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MOD (year 3) > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

why should a cuffed endotracheal tube be used to intubate dogs, cats, ruminants?

A

at risk of regurgitation

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2
Q

what does IPPV stand for?

A

intermitent positive pressure ventilation

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3
Q

what does ASA stand for?

A

American society of anaesthesiologists

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4
Q

what is the ASA status of the patient for?

A

attempt to classify the risk of anaesthesia according to an animals physiological status (not surgical risk)

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5
Q

what are the aims of anaesthesia?

A

unconsciousness
analgesia
muscle relaxation
(autonomic stability)

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6
Q

why is balanced anaesthesia needed?

A

no agents provide analgesia, unconsciousness and muscle relaxation

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7
Q

what is balanced anaesthesia?

A

anaesthesia from two or more agents/methods of anaesthesia

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8
Q

what are the benefits of balance anaesthesia?

A

reduction of dose/side effects

post-operative analgesia

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9
Q

what type of procedures is sedation used for?

A

non-invasive

non-painful

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10
Q

what is sedation used for?

A 
relieve patient anxiety
facilitate handling
provide analgesia
provide muscle relaxation
enable procedures
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11
Q

what is premedication used for?

A

smooth induction, maintenance, recovery of GA

reduce dose of induction/maintenance agent

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12
Q

what must drugs used via the cascade for food producing animals have?

A

maximum residue limit (withdrawal period)

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13
Q

what can be given to an anxious horse pre-appointment?

A

acepromazine or detomidine oral gel

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14
Q

what can be given to an anxious dog/cat pre-appointment?

A

gabapentin or trazadone

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15
Q

what are examples of opioids?

A 
butorphanol
buprenorphine
methadone
fentanyl 
(morphone)
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16
Q

what is an example of a phenothiazine?

A

acepromazine

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17
Q

what are examples of alpha 2 receptor agonists?

A 
xylazine
detomidine
romifidine
medetomidine 
dexmedetomidine
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18
Q

what are examples of benzodiazepines?

A

diazepam

midazolam

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19
Q

what are some adjuncts for sedation?

A

ketamine
alfaxalone
propofol
physical restraint

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20
Q

what patients are opioids good at sedating?

A

very painful/sick animals

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21
Q

what is the main side effect of opioids?

A

respiratory depression

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22
Q

what cases can acepromazine be used for?

A

mitral valve disease
BOAS patients
laryngeal paralysis

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23
Q

what are the main side effects of acepromazine?

A

vasodilation

unreliable

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24
Q

what is acepromazine often used in combination with?

A

alpha 2 agonists (acepromazine for calming effect)

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25
what situations is acepromazine not suitable for?
``` very young animals hepatic impairment haemorrhage hypotension sepsis ```
26
what are the disadvantages of acepromazine?
no analgesia not reversible long duration moderate MAC sparing
27
what are the side effects of alpha 2 agonists?
peripheral vasoconstriction (reflex bradycardia) reduce cardiac contractility increase urine production
28
how reliable is alpha 2 agonist sedation?
very
29
what are the advantages of alpha 2 agonists?
analgesia reversible (atipamezole) duration depends on drug/dose large MAC sparing
30
what are alpha 2 agonists not suitable for?
mitral valve disease very young animals if bradycardia would be a problem urinary obstruction
31
what animals are benzodiazepines useful for?
very young, old and sick
32
how reliable is benzodiazepine sedation?
poor
33
what animals are benzodiazepines not suitable for?
farm animals | portosystemic shunts
34
what are the advantages of benzodiazepines?
reversible (flumazenil) | duration depends on dose
35
what are the disadvantages of benzodiazepines?
no analgesia | moderate MAC sparing
36
what can be used to sedate food producing animals?
butorphanol xyalzine detomidine
37
what drug are ruminants very sensitive to?
xylazine
38
when giving a horse opioids and alpha 2 agonists, what should be given first?
alpha 2 agonist (stops pacing)
39
what equine cases should acepromazine not be used in?
colic (vasodilation)
40
what small animal cases is acepromazine useful for?
long duration that require calming
41
what are possible agents used for induction?
``` propofol alfaxalone ketamine tiletamine pentobarbital thiopental etomidate ```
42
what are possible co-induction agents?
ketamine benzodiazepines guaifenesin opioids
43
what species considerations need to be considered when inducing cats?
mask subclinical disease well don't tolerate restraint variable temperament
44
what species considerations need to be considered when inducing horses?
don't like being recumbent | flight animals
45
what are the possible inhalation maintenance agents?
isoflurane | sevoflurane
46
what are possible injectable maintenance agents?
propofol alfaxalone ketamine
47
what is TIVA?
total intravenous anaesthesia
48
what is MAC?
minimal alveolar concentration
49
how can the plane of anaesthesia be assessed using the eye?
pupil size eye position palpebral reflex
50
what are adjuncts for maintain of anaesthesia?
multimodal analgesia locoregional technique PIVA monitoring
51
what is PIVA?
partial intravenous anaesthesia
52
what are the ways the airway can be managed?
face mask endotracheal tubes supraglottic airway devices (LMA, V-gel)
53
what are two types of supraglottic airway devices?
LMA (laryngeal mask airway) | V-gel
54
where do supraglottic devices sit?
don't go into trachea (sit over larynx)
55
what can be used in cases when emergency airway access is needed?
urinary catheter stomach tube (guide ETT) tracheostomy
56
what is pain?
unpleasant sensory/emotional experience associated with actual/potential tissue damage
57
what is nociception?
relay of noxious stimuli from the periphery to the CNS
58
what is the difference between pain and nociception?
pain is when the nociceptive input is processed and perceived
59
what are the types of acute pain?
somatic visceral neuropathic
60
what causes visceral pain?
chemical, thermal, mechanical stimuli to bone, skin, muscle... (localised)
61
what causes visceral pain?
inflammation, ischaemia or distention of viscera (diffuse)
62
what is neuropathic pain?
lesions within the nervous system (localised/diffuse)
63
what is hyperalgesia?
exaggerated pain sensation in response to noxious stimuli
64
what is allodynia?
perception of pain to a normally non-noxious stimuli
65
what is peripheral sensitisation?
increased responsiveness of nociceptors (reduced activation threshold)
66
what causes peripheral sensitisation?
tissue damage and inflammation
67
what does peripheral sensitisation cause at the site of injury?
hyperalgesia and allodynia
68
what is central sensitisation?
increased efficiency of nociceptive signal transmission that can persist after cessation of nociceptive input
69
what is central sensitisation due to?
prolonged/repeated nociceptive input
70
why is acute pain associated with behavioural changes?
minimise damage | optimise tissue healing
71
what are the 4 stages of the nociceptive pathway?
transduction transmission modulation perception
72
what drug types are available for acute pain?
``` NSAIDs Opioids Paracetamol Local anaesthetics Alpha 2 agonists NMDA antagonists ```
73
what do NSAIDs inhibit?
COX enzyme
74
what stages of the nociceptive pathway do NSAIDs effect?
transduction, modulation, perception
75
what stages of the nociceptive pathway do opioids effect?
modulation, perception, transduction
76
what receptors do opioids effect?
mu
77
what opioids are full mu agonists?
pethidine morphine methadone fentanyl
78
what opioid is a partial mu agonist?
buprenorphine
79
what opioid is a mu antagonist and kappa agonist?
butorphanol
80
what is generally the first choice opioid in small animals?
methadone
81
what opioid should not be administered IV?
pethidine
82
what are the mechanisms of action of tramadol?
weak mu receptor agonist inhibit serotonin and noradrenaline reuptake alpha 2 agonist
83
what are the side effects of tramadol?
salivation, vomiting, seizures
84
what stage of the nociceptive pathway does paracetamol effect?
modulation
85
what is the mode of action of local anaesthetics?
sodium channel blockers
86
what stage of the nociceptive pathway do local anaesthetics effect?
transmission (true analgesics)
87
what stages of the nociceptive pathway do NMDA antagonists effect?
modulation, perception
88
what is the mode of action of gabapentinoids?
calcium channel blockers
89
what stages of the nociceptive pathway do gabapentinoids effect?
modulation, perception
90
what is an example of a NK-1 antagonist?
maropitant
91
what is a multidimensional composite pain scale used for dogs?
Glasgow composite measure canine pain scale
92
what is a multidimensional composite pain scale used for cats?
Glasgow feline composite measure pain scale
93
chronic pain can cause changes to central pain processing, what are these?
hyperalgesia | allodynia
94
what are the types of chronic pain?
``` nociceptive/inflammatory neuropathic neoplastic mixed referred myofascial ```
95
what is referred chronic pain?
pain that is projected from the source to a distant site (makes identification difficult)
96
what causes myofascial trigger points?
general wear/tear of muscles (damage to motor end plates)
97
what muscles are commonly effected by myofascial pain?
postural (neck, shoulders, lumbar spine)
98
what implications are associated with chronic pain?
``` sensory emotional cognitive (conditioned responses) motor welfare ```
99
what can be used to assess lameness associated with chronic pain?
force plate analysis
100
how is the majority of chronic pain assessed?
owner questionnaires
101
what are the steps in a chronic pain consult?
``` identify owners concerns identify problem assess degree of pain classify pain components identify source of pain identify aims of management devise treatment implement plan ```
102
what does PLATTER stand for?
``` plan anticipate treat evaluate return (management of chronic pain) ```
103
what does ABCDE stand for in regards to treating chronic pain?
``` analgesia bodyweight control of complications and comfort disease modification exercise ```
104
what are some possible analgesic interventions for chronic pain?
``` acupuncture physiotherapy hydrotherapy laser therapy transcutaneous electrical nerve stimulation ```
105
what drugs are commonly used for nociceptive/inflammatory pain?
NSAIDs
106
what should be monitored in animals on long term NSAIDs?
serum biochemistry and urinalysis (check for side effects)
107
what is the mode of action of grapiprant?
prostaglandin receptor antagonist
108
what drugs can be used to treat chronic pain?
``` NSAIDs grapiprant paracetamol tramadol NMDA antagonist gabapentin tricyclic antidepressants ```
109
what are the side effects of longterm NMDA antagonist use?
GI signs agitation restlessness
110
how does acupuncture work?
needles cause local vasodilation and nerve growth factors stimulate wound healing
111
what is physiotherapy used for?
muscle strengthening | myofascial pain
112
how does laser therapy for chronic pain work?
reduces pro-inflammatory mediator and cytokines
113
what can exacerbate pain/inflammation in obese animals?
adipokines
114
what can be used to treat chronic pain in food producing animals?
NSAIDs paracetamol ketamine
115
why is anaesthesia monitored?
``` maintain physiology maintain anaesthetic depth prevent pain safety legal implication ```
116
how is the CNS monitored during anaesthesia?
``` reflexes (palpebral, corneal) anal tone eye position/movement lacrimation autonomic tone (sweating...) muscle tone (jaw...) movement response to surgery ```
117
where do small animals eyes rotate in an adequate plane of anaesthesia?
ventromedially
118
what is the HR of a horse?
20-40bpm
119
what is the HR of a dog?
50-100bpm
120
what is the HR of a cat?
80-160bpm
121
what is the respiratory rate of a horse?
4-10bpm
122
what is the respiratory rate of a dog?
10-20bpm
123
what is the respiratory rate of a cat?
15-30bpm
124
what is an oesophageal stethoscope used for?
auscultating heart/lungs even if animal is covered by drapes
125
what does an ECG monitor?
electrical activity of the heart
126
what is arterial blood pressure used to monitor?
indication of cardiac output and perfusion
127
what are the three values given for arterial blood pressure?
systolic pressure diastolic pressure mean pressure
128
what is normal systolic arterial blood pressure?
80-140mmHg
129
what is normal diastolic arterial blood pressure?
50-90mmHg
130
what is normal mean arterial blood pressure?
60-90mmHg
131
what are the two ways of monitoring arterial blood pressure?
invasive (gold standard) | non-invasive
132
what does pulse oximetry measure?
% saturation of haemoglobin with oxygen
133
what is normal haemoglobin oxygen saturation?
>95%
134
what are the limitations of pulse oximetry?
``` hypoperfusion bright lights movement anaemia probe can blanch capillary bed ```
135
what does capnography measure?
end tidal CO2
136
what is normal end tidal CO2?
35-45mmHg
137
what can capnography tell you? (other than CO2)
correct ETT placement | confirms cardiac output indicates problem with breathing system
138
what are the three common complications of anaesthesia? (Hs)
hypotension hypothermia hypoventilation
139
what figure should mean arterial blood pressure stay above during surgery?
>60mmHg
140
what can cause hypotension during surgery?
reduced cardiac output (reduced stroke volume and HR) | reduced systemic vascular resistance
141
what are the steps for treating hypotension under anaesthesia?
``` check cuff (repeat reading) check plane of anaesthesia check HR give fluid drugs change position ```
142
what drugs can be given to treat hypotension during anaesthesia?
vasoconstrictors | positive inotropes
143
what are the main organs/tissues are we concerned about being damaged during hypotension from anaesthesia?
acute kidney injury | myopathy
144
why does hypothermia occur under anaesthesia?
increase heat loss reduced heat production no behaviour responses (shivering) alterations to hypothalamic function
145
what are the consequences of hypothermia?
arrhythmias coagulopathies reduced immune function and drug metabolism
146
what can hypoventilation cause?
hypercapnia | hypoxaemia
147
when should hypercapnia be treated?
end tidal CO2 >60mmHg
148
how is hypercapnia treated?
increase minute ventilation - lighten plane and mechanical ventilation
149
when should hypoxaemia be treated?
saturation O2 <90%
150
how can hypoxaemia be treated?
``` increase oxygen delivery mechanical ventilation increase gas exchange (bronchodilators) check ETT blockage fluids ```
151
what can cause bradycardia under anaesthesia?
increased parasympathetic system activation (drugs) hypothermia disease (hyperkalaemia)
152
what can cause tachycardia during anaesthesia?
increased sympathetic tone hypovolaemia hyperthermia hypercapnia
153
why is recovery phase of anaesthesia so dangerous?
physiological support reduced monitoring is reduced some problems manifest after a delay
154
what are the most common recovery problems?
hypotension hypothermia emergence delirium hypoxaemia
155
what are the consequences of hypothermia in recovery?
reduced MAC requirement shivering delayed recovery wound healing problems
156
what is emergence delirium?
state of dissociated consciousness where the patient is incoherent, irritable and uncooperative
157
what can be done to treat/prevent emergence delirium?
sedate/restrain reduce stimulation, noise and light analgesia
158
what are the clinical signs of hypoxaemia?
cyanotic MM tachypnoea stertor/stridor reduced consciousness
159
when do you extubate an animal?
once they can protect their own airway (once swallowing)
160
what issues are seen in dogs/cats during recovery?
gastric reflex/aspiration tracheal tear (cats) blindness (cats)
161
what issues are seen in horses during recovery?
colic myopathy/neuropathy fracture
162
what issues are seen in ruminants during recovery?
regurgitation/aspiration | bloat
163
what issues are seen in pigs during recovery?
respiratory obstruction | hyperthermia
164
what needs to be assessed in an emergency patient?
ABC mentation problems (prioritise)
165
what basic diagnostic tests can be done on emergency cases?
PCV/TP, electrolytes, glucose T-FAST, A-FAST thoracic/abdominal radiographs
166
how is fluid therapy given in emergency cases?
(bolus) - 10-20ml/kg of crystalloid over 10 minutes
167
what are potential problems when anaesthetising emergency cases?
CV respiratory pain temperature
168
what drugs can be used to sedate emergency cases?
``` alpha 2 agonists acepromazine benzodiazepines ketamine opioids ```
169
what alpha 2 agents would be most suitable for IM administration to a horse?
detomidine
170
which opioid is good for very painful 3-4 hour procedures in a cat?
methadone

MOD (year 3) (45 decks)

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