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ANESTHESIA > 1 – Introduction > Flashcards

1 – Introduction Flashcards

1
Q

General anesthesia:

A
  • State of unconsciousness produced by CONTROLLED, REVERSIBLE intoxication of CNS
  • Patient does not perceive or recall noxious (or other) stimuli
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2
Q

Triad of anesthesia:

A
  1. Unconsciousness
  2. Analgesia
  3. Muscle relaxation
    *one drug CANNOT do all three components unless high doses
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3
Q

Mechanism of action of anesthetics:

A
  • Largely unknown
  • *LIPOPHILIC to have action within CNS due to BBB
  • Interacts with GABA in BRAIN
  • Interacts with Glycine in SC
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4
Q

Multimodal (Balanced) Anesthesia:

A
  • Number of different drugs used to fulfil the triad of anesthesia
  • Ex. unconsciousness: isoflurane
  • Ex. analgesia: opioids, NSAIDs
  • Ex. muscles relaxation: benzodiazepines
    o *use peripheral neuromuscular blocking agents if require NO muscle tone
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5
Q

Overall effect on the ANS:

A
  1. CNS depression
  2. CVS depression
  3. Respiratory depression
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6
Q
  1. CNS depression
A

a. Loss of consciousness
b. Damping of reflexes
i. Cardiovascular=hypotension
ii. Respiratory=hypoventilation
iii. Thermoregulatory=hypothermia
iv. Postural=reduced muscle tone
c. Central modulation of nociception

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7
Q
  1. CVS depression
A

a. Baroreflex suppression
b. Changes in autonomic balance
c. Changes in vasomotor tone
d. Myocardial depression
i. Direct (drugs)
ii. Indirect (hypoxemia, hypercapnia)
e. HYPOTENSION

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8
Q
  1. Respiratory depression
A

a. Reflex suppression
b. Reduced muscle activity
c. Aleolar collapse
d. Reduced functional residual capacity
e. Ventilation/perfusion mismatch
f. HYPOVENTILATION (hypercapnia/hypoxemia)

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9
Q

Risks of anesthesia:

A
  • High does leader to deeper brain depression, overdose can cause DEATH
    o Suppression of reflexes with ANS and SNS
    >Autonomic: BAD (hemodynamics, respiratory)
    >Somatic: GOOD (proprioceptive reflexes and muscle relaxation)
  • Risk is linked with physical status
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10
Q

Ways to minimize risks:

A
  • Vigilance (never assume!)
  • Build intervention points (use SOPs)
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11
Q

Stages of anesthesia:

A
  1. Stage 1: voluntary excitement
  2. Stage 2: involuntary excitement
  3. Stage 3:
    a. Plane 1: light
    b. Plane 2: surgical depth=where most procedures are performed)
    c. Plane 3: deep
  4. Stage 4: cardiopulmonary arrest imminent
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12
Q

Phases of anesthesia:

A
  • Pre-operative assessment
  • Premedication
  • Induction
  • Maintenance: continuation
  • Recovery
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13
Q
  • Pre-operative assessment
A

o Stabilization and provision of analgesia
o Dogs, cats, horses: 6-8hrs fasted (horses can have hay)
o Ruminants: 24-48hrs fasted to prevent bloat

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14
Q
  • Premedication
A

o Sedation and initiation of analgesia if not already provided
o Choice depends on:
 Species
 Facilities
 Clinician preference
 Health status of animal
o Ex. acepromazine, benzodiazepines, opioids

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15
Q
  • Induction
A

o Rapid with IV, slower with inhalation techniques
o Stressful for body (ensure animal can tolerate changes)

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16
Q
  • Maintenance: continuation
A

o If can pass an endotracheal tube=anesthesia (NOT sedation)

17
Q
  • Recovery
A

o Aftercare and continuation

18
Q

Monitoring tools:

A

-respiratory
-cardiovascular
-CNS

19
Q

Monitoring Tools: respiratory

A

-6-12 br/min
o Too much muscle tone can compromise lung ventilation
o ‘light’: fast, deep, breath holding
o ‘surgical’: rhythmic, intercostal/abdominal

20
Q

Monitoring Tools: cardiovascular

A

o Minimum BP: 60
o Aim for: 120/80 (90)
o *HR not predictable of anesthetic depth

21
Q

Monitoring Tools: CNS

A

o Reflexes
>Pedal withdrawal reflex (ex. exotics)
>Corneal reflex (not advised=corneal damage)
>Anal tone
o Muscle tone
o Breath patterns (more abdominal and less intercostal with depth)

22
Q

Reflexes (CNS monitoring): Basic eye reflexes: dog/cat

A

*‘light’ plane
-Eye central
-Palpebral reflex present
-Shiny cornea
*‘surgical’ plane
-Eye rotated ventral
-No (or slight) palpebral reflex
-Move UPPER eyelid to check
-Dry cornea-lube

23
Q

Reflexes (CNS monitoring): Basic eye reflexes: horses

A

*‘light’
o Tearing
o Nystagmus
o Spontaneous blinking
*‘surgical’
o Inhalation=central eye, sluggish palpebral
o Injectable=central eye, rapid palpebral

24
Q

What is required for supportive care?

A
  • Warmth
  • Hydration
  • BP support: IV fluids, drugs
  • Delivery of oxygen and lung ventilation
  • Protect musculoskeletal and NS
25
Q

Why is provision of analgesia important during a surgical/anesthetic event?

A
  • Make patient comfortable
26
Q

Pre-emptive analgesia:

A
  • Anticipate a painful event – administer analgesics beforehand
27
Q

Importance of pre-emptive analgesia:

A
  • Stop the pain pathway from firing
  • Minimize the potential for wind up/sensitization
28
Q

Concept of multi-modal analgesia:

A
  • Different drugs combat pain in different ways

ANESTHESIA (18 decks)

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