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Anesthesia Exam
| Question | Answer |
|---|---|
| the normal muscle cell is _______ at rest | polarized |
| how does normal neuromuscular transmission take place | 1. Acetyl choline is released from the axon nerves and attaches to receptors on the muscle cell 2. this causes the muscle to depolarize 3. depolarization wave causes the muscle to contract |
| what are the 2 types of muscle paralyzing agents | 1. depolarizing type (not reversible) 2. non-depolarizing type (reversible with drugs) |
| how does the depolarizing type work | act by occupying receptors, mimicking the act of acetyl choline, muscle becomes depolarized and contracts |
| why in a depolarizing muscle paralyzing agent the muscle cannot relax | since acetylcholinesterase cannot degrade the "pseudo acetylcholine" the muscle remains contracted |
| what is an example of a depolarizing muscle paralyzing agent | Succinyl Choline |
| how does the non-depolarizing type of muscle paralyzing agent work? | blocks the acetyl choline receptors on the muscle cell but does not occupy them. It acts as a force-field preventing acetyl choline from reaching the muscle cells |
| what can be given to reverse a non-depolarizing agent | neostigmine |
| how does the neostigmine work | -hold on to acetylcholinesterase to allow acetyl choline to build up. eventually it will be at such a high concentration that is will be able to over power the force filed and reach the muscle receptors |
| what does neostigmine have an effect on | the heart causing bradycardia and arrhythmias |
| what can be given with neostigmine to reduce its unwanted side effects | atropine |
| 4 reasons to use muscle paralytics in small animals | 1. ventilating an animal that is still breathing on its own 2. treating coxofemoral luxations 3. provide additional muscle relaztion during orthopedics 4. part of balances anesthesia for c-section |
| true or false: muscle paralytics provide analgesia | false |
| what was succinyl choline used in horses for and why isn't it anymore | standing castrations, deemed unethical because they could still feel the pain but not be able to move |
| why should an animal always have an ET tube in when giving muscle paralytics | muscles of respirations are also paralyzed |
| what does IPPV stand for | Intermittent positive pressure ventilation |
| ventilator or manual IPPV should be continued until the muscle relaxant ___________ _______ or is ____________. | wears off, reversed |
| when should muscle paralytics not be used | - on ill animals - of the animal has had recent treatment with an amino-glycoside antibiotics (gentamycin) -if an animal has had organophosphates - if an animal has potassium or calcium imbalances (eclampsia) |
| what is balanced anesthesia | combination of agents for analgesia, anesthesia, muscle paralysis |
| advantage of balanced anesthesia | they have synergistic effects, thus lowering dosages of each drug to be used |
| main disadvantage of balanced anesthesia | the necessity of understanding all of the drugs and their potential interactions very thoroughly |
| what agents does balanced anesthesia involve | -atropine -acepromazine -narcotics -inducing agents -muscle paralyzing agents -inhalation anesthetic agents -local analgesics |
| what are pediatric patients | those that are less than six to seven weeks of age |
| what are infant patients | those between 2 and 6 weeks of age |
| what are neonate patients | less than 2 weeks of age |
| what are the 4 procedures commonly performed on pediatric patients | -ear cropping -correction of life-threatening congenital defects -intussceptions or foreign body removal -fracture repair |
| why do pediatrics not tolerate bradycardia very well | the cardiac output is very closely related to the heart rate |
| why are pediatric more prone to hypoglycaemia | decreased glycogen reserves |
| what is the rules with fasting pediatric patients | they shouldn't be fasted, in fact sugar water can be given up to 2 hours prior to the surgery and 5% dextrose should be given IV throughout the surgical procedure |
| hypothermia is common in pediatrics due to their inability to _______ and their lack of ________ ________. | shiver, SQ fat |
| what 3 procedures are especially difficult in pediatrics | -intubation -IV injection -catheterization |
| in a pediatric where might you accidentally place the ET tube if not properly measured | primary bronchus |
| how long do you have to wait before giving a pediatric atropine | after 14 days of age, before this time is it ineffective |
| anesthetics that are suitable for pediatrics | -atropine -diazepam -opioids -dilute ultrashort barbiturates -ketamine -inhalants |
| what 2 agents should be AVOIDED in pediatric patients | -acepromazine (hypotension and excessive CNS depression) -xylazine (prolonged sedation and resp and cardiac depression) |
| what are geriatric patients | those that have reached 75-80% of their life expectancy |
| 2 common procedures on geriatric patients | -dentistry -surgery for neoplasia |
| what are geriatric patients more prone too | hypoxemia, hypercarbia, resp depression |
| what tests/info should be performed on a geriatric before anesthesia | -accurate history -thorough PE -hematology and biochemical tests -rads -ECG readings |
| how should you pre-oxygenate geriatric patients | give 100% oxygen for 2-4 mins before induction |
| anesthetics that are suitable for geriatric patients | -inhalants (iso 1%) -propofol -diazepam + ketamine (slow titration) -diazepam + opioid (slow titration) |
| anesthetics to be avoided in geriatric patients | -acetylpromazine (hypotension) -xylazine (bradycardia, arrhythmias) -atropine (tachycardia) -barbiturates (effects on heart,liver,lungs,kidneys) -methoxyflurane (impaired heptic/renal function) |
| patients with impaired cardiovascular systems are also susceptible to ____________ | overhydration |
| common cardiovascular problems seen in vet patients | -congenital heart disease -heart worm -hyperthyroidism in cats -anemia -shock |
| what are the goals for anesthesia regimes in cardiac patients | -avoid tachycardia -avoid bradycardia -avoid arrhythmias -maintain normal blood pressure |
| what is the rate of tachycardia | >180 bpm |
| what is the rate of bradycardia | <80 bpm |
| agents that are suitable for cardiac patients | -propofol -ISO -opioids |
| agents that should be avoided in cardiac patients | -anticholinergics -ketamine -xylazine -halothane |
| common resp problems that may interfere with anesthesia | -pulmonary edema, pleural effusion, pneumothorax, airway obstruction, diaphragmatic hernias, pneumonia |
| what rads should be taken before anesthesia in patients with resp problems | thoracic radiographs |
| how long should resp patients be given 100% oxygen before anesthesia | 5-7 mins |
| agents that are more suitable for resp patients | -diazepam -acteylpromazine -inhalant anesthetics |
| for resp patients which route of induction do you use | IV so that you can secure a patent airway |
| True or false: often lower than normal dosage rates should be considered with hepatic patients | true |
| what 2 problems should you watch for in hepatic patients | -hypoproteinemia (lower than normal levels of protein) -bleeding disorders (clotting factors may be decreased) |
| safe drugs for hepatic disease patients | -low dose diazepam with a narcotic given slowly IV -mask induction with ISO -propofol |
| clinical signs of kidney disease | -dehydration -polyuria -polydipsia -weight loss -anorexia |
| when are clinical signs of kidney disease particularly common | when BUN is elevated |
| when a patient has renal disease what should you assess before putting them under anesthesia | -BUN -Creatinine -Urinalysis -Dehydration -Anemia -Metabolic acidosis -Hyperkalemia |
| what tranquilizer should you not use in renal disease patients | xylazine |
| what is the fluid supplementation rate in patients with renal disease | 10-20 ml/kg/hr |
| if hyperkalemia and metabolic acidosis are present what should be supplemented | bicarbonate |
| agents that are not safe for patients with neurological disease | -acepromazine -ketamine -opioids in cats |
| what procedures are known to cause seizures | -CSF (cerebrospinal fluid tap) -myelograms -surgery for head trauma |
| safe regimes for patients with neurological disorders | -diazepam IV -diazepam + opioids (dogs only) -propofol or alfaxalone IV -barbiturates -masking with inhalants |
| what are the 2 drugs that treat seizures | -Diazepam IV -Barbiturates IV |
| True or false: C-sections are normally emergency surgeries thus the female may already be vomiting, dehydrated or in shock | True |
| the _____ volume of the female will be ______ than normal due to the size of the uterus | lung, smaller |
| since compromised breathing and blood loss happens during c-sections what must be available | -IV access -Supplemental IV fluids |
| what agents should be avoided in C-sections | -IM ketamine -barbiturates |
| which drug will result in close to 100% fetal mortality | pentobarbital |
| what is the percentage that kittens and puppies will survive a c-section | 96% |
| 4 specific regimes/techniques used in c-sections | 1. general anesthesia 2. regional anesthesia 3. epidural anesthesia 4. balanced anesthesia |
| True of false: you keep anesthesia as heavy as possible until the fetuses are removed | false (keep it as light as possible) |
| what is regional anesthesia | administration of a neuroleptanalgesic to sedate the dam followed by a lidocaine block. both mother and neonates can receive a reversal agent for the narcotic once the procedure is completed |
| when is an epidural not useful | if the dam is ecited or active |
| where does an epidural provide analgesia to? | rear abdomen, pelvis, legs |
| is an epidural reversible | no |
| early postnatal care | -remove membranes from nose and mouth -remove fluid from oral and nasal cavities -rubbing chest gently with towel to stimulate resps -admin reversal agents -oxygen supplementation by mask -doxapram to increase resps -atropine to increase heart rate |
| common indications for gastrointestinal surgery | -intestinal blockage -gastric dilation and volvulus -neoplasia -biopsy |
| what does GDV | gastric dilation/volvulus |
| shock is often found in patients with... | hypovolemia, endotoxemia, necrosis |
| what inhalant anesthetic is the safest for the heart | Isoflurane |
| why is nitrous oxide avoided | danger of further enlarging the trapped gas space |
| surgery on trauma patients should be postponed until..... | they are stabilized |
| how long does it take for a trauma patient to become stabilized | 24-72 hours |
| Although rads are good to diagnose, the restraint and anesthesia can cause complications for trauma patients, therefore what do we do instead | treat the suspected disorder and observe the response to therapy |
| what is the main cause of shock | blood loss |
| how long can cardiac arrhythmias last for after thoracic trauma | 12-72 hours |
| 4 anatomical abnormalities of brachycephalic | -stenotic nares -elongated soft palate -hypoplastic trachea -tendency towards obesity |
| techniques to minimize complications after surgery for brachycephalics | -pull out tongue -extend the neck -keep ET tube in for as long as possible -keep animal on its sternum |
| what are sight hounds prone to during anesthesia | -hypothermia -prolonged recoveries when ketamine and barbiturates are used |
| safe preanesthetic agents used for sight hounds | -propofol, alfaxalone , masking with inhalant anesthetic |
| why is ISO a preferred inhalant anesthetic | does not require very much metabolism or excretion by the liver or kidneys |
| how can you avoid prolonged recoveries in sight hounds | -avoid hypothermia -provide IV fluids |
| what is the MAJOR problem with obese animals during anesthesia | -overdosing |
| how should an obese animal have their drugs calculated and why | calculated on lean weight rather than their actual weight because fat does not have a large blood supply and does not require much anesthetic. |
| true or false: ET tube should be left in for as long as possible in obese animals aswell | true |
| what do some people refer to pain as | Fourth Vital Sign |
| what does nociception mean | refers to the detection of tissue injury or the potential for it by the nervous system |
| physiology of pain is divided into 2 groups | -physiological pain (when something sharp/hot chemically noxious is encountered) -pathological pain (when tissue damage has occured) |
| Mechanisms of pathological pain | -inflammatory -neuropathic -cancer -idiopathic |
| origin of pathological pain | -visceral or somatic -superficial or deep |
| severity of pain in pathological pain | -none, mild, moderate, severe |
| 4 steps of the pain pathway | 1. transduction 2. transmission 3. modulation 4. perception |
| what are "action potentials" | when noxious stimuli are converted into electrical signals |
| what is transduction in the pain pathway | noxious stimuli (chemical, thermal, mechanical) are transformed into electrical signals |
| what is multimodal therapy | analgesics act upon different steps of the pain pathway and ideally agents are effective on more than one pathway |
| what is transmission in the pain pathway | conduction of impulses from the peripheral pain receptors to the spinal cord |
| what is modulation in the pain pathway | -amplification or suppression of pain impulses by neurons in the spinal cord |
| what is perception in the pain pathway | processing and recognition of pain in the brain |
| ideally pain is treated ____________. | preemptively |
| what happens when the body goes into a catabolic state | happens when pain is untreated and can lead to a decrease in body mass |
| consequences of untreated pain | -go into catabolic state -impair immune system -cause inflammation -patient suffering |
| what is peripheral hypersensitivity also known as | primary hyperalgesia |
| what happens during peripheral hypersensitivity | inflammation causes the release of chemical mediators, this results in stimuli near the site of injury that would normally not be noxious causing pain |
| what is central nervous system sensitization also known as | secondary hyperalgesia |
| what happens during CNS sensitivity | involves hypersensitivity further from the site of injury, spinal neurons become hyperexcitable and sensitive due to low level stimuli |
| what does NDMA receptors stand for | N-methyl-D-asparate |
| where are the NDMA receptors in the spinal cord | dorsal horn |
| what can help wind up pain from occurring | ketamine, NMDA |
| what does pain cause the release of | adrenocorticotropic hormone, increased cortisol, norepinephrine, epinephrine |
| true or false: young patients are less likely to tolerate pain | true |
| 4 pain assessment tools | -verbal rating and descriptive scales -numeric rating -visual analogue scales -comprehensive scales |
| advantage and disadvantage of verbal rating scales for pain assessment | -quick and easy but subtle or chronic signs of pain are not easily identified |
| how does the numeric rating scale for pain work | physiological and behavioural signs of pain including locomotion are assessed via a numeric scale for each category. The scores are totaled. |
| how does a visual analogue scale work for pain | -you place an "x" on a continuum between no pain and the worst pain possible. |
| what are comprehensive scales for pain assessing | -these combine several types of scales to provide a more comprehensive assessment of an individual animals pain |
| how often must surgical pain be assessed | assessed hourly |
| how often is chronic pain such as arthritis assessed. | Monthly |
| pain is best controlled through a combination of _________ ___________ and __________ therapy. | preemptive analgesia, multimodal |
| what is the common preemptive analgesia option for small animals | opioids by injection or fentanyl patch |
| what is the common preemptive analgesia option for large animals | NSAIDS |
| what is pharmacological analgesic therapy | rather than simply during surgery, analgesia is required at multiple stages of hospitalization and treatment. |
| what are the stages of pharmacological analgesic therapy | 1. preanesthetic period 2. surgical period 3. immediate post op period 4. remainder of hospital stay 5. at home |
| what does the choice of a drug depend on | -severity of pain -patients general condition -route of delivery |
| what do opioids do | help diminish windup pain |
| what do opioids provide when combined with a tranquilizer | neuroleptanalgesia |
| how long do opioids last for | 2-4 hours |
| what are the side effects of opioids | gastrointestinal effects: -nausea, vomiting, diarrhea -ileus, colic, constipation |
| which opioids are the most potent | Mu opioid receptor agonists |
| True or false: morphine is a narcotic in Canada | true |
| what kind of pain can morphine be used for | -moderate to severe visceral or somatic pain |
| what are morphines side effects in cats and horses | excitement or dysphoria |
| When using morphine, cats are more likely to experience ________ and _________. While dogs are more likely to experience ___________ and ____________. | mydriasis, hyperthermia, miosis, hypothermia |
| what is the main advantage to using morphine | can be given by many routes including IV, IM, SQ, IA, epidural or spinal injection |
| oxymorphone is a pure _______ __________ | opioid agonist |
| true or false: oxymorphone provides better analgesia and sedation than morphine | true |
| what is the main disadvantage of oxymorphone | very expensive, has been very difficult to acquire in Canada for years |
| Hydromorphone is less ________ than oxymorphone and less ______. | potent, expensive |
| true or false: hydromorphone causes hypothermia in cats | false (hyperthermia) |
| what kind of opioid is Methadone | synthetic |
| what does Methadone do | prevents central desensitization and produces less of an emetic effect |
| how fast does fentanyl work | 2 minutes (very rapid onset) |
| What drug is very potent with a rapid onset of 2 mins and a short duration of 20-30 mins | Fentanyl |
| what was the commercial product for fentanyl | Innovar Vet |
| what drug is a pure opioid agonist, less potent and has less resp and gastro side effects. Also can be given to puppies combined with a tranquilizer | Meperidine/Pethidine |
| What is butorphanol | Synthetic opioid |
| why is Butorphanol less effective as an analgesic | because it has both agonist and antagonist properties |
| Butorphanol stimulates ______ receptors and blocks ___ receptors. | kappa, Mu |
| what can butorphanol help reverse | excessive sedation or respiratory depression |
| why is Buprenorphine unique | it has a longer duration of action particularly in cats but the onset of action is delayed |
| what species is buprenorphine commonly used on in lab research practices | rats |
| which drug is not a controlled drug and is a reversal agent for opioids such as morphine and fentanyl | Nalbuphine |
| what is the benefit of giving opioids by intravenous infusion | side effects are minimized and analgesia is provided continuously |
| where are opioids most commonly injected intraarticularly | elbow or stifle |
| how is an IA injection performed | opioid is combined with sterile saline and inserted into the joint via a sterile catheter |
| how can you prolong analgesia when using opioids via Intraarticular injection | all local anesthetic such as bupivicaine |
| where does an epidural provide analgesia too | hind limbs, abdomen, caudal thorax, pelvis, tail |
| what drugs are an option for epidurals | -morphine, oxymorphone, fentanyl, hydromorphone |
| epidurals are administered after ________ but _________- after surgical procedure _________. | induction, before, begins |
| what is the onset of action or a epidural and duration of action | onset: 20-60 mins duration: 6-24 hours |
| why should patients be repositioned every 2-4 hours after being given an epidural | reduce the likelihood of nerve damage or pulmonary atelectasis |
| which drug is the only one approved for transdermal use | Fentanyl |
| when are fentanyl patches ideal? | very painful conditions such as burns, trauma, cancer |
| what are the fentanyl patch sizes available | 20, 50, 75, 100 mcg/hr |
| what 2 things should animals be specifically monitored for when using a fentanyl patch | breath through pain and overdose |
| what happens in an overdose of fentanyl patch | patch is to be removed and/or a reversal agent is administered |
| why can we not use heat with a fentanyl patch | since heat can increase absorption administration to animals with fevers and the use of supplemental heat should be avoided |
| 3 examples of an NSAID | -meloxicam -robenacoxib -carprofen |
| how do NSAIDS differ from eachother | efficacy, onset and duration, toxicity, analgesic properties and anti-inflammatory effects |
| Acetaminophen is extremely toxic to what species | Cats |
| where are NSAIDS metabolized from and removed from | -metabolized by the Liver, and removed by the kidney, GI tract -careful in patients with hepatic, renal, and gastro disease |
| all NSAIDS exhibit their effects through their inhibition of ________ _____________ | prostaglandins synthesis |
| what are prostaglandins involved in | pain and inflammation, maintaining normal function of GI tract, repro organs, kidney and eyes |
| what enzymes do NSAIDS act on | COX -2 (cyclooxygenase) |
| True or False: NSAIDS that inactivate COX-2 enzyme have less side effects | True |
| the effects that NSAIDS have on platelet aggregation can lead to _________ __________- time and ______________. | prolonged bleeding, hemorrhage |
| what breed of dog is Hepatic Toxicosis most common in | Labrador Retrievers |
| True or False: NSAIDS should be avoided in a patient who is receiving corticosteroids | True |
| advantage of local anesthetics | -complete anesthesia of infected area -low toxicity -rapid onset of action |
| disadvantages of local anesthetics | -short duration of action -associated with CNS and cardiac toxicity if used multiple times on the same animal |
| what are 3 examples of Alpha 2 - Adrengeric Agonists | -xylaxine, dexmedetomidine, and detomidine |
| why should Alpha 2 - Adrengeric Agonists only be used on young healthy animals | cause resp depression, emesis, bradyarrhythmias, hypotension |
| xylazine and detomidine are commonly used on standing procedures on ________ as they provide ________, _________, and __________ | horses, sedation, muscle relaxation, and analgesia |
| what can Alpha 2 - Adrengeric Agonists cause in horses | Ataxia |
| what is xylazine reversed with | Yohimbine |
| what is Dexmeditomidine reversed with | Atipamezole |
| what drugs is commonly used as an induction agent but also has analgesic properties if combined with an opioid | Ketamine |
| major advantages of Ketamine | -blockage of NMDA at the level of the spinal cord and preventing windup pain |
| what are some side effects of ketamine | -tachycardia -salivation -Increase BP -seizures -post op delirium -increased IO pressure -increased Intracranial pressure |
| what are corticosteroids usually used for | anti-inflammatory effects and their effect on prostaglandin activity |
| primary side effects of corticosteroid are generally associated with | -chronic use -gastrointestinal ulcers -hyperadrenocorticism -immunosuppression |
| what drug is NOT an opioid and acts on mu receptors | Tramadol |
| how do Tramadol analgesic effects work | inhibition of norepinephrine and serotonin uptake |
| True or false: Tramadol is an oral drug and can be sent home with owners | True |
| What do tranquilizers not have | their own analgesic properties |
| what do tranquilizers do | help reduce anxiety and excitement sometimes seen with opioid use, particularly in cats an horses |
| For multimodal therapy what does this combo do? -Acetaminophen and codeine | admin orally for moderate to severe pain in canines |
| For multimodal therapy what does this combo do? Fentanyl and meloxicam | if admin concurrently to cats, meloxicam provides analgesia until fentanyl patch exerts effects |
| For multimodal therapy what does this combo do? Morphine and injectable NSAID | opioid administered at the end of surgery, followed by oral NSAID for 3 days |
| For multimodal therapy what does this combo do? MLK (morphine, lidocaine, ketamine) | when administered IV fluid Peri-op reduces concentration on inhalation anesthetic required |
| what 2 conditions is home analgesia especially important for | chronic conditions such as osteoarthritis and cancer |
| what are the 2 options for at home analgesia | fentanyl patches, NSAIDS |
| other than drugs what can also alleviate pain | good nursing care |
| some examples of good nursing care | -keep cage/stall clean and dry -quiet and comfortable environment -avoid animals soiling themselves -provide opportunity for them to urinate and defecate -turn animals every 2-3 hrs if they cant move on their own |
| what are some examples of non-pharmacological therapies | -acupuncture -chiropractic, transcutaneous electric nerve stimulation -massage therapy -physiotherapy -herbal remedies |
| For acute injuries you can apply ________ and for chronic injuries you can apply ____________. | cold, heat |
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jscott41
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