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Rotation 6
Monitoring
69
Veterinary Medicine
Undergraduate 3
02/21/2014

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Cards

Term
What is included in a state of general anesthesia?
Definition
relaxation of skeletal muscles, reduction of protective reflexes, unconsciousness
Term
If a patient is on a light plane on anesthesia and a painful stimulation is applied, what will you see?
Definition
increased respiratory rate
Term
How many stages of general anesthesia are there?
Definition
4
Term
What happens in the first stage (State 1) of general anesthesia?
Definition
exaggerated response to all stimuli; CNS excitement
Term
What happens in the second stage (State 2) of general anesthesia?
Definition
delirium or struggling may occur; excess epinephrine levels may occur
Term
What happens in the third stage (State 3) of general anesthesia?
Definition
sleep or surgical state of anesthesia
Term
What are the planes that stage 3 gets divided into?
Definition
plane 1, 2, 3 and 4
Term
What happens during plane 1 of general anesthesia?
Definition
light plane of anesthesia; RR 12-20, HR 90-120; eyes are rotated medially and the 3rd eyelid is prolapsed; all reflexes present; muscle tone still evident; usually can intubate
Term
What happens during plane 2 of general anesthesia?
Definition
considered the normal surgical plane; increased RR may be seen as surgery is finishing; mild decrease in HR and BP; slight medial rotation of the eyeball with the 3rd eyelid still prolapsed; pupil constricted or moderately dilated; palpebral reflex is absent; toe pinch reflex is also absent; muscle tone is generally absent but degree of relaxation will depend on the anesthetic agent used
Term
What happens during plane 3 of general anesthesia?
Definition
very deep plane and only desireable for very manipulative surgical procedures; shallow and irregular breathing, less than 8 per minute; decease in HR and lowering of blood pressure; CRT will extend beyond 2 sec; eyeball is centrally fixed and the 3rd eyelid is not as prolapsed
Term
What happens during plane 4 of general anesthesia?
Definition
considered an overdose plane of anesthesia with the respiratory system and the cardiovascular system in danger of failing; respiration is shallow and irregular; HR and BP decreased; prolonged CRT; eyeball is centrally fixed; pupil is widely dilated and does not respond to light; reflexes are absent (loss of anal tone is a crude indicator of excessive anesthetic depth);
Term
What happens in the fourth stage (State 4) of general anesthesia?
Definition
terminal stage; cardiac muscle and brain tissue are in danger of failing; immediate resuscitative measures are needed
Term
What are the main signs used to monitor anesthesia?
Definition
HR and rhythm, RR and rhythm, arterial pulse and blood pressure, temperature, MM color, CRT, pupil size, reflexes
Term
What happens to the heart rate during anesthesia?
Definition
decreases by 10%
Term
What happens to the heart rate during induction?
Definition
may increase due to epinephrine release
Term
Define bradycardia
Definition
slow/decreased heart rate
Term
When is a heart rate considered too slow in a dog/cat?
Definition
dog, less than 70; cat, less than 80
Term
What ways can you monitor a HR?
Definition
digital palpation; Audio Patient Monitor (APM); ECG/EKG; Oscilloscope; Doppler flow detector
Term
How does the Audio Patient Monitor work?
Definition
it is connected to an esophageal stethoscope and amplifies the heart and lungs sounds
Term
How does the Doppler flow detector work?
Definition
monitors arterial pulses through vessels
Term
Which arteries are used for monitoring?
Definition
superior palmar metacarpal and plantar metatarsal
Term
What happens to the tidal volume of air under general anesthesia?
Definition
decreases by 25-30%
Term
How can you calculate the amount of tidal air?
Definition
5ml/lb
Term
What is the minute volume?
Definition
air exchanged with each minute
Term
How can you calculate the minute volume?
Definition
MV = TV x RR
Term
What happens to the RR under general anesthesia?
Definition
may decrease to 10-16 BPM
Term
What ways can you monitor the RR?
Definition
esophegal stethoscope, grossly watching
Term
What is the measurement of blood co2?
Definition
capnometry
Term
What do you look for when checking arterial pulse and blood pressure?
Definition
check for the character of the pulse wave and to check the heart rate
Term
When do pulse deficits occur?
Definition
when the heart rate exceeds the pulse rate
Term
What arterial vessels are used for monitoring?
Definition
femoral, lingual, metacarpal, metatarsal
Term
What causes a decrease in body temperature?
Definition
general anesthesia
Term
Which patients lose heat faster and why?
Definition
small animals will lose body heat faster because of a higher surface area to body mass ratio
Term
What measures can you take to preserve body temperature?
Definition
do not place animal directly on a stainless steel table; avoid drafts; cover with blanket or towels during recovery; use warm water circulating pads; styrofoam positioning pads on surgery table; heating pads
Term
What can happen when a patient becomes hypothermic?
Definition
hypothermia may slow the rate that the anesthetic is metabolized which results in a prolonged anesthetic time
Term
What happens to MM when animals are breathing 100% o2 when on inhalation anesthetics?
Definition
membranes will appear more pink
Term
If you do a CRT and blood pressure is low, what will you see?
Definition
an abnormally long time will be needed for the color to return
Term
What happens to the pupils under general anesthesia?
Definition
a pupil that is widely dilated indicates a deep level of anesthesia
Term
What is the palpebral reflex and when is it seen?
Definition
When touching near the corner of the eye, the animal will blink; it is present in the awake or lightly anesthetized animal
Term
What is the pedal reflex and when is it seen?
Definition
assessed by pinching the middle toe and observing for contraction of the limb; present in the awake or lightly anesthetized animal
Term
What is the jaw tone reflex?
Definition
should be diminished during induction in order to pass an endotracheal tube
Term
What is the anal tone reflex?
Definition
loss of anal tone is considered a crude indicator of excessive anesthetic depth
Term
What does a pulse oximetery unit do?
Definition
measurement of hemoglobin saturation with oxygen
Term
What is NOT detected by the pulse ox?
Definition
tachycardia (fast heart rate)
Term
Where can a pulse ox probe be placed?
Definition
tongue, vulvar mucosa, shaved ear, toe webbing, rectal probe
Term
What can interfere with a pulse ox reading?
Definition
patient motion, poor positioning of probe, skin pigment, hair, poor peripheral vasoconstriction, pigmentation of the tissues
Term
What is a desired oxygen saturation reading on a pulse ox?
Definition
95% or greater
Term
When do CO2 levels increase?
Definition
respiratory function is depressed; hypoventilation occurs
Term
For the respiratory system, what are signs of anesthetic emergencies?
Definition
decreased rate of ventilation (<8/min); decreased depth; apnea (absence of respirations); cyanosis
Term
What medication is used in case of respiratory arrest as a respiratory stimulant?
Definition
Dopram
Term
For the circulatory system, what are signs of anesthetic emergencies?
Definition
decreased heart rate (<70 BPM for the dog and <80 for the cat); decreased pulse pressure leading to shock; prolonged capillary refill time (CRT); hypothermia (cold to touch)
Term
What fluid is good for shock therapy?
Definition
Lactated Ringers
Term
What is the IV fluid shock rate for dogs?
Definition
90 ml/kg/hr
Term
What is the IV fluid shock rate for dogs?
Definition
45 ml/k/hr
Term
What drug is used in case of cardiac arrest?
Definition
epinephrine
Term
What is another sign when dealing with an anesthetic emergency?
Definition
widely-dilated pupils
Term
What are the signs of cardiopulmonary arrest?
Definition
mucous membrane color becoming pale or capillary refill time increasing beyond 2 seconds; reduction of the heart rate; changes in the parameters of the respiratory or cardiovascular system
Term
When should cardiopulmonary resuscitation be performed?
Definition
when sudden apnea occurs and the heart action in not sufficient to adequate circulation
Term
What are 3 anesthetic emergencies?
Definition
anesthetic overdose and cardiopulmonary arrest; aspiration; airway obstruction
Term
What are signs of aspiration pneumonitis?
Definition
wheezing; harsh RR; cyanosis; dyspnea; can occur in induction as well as recovery
Term
What are treatments for aspirations?
Definition
100% O2 therapy with O2 cage or nasal catheter; broad spectrum antibiotics; corticosteroids; bronchodilating drugs; may need tracheostomy
Term
What are signs of airway obstructions?
Definition
accumulation of secretions; soft tissue obstruction (soft palate, more in brachycephalic breeds); collapsing trachea; space occupying tumors in the mouth; inflamed tonsils; laryngospasm
Term
What are mechanical signs of airway obstructions?
Definition
dislodged endotracheal tube; occluded breathing tubes; sticky inhalation or exhalation valves; overinflated rebreathing bag; kinking of the endotracheal tube; occlusion of the endotracheal tube
Term
What can be used to assist in respiration?
Definition
Ambu bag
Term
What are the ABCD's of CPR?
Definition
A= Airway. Establish an airway via trach tube
B= Breathe/ventilate patient at 5 breaths per minute
C= Cardiac compressions at 80 to 100/minute
D= Drug therapy
Term
What are the key factors in drug metabolism?
Definition
liver function, body temperature, kidney function
Term
What is the Jorvet Vetalarm? How does it work?
Definition
respiratory monitor or apnea monitor that connects between endotracheal tube and anesthesia hoses; will detect changes in the temperature of the expired gases; alarm will sound if animal does not breath within pre-set interval
Term
What does the Ocsilloscope do?
Definition
provides the ECG tracing on a TV type screen
Term
What is a Doppler pressure monitoring device?
Definition
will measure the blood pressure by the indirect method; a sensor is placed over a peripheral artery
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