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Medical Nursing > Anaesthesia in animals with pre-existing disease > Flashcards

Anaesthesia in animals with pre-existing disease Flashcards

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1
Q

What is the monroe Kellie hypothesis?

A

Is a pressure-volume relationship that aims to keep a dynamic equilibrium amoung the essential non-compressible components inside the rigid compartment of the skull

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2
Q

When may the blood brain barrier be disrupted?

A

Trauma
Inflammation
Hypertension

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3
Q

What % of the co does the brain receive and why?

A

15% because it has a high metabolic rate

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4
Q

What is intercranial pressure influenced by?

A

Cerebral perfusion pressure
PaCO2
PaO2
Cerebral metabolic activity

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5
Q

What is the cushings reflex?

A

Nervous system response to increased intercranial pressure
Cushings traid of increased blood pressure
Irregular breathing
Bradycardia

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6
Q

What can be used to reduce intercranial pressure?

A

Mannitol osmotic diuresis

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7
Q

What are the clinical signs of increased intercranial pressure?

A 
Seizures 
Odema around the optic nerve 
Subdued 
Depressed mentation
Reluctant to move
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8
Q

What is cerebral percussion pressure and what can it be influenced by?

A

Pressure gradient between MAP and ICP
Cerebral blood flow is autoregulated MAP 50-150mmhg
Coughing, vomiting, pressure on the jugulars increases venous outflow pressure

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9
Q

Why is it important to control PaCO2 in a neuro patient?

A

Every 1mmhg increase in co2 there’s a 4% increase in cerebral blood flow

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10
Q

At what parameters should you maintain CO2 at during anaesthesia for a neuro patient?

A

30-45mmhg

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11
Q

What steps may you take to decrease CO2 during anaesthesia in a neuro patient?

A

Ventilate

Pre-oxygenate before surgery

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12
Q

What should be avoided when placing an ET tube in a neuro patient?

A

Coughing raises ICP

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13
Q

What is intracerebral steal?

A

Damaged area loses ability to autoregulate whenundamged are vasodilates blood is shunted away from damaged area

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14
Q

What is inverse steal in the brain?

A

Damaged areas cannot auto-regulatevasoconstriction if un damaged area leads to blood shunted towards the damaged areas

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15
Q

Why should hypoxia be avoided in a neuro patient?

A

It will cause dilation

Consider 100% oxygen for recovery

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16
Q

Why should hypothermia and barbiturates be avoided in a neuro patient?

A

Will decrease cerebral activity

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17
Q

What are the effects of ACP and dexmedotomidine and which one should be used in a neuro patient?

A

Dexmeditomidine
Initial hypertension maintains MAP below 150mmHg
Cerebral protection
Can get vomiting
Acepromazine
Peripheral vasodilation can increase cerebral blood flow and intercranial pressure

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18
Q

Which inhalation agent should be used in a neuro patient and why?

A

Sevoflurane

Cerebral protectant

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19
Q

Why should neuro patients be handled and positioned carefully?

A

Harness to reduce pressure on jugular veins

Keep head elevated to improve cerebral venous drainage

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20
Q

Why should fluid balance be carefully monitored in the neuro patient?

A

Hypertension can increase intercranial pressure

Hypotension can limit the blood supply to the brain (vasodilation)

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21
Q

What should also be monitored for in the neuro patient?

A

Seizures

22
Q

How should an anaesthetic patient be monitored if they have a clinical history of seizures?

A

Be aware of the current medication
Phenobarbital can induce hepatica enzymes
Potassium bromide causes and electrolyte abnormality
Iv carheter essential
Close monitoring before and after anaesthesia
Capnography
Blood presure

23
Q

What must be considered when anaesthetising a neuromuscular disorder patient?

A

Pre-disposed to regurgitation and aspiration
Check gag reflex
May affect respiratory muscles
Capnography may require IPPV

24
Q

What is important to consider when anaethetising and myasthenia graves patient?

A

Exxagerated response toNMB agents

25
Q

What is important to consider in patients being anaesthetised who have an oesophageal foreign body?

A

Tube may be damaged during surgery or need to be removed
Stabilisation before
Dehydration( not been able to drink)
Potential for regurgitate and aspiration
Pre-oxygenation
Suction available
Keep the head elevated until the ET tube is inserted and cuff inflated
Possible rupture of the oesopagus
Analgesia

26
Q

What are important considerations for the GI foreign body anaesthetised patient?

A 
Fluid balance disruptions hypovolamia acid base electrolytes dehydration 
Avoid vomiting inducing drugs 
Potential regurgitate and aspiration 
Slow release of fluid from the abdomen 
Hypothermia
Monitor respiratory rate carefully
27
Q

What are the considerations for the GDV patient undergoing anaesthesia?

A 
Shock, stabilise first fluids 
Decompress stomach
Arrhythmias
Careful monitoring cardiovascular system 
Hypotension 
Pressure on the diaphragm from distended viscous 
Clotting abnormalities 
Possible pneumothorax 
Intensive post-op care
28
Q

What are the important considerations for the colic surgery horse being anaesthetised?

A 
Electrolyte and acid base imbalance 
Hypovolameia shock 
Dehydration 
Cardiovascular arrhythmia 
 Very painful! Analgesia-NSAIDs, Xylazine, opioids 
Decompress stomach 
Distended viscera pressure on the lungs risk of rupture 
Endotoxamia 
Fluids-Hartmanns, 7.5% Nacl, colloids
29
Q

What conditions can affect the livers function?

A

Acute liver failure
Portosystemic shunt
Billary tract obstruction/trauma
Chronic disease

30
Q

What is the livers function?

A 
Clotting factors 
Production plasma proteins 
Drug and hormone bio transformation 
Bilirubin excretion 
Urea production 80% of the blood supply passes through the portal vein
31
Q

What are liver patients at risk of during surgery?

A

Hypothermia
Hypoglycemia
Haemorrhage
Increased free fraction of drugs (less plasma proteins to bind to)
Decreased hepatic clearance of drugs
Water and sodium retention, potassium loss

32
Q

What are the effects of anaesthesia on the liver function?

A

Hypotension-decreased perfusion
Hepatotoxicity
Enzyme induction

33
Q

Pre-anaesthetic laboratory tests required for the liver

A 
Liver enzymes 
Bile acids 
Clotting function 
Urea 
Plasma proteins 
Glucose
34
Q

What are the general considerations for a anaethetised liver patient?

A 
Thermoregulation 
Medical management encephalopathy 
Monitor blood glucose 
Blood pressure 
Maintain adequate renal perfusion 
Monitor blood loss 
Avoid hypoxia and hyopercapnia 
CVP 
Use of short acting drugs 
Monitor individual animal response
35
Q

What considerations should you make for an anaethetised insulinoma patient?

A 
Monitor glucose 
5% dextrose infusion 
Pain!! 
Medical management-prednisalone, diaoxide, glucose 
Avoid hyperglycaemia and hypoglycemia 
May consider NMB agent
Post-operative pancreatitis
36
Q

What considerations must we make for a diabetic patient undergoing anaesthesia?

A

Stabilise prior to surgery- ketosis, dehydration, weight loss, fatty liver
Feed asap after surgery
Postpone fasting for as long as possible
Glucose infusion if required
Avoid hypoglycemia and hyperglycaemia
Monitor temperature
Give half dose insulin before the procedure then half dose once eaten afterwards
Know the routine at home (favourite food)
1st patient of the day
Fluids include glucose
Avoid medetomidine(hyperglycemia)
Good analgesia
Short acting drugs
Poss 2nd iv

37
Q

What considerations should we make for the anaesthetised hyperthyroid patient?

A 
Difficult to handle 
Easily stressed 
IM sedation then IV 
Sedation with opioids and ACP 
Avoid ketamine and medetomidine 
Iv induction
Consider chamber 
Iv fluids 
Monitor ECG
Fast metabolism 
Prone to hypothermia 
PUPD 
Thin 
Muscle weakness 
Hypertrophic cardiomyopathy
38
Q

What considerations should we make for the anaesthetised patient undergoing a thyroidectomy?

A 
Monitor blood pressure 
Monitor other parameters for depth of anaesthesia as surgery located at the head end 
Potential laryngeal paralysis post op
Monitor for hypocalcemia 
Keep Iv in and patent
39
Q

What considerations should we make during anaesthesia for the hypothyroid patient

A 
Prone to hypothermia 
May have megaoesophagus 
Decreased GI motility 
Obesity 
Lethargy 
Bradycardia and hypotension 
Slow biotransofrmation of drugs
40
Q

What considerations should we make for hyperadrenocortisim?

A 
Cushings 
Poor muscle tone 
Overweight 
Lethargic 
Poor thermoregulation
Bruising 
Risky of pulmonary thromboembolism 
Hypercoagulability 
PUPD sodium retention potassium excretion
Risk of wound infection and dehiscence
41
Q

Hypoadrenocortisim considerations for the anaesthetised patient?

A 
Addisions 
Lack of cortisol production. 
Hyperkalaemia 
Dehydration 
Bradycardia 
Weight loss 
Weakness 
Lethargy 
Stabilise before anaesthetic
42
Q

Why is jaundice a problem in the anaesthetised patient?

A

Neohrotoxic

43
Q

Why might hypoalbmenia be a problem in an anaesthetised patient?

A

More free fraction of drugs

Albumin binds the anaesthetic drugs

44
Q

Why may hypotension be a problem in the liver diseases anaesthetised patient?

A

Reduced hepatic perfusion

Hepatocellular compromise

45
Q

What drug is recommended for analgesia in the liver patient?

A

Pethidine usually lasts 1-2 hours can last up to 24 hours in a hepatic compromised patient

46
Q

What other drug should be avoided if an insulinoma patient is already receiving prednisalone?

A

NSAIDS

47
Q

What may hyperthyroid cats be predisposed to before surgery?

A

Arrhythmia

48
Q

What does obesity increase the risks of in anaesthesia?

A

Ventilation compromised

Regurgitate and aspiration

49
Q

What is it important to encourage a hyperadrenocortisim patient to do after surgery?

A

Mobilise

50
Q

What is an hypoadrenocortisim patient unable to do?

A

Mount a stress responses

Medical Nursing (22 decks)

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