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Anesthesia -Scott Newman & Janet King > Unit 2 Notes > Flashcards

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Procedures to be done during the pre-anesthetic period

Assess patient, collect patient data, fast patient, give PA drugs, ET tube supplies ready, fill out anesthesia form, draw up induction agents, evaluate all equipment to be used.

1

PA Period Definition

The period of time immediately preceding induction (up to 24 hrs prior), in which you prepare yourself and the patient for the anesthetic procedure. Most important. Of anesthesia must look for potential complications

2

Steps to Evaluating anesthetic machine

Hook up breathing system, check O2 level and pressure gauge, check anesthetic gas levels, check O2 absorbing granules, pressure check for leaks

3

Reasons for placing IV catheters

* Should always be placed for any procedure, no matter how small! Allows forward administration of surgical fluids, rapid and easy administration of emergency drugs, administration of anesthetics that are irritating if given perivascular

4

Risks involved with placing an IV catheter

Introduction of the air into the bloodstream, developing broken catheter tips, accidental overhydration, catheter induced sepsis, giving drugs to rapidly

5

Supplies needed for placing an IV catheter

IV catheter, heparinized saline flush, tape, surgical clippers, surgical scrub, T-port

6

Choosing an IV catheter

Cats and small dogs 22 gauge average dog 20 gauge
large dog 18 gauge
giant breeds 18 to 16 gauge
*all breeds 1 inch length

7

How to tape a catheter in place

1. Half inch tape first with sticky side up under catheter. 2. Then take 1 inch tape with notch, place sticky side down under catheter 3. then take 1 inch tape placed proximal to the Catheter with half on tape half on skin 4. Place last piece of 1 inch tape distal to the catheter to create sterile surface

8

What size surgical clippers would you use

#40 blade

9

Standard surgical fluid rate

10mls/kg/hr

10

Hypotensive fluid rate

20mls/kg/hr
*5mls/kg/15min allow for increased monitoring

11

Crystalloid fluids

Replace fluid portion of blood only. Can cause hemodilution, should not use with hypotensive fluid rate.
Ex: LRS, Normosol, 0.9% NaCL

12

Colloid fluids

$$$- Replace cells and blood.
Ex: Whole blood, hetastarch, and Oxyglobin.

13

7 Steps to IV catheter placement

1. Get all supplies ready
2. clip area with 40 Blade
3. scrub area
4. place IV catheter
5. tape in place
6. attached T-port
7. flush catheter

14

Placing the IV catheter

1. Take cap off, place in T port tray to keep sterile 2. break seal 3. hold on top of catheter only using thumb and middle finger 4. drop catheter to patients arm, as flat as possible 5. Poke skin should see flash of blood using ring finger to put pressure on back of catheter to flatten out 6. advance into vain 7. flick catheter off of stylet 8. cap Catheter

15

Most common ET tube

Murphy Eye. Has inflatable cuff on distal end, the eye at the end of the tube allows air to enter if blocked.

16

Coal ET tube

Two different diameters of tubing within the same two. Original style, not commonly used anymore

17

Ways of running a successful anesthesia protocol

Know your drugs, have a basic understanding of physiological function, be able to monitor patient successfully, know the equipment you're using.

18

Presurgery bloodwork

PCV and TP
chemistry- evaluates liver (ALT/Alk Phos) and kidney (BUN/Creat) function

19

Protocol if poor liver and kidney function

Use gas anesthetic only

20

Do not run anesthesia PCV and TP values are less then

PCV- < 20%
TP- < 3.5 g/dl

21

Class one anesthetic risk

Excellent anesthetic risk. Completely healthy patient, six months to six years of age, elective surgery only

22

Class two anesthetic risk

Good anesthetic risk. Brachycephalic breeds and sight hounds, neonates and geriatrics, simple fractures and patients with mild systemic disease (Slight dehydration, murmurs and compensated heart disease)

23

Class three anesthetic risk

Fair anesthetic risk. Moderates a systemic disease, but not showing clinical signs (Pulse deficits moderate anemia, anorexia, chronic heart disease, chronic renal disease, compound fractures and shock, extremely fearful patients)

24

Class four anesthetic risk

Poor anesthetic risk. Severe systemic disease, constant threat to patients life, showing significant symptoms (Shock, severe dehydration, hypovolemia, diabetic patients, GDV, severe pulmonary disease)

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Class five anesthetic risk

Guarded anesthetic risk. Morbid patients, not expected to live 24 hours with or without surgery terminal malignancy (Severe trauma, multi- organ failure, DIC patients)

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Breeds that can never be class one

Brachycephalic dogs and sight hounds

27

Went to add an E to anesthetic risk classifications

Can only be added to classes two through five. GDV and pyometra

28

Why do we use PA drugs

Sedate and calm the patient, preemptive analgesia, reduce amount of induction, maintenance and post op drugs, decreased salivary secretions, intestinal movement and prevent bradycardia, provides smooth recovery, Adjunct to local or regional to prevent movement

29

Five classifications of routine PA drugs

1. Anticholinergics- glycopyrrolate and atropine.
2. Tranquilizers- phenothiazines and benzodiazepines.
3. Sedatives (alpha-2)- xylazine and Medetomidine.
4. Opioids- morphine and Buprenorphine.
5. Neuroleptanalgesia- combo of sedatives or tranquilizer with an opioid

30

What three main effects do anticholinergics achieve

1. *Drying agent, dry secretions
2. *Block vagal tone, prevents drop in heart rate
3. Reduce gastric and intestinal motility

31

SLURED ❤ Affects of anticholinergics

S- decrease salivation, positive effect
L- decrease Lacrimal secretions, negative affect must do the eyes
U- Decreased contractions of bladder and ureter, not an issue
R- Decreased respiratory secretions, negative affect causing thick mucus
E- Mydriasis, not an issue
D- Decrease G.I. motility, not an issue
❤- Increased heart rate, block vagal response

32

Unwanted reactions of anticholinergics

May cause initial bradycardia after IV administration, sinus tachycardia which increases O2 supply, first and second degree AV blocks, colic in horses

33

Indications for use of anticholinergics

Use with bradycardia, use with drugs that cause vagal stimulation, use if procedure will cause vagal stimulation

34

Atropine length of duration

60-90 min

35

Atropine can treat what

Bradycardia and AV blocks

36

Contraindications for atropine

Tachycardic patients and patients with ileus or constipation

37

Glycopyrrolate length of duration

4-6 hours

38

Advantage of glycopyrrolate

Prevents bradycardia without causing tachycardia

39

Atropine sulfate namebrand

Atropine®

40

Sedatives are also known as what

Alpha-2 agonist

41

Properties of tranquilizers as PA drugs

Relaxation and calmness, management of patients fear, anxiety and aggression by depressing the CNS.

42

Tranquilizers do not provide what

Analgesia

43

General characteristics of tranquilizers

Work on CNS, can cause ataxia, or prolapse of third eyelid

44

Three groups of tranquilizers

Phenothiazines, benzodiazepines, butyrophenones

45

Acepromazine name brand and group

Promace®
phenothiazine

46

Diazepam name brand and group

Valium®
benzodiazepine

47

Midazolam name brand and group

Versed®
Benzodiazepine

48

Zolazepam name brand and group

Telazol® (with Tiletamine)
Benzodiazepine

49

Droperidol Name brand and group

Innovar-Vet® (with Fentanyl)
Butyrophenone

50

Physical properties of Acepromazine

Water-soluble, mental calming and decreased motor activity. Improves analgesic effects of other agents

51

Acepromazine duration of action

4-8 hours

52

Acepromazine route of elimination and administration

Elimination via the liver. Administration by oral, or more commonly parenteral

53

Main side effects of acepromazine

Tachycardia, hypotension, hypothermia, decrease seizure threshold, Respiratory depression, personality changes

54

3 Benzodiazepine drugs

Diazepam, Midazolam, Zolazepam

55

Acepromazine maximum dose

3mg, but will never reach this dose in clinical use.

57

Benzodiazepines are controlled substances

True
Class IV

58

Diazepam is not water-soluble and therefore cannot...

Mix with other agents
Absorption IM or SQ is unreliable

59

Midazolam and Zolazepam are water-soluble and therefore can...

Mix with other agents, but have no analgesic properties

60

Main affects of benzodiazepine

Minimal CNS depression, skeletal muscle relaxation, anticonvulsant, Minimal hypotension, increased anxiety in cats

61

Benzodiazepine duration of action

Rapid onset of action, duration of 1-4 hours

62

PA drug of choice for seizure patients

Benzodiazepines

63

Diazepam route of administration

Most commonly IV, can also be given rectally at 2x IV dose

64

Midazolam and Zolazepam routes of administration

IV, IM, or SQ

65

Sedatives/alpha-2 agonist drugs

Xylazine, Medetomidine, Detomidine, and Dexmedetomidime

66

Alpha-2 agonist definition

Causes a decrease in the level of the neurotransmitter Nor-epinephrine release, causing sedation and analgesia

67

Sedatives/alpha-2 agonist cause what the effects

Profound sedation five times more potent then with Acepromazine. Produce calming, sedation, muscle relaxation and analgesia

68

Negative side effects of sedatives/alpha-2 agonist

Bradycardia and sometimes hypotension

69

Sedative/alpha-2 agonist routes of administration

IV, SQ, IM, PO- All are water soluble and very reliable

70

Xylazine brand name

Rompun®

71

Xylazine advantages

Good muscle relaxation and minimal respiratory depression

72

Xylazine disadvantages

Peripheral vasoconstriction and vomiting

73

Medetomidine brand name

Domitor®

74

Medetomidine advantages

Powerful analgesic, 100x more potent than xylazine and good muscle relaxation

75

Medetomidine Disadvantages

Profound bradycardia and vomiting

76

Medetomidine Duration of action

Up to 1.5 hours with minimal respiratory depression

77

Xylazine reversal agent

Yohimbine

78

Alpha-2 agonist reversal agent

Tolaxoline

79

Medetomidine reversal agent

Atipamazole

80

Not a specific antagonist, but is useful for reversing respiratory depression while keeping the patient sedate

Doxapram

81

Three types of opioid receptors

Mu- sever pain
Kappa- mod pain
Sigma- chronic pain

82

Morphine potency and Classification

1x, Pure agonist

83

Oxymorphone potency and classification

5-10x, Pure agonist

84

Fentanyl potency and classification

100x, Pure agonist

85

Butorphanol potency and classification

2-5x, Mixed opioid
Stimulates Sigma/Kappa &
Blocks Mu

86

Buprenorphine potency and classification

3-5x, Partial Mu agonist

87

Hydromorphone Potency and classification

7x, Pure agonist

88

M-99 Potency and classification

1,000x, pure agonist

89

Most effective medication for the treatment of pain

Opioids

90

When is an opioid best given and why

During PA period, To provide preemptive analgesia

91

Opioid duration of action

30min- 12hrs

92

CNS effects of opioids

Depression or excitement depending on dose, drug, and species

93

G.I. effects of opioids

Increases peristaltic movement, nausea and vomiting

110

Benzodiazepine reversal agent

Flumazenil

111

Morphine advantages

Inexpensive and good sedation/analgesia

112

Morphine disadvantages

Mania in cats and respiratory depression
Vomiting

113

Oxymorphone brand name

Numorphan®

114

Oxymorphone max dose

3mg

115

Opioids are controlled substances

True
Most- Class II-N
Torb- Class IV
Buprenorphine- class III

116

Oxymorphone advantages

Less vomiting and cardio depression
Good sedation/analgesia

117

Oxymorphone disadvantages

Expensive and respiratory depression

118

Fentanyl injectable brand name

Sublimaze®

119

Fentanyl patch brand name

Duragesic®

120

Fentanyl advantages

Mild sedation with very good analgesia and can be reversed

121

Fentanyl disadvantages

Decrease in tidal volume and short duration < 30min

122

Opioid that is used in patients with pulmonary edema and heart failure because it will increase the capacity of the great veins

Morphine

123

Butorphanol brand name

Torbugesic®

124

Butorphanol advantages

Visceral analgesia (Kappa) Potentiates action of other anesthetic agents

125

Butorphanol disadvantages

Unreliable sedation when used alone and controlled substance

126

Buprenorphine brand name

Buprenex®

127

Buprenorphine Advantages

Long-term analgesia about 10 hours and mild sedation with no excitement (good for cats)

128

Buprenorphine Disadvantages

Unreliable sedation when used alone and difficult to reverse

129

M-99 brand name

Etrophine®

130

When using what drug, must you have Naloxone ready to use In case of contact with the person administering the medication, not so much for the patient

M-99

131

Hydromorphone brand name

Dilaudid®

132

Opioid used in cats and humans only

Hydromorphone

133

Opioid reversal agent

Naloxone

134

Naloxone brand name And classification

Narcan®
Pure antagonist

135

3 main actions of NSAIDs

Anti-inflammatory, antipyretic, and analgesia

136

NSAID drugs

Phenylbutazone, Carprofen, Deracixib, Tepoxalin

137

Phenylbutazone brand name and use

Butazolidin®
Equine anti-inflammatory only

138

Carprofen brand-name and use

Rimadyl®
Joint abnormalities in dogs
General Cox inhibitor

139

Deracixib Brand-name and use

Deramaxx®
Osteoarthritis pain
Cox-2 inhibitor

140

Acetaminophen brand-name and use

Tylenol®
effective for both anti-inflammatory and analgesia
never give to animals

141

Tepoxalin Brand-name and use

Zubrin®
Cox-2 inhibitor

142

Meloxicam brand-name and use

Metacam®
Cox-2 inhibitor