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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
Q

Antagonists of “Benzodiazepine tranquilizers”:

A

Flumazenyl, Sarmazenyl

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26
Q

Opioid analgesic agent effects:

A

Good painkillers, no sedation

Pre, intra and postop pain management!

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27
Q

Administration of analgesic:

A

IV
Onset of action: 15 min
Duration: 3-6 hrs

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28
Q

Name some opioid agonists:

A

Methadone, morphine = IV + IM
Fentanyl

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29
Q

Name some opioid agonist - antagonists:

A

Butorphanol = IV + IM
Pentazocin

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30
Q

Name some opioid antagonists:

A

Naloxan and nalorphin

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31
Q

What is local or regional anaesthesia?

A

Temporary anaesthesia in certain body areas, the patient is consciousness

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32
Q

Indications of local or regional anaesthesia?

A
  1. Very young or old horses
  2. Risk causes
  3. wounds etc.
  4. Surgery in both standing and anesthezised horse
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33
Q

Side effects of local or regional anaesthesia?

A
  1. Can be toxic IV
  2. Can give CNS symptoms: tremor, restlessness, epileptic
  3. Cardiovascular problems: Vasodilation and hypotension
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34
Q

local or regional anaesthesia: Which drug to use in opthalmology?

A

Tetracaine: Very effective, prolonged duration, good topical anaesthesia, relatively toxic - corneal epithel

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35
Q

Local or regional anaesthesia: Which drug to use on mucous membrane and skin?

A

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)

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36
Q

Name local anaesthetic methods:

A
  1. Terminal
  2. Perineural
  3. Paravertebral
  4. Central perineural (epidural)
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37
Q

What does the “terminal” local anaesthetic method work?

A

Act at pain-sensitive nerve ends

Have some undergroups:
topical
infiltrational
regional iv.
intrasynovial

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38
Q

Where is topical anaesthesia used, under terminal local anaesthesia:

A
  1. Skin
  2. Conjunctiva, cornea
  3. Oral cavity, larynx, intubation
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39
Q

Where is infiltration anaesthesia used, under terminal local anaesthesia:

A

Often used in Standing castration

Safest
2% lidocaine
Danger of haematoma, large amount of drug,
Often uncomplete analgesia

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40
Q

Where is regional IV anaesthesia used, under terminal local anaesthesia:

A

Used in cattle and swine

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41
Q

Where is intrasynovial anaesthesia used, under terminal local anaesthesia:

A

Intraarticular, intratechal, tendon sheath

Use: Mepivacaine, bupicavaine, lidocaine

42
Q

What does the “perineural” local anaesthetic method work?

A

Used for lameness diagnostik, as nerve block.
Palliative in case of lamnitis
Surgery on head
Dental and muzzle block

43
Q

What does the “paravertebral” local anaesthetic method work?

A

Used for laparoscopy and flank laparotomy

44
Q

How would you perform “perineural” local anaesthetic?

A

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
Q

Another name for central perineural anaesthesia?

A

Epidural

46
Q

How would you perform a epidural?

A

Between C1+C2
20Gx90mm spinal needle, 2-5 cm deep

Drug: Lidocaine, xylazine, detomidine

47
Q

General considerations of local anaesthesia

A
  • 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
Q

What is general anaesthesia?

A

causes unconsciousness. Drugs in combinations is used

49
Q

Equipment for general anaesthesia:

A

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
Q

Which drug would you use for premedication in general anaesthesia?

A

Phenothiazine + alpha-2 agonist/opioid

51
Q

Which drug would you use for induction in general anaesthesia?

A
  1. Ketamine + diazepam
  2. Guaiphensin = Centrally acting muscle relaxant, but NO sedation, analgesia
  3. Barbiturates = Fast onset, NO analgesia
  4. Propofol
52
Q

Which drug would you use for maintenance in general anaesthesia?

A

TIVA

Inhalational anesthesia

PIVA

53
Q

What is TIVA?

A

Total intravenous anesthesia

54
Q

Advantages of using TIVA?

A

-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
Q

Disadvantages of using TIVA?

A

drug accumulation
infusion pump needed

56
Q

Methods of drug delivery in case of TIVA:

A

-intermittent injection (bolus)
-drip technique (infusion/ syringe pump)

57
Q

Name drugs which belong to inhalational anasthesia:

A
  1. Isoflurane
  2. Sevoflurane
  3. Desflurane
  4. Halothane
58
Q

Advantages of inhalational anasthesia

A

☺depth can be changed rapidly
☺ can be monitored (FiIso, EtIso)
☺ min. drug accumulation
☺ elimination is ventilation dependent

59
Q

Disadvantages of inhalational anasthesia

A

 pollution of operation theatre
 cardiorespiratory depression
 min. analgesia
 expensive
 recovery is not as good as TIVA

60
Q

What is PIVA?

A

PIVA = Partial intravenous anesthesia

Combined use of INHALATIONAL and INTRAVENOUS anaesthetic

61
Q

Advantages of PIVA:

A

☺ 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
Q

Disadvantages of PIVA:

A

 pollution
 cardiovascular depressioninhal. drugs
 equipment: IV + inhal. drugs !!
 long procedures→IV drugs accumulation !!

63
Q

Combinations of drugs used in TIVA:

A
  1. GGE + Xylazine + ketamine
  2. Ketamine + xylazine + diazepam -> in infusion
  3. Bolus or infusion/syringe pump
64
Q

Drugs used in PIVA:

A
  1. Ketamine
  2. Alpha-2 agonists: Medetomidine, romifidine, xylazine
  3. Ketamine + alpha-2 agonists
  4. Lidocaine
  5. Lidocaine + ketamine
65
Q

Why do we give fluids parallelly to anaesthetics?

A

Fluids counteract the hemodynamic effects of anaesthesia and replace the fluid which is lost.

Rate: 5-10 ml/kg/hr

66
Q

Thermoregulation during general anasthesia:

A
  • 0.4 degrees
67
Q

How can we prevent thermoregulation decreasing?

A

Adults:
keep warm
avoid cold surfaces
use re-breathing circuit
use low fresh gas flow

Neonatal foals:
Active heating
Warm IV fluids

68
Q

Which padding would you use for GA?

A

Proper padding: Foam, water / air cushions

69
Q

What is the worst position of a horse in GA, and which surgical procedure is it used for?

A

Trendelenburg dorsal recumbency, used in laparoscopy

70
Q

Position of the head during GA:

A

neutral position = overextension

71
Q

Other necessary things to do with the horse under GA, regarding position:

A
  • halter should be removed
  • eyes protected
  • limbs should be properly fixated
72
Q

How can we improve the recovery of a horse?

A

use of part-dose of alpha-2-agonists in recovery,
keep in lateral recumbency, dark, quiet box,
urethral catheter

73
Q

When would you assist the recovery?

A

In case of a fracture

74
Q

Name complications regarding GA:

A
  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
Q

Case of Cardiopulmonary resuscitation:

A

Deep anaesthesia + hypotension

76
Q

Signs of Cardiopulmonary resuscitation:

A

weak pulse, cyanotic mucous membrane, dilated pupils, agonic breathing

77
Q

Treatment of Cardiopulmonary resuscitation:

A
  • Stop anaesthesia administration
  • Chest compression
  • Oxygen supply
  • IPPV = Invasive positive pressure ventilation

IV: Epinephrine, dobutamine, atropine, lidocaine

78
Q

What is anaphylaxis?

A

Very uncommon.

79
Q

Signs of anaphylaxis:

A

weak pulse, ABP (ambulatory blood pressure) decreases, cardiac arrest (ECG), bronchospasm, pulmonary edema, SpO2 (Venous oxygen saturation) decreases

80
Q

Treatment of anaphylaxis:

A

Drugs: epinephrine, bronchodilatator, corticosteroids, antihistamines

81
Q

When is intra-OP hypotension most common

A

inhalational anasthesia

82
Q

Cause of intra-OP hypotension:

A

Bradycardia, myocardial depression, hypovolaemia, acidosis, electrolyte imbalance

83
Q

Treatment of intra-OP hypotension:

A
  • Infusion of electrolyte, colloid, hypertonic
  • Dobutamine
  • Calcium (if low)
84
Q

What can intra-OP hypotension cause if not treathed?

A
  • Spinal cord ischaemia
  • Cerebral necrosis
  • Myocardial dysfunction
85
Q

What is Hypoxemia and hypoxia?

A

Hypoxemia: PaO2 (Venous oxygen saturation) = under 60mmHg

Hypoxia: inadequate tissue oxygenation

86
Q

Signs of Hypoxemia and hypoxia:

A

pulsoxi, blood gas

87
Q

Causes of Hypoxemia and hypoxia:

A
  • failure in O2 supply
  • problem with endotracheal tube, hypoventilation
  • distension of abdominal contents
  • RAO, acute pulmonary edema
  • shunt
88
Q

Treatment of Hypoxemia and hypoxia:

A

Bronchodilaters, early IPPV

89
Q

What is hypercapnia?

A

PaCO2 > 45 mmHg

90
Q

Causes of hypercapnia:

A
  • respiratory center depression
  • hypoventilation
  • Increased CO2 production: malignant hyperthermia and hyperkalemic periodic paralysis (HYPP).
91
Q

Treatment of hypercapnia:

A

IPPV, plane anaesthesia

92
Q

Cause of post-OP myopathy:

A
  • large body
  • long anaesthesia
  • inadequate padding/positioning
  • intraop. hypotension, hypoxemia
93
Q

Treatment of post-OP myophaty:

A
  • adequate padding
  • assistance to stand
  • mild case: light exercise, walking
94
Q

Cause of Postoperative neuropathy:

A

-inadequate padding/positioning
-overextension of limbs

95
Q

What is postoperative neuropathy?

A

Radial/ femoral/ facial nerve injury

96
Q

Treatment of postoperative neuropathy?

A

sling or splint

97
Q

What can postoperative neuropathy cause if not fixed?

A

Spinal cord myelomalacia

Cerebral cortical necrosis
blindness, behavioral disturbances, seizures
euthanasia

98
Q

What can spinal cord myelomalacia cause? prognosis?

A
  • foal/young, hypotension, embolus ‘dog-sit’, loss of deep pain perception

poor prognosis

99
Q

What can cerebral cortical necrosis cause? Prognosis?

A

blindness, behavioral disturbances, seizures

Euthanasia

100
Q

Cause of Postoperative laryngeal oedema:

A

bilateral nasal/laryngeal oedema
bilateral laryngeal neuropathy = hemiplegia
Negative pressure pulmonary edema

101
Q

Treatment of Postoperative laryngeal oedema

A

temporary tracheostomy

102
Q

Complications of a temporary tracheostomy:

A

infection, subcutan emphysema, airway obstruction

Equine final practical exam - Surgery (12 decks)

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