Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ANESTHESIA > 23 – Complications > Flashcards

23 – Complications Flashcards

1
Q

3 broad categories of complications?

A
  1. Anesthesia related
  2. Procedure related
  3. Patient specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the anesthesia related complications?

A
  • Hypothermia
  • Hypotension
  • Hypoventilation (hypercapnia)
  • Hypoxemia
  • Bradycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some procedure related complications?

A
  • Pain
  • Hemmorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some specific patient complications for a brachycephalic breed?

A
  • Upper airway obstruction
  • Regurgitation/vomiting ->aspiration
  • Hyperthermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the normal PaO2 and FiO2?

A
  • PaO2= 80-11mmHg
  • FIO2=21%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the normal saturation of hemoglobin (SpO2)?

A
  • 97-100%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What values for PaO2 and SpO2 indicate hypoxemia?

A
  • PaO2<60mmHg
  • SpO2<90%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some causes of hypoxemia and low SpO2?

A
  • Low inspired O2 (FiO2)
  • Hypoventilation
  • Diffusion problem (pulmonary disease)
  • Ventilation perfusion (V/Q) mismatch
  • Right to left shunt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical effects of mild hypoxemia (SpO2>80%)?

A
  • Activation of SNS
  • Increase HR
  • Mild hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the clinical effects of moderate hypoxemia (SpO2: 60-80%)?

A
  • Local vasodilation ->hypotension
  • Reflex increase in HR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical effects with severe hypoxemia (SpO2<60%)?

A
  • Local depressant effects predominate
  • Rapid decrease in BP ->severe hypotension
  • Bradycardia -> ventricular fibrillation or cardiac arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the consequences of hypoxemia?

A
  • Tissue hypoxia
  • Lactic acidosis
  • Organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the high risk patients for hypoxemia?

A
  • Brachycephalic
  • Diaphragmatic hernia
  • Pneumothorax, pulmonary contusion
  • Upper airway obstruction
  • Pneumonia
  • Abdominal distance (C-section)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can you do for high risk patients to hypoxemia prior to anesthisa?

A
  • Pre-oxygenation!
  • NO contra-indication to oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some causes of hypoxemia?

A
  • Low inspired O2 (FiO2)
  • Hypoventilation
  • Ventilation perfusion mismatch and intrapulmonary shunting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Low inspired O2 (FiO2)

A
  • Check O2 supply
  • Check endotracheal tube
  • Check that breathing system is tight to ET-tube
  • Airway obstruction: remove or bypass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the definition of hypotension (SAP, MAP, DAP)?

A
  • SAP<80mmHg
  • MAP<60mmHg
  • DAP<40mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the minimal acceptable MAP for large animals?

A
  • MAP=70mmHg (myopathy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 3 basic pathophysiological mechanism that lead to hypotension?

A
  • Decreased vascular tone
  • Decreased CO
  • hypovolemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do you do if patient is hypotensive?

A
  1. Check depth of anesthesia
  2. Check HR
  3. Fluid bolus
  4. Ephedrine
  5. Add positive inotrope – dobutamine
  6. *last resort: add a vasopressor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Check depth of anesthesia

A
  • Decrease vaporizer setting
  • Maybe need to administer anesthetic sparing drugs
    o Opioid: no CV side effects
22
Q

Check HR

A
  • Treat bradycardia (1/2 resting HR)
    o Can decrease CO
  • Slow normal HRs do not usually affect CO
  • *treatment: atropine, glycopyrrolate
23
Q

Fluid bolus in hypotension recommendations for cats and dogs

A
  • Cats: 3ml/kg over 15 mins
  • Dogs: 5ml/kg over 15 mins
24
Q

Why give a fluid bolus (crystalloid fluids: isotonic balanced)?

A
  • Increase intravascular volume and improves venous return
  • Repeated once if needed
25
Q

When would you give a colloid bolus?

A
  • If response to crystalloid fluids is inadequate
  • Maximum dose 20ml/kg/day
  • Pentaspan 6%
26
Q

When would you give a hypertonic saline (7.5%)?

A
  • 4mL/kg over 10 min (duration 30-120min)
  • Blood loss
  • Need of rapid volume expansion
27
Q

Ephedrine

A
  • Synthetic noncatecholamine=stimulates alpha1 and beta1 receptors
  • Indirect acting: release of endogenous NE
  • Vasoconstrictor/venoconstrictor
  • *effects last up to 15mins
28
Q

Add positive inotrope – dobutamine

A
  • Beta1 agonist=increases myocardial contractility
  • Useful for low CO stages in patients with ADEQUATE intravascular volume
  • Used as an infustion (short half life)
  • Less risk of cardiac arrhythmias
29
Q

What are 2 options for the last resort of adding a vasopressor

A
  • NE infusions
  • Vasopression infustions
30
Q

NE infusions as a last resort

A
  • Alpha1 constictor
  • May dimmish visceral organ perfusion (liver, kidneys)
  • Try to limit to emergency use only
  • Treatment for refractory hyptension (septic patients)
31
Q

Vasopressin infusions

A
  • Non-catecholamine vasopressor
  • Used for refractory hypotension
  • Very sick patents of post cardiac arrest
32
Q

What are some causes of bradycardia?

A
  • Drugs: alpha2 agonists, opioids
  • Deep plane anesthesia
  • Hypothermia
  • Vagal reflexs (oculo-cardiac reflex)
  • Electrolyte imbalance
33
Q

What are the different forms of bradycardia?

A
  • Sinus bradycardia
  • AV block
  • Sinus arrest
  • Ventricular escape beats
  • Asystole (NO P waves)
34
Q

Tachycardia rates in dogs and cats

A
  • Dog >180bpm
  • Cat >200bpm
  • *correct the underlying problem
35
Q

Tachycardia is a sympathetic response to

A
  • Pain
  • Awareness
  • Hypotension
  • Hypoxemia
  • Hypercapnia
  • Hypovolemia
36
Q

What do you treat a ventricular premature complex with?

A
  • Lidocaine bolus
37
Q

What do you treat sinus bradycardia with escape beats?

A
  • Atropine or glycopyrrolate
  • *goal is to increase HR as the escape beat is due to slow sinus rate
38
Q

What are some predisposing factors to regurgitation?

A
  • Brachycephalic breeds
  • Drugs relaxing LES (volatiles, opioids, anticholinergics, propofol)
  • Increased intra-abdominal pressure: pregnancy, obestity , surger, head-down position
  • Prolonged anesthesia
39
Q

What are some preventative measures for regurgitation?

A
  • Appropriate pre-anesthetic fasting
  • Pretreatment with OMEPRAZOLE, maropitant, metoclopramide
  • Use of cuffed ET-tube
40
Q

How do you treat regurgitation?

A
  • Secure airway in unconscious patient: check cuff
  • Place suction catheter in esophagus
  • Suction refluxate and lavage with tap water
  • Instillation of 5-10ml Na-citrate solution
  • Check and suction again prior to extubation
  • *pantoprazole, famotidine
41
Q

What does mild hypercapnia (45-60mmHg) cause?

A
  • SNS: tachycardia, mild hypertension
42
Q

What are the clinical signs that are usually seen when PaCO2>60mmHg?

A
  • Bounding pulses (high systolic, low diastolic)
  • Vasodilation: brick red colour, capillary oozing
43
Q

What are the clinical signs that are seen with sever hypercapnia (PaCO2>90mmHg)

A
  • Severe CNS depression (narcosis)
  • Respiratory arrest (depression of brainstem)
44
Q

What are some causes of hypercapnia?

A
  • Hypoventilation
  • Equipment failure
  • Endobronchial intubation
  • V/Q mismatch
  • Apparatus dead-space (overlong ET-tube)
  • Increased CO2 production (hyperthermia)
45
Q

When does hypoventilation occur?

A
  • Respiratory depressant drugs
  • Position (dorsal)
  • Abdominal distension
  • Obesity
46
Q

What are some equipment failures that can occur that cause hypercapnia?

A
  • Uni-directional (one-way) valves (circle systems)
  • CO2 absorber exhausted
  • Inadequate fresh gas flow (non-rebreathing system)
47
Q

What are some way to prevent heat loss?

A
  • Insulation
  • Warming mats
  • Warm air blankets
  • Radiant heat lamps
  • Warm IV fluids/irrigation fluids
48
Q

What are some potential problems with warming devices?

A
  • Patient cannot move away from the source
  • Blood flow may no conduct heat away
  • Body pushed into heat source
  • *always observe and monitor T
  • Avoid direct contact to avoid burns
    o Use towel for insulation
49
Q

What are some circumstances where hyperthermia occurs?

A
  • Heavy-coated dogs on circle rebreathing system
  • Post op in cats
    o If used mu-opioids, ketamine, intra-op hypothermia
  • Malignant hyperthermia
50
Q

What is the treatment for hyperthermia?

A
  • Turn of supplemental heat, remove blankets, ice packs
  • Water, alcohol to inguinal and axillary regions
  • Fans: careful corneal ulcers
  • Acepromazine?
51
Q

What is important with extubation in brachycephalic breeds?

A
  • Late extubation to avoid airway obstruction
  • *BE PATIENT
    • keep period between extubation and full alertness as SHORT as possible

ANESTHESIA (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions