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Anesthesiology > 1/2: Intro & Patient Evaluation > Flashcards

1/2: Intro & Patient Evaluation Flashcards

1
Q

What is anesthesia?

A

Loss of sensation to all or part of the body

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2
Q

Anesthetic drugs depress _____ _____ locally, regionally, and centrally.

A

nervous tissue

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3
Q

What is general anesthesia (2 definitions)?

A

Drug-induced unconsciousness;

Controlled/reversible depression of CNS and perception

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4
Q

What are the 5 requirements for surgical GA?

A
  1. Unconsciousness (hypnosis, narcosis)
  2. Amnesia
  3. Muscle relaxation
  4. Lack of pain perception
  5. Suppression of reflexes (motor, autonomic)
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5
Q

What is pain?

A

Unpleasant sensory/emotional experience associated with actual/potential tissue damage

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6
Q

What is analgesia?

A

Absence of pain in response to painful stimulus;

Patient may be unconscious

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7
Q

What is nociception?

A

Physiologic process underlying pain perception;

Neural encoding process of stimuli;

Does not require consciousness (i.e. can occur during GA)

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8
Q

T/F: pain perception can still occur during GA

A

True

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9
Q

What is local anesthesia? Example?

A

Loss of pain sensation to a body area (i.e. dental block)

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10
Q

What is regional anesthesia? Example?

A

Loss of pain sensation to larger body area (i.e. epidural)

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11
Q

What is balanced anesthesia and what are some things that it targets?

A

Use of multiple drugs/techniques targeted to specific components (amnesia, muscle relaxation, anti-nociception, autonomic reflexes)

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12
Q

What is a specific example of balanced anesthesia?

A

Using low dose ketamine with low dose propofol;

Ketamine increases HR while prop decreases HR

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13
Q

What are 6 factors that can increase anesthetic risk?

A
  1. Major vs. minor procedures
  2. Major organs
  3. ER procedures
  4. Duration of anesthesia/surgery
  5. Anesthetic choice/manner given
  6. Human error
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14
Q

What length procedures have higher risk for adverse outcome and why?

A

Longer procedures due to increased tissue handling

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15
Q

Which anesthetic risk results in the highest number of human deaths?

A

Human error

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16
Q

Regarding anesthetic risk, there are no safe _____, only safe _____.

A

anesthetic procedures, anesthetists

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17
Q

What 3 things correlate with a higher mortality risk?

A
  1. Increased physical status of patient
  2. Increased age
  3. Emergency situations
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18
Q

According to Brodbelt et al 2008, what is the risk (%) of anesthetic sedative-related death in dogs? Cats? Rabbits?

A

Dogs = 0.17%

Cats = 0.24%

Rabbits = 1.39%

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19
Q

According to Brodbelt et al 2008, what type of patient in general is going to have a higher risk of anesthetic-related mortality?

A

sick (as opposed to healthy)

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20
Q

In order from highest to lowest risk, what was the anesthetic risk for sick animals in Brodbelt et al 2008?

A

Rabbit (7.37% > Cats (1.4%) > Dogs (1.33%)

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21
Q

In general, at what phase of a procedure do we see the highest risk for mortality?

A

Post-op (0-3 hours)

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22
Q

Why do we see a high risk of mortality 0-3 hours post-op?

A

Lack of observation and lack of O2 support

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23
Q

What is the overall anesthesia-related mortality in horses?

A

1%

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24
Q

Including obstetric/colic patients, what is the mortality rate in horses?

A

10%

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25
Q

What are the 2 most common reasons for mortality in horses undergoing a procedure?

A

Cardiac arrest, recovery injury (this is really due to euthanasia)

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26
Q

Horses have a ___ fold mortality rate over dogs/cats.

A

10

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27
Q

Horses have a ___ fold mortality rate over humans.

A

100

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28
Q

What are some owner concerns regarding anesthesia that we need to have answers for?

A
  1. Who monitors the patient?
  2. What do you monitor?
    1. HR/rhythm, RR, MM, SpO2, BP, temp, EtCO2
  3. How will you manage my pet’s pain?
  4. Why do animals need GA when procedure can be formed awake in people?
  5. Are there specific spp/breed/individual concerns?
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29
Q

What are the 5 general steps of anesthesia?

A
  1. Pre-anesthetic evaluation
  2. Pre-medication period
  3. Induction of anesthesia (usually IV but can be IM)
  4. Maintenance
  5. Recovery
  6. Post-anesthetic period
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30
Q

What are the 12 general principles of anesthesia?

A
  • Critical evaluation of history, PE, and lab data
  • Stabilize & correct identified abnormalities, if possible, prior to anesthesia
  • Be organized and efficient to minimize anesthesia time
  • Select protocol based on patient, existing abnormalities, and to minimize adverse effects
  • ID and prepare for potential complications
  • Establish IV access whenever possible
  • Secure & maintain patient airway
  • Use supplemental oxygen when indicated and provide ventilatory support
  • Monitor vital body systems (cardio, respiratory, CNS)
  • ID and correct abnormalities that arise
  • Continue monitoring and support thru recovery
  • Use appropriate analgesia and sedation to minimize pain and distress
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31
Q

What are the 4 components to patient evaluation?

A
  1. History
  2. Signalment
  3. PE
  4. Labs and diagnostics
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32
Q

Why is a thorough history critical?

A

Allows evaluation of underlying disease processes (systemic effects, chronicity) and ID of other abnormalities that may affect outcome of surgery

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33
Q

What are 6 good questions to ask the owner regarding the patient history?

A
  1. Past medical problems?
  2. Previous anesthesia?
  3. Pet’s energy level? Tire easily/out of breath?
  4. Any changes in drinking/urination?
  5. Current meds? (Rx’ed and OTC, supplements)
  6. Diet, exercise, environment
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34
Q

Why is species an important signalment?

A

There are many spp differences in anesthetic management, risks, and drug selection;

Anesthetist needs working knowledge of these differences

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35
Q

What are brachycephalic breeds more prone to?

A

upper airway obstruction

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36
Q

What is important about Greyhounds and Collies?

A

drug metabolism

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37
Q

What breeds are predisposed to cardiac disease?

A

Cavaliers, Maine Coons

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38
Q

What are Poland China, Landrace, and Duroc pigs predisposed to?

A

malignant hyperthermia

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39
Q

What are quarter horses predisposed to?

A

Hyperkalemic periodic paralysis (HYPP)

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40
Q

What are draft horses predisposed to?

A

Laryngeal hemiplegia (35%)

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41
Q

What are 3 concerns regarding anesthesia in geriatric patients?

A
  1. Decreased organ reserve –> cardio, liver, kidney
  2. Decreased sedative doses
  3. Osteoarthritis –> positioning/padding
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42
Q

What are 4 concerns regarding anesthesia in pediatric patients?

A
  1. Immature liver, CV/autonomic reflexes
  2. Decreased drug metabolism
  3. Hypoglycemia
  4. Hypothermia
43
Q

What are 2 concerns regarding anesthesia related to sex/neuter status?

A
  1. Temperament (i.e. stallions, bulls)
  2. Sex-related drug metabolism differences
44
Q

What 3 things are important considerations regarding an aggressive/fractious, anxious, or fearful patient?

A
  1. Poses a danger to staff
  2. Limits pre-anesthetic examination
  3. Need for more potent drugs, higher doses or combos
45
Q

Accurate body weight is needed for _____ _____.

A

drug calculations

46
Q

What are 3 anesthetic concerns related to body condition score?

A
  1. Cardiopulmonary effects
  2. Complicated by age-related factors
  3. Drug doses (most should be dosed on lean body weight)
47
Q

Lean body weight = _____% ideal body weight

A

~120-130%

48
Q

In the USA, ___% of dogs and ___% of cats are obese.

A

55%, 53%

49
Q

Worldwide, ____% of dogs are obese

A

>22-40%

50
Q

What % of horses are obese in Great Britain? Denmark? Australia? Canada?

A

GB = 31.2%

Denmark = 24%

Australia = 24.5%

Canada = 28.6%

51
Q

What is the scale used for BCS and what is the ideal?

A

9-point;

Ideal = 5/9, ~20-25% body fat

52
Q

What is the BCS scale for horses called?

A

Henneke BCS

53
Q

What does the Henneke BCS scale assess?

A

SQ fat deposition in 6 areas:

Crest of neck, withers, behind shoulder, over ribs, along back, around tail head

54
Q

What are the 7 body systems that should be evaluated during a PE?

A
  1. General body condition, attitute, mental status
  2. Neuro
  3. Ortho
  4. Respiratory
  5. Cardio
  6. GI
  7. Genitourinary
55
Q

What does an anesthesia PE focus on?

A

Cardio, respiratory, CNS, liver and kidney function

56
Q

When should the focused anesthesia PE be done?

A

Only after a FULL PE

57
Q

What lab data should be collected on normal healthy patients or with localized disease (<5 years old)?

A

Big 4: PCV, TP, azostrip, BG

58
Q

What does a high TP mean? Low?

A

High = dehydration, chronic inflammation

Low = protein loss thru GI or kidney, decreased production (liver failure)

59
Q

What is an azostrip?

A

Reagent strip for BUN

60
Q

What lab data should be collected from geriatric dogs and cats (>5-7 years old)?

A

CBC, chem, UA

61
Q

___% of geriatric dogs have subclinical disease identified by pre-op bloodwork

A

30%

62
Q

What lab data should be collected on horses >12-15 years old?

A

CBC, chem

63
Q

What is the minimum PCV for surgery?

A

20%

64
Q

What things make up a TP?

A

albumin + globulins + fibrinogen

65
Q

What does a decreased albumin do to anesthetic drug binding?

A

Decreases binding and increases their effect

66
Q

What is ALT?

A

Alanine transaminase - “leakage enzyme”

67
Q

What is ALP?

A

Alkaline phosphatase - relates to cholestasis

68
Q

What are the 4 main biomarkers of liver function?

A
  1. BUN
  2. Glucose
  3. Albumin
  4. Clotting factors
69
Q

How is BUN synthesized in the liver?

A

Protein –> ammonia –> urea

70
Q

What electrolytes are important for fluid and acid base homeostasis?

A

Na, Cl, K, Ca

71
Q

What are some additional diagnostic tests that can be performed prior to anesthesia?

A
  1. Thoracic rads
  2. Echocardiography
  3. Clotting profile
  4. CT, MRI, ultrasound
72
Q

What can thoracic rads show us?

A

Pulmonary contusions, pneumothorax, diaphragmatic hernia

73
Q

What can abdominal rads show us?

A

Urinary bladder rupture, hemoabdomen

74
Q

What is an anesthetic physical status of I? Example?

A

Healthy, no disease;

EX: spay, neuter

75
Q

What is an anesthetic physical status of II? Example?

A

Healthy, localized or mild systemic disease;

EX: patellar lux, CCR

76
Q

What is an anesthetic physical status of III? Example?

A

Moderate systemic disease;

EX: murmur, anemia

77
Q

What is an anesthetic physical status of IV? Example?

A

Severe systemic disease, life threatening;

EX: heart, liver failure

78
Q

What is an anesthetic physical status of V? Example?

A

Moribund, not expected to live >24 hours;

EX: multi-organ failure

79
Q

Anesthesia physical status is directly related to risk of peri-anesthetic _____.

A

death

80
Q

What is the % risk of peri-anesthetic death in dogs and cats with Class I-II physical status?

A

0.12%

81
Q

What is the % risk of peri-anesthetic death in dogs and cats with Class III-V physical status?

A

>40%

82
Q

What is the % risk of peri-anesthetic death in horses for non-emergency procedures?

A

1%

83
Q

What is the % risk of peri-anesthetic death in horses for emergency procedures?

A

2-10%

84
Q

Anesthetic drugs alter normal physiology/ability to maintain _____.

A

homeostasis

85
Q

What are examples of cases that need to proceed immediately to anesthesia and surgery?

A

Continued blood loss (splenic tumor rupture), acute abdomen (GDV)

86
Q

What steps can be taken to stabilize a patient for surgery?

A

Rehydration, correction of acid base and electrolyte abnormalities, anemia, hypoproteinemia

87
Q

What are the steps on the pre-emptive pain scoring system?

A

None, mild, moderate, severe

88
Q

What are 6 things that a complete anesthetic plan addresses?

A
  1. Pre- and post-anesthetic sedation/tranquilization
  2. Peri-op analgesia - pre-emptive, intra-op, post-op
  3. Induction and maintenance drugs
  4. Ongoing physiologic support
  5. Monitoring plan
  6. Anticipation and response plan to adverse events or complications
89
Q

An individualized anesthetic plan is _____ to allow for patient responses during anesthesia.

A

flexible

90
Q

Why do we fast dogs and cats prior to anesthesia?

A

Decreased risk of regurgitation/aspiration

91
Q

How long do we fast dogs and cats?

A

6-12 hours (3-6 may be sufficient)

92
Q

How long do we fast dogs and cats up to 4 months old and why?

A

~4 hours due to risk of hypoglycemia

93
Q

T/F: Dogs and cats cannot have water before a procedure.

A

False

94
Q

How can we prevent peri-anesthetic nausea and vomiting in dogs?

A

Give Maropitant (Cerenia)

1 mg/kg SQ at least 1 hour before opioid administration

95
Q

What type of drug is maropitant (Cerenia)?

A

Neurokinin-1 antagonist

96
Q

T/F: Maropitant provides adjunct analgesia.

A

True

97
Q

How long do we fast horses before anesthesia?

A

6-12 hours with access to water

98
Q

Why do we fast horses if they cannot vomit?

A

Weight of GI contents –> increased P on diaphragm –> limits lung expansion –> decreased ventilation –> decreased arterial oxygen and increased arterial CO2 levels –> ventilation-perfusion mismatch

99
Q

How long do we fast cattle before anesthesia?

A

24-48 hours food

12-24 hours water

100
Q

Why do we fast cattle?

A

Regurgitation and aspiration risk of rumen contents

101
Q

What can bloat in cattle lead to?

A

Bloat –> increased P on diaphragm –> limits lung expansion –> decreased ventilation –> decreased arterial O2 and increased arterial CO2 –> ventilation-perfusion mismatch

102
Q

How long do we fast sheep/goats before anesthesia?

A

12-24 hours food

+/- water

103
Q

How long do we fast all ruminants < 4 weeks old and why?

A

2-4 hours;

Are still nuring, monogastric, and less prone to regurgitation

Anesthesiology (12 decks)

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