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Anesthesiology > 9: Monitoring > Flashcards

9: Monitoring Flashcards

1
Q

When monitoring, what 3 things together maintain tissue/organ perfusion with oxygenated blood?

A

Circulation, Ventilation, Oxygenation

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2
Q

What does the word “monitor” mean?

A

To warn

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3
Q

Physiology/homeostasis is altered by _____.

A

drugs

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4
Q

What is the purpose of a monitor?

A

To warn anesthetist of changes in depth or status of patient to facilitate an early response

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5
Q

When does monitoring begin and end?

A

Begins at pre-op, ends at recovery

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6
Q

Peri-op mortality usually occurs within _____.

A

1st 3 hours

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7
Q

An individualized anesthesia plan provides basis for what 3 things?

A
  1. Drug selection
  2. Monitoring & support
  3. Anticipated complications (& plan of action to address them)
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8
Q

T/F: The anesthesia record is a legal document.

A

True

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9
Q

The anesthesia record prompts to _____, _____, & _____ patient status.

A

observe, evaluate, record

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10
Q

When can irreversible CNS and cellular changes occur?

A

Within 3-5 min of cessation of blood flow

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11
Q

What is the best/most expensive monitoring equipment?

A

YOU!!!

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12
Q

What should you, the anesthetist, know about your equipment?

A

Limitations, reasons for erroneous readings, how to troubleshoot

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13
Q

What things can we observe to determine anesthetic depth?

A

Eye position, reflexes, MAC, end tidal inhalant gas, EtCO2

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14
Q

What things can we observe to monitor circulation?

A

PE, ECG, BP (indirect, direct)

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15
Q

What things can we observe to determine ventilation?

A

Clinical evaluation, esophageal stethoscope, capnography, blood gas analysis

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16
Q

What things can we observe to determine oxygenation?

A

Clinical evaluation, pulse ox, blood gas analysis

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17
Q

What specific things do we look at in our patient to determine anesthetic depth?

A

Eye position, reflexes, muscle relaxation, movement, end tidal [] of anesthetic gases

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18
Q

In what spp is eye position a reliable indicator of anesthetic depth?

A

Dogs, cats, cattle

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19
Q

Eyes roll _____ at the surgical plane.

A

ventrally

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20
Q

Eyes are _____ at light/deep planes.

A

centered

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21
Q

Eyes are centered at all planes with _____ anesthetics.

A

dissociative

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22
Q

What eye position do horses keep under anesthesia? How can you tell if they are too light?

A

Medial position;

Nystagmus/tearing = too light

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23
Q

Why is eye position unreliable in goats, sheep, and camelids?

A

The globe does not rotate

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24
Q

What is one main reflex that can be used to check anesthetic depth?

A

palpebral

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25
Q

How is the palpebral reflex associated with depth in small animals and how is it determined?

A

Absent at surgical plane;

Tap medial canthus

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26
Q

How is the palpebral reflex associated with depth in horses and how is it determined?

A

Present at surgical plane;

Gently brush cilia, slow closure of eyelids

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27
Q

How is the palpebral reflex associated with depth in ruminants/swine?

A

Absent at surgical plane

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28
Q

What reflexes other than palpebral can be used to evaluate anesthetic depth?

A

Withdrawal (toe pinch), corneal (ALWAYS present)

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29
Q

When should a corneal reflex NOT be checked?

A

When a patient is believed to be alive

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30
Q

What is the relationship between jaw tone and anesthetic depth?

A

It will vary with depth, is subjective, and is not reliable with dissociative anesthetics

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31
Q

What is MAC?

A

(Minimum Alveolar Concentration)

[] of inhalant in the lungs needed to prevent movement (motor response) in 50% of animals in response to a noxious or surgical (pain) stimulus

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32
Q

MAC is used to compare the _____ or _____ of inhalant anesthetics.

A

strengths, potency

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33
Q

What is the MAC for iso in dogs? Cats? Horses?

A

Dogs = 1.28%

Cats = 1.63%

Horses = 1.3%

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34
Q

What is the MAC for sevo in dogs? Cats?

A

Dogs = 2.3%

Cats = 2.6%

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35
Q

95% of patients are adequately anesthetized at ____ MAC.

A

1.5x

36
Q

What things can decrease MAC?

A

Pre-med, intra-op analgesia

37
Q

MAC reflects _____, not _____.

A

population, individual

38
Q

What is End tidal-inhalant?

A

[] of inhalant gas expired at the end of expiration

39
Q

What does Et-inhalant reflect?

A

[] of gas in brain

40
Q

Et-inhalant % is _____ than the vaporizer setting.

A

more precise

41
Q

What is normal repiration controlled primarily by?

A

Blood levels of CO2 (PaCO2)

42
Q

EtCO2 monitors exhaled CO2 _____.

A

noninvasively

43
Q

EtCO2 is an indirect measure of _____.

A

arterial Co2 (PaCO2)

44
Q

What is the value difference between EtCO2 and PaCO2?

A

EtCO2 is 3-5 mmHg < PaCO2

45
Q

What is the normal awake value for EtCO2?

A

~40

46
Q

What is the normal EtCO2 value in anesthetized patients?

A

<55-57 mmHg

47
Q

Adequate _____ is the key to patient survival.

A

DO2 = delivery of oxygen to tissues

48
Q

What does DO2 require?

A

CV and respiratory systems

49
Q

What is the DO2 equation?

A

DO2 = CO x CaO2

(CaO2 = oxygen content of blood)

50
Q

What is the equation for CaO2?

A

CaO2 = HbO2 + PaO2

(HbO2 = oxygen bound to Hgb)

51
Q

How can circulation be assessed pre-op?

A

CRT

52
Q

What is normal CRT? What does it mean if this is prolonged?

A

Normal = <2 seconds

Prolonged –> poor tissue perfusion or dehydration

53
Q

Why is CRT not very useful during anesthesia?

A

Drugs and increased PaCO2 cause vasodilation (CRT can decrease);

Dexmedetomidine –> vasoconstriction

54
Q

How can circulation be clinically evaluated?

A

Palpation of pulses, auscultation (esophageal stethoscope, doppler), ECG, BP

55
Q

What aspects of the heart beat should be ausculted?

A

Presence, absence, strength, rhythm

56
Q

Where can peripheral pulses be palpated in the dog and cat? Horses?

A

Dog and cat = femoral, dorsal pedal, lingual

Horses = facial, trans facial, MC/MT, coccygeal

57
Q

What is a normal HR in dogs? cats? Horses?

A

Dogs = >60

Cats = >80

Horses = constant whether or not it is under anesthesia

58
Q

How is pulse pressure (PP) calculated?

A

SAP (systolic) - DAP (diastolic)

59
Q

PP does not indicate _____.

A

MAP

60
Q

Where does the tip of the esophageal stethoscope go?

A

@ level of heart

61
Q

What are advantages to using an esophageal stethoscope?

A

Inexpensive, can monitor resp rate

62
Q

What are disadvantages to using an esophageal stethoscope?

A

Difficult to use in certain cases, can disconnect, need amp or dedicated person

63
Q

What are 3 limitations to ECG?

A
  1. Electrical activity only, no info about mechanical function
  2. PEA/EMD –> cardiac arrest, normal electrical activity but no pulses
  3. Should not be used alone
64
Q

How should the 3 ECG leads be attached (3 ways)?

A

Limb leads, esophageal leads, base apex

65
Q

Where do the limb leads of an ECG go?

A

RA, LA, LL;

Selection of lead II on the ECG

66
Q

Where are probes of an esophageal ECG placed?

A

RA and LL on esophageal probe, LA on ear or neck;

Select lead II on ECG

67
Q

What are 3 advantages to using an esophageal or base-apex lead placement?

A
  1. Avoids attachment to hindquarters
  2. Accessible by anesthetist
  3. Minimize motion artifact
68
Q

Where are base apex ECG leads placed?

A

RA and LL attach to right or left jugular furrow, LA attach to opposite thoracic wall caudal to heart;

Lead I - negative deflection

Lead III - positive deflection

69
Q

How can BP be taken indirectly?

A

Doppler (SAP)

Oscillometric (SAP, DAP, MAP)

70
Q

How can BP be measured directly?

A

Arterial catheter, transducer & monitor

(SAP, DAP, MAP)

71
Q

What is an ultrasonic doppler used for?

A

Measures pulse, blood flow, and SAP using sphygmomanometer & cuff

72
Q

How is a doppler BP taken?

A
  1. Probe and gel placed over peripheral artery - limb or tail
  2. Cuff placed proximal to probe, inflated until it exceeds SAP (silences doppler signal)
  3. Cuff gradually deflated until first signal is audible
  4. BP on sphygmomanometer is SAP
73
Q

What are advantages to using a doppler?

A

Cost, SAP

74
Q

What are disadvantages to using a doppler?

A

Proficiency of use, not automatic, accuracy dep on cuff, weak signal with vasoconstriction/hypotension

75
Q

Cuff for BP should be ___% circumference of limb.

A

~40%

76
Q

Where can a cuff for oscillometry be placed?

A
  1. Limb
    1. Hind = above or below tarsus
    2. Fore = above carpus
  2. Tail base
77
Q

What are advantages of using oscillometry?

A

Easy to use, set for automatic measurements

78
Q

What are disadvantages to using oscillometry?

A

Technology motion sensitive, decreased accuracy at low BP/high HR or arrhythmia, accuracy dep on cuff size

79
Q

Too small of a cuff _____ BP.

A

overestimates

80
Q

Too large/loose of a cuff _____ BP.

A

underestimates

81
Q

What is the gold standard for measuring SAP, DAP, and MAP?

A

direct measurement

82
Q

What are advantages to using direct BP measurement?

A

Accurate, continuous, arterial blood gas sampling, ideal for critical patients

83
Q

What are disadvatages to using direct BP?

A

Cost, skill, complications

84
Q

What are some complications that can arise from using direct BP?

A

Infection, thrombosis, hematoma, air embolism, exsanguination, drug injection

85
Q

Where are common sites of arterial catheter placement in dogs and cats? Horses?

A

Dogs and cats = dorsal pedal, lingual

Horses = facial, ear, MT, trans facial

Anesthesiology (12 decks)

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