Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FCP Week 3 > Anaesthesia for sicker patients > Flashcards

Anaesthesia for sicker patients Flashcards

1
Q

ASA Physical Status 1

A

A normal healthy patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ASA Physical Status 1 Examples

A

Non-brachycephalic
Normal body condition score
No underlying disease present
Procedures such as neutering or simple fracture repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ASA Physical Status 2

A

A patient with mild systemic disease (animal well compensating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ASA Physical Status III

A

A patient with severe systemic disease (animal not compensating fully)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ASA Physical Status IV

A

A patient severe disease that is a constant threat to life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ASA physical Status V

A

A moribund patient who is not expected to survive without this procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Addition of letter ‘E’ to physical status

A

Denotes an emergency defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is a sinus rhythm normal

A

Normal in dogs, abnormal in cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a gallop rhythm an indicator of

A

Myocardial disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Effect of cardiovascular disease

A

Reduced cardiac output and stroke volume -> poor profusion, this has other organs such as on GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What to do before anaesthetising a patient with cardiovascular disease

A

Try to get a diagnosis- echocardiogram
Try to stabilise patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does cardiac disease affect drugs for anaesthesia

A
  • Longer onset for drugs given IM or IV
  • Quicker increases in plasma concentration of inhalation anaesthetics due to reduced CO
  • Effects of drugs less predictable due to altered volume distribution
  • Lower doses needed if patient has reduced albumin levels
  • Longer duration of drugs if blood flow to liver reduced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examples of Drug combinations for patients with cardiovascular disease

A

Midazolam (benzo) and opioid OR
Alfaxalone (low dose) and opioid
May consider co-induction - propofol/midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Measures for patients with cardiovascular disease

A

Preoxygenation
Prompt intubation at induction
Avoid stress and nociception
Be prepared to give IPPV
Avoid increasing vagal tone- careful with eyes and moving head
Care with IVFT as this can create more work for the heart
Have emergency drugs drawn up or to hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pre-operative assessment of patient with renal disease

A

Check dehydration/hypovolaemia
Is the patient blocked?
History- PUPD, weight loss
Bloods- determine degree of azotaemia, anaemia, hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to stabilise patient with renal disease

A

IVFT- dehydration
Anti-emetics- prevent emesis and risks of regurgitation
Blood transfusion- severe anaemia
Relieve blockage- cysto or urinary catheter

17
Q

MAP under which renal autoregulation of blood flow no longer functoins

A

<80mmHg, after this point perfusion is proportional to blood flow

18
Q

Main cause of hypovolaemia under anaesthetic

A

Inhalation agents

19
Q

Ionotropic Agents ( examples and use)

A

Dobutamine, dopamine
Used to maintain/ increase Cardiac Output

20
Q

Drug alterations for patients with renal disease

A

NSAIDs are contraindicated
Reduce renally excreted drugs to prevent accumulation

21
Q

Why are NSAIDs contraindicated in renal disease

A

Inhibit prostaglandin and therefore afferent vasodilatory mechanisms

22
Q

Considerations when anaesthetising patients with GI disease

A

Provide anti-emetics
Treat dehydration/hypovolaemia/pre-renal azotaemia
Use cuffed ET to prevent regurg
Analgesia- for chronic or acute pain (NSAIDs contra-indicated_
Titre drugs to effect- if low albumin-> more free drug

23
Q

Considerations in Anaesthetic for animal with severe liver disfunction

A
  • Metabolism in liver reduced-> effects will be prolonged
  • Albumin is produced in the liver so less albumin -> more free drug-> reduce doses
  • Gluconeogenesis and glycogenolysis occur in liver so patient may be hypoglycaemic
  • Patient may be hypotensive as bile acids affect the endothelium of the blood vessels
  • Increased risk of infection
24
Q

Considerations for anaesthetic in animal with Diabetes insipidus

A
  • caused by lack of ADH or a failure of kidneys to respond to it
  • Patients will have severe polyuria with compensatory polydipsia
  • They can become easily dehydrated and hypovolaemic so can end up with v high sodium concentrations (hypernatremia) in the blood
  • Don’t deprive them of water and maintain vascular volume
  • Start treatment with desmopressin to improve the patient’s condition before GA
25
Q

Analgesia for ASA 5

A

Aim to calm animal
Pure mu opioids
Rarely require alpha-2-agonsitsts

26
Q

Induction agent for ASA 5

A

is often not requires

27
Q

Anaesthetic protocol for ASA 5

A
  • Preoxygenate, prepare ET tubes, laryngoscope
  • Combine induction/premedication to save time
  • Secure IV access, give IVFT
28
Q

Example anaesthetic drugs used for ASA 5

A

Benzodiazpine+ opioid + induction agent IV (alfaxlone/ketamine/propofol). or
Benzodizipine +induction agent IV (opioid IM)

29
Q

Drugs to avoid for ASA 5

A

Alpha-2-agonist, ACE, propofol (can cause apnoea and reduce HR and BP)

30
Q

Anaesthesia for Caesarean

A

Choose dugs with a short duration of action
Use the lowest possible dose
Provide oxygen and intubate (if GA)
Opioids to the dam
Use LA if possible t reduce MAC & provide analgesia
monitor ABP, give fluids

31
Q

Preventing emesis and aspiration in caesarean

A

GI changes during pregnancy and post-op pneumonia are reported

32
Q

Drugs to use in pregnant dam

A

All perioperative drugs may have an effect on neonates
Xylazine- associated with neonatal mortality (newer alpha-2-agonists may not have the same effect however the vasoconstriction and decreased cardiac output associated wiht the is likely to have a negative effect on dam and fetuses- may be required with turly fear or fractious animals)
ACP- should be used cautiously as it is long acting, irreversible and ay reuse in hypotension
Careful assessment of anaesthetic agent
frequent pain scoring required

33
Q

Which gauge IV access should be used in an emergency

A

18 gauge (in each cephalic) to allow shock rate fluid if necessary

34
Q

Considerations for GDV

A

Is it possible to decompress with a stomach tube
Electrolyte imbalances can cause arrhythmias
Possible regurgitation and aspiration
Pain and distress
metabolic acidosis and increased lactate

35
Q

Pre-med for GDV

A

Full mu opioid for alangesia
If the patient is obtunded it may not be necessary
Drugs with major cardiovascular effects- such as alpha-2s- should be avoided

36
Q

Induction for GDV

A

Any agent can be used
Dose to minimal effect v important

37
Q

What is a sinus rhythm

A

FCP Week 3 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions