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FCP > Anaesthesia and analgesia > Flashcards

Anaesthesia and analgesia Flashcards

1
Q

Define nociception

A

lack of awareness of painful inputs

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2
Q

Why do we give a premed ?

A

-reduce dose of inducing agent
-reduce dose of maintenance agent
-pre-emptive analgesia
-smooth recovery

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3
Q

List pre med drugs

A

acepromazine ACP
alpha 2 agonist -medetomidine
benzodiazepine - midazolam
alfaxalone
opiod

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4
Q

Describe the use of ACP as a pre med

A

-usually with opiod
-sedation
-cause vasodilation - not good for sick animals
-SC,IM,IV and oral

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5
Q

What alpha 2 agonists do we use for small animals ?

A

medetomidine or dexmedetomidine

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6
Q

What alpha 2 agonists do we use for horses ? ( fast-slowest to kick in )

A

xylazine - fastest
detomidine - middle
romifidine - slowest

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7
Q

What alpha 2 agonists are used in cattle ?

A

xylazine
detomidine

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8
Q

Describe alpha 2 agonist as a pre med

A

-cardiovascular effects
-analgesia
-increase urine production - no blocked cats
-effects glucose - diabetic patients
-not in sick patients
-has reversal agent ( atipamezole )

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9
Q

List examples of benzodiazepines

A

midazolam
diazepam

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10
Q

Describe the action of benzodiazepines as pre meds

A

-no analgesia
-ASA 3 - can use in sick animals
-wide therapuetic index
-avoid in excitable animals
-works on GABA
-reversal ( flumazenil )
- usually combined opiod, ketamine or alfaxalone

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11
Q

Describe the action of alfaxalone

A

-IV and IM
-usually combined opiod
-minimal cardiovascular effects
-painful in large animals IM - large amount

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12
Q
A
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13
Q

List some examples of opiods

A

methadone (dog , cat , horse )
fentanyl ( dog, cat )
butorphanol ( used lot in equine )
buprenorphine ( horse , dog , cat )

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14
Q

Describe the action of opiods as pre med

A

-analgesia
-limited cardiovascular effects

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15
Q

TRUE/FALSE ASA 5 is a healthy animal

A

false

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16
Q

TRUE/FALSE no alpha 2 agonists in sick patients

A

true

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17
Q

List some induction agents

A

propofol
alfaxalone
ketamine

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18
Q

TRUE/FALSE volatile agents are mainly used for maintenance

A

true

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19
Q

What does propofol target ?

A

GABA receptors

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20
Q

State disadvantages and advantages of propofol

A

-rapid uptake
-rapid smooth recovery

-resp and cardiovascular depression - Good to have IPPV breathing system
-no analgesia

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21
Q

What does alfaxalone target ?

A

-GABA receptors

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22
Q

Advantages and disadvantages of alfaxalone as a induction agent

A

-rapid onset of action
-rapid and smooth recovery
-licensed for rabbits too

-resp and cardiovascular depression
-no analgesia

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23
Q

What does ketamine target ?

A

-NMDA receptor antagonist

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24
Q

Advantages and disadvantages of ketamine as an inducing agent

A

-analgesia
-licnesed ruminants,rodents,rabbits ,primates and horses as well as cat and dog

-poor muscle relaxation ( combine with alpha 2 or BZD)
-schedule 2

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25
Q

What in feline triple

A

opiod,ketamine and alpah 2

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26
Q

What in a feline quad ?

A

opiod , alpha 2 , midazolam and ketamine

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27
Q

How do you measure an ET tube ?

A

nares to point of shoulder

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28
Q

TRUE/FALSE = gags are usually required for large animal intubation

A

true

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29
Q

What is a supraglottic airway device ?

A

v-gel
use cats, rabbits

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30
Q

Name some non rebreathing systems .

A

-lack
-bain
-T piece

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31
Q

Name the weight , circuit factor and IPPV ability of a lack and mini lack

A

-10 kg
- 1
-not long term IPPV

Mini lack same as above but for 2-10 kg

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32
Q

State the weight, CF and IPPV ability of a bain.

A

-7-30 KG
- 2.5
-really good IPPV

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33
Q

State the weight , CF and IPPV ability of a T piece .

A

-less than 10kg
-2.5
-IPPV

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34
Q

lacks full name

A

parrallel lack

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35
Q

How to do fresh gas flow calculation ?

A

fresh gas flow per minute=MV x CF

TV= 10mls/kg ( so need to x 10 by weight )
MV = TV x RR (20 bpm) = usually 0.2 L
CF - of what breathing system you select

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36
Q

Name a rebreathing system with weight and IPPV ability .

A

-circle
-10-150 kg ( 30-1000kg in LA )
-IPPV

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37
Q

How to calculate fresh gas flow for a circle

A

-first 10-15 min - 100mls/kg/min(2-4L/min)
-then 50ml/kg/min ( 1-2l/min)

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38
Q

What is a minimum alveolar conc and how does it help ?

A

-minimum alveolar conc
-how much needed in order to not respond to surgery if didn’t have pre med

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39
Q

TRUE/FALSE a patient with more fat will have a longer recovery

A

true - anaesthetic will redistribute into fat and this will act as a reservoir for anaesthetic

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40
Q

What do we use to maintain anaesthesia ?

A

inhalation agents

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41
Q

Name some advantages and disadvantages of isoflurane

A

-less mortality than halothane
-licensed - dog, cat, horse, exotics

-lower solubility -not washed away as quick
-cardiovascular and resp depression

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42
Q

Name some advantages and disadvantages of sevoflurane.

A

-faster induction and recovery

-more expensive
-not licensed horses
-cardiovascular and resp depression

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43
Q

What is TIVA and how is it achieved ?

A

-total intravenous anaesthesia
-top up bolus injections (propofol,alfaxalone, ketamine )or continuous rate infusions ( triple drip use equine ,propofol,alfaxalone )

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44
Q

What is the triple drip in equine ?

A

detomidine , guaifenesin , ketamine in fluid bag

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45
Q

What is PIVA ? what are the main goals of it ?

A

-Partial intravenous anaesthesia
-reduce MAC , cardiopulmonary depression
-additional analgesia
-balanced anesthesia

e.g use of inhalation agent and lidocaine , ketamine , alpha 2 agonist , opiods - continuous rate infusion or top-up boluses

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46
Q

Name ways to establish depth of anaesthesia.

A

-jaw tone ( brachy maintain some jaw tone, ketamine increase muscle tone )
-eye position
-palpebral reflex

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47
Q

How can we monitor temperature during surgery ?

A

-oesophageal temp probe
-rectal thermometer

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48
Q

What does SpO2 tell us ?

A

percentage of haemoglobin that is saturated with oxygen
normal is about 95%

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49
Q

What does capnograph measure ? what does this tell us ?

A

ventilation
-expired (EtCO2 level of CO2 released at end of expired breath ) and inspired CO2 levels
-problem ventilation, metabolism(will be impacted by perfusion ) , perfusion

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50
Q

Normal EtCO2 in cats and dogs

A

dog - 35-45mmHg
cats- 28-45 mmHg

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51
Q

What can low CO2 indicate ?

A

hyperventilation - CO2 exhaled faster than being produced

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52
Q

What can high CO2 indicate ?

A

hypoventilation - CO2 exhaled slower than its being produced

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53
Q

Why treat pain ?

A

effects us on a sensory , motivational and cognitive level

54
Q

How can measure pain ?

A

-physiological measurements
-pain scales -composite measure pain scale (feline, dog ) , equine pain scale or equine composite pain scale
-pain faces and grimace scale ( cats , muzzle tension , orbital tightening ,ear positioning )

55
Q

What drugs can we use to manage pain ?

A

-NSAIDs -galiprant - joint specific
-paracetamol
-opiod -preventative analgesia
-local anaesthetics -easy to overdose
-Alpha 2 agonists - pre medy
-ketamine - more for perioperative analgesia , good zoo ,exotics

56
Q

Name some chronic pain scales

A

helsinki chronic pain index
guvquest

57
Q

How do local anaesthetics work ?

A

-ionised
-interact with sodium channels

58
Q

Name local anaesthetics used in vet med .

A

-procaine
-lidocaine
-bupivacaine
-mepivacaine
-proparacaine

59
Q

State some advantages and disadvantages of use of procaine

A

-rapid
-last 40-60 minutes
-low toxicity
-cattle

-low potency

60
Q

State some advantages and disadvantages of lidocaine

A

-rapid
-1-2 hr
-low toxicity
-all species

-low potency

61
Q

Some advantages and disadvantages of bupivacaine

A
  • last 4-6 hours
    -very high potency
    -small animals

-slow
-very high toxicity

62
Q

What species is mepivacaine used in ?

A

equine

63
Q

Name some blocks

A

-preincisional
-castrate - pre incisional , intra testicular
-ovariohysterectomy - direct infiltration of mesovarium ligament , lavage peritoneal cavity with local
-eye - retrobulbar (curved or straight needle )
-epidurals - lumbosacral , sacrococcygeal
-dental - rostral maxillary ( soft tissue ) , caudal maxilary, mandibular block ( and rostral mandibular )
-IVRA intravenous regional analgesia

64
Q

What’s a nerve locater ?

A

use it to find nerve to administer nerve block

65
Q

TRUE/FALSE only use pure lidocaine IV

A

true

66
Q

Name 3 local anaesthesia techniques for flank surgery

A

-line block
-inverted L block
paravertebral anaesthesia

67
Q

What gauge and length needle would you use for large animal nerve blocks ?

A

18 gauge , 1 1/2 inch

68
Q

Describe how to do a line block and some properties

A

-local at varying depths along incision site
-unrealiable anaesthesia of peritoneum
-slow

69
Q

Describe how to perform an inverted L block and some properties

A

like a line block but in inverted L shape - block both routes to the flank area
-unrealiable anaesthesia of peritoneum
-slow

70
Q

Describe how to perform paravertebral anaesthesia .

A

-T13 , L1, L2 (L3 for caesarean )
-once deep to transverse processes insert local then pull up insert more before coming out
-fast
-anaesthesia in most of flank - include peritoneum

71
Q

Name some blocks for foot surgery in cattle

A

-ring block
-IVRA

72
Q

What local do we use for cattle ?

A

procaine

73
Q

What local do we use for horses ?

A

lignocaine

74
Q

What are the 5 sensory nerve blocks of the head in a horse ?

A

-supraorbital - frontal nerve 9 branch optic )
-lacrimal -lateral canthus
-zygomatic - (zygomatic nerve )
-infratrochlea - Medial canthus
-retrobulbar - cilary body nerves

75
Q

What sedatives do we use for cattle ?

A

xylazine
detomidine

76
Q

What GA do we use fro cattle

A

ketamine

77
Q

What opiods do we use for cattle ?

A

butorphanol

78
Q

TRUE/FALSE ACP is licensed in horses

A

true

79
Q

When to avoid using ACP in horses ?

A

neonates , pregnant , hypotensive , breeding stallions ( effects retractor penis muscle )

80
Q

TRUE/FALSE Brachy at risk of airway obstruction in recovery

A

true

81
Q

What are some common causes of upper airway obstruction ?

A

-loss of pharyngeal muscle tone
-regurgitation or vomiting
-laryngospasm or laryngeal oedema ( especially cats - don’t extubate too late
-traumatic intubation
-brachy

82
Q

Signs of upper airway obstruction

A

-increased resp noise and effort
-abdominal effort
-nares flare
-“air hunger “ - head and neck extended
-cyanosis ( late sign )
-restless
-agonal breathing ( terminal sign )

83
Q

why high mortality rate in horse anaesthesia ?

A

-fractures in recovery
-post anaesthetic myopathy
-neuropathies and spinal cord malacia
-intraoperative cardiac arrest
-resp obstruction

84
Q

What risk factors increase mortality rates in horses ?

A

-increase ASA grade
-increase age and foals
-surgery type and position - dorsal
-duration - pressure on parts of body
-time of day - in OOH vet tired , less staff
-agents - premed TIVA
-recovery quality

85
Q

What fresh gas flow rate to use for a large animal circle ?

A

-start 6-8l/min
-after 15 min reduce to 3-4l/min

86
Q

TRUE/FALSE: ACP as a pre med for horses reduces mortality rates

A

true

87
Q

Common induction agents in equine

A

-ketamine
-benzodiazepine

88
Q

TRUE/FALSE biggest problem with maintenance of anaesthesia in horses is hypotension

A

true

89
Q

How long does triple drip last ?

A

45 min

90
Q

What top-up bolus injections can you give to a horse to maintain anaesthesia ?

A

ketamine 0.5mg/kg every 10 min - can only do for 20 minutes

91
Q

What PIVA can you use for horse and what will this do ?

A

-ketamine infusion
-lidocaien CRI
-Alpha 2 agonist infusion

-reduce MAC and amount of inhalation agent required

92
Q

State some complications that occur during equine anaesthesia .

A

-hypotension
-hypoxaemia
-hypercapnia
-bradycardia
-tachycardia
-neuropathy
-eye problems

93
Q

How would you improve hypotension in horse under anaesthesia ?

A

-positive inotrope - dobutamine
-reduce iso
-use PIVA
-increase fluid

94
Q

How would you improve hypoxaemia in horse under anaesthesia ?

A

-check not just machine
-switch down iso
-IPPV
-IVFT
-tilt head
-give beta agonist - salbutamol

95
Q

How would you improve hypercapnia in horse under anaesthesia ?

A
  • can tolerate up to 70 CO2
    -reduce iso
    -IPPV
96
Q

How would you improve bradycardia in horse under anaesthesia ?

A

-cause - volatile agent? opiod?
-if still low give hyoscine N butylbromide

97
Q

How would you improve tachycardia in horse under anaesthesia ?

A

-cause ? - sympathetic stim ? , CO2 ?
-increase depth with ket bolus iv
-more analgesia

98
Q

TRUE/FALSE must protect lowermost eye with padding and lubricate when a horse is anesthetised or they’ll get corneal ulcers

A

true

99
Q

What are the optimal timings for a horses movement in recovery ?

A

-lateral - 30 min
-sternal - 10-15 min
-standing - 15 min

100
Q

TRUE/FALSE give a low dose sedative while in recovery so horses don’t hurt themselves as the anaesthesia wears off

A

true

101
Q

Name some causes of bradycardia when under GA

A

-drug
-toxaemia
-vagus stimulation (e.g if touching eye , gut)
-heart problem
-hypoxia
-hypothermia

102
Q

How to approach bradycardia in anaesthetised patient ?

A

-look ABP and SPO2 -see if affected
-check depth , vagal tone , hypoxia , toxaemia
-if drug induced give reversal or give anticholinergics ( e.g atropine )

103
Q

What might cause tachycardia in an anaesthetised patient?

A

-sympathetic stimulation - too light
-abnormalities in ph , CO2 ,O2
-low ABP
-drugs

104
Q

How would approach tachycardia in anaesthetised patient ?

A

-check ABP and O2
-depth of anaesthesia ,CO2
-IV opiod ( fentanyl , methadone) /lidocaine
*can increase volatile agent with increase in opioid

105
Q

What might cause a ventricular ectopic beat in the anaesthetised patient ?

A

-circulating catecholamines ( stress)
-hypoxia/hypercapnia
-hypovolaemia or hypotension
-drugs
-myocardial inflammation or stimulation
-trauma

106
Q

How would you approach a ventricular ectopic beat in patient under GA ?

A

-check ABP,O2
-is there risk fibrillation
-check depth , CO2
-IV opiod /lidocaine
*vaporiser setting increased with opiod

107
Q

What are the common causes of hypotension in GA ?

A

-anaesthetic drugs
-hypovolaemia and haemorrhage
-cardiac insufficiency

108
Q

How would you approach hypotension ?

A

-try determine cause
-reduce volatile agent
-increase IVFT
-re-check ABP
-inotrope ( dobutamine ) - make heart pump harder
-or vasopressor ( noepinephrine ) -

109
Q

Why would hypercapnia occur in GA ?

A

-depth
-hypoventilation - panty
-pyrexia
-rebreathing
-fresh gas too low

110
Q

Reasons why hypocapnia might occur under GA

A

-disconnection
-mis -intubation
-obstruction
-hyperventilation
-cardiac arrest

111
Q

TRUE/FALSE cats have a higher ET CO2 reading on non-breathing systems

A

false -its lower

112
Q

TRUE/FALSE = cardiogenic oscillations are an emergency

A

false - nothing to worry about

113
Q

How would you approach hypoxaemia ?

A

-replace pulse oximeter probe to check right
-check not disconnected
-reduce volatile agent
-improve perfusion - IVFT, inotropes
-ventilate , tilt table if obese
-investigate other causes ( haemorrhage , pneumothorax )

114
Q

State some signs of cardiopulmonary arrest

A

-loss of consciousness
-apnoea /agonal gasp
-no corneal reflex or palpebral

115
Q

Name reversals / antagonists of alpha 2 , opiod , opiods, benzodiazepine

A

-alpha 2 - atipam ( atipamezole)
-opiod - naloxone
-benzodiazepine - flumazenil

116
Q

What is Asystole and PEA and what would you do to correct these ?

A

-asystole - flat line
-PEA - pulseless electrical activity * can look normal

-adrenaline - shunts blood from preiphery to heart
-vasopressin - peripheral vasoconstriciton
-atropine - reduce vagal tone

117
Q

How would you prepare for operation of sick animal ?

A

-preop bloods
-IVFT resuscitation
-anti anxiety

118
Q

What pre med would you give to a sick patient ?

A

-opiod
-fentanyl and midazolam
-ketamine and midazolam - cats
-alfaxalone with opiod
*avoid alpha 2 agonists

119
Q

How would you induce a sick patient

A

-palpate pulse during induction
-mucous membranes

120
Q

How is maintenance and monitoring of GA different in sick animal ?

A

-avoid too much depth
-PIVA and TIVA can reduce reliance on volatile agent
-IVFT
-analgesia , local blocks
-emergency drugs ready and calculated
-efficiency
-warm

121
Q

What does APL stand for and what does it allow ?

A

-adjustable pressure limiting valve
- allows exhaled waste gas and fresh gas to leave the breathing system when pressure within the system exceeds the valves opening pressure

122
Q

TRUE/FALSE don’t need to starve rabbits before surgery

A

true

123
Q

How would you ventilate rabbit?

A

v-gel

124
Q

TRUE/FALSE you want to keep a rabbit in sternal for as long as you can when undergoing surgery

A

true
( want to keep thorax higher than abdomen if have to lie on back - so organs don’t effect resp rate as much )

125
Q

What would you use to monitor rabbit ?

A

-capnograph - very important
-doppler
-temp

*SPO2- bv too small
ECG - too fast hard to read , hair

126
Q

How would you increase rabbits bp ?

A

-warm up
-drugs - vasopressins
-fluids - 10ml/kg for 10-15 min - can do at least 3-4 times
-increase heart rate with atropine

127
Q

TRUE/FALSE = red blood cells in bird are nucleated

A

true
*messes up SPO2 reading

128
Q

Where would you administer fluids to bird ?

A

-iv in wing vein or medialmetitarsal vein
-interoseous - easy in birds

129
Q

TRUE/FALSE tortoises will stop metabolising the drugs you’ve given if the surrounding area is around 30 C

A

true

130
Q

Why is it important to ventilate tortoises in recovery ?

A

their breathing isn’t stimulated by co2 in blood is triggered by oxygen

131
Q

What are the top 5 anesthetic complications ?

A

-hypotension
-hypothermia
-abnormal heart rate
-hypoventilation
-difficult recovery

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