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Anesthesia -Scott Newman & Janet King > Test 3 Notes: Janet > Flashcards

Test 3 Notes: Janet Flashcards

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1
Q

Define induction

A

taking patient from a conscious to an unconscious state

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2
Q

2 Methods of induction

A

Injection

Inhalation

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3
Q

4 Benefits of ET intubation

A

Establish pt. airway
Prevent aspiration
IPPV
Decrease gas exposure to personnel

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4
Q

3 Types of ET tubes

A

Murphy tubes
Cole Tubes
Cuffless ET tubes

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5
Q

Cole Tube

A

Used for small animals & exotics
Skinny end inserted into trachea
Tie behind ears so wider part creates seal
Are easily dislodged

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6
Q

Murphy Tube

A 
Beveled end (easier to insert)
Murphy eye (prevents complete blockage) 
Cuff
Pilot line with balloon 
Radiopaque strip
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7
Q

What are 3 benefits to using a cuffed ET tube

A

Prevents aspiration
Prevents leakage of gas to room
Prevents animal from breathing in room air

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8
Q

Cuffs do NOT ____, they create a ____

A

Hold the ET tube in place, they create a seal

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9
Q

How are ET tubes measured?

A

french scale= external diameter

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10
Q

How do you choose an ET tube size?

A

Use a chart based on weight
Palpate trachea
Measure tube diameter in comparison to nasal opening

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11
Q

How is the length of the ET tube measured?

A

From the tip of the nose to the thoracic inlet

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12
Q

What could happen if the ET tube is too long?

A

Endobronchial intubation

Increased resistance to respiration

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13
Q

How should a patient be restrained for placement of the ET tube?

A

Sternal recumbency
Restrainer holds top jaw
Extend neck and raise head
Intubator will pull tongue down to open mouth

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14
Q

Medical term for vocal folds

A

arytenoid cartilages

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15
Q

How do you restrain a ET tube?

A

Muzzle gauze
Rubberbands/ties
IV tubing

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16
Q

What is the best way to know the ET is in the trachea?

A
  • *To visualize it
  • use fingers to feel for tube between vocal folds
  • feel air with exhalation
  • res. bag movement
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17
Q

How would you know the ET tube is NOT properly placed?

A

You hear vocalization

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18
Q

What are 2 ways to know how much air to use in cuff

A

Back pressure in syringe

Use pressure manometer

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19
Q

What numbers do you look at when using the pressure manometer to inflate the cuff?

A

Hear slight leak at 20cmH2O

No leak at 15cmH2O

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20
Q

What could happen if you over-inflated the cuff?

A

Compression of the tube
Pressure necrosis of trachea
Tracheal rupture/tear

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21
Q

Why are cats more difficult to intubate?

A

Small trachea diameter
Larynx sits deeper in neck (harder to visualize)
Laryngospasms
Vocal folds cover more of the glottis

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22
Q

How would you intubate a cat?

A

Using a stylet or by putting lidocaine on the vocal folds

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23
Q

How much lidocaine would you put on the vocal folds?

A

0.1ml

one drop on each vocal fold

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24
Q

Succinylcholine properties

A

For feline intubation
IV
Lasts 5-10min.
Relaxes jaw tone and prevents spasms

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25
What is the instrument that depresses the base of the tongue and has a light source?
Laryngoscope
26
What are some complications associated with ET intubation?
``` Pressure necrosis of lining of trachea Plugged ET tube (mucus plug) Kinked tube Stimulation of vagus nerve Trauma Animal could chew tube during recovery ```
27
How long do you leave the cuff inflated when extubating the patient?
Until you see 2 good swallows or you see signs of recovery
28
What do you do if the animal vomits with an ET tube in?
Deflate the cuff 1/2 way and remove (the cuff acts a squeegee)
29
How are ET tubes cleaned?
With dilute antiseptic (like chlorhexadine) OK to submerge under water Inflate cuff to remove all mucus Use brush or pipe cleaner to clean inside Rinse and hang to dry with cuff inflated
30
What should you be aware of if lasers are being used during surgery?
The laser mixed with the high oxygen could start a fire Wrap ET tube with duct tape Use a special laser safe ET tube
31
What is the Corneal reflex
touch cornea with sterile swab, animal should blink and withdraw eye, should be present during surgical plane, more common in equine
32
What is the Ear flick reflex
Gently touch hairs on inside of ear and look for "flick" could be absent or present during surgical plane More reliable in cats
33
What is the Palpebral reflex
Gently tap medial canthus of the eye and observe blinking reflex Should be gone during surgical plane
34
What is Jaw tone
Open jaw and observe muscle tone, should have some tone but mostly relaxed Puppies and kittens have weak jaw tone
35
Eye position & Pupil size
Usually eyes will rotate ventromedial during surgical plane but can also be central Pupils should be slightly dilated during surgical plane
36
10 Common vital signs to monitor during anesthesia
``` Heart rate Pulse ECG Resp. rate MM color CRT Temp Blood pressure O2 saturation ETCO2 ```
37
Stage 1
``` Voluntary excitement phase- induction Immediately after admin of injectable or inhalant (usually rougher and longer) Animal is conscious, but disoriented HR & RR can be normal or increased All reflexes present ```
38
Stage 2
Involuntary excitement phase Begins with loss of consciousness, all reflexes present, animal is able to chew and swallow May have rapid movement of limbs, vocalization, struggling etc. Shorter stage 2 = better!
39
Stage 3, plane 1
Light plane of anesthesia Can be intubated Relaxed jaw tone NOT able to withstand sx.
40
Stage 3, plane 2
Medium plane of anesthesia Suitable for most surgical procedures Slight response to surgical stimulation Patient is unconscious and immobile
41
What is the normal RR during Stage 3, plane 2?
8-30rpm
42
Stage 3, plane 3
Deep plane of anesthesia Significant depression of circulation and respirations Excessively deep for most sx procedures Good plane for very painful surgery Marked muscle relaxation & slack jaw tone NO surgical response
43
Stage 3, plane 4
Anesthetic overdose Patient is too deep Drop in HR, BP, CRT and pale MM
44
Stage 4
Death CPCR necessary to save patient Turn off vaporizer
45
What are the 6 injectable anesthetic agents?
``` Barbiturates Cyclohexamines (dissociatives) Propofol Etomidate Neuroleptanalgesia Guaifenesin ```
46
What are the 2 main uses for Barbiturates?
Anticonvulsants (Pheno) | Euthanasia (Pento)
47
What is the ultra-short acting barbiturate?
Methohexital, thiopental | death row drug
48
Primary use of Phenobarbital
(Barbiturate) | Anticonvulsant
49
Primary use of Pentobarbital
(Barbiturate) Euthanasia solution ONLY DOUBLE THE ANESTHESIA DOSE!
50
Barbiturates properties
Controlled NOT reversible NO analgesia IV admin only
51
4 effects of barbiturates
1.CNS depression anti-convulsants excitement during induction and recovery (Prolonged stage 2) 2.Potent respiratory depression apnea with rapid admin or high doses decreased RR and depth 3.Cardiovascular depression decreased BP and cardiac output 4.Tissue irritation IV admin only
52
What breeds have increased potency with barbiturates?
Sighthounds & lean animals
53
Thiopental properties
(Pentothal) -Barbiturate Ultra-short acting Used to be used as induction agent No longer made in the US
54
Methohexital properties
(Brevital) -Barbiturate Ultra-short acting Best for use in sighthounds Death row drug
55
What are the 2 Cyclohexamines?
Ketamine (Ketaset, Ketalar, Vetalar) | Tiletamine (in Telazol)
56
Cyclohexamine uses and properties
``` Induction agent Controlled NOT reversible Some analgesia IV or IM admin. ```
57
Cyclohexamine mode of action
CNS STIMULATION Disrupts or scrambles nervous system pathways so they never make it to the brain "Trance-like" anesthesia- appears awake, but immobile and unaware
58
CNS effects of Cyclohexamines
- Increased CSF, intracranial pressure, and intraocular pressure - Lowers seizure threshold - Increased sensitivity to sound - Hallucinations
59
What drug combined with Cyclohexamines can help decrease the rough recovery?
Benzodiazepine tranquilizers
60
Cardiovascular effects of Cyclohexamines
Tachycardia Combine with Glycopyrrolate instead of Atropine Apneustic respirations
61
What are apneustic respirations
Breath holding, prolonged pause after inspiration
62
Other effects of Cyclohexamines
``` Catalepsy (increased muscle tone) Spastic reflexes Open, dilated eyes Nystagmus (mainly cats) Ptyalism (increased salivation) ```
63
What is ptyalism & what can help this?
Increased salivation | Anticholingergics can decrease this
64
How are Cyclohexamines metabolized?
Dogs- metabolized by the LIVER, then excreted Cats- excreted by the KIDNEYS only
65
Ketamine general properties
Most common induction agent Can be used for short procedures Can squirt into the mouths of aggressive cats (takes 5-10mins)
66
Advantages of IV Ketamine
Faster onset and recovery Decreased dose compared to IM No tissue irritation
67
Advantages of IM ketamine
Can be used in wild/fractious animals | Longer duration of anesthesia
68
Duration of IV & IM Ketamine
IV= 3-10min. IM= Dog: 20-30min, Cat: 30-60min.
69
What is the most common Ketamine combo?
Diazepam + Ketamine | commonly mixed with tranquilizer or sedative
70
What are the 3 advantages of Ketamine combos?
Increases muscle relaxation Decreases potential for seizures Smoother recovery
71
Ketamine-diazepam properties
Ket/Val IV ONLY! Very common Can mix in the same syringe
72
Tiletamine properties
Newer dissociative, very similar to Ketamine In Telazol Can be given IV, IM, or SQ (very useful for aggressive pts.)
73
Tiletamine common combo
``` Tiletamine & zolazepam (benzodiazepine tranquilizer) Decreases risk of seizures Increases muscle relaxation Smoother recovery ```
74
Porpofol general properties
``` (Propo-flo) -No family Common IV induction agent Oil in water emulsion (shake well) Milky white but is still given IV NOT controlled NO analgesia NOT reversible More expensive ```
75
Cardiovascular effects of Propofol
Hypotension immediately after injection due to vasodilation - usually short duration in healthy patients - IV fluids will minimize this
76
Respiratory effects of Propofol
Respiratory depression | -transient apnea if given rapidly
77
How should you give Propofol?
Slowly over 20-60seconds, titrate to effect Monitor respirations carefully for a couple min. Once respirations are good, turn on vaporizer
78
Why should you pre-oxygenate with Propofol?
Flow-by or mask patient | To increase the amount of oxygen saturated with hemoglobin
79
Propofol drug properties
Very short acting Rapidly metabolized Minimal hangover Wide margin of safety
80
Duration of Propofol
Duration= 5-10min. | Complete recovery= 20-30min.
81
Propofol shelf-life
Limited, no preservatives Ingredients support growth of bacteria Use within 6 hours- Ok to extend to 24 hours
82
PropoFlo28 general info.
Newer formulation Contains benzyl alcohol to minimize bacterial growth Lasts 28 days
83
Muscle myoclonus with Propofol
Seizure like muscle twitch during anesthesia- no treatment required and not common
84
IV injection of ____ prior to Propofol can decrease induction amount by __%
Benzodiazepine tranquilizer | 33%
85
Etomidate general properties
``` (Amidate) -No family Rapid acting Ultra short NO analgesia NOT controlled NOT reversible Very similar to propofol ```
86
Effects of Etomidate
``` Minimal cardio effects Mild respiratory depression (transient apnea) Wide margin of safety Rapid loss of consciousness Rapid, smooth recovery ```
87
Adverse effects of Etomidate
IV may cause pain/irritation in people High doses/CRI can cause RBC lysis Muscle rigidity/myoclonus- Benzos can minimize this
88
Etomidate endocrine effects
Suppression of adrenal-cortical axis for 6 hours in dogs and 3 hours in cats Single induction doses usually not a issue
89
Etomidate should be avoided with what patients?
Hypoadrenocorticism patients (Addison's Dz.) vNa ^K
90
Neuroleptanalgesics
Combo of opioid and tranquilizer or sedative | Used to achieve increased sedation and analgesia
91
When can Neuroleptanalgesics be used as a induction drug?
Only with SICK/debilitated patients | Will NOT produce unconsciousness in a young, healthy patient
92
Guaifenesin general properties
(Glycerol guaiacolate- GG or GGE) Muscle relaxant Given to large animals to help induce or maintain anesthesia
93
Common Guaifenesin combos
Ketamine, Diazepam, Xylazine | Triple drip: GKX
94
How are liquid anesthetics delivered?
They are vaporized then delivered by carrier gas (Oxygen)
95
Diffusion of anesthetic gas
Gas crosses ALVEOLI then wants to travel to a place with less concentration so it goes to the BLOODSTREAM then the BRAIN becomes saturated due to high blood flow
96
How is the rate of diffusion of anesthetic gas controlled?
by a concentration gradient between the alveoli and bloodstream (Goes from high to low concentration)
97
Concentration of gas in alveoli and blood during induction
``` Alveoli= increased concentration Bloodstream= decreased concentration ```
98
How is depth of anesthesia determined?
Concentration of anesthetic in the brain
99
How is anesthesia maintained?
By insuring concentration of anesthetic in alveoli, blood, and brain is maintained
100
When recovering, how is the concentration reduced?
When the gas in the alveoli is reduced, the higher concentration in the blood will diffuse from blood stream to the alveoli Then when the concentration of gas in the blood is less than the brain, it will diffuse from the brain, to the blood, to the alveoli
101
How long should animals receive 100% oxygen after the vaporizer is turned off?
5 minutes- creates a steep concentration gradient between the blood and alveoli
102
Precision vaporizers deliver inhalants as __ and are VOC. Meaning:
a % VOC= vaporizer out of circuit (Precision vaporizer)
103
What are the 6 inhalant anesthetics?
Iso Sevo Nitrous oxide Methoxyflurane Halothane Desflurane
104
Nitrous oxide properties
Stil used in human medicine (laughing gas) Wide margin of safety NEVER used alone!
105
Nitrous oxide provides ____ & ____
Good analgesia & muscle relaxation
106
Color of Nitrous oxide cylinder
Blue
107
What 3 things does the patient breathe when using Nitrous oxide?
Oxygen Nitrous Anesthetic gas
108
Respiratory effects of inhalant anesthetics
Decreased RR and Tidal Volume | -can lead to respiratory acidosis and atelectasis
109
Cardiovascular effects of inhalant anesthetics
Cardiovascular depression - Vasodilation, Bradycardia, Hypotension, Hypothermia...etc. - Increases heart's sensitivity to epinephrine
110
What are the 3 physical properties of inhalant gases?
Vapor pressure Solubility MAC value
111
What does MAC stand for?
Minimum Alveolar Concentration
112
What does vapor pressure measure?
the tendency of anesthetic to go from liquid to gas
113
Inhalants with high vapor pressure want to ___. Low vapor pressure gasses want to ___.
Be a gas (evaporate readily) | Be a liquid (slow evaporation)
114
High vapor pressure agents must use a ____ vaporizer to carefully control the % being evaporated.
Precision (VOC)
115
2 other words for VIC & anesthetic agent used with this.
Vaporizer In Circuit non-prescision Methoxyflurane
116
What 3 anesthetic agents need a VOC/Precision vaporizer?
Isoflurane Sevoflurane Halothane
117
What does the Solubility coefficient measure?
The solubility of an anesthetic gas in rubber tubing, blood, fat, and other tissues
118
What does Solubility provide info on?
SPEED of induction, depth change, and recovery
119
High solubility would mean that it is ____ dissolved in "stuff" and low solubility would mean it ____.
Easily | Will not dissolve easily
120
Inhalants with ___ solubility will move rapidly to the brain because they don't want to ____.
Low stay dissolved in blood, fat, etc. (faster induction, depth changes, and recovery)
121
Inhalants with ___ solubility are slower, so they will ____.
High be absorbed by tubing, blood, fat, tissues. (slower induction, depth changes, and recovery)
122
List the 4 inhalant drugs from lowest to highest solubility. (Fastest to slowest)
Sevoflurane--fastest: low solubility Isoflurane Halothane Methoxyflurane --slowest: high solubility
123
Inhalants with low solubility are best for what kind of induction?
Mask or chamber (faster= better)
124
Low solubility agents allow for ____ stage/plane changes and ____ recovery
Quick | Rapid
125
Define Minimum Alveolar Concentration
The minimum alveolar concentration (%) of gas that produces no response to surgical stimulation in 50% of patients
126
What is MAC measuring & this gives an indication of the ____
The % of gas in alveoli | Potency
127
The ____ the MAC the ____ the gas is.
Higher Less potent (more needed for sx)
128
The ____ the MAC the ____ the gas is.
Lower More potent (less needed for sx)
129
MAC x ___= light plane of anesthesia
1
130
MAC x ___= surgical plane of anesthesia
1.5
131
MAC x ___= deep anesthesia
2
132
List the inhalant agents from lowest to highest MAC
Methoxyflurane (most potent) Halothane Isoflurane Sevoflurane (least potent)
133
Halothane vapor pressure & solubility
High vapor pressure Medium solubility -fairly rapid induction, depth change, and recovery -popular with equine anesthesia
134
Adverse effects of Halothane
Sensitizes heart to epinephrine induced arrhythmias Increases vagal tone **Cardio depression **Respiratory depression- could lead to Atelectesis
135
___% of Halothane is metabolized by the liver and the rest is eliminated through the ____
20% | respiratory tract
136
Effects of Halothane
- Fair muscle relaxation - Slight analgesia - Malignant hyperthermia
137
What is malignant hyperthermia
A rare, but often fatal disorder of thermoregulation Results in increased temp. muscle rigidity, cardiac arrhythmias. Can happen with any inhalant gas, but more common with Halothane
138
Isoflurane vapor pressure and solubility
High vapor pressure Low solubility -rapid induction, depth change, and recovery -great for mask/chamber induction but can be irritating to mm
139
Isoflurane has ___ changes in depth of anesthesia (within ____ after vaporizer is changed)
Rapid | 1-2 minutes
140
Isoflurane has ___ recovery (within ____ after gas is turned off) But don't turn off vaporizer until ____.
Rapid 1-2 minutes Close to, or on last stitch
141
Isoflurane has a ____ MAC
Higher
142
Common induction % with Isoflurane= | Common maintenance %=
2.5% 1.5-2.5% (Settings vary from patient to patient!)
143
____ has a wider margin of safety than Halothane & has little effect on the heart.
Isoflurane * *Cardiovascular depression * *Respiratory depression
144
How much Isoflurane is metabolized? (%)
0.2% | the rest is exhaled
145
Isoflurane has excellent ____ but little to no ____ post-op
Excellent muscle relaxation Little or no analgesia post op (give pre-emptive & post op analgesics to prevent windup)
146
3 Sevoflurane facts
Newest inhalant anesthetic More expensive than Iso Less pungent odor and less irritating to MM than Iso
147
Sevoflurane has ____ vapor pressure & ____ solubility
High vapor pressure & has the lowest solubility
148
Which gas is the fastest acting?
Sevoflurane- lowest solubility
149
When should you turn off your vaporizer when using Sevoflurane?
Not until surgery is COMPLETE! | Rapid recovery
150
Which gas has the highest MAC value?
Sevoflurane
151
Sevo requires ____ vaporizer settings because it is ____.
Higher | the least potent (High MAC)
152
How much (%) Sevo is metabolized?
3% | the rest is exhaled
153
Effects of Sevo
Greater effect on the heart than Iso, but still considered safe Moderate muscle relaxation Little to no analgesia post-op Smoother recovery- cognitive/motor function **Cardio depression **Resp depression
154
Sevo has slightly more ____ than Iso
Respiratory depression | Decreased RR & Tidal Vol.
155
Sevo's manufacturer states that ____ & ____ return simultaneously which results in ____.
Cognitive & motor function | Smoother recovery
156
What is the only benefit of induction chambers?
Little physical restraint (good for feral patients)
157
What are the 4 disadvantages of induction chambers?
Only for small animals Difficult to monitor patient in chamber (vitals) No control of airway Not a good induction method for brachys or animals with resp. or cardio. problems
158
What 2 things do you need when using an induction chamber?
1. Inlet for gas/oxygen 2. Outlet for scavenge (fresh gas in, escaped gas to scavenge)
159
What is the induction chamber procedure?
1. Deliver 100% oxygen for about 5 min. | 2. Gradually add inhalant anesthetic by 0.5% increments every 10 seconds
160
The induction chamber procedure uses ____ vaporizer settings for a ____ induction.
Higher | Faster
161
How can you tell if a patient is ready to be intubated when using a induction chamber?
Observe for loss of righting reflex | Shake the chamber or bang on the glass
162
What are 2 disadvantages of mask induction
Some animals resist the mask which leads to stress | Not recommended for brachys or pts. with respiratory problems (no control of airway)
163
When using mask induction and the animal is stressed what could happen?
Stress causes release of epinephrine which can predispose patient to cardiac arrhythmias
164
When does the mask induction technique work best?
When the patient is calm or sedated
165
Mask induction procedure
Hook up rebreathing tubing (can also use NRB) Hook up tightest fitting mask to Y tubing Deliver 100% oxygen Gradually add inhalant increasing by 0.5% increments When patient appears relaxed, turn off vaporizer, remove mask and intubate
166
Mask induction will need ____ vaporizer settings for a ____ induction
Higher | Faster

Anesthesia -Scott Newman & Janet King (13 decks)

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