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Equine final practical exam - Surgery > 6. Anaesthesia of the equine patient > Flashcards

6. Anaesthesia of the equine patient Flashcards

1
Q

Name 3 types of anaesthesia:

A
  1. Neuroleptanalgesia
  2. Local or regional anaesthesia
  3. General anaesthesia
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2
Q

What is neuroleptanalgesia?

A

A combination of sedatives + analgesics

The patient is partially remained consciousness, it give muscle relaxation and analgesia

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3
Q

What is the aim of neuroleptanalgesia?

A

Diagnostic or therapeutic

(Tooth extractions, US, suturing, opening of abscesses, etc.)

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4
Q

Name common combinations of drugs used for neuroleptanalgesia?

A

ACP + Butorphanol
Xylazine + Butorphanol
Deteomidine + Butorphanol
ACP + Xylazine + Butorphanol

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5
Q

Name 3 under-groups of the sedatives used:

A

Alpha-2 receptor agonists
Phenothiazine derivates
Benzodiazepine tranquilizers

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6
Q

Which drugs belong to “Alpha-2 receptor agonists”?

A

Xylazine
Detomidine
Medetomidine
Romifidine

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7
Q

Which main effect does the “Alpha-2 receptor agonists” have?

A

Sedation, analgesia

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8
Q

Effects of “Alpha-2 receptor agonists”:

A

Cardiopulmonary effect
GI effect
Increased urination

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9
Q

Which specific cardiopulmonary effects does the “Alpha-2 receptor agonists” have?

A
  1. Increased vagal tone causing BRADYCARDIA and decreased CO

2.dysrrhytmia or arrhytmia

  1. central respiratory depression. High dose = Decreased respiratory rate
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10
Q

Which specific GI effects does the “Alpha-2 receptor agonists” have?

A
  1. Swallow reflex is blocked
  2. Reduced bowel motility and visceral perfusion
  3. Good visceral analgetics – colic cases!!
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11
Q

Important for foals in case of “Alpha-2 receptor agonists”:

A
  1. NOT given in foals under 6 weeks
  2. Large dose in foal → recumbent, dyspnoe (intubation)
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12
Q

Administration route and duration of “Alpha-2 receptor agonists”, time for onset of action:

A

IV and IM
Duration: 20-120 minutes (15-20 min analgesia - dose dependent)

Onset of action:
IV = 3-5 min
IM = 10-15 min

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13
Q

Important in case of IA (Intra Arterial) for “Alpha-2 receptor agonists”:

A

Collapse, reversible central blindness

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14
Q

Antidotes of “Alpha-2 receptor agonists”:

A

Alpha-2 receptor antagonists.

  1. Yohimibine
  2. Tolazoline
  3. Atipamezole
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15
Q

Which drugs belong to “Phenothiazine derivatives”, injection route?

A

ACP (Acepromazine) and propriopromazine

ACP = IV, IM, PO
Propriopromazine = IV

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16
Q

Main effect of “Phenothiazine derivatives”?

A

Mildly tranquilizing - painkillers

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17
Q

Cardiopulmonary effects of “Phenothiazine derivatives”?

A

Vasodilation, hypotension, reflextachycardia
Antiarrythmic, antipyretic, hypothermia
Decreased respiratory rate

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18
Q

Contraindications in case of “Phenothiazine derivatives”:

A
  • severe pain
  • shock or endotoxic shock - can cause colic
  • ileus
  • young foal (hypothermia)
  • excited animal - No effects
  • stallion - Penile prolapse
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19
Q

Effect of Intra Arterial injection of “Phenothiazine derivatives”?

A

Seizures and sudden death

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20
Q

Duration of “Phenothiazine derivatives”:

A

2 hours

Onset of action: 15-20 min

Higher dose = higher duration

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21
Q

Can “Phenothiazine derivatives” be used in combination, which effect does it have?

A

Yes. Can be used with analgetics or anaesthetics

In premedication: Decreased risk of death
Intra-OP: decreased Minimal Anaesthetic Concentration, decreased afterload

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22
Q

Name some drugs of “Benzodiazepine tranquilizers”:

A
  1. Diazepam
  2. Midazolam
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23
Q

Effect of “Benzodiazepine tranquilizers”:

A

Weak sedation, good muscle relaxation

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24
Q

Other effects “Benzodiazepine tranquilizers” gives:

A
  1. Minimal cardiovascular and pulmonary effects
  2. In adult horse - induction, antiseizure activity
  3. Neonatal foals: sedation / induction
  4. Rapid injection → excitement, ataxia
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25
Antagonists of "Benzodiazepine tranquilizers":
Flumazenyl, Sarmazenyl
26
Opioid analgesic agent effects:
Good painkillers, no sedation Pre, intra and postop pain management!
27
Administration of analgesic:
IV Onset of action: 15 min Duration: 3-6 hrs
28
Name some opioid agonists:
Methadone, morphine = IV + IM Fentanyl
29
Name some opioid agonist - antagonists:
Butorphanol = IV + IM Pentazocin
30
Name some opioid antagonists:
Naloxan and nalorphin
31
What is local or regional anaesthesia?
Temporary anaesthesia in certain body areas, the patient is consciousness
32
Indications of local or regional anaesthesia?
1. Very young or old horses 2. Risk causes 3. wounds etc. 4. Surgery in both standing and anesthezised horse
33
Side effects of local or regional anaesthesia?
1. Can be toxic IV 2. Can give CNS symptoms: tremor, restlessness, epileptic 3. Cardiovascular problems: Vasodilation and hypotension
34
local or regional anaesthesia: Which drug to use in opthalmology?
Tetracaine: Very effective, prolonged duration, good topical anaesthesia, relatively toxic - corneal epithel
35
Local or regional anaesthesia: Which drug to use on mucous membrane and skin?
Lidocaine, bupivacaine or mepivacaine Lidocaine: most stabile, less irritant. Duration of action 1,5-2h Bupivacaine: Duration of action 4-6 h Mepivacaine: Fast effect, short duration (1-2 h)
36
Name local anaesthetic methods:
1. Terminal 2. Perineural 3. Paravertebral 4. Central perineural (epidural)
37
What does the "terminal" local anaesthetic method work?
Act at pain-sensitive nerve ends Have some undergroups: topical infiltrational regional iv. intrasynovial
38
Where is topical anaesthesia used, under terminal local anaesthesia:
1. Skin 2. Conjunctiva, cornea 3. Oral cavity, larynx, intubation
39
Where is infiltration anaesthesia used, under terminal local anaesthesia:
Often used in Standing castration Safest 2% lidocaine Danger of haematoma, large amount of drug, Often uncomplete analgesia
40
Where is regional IV anaesthesia used, under terminal local anaesthesia:
Used in cattle and swine
41
Where is intrasynovial anaesthesia used, under terminal local anaesthesia:
Intraarticular, intratechal, tendon sheath Use: Mepivacaine, bupicavaine, lidocaine
42
What does the "perineural" local anaesthetic method work?
Used for lameness diagnostik, as nerve block. Palliative in case of lamnitis Surgery on head Dental and muzzle block
43
What does the "paravertebral" local anaesthetic method work?
Used for laparoscopy and flank laparotomy
44
How would you perform "perineural" local anaesthetic?
5-6 cm from midline Lateral and ventral branches th13, L1, L2 18G, 15 mm spinal needle aspiration, 20 ml inj. x3 Successful block: band of vasodilation, skin warmth, sweating
45
Another name for central perineural anaesthesia?
Epidural
46
How would you perform a epidural?
Between C1+C2 20Gx90mm spinal needle, 2-5 cm deep Drug: Lidocaine, xylazine, detomidine
47
General considerations of local anaesthesia
* Aseptic technique, sterile solution and injection! * Do not anesthetise inflammed region! * New, sterile, fine tiped needle should be used! * Less gauged needle should be used: 22-25G! * Do not inject into the vessels (aspiration test)! * Avoid direct damage to nerves from needle placement * Use the still effective concentration! * Use the smallest amount of drug!
48
What is general anaesthesia?
causes unconsciousness. Drugs in combinations is used
49
Equipment for general anaesthesia:
Sling door for induction Mouth gag Endotracheal tubes with inflatable cuff An. machine: for volatile agents Infusion pump: exact dosage of IV agents Monitor
50
Which drug would you use for premedication in general anaesthesia?
Phenothiazine + alpha-2 agonist/opioid
51
Which drug would you use for induction in general anaesthesia?
1. Ketamine + diazepam 2. Guaiphensin = Centrally acting muscle relaxant, but NO sedation, analgesia 3. Barbiturates = Fast onset, NO analgesia 4. Propofol
52
Which drug would you use for maintenance in general anaesthesia?
TIVA Inhalational anesthesia PIVA
53
What is TIVA?
Total intravenous anesthesia
54
Advantages of using TIVA?
-less depression to the cardioresp.syst -TIVA stress inhal. an. -good analgesia -less complication/mortality -less movement during an. -nice recovery -min. tissue toxicity -less pollution to surgery room -several components in combination
55
Disadvantages of using TIVA?
drug accumulation infusion pump needed
56
Methods of drug delivery in case of TIVA:
-intermittent injection (bolus) -drip technique (infusion/ syringe pump)
57
Name drugs which belong to inhalational anasthesia:
1. Isoflurane 2. Sevoflurane 3. Desflurane 4. Halothane
58
Advantages of inhalational anasthesia
☺depth can be changed rapidly ☺ can be monitored (FiIso, EtIso) ☺ min. drug accumulation ☺ elimination is ventilation dependent
59
Disadvantages of inhalational anasthesia
 pollution of operation theatre  cardiorespiratory depression  min. analgesia  expensive  recovery is not as good as TIVA
60
What is PIVA?
PIVA = Partial intravenous anesthesia Combined use of INHALATIONAL and INTRAVENOUS anaesthetic
61
Advantages of PIVA:
☺ cardiorespiratory depression ↓ (MAC ↓) ☺ analgesia ↑ ☺ organ toxicity ↓ ☺ pollution of surgical suite ↓ ☺ movement in response to surgical stimuli ↓ ☺ recovery ↑ ☺ mortality ↓ ☺ muscle-relaxing effects of inhal. an.
62
Disadvantages of PIVA:
 pollution  cardiovascular depressioninhal. drugs  equipment: IV + inhal. drugs !!  long procedures→IV drugs accumulation !!
63
Combinations of drugs used in TIVA:
1. GGE + Xylazine + ketamine 2. Ketamine + xylazine + diazepam -> in infusion 3. Bolus or infusion/syringe pump
64
Drugs used in PIVA:
1. Ketamine 2. Alpha-2 agonists: Medetomidine, romifidine, xylazine 3. Ketamine + alpha-2 agonists 4. Lidocaine 5. Lidocaine + ketamine
65
Why do we give fluids parallelly to anaesthetics?
Fluids counteract the hemodynamic effects of anaesthesia and replace the fluid which is lost. Rate: 5-10 ml/kg/hr
66
Thermoregulation during general anasthesia:
- 0.4 degrees
67
How can we prevent thermoregulation decreasing?
Adults: keep warm avoid cold surfaces use re-breathing circuit use low fresh gas flow Neonatal foals: Active heating Warm IV fluids
68
Which padding would you use for GA?
Proper padding: Foam, water / air cushions
69
What is the worst position of a horse in GA, and which surgical procedure is it used for?
Trendelenburg dorsal recumbency, used in laparoscopy
70
Position of the head during GA:
neutral position = overextension
71
Other necessary things to do with the horse under GA, regarding position:
- halter should be removed - eyes protected - limbs should be properly fixated
72
How can we improve the recovery of a horse?
use of part-dose of alpha-2-agonists in recovery, keep in lateral recumbency, dark, quiet box, urethral catheter
73
When would you assist the recovery?
In case of a fracture
74
Name complications regarding GA:
1. Cardiopulmonary resuscitation 2. Anaphylaxis 3. Intraoperative hypotension 4. Hypoxemia and hypoxia 5. Hypercapnia 6. Postoperative myopathy 7. Postoperative neuropathy 8. Postoperative laryngeal oedema
75
Case of Cardiopulmonary resuscitation:
Deep anaesthesia + hypotension
76
Signs of Cardiopulmonary resuscitation:
weak pulse, cyanotic mucous membrane, dilated pupils, agonic breathing
77
Treatment of Cardiopulmonary resuscitation:
- Stop anaesthesia administration - Chest compression - Oxygen supply - IPPV = Invasive positive pressure ventilation IV: Epinephrine, dobutamine, atropine, lidocaine
78
What is anaphylaxis?
Very uncommon.
79
Signs of anaphylaxis:
weak pulse, ABP (ambulatory blood pressure) decreases, cardiac arrest (ECG), bronchospasm, pulmonary edema, SpO2 (Venous oxygen saturation) decreases
80
Treatment of anaphylaxis:
Drugs: epinephrine, bronchodilatator, corticosteroids, antihistamines
81
When is intra-OP hypotension most common
inhalational anasthesia
82
Cause of intra-OP hypotension:
Bradycardia, myocardial depression, hypovolaemia, acidosis, electrolyte imbalance
83
Treatment of intra-OP hypotension:
- Infusion of electrolyte, colloid, hypertonic - Dobutamine - Calcium (if low)
84
What can intra-OP hypotension cause if not treathed?
- Spinal cord ischaemia - Cerebral necrosis - Myocardial dysfunction
85
What is Hypoxemia and hypoxia?
Hypoxemia: PaO2 (Venous oxygen saturation) = under 60mmHg Hypoxia: inadequate tissue oxygenation
86
Signs of Hypoxemia and hypoxia:
pulsoxi, blood gas
87
Causes of Hypoxemia and hypoxia:
- failure in O2 supply - problem with endotracheal tube, hypoventilation - distension of abdominal contents - RAO, acute pulmonary edema - shunt
88
Treatment of Hypoxemia and hypoxia:
Bronchodilaters, early IPPV
89
What is hypercapnia?
PaCO2 > 45 mmHg
90
Causes of hypercapnia:
- respiratory center depression - hypoventilation - Increased CO2 production: malignant hyperthermia and hyperkalemic periodic paralysis (HYPP).
91
Treatment of hypercapnia:
IPPV, plane anaesthesia
92
Cause of post-OP myopathy:
- large body - long anaesthesia - inadequate padding/positioning - intraop. hypotension, hypoxemia
93
Treatment of post-OP myophaty:
- adequate padding - assistance to stand - mild case: light exercise, walking
94
Cause of Postoperative neuropathy:
-inadequate padding/positioning -overextension of limbs
95
What is postoperative neuropathy?
Radial/ femoral/ facial nerve injury
96
Treatment of postoperative neuropathy?
sling or splint
97
What can postoperative neuropathy cause if not fixed?
Spinal cord myelomalacia Cerebral cortical necrosis blindness, behavioral disturbances, seizures euthanasia
98
What can spinal cord myelomalacia cause? prognosis?
- foal/young, hypotension, embolus ‘dog-sit’, loss of deep pain perception poor prognosis
99
What can cerebral cortical necrosis cause? Prognosis?
blindness, behavioral disturbances, seizures Euthanasia
100
Cause of Postoperative laryngeal oedema:
bilateral nasal/laryngeal oedema bilateral laryngeal neuropathy = hemiplegia Negative pressure pulmonary edema
101
Treatment of Postoperative laryngeal oedema
temporary tracheostomy
102
Complications of a temporary tracheostomy:
infection, subcutan emphysema, airway obstruction

Equine final practical exam - Surgery (12 decks)

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