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Anesthesiology > 13/14: Anesthesia in Dogs & Cats > Flashcards

13/14: Anesthesia in Dogs & Cats Flashcards

1
Q

What is a common way to prevent peri-anesthetic nausea and vomiting?

A

Maropitant - 1.0 mg/kg 1 hour before opioid administration

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2
Q

When is injectable maropitant given to cats?

A

20 hours prior to dexmetetomidine + morphine

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3
Q

What is the result of giving cats injectable maropitant pre-op?

A

Significant decrease in vomiting, no significant decrease in nausea

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4
Q

When is oral maropitant given to cats pre-op?

A

2-18 hours prior to dexmedetomidine + morphine

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5
Q

What is the result of giving cats oral maropitant pre-op?

A

Significant decrease in vomiting but not signs of nausea

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6
Q

When are dogs treated with maropitant pre-op?

A

45 min prior to morphine

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7
Q

When do dogs return to normal feeding PO if treated with maropitant?

A

20 hours

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8
Q

What is the consumption difference in dogs pre-tx with cerenia vs those that are not?

A

Pre-tx = higher mean total food consumption (4.85x more food)

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9
Q

T/F: Owners generally do not worry that their pets will have nausea and vomiting related to surgery

A

False

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10
Q

What % of owners would probably or definitely choose treatment for nausea? Vomiting?

A

Nausea = 95.7%

Vomiting = 99%

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11
Q

What % of owners were likely to accept nausea/vomiting treatment for their pets if veterinarian recommended?

A

95%

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12
Q

Generally, what effects do opioids have on CV, MAC, and respiration?

A

Mild CV effects, decreased MAC, bradycardia, resp depression

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13
Q

What type of drug is butorphanol?

A

K agonist/Mu antagonist

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14
Q

Does butorphanol provide sedation/analgesia?

A

Yes, mild to both

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15
Q

How long does sedation from butorphanol last?

A

1-2 hours

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16
Q

How long does analgesia from butorphanol last?

A

~90 min

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17
Q

Does butorphanol have a ceiling effect?

A

Yes

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18
Q

What is butorphanol used for?

A

Non or mildly painful procedures

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19
Q

What type of drug is buprenorphine?

A

Partial mu agonist

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20
Q

Does buprenorphine provide sedation/analgesia?

A

Yes: little sedation, mild to moderate analgesia

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21
Q

What does it mean when we say that buprenorphine is “sticky” to the mu receptor?

A

It is difficult to reverse or to follow with a mu agonist

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22
Q

What is the onset of buprenorphine? Duration?

A

Onset = 30-45 min (slow)

Duration = 4-10 hours in dogs, 6-12 hours in cats

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23
Q

Does buprenorphine have a ceiling effect?

A

yes

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24
Q

What are the full mu agonists?

A

Hydromorphone, Morphine, Oxymorphone, Methodone, Fentanyl

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25
Q

What type of pain are full mu agonists used for?

A

moderate to severe

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26
Q

What is the duration of action of hydro/oxymorphone?

A

2-4 hours

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27
Q

What is the duration of action of morphine/methadone?

A

4-6 hours

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28
Q

What is the duration of fentanyl?

A

20-30 min

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29
Q

What does fentanyl require for administration?

A

IVC/CRI

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30
Q

What does fentanyl do to the MAC of iso?

A

Decreases it by ~65%

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31
Q

What side effect does fentanyl not have compared to the other mu agonists?

A

vomiting

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32
Q

What is the main CV effect that fentanyl has?

A

Bradycardia

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33
Q

What type of drug is acepromazine?

A

Phenothiazine, alpha-1 antagonist

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34
Q

What is the duration of action of ace?

A

4-6 hours

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35
Q

Does ace have a reversal agent?

A

No

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36
Q

What CV effects does ace have?

A

Vasodilation, hypotension, bradycardia

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37
Q

What is the onset of dexmedetomidine?

A

Short = ~5-10 minutes

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38
Q

What is the duration of dexmedetomidine?

A

Short

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39
Q

What are the CV effects of dexmedetomidine?

A

40% decrease in CO, reflex bradycardia due to vasoconstriction

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40
Q

Does dexmedetomidine have a reversal?

A

Yes - atipamazole (Antisedan)

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41
Q

When should midazolam not be used as a sedative?

A

Young, healthy dogs

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42
Q

What are the CV effects of midazolam?

A

Mild

43
Q

What is midazolam used as an adjunct with?

A

propofol

44
Q

What can midazolam be used to treat?

A

seizures

45
Q

Which anti-cholinergic crosses the BBB/placenta?

A

atropine

46
Q

What is the onset of action of atropine?

A

5 min IM

1 min IV

47
Q

What is the duration of atropine?

A

60-90 min

48
Q

What is the onset of glycopyrrolate?

A

3-5 min

49
Q

What is the duration of glycopyrrolate?

A

2-4 hours

50
Q

What are CV side effects of anti-cholinergics?

A

Sinus tachycardia, 2nd deg AV block

51
Q

What drug should anti-cholinergics NOT be used with if the patient has high BP?

A

dexmedetomidine

52
Q

What airway issues are common in cats?

A

Laryngospasm, tracheal rupture

53
Q

What is the anesthetic protocol for premeds in cats?

A

Sedative (usually dexmedetomidine) + an analgesic (opioid)

54
Q

In addition to a sedative + analgesic, what can be added to cats for “kitty magic”?

A

Ketamine or telazol

55
Q

What cat patients is use of ketamine or telazol contraindicated in? What can be used instead?

A

Hypertrophic cardiomyopathy;

Can use alfaxalone instead of ketamine

56
Q

T/F: Alfaxalone + butorphanol does not affect ECG parameters in healthy cats

A

True

57
Q

What does “kitty magic” start with?

A

Dexmedetomidine

58
Q

What is used in “kitty magic” for analgesia?

A

Opioid (Butorphanol, buprenorphine, methadone, hydromorphone, morphine)

59
Q

What type of dosing does buprenorphine have good bioavailability with?

A

oral transmucosal

60
Q

Timing wise, what happens if buprenorphine is given alone with dexmedetomidine?

A

Less sedation and delayed onset of analgesia

61
Q

What should be done to bridge the time gap of opioids in kitty magic?

A

Butorphanol pre-med, then give buprenorphine 1 hour later (butorphanol will kick in quickly, then once it wears off buprenorphine kicks in ~1 hour later)

62
Q

What is a good substitute for buprenorphine to use in kitty magic if you need a full mu agonist?

A

methadone

63
Q

What does methadone cause in cats?

A

euphoria

64
Q

How can methadone be administered?

A

transmucosally

65
Q

What unwanted effect can hydromorphone have in cats?

A

Hyperthermia

66
Q

What drugs can be added for difficult cats to produce total injectable anesthesia?

A

Ketamine or Telazol

67
Q

What are 3 examples of “kitty magic” options?

A
  1. Dexmedetomidine + Butorphanol
  2. Dexmedetomidine + Ketamine (or Telazol) + Buprenorphine
  3. Dexmedetomidine + Methadone
68
Q

What kind of procedures would call for use of dexmedetomidine + methadone in cats?

A

More extensive procedures in cats with moderate to severe pain

69
Q

When using dexmedetomidine + butorphanol, what must be given 1 hour later?

A

buprenorphine

70
Q

Ketamine based protocols require _____ to decrease salivation.

A

anti-cholinergic

71
Q

What are 2 general functions of drug metabolism?

A
  1. Conversion of pro-drug to active form
  2. Metabolism of drugs to inactive, more water-soluble form for excretion
72
Q

What are phase I reactions of drug metabolism?

A

Oxidation (CYP450) reduction, hydrolysis

73
Q

What are phase II reactions of drug metabolism?

A

Conjugation:

  1. Glucuronic acid
  2. Sulfate, glycine, glutamate, glutathione, acetylation, methylation
74
Q

What mutation do cats have that impacts their drug metabolism?

A

Mutation in gene sequence for UGT1A6

75
Q

What size ETT will most cats take?

A

4.5

76
Q

How do you position a cat for intubation?

A
  1. Sternal recumbency, extend head/neck toward ceiling
  2. Thumb & forefinger behind canine teeth
  3. Tongue out of mouth between lower canines (straight out, not down!)
77
Q

What can happen to the tongue during anesthesia?

A

Lingual edema - trauma from intubation, pulse ox probe, entrapped in ETT tie

78
Q

What local anesthetic is placed on arytenoids of cats?

A

Lidocaine 0.1-0.2 mls 2% in syringe

79
Q

How is local anesthetic used in intubation of cats?

A
  1. Position laryngoscope and visualize arytenoids
  2. Swab arytenoids with topical lidocaine on a Q-tip, then use another to go thru glottis and coat inside of the larynx
  3. Wait ~30 seconds
  4. Proceed with intubation
80
Q

What local anesthetics cannot be used on arytenoids and why?

A

Cetacaine - methemoglobinemia (cats and sheep)

Zylocaine - risk of toxicity with multiple sprays in cats < 5 kg

81
Q

What is the intubation technique?

A
  1. Blade of laryngoscope on tongue, under epiglottis, press down
    1. DO NOT touch epiglottis
  2. Direct tube to ventral aspect of glottis
  3. Rotate bevel of tube if arytenoids are closed
  4. Stylet if needed
82
Q

What are likely causes for tracheal rupture?

A

Over-inflation of ETT, use of stylet, change of positioning without d/c from Y-piece

83
Q

What drug mixture can be used in aggressive dogs?

A

Dexmedetomidine + Ketamine + Opioid (butorphanol)

84
Q

What are disadvantages to using a boxing chamber and when should it be used?

A
  1. High doses needed
  2. Unable to monitor
  3. Waste gas pollution
  4. VERY stressful, increase SNS stim
  5. Thorough PE not possible

Use as a last resort

85
Q

How should propofol be given IV?

A

1.0 mg/kg slowly over 30-60 seconds, then to effect for intubation

86
Q

What are advantages to using propofol as an induction agent?

A

Smooth recoveries, not controlled, inexpensive

87
Q

What is the benefit to giving alfaxalone over propofol?

A

Can be given IM

88
Q

What are disadvantages to using alfaxalone as an induction agent?

A

Decreased recovery quality with high doses, controlled (Sched IV), more expensive

89
Q

What is the benefit to using propofol and ketamine together?

A

They cancel out each other’s CV effects, better quality of induction/intubation

90
Q

What is a proper induction protocol for critically ill patients (GDV, septic/hemoabd, severe heart dz)?

A

Opioid + BDZ (i.e. fentanyl + midazolam)

91
Q

What is the MAC of iso in dogs? Cats?

A

Dogs = 1.3%

Cats = 1.6%

92
Q

What is the MAC of sevo in dogs?

A

2.3%

93
Q

What is a disadvantage to using sevo?

A

Expensive, toxic metabolites

94
Q

What is the MAC of nitrous oxide in dogs?

A

~200%

95
Q

What are benefits to using nitrous oxide?

A

Inexpensive, provides adjunct analgesia

96
Q

What is MLK?

A

Morphine, Lidocaine, Ketamine

97
Q

What is HLK?

A

Hydromorphone, Lidocaine, Ketamine

98
Q

What is FLK?

A

Fentanyl, Lidocaine, Ketamine

99
Q

Other than MLK, HLK, and FLK, what are some CRIs that can be used?

A
  1. Fentanyl
  2. Fentanyl + Ketamine
  3. Dexmedetomidine
  4. Dexmedetomidine + MLK
100
Q

What drug classes inhibit pain perception?

A

Anesthetics, opioids, alpha-2 agonists, BDZ, phenothiazines

101
Q

What drug classes inhibit pain transmission?

A

Local anesthetics and alpha-2 agonists

102
Q

What drug classes modulate spinal pathways?

A

Local anesthetics, opioids, alpha-2 agonists, NSAIDs, NMDA antagonists, tricyclic antidepressants, anticonvulsants

103
Q

What drug classes inhibit pain transduction?

A

NSAIDs, opioids, local anesthetics, corticosteroids

Anesthesiology (12 decks)

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