Age Conciderations

Question 1

Neonatal are animals younger than ??

Answer 1

Dog and cat < 6weeks

Foals and calves < 2weeks

Question 2

Pediatric animals are less than ??

Answer 2

12weeks old

Question 3

How does the cardiovascular system of neonates differ from adults?

Answer 3

Dependent on heart rate for CO —> minimal ability to increase contractility

Immature sympathetic NS

Increased extracellular fluid volume

Higher metabolic rate

Persistent fetal circulation (esp in foals)

Question 4

How does the respiratory system of neonates differ from adults?

Answer 4

High resting respiratory rate/minute ventilation
- d/t increased O2 demand

Greater work of breathing

Minimal pulmonary reserve

Question 5

What hematologic differences are present in neonates compared to adults?

Answer 5

PCV decreases 1/3 in fist 28days in small animals
-Blood loss -> significant decreased in O2 delivery to tissues

Hypoalbuminemia
-highly protein-bound drugs will have greater activity

Question 6

Why are drug effects prolonged in neonates?

Answer 6

Deficient hepatic microsomal enzymes

Decreased GFR

Question 7

Why are neonates susceptible to hypoglycemia?

Answer 7

High metabolism and minimal hepatic glycogen

Question 8

T/F: pain experienced as a neonate may cause altered pain processing/perception for life ?

Answer 8

True

—> analgesia important in all ages

Question 9

How long do you fast nursing animals? What about weaned animals?

Answer 9

You don’t fast nursing animals —> susceptible to hypoglycemia

Weaned - 3-4hrs

Question 10

Where do you get IV catheter access in neonates?

Answer 10

IV catheter difficult or impossible

Intraosseous —> anything given IV can be given IO
Fluid, blood product, drugs

Question 11

Why are phenothiazines and A2 agonsits not recommended ?

Answer 11

Acepromazine —> hypotension
A2 agonsit—> bradycardia

CV depression cannot be handled well in neonate

Question 12

What are generally safe sedatives in young animals? Which of this family of drugs is usually preferred?

Answer 12

Benzodiazepines

Midazolam because it requires less liver metabolism

Question 13

What is a good choice drug for analgesia +/- sedation in young and geriatric animals?

Answer 13

Opioids

• minimal CV/resp effects
• reversible

Pure mu > partial

Buprenorphine has long duration of action and is poorly reversible

Question 14

What do we often give young animals with premed to maintain heart rate for CO?

Answer 14

Anticholinergic

—young animals are solely reliable on HR for cardiac output because they cannot change contractility

Question 15

Can NSAIDS be used in neonates?

Answer 15

Nope
Immature hepatic and renal function

NSAIDS 4-6months minimum

Question 16

What is used for induction in young animals?

Answer 16

Propofol -rapid onset and recover but can cause hypotension and respiratory depression

Alfaxalone -rapid onset, CV stability, but respiratory depression (use in sick or if there are CV problems )

Etomidate- rapid onset, CVstability, but respiratory depression

Ketamine - longer induction and recover, hepatically meatbolized (longer duration than in adult)

Question 17

T/F: foals can be induced with iso/sevoflurane

Answer 17

True

• via nasotracheal tube
  —> smooth induction

Question 18

What is used for maintenance in young?

Answer 18

Sevoflurane / iso
Minimal metabolism

Can cause hypotension and hypoventilation

Question 19

What is the BP in neonates?

Answer 19

50mmHg

Question 20

Why do you need to be careful when administering fluids to young?

Answer 20

Higher daily fluid requirements, BUT less tolerant of fluid overload

Question 21

How does the cardiovascular system change in geriatric patients?

Answer 21

Dependent on atrial kick and normal sinus rhythm for cardiac output
-adequate preload is important

Limited ability to increase HR
-LEss responsive baroreceptors

Rely on increased SV to increase Cardiac output

Decreased
-arterial and myocardial compliance
May have valvular incompetence

Question 22

How does respiratory function change in geriatric patients?

Answer 22

Overall decreased in function and efficiency
-decreased—> gas exchange, viral capacity, thoracic compliance, and lung elasticity

-decreased PaO2
Increased work of breathing

Question 23

Why is there usually prolonged DOA of drugs in geriatrics?

Answer 23

Decreased liver mass- decrease drug clearance

Decreased kidney mass and fontina nephrons
-> decreased GFR, decreased concentration of urine, decreased volume correction

Question 24

Is MAC increased/decreased in geriatrics?

Answer 24

Decreased

Question 25

Do geriatrics have more or less body water?

Answer 25

Decreased —> increased plasma drug concentration

Question 26

What sedatives can be used in a HEALTY older patient?

Answer 26

Phenothiazines and A2 agonists

• cause CV side effects
• conservative dosing

Question 27

What would you use as a sedative in a sick geriatric patient?

Answer 27

Benzodiazepines

-maintains resp and CV runtion

Question 28

How would you sedate an ancient crabby cat??

Answer 28

Heavy IM sedation may be needed for diagnostics of IVC placement

May have murmur, hyperthyroid, or renal disease

Alfaxalone is probably the most appropriate with opioid and benzo

Dexmedetomidine and ketamine can have significant CV effects, avoid if possible

Question 29

Would you use anticholinergic as part of your premed in geriatric animals?

Answer 29

No

- only use as needed for bradycardia or procedures causing vagal stimulation

Question 30

What are benefits of local anesthetics in geriatrics ?

Answer 30

Provide good analgesia
Decrease MAC

*remember to adjust dose if there is hepatic dysfunction

Question 31

Can NSAIDS be used in geriatrics?

Answer 31

In healthy, yes

Requires normal liver and kidney function

Question 32

What induction agent should you avoid in cats with chronic renal fialure?

Answer 32

Ketamine

Excreted renally

Also avoid in cats with confirmed/suspect heart disease —» can precipitate CHF

Question 33

If your geriatric patient has renal disease, you want to maintain your MAP ______mmHg

Answer 33

> 70