Term
| How to check ET tube function |
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Definition
- Attempt to bag pt, see if chest rises. If tube blocked, no movement seen and resistance to passage of air into pt
- Disconnect from machine. w/ ET tube in place, feel for air coming from tube when chest is pressed. If no air felt, may be blocked.
- If blocked, remove tube and replace
- If blood, mucus or similar material is causing obstruction, can suction w/ 20 ml syringe and feeding tube cut to length of ET tube |
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Term
| Signs of ET tube blockage |
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Definition
- Exaggerated breathing pattern
- Reservoir bag no longer inflating/deflating
- May become dyspneic, develop cardiac arrhythmias, respiratory arrest |
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Term
| Can anesthetic vaporizers ever be safely tipped? |
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Definition
| No, tipping may lead to leakage of anesthetic into the oxygen bypass channel, resulting in higher concentrations of anesthetic reaching the pt and therefore potential overdose. |
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Term
| Are multidrug protocols generally safer than the use of just one or two drugs |
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Definition
| Yes, provided that the doses of the individual drugs are appropriately reduced. Ex: conc of iso needed to anesthetize an animal is sig reduced if premed w/ ace/butorphanol, compared to no premed. |
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Term
| Should obese animals receive anesthetic doses based on their actual body weight rather than their ideal body weight? |
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Definition
| No, it should be based the weight halfway between the normal breed weight and the actual weight. This because the blood supply to fat is relatively poor, anesthetics are not efficiently distributed to fat stores |
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Term
| What are, and are not, the inherent risks associated with performing anesthesia on a patient for a caesarean section? |
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Definition
Dam Risk Factors:
- Increased workload to heart
- Resp may be compromised
- Increased tendency to vomit or regurgitate
- Increased risk of hemorrhage
Strategies to decrease risk
- Admin IV fluids
- Clip pt before induction
- Preoxygenate
- Use lowest effective dose of gen anesthetic
- Avoid pentobarbital and ket-val
Offspring Risk Factors
- Anes agents cross placenta and may reduce resp and cardiovascular fxn
Strategies to decrease risk
- Use reversal agents and doxapram
- Administer oxygen by mask
- Administer atropine for bradycardia |
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Term
| A geriatric patient is one that has reached what % of its expected life expectancy? |
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Definition
| 75% of life expectancy for that species and breed |
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Term
| Sighthounds show an increased sensitivity to which class of anesthetic agents? |
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Definition
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Term
| Which drug can be used to stimulate respiration in neonatal patients after a cesarean section? |
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Definition
Doxapram to stimulate respiration
Atropine to combat bradycardia |
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Term
| Which agent should be avoided for caesarian sections because pediatric patients and neonates poorly metabolize it? |
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Definition
| Use of diazepam should be avoided because it is poorly metabolized by pediatric animals |
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Term
| Effects of hepatic disease on anesthetic patients |
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Definition
Hepatic Dz:
- Delayed metabolism of anes agents
- Decreased synthesis of blood clotting factors
- May be hypoproteinemic
- Dehydration common
- May be anemic and/or icteric
Strategies to decrease risk:
- Preanes blood chemistry tests
- May omit preanesthetic medication
- Inhalant agents preferred over injectable agents
- Expect prolonged recovery |
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Term
| Effects of renal disease on anesthetic patients |
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Definition
Renal dz:
- Delayed excretion of anesthetic agent
- Electrolyte imbalances common, incl hyperkalemia, hyperphosphatemia, and metabolic acidosis
- Dehydration usually present
Strategies to decrease risk:
- Rehydrate before sx
- Obtain renal fxn tests/values
- Reduce doses of anes agents
- Use caution w/ barbiturates
- May require intraoperative IV fluids |
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Term
| What are the anesthetic concerns for patients undergoing a cesarean section? |
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Definition
Anesthetic Concerns
- Hypoxemia
- Hypercarbia
- Hypotension
- Bleeding
- Acid-base imbalance
- Tissue trauma
- arrhythmias |
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Term
| What are the physiological concerns for patients undergoing a cesarean section? |
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Definition
- aspiration of vomitus
- decreased lung capacity
- increased cardiac workload
- physiologic anemia because of increased plasma volume w/o a corresponding increase in the # of RBC (accentuated as # fetuses increases)
- poor regulation of BP
- decreased anesthetic requirements because of the effect of progesterone and its metabolites on gamma-aminobutyric acid (GABA) receptors |
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Term
| Special needs of pediatrics |
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Definition
- Pts under 3 months old
- Preanesthetic fasting not advisable
- Fluid admin rate should not exceed 5 ml/kg/hr unless shock or dehydration is present, because peds are prone to overhydration with rapid fluid admin
- Use of a syringe driver or prediatric microdrip admin set w/ a delivery rate of 60 drops/ml and a burette is helpful in preventing inadvertent overinfusion of fluid
- Avoid inj anes agents that require liver metabolism for inactivation, can have a prolonged effect in pups/kittens less than 8 wks old
- Renal fxn also inefficient compared to adult and excretion of drugs by this route may be slow.
- Prone to hypothermia |
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Term
| What situation or condition will cause many brachiocephalic patients will exhibit bradycardia? |
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Definition
Many have abnormally high parasympathetic tone, which may cause bradycardia
Use of atropine or glyco in these pts is helpful for increasing HR before sx |
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Term
| What drugs are used to prevent bradycardia in brachiocephalic patients? |
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Definition
| Use of atropine or glyco in these pts is helpful for increasing HR before sx |
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Term
| According to the text, what is the preferred agent for the induction and maintenance of anesthesia in pediatric patients? |
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Definition
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Term
| How to allow the ET tube to be left in longer |
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Definition
| Possible to give a low dose of morphine or hydromorphone just before turning off vaporizer. |
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Term
| What is the rapid shallow respiratory pattern that obese dogs and toy breeds often exhibit during anesthesia? This breathing pattern may result in what condition? |
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Definition
Rapid shallow respirations may result in hypercapnia
Should assume control over respiration bu bagging the pt w/ o2 and inhalant anes, once every 5 sec, until increased anes depth and slower respirations are observed.
Can also slow the RR by admin of opiods such as hydromorphone or oxymorphone, esp if the elevated rate is a result of surgical stimulation, although occas. opiods may cause panting |
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Term
| Which agent is most indicated for anesthesia in a patient with hepatic disease? |
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Definition
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Term
| Changes in BP - causes and dangers |
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Definition
- Any change in cardiac output or vascular tone will have an effect on BP
- Inadequate BP decreases tissue perfusion, resulting in tissue hypoxia or anoxia leading to tissue glycolysis via the anaerobic method, with the production of lactic acid, and therefore, an acid-base imbalance
- Poor or weak pulse, along with slow CRT (>2s) is suggestive of hypotension
- Mean arterial BP of <60 mmHg indicates inadequate tissue perfusion |
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Term
| A MAP of ___ indicates inadequate tissue perfusion |
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Definition
| - Mean arterial BP of <60 mmHg indicates inadequate tissue perfusion |
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Term
| Changes in BP - causes and dangers |
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Definition
- Any change in cardiac output or vascular tone will have an effect on BP
- Inadequate BP decreases tissue perfusion, resulting in tissue hypoxia or anoxia leading to tissue glycolysis via the anaerobic method, with the production of lactic acid, and therefore, an acid-base imbalance
- Poor or weak pulse, along with slow CRT (>2s) is suggestive of hypotension
- Mean arterial BP of <60 mmHg indicates inadequate tissue perfusion |
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Term
| A MAP of ___ indicates inadequate tissue perfusion |
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Definition
| - Mean arterial BP of <60 mmHg indicates inadequate tissue perfusion |
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Term
| Know the various types of colloid solutions and important facts about colloids. |
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Definition
- Hetastarch
- Dextran 40 or 70
- 10% Pentastarch
- Plasma
- Whole Blood
- Often beneficial if BP cannot be maintained, esp if plasma protein is < 3.5g/dL
- Are lg macromolecules, remain w/in the vascular system for a longer period of time than crystalloids
- Will increase the colloidal osmotic pressure and hence help stabilize BP before and/or during anes
- Given in much smaller vol than crystalloids and always given in concert w/ crystalloids
- Results include increased cardiac output and BP |
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Term
| . Which drugs are used to stabilize the blood pressure in traumatized or anesthetic patients? |
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Definition
One or more of various meds, such as:
- Dopamine (1 – 5 mcg/kg/min) if the HR is low and BP is low
- Dobutamine (1 – 5 mcg/kg/min) for the pt w/ normal HR but decreased BP |
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Term
| What are the signs of fluid overload in a patient? |
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Definition
Signs in the awake pt may include:
- Crackles or wheezes on lucg auscultation
- Serous nasal d/c
- Bulging eyes (chemosis)
- Increased ventilatory rate or effort or both
- Coughing
- Vomiting or diarrhea
- Restlessness
- Increased urine output
Most clinical signs are not evident in the anesthetized pt so it is prudent to auscultate the lungs in all 4 quadrants if fluids are beings administered rapidly |
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Term
| Crystalloid fluid rates for low BP – info re crystalloids |
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Definition
- Rates of 10 – 20 ml/kg/hr
May be necessary to give short-term small fluid boluses to help improve BP quickly:
- Cats - 10 – 20 ml/kg over 15 min
- Dogs – 20 – 40 ml/kg over 15 min (~ 2ml/kg/min)
Most crystalloids will be gone from intravascular fluid space in less than 2 hrs
Always closely monitor for fluid overload
During fluid admin monitor:
- HR
- BP
- MM
- CRT |
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Term
| what other problems might be encountered when anesthetizing traumatized or at-risk patients? |
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Definition
- Respiratory difficulties are common, may be the result of pneumothorax, pulmonary contusions, hemorrhage, or diaphragmatic hernia
- Any of these decreases the tidal volume of the pt and therefore can decrease oxygenation
- Lack of adequate oxygen exchange will lead to hypoxemia, which will lead to myocardial hypoxia and therefore arrhythmias, cell death, and acid-base imbalances
- Increased CO2 caused by lack of proper ventilation will also lead to acid-base imbalances and arrthymias
- Loss of blood or sequestration of fluid will result in BP changes |
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Term
| What class of drugs would be most likely to depress the myocardium or exacerbate arrhythmias? |
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Definition
| Alpha2 agonists (ex: xylazine) will augment the arrhythmogenic effects of epi in animals that are fearful or excited |
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Term
| What is the formula for Arterial Blood Pressure? |
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Definition
AFB = CO x SVR, with CO = HR x SV
AFP: Arterial Blood Pressure
CO: Cardiac Output
SVR: Systemic Vascular resistance (the degree of systemic arterial dilation or constriction)
HR: Heart rate
SV: Stroke volume (the vol of blood the heart pumps out with each contraction; influenced by the vol of venous blood returning to the heart and the contractile force of the heart muscle) |
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Term
| What is the drug of choice for treating tachyarrhythmias in cats? |
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Definition
| Beta blockers or calcium channel blockers (lidocaine tends to be more toxic in cats) |
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Term
| What is the drug of choice for treating tachyarrhythmias in dogs? |
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Definition
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Term
| What conditions would be likely to cause a cardiac arrhythmia? |
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Definition
- CO2 Absorbant exhaustion
- ET tube blockage resulting in cessation of O2 to pt and retention of CO2
- alpha2 agonist administration
- anoxia, hypercarbia
- poor perfusion
- acid-base imbalance
- damaged myocardial tissue |
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Term
| What types of cardiac arrhythmias might be encountered when anesthetizing traumatized or at-risk patients? |
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Definition
- premature ventricular contractions
- atrial fibrillation
- ventricular fibrillation
- first and second degree heart block (normal in equines)
- ventricular tachyarrhythmias
- sinus arrest w/ escape beats |
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Term
| What system would be the most useful in monitoring overhydration in trauma or anesthetic patients? |
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Definition
| Auscultate the lungs in all four quadrants if fluids are being administered rapidly |
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