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Anesthesiology > 10. Anesthetic Complications > Flashcards

10. Anesthetic Complications Flashcards

1
Q

Anesthetic overdose. absolute v. relative

A

absolute - gave incorrect dose.

relative - right dose, but there was an underlying patient condition

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2
Q

signs of overdose

A

bradycardia, hypotension…. cardiac arrest, no pulse.

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3
Q

What do you do if theres an anesthetic overdose?

A
  1. get oxygen in, intubate

2. reverse any drugs

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4
Q

What drugs can you reverse? with what?

A

xylazine - yohimbine (can use atipamazole in theory)
opioids - naloxone
benzos - flumenazil (1/10 dose of dose of benzo)
dexmedetomadine - atipazole (equal volume)

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5
Q

NaBicarb (barbituates) overdose, what do you do?

A

balanced fluids! without dextrose (will swell brain) - support CV function (dopamine/dobutamine for BP, atropine/glyco for brady)

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6
Q

Nalve question -

phenobarbital overdose

A

ventilate

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7
Q

isoflurane put in sevoflurane vaporizor

reverse?

A

iso is more volatile, higher iso concentration will be delivered
Sevo has higher MAC also can go deep/into cardiac arrest quickly.

reverse? sevo in iso - pt will be light than expected

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8
Q

if using a rebreathing circuit you must ______ oxygen flow to reduce the amount of anesthetic being inhaled.

A

increase.

not necessary in nonrebreathing circuit

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9
Q

Tachypnea can be caused by

A
  1. **hyperthermia - opioids/other
  2. Equipment Malfunction (unidirectional valve stuck, soda exhausted)
  3. Light plane
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10
Q

PaCO2 is ______ when tachypnic

A

unpredictable

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11
Q

how to manage tachypnea

A

IPPV in just hypoventilating

check temp/equipment

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12
Q

Animals hyperthermic what do you do?

A

> 102.5

  1. Turn off warming devices
  2. COLD IV fluids
  3. iced gastric lavage or cold water enema
  4. electric fan and water spray (cats)
  5. increase O2 flow
  6. steroids if brain trauma
  7. NSAID if contaminated pyrogen
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13
Q

signs of hyperthermia

A
  1. tachypnea

2. tachycardia

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14
Q

causes of hyperthermia

A
  • obese/dense hair coat - fialure to lose heat
  • low flow circuit
  • bair hugger/hot dog too hot/lamp OR temp
  • drugs contaminated with pyrogens
  • CNS injury
  • hypermetabolic state (MALIGNANT HYPERTHERMIA, or bacteremia, or high T4)
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15
Q

signs of malignant hyperthermia

A
  • genetic
  • accumulation of Ca in muscles in hypermetabolic state.
  • tachypnic, tachycardic
  • acidemia high CO2 in spite of tachypnea (RESPIRATORY ACIDOSIS)
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16
Q

treatment of malignant hyperthermia

A 
- stop inhalants (most common cause)
maintain anesthesia with injectable
-  inc. O2 flow
- change anesthetic machine
- ***DANTRIUM reduces Ca in sarcoplasmic reticulum
- ice packs/spray down
- Na bicarb for acidosis
- dobutamine for hypotension
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17
Q

hyperthermia post anesthesia is common in ____. Associated with which drugs?

A

cats

ketamine and hydromorphone. (But all opioids can cause hyperthermia in cats)

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18
Q

What to do in cat with post-op anesthesia?

A
  • give ace

- fan and spray with water

19
Q

anaphylaxis vs. anaphylactoid reaction?

A

anaphylaxis - Prior sensitization (IgG prod first time, second time -> anaphylaxis)

anaphylactoid - no prior sensitization (give drug -> histamine release)

20
Q

common anaphylactic anesthetic drugs

A
  • thiopental, propofol, atropine, xylazine
  • opioids: morphine, meperidine
  • cremophor EL (used to be used as preparation for propofol/alfaxolone)
  • NMBAs: allamine/Atracurium (give slowly), procaine, ketamine,
  • blood products
  • abx
21
Q

signs of anaphylaxis

A

CV: disrhythmias, HYPOTENSION
respiratory: cyanosis, labored breathing, bronchospasm
Cutaneous: hives, swollen paws

22
Q

anaphylaxis:
if hypotensive, ______ the inhalant and ___drugs?___.

If bronchospasm and normotensive, _______ the inhalant.

A

hypotensive - turn off inhalant, give fluids and epinephrine .01mg/kg IV (IM/DC if less severe) or give diphenhydramine

keep on inhalant - its a bronchodilator

23
Q

how to prevent anaphylactic reactions

A
  1. give drugs slowly (ex/ abx)

2. prophylactic diphenhydramine, corticosteroids

24
Q

hypoxemia signs/numbers?

A 
SpO2 <90%
PaO2 < 60 mmHg
MM: normal OR CYANOTIC
bradycardia or VPCs if chronic 
dog may open mouth if severely hypoxemic, bc brain overrides, needs O2
25
Q

When will you see cyanosis?

A

if Hb <5

26
Q

causes of hypoxemia (5)

A
  1. Low FiO2
  2. Hypoventilation
  3. V/Q mismatch
  4. Shunt
  5. diffusion impairment
27
Q

All causes of hypoxemia except ______ will respond to High FiO2

A

shunt

28
Q

Nitrous oxide caused hypoxia?

A

low inspired O2 concentration, diffusion hypoxia occurs after nitrous oxide is turned off. so keep them on 100% O2 for 5 minutes after discontinuing Nitrous oxide.

29
Q

hypoventilation causes hypoxemia when _____ only

A

breathing room air

30
Q

V/Q mismatch diseases

A
  • pneumonia, pulmonary edema, aspiration
  • shunt is worst form of mismatch
  • venous admixture - diaphrag hernia, bronchial obstructure
31
Q

shunting of venous admixture cause ________. as hypoxemic blood passes alveoli, it doesn’t get more fresh oxygen

A

alveolar collapse

32
Q

worst form of V/Q mismatch

A

***intrapulmonary shunting!!!

33
Q

how to ascertain cause of hypoxemia

A
  1. look at bag
    - big bag (pop off valve closed)
    - no air in bag (no O2 source)
  2. assess pulmonary compliance
  3. larger tidal volume to open up tidal alveoli
  4. PEEP if everything fails
34
Q

healthy animal turned blue while under anesthesia, what are the options?

A
  1. Endobronchial intubation
  2. anesthetic machine malfunction pop off valve
  3. nitrous oxide
35
Q

pop off occlusion valve

A

prevents people from keeping pop off closed; makes it impossible to forget to untwist valve

36
Q

(Cant intubate)

what to do while waiting to set up for tracheostomy?

A

put needle through cricothyroid and hook up to O2 source

37
Q

pulmonary edema, steps?

A

intubate, put on 100% O2
use peep
lasix
use inotropes if cardiogenic

38
Q

steps to treat pneumonia?

A

100% O2

intubate, use PEEP

39
Q

steps to treat bronchospasm?

A

100% O2
intubate, IPPV
epinephrine or aminophyllum
can suction trachea

40
Q

causes of airway obstruction?

A 
failure to remove packing in oral cavity
ETT problems
breathin circuit malfunction
bronchospams (aspiration or allergic rxn)
trauma - ruptured trachea, cervical swelling
mass
tracheal collapse
bandage around neck to tight
41
Q

paradoxical breathing indicates?

A

airway obstruction

42
Q

known airway problem?

A
  • preoxygenate
  • minimize stress
  • be prepared to intubate again in they decompensate
43
Q

intubating for tracheal collapse?

A

have long enough tube that covers the collapse

- can intentionally ventilate one lung

44
Q

succinylcholine and airway obstruction?

A

for muscle relaxation for complete laryngospasm in cats

lidocaine for partial laryngospasm

Anesthesiology (21 decks)

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