Term
| Why do we bother monitoring anesthesia? |
|
Definition
-patient cannot maintain normal homeostasis under anesthesia
-ensure safety for the patient and allows monitoring the depth of anesthesia
-prevents complications before they arise
=> EARLY DETECTION = EARLY CORRECTION <= |
|
|
Term
What is the anesthetic mortality for the following species:
a) Dogs
b) cats
c) equine
d) human |
|
Definition
a) 0.17%
b) 0.2%
c) 2.0%
d) 0.01- 0.02% |
|
|
Term
| What factors increase the risk of anesthetic mortality? |
|
Definition
-Age: super young and super old
-Weight
-ASA status: goes up the more sick you are
-urgency or complexity of the procedure |
|
|
Term
|
Definition
-ALWAYS
-Anesthesis: pre, intra and post- anesthetic periods
-sedation |
|
|
Term
|
Definition
-circulation
-oxygenation
-ventilation
-temp |
|
|
Term
| Anesthetic depth is determined by what three things? |
|
Definition
-amount of anesthetics in the brain
-magnitudes of surgical stimulation
-conditions that can have a synergistic effect on CNS depression |
|
|
Term
| Describe the physical signs of the IV stages of anesthetic depth. |
|
Definition
-Stage I: disorientation
-Stage II: excitement
-Stage III: surgical (Plane 1, 2, 3, or 4
-Stage IV: severe medullary depression |
|
|
Term
| What does the phrase "MAC awake" mean? |
|
Definition
| -response to verbal command |
|
|
Term
| What does the phrase "MAC incision" mean? |
|
Definition
| -prevention of muscular movement |
|
|
Term
| What does the phrase "MAC bar" mean? |
|
Definition
| -block of autonomic response to skin incision |
|
|
Term
| What are the signs we test to determine anesthetic depth |
|
Definition
-movement: purposeful or swallowing
-palpebral reflex
-autonomic response: towel clamps
-Mandibular tone: only for SA
-pupillary light reflex
-eye position
-lacrimation and nystagmus: horses |
|
|
Term
| What kinds of animals exhibit spontaneous chewing when lightly anesthetized? |
|
Definition
|
|
Term
| True or False: The eyeball always rotates under anesthesia. |
|
Definition
| -FALSE, it does not rotate with ketamine |
|
|
Term
| Fast nystagmus means wheat? |
|
Definition
| -horse, swine, and ruminants are light |
|
|
Term
| What is the purpose of an encephalogram? |
|
Definition
-relies on various brain indices to determine anesthetic depth
-changes from low-amplitude, high frequency during the awake state to high amplitude low-frequency pattern during anesthesia to burst suppression and finally persistent electrical silence with deep levels of anesthesia |
|
|
Term
| What is the anesthetic significance of bradycardia? |
|
Definition
| -may diminish overall CO even though SV will increase due to longer filling time |
|
|
Term
| What is the anesthetic significance of tachycardia? |
|
Definition
| -diminish CO and reduce SV (when treating ust be careful b/c may be compensatory) |
|
|
Term
| What is the anesthetic significance of ventricular arrhytmisas? |
|
Definition
| -evidence of impaired forward flow, ventricular rhythm may proceed to v-fib |
|
|
Term
| How do we use esophageal stethoscopes monitor the CV system? |
|
Definition
-regularity of HR and quality of tones
-quality of breath sounds: wheezes or stridor
-avoided in patients with esophageal disordrs |
|
|
Term
| Describe the clip method when monitoring the CV system. |
|
Definition
-white on right
-smoke over fire
-green is gound lead |
|
|
Term
| Any contraindications to CV leads? |
|
Definition
| -none, should be used in all anesthetized patients |
|
|
Term
| What are the 4 possible causes of bradycardia? |
|
Definition
-anesthetic agents
-increased vagal tone
-metabolic
-heart disease |
|
|
Term
| What are the 5 possible causes of tachycardia? |
|
Definition
-light plane of anesthesia
-drugs
-metabolic disease
-heart disease |
|
|
Term
| Hypotension MAP is what? Systolic? |
|
Definition
|
|
Term
| What is the MAP of hypertension? Systolic? |
|
Definition
|
|
Term
| What are the effects of hypotension on the CV system? |
|
Definition
-low venous return
-poor diastolic function
-poor systolic function
-impaired systolif efficiency
-bradycardia
-low systemic vascular resistance |
|
|
Term
| What are the CV system effects of hypertension? |
|
Definition
-vasoconstriction
-light plane aneshtesia
-sympathomimetic drugs
-renal failure
-Cushing disease
-hyperparathyroidism
-pheochromocytoma
-elevated ICP |
|
|
Term
| True or False: Pressure is a measure of organ perfusion. |
|
Definition
| -FALSE, pressure is an indicator NOT a measure of organ perfusion |
|
|
Term
| What is systolic uptroke? What does the rate indicate? |
|
Definition
-ventricular ejection
-rate indicates contractility |
|
|
Term
| What is peak systolic pressure? |
|
Definition
| -max pressure generated during the systolic efection (poor compliance causes a very high peak) |
|
|
Term
| What is the systolic decline? |
|
Definition
| -rapid decline and where ventricular contraction comes to an end |
|
|
Term
| What is the dicrotic notch? |
|
Definition
| -represents the closing of the Ao valve, will move in position in accordance to where hte arterial line is placed |
|
|
Term
| What is the diastolic run? |
|
Definition
| -ventricular contraction coming to an end and the peripheral vascular resistance |
|
|
Term
| What is end-diastolic pressure? |
|
Definition
| -this pressure is exerted by the vascular tree backk upon the aortic valve (aortic regurgiitation will cause this to be lower than normal as the back pressure will not meet the aortic volve but will follow along the ventricle via the regurgitate jet) |
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|
Term
|
Definition
|
|
Term
| What is the equaiton for mean arterial pressure? |
|
Definition
| (2/3 diastolic) + (1/3 systolic) |
|
|
Term
| Definition: Venturi effect |
|
Definition
| -the reduction of fluid pressure that results when a fluid flows through a constricted section of pipe (ex: aorta) |
|
|
Term
| Definition: Windkessels effect |
|
Definition
| -the term that accounts for the shape of the arterial waveform; has to do with the elastic recoil of very large arteries, aids to dampen the fluctuation in BP over the cardiac cycle and maintains perfusion in diastole |
|
|
Term
| Outline the steps for using an aneroid manometer. |
|
Definition
1. Close stopcock #1 to the patient and stopcock #2 to the aneroid meter
2. Expel all the fluid and air in the middle tubing that was left over from the last readinf from stopcok #2 through stopcock #1
3. Close stopcock #2 to the syringe and inject saline from syringe 1 into the tubing toward the manometer until the pressure is well above MAP of the patient
4. clost stopcock #1 to the syringe allowing saline to flow from the high pressure with the tubing into the patient
5. The equalized pressure represents the MAP |
|
|
Term
| Where on the body do we measure indirect BP? |
|
Definition
| -forelimb, hindlimb, tail |
|
|
Term
| To take an indirect BP, the width of the cuff should be ___% the circumberene of the appendage. Why? |
|
Definition
-40%
-too narrow = overestimate & too big = underestimate |
|
|
Term
| How is Doppler used in wildlife species? |
|
Definition
| -the first audible sounds are approximated of systolic pressure (cannot measure diastolic pressure) when hear double sounds you are hearing the diacritic notch |
|
|
Term
| Definition: Doppler effect |
|
Definition
| -the shift of frequency of sound waves when their source moves relative to the observer |
|
|
Term
|
Definition
| -inflation and deflation of the cuff occur and hte fluctuations in cuff pressure are measured, the mean pressure is taken as the cuff pressure at which max oscillaiton occur |
|
|
Term
| Indirect measuring of BP is noninvasive but tends to (over-/underestimate) systolic and (over-/underestimate) BP in hypotensive and a wider variabiity when compared to IBP. |
|
Definition
-underestimate
-overestimate |
|
|
Term
| What is the purpose of measuring the central venous pressure (CVP)? |
|
Definition
| -approximates right atrial pressures |
|
|
Term
| What three charateristics of the pulmonary system do we monitor? |
|
Definition
-breathing rate
-rhythm
-effort |
|
|
Term
| How do we monitor breathing rate? |
|
Definition
-chest wall movements
-movement of reservoir bag
-auscultation |
|
|
Term
| Physiological dead space composes what percentage of TV and MV? Does it decrease or increase with rapid shallow breathing? |
|
Definition
|
|
Term
| Describe the equation for compliance. |
|
Definition
| -Expired TV / change in pressure that it took to generate the breath |
|
|
Term
| Peak pressure = (dynamic/static) compliance & pause pressure = (dynamic/static) compliance. |
|
Definition
|
|
Term
|
Definition
| -normal breahting rate and pattern |
|
|
Term
|
Definition
|
|
Term
|
Definition
| -decreased respiratory rate |
|
|
Term
|
Definition
|
|
Term
|
Definition
| -normal rate with deep respiration |
|
|
Term
| Definition: Cheyne-Stokes |
|
Definition
| increases and decreases in rate with periods of apnea |
|
|
Term
|
Definition
| -gasp with short pauses between sets |
|
|
Term
|
Definition
| -increased rate and depth of breathing |
|
|
Term
|
Definition
| -prolonged inspiratory with shortened expiratory |
|
|
Term
|
Definition
| -feeling associated with impaired breathing |
|
|
Term
| What are a few of the million causes of tachypnea and exaggerated breathing? |
|
Definition
-light plane of anesthesia
-deep level of anesthesia
-hypoxemia, hypercapnia, hyperthermia
-hypotension
-atelectasis
-airway obstruction
-excitement stage of anesthesia
-post-op pain
-post-op delirium
-post-op bladder distention |
|
|
Term
| What does capnography measure? |
|
Definition
| -end-tidal CO2 concentration |
|
|
Term
| Describe the usual PetCO2 in dogs. What about in horses? |
|
Definition
-Dogs: 3-6 mmHg
-Hoses: 10-15 mmHg |
|
|
Term
| How does tachypnea graphically appear? |
|
Definition
| -will not have good separation of anotomic and alveolar gases thus baseline does not go down to zero |
|
|
Term
|
Definition
|
|
Term
| What are the most frequent problems with oxygen? |
|
Definition
| -motion artifact and signal-noise ratio |
|
|
Term
|
Definition
| -the pO2 where 50% of Hb is saturated |
|
|
Term
| Can see cyanosis when unoxygenated Hb is __mg/dL. |
|
Definition
|
|
Term
| What are a few of the 5 factors that can cause hypoxia? |
|
Definition
-low FiO2
-hypoventilation
-V/Q mismatch
-diffusion barrier
-anatomical shunts |
|
|
Term
| What is the significance of oximetry? What are the values for HbO2 and DHb? |
|
Definition
-oxygenated and deoxygentaed Hb differ in their absorption of red and infrared light
-HbO2 = 940 nm
-DHb = 660 nm |
|
|
Term
|
Definition
-the change in light absorption during pulsatile flow is the basis of determination, the ratio of absorptions at the red and infrared wavelengths is analyzed by a microprocessor to proved the Sp O2
-the greater the ratio the lower the saturation |
|
|
Term
| What are some causes of oximetry artifacts? |
|
Definition
| -excessive ambient light, mortion, methylene blue dye, venous pulsations, low perfusion, malposition of sensors, leakage of light from the emitting sensor diode, bypassing the arterial bed (optical shunting) |
|
|
Term
| Oxygen and nitrogen (do/ do not) absorb infrared light) |
|
Definition
|
|
Term
| There are two ways in which light can go through measuring for pulse oximetry. What are they? |
|
Definition
|
|
Term
| Describe the transmission of light in pulse oximetry. Is it common or rare? |
|
Definition
-the emitter and photodector are on opposite sides with the measuring site in-between
-most common |
|
|
Term
| Describe reflection pulse oximetry. |
|
Definition
| -the emitter and photodector are next to each other on the top of the measuring site |
|
|
Term
| What does the Bee portion of the Beer-Lambert law say? What about the Lambert part? |
|
Definition
-absorption of light is prop to the concentration of a sample
-absorption is prop to the thickness of a sample |
|
|
Term
| What are some of the sources of error for pulse oximetry? |
|
Definition
-movement
-electrocautery
-BP cuff
-high intensity light
-pulse strength
-venous pulse
-dyshemoglobinemias |
|
|
Term
| Temperature should always, always be measured. What are some of the effects of hypothermia? |
|
Definition
-delayed drug metabolism
-inc glood glucose
-vasoconstriction
-impaired coagulation
-decreased immune function |
|
|
Term
| Temperature should always, always be measured. What are some of the effects of hperthermia? |
|
Definition
-tachycardia
-vasodilation
-neuro injury
-metabolic acidosis
-cellular damage over 108 deg |
|
|
Term
|
Definition
| -semiconductors: resistance decreases predictably with warming |
|
|
Term
| How do thermocouples work? |
|
Definition
| -circuit of two dissimilar metals: potential difference is generated at different temperatures |
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