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ANESTHESIA > 9b – Induction and Injectable Anesthetics > Flashcards

9b – Induction and Injectable Anesthetics Flashcards

1
Q

Propofol

A
  • Acts on GABAa recepotrs in CNS to produce anesthesia
  • Induction is smooth and rapid
  • Short duration of action depends on REDISTRIBUTION
  • Recovery is fast and smooth
  • Used for induction and maintenance (TIVA): minimal accumulation
  • No analgesia
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2
Q

Propofol induction is smooth and rapid

A
  • Onset 40-90s
  • One does lasts 5-10mins
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3
Q

Propofol when injecting: pain/damage

A
  • Occasionally pain upon IV injection
  • NO tissue damage if injected perivascular
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4
Q

Propofol vehicle

A
  • Lipid emulsion=WHITE
    o Will grow bacteria=discard within 24hrs of opening
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5
Q

PropoClear (propofol)

A
  • Lipid free formulation
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6
Q

Propoflo 28 (propofol)

A
  • Contains preservative (May be toxic for cats!)
  • Labelled for use up to 28 days after opening
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7
Q

Propofol: CV effects

A
  • Depression is dose dependent
  • Myocardial depression
  • Venodilation=decrease BP
  • *RESETS baroreceptor reflex: increase HR with a drop in BP does NOT occur (only last 10mins)
  • AVOID in hypovolemic animals and cardiac disease patients
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8
Q

Propofol: respiratory system effects

A
  • Depression is DOSE dependent
  • Post: induction apnea and cyanosis
  • Supplement O2, pre-oxygenate
  • Mild bronchodilation
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9
Q

Propofol on induction and/or recovery can occasionally see in dogs

A
  • Paddling movements
  • Opisthotonus
  • Twitching
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10
Q

Propofol is recommended for

A
  • C-sections
  • Cerebroprotection: reduces cerebral blood flow and cerebral metabolic rate
  • Patients with compromised LIVER function
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11
Q

Propofol in cats

A
  • Reduced capacity for glucuronide conjugation
  • Propofol infusion=recovery from anesthesia delayed
  • Repeated administration over several days
    o Hemolysis and Heinz body formation
  • *can use it on cats still
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12
Q

Alfaxalone

A
  • Acts on GABAa receptors in CNS
  • Induction smooth and rapid
  • Short duration depends on REDISTRIBUTION
  • Fast recovery (quality improves with premedication)
  • Used for induction and maintenance (TIVA)
  • NO analgesia
  • NO pain or tissue damage
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13
Q

Alfaxalone: smooth and rapid induction

A
  • Onset: 15-45seconds
  • One dose lasts: 5-10mins
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14
Q

Alfaxalone vs. Propofol

A
  • Longer shelf life (open for 30 days)
  • Clear solution
  • Can be administered IM
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15
Q

Alfaxalone CV effects

A
  • Depression Is DOSE dependent
  • Hypotension: combo of myocardial depression and some peripheral vasodilation
  • Compensation via reflex tachycardia (baroreceptor reflex)
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16
Q

Alfaxalone respiratory system affects

A
  • Depression is DOSE dependent
  • Post-induction apnea
17
Q

Alfaxalone effects

A
  • Good muscle relaxation
  • Produces reliable sedation in cats when give IM
  • Excellent in reptiles (IM)
18
Q

Co-induction when using alfaxalone OR propofol to minimize amount required: typical agents included are

A
  • Benzodiazepines (Midazolam or Diazepam)
  • Ketamine
19
Q

Ketamine

A
  • Dissociative anesthetic agent
    o Interrupts info reaching higher centers in the brain
  • Comes in a racemic mixture
20
Q

How is ketamine different from GABAa agonist drugs?

A
  • Cateleptoid state with slow nystagmus
  • Muscle rigidity with higher doses
  • Maintains CN reflexes (gag, swallow, palpebral and central eye in dogs and cats)
21
Q

Ketamine and vet med

A
  • Popular
  • Used for INDUCTION and MAINTENANCE and ANALGESIA
  • *profound analgesic (somatic>visceral, wind up pain)
  • Neither anti- or pro-convulsant
  • *AVOID IN CATS with renal function
22
Q

Ketamine onset and duration

A
  • Onset: 30-90s
  • Duration: 20-30mins (longer)
23
Q

Ketamine can be administered

A
  • IM
  • IV
  • SC
  • TM
24
Q

Ketamine: mechanisms of action

A
  • NMDA receptor antagonist
  • CNS voltage dependent Na, K, Ca channels
  • Depression of CNS acetyl choline receptors
  • Some action at GABAa receptors
  • Depression of nociceptive cells in dorsal horn of spinal cord
25
Q

Ketamine causes muscle rigidity so

A
  • ALWAYS combine with a muscle relaxant (ex. benzodiazepine OR alpha2-agonist)
26
Q

Ketamine: auditory and visual stimuli distributed during recovery to cause

A
  • Emergence delirium
27
Q

Ketamine use with other drugs to reduce side effects

A
  • Alpha2 agonists
  • Benzodiazepines
  • Acepromazine
28
Q

CV system: ketamine

A
  • Healthy animals=indirect mild CV stimulation
  • Sympathomimetic effects for 2-15mins
  • Increase in cardiac work and myocardial oxygen consumption
  • AVOID in CATS with hypertrophic cardiomyopathy
29
Q

CV system: ketamine with critically ill patients OR catecholamine depleted

A
  • May see mild direct myocardial depressant effects
30
Q

Respiratory system: ketamine

A
  • Minimal respiratory depression
  • Bronchodilation
  • Laryngeal and pharyngeal reflexes preserved
  • Irregular/periodic breathing pattern: apneustic breathing
31
Q

Behavioural side effects: ketamine

A
  • Can cause rough recoveries
    o Head shaking, vocalization, dysphoria, salivation
32
Q

When combining drugs with ketamine the major goals

A
  • Decrease amount of ketamine needed
  • Eliminate unwanted side effects (improve recovery quality)
  • Produce good skeletal muscle relaxation
  • Improve visceral analgesia
  • Prolong period of anesthesia/immobilization
33
Q

Ketamine/diazepam (‘Ket-Val’)

A
  • IV induction agent: dogs, cats, neonatal foals, horses, calves, cattle
  • Slow onset (30-90s)
  • Short acting, rapid recovery
  • *MINIMAL CV and respiratory side effects
  • *do NOT use for C-sections (diazepam accumulates in neonates)
34
Q

Alpha2 agonist + ketamine examples:

A
  • Xylazine + ketamine
  • Dexmedetomidine – ketamine – opioid
35
Q

Xylazine + ketamine

A
  • Good combo for large animals or wildlife immobilization
  • Analgesia, muscle relaxation, narcosis
  • Potent cardiopulmonary depression
  • NOT recommended for routine use in cats and dogs
36
Q

Dexmedetomidine – ketamine – opioid

A
  • Wildlife, game ranch animals
  • Supportive care
  • Monitor closely
  • Alpha2 reversible
37
Q

Induction apnea

A
  • Usually observed after rapid bolus of IV induction agent
  • Once IV induction is redistributed=animal wakes up
  • Assist ventilation until spontaneous ventilation returns
  • Once induction agent wears off=inhalant plasma concentration should be enough to keep them anesthetized
  • Apnea can be avoided by titrating to effect
38
Q

Apnea or hypoventilation result in

A
  • Poor uptake of maintenance inhalant anesthetic
  • Poor transition to maintenance phase (stable plane) or inhalant anesthesia
39
Q

Guaifenesin

A
  • Only used for sedation and muscle relaxant effects

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