Surgery Midterm Flashcards
(230 cards)
1
Q
Instrument metal that is harder and stronger, used for thumb forceps, hemostats, retractors, and needle holders.
A
Martensitic Steel
2
Q
Instrument metal that is softer, high tensile strength resistant to corrosion, surgical implants, bowls, pans and trays are usually made out of this.
A
Austenitic Steel
3
Q
Occasionally used as inserts in tips of instruments especially needle holders, often identified by golden handles.
A
Tungsten Carbide
4
Q
Cleans by a process called cavitation, utilizes high frequency vibrations to remove dirt.
A
Ultrasonic Cleaning
5
Q
What are three ways to lubricate medical instruments?
A
Instrument detergents that contain lubricants, lubricant sprays, instrument milk
6
Q
Common methods of instrument sterilization
A
Steam autoclave
Ethylene oxide gas
Cold sterilization
7
Q
Gas cylinders contain _____ or _____ ____ for deilvery to the patient
A
Oxygen or nitrous oxide
8
Q
Oxygen is delivered at ____% versus room air which is __-___%
A
100%, 20-21%
9
Q
Oxygen cylinders are colorer _____
A
Green
10
Q
Volume in any E cylinder can be calculated by multiplying the pressure in pounds per square inch by __
A
0.3
11
Q
Full Oxygen tank
A
2200 PSI / 660 Liters
12
Q
1/2 full oxygen tank
A
1100 PSI / 330 Liters
13
Q
Nitrous Oxide containers are ____
A
Blue
14
Q
What is different on nitrous oxide and oxygen to avoid confusion?
A
Pin number on the yoke
15
Q
Gas enters at the ___, exits at the ___, displacing the rubber or plastic gauge
A
bottom, top
16
Q
What is the minimum oxygen flow rate to a patient?
A
1/2 Liter (500 mL)
17
Q
Wick in a glass jar absorbs anesthetic to increase surface area, as oxygen flows past wick it collects the anesthesia to carry to the patient
A
Non-Precision Vaporizor
18
Q
Designed for use with one anesthetic only, deliver exact concentration of gas as dialed
A
Precision Vaporizor
19
Q
Allows oxygen to bypass vaporizer and enter the breathing circuit, containing no anesthetic gas. Best to depress when patient is not directly attached to the system
A
Oxygen flush valve
20
Q
Dilutes the concentration of inhalation agent delivered
A
Oxygen flush valve
21
Q
A low pressure hose that carries gas and/or gas mixed with anesthetic to the breathing circuit, preventing return of this gas to other components
A
Fresh Gas inlet
22
Q
Minimum volume bag to select for a patient
A
60 ml/kg
23
Q
Periodic bagging helps prevent ____
A
Atelectasis
24
Q
Flushes the alveoli and airways with fresh gas, necessary when animal is not breathing on its own
A
Bagging
25
What occurs when a bag is overinflated?
Back pressure into the lungs and can cause alveoli to break
26
Maximum amount to bag
15-20 cm H2O (mm HG)
27
If the scavenger is too strong, what may occur to the bag?
Under inflation
28
On exhalation, the gas passes through the exhalation hose and either to the ___ \_\_\_\_ ___ or into the ____ \_\_\_\_\_
Pop off valve, CO2 Canister
29
Prevents buildup of excessive pressure in the system
Pop Off Valve
30
What two instances should the pop off valve be closed for?
Bagging a patient, conducting a leak test
31
Gases that do not exit via the pop off valve go where?
CO2 Canister
32
\_\_\_ ___ in canisters cleanses CO2 from the circuit
Soda lime
33
When should CO2 canisters be changed?
Every 6-8 hours of use
34
Usually situated on top of the CO2 absorber, measures pressure within the circuit
Pressure manometer
35
Pressure should not exceed ___ cm H2O or mmHg
20 cm
36
Rebreathing circuits are available in what sizes?
3: pediatric, large animal, adult
37
2 types of rebreathing systems
Closed, semi-closed
38
What breathing circuit is used for animals \<5-7 kg?
Non-rebreathing
39
This breathing circuit has no inhalation flutter valve, allowing gas to flow directly through the fresh gas inlet to the inlet hose for delivery to the patient.
Non-rebreathing system
40
What breathing circuit reduces resistance associated with breathing
Non-rebreathing
41
Mask induction level
300 ml/kg/min
42
Intubation after induction with injectable drugs (level)
200 ml/kg/min
43
Non-rebreathing flow rates
High, 200 ml/kg/min
44
Rebreathing flow rates (closed and semiclosed)
Closed: 15 ml/kg/min
Semi-closed: 25-50 ml/kg/min
45
Flow rates at the end of anesthesia are _____ immediately to the flow rates used during induction
increased
46
What does inceasing flow rates fo recovery do?
Saturates anesthetic circuit with oxygen
Dilutes the expired concentration of gases, replacing them with pure oxygen
More rapid recovery results
47
What are some long term effects of anesthetic gas exposure?
Reproductive disorders, liver and kidney damage, nervous system dysfunction
48
What anesthetics are considered greater hazards?
Methoxyflurane, halothane
49
Do waste anesthetic gases have cancer causing effects?
No
50
Whenever possible avoid being closer than ___ feet from the nose of an animal recovering from anesthesia
3 minutes
51
Hoses, reservoir bags, masks, ET tubes, and other rubber components can be washed with?
Soap and water (minimal soap, usually chorohexadine)
52
What is available if human exposure to injectable agents?
Narcotic reversing agents
53
Delivers anesthetic gases directly from the anesthetic machine to the lungs
Endotracheal tubes
54
ET tubes with beveled end and side holes, possible cuff
Murphy tube
55
ET tube with no side hole or cuff, abrupt decrease in diameter of tube, used in birds and reptiles
Cole tubes
56
Clear and stiff material used for ET tubes
Polyvinyl chloride
57
Flexible, less traumatic, absorbant ET tube material, may kink or collapse
Red rubber
58
Pliable, strong, less irritating ET tube material, resists collapse
Silicone
59
ET tubes are measured by ____ diamter
Internal diameter
60
ET tubes range in size from __ - __ mm
1-30mm
61
Clear, aquarium like boxes used to induce general anesthesia
Anesthetic chambers
62
Used in feral, vicious, or intractable animals to reduce stress
anesthetic chamber
63
Anesthetic chambers are either ____ or \_\_\_\_
Acrylic or Perspex
64
Disadvantage of anesthetic chambers
Can not monitor patient closely
65
Carrier gas for anesthetic machines is either _____ or ____ \_\_\_\_
Oxygen or nitrous oxide
66
Small cylinders attached directly to anesthetic machine
E tanks (small)
67
Large cylinder attached remotely to anesthetic machine
H Tanks (large)
68
Reduces outgoing pressure to a usable level
Pressure reducing valve
69
In Canada, oxygen cylinders are white, in the US they are \_\_\_\_\_
Green
70
Nitrous cylinders are what color?
Blue
71
Carbon dioxide cylinders are what color?
Gray
72
What color are medical air cylinders?
US- yellow
Canada/Europe- white and black
73
Pressure reducing valves (pressure regulator) reduce gas pressure to a constant \_\_-\_\_ psi
40-50 psi
74
Indicated pressure in the gas line between the pressure reducing valve and flowmeter
Line Pressure Gauge
75
Line pressure gauge should read \_\_-\_\_ psi after the oxygen tank is opened
40-50 psi
76
Sizes of laryngoscopes for small animals
0-5
77
Size of laryngoscopes for large animals
18 inch blade
78
Indicated gas flow in liters per minute
Flowmeter
79
Where carrier gas enters a vaporizer from the flowmeter
Vaporizer inlet port
80
Bypasses vaporizer and flowmeter, delivers short, large burst of pure oxygen directly into rebreathing circuit, used to refill rebreathing bag to deilver pure oxygen to a patient
Oxygen Flush Valve
81
Used to deliver low vapor pressure anesthetics, rarely used
Non-precision Vaporizer
82
Used to deliver high vapor pressure anesthetics
Precision Vaporizers
83
Precision vaporizers, high resistance gas flow
VOC (Vaporizer Out of Circuit)
84
Low resistance gas glow, Non precision vaporizer
VIC (Vaporizer in circuit)
85
In these vaporizers, oxygen from the flowmeter enters the vaporizer prior to entering the breathing circuit
VOC
86
In these vaporizers, oxygen enters the breathing circuit from the flowmeter, exhaled gases pass through the vaporizer
VIC
87
Due to manual ventilation or activation of oxygen flush valve
Back pressure
88
Color code for Isoflurane
Purple
89
Color code for Sevoflurane
yellow
90
Color code for Halothane
red
91
Color code for Desflurane
blue
92
Induction rate for Isoflurane
3-5%
93
Maintenance rate for Isoflurane
1.5-2.5%
94
Induction rate for Sevoflurane
4-6%
95
Maintenance rate for Sevoflurane
2-4.5%
96
Induction rate for Desflurane
10-15%
97
Maintenance rate for Desflurane
8-12%
98
What is the primary absorbant ingredient in CO2 canisters?
Calcium Hydroxide
99
CO2 becomes more ____ with use
acidic
100
Negative pressure is indicated by what?
A collapsed reservoir bag
101
What three sizes do breathing tubes come in?
50 mm, 22mm, 15 mm
102
Non-rebreathing system used in very small patients (\<2.5 kg)
Semi-open system
103
What is **not** found on a semi-open non-rebreathing system?
No CO2 canister, pressure manometer or unidirectional valves
104
Machine choice is based on animal body weight. What is considered small and large?
Small \<150 kg
Large \>150 kg
105
What is maintenance fluid rate?
30 ml/lb/day (60 ml/kg/day)
106
What is fluid rate during anesthesia?
5 ml/lb/day (11 ml/kg/day)
107
What are fluid rates for shock? (cats and dogs)
Dogs: 40 ml/lb/day (88 ml/kg/day)
Cats: 25 ml/lb/day (55 ml/kg/day)
108
Balanced electrolytes, saline and Dextrose are what type of fluid?
Crystalloid solutions
109
Blood/plasma, Synthetics and Blood substitues are what type of fluid?
Colloid Solution
110
Controlled drugs that have extreme potential for abuse, no approved use
C1
111
Controlled drugs that have high abuse potential (give examples)
CII - Opium, pentobarbital, morphine
112
Controlled drugs that have some abuse potential
CIII
113
Controlled drugs that have low abuse potential (give examples)
CIV - phenobarb, diazepam
114
Controlled drugs with the lowest abuse potential
CV
115
Sympathetic drugs used to decrease salivation and inhibit bradycardia
Anticholenergics
116
Similar to Atropine but has a longer duration (can last 2-3 hours)
Glycopyrrolate (Robinul)
117
Quicker onset than Glycopyrrolate, can also be treatment for organophosphate toxicity, and is a pretreatment/treatment for bradycardia, AV block
Atropine Sulfate
118
Examples of anticholinergics
Atropine and Glycopyrrolate
119
Example of a Phenothiazine
Acepromazine maleate
120
Neurologic agent, "modifying psychotic behavior", provides no analgesia. Reduces seizure threshold, mental calming sedation, and increased threshold to external stimuli.
Acepromazine
121
\_\_\_\_\_\_ Acts on the brainstem to cause a loss of vasomotor regulation leading to lower blood pressure
Phenothiazine
122
What side effects are associated with Ace?
"Ace face", ataxia, hypotension, hypothermia, decreased platelet function
123
What species should avoid use of Ace?
Horses (causes penile prolapse), geriatric animals, animals in shock, boxers, sighthounds
124
Mixture 50/50 with ketamine in same syringe as an induction agent
Diazepam
125
Less irritating than Diazepam
Midazolam
126
Induction agent when combined with tiletamine
Zolazepam
127
Special considerations for Benzodiazepines
Light sensitive
128
Xylazine (Rompun), Medetomidine (DexDomitor), and Detomidine are examples of what?
Alpha 2 Agonsists
129
What is the site of action for alpha 2 agonists?
Sympathetic nervous system receptors in the brain
130
What is a benefit of alpha 2 agonists?
They have reversal agents
131
What is released as a neurotransmitter of the sympathetic nervous system (stimulation of fight or flight)?
Norepinephrine
132
Stimulation of the ___ \_ recepter causes a STOP in the release of norepinephrine
Alpha 2
133
Side effects of alpha 2 agonists
Profound bradycardia, supresses salivation and swallowing reflex
134
Antagonist to xylazine and detomidine, primarily used for dogs
Yohimbine
135
Antagonist to Medetomidine
Atipamezole (Antisedan)
136
Oxymorphone, hydromorphone, fentanyl, torb, bupenorphine, morphine and tramadol are all examples of what type of drugs?
Opioids
137
Pure agonist, 10x more potent than morphine
Oxymorphone
138
This drug is an excellent choice for orthopoedic or very painful procedures
Oxymorphone
139
Agonist that is similar to oxy but less expensive and more available
Hydromorphone
140
What problems are associated with fentanyl?
Heat increases absorption, ingestion could lead to death due to resp depression, must be returned to clinic, takes a min of 12 hours to take effect
141
Opioid best used against mild-moderate soft tissue pain such as spays/neuters and mild disease.
Butorphanol (Torb)
142
Reversal agent for Torb
Naloxone
143
Agonist of Mu receptor
Buprenorphine
144
If given IV, _____ can cause hypotension
Morphine
145
Mu receptor agonist used for chronic pain
Tramadol
146
Combination of a tranq or sedative and an opioid
Neuroleptanalgesics
147
4 examples of neuroleptanalgesics
Ace/Torb
Ace/Oxy
Ace/Buprenorphine
Domitor/Torb
148
Decreased responsiveness of normal muscle reflexes
Hyporeflexia
149
General anesthesia ideally includes what 4 things?
Hypnosis, Hyporeflexia, muscle relaxation and Analgesia
150
What are the 4 components of anesthetic protocol?
1. Preanesthesia
2. Induction
3. Maintenance
4. Recovery
151
What stage of anesthesia can NOT be skipped?
Induction
152
The same drug is often used for _____ and \_\_\_\_\_
Induction and maintenance
153
When does recovery begin?
When the concentration of anesthetic in the brain begins to decrease
154
Inhalation anesthetics are removed during \_\_\_\_\_
respiration
155
What is the single most important factor in preventing serious anesthetic problems?
Monitoring
156
This stage of anesthesia begins immediately after the administration of an induction drug
Stage 1
157
What stage of anesthesia begins witht the loss of consciousness
Stage 2
158
What stage is "fighting anesthesia"?
Stage 2
159
This stage ends with signs of muscle relaxation, slowed respiratory rate, and decreased reflex activity
Stage 2
160
Stage 3 is divided into how many plans?
4
161
What is the surgical plane of anesthesia?
Stage 3 Plane 2
162
Minimum average heart rate for a dog under anesthesia
60 bmp
163
Minimum heart rate for a cat under anesthesia
100 bpm
164
What heart rate range is common during anesthesia?
60-120 bmp
165
\_\_\_ is the force exerted by the flowing blood on arterial walls
BP
166
What can cause hypotension?
Excessive anesthetic depth
Vasodilation
Cardiac insufficiency
Blood loss
167
Systolic pressure: Highest Pressure \_\_\_\_
120
168
Diastolic pressure: Maintenance pressure \_\_\_\_
80
169
Mean Arterial BP: Average pressure \_\_\_-\_\_\_
90-100
170
What are indirect methods of monitoring BP?
Doppler and Oscillometer
171
What amount of blood loss is acceptable?
5mL/lb
172
What percent blood loss has serious circulatory side effects?
\>15%
173
Normal anesthesic respiratory rate
8-20 bpm
174
Inspiration followed by a prolonged period before expiration
Apneustic breathing
175
What is the most common complication in veterinary patients?
Hypothermia
176
Common reasons for hypothermia?
Stainless steel tables
Clipped/scrubbed patients
Decreased metabolic rate
Age
Open body cavity
177
Measure of oxygenation of RBCs
Systemic oxygenation
178
What can affect systemic oxygenation?
Blood loss, anemia, type of anesthetic used
179
What does direct monitoring of systemic oxygenation measure?
oxygen saturation, CO2 saturation, bicarbonate levels
180
Normal Oxygenation
90-100%
181
What oxygenation level is considered hyopxia?
less than 90%
182
What 2 factors indicate degree of oxygenation?
PaO2/SPaO2
183
During ____ CO2 is close to zero
Inspiration
184
During ____ CO2 rises to 32-40
Expiration
185
\>40 mmHg CO2 indicates?
Hypercapnea
186
\<30 mmHg CO2 indicates
Hypocapnea
187
Sensor at the end of the ET tube that monitors CO2 in breathed air
Capnograph
188
What is most commonly seen after the administration of alpha 2 agonists such as Medetomidine and Xylazine?
Heart Block
189
Degree of heart block where the P wave is seen with delayed QRS complex following
First degree
190
Degree of heart block where the P wave is present with an absent QRS complex
Second Degree
191
Degree of heart block where there is a series of P waves with no QRS complex?
Third degree
192
Occurs when electrical impulses that cause the heart to beat are not being transmitted properly through the heart
Heart block
193
An electrical impulse that arises from the ventricle, not the atria, and causes an uncoordinated and ineffective contraction
Premature Ventricular Contractions
194
What are some causes of PVC?
Hypoxia, Systemic diseases (GDV, heart disease), Epinephrine
195
Treatment for PVC
IV Lidocaine
196
Rapid, randomized, uncoordinated muscle twitching of the heart. May cause lack of circulation and loss of pulse.
Fibrillation
197
Valium/Xylazine ____ muscle tone
decrease
198
Ketamine/Tiletamine ____ muscle tone
increase
199
During what stage of anesthesia are pupils constricted then dilate as level increases?
Stage 2
200
Dilated central pupil with no light reflex may indicate what?
Dangerously deep anesthesia
201
Cats are prone to _____ therefore should be extubated as soon as possible.
Laryingospasms
202
Recovery period complications
Hemorrhage, aspiration, dyspnea, self trauma
203
In what percentage of procedures do complications arise?
10-15%
204
Average mortality rate for anesthesia?
5 per 1000
205
Geriatric patients are at a high risk for \_\_\_\_\_\_
Hypothermia
206
Geriatric patients can be easily \_\_\_\_\_
overhydrated
207
For geriatrics, reduce anesthesia \_\_\_-\_\_\_%
30-50%
208
Fluid rates for geriatric patients should be kept \_\_\_\_
lower
209
What oxygen strategy can be used for geriatrics?
Pre-oxygenate with a mask or chamber for 5 minutes prior to induction
210
What should be avoided in neonates to prevent hypothermia?
Avoid using alcohol in surgery prep, avoid using Acepromazine because it lowers BP
211
For neonates ____ are preferred over injectables
inhalants
212
For neonates, administer ___ \_\_\_\_ in LRS via micro drip set
5% Dextrose
213
Fasting should be avoided in \_\_\_\_
neonates
214
For Brachycephalic breeds, ___ tubes will be necessary
smaller
215
For obese animals, dose according to ___ \_\_\_
ideal weight
216
For patients undergoing C-sections, ___ should be used instead of ketamine/valium
Propofol
217
For cardiovascular problems, patients should be given _____ to reduce pulmonary edema
diuretics
218
What blood work should be ran for hepatic failure strategies?
Profile, CBC, Clotting profile
219
\_\_\_\_ agents are preferred for hepatic problems
inhalant
220
For patients with urinary obstruction, avoid IM \_\_\_\_
Ketamine
221
Treat hyperkalemia with \_\_\_
NaCl
222
To treat excessive anesthetic depth immediately ____ vaporizer and ____ O2 flow
decrease/increase
223
What should the adjustments be for a patient that is too awake?
Increase vaporizer setting and increase O2
224
What should the adjustments be for a patient that is too deep?
Increase O2 and decrease or turn off vaporizer, reversal drugs can be used.
225
Loose metatarsal pulse
\<60
226
Loose femoral pulse
\<40
227
What is the IV fluid rate for hypotension?
20 ml/kg for 15 mins (90 ml/kg/hr max)
228
What drugs should be used for shock?
Solu-delta Corteff
Dexamethasone SP
Dobutamine
Bicarb
229
What is asystole treated with?
epinephrine, atropine and bicarb
230
What is ventricular fibrillation treated with?
lidocaine and a defib
