1. SA Anesthesia Flashcards
What is included in a pre-anesthetic assessment?
Full PE - age, temperment, breed (brachycephalic, greyhound)
Medical hx - past problems and drug reactions, anesthetic events, present problems (current meds)
Basic hematology (PCV, TP, BUN, Gluc)
What are some diagnostic tests done for older and/or sick patients before going under?
CBC, serum chem, UA - also on basis of PE and hx
Xray of thorax for trauma, resp. problems)
ECG, echocardiography (murmurs, arrhythmias)
Delay anesthesia until - further assessment is performed, patient is stabilized, anasthetic risk established
Why is client communication important?
explain anesthetic risk and set expectations, patient prep starts at home
May get pre-hospital anxiety drugs like trazodone and gabapentin
What are the 5 categories of the ASA physical status classification?
ASA 1: normal healthy patient
ASA 2: mild systemic dz - no func. limitations
ASA 3: severe systemic dz - definite func. limitation
ASA 4: severe systemic dz that is a constant threat to life
ASA 5: Moribund, not expected to survive w/o operation
How do we prepare patients for anesthesia?
food + water: free access - important for old anims + anims with inc fluid req’s
Fast b4 anesthesia - yg animals: req shorter times bc of hypoglycemia
6-16wks: 4hrs, older than 16wks: 6-8hrs
What might determine the anesthesia protocol?
PE, age, temperment, surgical procedure, clinical setting
What goes into the anesthetic protocol?
premeds: sedative + opioid
Induction
Maintenance: inhalant +/- opioid +/- local anesthetic
Post operative pain management: NSAID, opioid
What are the aims of premedication?
Sedation and anxiolysis (fear free)
facilitate animal handling
Balanced anesthetic technique
analgesia
Smooth and quiet recover
What category of drug should not be administered along with dexmedetomidine?
An anticholinergic
Give an example of some premed drugs of opioids, sedatives and anticholinergics
Opioids: hydromorphone, methadone, butorphanol, buprenorphine
Sedatives: acepromazine, dexmedetomidine, midazolam
Anticholinergics: atropine, glycopyrrolate
For premedding dogs, what is the protocol for calm dogs?
- Acepromazine: 0.01-0.05 mg/kg
- Hydromorphone: 0.1 mg/kg
- Dexmedetomidine: 1-5 μg/kg
- Hydromorphone: 0.1 mg/kg
For pre-medding dogs, what is the protocol for excited and/or agitated dogs?
- Acepromazine: 0.01-0.02 mg/kg
- Dexmedetomidine: 1-10 μg/kg
- Hydromorphone: 0.1 mg/kg
For premedding aggressive dogs, what might we add on?
- Plus Ketamine 1-10mg/kg
What is the standard drug protocol for premedding cats?
- Dexmedetomidine: 8-30 μg/kg
- Hydromorphone: 0.1 mg/kg
What is kitty magic?
For more reliable sedation use a ketamine-based protocol
provides GA for invasive short procedures
Monitor patient + provide life support
DEXMEDETOMIDINE (5-15 μg/kg)
Midazolam (0.2 mg/kg)
Butorphanol (0.4 mg/kg)
DEXMEDETOMIDINE (10-25 μg/kg)
Ketamine (2-10 mg/kg)
Butorphanol (0.4 mg/kg)
ALFAXALONE 2 mg/kg
Butorphanol (0.4 mg/kg)
Midazolam (0.2 mg/kg)
What equipment do we need to check before doing the procedure
Ensure ET tubes readily available
monitor equipment
Anes. machine - proper breathing system, leak tested, check O2, inhalant, CO2 absorbent, waste scavenging
When doing induction, how do we prepare our patients/
venous access - catheter placement
Stabalize hemodynamically instable patients
check HR, pulse quality and RR
Connect monitoring equipment (appropriate for dz condition)
Pre-O2: reduce risk of hypoxemia
Quiet environment
What are some common drugs used for induction?
propofol, diazepam + Ketamine, alfaxalone
Mask: iso and sevoflurane
ADMINISTER TO EFFECT
What are the ABC’s of anesthesia induction?
Airway: intubation, secure tube, inflate cuff
Breathing: auscultate for bilat lung sounds while manually ventilating. Check for spontaneous ventilation
Circulation: auscultation of heart beat
Depth and Drugs: assess depth of anesthesia, turn on vaporizer
Equipment: BP, eye lube very last on list (lube prior to induction)
Fluids
Before we intubate, what do we need to check?
ETT for patency, cuffs for leaks
Have multiple sizes available
Grab laryngoscope, kling, cuff syringe
Pre-measure ET tube length (incisor teeth > thoracic inlet)
What is the technique for intubating a dog?
can be performed in sternal, lateral or dorsal
Apply slight coating of lube (improve’s cuffs ability to seal)
Open the dog’s mouth, pull tongue forward gently
Straighten head and next, extend tongue
Put tip of laryngoscope blade on base of tongue, NOT on epiglottis
insert ETT under visualization
Inflate cuff and check for leaks
Secure tube
What is the technique for intubating a cat?
They have a small oropharynx so prone to laryngospasm
A local anes. like lidocaine good to prevent it
- Lidocaine Spray: metered dose 12mg
- Lidocaine neat 2% (2mg per 0.1mL)
How do we confirm ETT placement?
direct visualization (use laryngoscope)
Rebreathing bag
Chest excursions
Palpate only ONE trachea below larynx
Capnograph
Auscultate both sides of lungs during manual ventilation
Why do we need to worry about depth and drugs for anesthesia induction?
check the depth of anesthesia, eye position, palpebral reflex, jaw tone
Base it on ur patients depth > turn on vaporizor
What equipment are we worried about with anesthetic induction?
apply monitoring equipment, doppler first: audible signal
monitorBP
Assess patient
Adjust vaporizer settingW
Why are fluids important with anesthesia?
correction of normal ongoing fluid losses
support of CV function
Countering of potential neg physiological effects
Maintaining patent IV catheter
What fluid rates are used during anesthesia?
Cats: 3ml/kg/hr
Dogs 5ml/kg/hr
Why is recovery the most critical phase of anesthesia?
47% of dogs and 60% of cats die within first 3 hours of recovery
Continuing monitoring and patient support
How and when do we extubate in small animals?
After dental sx check oral cavity for fluid
Don’t untie tube until patient has reached final recovery spot
ETtube cuffs not deflated until just before extubation
Dogs: extubation on return of swallowing on return
Cats: ear twitch or sooner, prone to laryngospasm or laryngeal edema
What are some common complications with recover?
emergence delirium, dysphoria, pain, delayed recover
Patients should be closely observed until alert, normothermic, and ambulatory
Optimal recover time is 10-30m end of anesthesia
How can we ensure a patient’s comfort during recovery?
reduce enviro stress *noise, bright lights)
Hypothermia, urinary bladder distension
Pain assessment and adequate pain mgmt
What supportive care can we give to an recovering patient
oxygen, fluids, heating, eye ointments
