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Anesthesia -Scott Newman & Janet King > Test 2 Notes: Janet > Flashcards

Test 2 Notes: Janet Flashcards

1
Q

Why is species important when administering different medications & dosages?

A

Cats can be sensitive to medicines that are normally fine for dogs
Smaller animals need different dosages than larger animals

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2
Q

2 Breed complications during anesthesia

A

Brachycepahlics tend to get airway obstructions during recovery due to:
Small tracheas
Narrow nares
Parasympathetic tone

Sight hounds are sensitive to barbituates during recovery due to their lack of fat
(barbituates need fat to metabolize)

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3
Q

How should obese patients be dosed?

A

by their ideal weight -most drugs are dosed according to brain size, not weight

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4
Q

How should emaciated patients be dosed?

A

by their true weight -these patients are prone to hypothermia and hypoglycemia so a quick recovery is ideal, may need to add dextrose to fluids to prevent hypoglycemia

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5
Q

Geriatric patients are prone to ____

A

Early, sub-clinical renal failure & hypothermia

always use IV fluids!

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6
Q

Why is it important to have IV fluids running on a patient?

A

Functional nephrons need good renal perfusion (Blood pressure and volume)
IV fluids keep the nephrons functional and prevent renal failure in the long run

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7
Q

Both geriatric and young animals ideally need what kind of drugs during anesthesia?

A

Short acting

Reversible

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8
Q

If a female is in heat during a spay what could happen?

A

Hemorrhage risk is increased due to increased blood flow and bigger arteries around uterus

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9
Q

Why would pregnant spays be an increased risk?

A

The patient will be dehydrated due to the removal of the fetuses and all of the enzymes and fluids she was providing for them. Give bolus of fluids

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10
Q

Aggressive patients are at a higher risk due to ____

A

Lack of ability to get PA information

Increased stress

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11
Q

Why is knowing how long the surgery will be important?

A

So you know when to turn down the anesthetic %

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12
Q

Liver and Kidney problems could be and issue with anesthesia due to ____

A

Decreased metabolism- would have trouble excreting the drug

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13
Q

Vomiting/Diarrhea

A

loss of electrolytes
Dehydration
Acid/base imbalance

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14
Q

What type of drug do you avoid if you have a patient with a history of seizures? and why?

A

Epileptogenic Drugs

They have a lower seizure threshold

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15
Q

What two specific drugs should be avoided for epileptic dogs?

A

Ketamine & Acepromazine (Use Valium instead)

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16
Q

Hyperthyroidism in cats causes ____ during anesthesia

A

Increased heart rate

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17
Q

Why is it important to know if the patient is currently on any other drugs?

A

Not all drugs work well together and may produce adverse side effects

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18
Q

Anesthesia history would be beneficial to have because ____

A

You can see if the patient had any previous complications or allergies

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19
Q

How long should you withhold food & water before PA drugs are given?

A

8-12 hours for food, water is okay up until PA drugs are given

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20
Q

Why is food withheld before a anesthesia procedure?

A

Most anesthetic drugs will cause vomiting which could lead to aspiration

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21
Q

Normal patient temp.

A

101.5 +/- 1degreeF

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22
Q

Respiratory rate

A

15-30rpm in dogs

20-30rpm in cats

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23
Q

Fever may indicate ___ which may worsen following anesthesia due to ____

A

an infection

stress and immunosuppression

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24
Q

Hypothermia ____ the effects of anesthesia, so ___

A

Potentiates

Less drugs are needed

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25
Hypothermia complications
Longer recovery Delay in wound healing Longer clotting times
26
Normal heart rate in dogs and cats and what spot is used to get this?
60-160 (up to 180 in toy breeds and 220 in puppies) 110-220 in cats Femoral ARTERY
27
Cachexia means ____
emaciated
28
S&S or S&R stand for
Strong and Synchronous | Strong and Regular
29
What is evaluated when palpating a pulse?
rate and character
30
A weak or absent pulse may indicate ____
hypotension
31
A bounding pulse may indicate ____
Hypertension
32
What could auscultating the heart help you find?
``` The rate and rhythm Could hear respiratory sinus arrhythmia (normal in dogs) Cardiac murmurs (fast-slow-fast-slow: matches respirations) ```
33
2 Main reasons for increased CRT and pale MM color
Peripheral Vasoconstriction | Decreased Tissue Perfusion
34
Examples of Peripheral Vasoconstriction causes
Hypothermia Pain Alpha-2 agonists (sedatives)
35
Causes of Cyanosis and why this is a result
Hypoxia | Because there is an increase in the amount of unsaturated hemoglobin
36
Things to look at when evaluating the pulmonary system
Respiratory rate, depth and effort MM color Auscultation of breath sounds
37
What is important to know when evaluating neuro system?
History of seizures--avoid epileptogenic agents--use Valium= tranquilizer + anticonvulsant Pupillary light reflex--both eyes should constrict
38
Hepatic function is important during anesthesia for ____
LIVER: Metabolism and elimination of drugs May effect other body systems
39
Renal function is important during anesthesia for ____
``` KIDNEYS: Elimination Water distribution Electrolytes Blood pressure RBC production ```
40
Sign of abnormal renal function
PU/PD
41
Things to evaluate when checking GI system
Do they have any: V/D-- dehydration & electrolyte imbalances Parasites-- anemia, diarrhea GDV-- impairs ventilation, decreased cardiac output, hypovolemic shock, ^^^RISK! Ascites-- fluid in abdomen, could indicate liver dz. or heart failure
42
What are the bare minimum lab tests that should be run? What tube should be used?
PCV & TP | RTT
43
What does the PCV evaluate for?
Anemia Oxygen carrying capacity Hydration status
44
If your patient is dehydrated the PCV will have a ____ & if they are over-hydrated the PCV will have a
Relative increase Relative decrease
45
TP evaluates for ____
Hydration status Blood loss Liver function
46
Increased TP would indicate
dehydration
47
Decreased TP could indicate ____
Over-hydration Liver disease Malnutrition
48
When there is blood loss and acute hemorrhage what will drop first?
TP, PCV will be normal ~12 hours post blood loss
49
CBC consists of what tests, and what will they evaluate?
``` RBC/Hct/Hgb= oxygen carrying capacity WBC= leukocytosis (infection/stress) leukopenia (immunosuppression/viral infection) Eos= parasites/allergies Plt= coagulation ```
50
The PA panel usually includes what 4 things?
1. Glucose 2. BUN/Creat 3. ALT/alk phos 4. TP
51
Glucose
pancreatic function test (DM) | could be stress induced
52
How to differ between DM and stress induced glucose in urine
Urine test to check for ^ GLU
53
BUN/creatinine
Kidney function (glomerular filtration of kidney)
54
When will glomerular filtration of the kidney be increased?
``` (Azotemia) When the animal is: Dehydrated In shock Hypotension or Impaired renal function ```
55
ALT/alk phos
Liver Function ALT= hepatocyte damage or destruction Alk phos= hepatobiliary obstruction or bone growth/injury
56
What is the liver specific enzyme in dogs and cats?
ALT
57
Normal electrolyte balance is important for _____
Normal physiologic function
58
Blood gas tests are more important in what species?
Equine anesthesia
59
Urinalysis consists of ____
USG-- renal tubular function Dipsticks-- pH, blood, bilirubin, GLU Sediment-- crystals (ethylene glycol/ammonium biurate)
60
What are 2 additional tests that may be run
ECG -- known heart dz. | Rads -- fractures, thorax, abdomen
61
4 reasons why placing a patient on a IVC is beneficial
1. easier to admin. IV induction agents (titrate) 2. can use CRI of anesthetics/analgesics 3. important if emergency drugs are needed 4. IV fluids
62
2 Reasons IV fluids are highly recommended
To maintain blood volume and support blood pressure
63
When would you DEFINITELY want IV fluids hooked up?
If the sx will result in significant blood loss Patient is dehydrated Long anesthesia Animal is at risk for hypotension or shock
64
Class I anesthetic risk
Excellent anesthetic risk | Normal healthy patient getting a elective procedure only (OHE, Declaw, Neuter)
65
Class II anesthetic risk
``` Good anesthetic risk Patient with slight to mild systemic disease Well controlled disease of ONE body system Neonatal or Geriatric Mild to Mod obese ACL repair Brachycephalic Sighthound Well-regulated diabetic ```
66
Class III anesthetic risk
``` Fair anesthetic risk Moderate systemic disease Mild clinical signs Controlled dz of 1 or more body systems Low to moderate fever Moderately dehydrated Anorexia/Cachexia Heart or renal disease Complicated fracture ```
67
Class IV anesthetic risk
``` Poor anesthetic risk Severe systemic disease that is a threat to life At least 1 poorly controlled severe disease High fever Azotemia Severe dehydration Morbidly obese Severe anemia Emaciated DKA, GDV *Sx must be preformed to save life* ```
68
Class V anesthetic risk
``` Guarded anesthetic risk Moribund (close to death) Patient not expected to survive 24 hours with or without surgery Sx preformed in desperation Not expected to survive ```
69
What are some myths of pain in animals?
Animals don't perceive pain like people- they tolerate it better than humans Owners won't pay for analgesics Better to keep animals in pain so they won't ruin the sx. site
70
Biology/physiology of pain
Increased anxiety and stress Alters metabolism Affects endocrine system Decreased immune function
71
Signs that animal is in pain
``` Vocalization Facial expressions Body posture- hunched over/abnormal Activity- restless/not moving Attitude- aggression/depressed Guarding/Licking/Chewing Decreased appetite Not sleeping Panting/Salivation ```
72
What are the first 4 vital signs?
1. Temp 2. Pulse 3. Resp. 4. Pain assessment
73
What is the wind-up effect?
Hyper-excitability of central neurons due to constant bombardment of pain signals -- will wake up with overwhelming pain sensation, harder to control.
74
Why should pre-emptive analgesics be used?
Decreases the wind-up effect | Decreases the amount of GA needed
75
What 2 things does the wind-up effect lead to?
Allodynia | Hyperalgesia
76
Allodynia
Pain caused by a stimulus that normally does not result in pain ex: petting
77
Hyperalgesia
increased response to a painful stimulus | Over-exaggerated
78
Opioids
Agonists | Best choice
79
What do opioids act on?
receptors in the brain and spinal cord | may also provide some sedation
80
OTM
Oral trans-mucosal | Butorphanol- cheek pouch in cats
81
Routes of administration for Opioids
``` PO IM & SQ Transdermal (patch) Intraarticular Epidural ```
82
Epidural duration of action
Most commonly morphine | Provides 6-24 hours of analgesia to caudal thorax, abdomen, hind limbs, pelvis, and tail
83
3 Properties of NSAIDs
1. Analgesia 2. Anti-Inflammatory 3. Anti-Pyretic (decreases fever)
84
2 Types of NSAID analgesia
Somatic (bones/joints) | Visceral (soft tissues/organs)
85
NSAIDs cause inhibition of ____
Prostaglandins (inflammation)
86
What 2 enzymes are inhibited by NSAIDs?
COX1 & COX2 (important in production of prostaglandins)
87
COX1 produces ____ prostaglandins & maintain what 3 things?
GOOD Renal blood flow Production of gastric mucus Platelet function
88
What can inhibition of the COX1 enzyme lead to?
Gastric ulcers | Kidney failure
89
COX2 enzymes produce prostaglandins that cause what 2 things?
Pain | Inflammation
90
What are some examples of NSAIDs?
``` Aspirin Acetaminophen Carprofen Meloxicam Deracoxib Etodolac ```
91
What are some examples of Opioids?
Morphine Hydromorphone Fentanyl Butorphanol
92
What is the shortest acting Opioid?
Remifentanil | 8-10min.
93
What are 3 NSAIDs not typically used in animals due to toxicity?
Aspirin Acetominophen Ibuprofen
94
How long does injectable carprofen usually last?
24 hours of analgesia
95
What are 4 side effects of NSAIDs
Gastric ulcers Renal toxicity Impaired platelet function Hepatic damage (from long term use)
96
If you are worried about an animal's liver before giving NSAIDs what test should you do?
Bile acids test to assess hepatic function | fast animal, test, feed animal, and test again
97
What do local anesthetics do?
Block sensory nerve impulses and transmission of pain impulses Temporary loss of sensation
98
What are 4 benefits of local anesthetics?
Few cardiovascular side effects Low cost Good pain control Minimal patient recovery
99
Why would local anesthetics be used with GA?
Not as much GA gasses are needed | Pain control during and after surgery
100
Topical local anesthetics normally come in an ____ and can be used to ____
Ointment Decrease laryngospasms when intubating a cat "Splash block" by applying directly on nerves during sx.
101
How are infiltration local anesthetics used?
By blocking the nerves on the incision site | Ring block for a Onychectomy
102
What does a direct nerve block do?
Targets specific nerves | Can be used for dental blocks,onychectomies, brachial plexus blocks, enucleation sx
103
MLK & benefit of this drug combo
Morphine Lidocaine Ketamine IV Local anesthetic Reduces inhalant anesth. requirements by 25-30%
104
FLK
Fentanyl Lidocaine Ketamine
105
Lidocaine patch
Produces analgesia, but no anesthetic effect | Apply at surgery site
106
Example of IV local anesthetics and benefits
CRI of Lidocaine Analgesia Decreased vaporizer settings Increases GI motility (horses)
107
Where do you inject an epidural?
Into lumbosacral region
108
What does local epidural do?
Loss of sensation and motor function
109
What does a opioid epidural do?
Use for pain control post-op
110
4 examples of local anesthetics
Lidocaine Bupivacaine Mepivacaine Tetracaine
111
What does adding epinephrine to local anesthetics do?
Causes vasoconstriction so local is not absorbed into the blood stream, and can increase the duration by 50%
112
What are some negative aspects of local anesthetics
Lidocaine toxicity- neurotoxicity Lidocaine CRI in cats- can cause seizures and bradycardia Bupivicaine- Never IV
113
Alpha 2 agonists are ____ & are _____ than analgesia
Sedatives | Longer lasting
114
What do Alpha-2 agonists act on?
Pain receptors in brain & spinal cord to diminish pain perception
115
Examples of Alpha-2 agonists
Xylazine Medetomidine Dexmedeomidine
116
How are Alpha-2 agonists reversed?
With Alpha-2 antagonists
117
Ketamine is a ____/____
Cyclohexamine/Dissociative
118
When is Ketamine commonly used?
For induction of anesthesia or as GA for short procedures (Does NOT create unconsciousness)
119
What are NMDA receptors?
Pain receptors in the spinal cord
120
Why would a NMDA antagonist be used?
To prevent a wind up effect
121
What are some non-pharmacologic methods of pain control?
``` Acupuncture Massage Chiropractic Cold/Heat Herbal Nursing care ```
122
What 2 things can amplify pain and how is this prevented?
Anxiety & Fear | Sedatives and Tranquilizers can help calm the patient
123
What are 5 reasons why we use PA drugs?
1. Sedate/Tranquilize- calms, decreases stress, and muscle relaxation 2. Pre-emtive analgesia to prevent wind up 3. Prevent bradycardia, dry secretions 4. Decrease amount of GA needed 5. Safer and smoother induction & recovery
124
How are PA drugs given?
IM or SQ | IV for Diazepam or emergency drugs
125
What are 5 classifications of routine Pas?
``` Anticholinergics Tranquilizers Alpha-2 agonists (sedatives) Opioids (narcotics) Neuroleptanalgesia (Combo) ```
126
What are the 2 Anticholinergics?
``` Atropine sulfate (Atropine) Glycopyrrolate (Robinul-V) ```
127
How do Anticholinergics work?
Against the cholinergic (parasympathetic) nervous system | Block function of acetylcholine and vagal nerve
128
What are the main effects of anticholinergics?
slured<3= Heart- prevents bradycardia or may increase rate
129
What is the MAIN reason for using an anticholinergic?
to prevent bradycardia
130
What is the duration of Atropine sulfate?
60-90 minutes
131
Which anticholinergic has a faster onset and increases the HR more?
Atropine
132
Which anticholinergic prevents bradycardia, without the risk of causing tachycardia?
Glycopyrrolate- milder on the heart than atropine
133
Which anticholinergic has a longer duration of action?
Glycopyrrolate
134
When would you NOT use an anticholinergic?
Tachycardic patient Constipated CHF or Hyperthyroidism
135
What are the 2 groups of Tranquilizers?
Benzodiazapines "P's" | Phenothiazines "Z's"
136
What is the 1 Phenothiazine Tranquilizer?
Acepromazine (Promace)
137
What are the 3 Benzodiazapine Tranquilizers?
Diazepam (Valium) Midazolam (Versed) Zolezapam (in Telazol)
138
What are some physical properties of Acepromazine?
Water soluble Yellow 10mg/ml concentration (usually diluted to 1mg/ml)
139
How long do Phenothiazines last?
(Acepromazine) 4-8 hours, sedation can last 24 hours 24-48 hours in geriatric or neonates
140
What are 10 effects of Phenothiazines?
``` (Acepromazine) Calming Decreased anxiety **Antiemetic (decreased V/D) Antiarrhythmic Antihistamine (dont use in animals getting allergy test) **Vasodilation**- can cause profound hypotension and hypothermia Prolapse of 3rd eyelid (Ace face) Penile prolapse in horses May lower seizure threshold NO analgesia but can improve analgesic effects Dysphoria in some cases ```
141
What is the maximum dose of Acepromazine?
3mg (IM,SQ) | NOT reversible!
142
What is the reversal agent for Benzodiazepines?
Flumazenil
143
What are some physical properties of Benzodiazepines?
Diazepam is NOT water soluble (can only be mixed with Ketamine) NO analgesic properties Controlled -human abuse potential
144
What are some main effects of Benzodiazepines?
**Anti-anxiety and calming** not as much CNS as Ace- appear calm, but still alert NO Analgesia Excitement instead of calming in some cases (works best when combined with other drugs)
145
What combination works best together to prevent excitement instead of calming?
Opioid & Benzodiazepines (tranquilizer)
146
Other effects of Benzodiazepines
Good skeletal muscle relaxation (counteracts muscle rigidity caused by Ketamine) Anticonvulsant - good for PA patients with seizure disorders Appetite stimulant Behavior modification: (oral diazepam)- aggression, anxiety, marking, licking
147
Which group of tranquilizers has minimal adverse side effects?
Benzodiazepines
148
Diazepam
``` (Valium) Benzodiazepine Calming Muscle relaxant Anticonvulsant ```
149
How should Diazepam be given?
IV slowly In combination with other drugs as PA May cause excitement if given alone
150
Midazolam
(Versed) Water soluble- can mix with other PA drugs Given IM or SQ Minimal sedation and possible excitement if used alone (use in combo)
151
Zolazepam
``` found in (Telazol) Can be used as induction agent or sole anesthetic agent for short, minimally painful procedures ```
152
What 2 drugs are in Telazol?
Zolazepam & Tiletimine
153
What are the 3 Alpha-2 agonists?
(Sedatives) Xylazine (Rumpun) Medetomidine (Domitor) Dexmedetomidine (Dexdomitor)
154
What is Xylazine reversed with?
Yohimbine alpha-2 antagonist (Yobine)
155
What are Dexmedetomidine and Medetomidine reversed with?
Atipamezole alpha-2 antagonist (Antisedan)
156
Properties of Alpha-2 agonists (sedatives)
NOT controlled Reversible Can be absorbed through skin & mm Produce analgesia, sedation, muscle relaxation Emetic- vomiting in 50% of dogs and 90% cats
157
How do Alpha-2 agonists (sedatives) work?
By binding to alpha-2 adrenoreceptors on sympathetic nerves within brain and spinal cord
158
Which group of drugs produces a potent, sleep-like state?
Alpha-2 agonists
159
Does sedation or analgesia last longer in alpha-2 agonists?
Sedation
160
How can alpha-2 agonists be given?
IV, IM, SQ, Epidural
161
Side effects of alpha-2 agonists
``` **Bradycardia and arrhythmias Hypotension Resp. depression Hypothermia Peripheral vasoconscriction ```
162
Xylazine
(Rompun) Only used in young, healthy animals Emetic
163
Medetomidine
(Domitor) Only used in young, healthy, calm animals Bradycardia is common
164
How is Medetomidine and Dexmedetomidine dosed?
By mcg per square meter of body surface (use chart for volume using body weight)
165
Dexmedetomidine
(Dexdomitor) Newer version of Medetomidine (Domitor) Adverse reaction in excited animals Use only in young, healthy and calm patients
166
What should be given before administration of alpha-2 sedatives?
Anticholinergics to decrease adverse cardio effects
167
What group of drugs are the most effective for treatment of pain?
Opioids
168
How are Opioids used?
For PA- decrease GA and windup Induction Intra-articular
169
What are the 3 classifications of Opioids and which is the best?
Pure agonists Partial agonists Mixed agonist/antagonist
170
What are the 2 Opioid receptors in the brain?
Mu Kappa Sigma
171
What are the 5 Pure agonist Opioids?
``` Morphine Hydromorphone Oxymorphone Methadone Fentanyl ```
172
What is the 1 mixed agonist/antagonist opioid?
Butorphanl
173
What is the 1 partial agonist opioid?
Buprenorphine
174
What is the reversal of Pure Agonist Opioids?
Naloxone
175
What are some CNS effects of Opioids?
CNS depression or excitement (dysphoria) | Euphoria in some patients (Cats love buprenorphine)
176
What are some signs of dysphoria?
Whining, barking, anxiety, restlessness
177
Analgesic effects of Opioids?
Most effective as pure agonists | Excellent PA for animals having painful surgery
178
What is the most common side effect of Opioids?
Respiratory depression can be serious dose related- smaller doses are much safer
179
What are a few GI side effects of Opioids and what drug can be used to decrease these?
Emetic (Vomiting/Diarrhea) Flatulence Atropine or Acepromazine decreases these effects
180
Dogs get ___ and ___thermia with Opioids | Cats get ___ and ___thermia with Opioids
Miosis & Hypothermia | Mydriasis & Hyperthermia
181
Morphine
(Duramorph) Pure agonist Can cause dysphoria Best when used with tranquilizer
182
What 2 things does Morphine produce?
(Duramorph) | Analgesia & Sedation
183
What are some benefits of Morphine?
(Duramorph) Inexpensive and effective for severe pain Can be added to fluids and given IV
184
Routes and duration of Morphine?
IM, SQ, IV (dogs only) Epidural Epidural- 12-24 hours IM or SQ- 4+ hours in cats (less chance of bad reaction SQ)
185
Hydromorphone
(Dilaudid) Pure agonist 5X more potent than morphine IV, SQ, or IM in both cats and dogs
186
Duration of Hydromorphone
Lasts 4 hours (IM,SQ)
187
Effects of Hydromorphone
``` Less likely to cause vomiting Less potential to cause excitement in cats -Resp. depression -Dysphoria -Bradycardia -Panting ```
188
Oxymorphone
(Numorphan) Pure agonist 10X more potent than morphine and more sedation
189
Duration and effects of Oxymorphone
``` (Numorphan) 3-4hours Less likely to cause vomiting More expensive than morphine and hydro Increased sensitivity to sound ```
190
Fentanyl
(Sublimaze) Pure agonist 100-150X more potent than morphine
191
Who is fentanyl not recommended in?
Cats
192
Duration of fentanyl
(Sublimaze) | Only 30min. so commonly used as CRI or Transdermal patch
193
Fentanyl patch brand name & facts
(Duragesic) | Transdermal delivery that provides continuous, steady-state analgesia for 3-5 days (Post op)
194
How long does it take the Fentanyl patch to reach therapeutic blood levels?
4-12 hours in cats 12-24 hours in dogs Apply patch 12-24 hours prior to anesthesia
195
Butorphanol
(Torbugesic or Torbutrol) Mixed agonist/antagonist Not as effective as pure is at treatment of severe pain Some sedation
196
What can Butorphanol reverse?
(Torbugesic or Torbutrol) Partially reverses pure agonists- can use to somewhat reverse resp. depression, sedation, or dysphoria but also reverses some analgesic effects.
197
Duration of Butorphanol
(Torbugesic or Torbutrol) 1-4hours 1 hour in dogs Up to 4 hours in Cats
198
Buprenorphine
``` (Buprenex) Partial agonist Expensive Analgesia for mild to moderate pain Some sedation Has the longest duration ```
199
Duration of Buprenorphine
(Buprenex) | Lasts 6-8 hours and up to 12 in some patients
200
Which opioid has a better analgesia for cats that is administered OTM?
Buprenorphine (Buprenex)
201
What does OTM mean?
Oral Transmucosal Cheek pouch administration in cats (Buprenorphine/Buprenex)
202
What do Opioid antagonists do?
Displace opioids from receptors, causing a reversal of the agonist effect Can reverse sedation, dysphoria, panting, resp. depression, hypotension, bradycardia...etc.
203
Naloxone blocks all ____ receptors
(Narcan) Mu receptors Can be titrated to minimize the reversal of analgesia
204
What is the elephant opioid?
Etorphine (M99) 3,000-8,000X more potent than morphine Can immobilize elephants and other large mammals Reversed with M5050
205
What are some common Neuroleptoanalgesics?
Acepromazine & Butorphanol Diazepam & Hydromorphone Versed & Fentanyl

Anesthesia -Scott Newman & Janet King (13 decks)

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