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Clinical Nursing Jan exam > Anaesthesia > Flashcards

Anaesthesia Flashcards

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1
Q

Define pain

A

Unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage

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2
Q

Define nociception

A

Neural process of encoding noxious stimuli

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3
Q

What is the difference between pain and nocicpetion

A

Pain is the interpretation of nociception, dependent on the individual, nociception can be present without pain

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4
Q

What is the purpose of pain and why does it need to be treated?

A

Protection

Can affect function and well-being of individuals

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5
Q

Define nociceptive pain

A

Pain from actual damage to non-neural tissues, activation of nociceptors

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6
Q

Define neuropathic pain

A

Pain from a lesion or disease to somatosensory system

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7
Q

Explain the difference between nociceptive and neuropathic pain

A

Nociceptive is in a normally functioning somatosensory system, neuropathic pain is in a damaged somatosensory system due to lesion or disease, harder type of pain to treat

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8
Q

Define hyperalgesia

A

Increased level of pain in response to a normally painful stimuli

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9
Q

Define allodynia

A

Pain from a normally non-painful stimuli

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10
Q

What is the differences between acute and chronic pain?

A

Acute- short term, acts as protection, can lead to chronic pain if untreated
Chronic- long term, generally not protective, causes suffering

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11
Q

What are physiological signs of pain?

A 
Tachycardia
Hypertension
High body temperature
Altered RR and pattern
Release of stress hormones (adrenaline, cortisol etc.)
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12
Q

What factors affect how animals present signs of pain?

A

Species
Individual
Condition
Prey or predator

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13
Q

What are signs of pain common to dogs and cats?

A 
Hunched over
Pain face
Lack of grooming
Inappetence
Condition specific signs
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14
Q

What are signs of pain in dogs?

A

Positive signs rather than reducing normal behaviour
Attention seeking
Submission
Vocalisation

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15
Q

What are signs of pain in cats?

A 
Absence of normal behaviour
Hiding
Tense
Fear-aggression
Unwilling to have human contact
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16
Q

What are signs of pain in rabbits?

A 
Tend to mask signs of disease
Immobility
Depression
Closed eyes
Not grooming
Isolation
Bruxism
Hunched over
Change in temperment
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17
Q

What are signs of pain in horses?

A 
Fight or flight response
Low head
Vocalisation
Grooming
Agitation
Restless
Lameness
Pain face
Bruxism
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18
Q

Why is it important to be able to quantify pain?

A

Determine the course of treatment and assess if its effective and if the animal has a good quality of life

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19
Q

Name and briefly describe different methods of quantifying pain

A

Numerical rating scale- number pain 1-10
Visual analogue scale- marking pain on a line
Simple descriptive scale- provide description of pain to assign

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20
Q

What is the preferred method of assessing pain and how is it used?

A

Composite pain scale
Tailored to dogs and cats, has specific parameters that are assessed to determine pain
Analgesia provided for cats above 5/20 and dogs above 5/20 or 6/24

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21
Q

What are challenges of pain assessments?

A

Animal themselves can’t tell you what or where the pain is
Needs to rely on owner or vets judgement which is subjective
Some patients will have different reactions to pain, some hide it etc so hard to be definite

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22
Q

What are some methods used for chronic pain assessments and how do they work?

A

LOAD questionnaire- mobility questions scored 0-4
CSOM- 5 normal behaviours determined and assessed over time whether they engage with these and how they change with treatments
Videos- track changes in normal environment
Tend to look at patterns not one point in time

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23
Q

Why are chronic pain assessments important?

A

Aid decision on treatment, keeps it consistent or need for euthanasia

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24
Q

Define preventative analgesia

A

Administering effective analgesia before, during and after procedure

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25
Q

Why is preventative analgesia important?

A

Prevents upregulation of nervous system in noxious stimuli so lowers intensity and length of acute pain, should also reduce chronic pain

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26
Q

What is multi-modal analgesia?

A

Using different classes of analgesic agents and techniques

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27
Q

Why is multi-modal analgesia used?

A

No single analgesic will block all nociceptive pathways

Leads to more effective analgesia and lowers doses so reduces side effects

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28
Q

What are the legal requirements for opioids?

A

Controlled drugs so need CD cabinet, records of drugs
Full agonists- schedule 2, special prescription, storage, destruction and record keeping requirements
Partial agonists- schedule 3, special prescription requirements, buprenorphine needs to be locked in cabinet

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29
Q

How do opioids produce analgesia?

A

Act at endogenous opioid receptors in brain and spinal cord

Mu agonists are most effective at providing analgesia

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30
Q

Name examples of opioids of full and partial agonists and antagonists

A

Full agonists- methadone, fentanyl
Partial agonists- buprenorphine, butorphanol
Antagonist- naxolone

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31
Q

State the type of opioid, licencing, species used in, use and duration of action of fentanyl

A

Type of opioid- Full mu agonist
Licencing- cats and dogs
Species used in- cats, dogs, rabbits, horses
Use- intraoperative, short term infusions
Duration of action- minutes

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32
Q

State the type of opioid, licencing, species used in, use and duration of action of morphine

A 
Type of opioid- full mu agonist
Licencing- non
Species used in- dogs, cats, horses
Use- general acute pre-, peri- and post-op pain
Duration of action- 2-4 hours
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33
Q

State the type of opioid, licencing, species used in, use and duration of action of methadone

A 
Type of opioid- full mu agonist
Licencing- cats and dogs
Species used in- cats and dogs
Use- general acute pre-, peri- and post-op pain
Duration of action- 2-4 hours
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34
Q

State the type of opioid, licencing, species used in, use and duration of action of pethidine

A 
Type of opioid- full mu agonist
Licencing- dogs, cats, horses
Species used in- mainly horses
Use- general acute pre-, peri- and post-op pain
Duration of action- minutes
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35
Q

State the type of opioid, licencing, species used in, use and duration of action of buprenorphine

A 
Type of opioid- partial mu agonist
Licencing- dogs, cats, horses
Species used in- dogs, cats, rabbits
Use- general acute pre-, peri- and post-op pain
Duration of action- 6 hours
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36
Q

State the type of opioid, licencing, species used in, use and duration of action of butorphanol

A 
Type of opioid- K agonist/mu receptor
Licencing- dogs, cats, horses
Species used in- dogs, cats, rabbits
Use- general acute pre-, peri- and post-op pain
Duration of action- 2 hours
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37
Q

How are opioids administered?

A

Usually IV, cant for pethidine

Well absorbed orally, SC, IM but oral has significant first pass metabolism

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38
Q

What are side effects seen when using opioids?

A

Respiratory depression- dose dependent, mainly when under anaesthesia
Sedation- more in dogs, dose dependent
Excitement- high doses, usually in pre-med
Bradycardia
Nausea- more in pre-med
Low GI motility- issue if using chronically
Urinary effects- when give epidurally

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39
Q

How do NSAIDs work to provide analgesia?

A

Inhibit prostaglandin production which are inflammatory mediators by inhibiting COX (cyclooxygenase) or LOX (lipoxygenase)

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40
Q

What are cautions that should be taken when using NSAIDs?

A

Metabolised by liver so care when patient has hepatic compromise
Care when patient is dehydrated or hypotensive
Can only use one in multi-modal analgesia

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41
Q

What NSAIDS and by what administration are licenced for dogs?

A 
Meloxicam- injection, oral
Carprofen- injection, oral
Robenacoxib- injection, oral
Ketaprofen- injection, oral
Firocoxib- oral
Phenylbutazone- oral
Grapiprant- oral
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42
Q

What NSAIDS and by what administration are licenced for cats?

A

Meloxicam- injection, oral
Carprofen- injection
Robenacoxib- injection, oral
Ketaprofen- injection, oral

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43
Q

What NSAIDS are used in rabbits?

A

Meloxicam- most common

Carprofen- sometimes used

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44
Q

What NSAIDS and by what administration are licenced for horses?

A 
Meloxicam- injection, oral
Firocoxib- injection, oral
Flunixin- injection, oral
Phenylbutazone- injection, oral
Ketaprofen- injection
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45
Q

What are common side effects of using NSAIDs?

A

GI ulceration- particularly if history, or has reduced drug clearance ability
Renal ischemia
Hepatopathy/liver disease- rare idiosyncratic reaction in dogs
CNS- unknown cause, dullness and lethargy in cats

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46
Q

When should dog and cat owners seek medical attention when using NSAIDs?

A

Vomiting, diarrhoea

General illness

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47
Q

When should horse owners seek medical attention when using NSAIDs?

A

Colic, diarrhoea, dehydration, weight loss

General illness

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48
Q

When should rabbit owners seek medical attention when using NSAIDs?

A

Anorexia, bruxism, depression, vomiting

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49
Q

Explain how local anaesthetics work as analgesics

A 
Enter nerve fibres and block voltage-operated Na+ channels, stabilising membrane so blocks nerve conduction
Blocks nociception (perception) before blocking proprioception (body position) and mechanoreception (stimuli detection)
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50
Q

What are the characteristics of local anaesthetics?

A

Weak bases
Only can cross lipid membranes and enter nerve cells when uncharged
When in higher pKa or lower pH more of drug is ionised so has slower and less effect

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51
Q

What are the two types of local anaesthetics and their properties?

A

Amide- i in name before caine, stable, broken down by cytochrome P450 liver enzymes, longer plasma half life
Ester- no i in name before caine, relatively unstable, rapidly broken down by cholinesterase so short plasma half life, PABA formed in hydrolysis which can be allergen

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52
Q

What are local anaesthetics used for?

A

Balanced anaesthesia
Desensitisation
Post-op pain relief
Lameness investigations

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53
Q

What is the licencing, species used in, length of action and other information about procaine?

A

Licencing- dogs, cats, horses
Species used in- dogs cats, horses, rabbits
Length of action- 50 minutes
Other- licenced versions contain adrenaline to vasoconstrict and keep in local area, least potent

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54
Q

What is the licencing, species used in, length of action and other information about lidocaine?

A

Licencing- dogs, cats, horses
Species used in- dogs, cats, horses, rabbits
Length of action- 20-40 minutes
Other- 2-5 minute onset, lower cardiotoxicity than bupivacaine, low potency

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55
Q

What is the licencing, species used in, length of action and other information about bupivacaine?

A

Licencing- none
Species used in- dogs, cats, rabbits
Length of action- 6 hours
Other- longer onset than lidocaine, most potent

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56
Q

What is the licencing, species used in, length of action and other information about mepivacaine?

A

Licencing- horses
Species used in- horses
Length of action- 2 hours
Other- used mainly for digit nerve blocks, more potent and toxic than lidocaine

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57
Q

What is the licencing, species used in, length of action and other information about ropivacaine?

A

Licencing- none
Species used in- small animals
Length of action- 6 hours
Other- lower CVS and CNS toxicity than bupivacaine, high potency

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58
Q

What is the licencing, species used in, length of action and other information about EMLA/eutectic mix of local anaesthetic/lidocaine and procaine?

A

Licencing- none
Species used in- rabbits
Length of action- 30-45 minutes
Other- topical, IV catheter placement

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59
Q

What is the licencing, species used in, length of action and other information about proparacaine and tetracaine?

A

Licencing- none
Species used in- cats, dogs
Length of action- 15 minutes in cats, 45 minutes in dogs
Other- opthalamogical preparations to desensitise cornea

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60
Q

Explain toxicity pharmacology for local anaesthetics

A

Increases as potency and dose increases
Causes neurotoxicity and CV toxicity
Prevented by not exceeding maximum dose, if need larger volumes dilute, aspirate to make sure isnt in vessels

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61
Q

How are local anaesthetics formulated?

A

Made into salt solution as otherwise poorly water soluble, does lower pH causing stinging on injection

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62
Q

What is meant by baricity?

A

Weight of one substance compared to another

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63
Q

How does baricity affect use of local anaesthetics in epidurals?

A

If moves into higher space could compromise respiratory muscles, need to add glucose to make solution heavier

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64
Q

What factors affect duration of action of local anaesthetics?

A

Lipid solubility
Strength of binding to channel
Speed of removal and metabolism

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65
Q

Why do vasoconstrictors get added to local anaesthetics?

A

Reduce speed of systemic absorption, prolongs duration of action, reduces toxicity and reduced bleeding at injection site

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66
Q

How does protein binding affect local anaesthetics?

A

Those that bind more readily have longer duration of action and lower toxicity risk as are only active when unbound

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67
Q

Side effects of local anaesthetics

A

Increased risk at increased doses
CNS- seen at lower doses, minor behavioural changes, muscle twitching, tremors, CNS depression, death
CV system- hypotension, dysrhythmias
Treat symptomatically as cant reverse local anaesthetics

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68
Q

What is paracetamol licenced for and when is it used?

A

Dogs, orally

Alternative to NSAIDs when contraindicated, useful to add to horse analgesia when in extreme pain. Toxic to cats

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69
Q

What is tramadol licenced for and when is it used?

A

Dogs, injection and oral
Also used in cats and rabbits, may cause GI motility decrease in horses
Alternative for opioids use at home, second analgesia in chronic pain

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70
Q

How does tramadol provide analgesia?

A

Acts centrally on mu opioid, noradrenergic and serotonergic systems
Wide therapeutic index but questions about efficacy
Should be used as co-analgesic

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71
Q

What analgesics have no licencing in animals and are used as second line anaesthesia to treat chronic pain?

A

Gabapentin
Pregabalin
Amantadine
Amitriptyline

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72
Q

How does gabapentin cause analgesia and what are side effects?

A

Binds to voltage gated calcium channels

Sedation, more when combined with tramadol, potentially toxic in liquid solutions with xylitol

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73
Q

What does pregabalin have a similar structure to and how does it differ?

A

Gabapentin

Better oral bioavailability and half life

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74
Q

What are features of amantadine?

A

NMDA receptor agonist
Antihyperalgesic, used along side other analgesics
Short duration of action
Renal excretion

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75
Q

How do you calculate fresh gas flow ml?

A

body weight (kg) x tidal volume (ml/kg) x respiratory rate x circuit factor
or
minute volume x circuit factor

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76
Q

How do you calculate drug volume (ml)?

A

(body weight (kg) x drug dose (mg/kg))/drug strength (mg/ml)

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77
Q

How do you convert mcg/kg to mg/kg?

A

mcg/kg / 1000

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78
Q

How to convert drug strength in % to mg/ml

A

% x 10

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79
Q

Define anaesthesia

A

Reversible state of production of state of unconsciousness

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80
Q

Define general anaesthesia

A

State of unconsciousness with absence of pain across whole body

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81
Q

Define local anaesthesia

A

Lack of sensation in localised part of the body

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82
Q

Define analgesia

A

Reduced pain

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83
Q

Define sedation

A

Alloying of excitement or irritability

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84
Q

Define premedication

A

Combination of drugs prior to inducing general anaesthesia

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85
Q

What is the purpose of anaesthesia?

A

Prevent pain and cause immobility to allow surgery and diagnostic testing

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86
Q

Define anxyolysis

A

Reduced anxiety

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87
Q

Define narcosis

A

Sleep like state

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88
Q

What is the risk of mortality due to anaesthesia in cats, dogs, horses and rabbits?

A

Cats- 0.24%
Dogs- 0.17%
Horses- 2.2%, 11.7% if colic
Rabbits- 1.39%

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89
Q

What increases risk of anaesthesia death?

A

If already sick
Extremes of patient size- unsuitable equipment
Aggressive patient- hard to examine pre-op, remove IV and ETT early
Drug sensitivities in certain breeds
Obesity- hard to inject IM, easily overdose as liver not bigger with higher body mass, more thoracic pressure so harder to breathe
Brachycephalic- harder to intubate, prone to gastroesophageal reflux, prone to dry eyes

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90
Q

What are the different classes of drugs in the schedule and examples?

A 
1- no veterinary use, amphetamines
2- full mu agonists, morphine, fentanyl
3- barbiturates, tramadol, gabapentin
4- benzodiazepines, steroids
5- codeine, morphine in small doses
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91
Q

What is meant by anaesthetic triad?

A

Narcosis
Analgesia
Muscle relaxation

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92
Q

Define balanced anaesthesia

A

Anaesthesia produced by smaller doss of multiple drugs

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93
Q

Why is balanced anaesthesia used?

A

Anaesthetic triad cant be provided by a single agent

By using smaller doses of multiple drugs it lowers risk of side effects

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94
Q

What needs to be included in owner conversation and consent pre-op?

A 
Explain procedure, risks, costs etc.
Get full history
Confirm fasting times
Gain informed consent, sign documents
Tell when they will hear from practice
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95
Q

Why is pre-op fasting recommended in dogs and cats?

A

Reduce risk of gastroesophageal reflux, regurgitation, aspiration
Help ventilation as less pressure on diaphragm

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96
Q

When should you not fast patients pre-operatively?

A

Not in rabbits as cause gut stasis

If too long excess stomach acid produced causing increased risk of reflux

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97
Q

What is checked in pre-op vet exam?

A

Full clinical exam, particularly MM for petechia, CRT, heart, pulses, respiration, temperature and any owner concerns
ASA classification
Drugs planned to use
Any diagnostic testing such as bloods or urine

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98
Q

What are the different ASA classifications?

A

I- normal healthy animal
II- mild systemic disease
III- controlled systemic disease
IV- severe uncompensated systemic disease
V- unlikely to survive 24 hours without intervention

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99
Q

Why are surgical checklists used?

A

Reduce rate of death and surgical complications

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100
Q

What preparation is taken before inducing an animal under anaesthesia?

A

Set up machines and equipment
Prepare medications, drugs and fluids
Place IV catheter
Premed patient

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101
Q

What is the purpose of premedication?

A

Calm patient
Lower risk of injury
Aid restraint
Decreases stress as stress hormones reduce response to anaesthesia
Pre-emptive pain relief
Reduce induction and maintenance drugs needed
Smooth induction and recovery

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102
Q

What are the routes of admin of premed?

A

IV
IM
SC
OTM

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103
Q

What are advantages and disadvantages of IV admin of premed?

A

Advantages- rapid onset, predictable effect

Disadvantages- need restraint and IV access

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104
Q

What are advantages and disadvantages of IM admin of premed?

A

Advantages- fairly rapid onset, predictable effect

Disadvantages- painful

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105
Q

What are advantages and disadvantages of SC admin of premed?

A

Advantages- easy administration

Disadvantages- not suitable for all drugs, slow onset, can be unpredictable

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106
Q

What are disadvantages of OTM admin of premed?

A

Not suitable for all drugs
Slow onset
Can be unpredictable

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107
Q

How does ASA grading affect premed protocols?

A

I and II- standard protocols and routine monitoring
III- stabilise prior, IV catheter and fluids in place
IV and V- same as III, also brief owners on risk, calculate and draw up first CPCR medication doses

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108
Q

What premedication protocols are typically used for cats and dogs with ASA I or II?

A

ACP + opioid

Alpha 2 agonist + opioid

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109
Q

What premedication protocols are typically used for dogs with ASA III?

A

ACP + opioid

Benzodiazepine + opioid

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110
Q

What premedication protocols are typically used for cats, dogs and rabbits with ASA VI or V?

A

Benzodiazepine + opioid
Benzodiazepine + ketamine
Opioid alone

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111
Q

What premedication protocols are typically used for cats with ASA III?

A

Benzodiazepine (midazolam) + ketamine

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112
Q

What premedication protocols are typically used for rabbits with ASA I or II?

A

ACP + opioid
Alpha 2 agonist + opioid
Fluanisone alone or with benzodiazepine

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113
Q

What premedication protocols are typically used for rabbits with ASA III?

A

Benzodiazepine + opioid

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114
Q

Name the classes of drugs used for premedication

A 
Phenothiazines
Alpha 2 agonists
Benzodiazepines
Butyrophenones
Opioids
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115
Q

How do phenothiazines act in the body and what effects do they produce?

A

Dopamine receptor antagonist in CNS

Sedation

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116
Q

How do alpha 2 agonists act in the body and what effects do they produce?

A

Alpha 2 adrenergic receptor in CNS

Sedation, analgesia, muscle relaxation

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117
Q

How do benzodiazepines act in the body and what effects do they produce?

A

Enhance GABA at GABA alpha receptor

Sedation, minor tranquiliser, muscle relaxation, anticonvulsant

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118
Q

How do butyrophenones act in the body and what effects do they produce?

A

Dopamine receptor antagonist in CNS, interferes with GABA, norepinephrine, serotonin mediated activity
Sedation

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119
Q

How do opioids act in the body and what effects do they produce?

A

Endogenous opioid receptors in CNS

Sedation, analgesia

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120
Q

Which drug is a phenothiazine, what is its licencing and what is it used for?`

A

Acepromazine

Cats and dogs for pre-med and sedation often in combination with opioids

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121
Q

How is acepromazine administered and how does each method effect time to peak effect?

A

SC
IM- 30-40 minutes
IV- 10-15 minutes

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122
Q

How long is duration of action of acepromazine and how is it eliminated?

A

4-6 hours

Liver metabolises

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123
Q

Why can’t acepromazine be given orally?

A

Poor oral bioavailability

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124
Q

What are side effects of acepromazine?

A

Peripheral vasodilatation causing lowered body temperature, and blood pressure

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125
Q

What are examples of alpha 2 agonists and what are they licenced for?

A 
Dexmedetomidine
Medetomidine
Romifidine
Xylazine
Cats, dogs and rabbits
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126
Q

How is dose of alpha 2 agonists calculated and why is it done this way?

A

Very potent so done by body surface area

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127
Q

How are alpha 2 agonists administered and how does this effect time to effect?

A

IV- rapid effect after 5 minutes

IM- effect after 15 minutes

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128
Q

What agent can be used to reverse alpha 2 agonists?

A

Atipamezole

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129
Q

If not reversed what is the duration of action of alpha 2 agonists and how are they metabolised?

A

2-3 hours

Liver metabolism

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130
Q

What are side effects of alpha 2 agonists?

A 
Bradycardia
Reduced CO
Second degree AV block
Hypertension initially then hypotension
Respiratory depression
GI stasis
Hyperglycaemia
Increased urine production
Uterine contractions
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131
Q

What are examples of benzodiazepines and what are they licenced for?

A

Diazepam in cats and dogs

Midazolam in horses

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132
Q

How are benzodiazepines administered?

A

IV by slow infusion as rapidly crosses blood brain barrier

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133
Q

How are benzodiazepines metabolised?

A

Liver

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134
Q

How does duration of effects of diazepam and midazolam differ?

A

Diazepam has shorter half life but longer length of action as its metabolites are active

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135
Q

What is the reversal for benzodiazepines and why is it rarely used?

A

Flumazenil

Very expensive

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136
Q

What are side effects of benzodiazepines?

A

Mild dose dependent respiratory depression

Minimal CVS effects

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137
Q

What is an example of butyrophenones and what is it licenced for?

A

Fluanisone, only in combination with fentanyl

Small furries

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138
Q

How is sedation as a result of benzodiazepines improved?

A

Combining with opioid, ketamine or alpha 2 agonist

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139
Q

What is the duration of action of fluanisone?

A

30-60 minutes

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140
Q

What is the result of combining benzodiazepine with fluanisone?

A

20-40 minutes of muscle relaxation

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141
Q

What are side effects of fluanisone?

A

Respiratory depression

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142
Q

How are opioids metabolised?

A

Liver

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143
Q

How should you care for premedicated or sedated patients?

A

Keep in quiet environment

Regular but preferably continuous monitoring of ABC, TPR, CRT, MM

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144
Q

What are common issues when patients have been premedicated?

A 
Excitement
Excess sedation
Airway obstruction
CVS up to and including cardiac arrest
Decompensation of existing conditions
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145
Q

Why is sedation used?

A

Allow procedures that would be impossible in fully conscious animals
Handling anxious, dangerous or feral animals
Keeping still for radiography
Minor procedures such as wound dressing

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146
Q

What drugs and protocols and used for sedation?

A

Same as premedication but higher doses

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147
Q

State the main method of admin of premed

A

IM

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148
Q

What is mean by induction phase?

A

Taking patient from conscious to unconscious state

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149
Q

Why should you pre-oxygenate patients before induction?

A

Give more time to place ETT before decompensation

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150
Q

What are the different methods of admin of injectable induction?

A

IV- titrate to effect, 2-10 minute onset, reliable, little stress to animal, does need IV access
IM- 10-20 minute onset, reliable, painful
SC- easy, less painful, 30-45 minute onset, lower efficacy, less reliable

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151
Q

What are different methods of inhalational induction?

A

Face mask- held tightly over face, cheap, easy, can give oxygen and VA quickly, lacks air way protection, not always tolerated, increased deadspace, harder to monitor, cant IPPV
Chamber- good when cant get IV, easy, cheap, stressful for animal, hard to observe

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152
Q

Why is injectable induction prefered?

A

Prevents risk of exposure to staff of inhalant VA

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153
Q

What needs to be considered when restraining for induction?

A

Minimal as possible physical restraint but ready for more
Dont compromise ventilation
Chemical restraint as needed

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154
Q

What are risks involved to the patient with restraining for induction?

A

Stress
Respiratory compromise
Cardiac arrhythmia
Raised ICP and IOP

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155
Q

Why do you need to restrain for induction?

A

Aid tube and catheter placement

Keep patient and staff safe

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156
Q

How does a laryngeal mask airway work and why are they uncommonly used?

A

Sits over larynx

Not designed for veterinary species

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157
Q

How do v-gels work and what are advantages and disadvantages?

A

Sits in pharynx forming secure seal over trachea
Advantages- can be reused, structure mirrors anatomical structure, useful in rabbits
Disadvantages- species and weight specific so need range, need to be trained to use

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158
Q

What is the gold standard for airway management and why?

A

Endotracheal tube

Prevent atmospheric exposure, protects airway and allows accurate provision of gases

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159
Q

What is the benefits of a cuffed ETT?

A

Prevents gas leakage and aspiration

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160
Q

What are the different types of cuffs on ETT?

A

Low volume high pressure- pressure produced on small area of trachea
High volume low pressure- pressure evenly distributed on larger area

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161
Q

What are safety features present on ETT?

A

Murpheys eye- hole in side of tube to allow ventilation if end of tube is blocked
Armoured- only some tubes, inner wire to prevent kink if in awkward position

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162
Q

List equipment needed for intubation

A 
Laryngoscope
ETT- length reaches from incisors to shoulder tip
Local anaesthetic- cats to prevent laryngeal spasm
Tie
Cuff syringe
Swab
Suction
Mask to pre-oxygenate
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163
Q

How do you check ETT is in correct place?

A 
Leak test
Capnograph trace (gold standard)
Visualise tube between vocal folds
Condensation in clear tubes
Feel air movement
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164
Q

What are common complications during induction?

A 
Injury to patient and staff
Lack of airway patency
Aspiration and regurgitation
Hypothermia
CV and respiratory effects from anaesthetic agents
Post induction apnoea
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165
Q

What are common complications involving the ETT during maintanance?

A

Twisted
Disconnected
Extubation
Wrong tube size placed

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166
Q

What factors determine technique used for anaesthetic maintenance?

A 
Species 
Behaviour
Access to IV
Procedure
Facilities
Expertise
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167
Q

What is the purpose of anaesthetic machines?

A

Delivery of oxygen and volatile gases to the patient

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168
Q

How should oxygen cylinders be stored?

A

Under cover, clean and dry
Indoors in well ventilated fireproof room
Not exposed to extreme heat, cold, flammable or combustible materials
Empty and full seperate
F, G, J stored vertically
C, D, E stored horizontally

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169
Q

How should you handle oxygen cylinders?

A

Hold correctly or move with trolley

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170
Q

What are the pressures inside oxygen and nitrous oxide cylinders?

A

Oxygen- 13700kPa

Nitrous- 4400kPa

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171
Q

How much do E, F and J oxygen cylinders hold?

A

E- 680 litres
F- 1360 litres
J- 6800 litres

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172
Q

What is a cylinder yolk on anaesthetic machine and what is its function and key features?

A

Area that holds cylinders in place, specific to each type of gas
Provides tight bodok seal to keep unidirectional flow
Has pin index safety system to make sure correct cylinder attaches

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173
Q

What do the different coloured pipelines supply?

A

White- oxygen
Nitrous- blue
Black- medical air

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174
Q

How are pipelines prevented from misconnection?

A

Connect to anaesthetic machine Schrader socket with their Schrader probe (unique diameter index collar to correspond to socket)

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175
Q

What are NISTs on pipeline and what is their purpose?

A

Non-interchangeable screw thread

Unique for each gas and has valve for one way flow

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176
Q

What is the function of pressure gauges on anaesthetic machines?

A

Indicate gas cylinder and pipelines pressure so shows when cylinder needs changing

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177
Q

What is the purpose of pressure regulators on anaesthetic machines?

A

Reduces pressure of gas from the cylinder to prevent damage
Compensate pressure as it decreases when cylinder empties
Smooth pressure fluctuations

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178
Q

How does an oxygen failure alarm work?

A

Alarm when oxygen supply falls below 200kPa

Should also cut off nitrous delivery

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179
Q

What is the purpose of hypoxic guard?

A

Prevent hypoxic mixture being delivered as nitrous is cut off when oxygen falls below 130-70kPa
Linked valves means minimum 1:1 ratio is maintained
Oxygen always on if nitrous is

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180
Q

How does a non-return pressure relief safety valve work?

A

One way valve preventing backflow to gas machine, opens when back bar pressure is more than 35kPa

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181
Q

What is a flow meter?

A

Measures flow of each gas passing through

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182
Q

What are the components of a flow meter?

A

Flow control valve- fine adjustment of gas flow, reduces pressure from 420kPa to 100 kPa
Tapered transparent tube- visual scale of gas flow
Bobbin or ball- rotates in tube as gas passes around

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183
Q

How do you read the bobbin and ball in flowmeter?

A

Bobbin- top

Ball- centre

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184
Q

What is the function of a vaporiser?

A

Contains volatile liquid anaesthetic agent picked up by gas from flow meter to deliver to patient

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185
Q

How do calibrated vaporisers work?

A

Gas entering from flowmeter goes down bypass channel or into chamber above liquid anaesthetic to pick up anaesthetic
Control valve adjusts how much gas goes to vapour chamber determining concentration of anaesthetic agent picked up

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186
Q

What is the effect of temperature cooling on vaporisers and how is it minimised?

A

Bi-metallic strip bends to resistance is reduced and more gas passes through VA chamber so more anaesthetic is delivered to the patient
Housed in brass and has TEC/temperature compensating mechanism

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187
Q

What is the purpose of wicks and baffles in vaporisers?

A

Wicks- increases surface area for anaesthetic agent to evaporate
Baffles- direct incoming gas to surface of liquid

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188
Q

What is the function of the back bar on anaesthetic machines?

A

Connects vaporiser by selectatec and interlock systems

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189
Q

What is the common gas outlet on anaesthetic machines?

A

Attaches breathing systems to deliver gases to patient

190
Q

What is the purpose of oxygen flush and how does it work?

A

Remove gas from system in an emergency

Supplies oxygen at 400kPa and 35-75l/minute, bypassing flowmeter and vaporiser

191
Q

When should you never use the oxygen flush?

A

When connected to the patient

192
Q

What is meant by scavenging?

A

Removal of environmental contaminants as waste VA and gases are subject to COSHH and HASAWA

193
Q

Describe active scavenging

A

Waste anaesthetic agents drawn outside of building by fan and vent system, with air break to prevent negative pressure on patients breathing effort

194
Q

Describe passive scavenging

A

Gas pushed by patients expiratory effort to outside building with increases resistance or into activated charcoal canister

195
Q

How do oxygen concentrators work?

A

Take in and purifies air using molecular sieve to remove nitrogen from air

196
Q

How is liquid oxygen stored?

A

In cold specific container, liquifies at -183 degrees, with vacuum installed evaporator
Outside

197
Q

How is liquid oxygen used?

A

Oxygen drawn off as needed, passed through vaporiser and turned to gas to enter pipes, flow regulated by control pannel

198
Q

Name safety features present on anaesthetic machines

A 
Pin index system
NIST on pipelines
Colour coding
Touch coded oxygen flowmeter (easier to turn than others)
Ratio regulators
Nitrous cut off and alarms
Air intake valve
Reserve oxygen cylinders
199
Q

How are staff kept safe when using anaesthetic machines?

A

Well ventilated rooms, 15-20 air changes per hour
IV induction when possible
Cuffed ETT
Connect breathing system before turning on VA
Low flow techniques
Leak check
Oxygen flush before disconnecting
Fill vaporiser with key and at end of day
Monitor exposure

200
Q

Define dead space

A

Volume of gas that doesn’t eliminate carbon dioxide

201
Q

Define tidal volume

A

Volume of gas entering lungs on each inspiration

202
Q

Define minute volume

A

Volume of gas entering lungs per minute

203
Q

Define metabolic oxygen requirements

A

Oxygen required each minute for metabolic processes

204
Q

Define rebreathing

A

Inspired gases reaching alveoli contain more carbon dioxide than can be accounted by just inhalation from patients dead space

205
Q

List functions of anaesthetic breathing systems

A

Provides oxygen and anaesthetic agents via common gas outlet to airway management device
Allow IPPV or spontaneous ventilation
Allow scavenging of expired gases

206
Q

List components of breathing systems

A

Reservoir bag
APL/adjustable pressure limiting valve
Tubing
Soda lime in circles

207
Q

What is the rough estimate for the size of reservoir bag to use?

A

3-6x tidal volume

208
Q

What is the effect of leaving the APL valve closed?

A 
Reservoir bag extends
System becomes high pressure
Thoracic movement reduces
Tachycardia, hypoxia
Pneumothorax, pneumomediastinum
Death
209
Q

How is resistance of tubing effected?

A

2x length = 2x resistance

2x radius = 16x less resistance

210
Q

What are the two arrangements of tubing in breathing systems?

A

Parallel- tubing lies next to each other

Coaxial- one tube inside the other

211
Q

What is the purpose of soda lime in circles?

A

Absorbs carbon dioxide in exothermic reaction

212
Q

What factors affect the choice of breathing system used?

A 
Size of patient
Valve position
IPPV requirement
Ease of scavenging
Cleaning and sterilisation
Heat and moisture retention
213
Q

What is the impact of increased resistance in breathing systems?

A

Low RR, altered pattern and increased effort
Decreased tidal volume
Hypoventilation, hypoxia, hypercapnia
Light plane anaesthesia due to reduced alveolar ventilation

214
Q

What causes increased dead space in breathing systems?

A

Long ETT

Part of system used

215
Q

What is the effect of increased dead space?

A

Increased PaCO2

Increased work of breathing to increase minute volume

216
Q

What are the two types of breathing systems?

A

Non-rebreathing

Rebreathing

217
Q

How do non-rebreathing systems work?

A

Fresh gas flow removes expired carbon dioxide

218
Q

What are advantages and disadvantages of non-rebreathing systems?

A

Advantages- inspired agent same as shown on vaporiser, low resistance, light weight, cheap
Disadvantages- more expensive, heat and moisture lost, increased risk of pollution

219
Q

State patient weight requirement, circuit factor, resistance, dead space and drag, ability to scavenge and location of bag for T-piece

A

Weight- less than 10kg
Circuit factor- 2-3
Resistance, dead space and drag- low resistance and dead space, reasonable drag
Ability to scavenge- hard unless APL valve present
Location of bag- expiratory limb

220
Q

State patient weight requirement, circuit factor, resistance, dead space and drag, ability to scavenge and location of bag for bain

A 
Weight- over 8-10kg and under 15-20kg
Circuit factor- 2-3
Resistance, dead space and drag- low drag and dead space
Ability to scavenge- easy
Location of bag- expiratory limb
221
Q

State patient weight requirement, circuit factor, resistance, dead space and drag, ability to scavenge and location of bag for lack

A

Weight- over 10kg less than 25-30kg, mini for over 1kg
Circuit factor- 1
Resistance, dead space and drag- moderate
Ability to scavenge- good
Location of bag- inspiratory limb

222
Q

Which breathing systems can be used for IPPV?

A

T-piece
Bain
Circle

223
Q

How do rebreathing systems work?

A

Soda lime removes expired carbon dioxide

224
Q

What are advantages and disadvantages of circle?

A

Advantages- lower FGF so lower pollution, less expensive to run, heat and moisture retained
Disadvantages- Slow changes in inspired anaesthetic agent concentration, higher resistance

225
Q

How is FGF calculated in circles?

A

Metabolic oxygen requirement

5ml/kg for large animals, 10ml/kg for small animals

226
Q

What is the weight requirement and resistance of circles?

A

Weight- over 10-15kg

Resistance- high due to unidirectional valves and soda lime canister

227
Q

What are the features of an ideal injectable anaesthetic agent?

A 
Rapid onset
Non-irritant allowing IM or IV admin
Minimal cardiopulmonary effects
Rapid metabolism and elimination
Non-cumulative to allow top ups
Good analgesia and muscle relaxation
228
Q

What are injectable anaesthetic agents commonly used for?

A

Induction of anaesthesia
Along side inhalational anaesthesia for balanced technique
Triple for short term anaesthesia- alpha 2 agonist, opioid, ketamine IM
TIVA
Euthanasia

229
Q

What factors affect the effect of injectable anaesthetics?

A 
Blood flow to brain- need to cross BBB
Amount of non-ionised drugs- brain protected from ionised drugs
Lipid solubility- BBB is lipid
Molecular size
Concentration gradient
Protein binding- only unbound cross BBB
Distribution and metabolism
Excretion
230
Q

Why is TIVA used?

A

Reduce exposure to inhalational anaesthetics
Allow anaesthesia without access to machines
Maintain stable plane of anaesthesia as no bolus

231
Q

What are the disadvantages of TIVA?

A

Can have longer recovery

Complicated calculations need to be done for dosing

232
Q

What are ideal properties of injectable anaesthetic agents that make it suitable for TIVA?

A

Rapid metabolism and elimination
Fast onset
High therapeutic index
Pharmacokinetics available to allow CRI dose calculations

233
Q

List the injectable anaesthetic agents available for use in animals

A 
Propofol
Alfaxalone
Ketamine
(mainly used^)
Tiletamine
Zolazepam
Thiopental
234
Q

What is licencing for propofol and how is it typically administered?

A

Cats and dogs

IV as irritant otherwise

235
Q

What is the drug class and mode of action of propofol?

A

Drug class- substituted phenol

Mode of action- GABA agonist (enhances inhibitory GABA in CNS)

236
Q

State the speed of onset and length of effect for propofol

A

Rapid onset

5-10 minutes effect

237
Q

What are features of propofol (protien binding, solubility, metabolism and elimination, cumulation)?

A

Highly protein bound
Lipid soluble
Rapid liver metabolism and elimination
Cumulative in cats (lack glucorinidation pathway) not in dogs

238
Q

What physiological effects can be seen after propofol admin?

A

Post induction apnoea

Hypotension from myocardial depression and peripheral vasodilation

239
Q

What components of the anaesthetic triad are provided by propofol?

A

Muscle relaxation

No analgesia

240
Q

What is the difference between propofol with and without preservatives?

A 
Non-preservative containing- discard whats not used in dose, used for TIVA
Preservative containing (benzyl alcohol)- can store 28 days once opened
241
Q

What is licencing and administration method of alfaxalone?

A

Cats, dogs and rabbits

IV, maybe irritant if IM

242
Q

What is alfaxalones drug class and mode of action in the body?

A 
Neuroactive steroid
GABA agonist (enhances inhibitory GABA in CNS)
243
Q

What is the formulation of alfaxolone?

A

Clear solution containing cyclodextrin ring as alfaxalone isnt water soluble without

244
Q

State features of alfaxalone (protein binding, speed of onset, metabolism, length of effect, cumulation)

A 
20-50% protein bound
Rapid onset
Rapid liver metabolism and elimination
15-30 minute effect
Non-cumulative
245
Q

What are potential physiological effects seen after alfaxalone admin?

A

Respiratory depression
Post induction apnoea
Tachycardia as response to hypotension

246
Q

What is licencing and method of admin for ketamine as injectable anaesthetic?

A

Cats, dogs and horses

IV and IM

247
Q

What is ketamines drug class and mode of action?

A

Drug class- phencyclidine derivative

Mode of action- NMDA antagonist (dissociative anaesthetic)

248
Q

Why is ketamine not used as a sole anaesthetic agent?

A

Muscle relaxation is poor and reflexes are maintained

249
Q

State features of ketamine when used as anaesthetic agent (speed of onset, length of effect, cumulation and metabolism, excretion, protein binding)

A 
Slow onset so need calm environment
20-40 minute effect
Non-cumulative through active metabolite by liver nor-ketamine
Renal excretion
50% protein bound
250
Q

What can be physiological effects seen after administering ketamine?

A

Increased IOP and ICP

251
Q

What components of the anaesthetic triad does ketamine provide?

A

Analgesia (and antihyperalgesia)

252
Q

When is ketamine most commonly used as an anaesthetic agent?

A

Horses for maintenance by TIVA

Cats IM as sedative or IV for induction

253
Q

What is tiletamine licencing and how is it administered?

A

Dogs and cats

IV or IM

254
Q

What is the mode of action of tiletamine?

A

NMDA antagonist

255
Q

What is licencing and mode of action of zolazepam?

A

Dogs and cats

GABA agonist

256
Q

What are the features of thiopental (mode of action, formulation, pH, speed of onset, protein binding, metabolism, cumulation)?

A 
Barbituate acting at GABA receptor
Powder, 2.5% or 5%
Alkaline
Rapid onset
Highly protein bound
Metabolised after redistributing
Does accumulate
257
Q

What can be physiological effects seen after admin of thipental?

A

Perivascular tissue necrosis
Cardiorespiratory depression
Short term ventricular bigeminy (alternating normal sinus and premature ventricular complexes)

258
Q

Define volatile anaesthetic

A

Liquid at room temperature changes to vapour and inhaled to produce general anaesthesia

259
Q

What are the main uses of inhalational anaesthesia?

A

Maintenance of anaesthesia

Induction

260
Q

What are the advantages and disadvantages of inhalational anaesthesia?

A

Advantages- easy to administer and calculate doses, can be used for most patients
Disadvantages- higher risk of death, exposure to staff

261
Q

List ideal properties of inhalational anaesthetic agents

A 
Non-irritant to MM
Minimal cardiopulmonary effects
Rapid uptake and elimination
Non-toxic
Non-flammable and chemically stable
Easily vaporised
Provide good analgesia and muscle relaxation
262
Q

Define MAC and state what it stands for

A

Concentration required to prevent purposeful movement in response to supramaximal noxious stimuli in 50% of patients
Minimum alveolar concentration

263
Q

Define MAC sparing

A

Reducing MAC by use of other drugs

264
Q

What increases and decreases MAC?

A

Increases- hyperthermia, young animals, hyperthyroidism

Decreases- drugs, hypothermia, pregnancy

265
Q

How does MAC affect potency?

A

Higher MAC the less potent a drug

266
Q

What factors affect uptake of inhalational anaesthetic agents?

A

Concentration in inspired air- higher has quicker uptake
Alveolar ventilation- higher increases uptake
Blood gas solubility- lower increases onset and recovery as moves to target organ faster
CO- lower increases onset and recovery as rapidly increases alveolar concentration so picked up in blood
Blood tissue solubility- affects distribution

267
Q

How are inhalational anaesthetics eliminated?

A

Metabolism
Biotransformation
Exhalation

268
Q

What needs to happen for animals to recovery from anaesthetic in terms of levels of agent?

A

Needs to be low enough in CNS

269
Q

What are side effects to animals when using inhalational anaesthetics?

A

Cerebral
CV
Respiratory

270
Q

What are effects to humans when exposed to inhalational anaesthesia?

A

Mutagenic
Tetragenic- cause congenital disorders
Reduced fertility
Renal and hepatic disease

271
Q

How are inhalational anaesthetics used safely?

A 
Avoid staff exposure
Avoid gaseous induction
Inflate cuff before turning on vaporiser
Keep patient on breathing system for few minutes to allow VA scavenging
Recover in well ventilated area
Training to deal with spillages
272
Q

Which inhalational anaesthetic agents are licenced for cats and dogs?

A

Isoflurane

Sevoflurane

273
Q

State features of isoflurane (whether irritant, toxicity, stability, ease of vaporising, MAC)

A 
Irritant to airways and MM
Toxic
Stable and non-flammable
Easily vaporised
MAC- 1.4-1.6
274
Q

State features of sevoflurane (whether irritant, toxicity, stability, ease of vaporising, MAC)

A 
Non-irritant to airways and MM
Toxic
Stable in presence of soda lime, flammable in oxygen or nitrous
Easily vaporised
MAC- 2.1-2.6
275
Q

What elements of the anaesthetic triad are achieved by isoflurane?

A

Muscle relaxation

No analgesia

276
Q

What elements of the anaesthetic triad are achieved by sevoflurane?

A

No analgesia or muscle relaxation

277
Q

State physiological effects associated with isoflurane use

A 
Vasodilation
Hypotension
Respiratory depression, hypoventilation, hypercapnia
Bronchodilation
Reduced renal and hepatic perfusion
278
Q

State physiological effects associated with sevoflurane use

A

Cerebral vasodilation, increase intercranial blood volume
Hypotension
Respiratory depression, hypoventilation, hypercapnia, less than isoflurane
Bronchodilation
Reduced renal and hepatic perfusion

279
Q

How does uptake and elimination differ between isoflurane and sevoflurane?

A

Iso- slower, blood gas solubility 1.4, 1% metabolic elimination
Sevo- faster, blood gas solubility 0.69, 3% metabolic elimination

280
Q

Which inhalational anaesthetics no longer have licencing?

A

Halothane

Desflurane

281
Q

What is nitrous used for in anaesthesia?

A

Analgesic

282
Q

What is meant by nitrous second gas effect?

A

Inhaled gas higher in alveoli than blood so nitrous diffuses into blood and isoflurane in alveoli is in much higher concentration

283
Q

What is meant by diffusion hypoxia of nitrous?

A

Equal nitrous and oxygen delivered and in blood, nitrous stopping causes it to rapidly diffuse to alveoli diluting alveolar oxygen

284
Q

State features of nitrous as anaesthetic gas (uptake and elimination, MAC, ratio given with oxygen)

A

Rapid uptake and elimination due to being insoluble
MAC over 100%
1:2 with oxygen in non-rebreathing systems
1:1 with oxygen in rebreathing systems

285
Q

Why should 100% oxygen be provided for 5-10 minutes after turning off nitrous?

A

Compensate hypoxia

286
Q

Why is it important to position patients correctly under anaesthesia?

A

Support joints to prevent muscle or nerve damage
Prevent pain post-op
Optimise ventilation
Aware of nasal congestion

287
Q

Why do you need to use GA records and how often are they updated?

A

Legal requirement

Every 5 minutes, sometimes continuous if needed

288
Q

What should be recorded on anaesthetic records?

A 
HR
RR
Temperature
BP
Pulse oximetry
Drug doses, oxygen, anaesthetic gas
Start time, date, finish time, critical event
289
Q

What parameters are monitored under anaesthesia?

A 
Depth of anaesthesia
CV system
Respiratory system
Drug administration
Temperature
Urine output
Blood parameters
Neuromuscular function
Pulses
Eye position
MM
CRT
290
Q

In what ways can heat be lost when anaesthetised?

A

Convection- loss of heat to cool air
Conduction- loss of heat to surfaces in contact
Radiation- loss of heat to structures not in contact
Evaporation- loss of heat from moisture evaporation

291
Q

What factors of patients will increase heat loss?

A 
High surface area: body weight
Low fat
Thin hair
Exposed internal tissues
Extreme age
292
Q

Why does anaesthesia cause hypothermia?

A

Increase blood flow from core to periphery so more heat lost

Reduced metabolic rate reducing heat produced

293
Q

What are the effects of hypothermia?

A 
CNS depression
Hypotension
Bradycardia
Hypoventilation
Low metabolic rate
Low urine output
294
Q

How do you minimise the risk of hypothermia?

A 
Minimal anaesthetic time
Minimal wetting of patient when scrubbing
High ambient temperature
Appropriate breathing system
Warmed fluids
Use insulating materials or heat sources
295
Q

What information does a capnograph give you?

A

Inspired carbon dioxide
Expired carbon dioxide
RR
Capnograph trace

296
Q

What are the normal ranges for end tidal carbon dioxide in cats and dogs?

A

Cats- 28-35

Dogs- 35-45

297
Q

What causes high and low end tidal carbon dioxide?

A

High- hypoventilation due to reduced RR and tidal volume
Low- hyperventilation, low CO, low metabolic rate, hypothermia, pulmonary embolism, leak in sample line or breathing system

298
Q

What causes high inspiratory carbon dioxide in non-rebreathing and rebreathing systems?

A

Non-rebreathing- too low FGF or too much dead space

Rebreathing- exhausted soda lime, faulty valves

299
Q

What are the two types of capnography machines and how do they work?

A

Side stream- takes small sample of air through sample line to machine for analysis
Mainstream- gas analysed in breathing system using infrared detectors of absorption by carbon dioxide

300
Q

State advantages and disadvantages of side stream capnography

A

Advantages- cheaper, less likely to break, easy to replace

Disadvantages- delay in readings, when low FGF can take large proportion, easily damaged sample line

301
Q

State advantages and disadvantages of mainstream capnography

A

Advantages- real time, doesnt effect FGF

Disadvantages- expensive, easily damaged, adds drag

302
Q

What are some advantages of capnogrpahy?

A

Non-invasive
Easy to set up and use
Effective monitoring of ventilation
Informs about CO (low carbon dioxide implies low CO)

303
Q

What are some disadvantages of capnography?

A

Increased dead space
Need ETT
Takes time to learn normal or abnormal

304
Q

What information is shown on ECG and how is this used?

A

ECG trace and HR

Non-diagnostic, look for normal and report abnormal

305
Q

What is meant by electromechanical dissociation?

A

Pulseless electrical activity of the heart few minutes post death

306
Q

What are common abnormalities that can be interpreted from ECG trace?

A

Electrolyte imbalance
Myocardial hypoxia
Arrhythmias

307
Q

What are indications for use of ECG?

A 
Arrhythmias on auscultation
Investigating syncope/fainting
Investigating CV disease
Monitoring arrhythmia
General monitoring
308
Q

How is ECG attached to paitents?

A

Clips or adhesive pads in good contact with skin, improved with ultrasound gel or surgical spirit

309
Q

What ECG leads are used in small animals?

A

Red- right fore
Yellow- left fore
Green- left hind

310
Q

What ECG leads are used in large animals?

A

Red- neck
Yellow- sternum
Green- lateral thorax

311
Q

What are potential reasons for abnormal ECG traces?

A

Poor contact
Leads fallen off
Electrical or movement interference

312
Q

What do the different waves on the ECG represent?

A

P- atrial depolarisation
QRS- ventricular depolarisation
T- ventricular repolarisation

313
Q

What is different about equine ECG compared to normal ECG?

A

Upside down QRS complex as leads are base apex not limbs

314
Q

What do some ECG abnormalities mean (tall p wave, wide p wave, tall r wave, wide r wave, deep s wave, wide s wave, abnormal t wave)?

A

Tall p wave- right atrial enlargement
Wide p wave- left atrial enlargement
Tall r wave- hypertrophy
Wide r wave- left bundle branch block
Deep s wave- right ventricular hypertrophy
Wide s wave- right bundle branch block
Abnormal t wave- myocardial ischemia, electrolyte imbalance

315
Q

What is commonly seen on ECG traces under anaesthesia?

A 
Tachycardia
Bradycardia
Heart block
Premature ventricular contraction
Arrhythmia/fibrillation
316
Q

What is a 1st degree block and how is it shown on ECG?

A

Signal held up in first part of cycle

Long PR distance

317
Q

What are the two types of 2nd degree block?

A

Wenckebach- lenghtening of PR until beats lost and impulse blocked
Mobitz- sudden beat loss

318
Q

What are 3rd degree blocks?

A

Complete block to signal at AV node, fatal

319
Q

What are the causes of ventricular premature comples?

A

High sympathetic tone

Electrolyte acid base imbalance

320
Q

What information does pulse oximetry give?

A

Haemoglobin oxygen saturation
HR
Pulse rate

321
Q

How does pulse oximetry work?

A

Probes emit and detect light which changes dependent on oxyhaemoglobin (absorbs more infrared) and deoxyhaemoglobin (absorbs more red light)
Only works on arterial blood

322
Q

Where should pulse oximeter be placed?

A 
Hairless and non-pigmented area
Tongue
Interdigital
Ear
Prepuce
Vulva
Skin webbing
323
Q

What do different haemoglobin saturations mean?

A

100%- best case
95-100%- good
90-95%- start to worry
Less than 90%- very concerned

324
Q

Define plethysmography

A

Trace mimicking arterial blood pressure on pulse oximeter

325
Q

What is a diachronic notch seen on plethysmograph caused by?

A

Aortic valve closing and distending aorta contracts causing brief arterial pressure change

326
Q

What are advantages of pulse oximetry?

A

Non-invasive
Widely available
Easy to set up and use
Can be used when conscious or unconscious

327
Q

What are disadvantages of pulse oximetry?

A

Can give false readings
Easily damaged
Not good if anaemic as shows good saturation even if have very low numbers of RBC
Large probes can compress small animal tissues
Ineffective if poorly perfused
False elevation with carboxyhaemoglobin

328
Q

What should you do if there are problems with pulse oximeter?

A

Reposition probe
Wet area
Test on own finger
Check actual patient status

329
Q

Define blood pressure

A

Measurement of pressure exerted by blood on walls of blood vessels

330
Q

Why does anaesthesia effect BP?

A

Drugs are vasodilatory

331
Q

What are advantages and disadvantages of direct BP measurements?

A

Advantages- accurate, reliable, beat to beat information
Disadvantages- invasive, need experience, risk of infection and bleeding, risk of patient removing, pressure bandage needed on removal

332
Q

What are the two methods of direct BP monitoring and how do they work?

A

Arterial line, gold standard- catheter in dorsal pedal or femoral artery
Haemodynamic monitoring- electronic using fluid filled tubing with catheter detecting pressure waves in arteries, transducer detects movement and converts to electrical signal

333
Q

What are advantages and disadvantages of indirect BP measurement?

A

Advantages- non-invasive, easier to run

Disadvantages- unreliable sometimes, less accurate, slower

334
Q

What are advantages and disadvantages of doppler for BP measurement?

A

Advantages- inexpensive, efficient, can detect pulses in low flow states, fast results
Disadvantages- only provides systolic information

335
Q

How does oscillometric BP monitoring work?

A

Artery wall oscillates as blood flows through as cuff inflates and deflates
Rapid increase in oscillation amplitude is systolic and rapid decrease is diastolic

336
Q

What are advantages and disadvantages of oscillometric BP monitoiring?

A

Advantages- provides systolic, diastolic and mean information, automated process
Disadvantages- less reliable as affected by movement, cant pick up trends well in small animals, more expensive

337
Q

What is the impact of incorrect cuff size when taking BP measurements?

A

Too big- artificially low result

Too small- artificially high result

338
Q

How should you manage hypotension?

A 
Find underlying cause and treat
Reduce VA as vasodilatory
Increase analgesia and local blocks
Manage bradycardia
Give fluids 
Ensure adequate ventilation
339
Q

What is meant by SpO2?

A

Measurement of how much oxygen the blood is carrying as percent of maximum able to be carried

340
Q

What checks should be made if SpO2 has fallen?

A

Check pulse oximeter is correctly working
Is patient intubated?
Is anaesthetic machines pressure gauges okay?
Is flow rate adequate?
Is breathing system correctly attached?
Are there any leaks in the breathing system or ETT?
Is the patient spontaneously breathing/are ventilator settings correct?
Does thorax expand if bag is squeezed or is there pressure or airway blockage?
Can lungs contract?

341
Q

What are causes of lungs being unable to contract when SpO2 has fallen under GA?

A 
Expiratory pathway blockage
Twisted bag
Closed APL valve
Kink in tubing
Blocked tube
342
Q

If SpO2 is fallen but all checks are normal what is causing the problem?

A

Poor tissue perfusion

343
Q

What are causes of abnormal breathing under GA?

A

Panting- inadequate anaesthesia

Paradoxical breathing- respiratory tract obstruction

344
Q

What are some causes of no breathing when under GA?

A

Post induction apnoea
Too deep anaesthesia reducing respiratory drive
Too light anaesthesia causing breath holding

345
Q

How do you identify tachycardia and bradycardia?

A

Monitoring pulses

Cardiac auscultation

346
Q

What are common causes of tachycardia when anaesthetised?

A 
Inadequate depth
Hypercapnia
Hypovolaemia
Drug action
Electrolyte abnormalities
347
Q

What causes of tachycardia under GA in ASA 1 and 2 pateints?

A

Inadequate depth

Hypercapnia

348
Q

How do you respond to tachycardia in response to inadequate depth of anaesthesia and what are signs this is the cause?

A

Increase depth of anaesthesia

Reaction to noxious and non-noxious stimuli, increased muscle tone, increased RR, increased BP, movement

349
Q

How do you respond to tachycardia in response to hypercapnia and what are signs this is the cause?

A

Follow steps for when SpO2 falls

Poor respiration

350
Q

How do you respond to tachycardia in response to hypovolaemia and what are signs this is the cause?

A

Stabilise before anaesthetic and manage fluid deficit

Patient is hypovolaemic or dehydrated

351
Q

What should you do if suspect drug action is the cause of tachycardia under GA?

A

Rule out other causes

352
Q

How do you respond to patients with electrolyte imbalances to prevent tachycardia under GA?

A

Identify on pre-assessment and stabilise

353
Q

What is stage one of anaesthesia and what can be observed in this stage?

A

From induction to unconsciousness

Increased pulse rate and RR, may have breath holding and dilated pupils

354
Q

What is stage 2 of anaesthesia and what can be observed in this stage?

A

Onset of unconsciousness until rhythmic breathing is present

All cranial nerve reflexes present, eyes wide and open with dilated pupils

355
Q

What is plane 1 of stage 3 of anaesthesia suitable for and what can be observed in this stage?

A

Minor procedures
Regular and deep respiration, brisk pedal reflex (pinching paw), slowing and disappearing nystagmus (involuntary rhythmic eye movement), eyes pointing ventromedially

356
Q

What is plane 2 of stage 3 of anaesthesia suitable for and what can be observed in this stage?

A

Most surgical procedures
Eyes ventromedial with partially separated eyelids, sluggish palpebral reflex (touching periocular skin), present corneal reflexes, relaxed muscles, lower pedal reflex, lower tidal volume, lower HR, lower BP

357
Q

What is plane 3 of stage 3 of anaesthesia suitable for and what can be observed in this stage?

A

All procedures
Eyes face centrally and eyelids start to open, increased pupillary diameter, no pedal reflex, relaxed abdominal muscles, low HR, low BP

358
Q

What is stage 4 of anaesthesia and what can be observed in this stage?

A

Overdose

Respiratory failure, rapid or slow pulses, eyes central, no palpebral reflex

359
Q

What are caused of bradycardia under anaesthetic?

A 
Too deep anaesthesia
Drug action
High vagal tone
Hypoxia
Hypothermia
Hyperkalaemia
360
Q

What are signs too deep anaesthesia is the cause of bradycardia and how do you respond?

A

Low RR, hypotension, low muscle tone, lack of reflexes

Adjust depth of anaesthesia

361
Q

How do you respond when drugs are the cause of bradycardia during GA?

A

Treat with atropine if worried about hypotension or arrhythmia

362
Q

What causes high vagal tone leading to bradycardia in GA and how is it treated?

A

Occulocardiac reflex- eye compression decreases pulse rate

Anticholinergics

363
Q

How should you treat patient to prevent bradycardia under GA when pre-assessment picks up hyperkalaemia?

A

Stabilise before anaesthesia and treat underlying cause

364
Q

What are causes of hypotension when under anaesthetic?

A

Reduced inflow to the heart, reduced pumping, vascular resistance due to drugs, hypovolaemia, shock, arrhythmia etc.

365
Q

What are some causes of respiratory failure under anaesthesia?

A

Depression of brains respiratory centre
Impaired movement of thorax
Impaired lung movement
Airway obstruction

366
Q

What is meant by cardiac arrest?

A

Cessation of effective circulation

367
Q

What are possible causes of cardiac arrest?

A 
Pre-existing CV disease
Anaesthetic overdose
Arrhythmia
Hypovolaemia
Electrolyte abnormalities
Respiratory arrest
368
Q

What are causes of hypertension under GA?

A

Nociception
Hypercapnia
Hypoxia
Drugs

369
Q

How can you prevent vomiting in patients under anaesthesia?

A

Fast before anaesthetic
Elevate head until ETT cuff inflated
Consider omeprazole in patients with high risk

370
Q

How do you respond to patients who vomit under anaesthesia?

A

Keep head down

Suction pharynx

371
Q

What are risks of oesophageal reflux when under anaesthesia?

A

Excess or inadequate fasting
Drugs
Abdominal pressure
Abdominal surgery

372
Q

What are causes of emergencies and accidents during anaesthesia?

A

Sick patients- stabilise before anaesthesia, prepare equipment and drugs
Human error, poor communication, not doing checklists, leaving APL valve open, drug admin errors, poor airway management, poor positioning, inadequate eye protection
Equipment failure
Poor preparation
Poor monitoring

373
Q

Name drugs used for euthanasia and what species they are used for

A

Pentobarbital- lots of species

Secobarbital sodium plus cincocaine hydrochloride- dogs, cats, horses, cattle

374
Q

What mode of action do euthanasia drugs act by?

A

Barbiturate enhances action of GABA at GABA receptor

Local anaesthetic blocks sodium channels in heart interrupting action potentials

375
Q

Explain the general stages of recovery from anaesthesia

A

End of procedure so need to regain consciousness
Stop anaesthetic agent and antagonise injectable drugs either just before or after procedure ends
Give 100% oxygen if nitrous was used
Maintain analgesia
Remove airway device as appropriate
Place in suitable recovery area

376
Q

What makes a suitable area to recover from anaesthetic?

A 
Safe
Secure
Well ventilated 
Warm
Easy to observe
Good access to supplies
377
Q

What should be observed in patients from extubation to full recovery?

A

Lift head
Sternal recumbency
Standing
No signs of sedation

378
Q

How should you prepare for extubation?

A

Untie ties

Deflate cuff when close

379
Q

When should you extubate dogs and rabbits?

A

Signs of laryngeal reflexes and spontaneous movement

380
Q

When should you extubate cats?

A

Early reflexes, before laryngeal reflex

381
Q

What happens if you extubate too early or late?

A

Early- unsupported airway

Late- distress, damage to airway, laryngospasm in cats

382
Q

What factors need considering when recovering animals?

A

Drug factors and doses
Species, breed, age
Co-morbidities
CV function- delivery and distribution to kidneys
Hepatic and renal function- metabolism and excretion
Temperature- hypothermia causes slower metabolism and renal plasma flow

383
Q

What parameters need monitoring when recovering animals?

A 
TPR
MM
CRT
Quality of recovery
Pain
Excretions
Comfort
Catheters
Surgical site
Food and water
384
Q

What causes hypothermia in recovery?

A

Vasodilation from drugs
Lack of movement
Cold environment

385
Q

What are the effects on recovery of hypothermia?

A 
Bradycardia
Cardiac arrhythmia
Atrial fibrillation - 30 degrees
Ventricular fibrillation- 24-38 degrees
Impaired coagulation and wound healing
Longer drug action so slower recovery
Low oxygen delivery
Slower metabolism
386
Q

What causes hyperthermia in recovery?

A

Decreased heat loss
Warm environment
Increased metabolic heat production

387
Q

What are the effects of hyperthermia in recovery?

A 
Higher metabolic rate
Higher oxygen requirement
Cell damage
Irreversible brain damage- 41 degrees
Death- 43 degrees
388
Q

What needs monitoring for respiration in patient recovery?

A

Patent airway
RR
Breathing pattern

389
Q

What measures should you put in place to protect respiration in recovery?

A

If worried of aspiration or vomiting, keep head down
Remove water bowl to prevent drowning
Supplement oxygen where needed

390
Q

How do you maintain a good quality of recovery?

A

Keep calm and stress free
Re-sedate if too excited
Be aware of causing injury

391
Q

What are signs of pain in recovery?

A 
Inappetence
Immobility
Vocalisation
Agression
Sleeping
Increased HR
Increased RR
Increased temperature
Increased BP
392
Q

What does CPCR stand for?

A

Cardiopulmonary cerebral resuscitation

393
Q

What are the mortality rates for patients who experience CPA?

A

Under anaesthesia- 53%

In general- 90%

394
Q

What does RECOVER stand for and what is its purpose?

A

Reassessment campaign on veterinary resuscitation

Use evidence based guidelines to treating CPA and identifies areas that need more development

395
Q

How should you prepare for a CPA?

A

Everyone involved knows what to do, what protocols are and where equipment, drugs etc. are kept

396
Q

When should you initiate CPCR?

A

Unresponsive apnoeic patient with no pulses

397
Q

What is classed as basic life support in CPCR?

A

Recognising CPA
Compressions- 100/minute 1/3 to 1/2 chest in lateral recumbency, compressing main part of heart and allowing full recoil
Ventilation- securing airway while compressions take place, 10 breaths/minute providing oxygen, can check effectiveness with capnography as hypoxia and hypercapnia reduce chance of circulation returning

398
Q

What are roles in a CPCR team?

A 
Lead
Cardiac compressor
Ventilator
Note keeper
Runner
399
Q

What is classed as advanced life support?

A

Drugs- IV where possible
Correcting cause of arrest
Monitoring- ECG, capnography, pulse oximeter
Fluids, eye lubrication, temperature regulation, IV catheter placement

400
Q

What is involved in post CPA care?

A

IVFT
Oxygen therapy
Referral where needed
Make sure CPCR process was correctly recorded

401
Q

Why is it important to debrief after CPCR?

A

Emotions high
Discuss what happened
Clear the air of any problems
Restock equipment and drugs

402
Q

How is CPA managed in already anaesthetised pateint?

A 
Note time and inform surgeon
Start compressions
Manually ventilate
Stop anaesthetic drugs and consider adrenaline
Manage same as other crashes
403
Q

What is a main contributor to pollution in veterinary practices and how does it contribute to global warming?

A

Anaesthetic gases

Greenhouse gases or plug atmospheric window (used to cool earth as low absorption of natural greenhouse gases)

404
Q

Why is nitrous bad for the atmosphere?

A

Although less global warming effect has lower potency so more needs using, is also ozone depleting

405
Q

How can practices improve carbon footprint?

A 
Dont use nitrous
Avoid unneeded anaesthesia
Use TIVA where possible
Sevoflurane is better than isoflurane
Dont waste resources
Low flow anaesthetic techniques
406
Q

How does low flow anaesthetic work with circle and lack and what are negatives?

A

Circle- over 5kg, has reduced FGF. Can dilute anaesthetic, slower onset and hypoxic mixture if using for long time
Lack- under 5kg, uses capnography to find lowest FGF that prevents rebreathing

407
Q

How should waste be disposed of in practice and what is the negative to reusing?

A

Correctly separated
Dont use unnecessary resources
Re-use and recycle where possible
Re-using has higher risk of infection and failure of equipment

408
Q

What should be checked before sedation or anaesthetising horses?

A

Check passport (food producing so drug regulations)
Assess temperament to decide drugs
Assess CV and respiratory systems
Assess facilities, procedure and pain levels likely
Dont withhold food
Get owner consent, inform that best for vet to be present whole time

409
Q

Describe the ideal environment for equine sedation

A 
Quiet
Calm
Lots of time
Safe
Equipment and drugs prepared
410
Q

How is equine sedation administered?

A

IV to jugular- ideal as fastest onset and most control of drug
IM- remote when cant gain IV access, need higher doses

411
Q

What sedative are licenced in horses?

A 
Acepromazine
Xylazine
Romifidine
Butorphanol
Buprenorphine
Pethidine
412
Q

What is the most common sedation combination used in horses?

A

Alpha 2 agonist and opioid

413
Q

When is acepromazine used in equine sedation?

A

Alone or in combination to provide mild sedation

414
Q

What is the onset time, length of effect, metabolism and any other effects of acepromazine in horses?

A

30 minute onset
4-6 hour duration
Metabolised by liver
Vasodilatory

415
Q

What effects does alpha 2 agonists have in horses?

A

Sedation
Muscle relaxation
Analgesia

416
Q

What side effects can alpha 2 agonists have in horses?

A

Bradycardia, second degree AV block so initially causes hypertension and vasoconstriction, then hypotension
Hypoinsulinemia
Decreased GI motility

417
Q

What are the alpha 2 agonists used in horses for sedation?

A

Xylazine- shorter lasting, faster onset

Romifidine

418
Q

Which opioids are used in horses for sedation?

A

Butorphanol- provides less analgesia
Buprenorphine- needs large volume
Pethidine- need to give IM, relieves colic

419
Q

What effects do opioids have when given to horses for sedation in combination with alpha 2 agonist?

A

Synergistic effect on analgesia, increases sedation and ataxia (un coordination)

420
Q

How should catheters be cared for in recovery?

A

Covered and suitably padded

Pressure placed on removal to prevent haemotoma

421
Q

What are common causes of death in equine anaesthesia?

A

Fractures
Myopathy
Cardiac arrest

422
Q

What are risk factors for equine anaesthesia?

A 
Drugs
Age
Duration of procedure
Type of procedure
Environment (field or hospital)
423
Q

What determines if horses are anaesthetised in field or hospital?

A 
Temperament
Can you get to hospital
Type of procedure
Length
Facilities available
424
Q

How should horses be prepared for general anaesthesia?

A

Full exam
Gained consent
Groom and remove shoes
Weigh
Antibiotics 30 minutes before anaesthesia if using to lower BP
Rinse mouth to prevent debris pushed into airway
IV catheter placed in left jugular

425
Q

What equipment is needed for equine anaesthesia?

A 
Padded head collar and lead rope
Towel for eyes and eye lubrication
Drawn up and labelled drugs
ETT and gag prepared
Table, monitors and machines prepared
426
Q

How are horses induced for anaesthesia?

A

Once fully sedated
Ketamine/diazepam and thiopental in fast IV bolus
May use GGE/guaiphenesin, a muscle relaxant
Field- free fall guiding head
Practice- tilt tables and gates

427
Q

What technique is used for equine intubation?

A

Blind technique, extend head and neck

Oral but can be nasotracheal

428
Q

What maintainace is used for horses in field and theatre?

A

Field- TIVA for max 2 hours

Theatre- TIVA, sevoflurane, isoflurane

429
Q

What are side effects of inhalational anaesthetics used in equine anaesthesia?

A

Respiratory depression
Hypotension
Rapid recovery

430
Q

What analgesics are used for equine surgery?

A 
NSAIDs- before anaesthetising
Opioids
Alpha 2 agonist
Ketamine
Local blocks
431
Q

What should be monitored in equine anaesthesia?

A

RR and pattern- easily compromised leading to hypoxaemia, hypoventilation, hypercapnia as not designed to lay down for long times
Eye position, nystagmus- depth of anaesthesia
Palpebral reflex
Muscle tone
Movement- may be sudden
BP- CO decreased in anaesthesia, commonly get hypotension
ECG- common to initially get 2nd degree AV block

432
Q

How should you recover horses from anaesthesia?

A

Quiet environment
Cover eyes to reduce stimulation and fear
Supplement oxygen
Remove ETT when respiratory effort increases (weak laryngeal reflexes)
Alpha 2 agonist to keep calm
Analgesia
Catheterise bladder to remove stimulation to stand

433
Q

What are causes and prevention of equine post anaesthetic myopathy?

A

Causes- damage during anaesthesia
Prevention- careful positioning, let down (take out of training) fit horses few days pre-op, minimise anaesthetic time, lighter anaesthesia, avoid hypoxia

434
Q

What are signs of equine post anaesthetic myopathy?

A 
Lameness
Cant stand
Distress
Hard swollen muscles
Myoglobinuria
High creatinine kinase muscle enzyme
435
Q

What is treatment for equine post anaesthetic myopathy?

A 
Analgesia
Sedation
Fluids
Nursing care
May need euthanasia
436
Q

What are common neuropathies/nerve compression in horses after anaesthesia and what are the prognoses?

A

Radial, facial and femoral, brachial plexus

Depends on degree of damage

437
Q

What is spinal cord malacia?

A

Softening of spinal cord

438
Q

What are causes, signs and result of spinal cord malacia?

A

Cause- unknown
Sign- complete hind limb paralysis
Result- fatal

439
Q

What are common causes of fractures in equine anaesthesia?

A

Trauma in induction, recovery
Pre-existing injury
Myopathy increases risk

440
Q

When is equine castration carried out typically?

A

6 months to 2 years

Testicles fully descended

441
Q

Where can equine castration be carried out and how?

A

In hospital or field by vet

Standing or under GA

442
Q

Why are horses castrated?

A

Behaviour modification- reduced agression, easier to handle geldings
Management- turn out with mares
Control breeding
Medical reasons- neoplasia etc

443
Q

What determines if a castration is done standing or under GA?

A

Size of horse for visualisation
Temperament
Cost

444
Q

What is an open castration?

A

Vaginal tunic incised and left open

445
Q

When are open castrations carried out?

A

Young unbred horses when being castrated standing in field

446
Q

How is an open castration performed?

A

Incision through skin and vaginal tunic to expose testes

Emasculators used on vas deferens and testicular vessels to crush and transect

447
Q

What is semi-closed castration?

A

Vaginal tunic incised then sutured closed

448
Q

What environment is semi-closed and closed castration carried out in?

A

Hospital under GA

449
Q

What is closed castration?

A

Vaginal tunic sutured proximally to testes before incision

450
Q

How is closed castration performed?

A

Incision through skin only with blunt dissection of vaginal tunic containing testes
Ligatures placed before emasculation

451
Q

What are options for the scrotum following castration?

A

Primary closure- sutured
Secondary closure- left open, used in field
May need ablation

452
Q

What are advantages and disadvantages of standing castration?

A

Advantages- quick, effective, cheap in well handled young horses
Disadvantages- poor asepsis, commonly get minor complications, risk to surgeon

453
Q

List equipment needed for standing castrations?

A 
Sedation
Local anaesthetic
Analgesia
Antimicrobials
Gloves
Scrub
Swabs
Needles and stitch kit
Scalpel
Emasculators
Ketamine and IV prepared if GA is needed
454
Q

What is the general process for preparing for standing castrations?

A 
Sedate
Check 2 testicles present
Scrub
Inject local anaesthetic into subcutis and testicle
Rescrub
455
Q

How should horses be positioned for GA castration in hospital or field?

A

Hospital- dorsal or lateral recumbency

Field- lateral recumbancy

456
Q

What are some common post-castration complications in horses?

A

Swelling
Bleeding
Infection- scirrhous cord/infection of spermatic cord remnant, staphylococcal infection
Tetanus
Evisceration- prolapse of omentum or intestine through inguinal ring, intestine is emergency

457
Q

What needs to be monitored post-castration in horses?

A

Bleeding- drips normal for 12 hours
Swelling- shouldn’t be more than original size
Surgical site- check for protrusions
Sedation- may cause colic, monitor appetite etc

458
Q

How do you manage horses after castration?

A 
Box rest for 24-48 hours
Walk 2-3 times daily after 2 days to reduce swelling and encourage drainage
Turn out after 7-10 days 
NSAIDs
Fertile for 2 months
459
Q

What is cryptorchidism and how is it detected?

A

Failure of testicular descent

Inguinal palpation, ultrasound, blood tests, surgical exploration

460
Q

How is cryptorchidism treated?

A

Laparoscopic cryptochidectomy

461
Q

What are potential causes of higher mortality rates in exotics under anaesthesia?

A

May lack history
Pre-existing diseases may be unrecognised
Small to hard to weigh accurately, examine, place IV
Completely different anatomies
Handling causes high stress
Equipment not suitable

462
Q

What parts of the patient to be considered in exotic anaesthesia?

A

Eyes- protuberant risks damage, corneal dissection
Pharyngeal pouch- needs emptying before intubation
Mouth- hard to intubate if large incisors, narrow jaw, obstructive pharyngeal tissue
Physiology- metabolic rate, rate of glucose and oxygen consumption
Temperature- high SA:V ratio
Respiratory system- hard to auscultate
GI system- diet, rabbits cant be starved
Species specific- drug concerns, diseases, husbandry

463
Q

What factors need considering for birds when anaesthetising?

A

Wide range of species
Hide illness
Handling causes stress, if too tight stops breathing as sternum cant move
Prone to hypothermia and hypoglycaemia
Hard to intubate as small and cant cuff as complete tracheal rings
Muscle relaxants majorly affect completely active respiration
Low HR
High metabolic rate

464
Q

What factors need considering for reptiles when anaesthetising?

A 
Can carry zoonotic disease on surface
Ectothermic
Free moving organs
Breath hold
Only open larynx in active respiration
1 heart ventricle
Long soft palette making intubation hard
Lower oxygen consumption
Snakes have single functional right lung
Cant cuff as complete tracheal rings
No muscular diaphragm so other muscles needed to respire such as tortoises limbs
Cant regurgitate
465
Q

What are recommended pre-op starvation for exotics?

A 
Rabbits/rodents- none
Guinea pigs- up to 4 hours, empty pharyngeal pouches
Ferrets- 6 hours
Reptiles- none, avoid live insects
Birds- species dependent
466
Q

What anaesthetic breathing equipment may be needed for exotic anaesthesia?

A 
T-piece
Gas chamber
Mask
ETT
V-gel
467
Q

List routes of admin of drugs to exotics

A

IV- basilic, medial tarsal, right jugular
IM- pectoral
IP
SC
IO- cranial tibiotarsus, ulna (high risk of pain and infection)
Inhalation
Oral

468
Q

What are signs of acute and chronic pain in exotics?

A

Acute- escape attempts, avoidance, agression, restlessness, increased respiration
Chronic- immobility, agression

469
Q

What parameters are monitored for exotics under anaesthesia to assess depth?

A

Rightwing reflex- ability to correct orientation of body by vestibular system, only when light
Withdrawal reflex
Jaw tone
Pulses

470
Q

What equipment can be used to monitor exotics under anaesthesia and how can it be adapted to be better suited?

A

Pulse oximeter- foot or tail base instead of tongue
Capnograph- mainstream to prevent reducing FGF
ECG- cut down pads, use needle electrodes
Doppler
Temperature- rectal, small probe

Clinical Nursing Jan exam (7 decks)

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