Decrease pain and discomfort associated with procedure
-Produce muscle relaxation
Do anticholinergics provide analgesia? Do they cause CV or resp depression at normal doses?
What's the difference between tranquilizers and sedatives?
Tranquilizer reduces anxiety but doesn't alter mentation and Sedative decreases mental ability & induces sleepiness
Sedatives and tranquilzers have 3 classes. What are they and which has analgesia?
-Alpha-2-agonist (only class w/ analgesia)
What is an example of a Phenothiazine?
What is an example of a Benzodiazepine?
What is another route to inject Diazepam if an animal is having a seizure?
T/F Diazepam should not be mixed with any other drug besides ketamine
What is an example of an Alpha-2-agonist?
Narcotics term reserved for agents with potential to cause physical dependence
Derived from opium, an extract of a species of ___ that bind both ___ and kappa receptors
Which class of drug is best for pain?
opioids, mu receptors tell you pain
Why should Morphine not be used in bowel obstructions or diaphragmatic hernias?
due to stimulation of vomiting and defecation
T/F To use barbiturates on a continuous or repeated basis during the course of a surgical procedure is contraindicated.
Because of depressant effects on the CV & resp systems and variation in dose requirements among patients, barbiturates are given?
half the calculated dose as a bolus and then to effect
Why are barbiturates contraindicated in sight hounds?
Avoid in sight hounds-Related to low fat stores and lipid solubility in the brain
Thiopental is ALWAYS given ___ and is Anesthesia ____ analgesia
T/F Propofol IV use ONLY and is the only turbid solution.
What do dissociatives do?
Inhibit NMDA receptors in CNS responsible for ‘windup’
T/F Dissociative anesthesia is characterized by: exaggerated reflexes (pharyngeal, laryngeal, palpebral)
Dissociative anesthesia is analgesia to integument but not to ____.
What are the 5 H's (common complications)
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
What is Nociception?
detection by the nervous system of the potential got or the actual occurrence of tissue injury
Pain occurring after tissue injury is?
1) Visceral pain arises from the _____
2) Somatic pain arises from the ______ system
4)joints, muscles or bones
What are 5 signs of behavioral pain?
5) Mydriasis (dilation of pupils)
T/F No single physiologic parameter is specific for pain.
What are the 4 main steps for nociception?
1) Transformation of noxious stimuli into electrical stimuli called action potentials called transduction
2) Sensory impulses carried to spinal cord via transmission
3) Signals altered either amplified or suppressed in process called modulation
4) Final step is perception
Interference with the translation of tissue injury
Block the generation and conduction of nerve impulses
Alterations of mood and level of consciousness profoundly affect pain experience
State of general anesthesia sufficient for surgical intervention
What are 4 examples of unbalanced anesthesia?
1) Any anesthetic protocol using one or two drugs to achieve state of unconsciousness
2) Mask induction and maintenance w/ iso
3) IV propofol alone
4) Bolus dose of thiopental to unpremedicated patient
What are the two causes of stress?
-Physical (Temperature extremes, disease, injury)
-Emotional (fear, conflict, frustration, anxiety)
1) Pure mu agonist-Occupy receptor and provide analgesia. The higher the dose the greater number of receptors occupied, the greater the _____
2) Partial mu agonist-Produces good analgesia at lower doses. ______: the higher doses do not give greater analgesia
2) Ceiling effect (Butorphanol is an example)
What opioid is a pure agonist for mu and kappa receptors
What is the only injectable opioid in VM not classified as controlled?
What is the objective of Analgesia by CRI (constant rate infusion)?
maintain steady state plasma or tissue concentration of the drug in the body
What is anesthesia? (2 words)
Name 1 anticholinergic drug and a reason for its use.
atropine, prevent bradycardia, reduce salivation
1 feature of alpha-2 agonists that sets is apart from the others?
1) not controlled
2) some analgesia
What class of drug has a dissociative effect?
A neuroleptanalgestic is a combination of?
opiod and tranquilizer
3 signs a patient needs analgesia?
What is Preemptive Analgesia? Why give it?
analgesia given before pain starts or procedure, to prevent windup
Only injectable opioid in VM not classified as controlled is?
What's the objective of analgesia by CRI (constant rate infusion)?
maintain steady state plasma or tissue concentration of the drug in the body
Blocks sodium ion channels in neuronal cells & membrane stabilization, If administered at higher infusion rate by mistake- CNS stimulation, sign of toxicity would be excitement
Analgesic effect stems from antagonistic role on specific brain receptors which when stimulated cause-CNS sensitization, Does not provide analgesia alone must be used with an opioid
T/F Injections may be administered in same manner in a rat as mouse.
T/F Monitor RR and quality prior to removal from original carrier
Ferrets should be fasted ___ hours prior to surgery
Since Ferret's GI transit time is fast, and longer periods without food increase the risk of ______.
Ferrets with insulinoma should only be fasted ___ hours
Birds also have extremely fast GI transit, so fasting ____ hours is usually sufficient to allow the crop to empty
Reptiles should have food and water withheld for longer periods. How long for lizards and chelonians? Snakes?
1) 12-24 hours
2) 72 hours
What is the most common problem?
T/F IV is not usable in small mammals, IO is used in severe cases.
Most preanesthetic drugs are given __, ___, ___ for small mammals.
SC, IP, IM
_____ only species may benefit from sedation prior to anesthesia
Why should rabbits be premedicated especially when using a mask?
May breath hold causing bradycardia
Induction is safest using this method
inhalation anesthetics (nonrebreather)
Most reliable reflex for small mammals is ______ or _______. The _____ reflex is not reliable.
pedal withdrawal(lost at light to medium planes) or tail pinch(lost at light to medium planes), ocular
When monitoring small mammals what is critical?
T/F Return to spontaneous respiration can be slow.
In mammals and birds the stimulus for respiration is increased blood ____ levels. In reptiles, however, the stimulus is low ____ levels. Therefore, providing pure O2 during recovery may actually delay spontaneous breathing in reptiles.
For birds, recovery is complete when? For small mammals? For reptiles?
1) the patient is alert, ambulatory, and begins eating and grooming(takes between 30 minutes to 3 hours)
2) grooming and return to eating take place within 6-12 hours
3) a return to normal movement appetite and activity may take 24-48 hours
What 4 things are the foundation for supportive care in birds and exotics?
1) providing heat
What are some signs of pain in small mammals?
1) Unkempt coat
2) Buildup of secretions around nose and eyes
3) Remains motionless
4) Abnormal posture or gait when encouraged to move
What are examples of other analgesics besides opioids?
3) Local anesthetics
4) Alpha-2 adrenergic agonists
List 2 of the 4 major classifications of anesthetic emergencies.
2) Excessive airway/thoracic pressure and volume
3) Anesthetic over- and underdose
In general, the most common cause of anesthetic emergencies is ____________
An anesthetized patient exhibiting an exaggerated breathing pattern would lead you to consider the problem to be respiratory obstruction caused by:
a) Twisted/kinked ET tube
b) Occlusion of ET lumen by faulty cuff
c) Bronchial intubation
d) Any/all of the above
d) Any/all of the above
What else will you see that tells you what the general problem is?
Lack of reservoir bag movement
If the pop-off valve is inadvertently left closed, it will:
a) Stop the oxygen flow from entering the circuit
b) Convert the circuit to low flow anesthesia
c) Cause a significant rise of pressure within the circuit and patient
d) Cause the flutter valves to malfunction
c) Cause a significant rise of pressure within the circuit and patient`
If the pop-off valve is left closed, this eventually will cause what to decrease in the patient?
Cardiac output (also BP drop & impeded venous return)
T/F With CO2 absorber exhaustion, the patient may exhibit bradyarrhythmias, dyspnea and pale to blue mucous membranes.
False-Hypercapnia causes tachypnea, tachycardia, other cardaic arrhythmias and brick red mucous membranes
What would be a cause of anesthetic gas underdose?
a) Problems with the vaporizer
b) Inappropriate/altered oxygen flow
c) Anesthetic leaks
d) Any/all of the above
d) Any/all of the above
How is hypoxia defined? The tissue most sensitive to the negative effects of hypoxia is?
A deficiency in O2 reaching the lungs or airway of the patient, brain
Why is it important to rapidly induce and intubate a brachycephalic patient?
Redundant soft tissue in pharyngeal area may obstruct trachea (sedation exacerbates by relaxing these tissues); may be obligate mouth breathers (stenotic nares common)
List 4 patient factors that increase anesthetic risk.
What is a bronchial spasm? First warning sign?
constriction of bronchioles, coughing
Most common anesthetic overdose? 2nd?
wrong agent in wrong vaporizer , both vaporizers turned on at the same time
Geriatrics are defines as reaching ___ of expected age for that species and breed.
What are concerns for pediatrics under anesthesia?
What are signs of fluid overload?
-crackles/wheezes in chest
-serous nasal discharge
Anesthetic drugs cause ______ to the heart which is the most common problem.
What drugs affect renal perfusion?
Most common causes of respiratory distress?
1) inability to obtain O2 from machine
3) flow meter off
4) flow blocked
What are signs of cardiac arrest?
1) no heartbeat auscultated
2) no palpable pulse
3) ECG tracing
4) MM gray or cyanotic
5) CRT >2
What is a factor to consider in the anesthetic protocol of a geriatric patient?
Hypothermia and reduced organ function
Which is a potential problem encountered during anesthesia of pregnant bitches for C-sections.
a) Decreased lung capacity
a) Decreased lung capacity
T/F Sighthounds are particulary sensitive to barbitutaes due to lack of body fat and reduced renal elimination of this drug.
false-inefficient hepatic metabolism
List one cause of post anesthetic dyspnea in the cat And dog.
dog-brachycephalic dogs, obstruction
Give one reason why nutritional intervention is crucial to patient recovery and survival.
-Support to counteract the immunosuppressive effects of disease, trauma & surgery
-Enhances healing - necessary for tissue synthesis
-Necessary for immune competence and drug metabolism
Baseline data includes:
-Body condition score
What is the purpose for nutritional assistance?
Support to counteract the immunosuppressive effects of disease, trauma & surgery
What are some indications for nutritional support?
-Recent weight loss of more than 10%
-Absent or poor food intake for more than 2 days
-Acute illness or injury
-Acute muscle wasting
-Heavy GI or urinary system losses of protein or electrolytes
What are lab indications for nutritional support?
Albumin, total protein, blood urea nitrogen (BUN)
Defined as any disorder of nutrients with inadequate or unbalanced nutrition
What is the best way to investigate malnutrition?
T/F Undernourished patients are three times as likely as well-nourished patients to have surgical complications
What are some common surgical complications?
-Delayed tissue healing
T/F There is no one clinical test to assess nutritional status.
____(enteral) is safest and most natural route for nutritional assistance.
What are some examples of enteral feeding?
1) Hand- feeding
Aspirate each feeding, but do not feed if air ______
What is the primary tissue target for most anesthetics?
What are 2 examples of an antagonist?
alpha-2 agonists, opioids
What are 4 potential harmful effects of mu agonists?
1) respiratory depression
3) GI effects
What is something significant about use of sedatives in brachycephalic breeds?
relaxed pharygneal tissue so becomes harder to breathe
What can happen if incompatible anesthetic drugs are mixed together in the same syringe?
-change in chemistry
-loss of potency
Why are some of these mixtures incompatible? What exception is there regarding mixing drugs in the same syringe?
Both of the mixtures are not water-soluble, ketamine and diazepam
What are 2 preanesthetic drugs that do not provide analgesia?
Which class has potential to cause physical dependence? What other class tranquilizer is known to in people?
What group is not used in sighthounds, why?
barbiturates because they are very lipid soluble and don't have a lot of fat
2 groups of drugs that provide muscle relaxation.
What is a major disadvantage to using propofol? What else is unusual about it?
poor storage characteristics, it is the only IV turbid solution
Which type of anesthesia is characterized by exaggerated pharyngeal, laryngeal, and palpabral reflexes?
What are the most common agents used to induce anesthesia?
2 side effects of hypothermia which can have an adverse reaction on patient recovery
-decrease in metabolism
-decrease in O2 consumption
How many steps are there in the realization of pain?
What type of drug is considered the best to use to control severe pain? What is an example?
pure mu agonists, morphine
Why do patients under inhalant anesthesia do not appear to react to pain?
unconscious not aware
2 non-specific behaviors that can be attributed to an early pain episoe
-reduced exercise tolerance
2 categories of factors that can cause stress to the animal
2 conditions/syndromes that can be attributed to being cause by stress.
-feline idiopathic cystitis
-feline cycogenic alopecia
2 methods to deliver CRIs:
-IV fluid bag
2 harmful side effects of NSAIDs
What is multimodal anesthesia and why is it used?
1 or 2 drugs, less adverse effects
Patient discomfort can be minimized, name 2 pain control.
hygiene, gentle reassurance
Where are intraperitoneal injections administered in small mammals? What is the reasons for using this area?
lower right quadrant, to avoid the cecum and bladder
What species of small mammal is the least amenable to pre-operative physical exams? Why?
hamsters because they bite hard and are difficult to restrain
Consequences from withholding food from small mammals?
hypoglycemia and it slows rabbit's GI
What anticholinergic is successful in rabbits?
What is the method of choice for anesthesia in most small mammals? 2 reasons for this choice.
inhalant, safer, no veins for catheter placement
1 species intubate with blind technique
Why can't eye position be monitored in animals?
may not be changed, or fixed
Which reflex is most reliable for small mammals?
Why does providing pure oxygen during recovery in reptiles actually delay breathing?
low O2 not high CO2
What class is safe to use in reptiles and rabbits?
What are the difference levels of consciousness?
4) comatose or awake again
2 patient characteristics that affect anesthesia?
1 advantage and disadvantage of inhalant anesthesia.
-adv: allows the constant delivery of 100% O2
-dis: anesthetic waste increase
The reflex used when anticholinergics are used is
(dilates pupils) PLR pupillary light reflex
What parameters are you monitoring with respiration with a patient under anesthesia?
Class of tranquilizer that is an antiemetic and antihistamine
2 causes of abnormal capnograph readings
2 areas on a patient where you can monitor respiration function.
4 vital signs to monitor under anesthesia
2) heart rate
3 body systems to monitor a patient that is on fluids
How can you make sure the patient is ventilating properly?
capnograph, eye position, rebreather bag
Name an anesthetic gas with no analgesia.
What causes pale pink mm
1 method to check to make sure the pulse oximeter is working
put it on your finger
Definition of a preanesthetic drug.
drug given before anesthesia for analgesia or to reduce amount of anesthesia
When does recovery begin and end?
when the iso is turned off and the animal is awake and walking
Anesthetic depth depends on what:
-route of administration
When checking cuff inflation, what indicates more inflation is needed?
hiss when you bag them
Advantages of the ET containing a side hole
mucus inside still gives O2 and anesthesia
4 reasons that effect recovery
1) how long the procedure was
2) the amount of drugs used
3) the patient's temperature
4) type of procedure
How can you check the correct placement of the ET tube with the machine
look at the rebreather bag, condensation in the tube
What procedure ensures that alectasis does not occur?
bagging the patient
What is a cause of back pressure?
Name 4 safety features on an anesthesia machine.
1) pin index
2) pop-off valve
3) pressure reducing valve
4) unidirectional valves
Name 4 reflexes to monitor during anesthetic prodecures
3) jaw tone
What tissues need a continuous supply of glucose for energy?
-Red blood cells
T/F Animal's nutritional requirements shift from an omnivore to an obligate carnivore requiring higher amounts of protein and fat.
Clinical signs of hypermetabolic state
= loss of desire for food before caloric needs have been satisfied
What are some causes of anorexia?
1) Disease or trauma
2) Fear or stress
The 1st energy source used is in an animal who is going through starvation is _____(depleted within the 1st 24-72 hours)
What is the GOAL of nutritional support?
provide the patient with adequate nutrition such that protein catabolism and negative nitrogen balance are corrected and/or prevented
Before starting nutritional support what must be corrected?
correct dehydration & acid/base disturbances
What should you consider when choosing a route?
-Available route of delivery
-Anticipated duration of enteral support
-Condition of GIT
Serious Complications of Tube Feedings.
How do you monitor gastric mobility?
Monitor by checking contents of stomach by aspirating tube prior to feeding
If greater than ___ of previous feeding remains in the stomach, recommend subsequent feeding be skipped.
What is an advantage and disadvantage of a Pharyngostomy Tube?
-adv: larger bore tube for wider variety of diets
-dis: placement through LES, too close to larynx
Pharyngostomy tube complications.
T/F PEG (Percutaneous endoscopic gastrostomy) tubes can be use right after they are placed.
false-must wait 24 hours
Proportions of fat, carbohydrates, and protein in food fed to hospitalized patients should be similar to that which the liver is estimated to be using from body stores. By the fifth day of food deprivation or longer, patients should receive the majority (greater than 50%) of their calculated _____ as fat.
resting energy requirement (RER)
Define resting energy requirement.
amount of energy animal requires for rest in a post-prandial state
Candidates for parenteral nutrition (delivery of nutrients IV) are unable to digest or absorb nutrients via the ____, or have uncontrolled ____.
GI tract, vomiting
T/F Parenteral nutrition does not supply all of patient’s nutrient needs.
T/F Parenteral nutrition goal is to provide short-term support for animals that are expected to recover soon.
Parenteral nutrition calculations are based on patient’s?
RER, disease history, protein levels, and hydration status.
Most common complication to parental nutrition is?
sepsis or bacterial contamination
Complications ofTotal Parenteral Nutrition (TPN)
What vitamin do you never give IV?
What is refeeding syndrome?
Electrolyte disturbance in patients with depleted intracellular ions in patients that are malnourished or starved
T/F Refeeding syndrome causes shift in patient from catabolic state where protein is primary energy source to anabolic state where carbohydrates are preferred energy source.
Refreeding syndrome causes dramatic shift of electrolytes from extracellular to intracellular, which electrolytes?
Phosphorus, potassium, magnesium