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CFC > Anaesthesia (01-22) > Flashcards

Anaesthesia (01-22) Flashcards

1
Q

a state in which there is lack of sensation

A

anaesthesia

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2
Q

a state of unconsciousness produced by anaesthetic agents, with absence of pain sensation over the entire body

A

general anaesthesia

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3
Q

lack of sensation caused by interrupting the sensory nerve conduction of any region of the body

A

regional anaesthesia

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4
Q

this is an insensibility to pain without loss of consciousness

A

analgesia

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5
Q

a state of reduced anxiety

A

anxiolysis

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6
Q

this is a state of reduced irritability or excitement

A

sedation

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7
Q

this is a state of stupor or unconsciousness

A

narcosis

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8
Q

this is an artificially induced state of passivity

A

hypnosis

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9
Q

a male pig can be castrated without anaesthesia up to this age

A

7 days

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10
Q

a male calf can be castrated without anaesthesia up to this age

A

2 months (7 days with rubber ring)

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11
Q

a male lamb can be castrated without anaesthesia up to this age

A

7 days

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12
Q

this feature of an ideal anaesthetic means the drug does what it is meant to do

A

efficacy

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13
Q

this feature of an ideal anaesthetic means the drug does the same thing on every occasion and in every animal

A

predictability

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14
Q

this feature of an ideal anaesthetic means that the ease of administration is desirable

A

convenience

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15
Q

a balanced anaesthesia should have this triad of functions

A

narcosis, analgesia, muscle relaxation

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16
Q

name the 5 phases of anaesthesia

A
  1. pre-operative period
  2. Pre-anaesthetic medication
  3. induction
  4. maintenance
  5. recovery
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17
Q

in this phase of anaesthesia: animals are examined, drugs/fluids given to control pre-existing medical conditions, anaesthetic equipment prepared for use

A

pre-operative period

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18
Q

in this phase of anaesthesia: drugs are used to sedate the animal to make it less anxious, relieve pain, and decrease drug doses required for subsequent events

A

pre-anaesthetic medication (premedication)

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19
Q

in this phase of anaesthesia: the animal is rendered unconscious with agents

A

induction

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20
Q

in this phase of anaesthesia: unconsciousness is maintained

A

maintenance

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21
Q

in this phase of anaesthesia: drug administration ceases and the animal is allowed to regain consciousness

A

recovery

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22
Q

what is the moral/ethical reason for anaesthesia

A

prevent suffering caused by stress and/or pain

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23
Q

what is technical/practical reasons for anaesthesia?

A

prevent patient moving during surgery, reduce human risk

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24
Q

what are 6 features of an ideal anaesthetic?

A
  1. safety
  2. efficacy
  3. predictability
  4. convenience
  5. cost
  6. legality
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25
Q

this is a concept where different agents are used to produce each element of the anaesthetic triad instead of just 1 drug for all elements

A

balanced anaesthesia

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26
Q

name 4 risk factors identified for small mammal death rates under anaesthesia

A
  1. recovery period
  2. increased operative time
  3. unfamiliarity with anaesthetic technique
  4. intubation/fluid administration for cats
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27
Q

name the breed(s) associated with the specific consideration

airway problems

A

brachycephalics

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28
Q

name the breed(s) associated with the specific consideration

high incidence of von Willebrand’s disease

A

Dobermann

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29
Q

name the ASA classification based on the patient’s physical status

normal, healthy animal

A

ASA I

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30
Q

name the ASA classification based on the patient’s physical status

mild systemic disease or impairment

A

ASA II

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31
Q

name the ASA classification based on the patient’s physical status

elderly dog but otherwise healthy

A

ASA II

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32
Q

name the ASA classification based on the patient’s physical status

more severe systemic disease which is well compensated/ controlled by treatment

A

ASA III

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33
Q

name the ASA classification based on the patient’s physical status

dog with heart murmur which is bright, lively, and active

A

ASA III

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34
Q

name the ASA classification based on the patient’s physical status

severe systemic disease which is not compensated

A

ASA IV

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35
Q

name the ASA classification based on the patient’s physical status

dog with heart murmur which is showing signs of cardiac failure and pulmonary oedema

A

ASA IV

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36
Q

name the ASA classification based on the patient’s physical status

Moribund, unlikely to survive 24 hours

A

ASA V

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37
Q

name the ASA classification

added to any classification if the anaesthetic is an emergency

A

E

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38
Q

food withdrawl period before anaesthesia?

dog/cats

A

4-6 h

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39
Q

food withdrawl period before anaesthesia?

horses

A

6-12 h

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40
Q

food withdrawl period before anaesthesia?

cattle

A

18-24 hours

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41
Q

name some physical factors to help prevent hypothermia during surgery (5)

A

increase temp of environment, BAIR hugger, no cold table, heat incoming fluids, insulate animals (foil/bubble wrap)

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42
Q

name some anaesthetic factors to help prevent hypothermia during surgery (5)

A
  1. short-acting anaesthetics
  2. anaesthetic depth not too deep
  3. adequate but not excessive ventilation
  4. rebreating systems
  5. HME exchangers
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43
Q

name some surgical factors to help prevent hypothermia during surgery (4)

A

minimize surgical time,
small incision size,
technique,
avoid unnecessary wetting/clipping of non-surgical area

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44
Q

3 features of a good environment for recovery period from anaesthesia

A

warm, comfortable, quiet (but observed)

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45
Q

when to extubate a dog

A

swallowing

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46
Q

when to extubate a cat

A

before swallowing

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47
Q

name the gas in the canister

black with white shoulder OR white

A

oxygen

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48
Q

name the gas in the canister

blue

A

nitrous oxide

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49
Q

name the gas in the canister

grey with white & black shoulder

A

medical air

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50
Q

name the part of the anaesthetic machine

reduces high cylinder pressure to useable pressure; keeps outlet pressure constant

A

presure regulator

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51
Q

name the part of the anaesthetic machine

fine regulation of fresh gas flow; tapered graduated tube with needle valve at base

A

flowmeters

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52
Q

name the part of the anaesthetic machine

locks the vaporiser to machine, O rings prevent leakage

A

backbar

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53
Q

name the part of the anaesthetic machine

allows a ventilator to be attached to the anaesthetic machine

A

mini schraeder connectors

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54
Q

name the anaesthetic machine safety feature

prevents wrong cylinder to be attached to hanger

A

pin index valves

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55
Q

name the anaesthetic machine safety feature

helps cylinders make good contact and prevents fires

A

bodok seal

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56
Q

these are methods used to remove environmental contaminants from the immediate surroundings of the staff to ensure exposure limits are not exceeded

A

scavenging

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57
Q

name the type of scavenging

fan draws waste anaesthetic gases to the outside of the building where it mixes with the air outside

A

active scavenging

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58
Q

which has a greater affect on resistance in a breathing system?

hose length or hose diameter

A

diameter

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59
Q
A
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60
Q

how to overcome most problems associated with resistance and reduce the work of breathing

A

intermittent positive pressure ventilation (IPPV)

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61
Q

high or low?

gas flow requirement in rebreathing systems

A

low

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62
Q

high or low?

gas flow requirement in non-rebreathing systems

A

high

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63
Q

high or low?

volatile agent required in rebreathing systems

A

low

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64
Q

high or low?

volatile agent required in non-rebreathing systems

A

high

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65
Q

high or low?

pollution risk in rebreathing systems

A

low

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66
Q

high or low?

pollution risk in non-rebreathing systems

A

high

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67
Q

high or low?

resistance to respiration in rebreathing systems

A

high

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68
Q

high or low?

resistance to respiration in non-rebreathing systems

A

low

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69
Q

conserved or lost?

expired heat and moisture in rebreathing systems

A

conserved

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70
Q

conserved or lost?

expired heat and moisture in non-rebreathing systems

A

lost

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71
Q

cheap or expensive?

rebreathing system

A

expensive

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72
Q

cheap or expensive?

non-rebreathing system

A

cheap

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73
Q

soda lime required?

in rebreathing system

A

yes

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74
Q

soda lime required?

in non-rebreathing system

A

no

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75
Q

slow or fast?

change in inspired anaesthetic agent in rebreathing systems

A

slow

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76
Q

slow or fast?

change in inspired anaesthetic agent in non-rebreathing systems

A

fast

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77
Q

what is minimum fresh gas flow calculated based on for rebreathing systems

A

based on metabolic O2 consumption

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78
Q

how is minimum fresh gas flow calculated for non-rebreathing systems

A

respiratory minute volume x X

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79
Q

name 2 types of rebreathing systems

A

circle system; to and fro system

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80
Q

name some effects of increased respiratory resistence

A
  1. hypoventilation
  2. increased work breathing
  3. positive end expiratory pressure (PEEP)
  4. hypoxia
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81
Q

name 4 types of non-breathing systems

A
  1. Magill
  2. Lack
  3. T-piece
  4. Modified T-pieces
  5. Bain
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82
Q

what rebreathing system is being described?

inspiratory and expiratory limbs connected to endotracheal tube connector with a Y connector

A

circle system

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83
Q

what rebreathing system is being described?

fresh gas inflow situated next to endotracheal tube connector, metal gauze screen at patient end of canister, APL valve between canister and patient

A

to and fro system

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84
Q

what non-rebreathing system is being described?

3-6 VT reservoir bag on inspiratory limb and corrugated hose ending at an expiratory valve

A

magill system

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85
Q

what non-rebreathing system is being described?

reservoir bag on inspiratory limb connects to an outer inspiratory limb which surrounds an inner expiratory tube that ends at an expiratory valve positioned at the machine connector

A

Lack system (coaxial Magill)

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86
Q

what non-rebreathing system is being described?

bag on inspiratory limb, inspiratory & expiratory limbs are separate and run parallel to one another

A

Parallel Lack System

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87
Q

what non-rebreathing system is being described?

reservoir bag on expiratory limb; inspiratory hose connects to the endotracheal tube connector and open ended expiratory limb at a T shaped connector

A

Ayres’ T-piece

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88
Q

what non-rebreathing system is being described?

respiratory bag on the expiratory limb; outer expiratory tube and inner inspiratory tube, +/- expiratory valve

A

Coaxial Bain system

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89
Q

what non-rebreathing system is being described?

has a T-piece with closed ended bag on expiratory limb and a pediatric low resistance valve

A

Parallel Bain System

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90
Q

what type of breathing system is N2O NOT recommended with

A

rebreathing systems

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91
Q

this is an agent that affects mood

A

tranquiliser

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92
Q

this is an agent that reduces anxiety

A

anxiolytic

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93
Q

this is an agent that causes drowsiness

A

sedative

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94
Q

this is an agent that depresses the CNS and induces sleep at higher doses

A

hypnotic

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95
Q

this is an agent that reduces aggression and agitation

A

neuroleptic

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96
Q

name the 4 major groups of tranquilizer/sedative drugs

A
  1. phenothiazines
  2. butyrophenones
  3. Alpha2-agonists
  4. Benzodiazepines
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97
Q

this group of drugs block alpha1 receptors, block histamine/muscarinic receptors, block 5-HT, tranquilize, sedate, and anxiolytic, but have no analgesic properties

A

phenothiazines

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98
Q

this group of drugs have sedative action, potent antiemetic properties but have unpleasent side effects, hallucinations, agitation, etc in people

A

butyrophenones

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99
Q

this group of drugs have a primarily anxiolytic action, anticonvulant properties, muscle relaxation and mechanism of action is via potentiation of GABA mediated inhibition

A

benzodiazepines

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100
Q

these agents have no intrinsic efficacy but bind to the receptor and prevent interaction between benzodiazepines and the receptor

A

benzodiazepine antagonists

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101
Q

these agents act on the GABA receptor, bind with high affinity, close the chloride channel causing the neuron to become vulnerable to excitation

A

benzodiazepine inverse agonists

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102
Q

name the 3 main classes of alpha2-agonists

A
  1. imidazoles
  2. oxazolines
  3. phenylethylamines
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103
Q

name 2 purposes of pre-anaesthetic medication

A
  1. reduce dose of other anaesthetic agents
  2. relief of anxiety and apprehension
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104
Q

general anesthesia is described as a triad of these 3 things

A
  1. unconsciousness
  2. muscle relaxation
  3. analgesia
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105
Q

this is an agent which produces dose dependent CNS depression & will produce unconsciousness at adequate doses
- varying degrees of analgesia and muscle relaxation

A

general anaesthetic

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106
Q

name the two types of general naesthetic agents

A
  1. injectable
  2. inhalational
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107
Q

name the 4 receptors that anaesthetic agents may interact with to produce general anaesthesia

A
  1. GABA(A)
  2. NMDA
  3. Glycine
  4. Nicotinic acetylcholine
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108
Q

as a general rule, injectable anaesthetics act here

A

within the brain

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109
Q

as a general rule, halogenated volatile inhalational anaesthetics act predominately here

A

within the spinal cord

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110
Q

name 5 ways injectable anaesthetics can be administered

A
  1. IV
  2. IM
  3. Intraosseous
  4. intraperitoneal
  5. SQ
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111
Q

name at least 5 properties of an ideal injectable anaesthetic agent

A
  1. Rapid onset and recovery
  2. No excitation or emergence phenomena
  3. Analgesic properties
  4. No pain on injection
  5. Safe following extravascular or intra-arterial injection
  6. Minimal cardiovascular and respiratory depression
  7. No histamine release
  8. No toxic effects or interactions with other agents
  9. High lipid solubility
  10. No accumulation
  11. Water soluble formulation
  12. Long shelf life at room temperature 13. Inexpensive
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112
Q

name 5 advantages of injectable anaesthetic agents

A
  1. little equipment needed
  2. easy to administer
  3. induction of anaesthesia can be rapid and smooth
  4. potentially relatively cheap
  5. no environmental pollution
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113
Q

name 5 disadvantages of injectable anaesthetic agents

A
  1. once administered, retrieval is impossible
  2. body mass of patient must be known
  3. high doses often required when used as a sole anaesthetic agent (therefore side effects)
  4. possibly less well tolerated by debilitated animals
  5. abuse potential of some drugs and risks of inadvertent self administration
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114
Q

a drug injected, or absorbed, into a vein must do these 5 things for uptake for general anesthesia

A
  1. travel in blood to R side of heart
  2. traverse the lungs
  3. travel through left side of heart
  4. travel in arterial blood to effect site
  5. cross blood brain barrier to interact with appropriate receptors
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115
Q

what is the primary role of drug metabolism

A

create a molecule which is more water soluble and more easily excreted by the kidney

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116
Q

what receptor does propofol interact with for general anaesthesia

A

GABA(A) agonist

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117
Q

name 2 adverse side effects of propofol

A
  1. dose dependent CVS depression (hypotension)
  2. dose dependent respiratory depression (apnea +/- cyanosis)
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118
Q

care must be taken with repeated doses or prolonged use of propofol in what species (bc they lack enzymes required to conjugate glucornides and have problems metabolizing triglycerides)

A

cats

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119
Q

name the general anaesthetic

licensed for IV use in cats and dogs (off-license in rabbits, birds, reptiles, small mammals);
smooth & rapid induction of anaesthesia;
generally smooth recovery from anaesthesia

A

propofol

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120
Q

name the general anaesthetic

licensed for IV use in cats & dogs (off-license in rabbits, birds, reptiles, small mammals);
smooth and rapid induction of anaesthesia;
occossional poor quality of recovery from anaesthesia;
can be used repeatedly or as an infusion

A

alfaxalone

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121
Q

what receptor does alfaxalone interact with for general anaesthesia

A

GABA(A) agonist

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122
Q

name 2 adverse side effects of alfaxalone

A
  1. dose dependent CVS depression (hypotension)
  2. dose dependent respiratory depression (hypoventilation +/- apnea)
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123
Q

name the general anaesthetic

licensed for use in cats, dogs, horses, cattle, pigs, and primates;
delayed anaesthetic induction;
possible poor quality anaesthetic recovery;
maintains cranial nerve reflexes under anaesthesia;
schedule 2 controlled drug

A

ketamine

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124
Q

name 2 adverse side effects of ketamine

A
  1. sympathomimetic actions on CVS
  2. irregular breathing pattern
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125
Q

name the 2 types of clinically important barbiturates

A
  1. thiopental (short acting)
  2. pentobarbital (longer acting)
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126
Q

name the general anaesthetic

no longer licensed for vet use (only used in equine anaesthesia as rapidly acting top-up agent to cease movement while under GA)

A

thiopental

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127
Q

name 2 adverse side effects of tihiopental

A
  1. CV depression (hypotension)
  2. dose dependent respiratory depression (apnea)
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128
Q

name the general anaesthetic

licensed only for euthanasia; concentrated and non-sterile preparations; should NOT be used for anaesthesia

(longer acting barbiturate)

A

pentobarbital

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129
Q

name the general anaesthetic

not licensed for vet med, rarely used BUT used occassionaly bc minimal CV and resp depression;
quality of anaesthetic induction may be poor;
results in decrease in adrenal gland function & cortisol production (appropriate stress response to anaesthesia & surgery cannot be mounted)

A

etomidate

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130
Q

name 5 factors that the choice of injectable anaesthetic agent for induction of anaesthesia may depend on

A
  1. species and temperament of animal
  2. Underlying medical conditions
  3. Nature of the procedure
  4. Available drugs, equipment and conditions
  5. Personal preference and experience
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131
Q

name the drug

10% solution licensed for IV use in horses;
central skeletal muscle relaxant that affects spinal cord and brain stem; NOT an anesthetic, NO analgesic properties

A

GGE (guiaphenesin or glyceryl guiacolate ether)

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132
Q

name the 2 main groups of inhalational anaesthetics

A
  1. volatile
  2. compressed “gases”
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133
Q

name 4 types of volatile liquid inhalational anaesthetics

A
  1. isoflurane
  2. sevoflurane
  3. halothane
  4. desflurane
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134
Q

name 2 compressed “gases” used as inhalational anaesthetics

A
  1. nitrous oxide (N2O)
  2. Xenon
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135
Q

name 4 ways in which inhalational anaesthetics can be administered

A
  1. induction chamber
  2. face mask
  3. nasopharyngeal insufflation
  4. endotracheal tube
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136
Q

name 3 advantages inhalational anaesthetic agents

A
  1. increased fraction of oxygen in inhaled gas mixture provided
  2. airway protection by endotracheal tube
  3. rapid induction and recovery from GA & rapid change of anaestetic depth
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137
Q

name 3 disadvantages of inhalational anaesthetic agents

A
  1. additional equipment required for administration
  2. control of waste gases required to avoid personnel exposure
  3. toxic or harmful components may be produced by contact with soda lime or liver metabolism
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138
Q

name some properties of an ideal inhalational anaesthetic agent

A
  1. easily vaporized
  2. non-flammable & stable on storage
  3. no reaction with anaestetic system components
  4. non-irritant or pungent
  5. minimally metabolized
  6. smooth induction and recovery from anaesthesia with rapid control of anaesthetic depth
  7. some analgesia and muscel relaxation
  8. few CV and resp side effects
  9. no renal or hepatic toxicity
  10. cheap and not requiring expensive vaporiser
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139
Q

list the pressure gradient passing from the vaporiser to the brain (5)

A
  1. vaporiser
  2. anaesthetic system
  3. alveoli
  4. blood
  5. brain
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140
Q

is the speed of anaesthetic induction and recovery faster or slower for more soluble agents?

(inhalational anaesthetics)

A

SLOWER

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141
Q

this is a figure which is used to descrive the number of parts of gas in the blood compared to the alveolus

A

blood gas partition coefficient

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142
Q

what does a high blood gas partition coefficient mean for an inhalational anesthetic

A

the gas is very soluble in blood

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143
Q

name 3 things that anaesthetic uptake in blood is affected by

A
  1. solubility of agent in blood
  2. pulmonary blood flow
  3. concentration gradient (diffusion) between alveoli and blood
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144
Q

name 3 factors that will affect inhalational anaesthetic uptake

A
  1. inspired agent concentration
  2. alveolar ventilation
  3. uptake by blood and tissues
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145
Q

name 3 things that affect anaesthetic uptake in tissues

A
  1. solubility of the agent in tissues
  2. tissue perfusion
  3. concentration gradient (diffusion) between blood and tissues
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146
Q

name the degree of metabolism for isoflurane

A

0.2%

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147
Q

name the degree of metabolism of sevoflurane

A

2%

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148
Q

name the degree of metabolism of desflurane

A

0.02%

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149
Q

name the degree of metabolism of halothane

A

20%

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150
Q

this is defined as the minimum concentration required to prevent movement in response to a painful stimulus in 50% of the subjects tested

A

minimum alveolar concentration (MAC)

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151
Q

in order to provide clinical anaesthesia, what factor of MAC is required of an inhalational anaesthetic

A

1.5x MAC

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152
Q

name some factors that affect MAC of an inhalational agent

A
  1. species
  2. age
  3. PaO2<40mmHg; PaCO2»90mmHg
  4. high circulating catecholamines
  5. pregnancy
  6. hypotension <50mmHg
  7. hyperthyroidism
  8. CNS stimulants or depressants
  9. pregnancy
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153
Q

do most inhalational anaesthetic agents provide analgesia?

A

NO

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154
Q

what are the 3 desirable effects of volatile anaesthetic agents

A
  1. unconsciousness
  2. amnesia
  3. immobility
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155
Q

what is the main CVS effect of volatile anaesthetic agents

A

hypotension

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156
Q

what is the MAC of nitrous oxide (N2O) in dogs and cats

A

200%

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157
Q

Nitrous oxide is thought to offer analgesia by acting as an antagonist at these receptors

A

NMDA

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158
Q

name 3 situations where nitrous oxide should be avoided as an anaesthetic

A
  1. GDV
  2. closed pneumothorax
  3. vascular air emboli
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159
Q

this is an unpleasant sensory and emotional experience associated with actual or potential tissue damage

A

pain

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160
Q

this is an absence of pain in the presence of stimuli which would normally be painful

A

analgesia

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161
Q

name the theory

Melzack & Wall suggested that nociceptive information is modulated in the substantia gelatinosa of dorsal horn;
inhibitory neurons can be stimulated by either descending inhibitory neurons or non-nociceptive afferent input

A

gate control theory

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162
Q

this is an increased amount of pain associated with a mild noxious stimulus

A

hyperalgesia

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163
Q

this is pain provoked by a non-noxious stimulus

A

allodynia

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164
Q

this is the increase of synaptic potential with each stimulus (determined in research setting)

A

“wind-up”

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165
Q

name the 6 analgesic groups

A
  1. opioids
  2. NSAIDs
  3. Local anaesthetics
  4. NMDA antagonists
  5. Alpha-2 adrenoreceptor agonists
  6. other (gabapentin, tramadol)
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166
Q

what is the active analgesic form of morphine

A

Morphine-6-glucuronide

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167
Q

how are morphine glucuronides excreted?

A

in urine

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168
Q

what are the opioid receptors

A

G-protein coupled receptors

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169
Q

name 6 side effects of opioids

A
  1. sedation
  2. resp depression
  3. negative chronotropy
  4. emesis
  5. dysphoria
  6. histamine release
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170
Q

name the 4 mu agonist opioids

A
  1. morphine
  2. pethidine
  3. fentanyl
  4. methadone
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171
Q

what is the ‘gold standard’ analgesic

(mu agonist)

A

morphine

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172
Q

name the analgesic

this is a schedule 2 controlled drug, unlicensed for vet use;
metabolized to active analgesic;
gold standard analgesic

(mu agonist)

A

morphine

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173
Q

name the analgesic

schedule 2 controlled drug, licensed for vet use;
spasmolyic, positive chronotrope;
histamine release when administered IV

(mu agonist)

A

pethidine

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174
Q

name the analgesic

schedule 2 controlled drug, licensed for vet use;
rapid onset, 15-20min duration

(mu agonist)

A

fentanyl

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175
Q

name the analgesic

schedule 2 controlled drug, licensed for vet use;
synthetic mu agonist;
no emesis

(mu agonist)

A

methadone

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176
Q

name the analgesic

schedule 3 controlled drug, licensed for vet use;
partial mu agonist, moderate pain

A

buprenorphine

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177
Q

name the analgesic

prescription-only medication (POM), licensed for vet use;
synthetic opioid agonist/antagonist;
mild pain;
effective anti-tussive

(kappa agonist, mu antagonist)

A

butorphanol (torbugesic)

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178
Q

these reversibly interfere with action potential generation and conduction of noxious impulse;
they do not effect resting membrane potential

A

local anaesthetics

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179
Q

name the two groups that make up a local anaesthetic

A
  1. lipid-soluble hydrophobic aromatic ring (lipophilic unit)
  2. basic hydrophillic amide group (hydrophilic unit)
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180
Q

local anaesthetics linked by this group include procaine and cocaine

A

ester

181
Q

local anaesthetics linked by this group include lidocaine and bupivicaine

A

amide

182
Q

metabolism of esters produces these which cause allergic reactions

A

para-aminobenzoates (PABA)

183
Q

this is the pH at which concentration of ionized and unionized forms of a local anaesthetic are equal

A

pKa

184
Q

name 6 ways local anaesthetics can be administered

A
  1. local infiltration
  2. splash blocks
  3. specific nerve blocks
  4. IVRA
  5. extradural
  6. topical
185
Q

distribution and duration of local anaesthetics are influenced by this

A

degree of protein binding

186
Q

higher level protein binding results in (longer or shorter?) duration of action of local anaesthetics

A

longer

187
Q

less potent local anaesthetic agents have a (faster or slower?) onset of action

A

faster

188
Q

how are ester-linked local anaesthetics broken down

A

by plasma enterases to inactive compounds

189
Q

how are amide-linked local anaesthetics metabolized

A

by hepatic amidases into metabolites

190
Q

which fibers will be blocked first by local anaesthetics?
1. small or large?
2. unmyelinated or myelinate?
3. C-fibers or Ad fibers?
4. Pain sensation or touch?

A
  1. small
  2. myelinated
  3. Ad fibers
  4. pain sensation
191
Q

name 3 CNS effects of local anaesthetics

A
  1. tremors
  2. convulsions
  3. respiratory depression
192
Q

name 2 CV effects of local anaesthetics

A
  1. reduced myocardial contractility
  2. vasodilation
193
Q

name 3 unwanted effects of local anaesthetics

A
  1. reduces epithelial repair
  2. tissue irritation
  3. allergic reactions
194
Q

name 4 amide-linked local anaesthetics

A
  1. lidocaine
  2. bupivicaine
  3. mepivicaine
  4. proxymetacaine
195
Q

name the local anaesthetic

adrenaline in prep prolongs action duration;
class 1B anti-arrhythmic;
infusion lowers MAC

(amide-linked)

A

lidocaine

196
Q

name the local anaesthetic

long acting (8h);
cardiac toxicity (no IV admin.)

(amide-linked)

A

bupivicaine

197
Q

name the local anaesthetic

equivalent potency to lidocaine;
less vasodilation than lidocaine;
less irritant to tissues;
expensive;
no preservative

(amide-linked)

A

mepivicaine

198
Q

name the local anaesthetic

used for conjunctival sac anaesthesia, but toxic to corneal epithelium;
rapid onset (10s);
10-20 min duration

(amide-linked)

A

proxymetacaine

199
Q

name the local anaesthetic

short duration
causes vasoconstriction
PABA reactions
added to penicillin to reduce pain on injection

(ester-linked)

A

procaine

200
Q

name the local anaesthetic

eutectic mix of local anaesthetic;
topical anaesthesia of skin;
used to facilitate venipuncture

A

EMLA

201
Q

name the NSAID

contraindicated in cats;
vet licensed prep is available;
overdose causes liver failure;
analgesic, antipyretic and mild anti-inflamm. properties;
little ulcerogenic potential, no effect on platelets or bleeding time

A

paracetamol

202
Q

name the NSAID

block excitatory amino acid (EAA) receptors, reducing modulation and CNS activity;
analgesia is produced at low doses, progressing to dissociative anaesthesia at higher doses

A

NMDA antagonists

203
Q

name the general anaesthetic

cyclohexane derivative;
chemical restraint/dissociative anaesthesia;
somatic analgesia;
inhibits central sensitization

A

ketamine

204
Q

name the NSAID

no vet license;
atypical synthetic opioid-like substance which reduces nociceptive transmission by binding at mu receptors;
also inhibits re-uptake of serotonin and noradrenaline in the CNS

A

tramadol

205
Q

name the NSAID

no vet license;
stabilizes electrical nerve activity and has been used as an analgesic, esp. for neuropathic pain

A

gabapentin

206
Q

name the NSAID

provides good visceral analgesia, along with profound sedation

A

Alpha-2 agonists

207
Q

name 5 advantages of local anaesthesia

A
  1. true analgesia
  2. only local disturbance of function
  3. limited systemic effects
  4. relatively inexpensive
  5. minimal equipment needed
208
Q

name 5 disadvantages of local anaesthetics

A
  1. rare complications
  2. systemic toxicity
  3. allergic reaction
  4. neurological injury
  5. technique failure
209
Q

name 5 potential side effects of local anaesthesia

A
  1. infection
  2. coagulopathy
  3. raised intracranial pressure
  4. pruritus
  5. hypotension
210
Q

name the 6 main ways local anaesthetics may be used

A
  1. Topical
  2. Local Infiltration
  3. Conduction blockade (nerve block)
  4. Intra-articular
  5. Intravenous regional anaesthesia (IVRA)
  6. Neuraxial anaesthesia
211
Q

name 4 uses of topical local anaesthetics

A
  1. laryngeal
  2. corneal
  3. cutaneous
  4. wound margins
212
Q

name 4 uses of local infiltration anaesthetics

A
  1. line block
  2. inverted L block
  3. intradermal
  4. ring block
213
Q

name the local infiltration anaesthetic technique

local anaesthetic solution is infiltrated in a linear fashion under the proposed incision site;
used for minor lumpectomies (small animal) & abdominal surgery (ruminants)

A

line block

214
Q

what are inverted L blocks used for in cattle

A

laparotomy

215
Q

name the local infiltration anaesthetic technique

Local anaesthetic injected through the skin as a transcutaneous “bleb” to facilitate passage of vascular catheters or large paravertebral or spinal needles

A

intradermal

216
Q

name the local infiltration anaesthetic technique

local anaesthetic solution is infiltrated on the circumference of an appendage in an attempt to block afferent sensory activity (distal limb and teat analgesia in cattle)

A

ring block

217
Q

what nerve is blocked in cattle for dehorning

A

cornual

218
Q

what 2 nerves are blocked in goats for dehorning

A

cornual branches of:
1. zygomatic-temporal n.
2. intratrochlear n.

219
Q

name the 4 nerves that can be blocked for dentistry

A
  1. mental
  2. mandibular
  3. infraorbital
  4. maxillary
220
Q

what does blocking the infraorbital nerve anaesthetize/provide analgesia for?

A
  1. upper lip and nostril
  2. upper incisors/gums
221
Q

what does blocking the mental nerve anaesthetize/provide analgesia for?

A
  1. lower lip
  2. lower incisors and gums
222
Q

what nerves are blocked for paravertebral local anaethesia

A

T13, L1, L2

223
Q

distal or proximal paravertebral nerve block?

needle is inserted vertically to skin off the cranial edge of transverse process of L1, the caudal edge of L1, and the caudal edge of L2

A

proximal

224
Q

distal or proximal paravertebral nerve block?

needle is inserted parallel to transverse process (half given ventral, half given dorsal to it) of L1, L2, & L4

A

distal

225
Q

what 3 things indicate a succesful paravertebral nerve block?

A
  1. scoliosis (spine curved with concavity to unblocked side)
  2. heat
  3. absence of response to pin-pricking
226
Q

name 4 nerve blocks for the eye

A
  1. retrobulbar
  2. Peterson (only cattle)
  3. Auricopalpebral
  4. Supraorbital
227
Q

what does an auricopalpebral block anaesthetize

A

motor fibers to the eyelids

228
Q

what does a supraorbital nerve block anaesthetize?

A

forehead and middle portion of upper eyelid

229
Q

what is intra-articular local anaesthesia used for?

A

prior to & following joint surgery or arthrocopy (horses)

230
Q

name 2 uses of intravenous regional anaesthesia (IVRA) in large animals

A
  1. digit amputatuon (cattle)
  2. distal limb surgery (horses)
231
Q

what technique of local anaesthesia involves applying a tourniquet (slowly so veins are occluded before arteries) before injection

A

IVRA (intravenous regional anaesthesia)

232
Q

what technique of local anaesthesia is the hanging drop technique used for?

A

extradural anaesthesia

233
Q

name the neuraxial local anaesthesia technique

site for injection ID’d by ‘pump-handling’ the tail to reveal first intercoccygeal space as most mobile in this part of the axis, injection is given just cranial to this;
abolishes Ferguson’s reflex

A

sacrococcygeal extradural

234
Q

what does lumbosacral extradural anaesthesia anesthetize?

A

both hind limbs & abdomen

235
Q

where should you give lumbosacral extradural anaesthesia

A

in palpable depression just caudal to L7

236
Q

what does RUMM conduction blockade in small animals anaesthetize?

A

below the elbow (radius, ulnar, musculocutaneous, and median nerves)

237
Q

what does brachial plexus conduction blockade in small animals anaesthetize?

A

from mid humerus (5-6 nerves blocked)

238
Q

what does femoral & sciatic conduction blockade in small animals anaesthetize?

A

from stifle (main nerves to hind limbs)

239
Q

name the term

an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

A

pain

240
Q

name the term

an absence of pain in the presence of stimuli which would normally be painful

A

analgesia

241
Q

name 4 reasons for analgesia

A
  1. ethical
  2. logical
  3. professional
  4. clinical
242
Q

name 3 undesirable things prevented by effective peri-operative anti-nociception

A
  1. central sensitization
  2. nociception: sypatho-adrenal outflow
  3. reflex movement
243
Q

name 5 things that must be taken into consideration with pain assessment

A
  1. species
  2. severity of pain
  3. somatic v visceral pain
  4. location
  5. level of consciousness
244
Q

name 4 benefits of effective pre-operative pain management

A
  1. facilitates prep & exam of animals
  2. reduces risk of personal injury
  3. reduces induction problems
  4. smoothes induction in horses
245
Q

clinical strategy for optimizing an animal’s peri-operative comfort

administration of analgesia before painful stimulus;
to prevent central sensitization

A

pre-emptive analgesia

246
Q

clinical strategy for optimizing an animal’s peri-operative comfort

maintain post-op anti-inflammatory drugs until the wound has almost healed

A

prolonged post-operative pain therapy

247
Q

clinical strategy for optimizing an animal’s peri-operative comfort

Infusing drugs like ketamine and short acting opioids during anaesthesia (which have less depressant effects); central sensitization is blocked, intra-operative analgesia is improved; anaesthetics can be used at minimal doses

A

Partial Intravenous Anaesthesia (PIVA)

248
Q

name 3 important advantages if partial intravenous anaesthesia (PIVA)

A
  1. reduces dose of inhalation anaesthetic required (less physiological depression)
  2. intra-operative analgesia is improved
  3. central sensitization is blocked
249
Q

clinical strategy for optimizing an animal’s peri-operative comfort

combining sub-analgesic doses of drugs from different classes to provide total analgesia resulting from additive or synergistic drug effects;
also reduces likelihood of adverse drug effects arising from the use of high doses of a single drug class

A

polymodal pain therapy (PMPT)

250
Q

this is analgesia resulting from additive or preferably synergistic drug effects ;
involves premedication, intraoperative analgesia, and postoperative analgesia

A

multimodal analgesia (polymodal analgesia)

251
Q

this is the process by which water is drawn across a semipermeable membrane in response to the presence of osmotically active particles

A

osmosis

252
Q

this is the theoretical pressure that would be needed to prevent osmosis

A

osmotic pressure

253
Q

name 4 osmotically active particles

A

Na+, Cl-, K+, glucose

254
Q

what is normal plasma osmolarity

A

280-320 mOsm/L

255
Q

this is a measure of the effective osmolarity and predicts the effect of the solution on cell volume at equilibrium

A

tonicity

256
Q

what is the tonicity of the fluid?

<280 mOsm/L
increased cell volume

A

hypotonic

257
Q

what is the tonicity of the fluid?

280-300 mOsm/L
= cell volume

A

isotonic

258
Q

what is the tonicity of the fluid?

> 300 mOsm/L
decr. cell volume

A

Hypertonic

259
Q

aka colloid osmotic pressure (COP);
the part of osmotic pressure which is contributed by the large molecules (proteins) - albumin

A

oncotic pressure

260
Q

this is a gel-like layer covering the luminal surface of vascular endothelial cells ;
acts as a macromolecular sieve;
controls vascular permeability and microvascular tone

A

endothelial glycocalix

261
Q

name 4 factors compromising the function of the endothelial glycocalix

A
  1. hyperglycemia
  2. ischemia
  3. inflammatory mediators
  4. hypervolemia
262
Q

name the type of fluid loss causing these consequences

  1. Solute is lost from the ECF
  2. ECF becomes hypotonic relative to ICF
  3. water moves from ECF to ICF
A

hypertonic fluid loss

263
Q

name the type of fluid loss causing these consequences

  1. water is lost from the ECF
  2. ECF becomes hypertonic relative to ICF
  3. water moves from ICF to ECF
A

hypotonic fluid loss

264
Q

name the type of fluid loss causing these consequences

  1. no change in osmolarity
  2. no fluid shifts
  3. hypovolemia
A

isotonic fluid loss

265
Q

name the type of fluid loss causing these consequences

  1. reduced oncotic pressure
  2. hypovolemia
A

protein-rich fluid

266
Q

name the 3 types of fluids

A
  1. crystalloids
  2. colloids
  3. blood products
267
Q

name the 3 main uses of crystalloid fluids

A
  1. replacement
  2. maintenance
  3. special situations
268
Q

name 4 types of crystalloid fluids used for replacement

A
  1. saline (NaCl 0.9%)
  2. Hartmann’s solution
  3. lactated ringer’s solution
  4. Plasma-Lyte
269
Q

name the crystalloid fluid

no buffer;
acidifying fluid leads to hyperchloemic metabolic acidosis;
no K+, can lead to hypokalemia if not supplemented;
used for short term vomiting, hypochloremia, hyponatremia, hypercalcium, etc

A

saline - NaCl 0.9%

270
Q

name the crystalloid fluid

balanced (similar electrolyte composition as plasma);
buffered (lactate), alkalizing effect;
used for fluid resuscitation and perioperative fluid therapy;
also diarrhea, renal failure, DKA

A

Hartmann’s solution

271
Q

name the crystalloid fluid

similar to Hartmann’s solution but uses acetate as a buffer (instead of lactate) and has magnesium

A

Plasma-Lyte

272
Q

list 3 options for using crystalloid fluids for maintenance

A
  1. 5% dextrose
  2. 0.18% saline & 4% glucose
  3. alternate btwn 1 bag Hartmann’s then 2 bags 5% dextrose
273
Q

what supplement is required when using cruystalloid fluids for maintenance

A

K+

274
Q

name 3 crystalline fluids that can be used in special circumstances

A
  1. Hypertonic saline (NaCl 7.2%)
  2. sodium bicarbonate
  3. potassium chloride
275
Q

name the crystalloid fluid

draws fluid into IV space by osmosis;
increases CO (by expanding plasma volume leading to sympathetic activation);
rapid onset (5min) but short duration (30-60min);
give 3-5 mL/kg over 10 min

A

hypertonic saline (NaCl 7.2%)

276
Q

name the crystalloid fluid

for treatment of severe metabolic acidosis;
contraindicated in respiratory acidosis, controversial in lactic acidosis;
respiratory function must be adequate to eliminate excess CO2

A

Sodium Bicarbonate

277
Q

name the crystalloid fluid

used for potassium supplementation;
mix thoroughly with NaCl or Hartmann’s;
maintenence requirements 20 mmol/day;
max safe rate: 0.5mmol/kg/h

A

potassium chloride

278
Q

name 4 types of colloid fluids

A
  1. HES
  2. gelatins
  3. dextrans
  4. human albumin 20%
279
Q

name the type of colloid fluid

synthetic;
manufactured in different molecular weights;
dose: 5mL/kg bolus repeated up to 4x

A

HES (hydroxyethyl starches)

280
Q

name the type of colloid fluid

natural, derived from bovine collagen;
risk of anaphylaxis;
rapid but transient volume expansion;
dose: 5 mL/kg bolus repeated up to 4x

A

gelatins

281
Q

name the type of colloid fluid

glucose polymers;
marked temporary volume expansion;
risk of coagulopathy and anaphylaxis;
risk of renal failure in presence of hypovolemia and pre-existing renal disease

A

Dextrans

282
Q

name the type of colloid fluid

natural, monodisperse, hyperoncotic;
high risk hypersensitivity reactions;
for treatment of severe hypoalbuminemia

A

human albumin 20%

283
Q

name 5 Blood products that may be used for fluid therapy

A
  1. whole blood
  2. packed red blood cells
  3. fresh frozen plasma (FFP)
  4. frozen plasma
  5. cryoprecipitate
284
Q

name the blood product for fluid therapy

contains RBCs, EBCs, platelets, proteins, clotting factors;
indicated in acute blood loss;
should be administered < 6h of collection;
may be refridgerated up to 28 days but protein degradation occurs after 12-24h

A

whole blood

285
Q

how much is 1 unit of canine whole blood

A

250 mL

286
Q

how much is 1 unit of feline whole blood

A

45-60 mL

287
Q

name the blood product for fluid therapy

PCV is high (60-90%);
needs resuspension in 0.9% NaCl;
for normovolemic anemia and whole blood loss (with crystalloids)

A

packed red blood cells (PRBCs)

288
Q

name the blood product for fluid therapy

contains clotting factors and other plasma proteins;
must be frozen within 6h of collection;
can be stored up to a year at -18C;
for coagulopathies or hypoproteinemia;
dose: 10-30 mL/kg over 4h

A

fresh frozen plasma (FFP)

289
Q

name the blood product for fluid therapy

contains vitK-dependent factors (II, VII, IX, X);
used for rodenticide toxicity

A

frozen plasma

290
Q

name the blood product for fluid therapy

contains vWF, fibrinogen and clotting factors VIII and XIII;
used for von Willebrand’s disease and hemophilia A

A

cryoprecipitate

291
Q

name 5 possible routes of fluid administration

A
  1. intravenous
  2. intraosseous
  3. intraperitoneal
  4. subcutaneous
  5. oral
292
Q

what is the fast and reliable route of choice for fluid administration

A

intravenous

293
Q

name the 3 common veins used in cats and dogs for intravenous fluid administration

A
  1. cephalic
  2. saphenous
  3. jugular
294
Q

name 3 places where fluids can be administered intraosseously

A
  1. proximal humerus
  2. tibial tuberosity
  3. wing of ileum
295
Q

what is a risk of intraperitoneal fluid administration

A

organ penetration

296
Q

what kind of fluids can be administered intraperitonealy or subcutaneously?

A

isotonic only

297
Q

how long does it take subcutaneous fluids to reach extracellular space

A

6-8h

298
Q

what is the maximum volume of fluids that can be administered subcutaneously

A

10 mL/kg

299
Q

what method of fluid administration is often used in farm animals

A

oral

300
Q

name 5 goals of fluid therapy

A
  1. supply normal maintenance requirements
  2. replace pre-existing fluid losses
  3. replace ongoing fluid losses
  4. optimize intravascular volume
  5. treat electrolyte derangements
301
Q

what is the ultimate goal of fluid therapy

A

support normal homeostasis and cellular metabolic function to produce optimal outcomes

302
Q

name the term

this is fluid loss from all compartments

A

dehydration

303
Q

name the term

this is specifically fluid loss from intravascular compartment

A

hypovolemia

304
Q

name the percentage of dehydration based on the clinical signs

Hx suggests increased losses or decr. intake but can’t be detected on clinical exam

A

<5%

305
Q

name the percentage of dehydration based on the clinical signs

tacky, dry mucuous membranes, normal-mild loss of skin turgor, eyes still moist

A

5-7%

306
Q

name the percentage of dehydration based on the clinical signs

dry oral mm, eyes dull and sunken, consideral loss of skin turgor, weak rapid pulse, reduced urine output, increased CRT

A

8-10%

307
Q

name the percentage of dehydration based on the clinical signs

very dry mm, eyes dull and retracted, zero skin turgor, no urine production, weak thready pulses;
may be recumbent, reduced level of consciousness

A

> 10-12%

308
Q

name the percentage of dehydration based on the clinical signs

very dry mm, eyes dull and retracted, zero skin turgor, no urine production, weak thready pulses;
may be recumbent, reduced level of consciousness;
very prolonged CRT, moribund

A

> 12-15%

309
Q

what is the recommended fluid rate for animals under anaesthesia

A

5 mL/kg/h (3-10 mL/kg/h)

310
Q

name 4 types of fluid therapy strategies for the hemodynamically unstable patient

A
  1. goal directed fluid therapy
  2. fluid challenge
  3. hypotensive resuscitation
  4. transfusion therapy
311
Q

name the fluid therapy strategy for the hemodynamicall unstable patient

the titration of fluid therapy to achieve specific endpoints;
aimed at optimization of cardiovascular dynamics;
associated with improved clinical outcomes

A

goal-directed fluid therapy

312
Q

name the fluid therapy strategy for the hemodynamicall unstable patient

the administration of a bolus to assess the fluid responsiveness;
used in hemodynamically unstable animals;
minimizes risk of volume overload

A

fluid challenge

313
Q

what is the estimated blood volume of dogs

A

80-90 mL/kg

314
Q

what is the estimated blood volume of cats

A

60 mL/kg

315
Q

what is the estimated blood volume of horses

A

80 mL/kg

316
Q

name the fluid therapy strategy for the hemodynamicall unstable patient

the restoration of lower than normal blood pressure;
aims at facilitating hemorrhage control and reducing the risk of bleeding while ensuring blood flow to vital organs;
temporary solution until surgical hemostatic control

A

hypotensive resuscitation

317
Q

why should we monitor anaesthesia?

A

to recognise trends early to resolve problems before they become life-threatening

318
Q

what is the mortality rate of dogs under anaesthesia

A

0.17%

319
Q

what is the mortality rate of cats under anaesthesia?

A

0.24%

320
Q

how often should variables be recorded on a written anaesthetic record?

A

every 5 min

321
Q

what 6 things should be monitored during anaesthesia

A
  1. CNS function (depth)
  2. Cardiovascular function
  3. respiratory function
  4. temperature
  5. Equipment
  6. General (surgeon, fluids, etc)
322
Q

name the 4 stages of anaesthesia

A
  1. voluntary excitement
  2. involuntary excitement
  3. surgical anaesthesia
  4. overdose
323
Q

what 5 things can be used to monitor anaesthesia depth

A
  1. cranial nerve reflexes
  2. other reflexes
  3. CV responses to surgery
  4. Resp responses to surgery
  5. skeletomuscular responses to surgery
324
Q

this reflex is most useful and often accessible;
it is present when plane of anaesthesia is light and is usally lost at surgical plane (except in horses)

A

palpebral risk

325
Q

name 3 things we can monitor to assess CV function during anaesthesia

A
  1. heart rate and rhythm
  2. pulses
  3. perfusion of tissues
326
Q

what 3 things should be done to montor heart rate and rhythm during anaesthesia

A
  1. palpation/observation of apex beat
  2. auscultation
  3. pulse palpation
327
Q

what 3 things can palpation of pulses give information on

A
  1. pulse rate
  2. rhythm
  3. quality
328
Q

what two arteries are useful to palpate in small animals during anaesthesia

A
  1. metacarpal
  2. dorsal pedal
329
Q

what 4 sites are useful in the horse to palpate a pulse

A
  1. facial
  2. palatine
  3. auricular
  4. dorsal metatarsal
330
Q

what 3 things should you assess when palpating a pulse

A
  1. pulse pressure
  2. mean pressure
  3. character of pulse
331
Q

what two things can you monitor for tissue perfusion during anaesthesia

A
  1. CRT
  2. mucus membrane color
332
Q

name 2 reasons to “sigh” lungs frequently during anaesthesia

A
  1. helps prevent atelectasis
  2. allows appraisal of lung/breathing system
333
Q

what 2 things can you assess using equipment to monitor CV function during anaesthesia

A
  1. ECG
  2. Blood Pressure
334
Q

name 2 limitations of ECG monitoring

A
  1. no info about mechanical activity
  2. displayed HR can be incorrect
335
Q

name two indirect (non-invasive) techniques of monitoring blood pressure

A
  1. Oscillometric
  2. Doppler
336
Q

what should the width of the cuff for oscillometric blood pressure monitoring be

A

40% of the arm/leg circumference

337
Q

name 3 limitations of oscillometric blood pressure monitoring

A
  1. affected by movements
  2. can over/under estimate SAP
  3. not continuous
338
Q

name 3 limitations of Doppler technique for monitoring blood pressure

A
  1. only gives systolic pressure
  2. less accurate and reible than direct monitoring
  3. difficulty in positioning and attaching probe
339
Q

what is the accurate ‘gold standard’ for blood pressure monitoring

A

direct (invasive) monitoring

340
Q

name 5 risks of direct blood pressure monitoring

A
  1. infection
  2. hematoma/bleeding
  3. thrombus formation
  4. blood flow occlusion
  5. accidental drug injection
341
Q

what does pulse-oximeter measure?

A

& oxygen saturation of hemoglobin (SpO2)

342
Q

name 4 respiratory monitoring devices

A
  1. apnea monitors
  2. capnography
  3. pulse oximetry
  4. blood gas analysis
343
Q

name the respiratory monitoring device

a thermistor detects warm air movements (expired gases);
gives no indication regarding accuracy;
may be misleading

A

apnea monitors

344
Q

name the respiratory monitoring device

gives a graphical representation of continuous measurement of PCO2 throughout the resp cycle (ETCO2 estimates PaCO2);
provides info about ventilation, CO, metabolism and equipment

A

capnography

345
Q

what does hypercapnia (ETCO2 > 45 mmHg) reflect

A

hypoventilation

346
Q

what does hypocapnia (ETCO2 < 35 mmHg) reflect

A

hyperventilation

347
Q

name 3 things that cause increased ETCO2

A
  1. decr. alveolar ventilation
  2. incr. CO2 production
  3. incr. inspired CO2
348
Q

name 4 things that cause decreased ETCO2

A
  1. incr. alveolar ventilation
  2. reduced CO2 production
  3. incr. alveolar dead space
  4. sampling error
349
Q

what does alveolar plateu getting lower over time on a capnogram indicate

A

decreasing ETCO2

350
Q

what does an elevated baseline on a capnogram indicate

A

inspired CO2 levels increasing

351
Q

angle of expiratory upstroke is reduced and it is prolonged on a capnogram;
what does this indicate?

A

increased resistance to exhalation

352
Q

what do these features on a capnogram indicate?

shallow expiratory upstroke, low ETCO2 and short alveolar plateau

A

inadequate seal

353
Q

this is the gold standard measurement of respiratory function

A

arterial blood gas analysis

354
Q

this is the act of inhaling and exhaling (the act of breathing)

A

ventilation

355
Q

this is the delivery of oxygen to tissues

A

oxygenation

356
Q

this means high blood carbon dioxide (PaCO2)

A

hypercapnia

357
Q

this means low blood oxygen (PaO2)

A

hypoxia

358
Q

central or peripheral?

which chemoreceptors monitor PaCO2?

A

central

359
Q

central or peripheral?

which chemoreceptors monitor PaO2?

A

peripheral

360
Q

what is the cause of hypercapnia (increase in PaCO2)?

A

reduced ventilation

361
Q

what should the fraction of inspired CO2 (FiCO2) be?

A

0 mmHg

362
Q

what 3 things can have an effect on arterial CO2 levels (PaCO2)

A
  1. FiCO2 (fraction of inspired CO2)
  2. VCO2 (CO2 production by the body)
  3. Va (Minute Ventilation)
363
Q

name 3 things that can increase VCO2 (prodiuction of CO2 by the body)

A
  1. pyrexia
  2. surgey
  3. malignant hyperthermia
364
Q

name 5 things that affect minute ventilation

A
  1. anaesthesia
  2. positioning
  3. drugs (opioids)
  4. Hypovolemia
  5. Pain
365
Q

name 5 consequences of hypercapnia

A
  1. tachypnea
  2. incr. cardiac output
  3. peripheral vasodilation
  4. narcotic
  5. bradydysrhythmias
366
Q

how do you resolve hypercapnea

A

increase ventilation

367
Q

name 3 consequences of hypoxia in the brain

A
  1. incr. ICP
  2. seizures
  3. death
368
Q

name 3 consequences of hypoxia in the myocardium

A
  1. decr. contractility
  2. arrhythmias
  3. death
369
Q

name 2 consequences of hypoxia in the kidney

A
  1. pre-renal failure
  2. nephrosis
370
Q

name 6 causes of hypoxia

A
  1. atmospheric
  2. tidal
  3. alveolar
  4. hemoglobinemia
  5. histotoxic
  6. demand
371
Q

name 4 ways to manage the airways during anaesthesia

A
  1. endotracheal tube
  2. laryngeal mask
  3. tracheostomy
  4. mask
372
Q

name the method of airway management for anaesthesia

gold standard;
protect airway when cuffed;
allows mechanical ventilation;

tracheal damage;
occlusion;
tube damage

A

endotracheal tube

373
Q

name the method of airway management for anaesthesia

may allow for mechanical ventilation;
some rated to protect airway;
very easy to place;

need to be positioned correctly;
easy to move;
laryngeal trauma?

A

laryngeal mask

374
Q

name the method of airway management for anaesthesia

definite airway;
bypass upper airway pathology;

requires equipment;
additional morbidity;
additional aftercare needed

A

tracheostomy

375
Q

name the method of airway management for anaesthesia

very easy to place and remove;
increases FiCO2;

no protection;
no mechanical ventilation;
no capnography

A

mask

376
Q

name 4 things that needed for Intermittent Positive Pressure Ventilation (IPPV)

A
  1. cuffed ET tube
  2. appropriate breathing system
  3. means of delivering ventilation
  4. methods of suppressing ventilation
377
Q

ame the 3 indications for IPPV (Intermittent Positive Pressure Ventilation)

A
  1. assist patient
  2. assist anaesthetist
  3. assist surgeon
378
Q

what is the anaesthetic risk of mortality in dogs

A

0.17%

379
Q

what is the anaesthetic risk of mortality in cats

A

0.24%

380
Q

what is the anaesthetic risk of mortality in rabbits

A

1.39%

381
Q

what is the anaesthetic risk of mortality in equine

A

1.9%

382
Q

name 6 respiratory complication and emergencies that can occur during anaesthesia

A
  1. hypercapnia
  2. hypoxemia
  3. aspiration
  4. barotrauma
  5. airway obstruction
  6. apnea
383
Q

name 4 cardiovascular complications and emergencies that can occur during anaesthesia

A
  1. hypotension
  2. cardiac arrhythmias
  3. hemorrhage
  4. cardiac arrest
384
Q

name 4 effects of hypercapnia

A
  1. cardiac depression
  2. SNS stimulation
  3. respiratory acidosis
  4. CNS depression
385
Q

name 3 causes of hypercapnia

A
  1. hypoventilation
  2. CO2 rebreathing
  3. Increased CO2 production
386
Q

this is a low level of oxygen in the blood

A

hypoxemia

387
Q

this is a low level of oxygen in the tissues

A

hypoxia

388
Q

name 5 effects of hypoxemia

A
  1. cellular hypoxia
  2. anaerobic metabolism
  3. SNS stimulation
  4. cardiac arrhythmias
  5. cardaic arrest
389
Q

name 4 ways to prevent/treat hypoxemia under anaesthesia

A
  1. pre-oxygenation
  2. increased FiO2
  3. lighten anaesthesia
  4. IPPV
390
Q

name 5 causes of hypoxemia

A
  1. inadequate oxygen supply (FiO2)
  2. hypoventilation
  3. V/Q mismatch
  4. R to L shunt
  5. diffusion impairment
391
Q

name 3 ways to prevent aspiration while under anaesthesia

A
  1. airway secured with leak-tested cuffed ETT
  2. fasting
  3. rapid induction
392
Q

name 3 possible causes of barotrauma during anaesthesia

A
  1. mechanical ventilation with high peak inspiratory pressures
  2. closed APL valve
  3. inappropriate use of oxygen flush
393
Q

name 5 causes of upper airway obstruction during anaesthesia

A
  1. soft tissue
  2. ETT
  3. blood
  4. vomit
  5. foreign body
394
Q

name teo emergency treatments of upper airway obstruction during anaesthesia

A
  1. reintubation
  2. tracheostomy
395
Q

this is total respiratory arrest and rapidly results in severe hypoxia and hypercapnia

A

apnea

396
Q

name 4 causes of apnea during anaesthesia

A
  1. anaesthetic drug overdose
  2. reflex apnea
  3. brainstem injury
  4. cardiac arrest
397
Q

name two consequences of hypotension during anaesthesia

A
  1. hypoperfusion
  2. organ dysfunction
398
Q

name 5 causes of hypotension during anaesthesia

A
  1. hypovolemia
  2. vasodilation
  3. decreased contractility
  4. cardiac arrhythmias
  5. reduced venous return
399
Q

if bradycardia is the cause of hypotension during anaesthesia, what is teh treatment?

A

anticholinergics (to incr HR)

400
Q

name some consequences of hypothermia

A
  1. MAC reduction
  2. recuction in metabolic rate
  3. impaired blood coagulation
  4. incr. bloof viscosity
  5. vasoconstriction
  6. hypoventilation
  7. arrythmogenic
401
Q

name 4 ways to improve anaesthetic safety

A
  1. ID potential complications prior to anaesthesia
  2. preparedness and prevention
  3. early recognition
  4. prompt treatment
402
Q

name 2 drugs that can cause narcosis with accidental self administration

A

opioids and alpha 2 agonist

403
Q

name 4 consequences of extravascular administration

(anaesthesia acccident)

A
  1. no anaesthetic effect
  2. tissue damage
  3. pain
  4. medico-legal consequences
404
Q

name the 3 ways to manage extravascular administration

(anaesthesia acccident)

A
  1. dilution
  2. analgesia
  3. record
405
Q

name 5 signs of intra-carotid injection

(anaesthesia acccident)

A
  1. abnormal activity
  2. violent reaction
  3. recumbency
  4. seizures
  5. loss of consciousnes
406
Q

name 3 ways to prevent and manage intraoperative awakening

(anaesthesia acccident)

A
  1. ensure IV access
  2. ensure top-up drugs
  3. monitor depth of anaesthesia
407
Q

name 3 ways to prevent ocular damage during anaesthesia

A
  1. eye lubrication
  2. towels
  3. general care
408
Q

name 4 effects of chronic low level personnel exposure to volatile anaesthetics

A
  1. reproductive disorders
  2. gestational disorders
  3. neoplastic disease
  4. psychiatric disorders
409
Q

name 4 storage requirements for cylinders

(anaesthesia)

A
  1. away from heat
  2. vertically/horizontally in approved cages
  3. dry and clean
  4. warning prohibiting smoking
410
Q

this is the sudden and often unexpected cessation of effective cardiac contractions

A

cardiac arrest

411
Q

this is the sudden complete cessation of respiratory movements

A

respiratory arrest

412
Q

what is the goal of CPR

A

O2 delivery to vital organs until return of spontaneous circulation (ROSC)

413
Q

name 4 things that put an aimal at risk of cardiopulmonary arrest

A
  1. severe critical illnesses
  2. polytrauma
  3. asphyxiation
  4. anaesthesia
414
Q

what is the ABC of basic life support

A

Airway
Breathing
Circulation

415
Q

what is the DEF of advanced life support

A

Drugs
Electrical defibrillation/ECG
Follow-up

416
Q

how many breaths per minute should you give during CPR

A

10 breaths per minute

417
Q

how should a dog with small, narrow chest be positioned for CPR

A

right lateral

418
Q

how should a dog with large-barrel chest be positioned for CPR

A

dorsal

419
Q

where should your hands be to give chest compressions over the heart in R lateral recumbency

A

3rd-6th intercostal space

420
Q

where should your hands be to give thoracic pump chest compressions to a dog > 15 kg

A

over highest point of thorax

421
Q

what should the rate of compressions be for CPR

A

100-120 cpm

422
Q

how long should each uninterrupted cycle of compressions be in CPR

A

2 minutes

423
Q

name 4 instances to consider internal cardiac compressions in

A
  1. pneumothorax
  2. cardiac tamponade
  3. penetrating chest wounds
  4. intraoperative arrests
424
Q

whare should you incise the chest for internal cardiac compressions

A

5th interspace

425
Q

name 4 disadvantages of internal CPR

A
  1. complicated
  2. sepsis risk
  3. invasive
  4. risk tissue damage and hemorrhage
426
Q

name 3 reasons why pulse oximetry, NIBP and pulse palpation are not reliable to monitor for success of CPR

A
  1. motion artifacts
  2. lack of sufficient arterial pulse
  3. poor tissue perfusion
427
Q

what two things should you monitor during CPR for success

A

ECG and capnography

428
Q

what is ECG monitoring key for during CPR

A

accurate rhythm diagnosis

429
Q

name the 2 non-shockable CPA rhythms detected by ECG

A
  1. asystole
  2. pulseless electrical activity (PEA)
430
Q

name the 2 shockable CPA rhythms detected by ECG

A
  1. ventricular tachycardia (VT)
  2. ventricular fibrillation (VF)
431
Q

how long does it take for a peripheral IV injection to reach central circulation

A

1-2 minutes

432
Q

name 2 vasopressors that can be used during advanced life support

A

adrenaline and vasopressin

433
Q

name the drug used during advanced life support

vasopressor;
alpha1, beta1 (beta2) receptors;
0.01 mg/kg (low) - 0.1 mg/kg (high)
every 4 minutes (every other cycle of BLS)

A

adrenaline

434
Q

name the drug used during advanced life support

vasopressor;
V1 receptor;
0.9 U/kg IV

A

vasopressin

435
Q

when should anticholinergics (atropine) be given during advanced life support (indications)

A
  1. asystole
  2. PEA (pulseless electrical activity)
436
Q

name the drug used during advanced life support

anticholinergic;
decr. parasympathetic tone;
single dose of 0.04 mg/kg IV;
worse outcome with higher doses;
indications: asystole or PEA

A

atropine

437
Q

name 2 antiarrhythmic drugs that can be given during advanced life support

A
  1. amiodarone
  2. lidocaine
438
Q

name the drug used during advanced life support

class III antiarrhythmic;
2.5-5 mg/kg IV;
refractory VF/PVT;
anaphylaxis in dogs

A

amiodarone

439
Q

name the drug used during advanced life support

class Ib antiarrhythmic;
2 mg/kg IV slow;
refractory VF/PVT

A

lidocaine

440
Q

name the drug used during advanced life support

to reverse opioids (be aware of analgesia);
0.04 mg/kg IV

A

Naloxone

441
Q

what is the recommended primary treatment for VF/pulseless VT

A

defibrillation

442
Q

name the drug used during advanced life support

to reverse benzodiazepines;
0.01 mg/kg IV

A

Flumazenil

443
Q

name the drug used during advanced life support

to reverse alpha2 agonists;
0.1 mg/kg IV

A

antipamezole

444
Q

fluid therapy is limited to patients with what condition during anaesthesia

A

hypovolemia

445
Q
A
446
Q

what is the survival to discharge rates for dogs and cats who need CPR

A

2-10%

447
Q

name some signs of effective CPR

A
  1. CO2 detectable on capnography
  2. palpable pulse during cardiac compression
  3. improvement in mm color
  4. ECG changes
  5. return of spontaneous ventilation
  6. pupillary constriction
  7. return of cranial nerve reflexes
  8. lacrimation
  9. resturn of other neurological function
448
Q

name the 3 goals of post-cardiac arrest care

A
  1. hemodynamic optimization
  2. respiratory optimization
  3. neuroprotection

CFC (6 decks)

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