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PF Anesthesia
Anesthesia and Analgesia for Veterinary Technicians
| What must a patient database include - at minimum? | Patient signalment, history, complete exam findings and results of preanesthetic workup |
| What is involved in the patient preperation "to do" list | Gather patient history, client communication, physical exam, direct patient preperation and equipment preparation |
| What are the 4 questions to ask clients about problems their pet is exhibiting? | How long, what is the volume or severity, how often and what is the character or appearance of the issue |
| What should be confirmed prior to a procedure? | Confirm the procedure being performed, confirm the location of the area or limb being worked on, confirm with o if histo/cytology is being done, confirm o's wishes about the doctor making decisions during procedure (go ahead or call first) |
| True or false? Horses and cats are more sensitive to opioids | True |
| Why should anticholinergics be avoided in ruminants? | It makes their saliva thick which could cause airway occlusion |
| Are large animals more likely to suffer respiratory depression and dependent lung atelectasis? | Yes |
| What breeds are more sensitive to acepromazine? | Boxers and giant breeds |
| Due to low body fat, which drug class should not be used on sighthounds? | Barbiturates |
| Pediatrics and Geriatrics have a harder time metabolizing drugs - why? | Peds: Their liver pathways are not developed yet Geriatrics: They have poor hepatic or renal functions |
| Why should acepromazine not be used in stallions? | Potential penile prolapse which would then make the stallion unusable. |
| Why should zylazine not be used in the 3rd trimester of pregnancy in sheep and cattle | It can cause uterine contractions |
| Sympathomimetics, when given with dissociatives, xylazine and barbiturates can cause ? | Increase in cardiac arrhythmias |
| Tricyclic antidepressants can predispose patients to ? | Cardiac arrhythmias, increase response to anticholinergics and CNS depressants |
| Chloramphenicol can prolong actions of which drugs and cause significant prolonged recovery | Propofol and ketamine and can decrease biotransformation of barbiturates |
| Monoamine oxidase inhibitors can increase effects of morphine and other opioids if given within what time frame? | 14 days |
| True or false: antihistamines can increase CNS and respiratory depression when combined with other depressive agents | True |
| How are very overweight animals dosed? According to lean or total bodyweight | Very obese should be dosed according to lean bodyweight |
| Describe a patient with <5% dehydration | No detectable findings |
| Describe a ~ 5% or mild dehydrated patient | Minimal loss of skin turgor, semidry mucous membranes |
| Describe a ~8% or moderate dehydrated patient | Moderate loss of skin turgor, dry mucous membranes, weak rapid pulses, depressed globes within orbits (enophthalmos) |
| Describe a >10% dehydrated patient | Considerable loss of skin turgor, extrememely dry mucous membranes, tachycardia, weak/thready pulses, hypotension, severe enophthalmos, altered level of consciousness |
| Describe signs of lethargy | Mildly depressed, aware of surroundings and can be aroused with minimal difficultly |
| Describe signs of obtunded patients | Very depressed, uninterested in surroundings, responds but cannot be fully aroused by verbal or tactile stimulus |
| Describe signs of a stuporous patient | Sleeplike state, nonresponsive to verbal stimulus, aroused only by painful stimulus |
| Describe signs of a comatose patient | Sleeplike state, cannot be aroused. |
| A patient that is normal with no health conditions would be assigned what physical status classification? | PS1 |
| A patient that has mild systemic disease would be assigned what physical status classification? | PS2 |
| A patient that has severe systemic disease would be assigned what physical status classification? | PS3 |
| A patient that has severe systemic disease that is a constant threat to life would be assigned what physical status classification? | PS4 |
| A patient that is moribund and is not expected to survive without surgery would be assigned what physical status classification? | PS5 |
| Is it ok for a PS3, 4 or 5 to undergo surgery? | Not without being stabilized prior |
| How long should dogs/cats, horses, cattle, small ruminants and pediatric patients have food withheld prior to surgery | Dogs/cats: 8-12 hours, Horses: 8-12 hours, Cattle: 24-48 hours, Ruminants: 12-18 hours, Pediatrics: None |
| How many mL/kg for dogs and large animals and how many for cats is used to calculate blood volume? | 80-90 mL/kg for dogs and large animals. 40-60mL/kg for cats |
| What are the cations in body fluid? | Sodium, potassium, magnesium and calcium |
| What are the anions in body fluid? | bicarbonate, phosphate and proteins |
| What are the names of crystalloid solutions | Lactated Ringers, Plasma-Lyte A, Plasma-Lyte 148 and Normosol-R, 0.9% NaCl, Normosol - M w/ 5% dextrose, 3% and 7% NaCl |
| Should patients with low blood protein, low RBC mass or low platelet count be given crystalloid solutions? | No |
| What does a hypertonic saline solution do? | rapidly draws water into the intravascular space to support BP but must be followed by colloids for long term blood volume expansions |
| What are dextrose solutions used in | Supports BG in patients |
| Colloid solutions support blood volume and BP. Do they diffuse across the endothelium or stay in the intravascular space? | They stay in intravascular space |
| What are the fluid rates for a healthy patient for the first hour? | Dogs: 5mL/kg/hr cats: 3mL/kg/hr and decreasing after the 1 hour |
| What are shock fluid rates? | 80-90 mL/kg for dogs and large animals and 40-60 mL/kg for cats |
| Names signs of overhydration | ocular/nasal discharge, chemosis, SQ edema, increased lung sounds and respiratory rate, dyspnea, coughing/restlessness and hemodilution |
| What are the five freedoms | hunger and thirst, discomfort, disease, injury and pain |
| What are the 2 types of ET tubes | Murphy: beveled end and a side hole and cuff Cole: no cuff or side hole. Used for pts with complete tracheal rings |
| What are some benefits of a ET tube | Maintain airway, decrease anatomic dead space, allow admin of gases, prevent aspiration, rapid emergency response, monitor and control respiration |
| What is a benefit of a cuffed tube | prevents gas leaks into the room, minimized risk of aspiration, prevents animal from breathing room air |
| What is the difference in a high pressure/low volume vs high volume/low pressure ET cuff | HP/LV: Higher level of pressure in a concentrated area which could damage trachea. HV/LP: A more balanced pressure over the entire cuff |
| What is the shape of a Miller and McIntoch blade laryngoscopes | Miller is straight. McIntosh is curved |
| Supraglottic airway devices have what benefits | connects to the glottis. Can decrease laryngospasm, resistance to breathing, airway trauma and no tracheal irritation |
| What are disadvantages to using masks | Does not maintain a open airway, can leak gases into the room, does not protect against pulmonary aspiration, cannot be ventilated |
| What factors affect vaporizer output | temperature, carrier gas flow rate, respiratory minute volume, time constants, respiratory rate and depth, back pressure |
| What is the color of the vaporizer and what gas does it use | Purple: isofluorane, Yellow: sevoflurane. Blue: desflurane. Red: halothane |
| What is the pathway of gas on a circle system | Gas is exhaled to unidirectional valve to CO2 canister, it goes past the reservoir bag, pop off valve and pressure manometer and back to the patient through the inspirational unidirectional valve and breathing tube. Fresh gas and O2 mix from the inlet |
| Why is bagging beneficial | helps reinflate collapsed alveoli, anesthetics depress respiratory drive and decrease Vt so it helps ensure gas exchange, helps normalize respiratory rate |
| Respiratory bags should hold how much air vs patient weight | 50mL/kg 500mL for pts up to 3kg 1L for 4-7kg 2L for 8-15kg 3L for 16-50kg 5L for 51-150kg 35L for over 150kg |
| What are the 2 factors that inflation is based on | the rate at which gas is entering the breathing circuit through the fresh gas inlet the rate at which gas is exiting the breathing circuit through the pop off valve |
| When should you change CO2 canister contents | Granules have become hard and brittle, off white, changed to violet/pink, when CO2 on capnograph is higher than near 0mmHg, after 6-8 hours of surgery or 30 days |
| What is nociception | detection by the nervous system for potential or actual tissue injury |
| What is adaptive pain | Physiologic pain that promotes survival by preventing injury and aiding healing of the injury |
| What is maladaptive pain | Pathologic pain that is amplified and persistent. It does not help the body. |
| What is inflammatory pain | occurs at the site of tissue injury due to the release of chemicial mediators like prostaglandins and histamine |
| What is neuropathic pain | injury to the nervous system |
| What is visceral pain | originates from organs |
| What is somatic pain | originates from the musculoskeletal system |
| What are the 4 steps of nociception | Transduction (of pain receptors), transmission (transfer from peripheral nerve fibers to the spinal cord), modulation (impulses can be amplified or suppressed), perception (transmitter to the brain, processed and recognized) |
| What can happen to a patient with untreated pain | Can produce a catabolic state which can lead to wasting, it suppresses the immune response which can lead to infection and other conditions, delays wound healing, requires higher doses of anesthetic drugs to maintain stable plane and causes suffering |
| peripheral hypersensitivity/primary hyperalgesia can cause what? | a increased sensitivity to pain that is worse than should be accounted for by the injury. Things that would not normally be painful, become overly so. This leads to "windup" |
| What are expected neuroendocrine changes that occur in response to pain? | release of ACTH, elevation in cortisol, norepinephrine, epinephrine and decrease in insulin |
| What are pain related physiologic changes | Hypertension, tachycardia, tachyarrhythmia, peripheral vasoconstriction, tachypena, shallow breathing, exaggerated abdominal movement, panting, open mouth breathing in cats, mydriasis |
| Name Mu opioid receptors | morphine, fentanyl, hydromorphone, oxymorphone, methaone, meperidine |
| Name partial mu agonist medication | Buprenorphine |
| Name partial mu agonist-antagonists | nalbuphine and butorphanol |
| If morphine is given too rapidly it can cause a histamine release - what signs would be seen | fall in blood pressure, flushing, pruritus |
| What drug is pure agonist for mu and kappa receptors | morphine |
| Dosing for morphine for a cat? | IV/IM/SQ 0.2-0.5 mg/kg with potential for excitment CRI 0.1-0.2 mg/kg/hr Epidural 0.05-0.1 mg/kg use preservative free drug |
| Dosing for morphine for a dog? | IV/IM/SQ 0.5-1.0 mg/kg CRI 0.05-0.3 mg/kg/hr loading dose up to 0.1 over 5 min. Stop if BP drops Epidural 0.1 mg/kg use preservative free PO 2-5 mg/kg Give BID |
| How is oxymorphone different from morphine | oxymorphone is more potent, has fewer adverse effect, a longer duration of analgesia and promots less vomiting |
| What side effects can oxymorphone have | excitement in cats, hyperresponsiveness to sound, respiratory depression, panting in dogs, bradycardia |
Created by:
TrenAK