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Anesthesiology > Age Considerations > Flashcards

Age Considerations Flashcards

1
Q

Patients are considered pediatric up to what age?

A

12 weeks

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2
Q

After what are are organ systems nearly developed?

A

12 weeks

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3
Q

Neonates are dependent on what for cardiac output?

This is due to a minimal ability to increase what?

A
  • Heart rate

- Contractility

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4
Q

Which nervous system is immature in a young animal?

A

Sympathetic

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5
Q

Which fluid volume is increased in young animals?

A

ECF

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6
Q

Do young animals have slower or higher metabolic rate?

A

Higher

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7
Q

What might persist in young animals, especially foals?

A

Fetal circulation with a R to L shunt.

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8
Q

Do young animals have a high or low resting respiratory rate/minute ventilation?
What is this due to?

A
  • High

- Increased oxygen demand

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9
Q

What is different about pulmonary reserve in young animals?

A

Have minimal pulmonary reserve.

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10
Q

T/F: Young animals have a greater work of breathing.

A

True

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11
Q

T/F: PCV increases by 1/3 in first 28 days in small animals.

A

False - PCV DECREASES by 1/3 in first 28 days in small animals.

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12
Q

Blood loss can lead to what in young animals?

A

Significant decrease in oxygen delivery to tissues.

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13
Q

What type of drugs will have a greater activity in young animals?
Why?

A
  • Highly protein-bound drugs

- Due to hypoalbuminemia

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14
Q

What type of enzymes can young animals be deficient in?

What effect does this have?

A
  • Hepatic microsomal enzymes

- Prolonged drug effects

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15
Q

Is GFR increased or decreased in young animals?

What effect does this have?

A
  • Decreased GFR

- Prolonged effect of drugs excreted in urine

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16
Q

Are kidneys more or less efficient in young animals?

What is a result of this?

A
  • Kidneys less efficient

- Less tolerant of fluid overload

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17
Q

Do young animals generally have a low or high level of body fat?
What effect does this have?

A
  • Low body fat

- Decreased mass for drug redistribution

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18
Q

Are young animals susceptible to hyperthermia or hypothermia?

A

Hypothermia

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19
Q

T/F: Young animals have low metabolism and significant hepatic glycogen.

A

False - Young animals have HIGH metabolism and MINIMAL hepatic glycogen.

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20
Q

Are young animals susceptible to hypoglycemia?

A

Yes

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21
Q

Do young animals have lower or higher permeability of the BBB?
What is seen with this?

A
  • Higher

- More profound drug effects

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22
Q

What is important for any age patient?

A

Appropriate analgesia

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23
Q

Pain experienced as a neonate may cause what?

A

Altered pain processing/perception for life.

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24
Q

Are nursing animals fasted?

A

No

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25
Q

How long are young animals fasted?

A

3-4 hours

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26
Q

What might be difficult or impossible to place in an emergency?

A

IV catheter

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27
Q

Anything given IV may also be given by what other route?

A

IO - Intraosseus

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28
Q

What are 2 types of sedatives that are not recommended with young animals?

A
  • Phenothiazines

- Alpha-2 agonists

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29
Q

What category of sedative provides good sedation in foals?

Is this the same for adult horses?

A
  • Benzodiazepines

- No

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30
Q

Which benzodiazepine is preferred in foals?

A

Midazolam

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31
Q

In young animals, benzodiazepines generally maintain what?

A

Respiratory and CV function

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32
Q

What category of drug is a good choice for young animals for analgesia and some sedation due to their minimal CV/respiratory effects?

A

Opioids

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33
Q

Which opioid has a long DOA and is poorly reversible?

A

Buprenorphine

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34
Q

Why are anticholinergics often given with the premed in young animals?

A

Dependent on heart rate for cardiac output.

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35
Q

Can anticholinergics be given intra-op with young animals?

A

Yes

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36
Q

What should be aggressively treated if seen in young animals?

A

Bradycardia

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37
Q

With local anesthetics in young animals, should the low end or high end of the dose range be used?

A

Low end

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38
Q

How are esters metabolized?

A

Plasma esterases

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39
Q

How are amides metabolized?

A

Hepatic metabolism

40
Q

Are NSAIDs recommended in young animals?

Why?

A
  • No

- Due to immature hepatic and renal function.

41
Q

What are 2 induction agents that can be used in young animals due to having rapid onset and recovery?

A
  • Propofol

- Alfaxalone

42
Q

What are 2 side effects seen with propofol?

A
  • Hypotension

- Respiratory depression

43
Q

What is a side effect seen with alfaxalone?

A

Respiratory depression

44
Q

Can etomidate be used for induction with young animals?

A

Yes

45
Q

Which induction agent has comparatively longer induction and recovery periods?

A

Ketamine

46
Q

What is an alternative induction method for foals?

A

May be induced with iso/sevo via a nasotracheal tube.

47
Q

What are 2 conditions to watch out for during the maintenance of anesthesia in young animals?

A
  • Hypotension

- Hypoventilation

48
Q

Do young animals tend to have a lower or higher BP under anesthesia?
What is an average BP in an awake 1 month old puppy?

A
  • Lower BP

- 50 mmHg

49
Q

Consider supplementing what in the fluids given to a young animals under anesthesia?

A

Dextrose

50
Q

What are 2 considerations for supportive care for young animals under anesthesia?

A
  • Active warming

- Careful fluid administration

51
Q

T/F: Young animals have a lower daily fluid requirement but are more tolerant of fluid overload.

A

False - Young animals have a HIGHER daily fluid requirement but are LESS tolerant of fluid overload.

52
Q

Animals that are older than 75% of their expected life spans are considered what?

A

Geriatric

53
Q

Dogs are considered geriatric in what age range?
Cats?
Horses?

A
  • Dogs: 7-10
  • Cats: 10-12
  • Horses: 18-20
54
Q

What are geriatric animals dependent on for cardiac output?

A

Atrial kick and normal sinus rhythm

55
Q

What is important for CV function in geriatric patients?

A

Adequate preload

56
Q

Neonatal refers to dogs/cats less than what age?

Foals/calves less than what age?

A
  • Less than 6 weeks

- Less than 2 weeks

57
Q

Why do geriatric animals have a limited ability to increase heart rate?

A

Beta receptors are LESS responsive

58
Q

What do geriatric animals rely on to increase cardiac output?

A

Increased stroke volume

59
Q

What are 3 cardiovascular functions that are usually decreased with geriatric patients?

A
  • Arterial compliance
  • Myocardial compliance
  • Maximum heart rate and cardiac output
60
Q

T/F: Geriatric animals may have valvular incompetence.

A

True

61
Q

T/F: With geriatric animals, there is a decrease in function but not efficiency of the respiratory system.

A

False - There is an overall decrease in function and efficiency in the respiratory system.

62
Q

What are 4 aspects of the respiratory system that are decreased in geriatric patients?

A
  • Gas exchange
  • Vital capacity
  • Thoracic compliance
  • Lung elasticity
63
Q

Is there an increase or decrease in PaO2 in geriatric animals?

A

Decrease in PaO2

64
Q

What respiratory function is increased with geriatric animals?

A

Increased work of breathing

65
Q

Is liver mass increased or decreased with geriatric patients?
What affect does this have on drug clearance?

A
  • Decreased liver mass

- Decreased drug clearance causes prolonged duration of action

66
Q

Is kidney mass increased or decreased in geriatric animals?

Functional nephrons?

A
  • Decreased kidney mass

- Decreased functional nephrons

67
Q

What are 3 kidney functions that are decreased in geriatric animals?

A
  • GFR
  • Ability to concentrate urine
  • Ability to correct volume or electrolyte derangements
68
Q

Is MAC increased or decreased in geriatric animals?

A

Decreased

69
Q

T/F: Muscle mass in increased and fat is decreased in geriatric animals.

A

False - Muscle mass in DECREASED and fat is INCREASED.

70
Q

The decreased plasma volume in geriatric animals lead to what?

A

Increased plasma drug concentration.

71
Q

Due to their decreased metabolic rate, geriatric animals are less able to maintain what?

A

Their body temperature

72
Q

If there is an arrhythmia auscultated in a geriatric animal, what should be run?

A

ECG

73
Q

If there is a murmur auscultated in a geriatric animal, what should be considered?

A

Echocardiogram

74
Q

The function of what 2 organs CBC/Chem/UA of a geriatric animal?

A
  • Liver

- Kidneys

75
Q

What 2 categories of sedatives can be used in healthy older patients with conservative dosing?

A
  • Phenothiazines

- Alpha-2 agonists

76
Q

Which type of sedative often provides better sedation in geriatric animals compared to younger adults?

A

Benzodiazepines

77
Q

Which type of sedative generally maintains respiratory and CV function better: phenothiazines, alpha-2 agonists or benzodiazepines?

A

Benzodiazepines

78
Q

What might be needed for diagnostics or IVC placement in a geriatric cat?

A

Heavy IM sedation

79
Q

What are 3 conditions that many geriatric cats have?

A
  • Heart murmurs
  • Hyperthyroidism
  • Renal disease
80
Q

What is probably the most appropriate sedative for geriatric cats?

A

Alfaxalone

81
Q

What are 2 sedatives to avoid if possible due to having significant CV side effects?

A
  • Dexdomitor

- Ketamine

82
Q

What are 2 reasons opioids are a good choice for analgesia and sedation in geriatric patients?

A
  • Minimal CV/resp effects

- Reversible

83
Q

Which opioid has a long duration of action and is poorly reversible?

A

Buprenorphine

84
Q

Are anticholinergics recommended for routine pre-medication in geriatric animals?

A

No

85
Q

What are 3 reasons anticholinergics may be used in geriatric patients?

A
  • Brachycephalics
  • Procedures causing vagal stimulation (ophtho, GI)
  • Bradycardia
86
Q

What are 2 affects local anesthetics have in geriatric patients?

A
  • Good analgesia

- Decreases MAC

87
Q

The dose for what type of local anesthetic needs to be adjusted if hepatic dysfunction is present?

A

Amides

88
Q

Can NSAIDs be used in healthy geriatric patients?

A

Yes

89
Q

What is required for the use of NSAIDs in geriatric animals?

A

Normal liver and kidney function

90
Q

What should be checked before administering NSAIDs to a geriatric patient?
Why?

A
  • Urine specific gravity

- Ensure concentration ability

91
Q

What are 2 good choices for induction of geriatric animals?

A
  • Propofol

- Alfaxalone

92
Q

Can etomidate be used for induction of geriatric animaos?

A

Yes

93
Q

What induction agent should be avoided in cats with chronic renal failure or with confirmed/suspected heart disease?

A

Ketamine

94
Q

What 2 maintenance inhalants are used for geriatric patients?
What are 2 possible side effects?

A
  • Sevoflurane and isoflurane

- Hypotension and hypoventilation

95
Q

If renal disease is present, what should MAP be kept above in geriatric patients?

A

Above 70 mmHg

96
Q

Careful attention should be paid to what 2 things in geriatric patients?

A
  • Body temperature

- Fluid balance

Anesthesiology (19 decks)

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