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Surgical and Anaesthesia nursing > Anaesthesia nursing > Flashcards

Anaesthesia nursing Flashcards

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1
Q

what are the 4 types of induction agents (with examples)

A
  1. Barbituates (e.g Thiopental)
  2. Steroids (e.g Alfaxalone)
  3. Cyclohexanones (e.g Ketamine)
  4. Phenols (e.g Propofol)
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2
Q

why do we need a pressure regulator valve? (2 marks)

A
  1. To keep constant

2. To lower the pressure going into the patient

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3
Q

What are the differences between rebreathing and non-rebreathing circuits?

A

Rebreathing:

  • Uses sodalime chamber to absorb CO2
  • Higher resistance to ventilation
  • More economic on gases
  • Denitrogenation for first 10 minutes

Non-rebreathing:

  • No CO2 absorption
  • CO2 cleared by high gas flow rate
  • Normally have ‘pop off’ valve
  • Low resistance to ventilation
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4
Q

What are the differences between rebreathing and non-rebreathing circuits?

A

Rebreathing:

  • Uses sodalime chamber to absorb CO2
  • Higher resistance to ventilation
  • More economic on gases
  • Denitrogenation for first 10 minutes

Non-rebreathing:

  • No CO2 absorbtion
  • Higher flow rate to clear CO2
  • Normally have ‘pop off’ valve
  • Low resistance to ventilation
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5
Q

What is the difference between a vapour and a gas?

A

Vapour: Turns to a liquid when put under pressure and is below is critical temperature
Gas: Does not turn to a liquid under pressure and is above is critical temperature

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6
Q

Why is a nitrous oxide cylinder pressure gauge inaccurate most of the time?

A

Nitrous Oxide is a vapour so gauge thinks cylinder is full due to it coming out in a gaseous form

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7
Q

What are the advantages and disadvantages of cyclohexanones (Ketamine)

A

Advabtages:

  • Provides analgesia
  • High therapeutic index so will not cause toxicity
  • Little effect on cardiorespiratory depression
  • Reflexes still in place
  • Multiple administration routes (IV & IM)
  • Blood pressure maintained

Disadvantages:

  • Confusion in monitoring (dilated eyes, still has reflexes)
  • Stormy recovering if given alone
  • No muscle relaxation
  • Hypersalivation
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8
Q

What are the properties of cyclohexanones (Ketamine)

A
  • Provides analgesia and amnesia
  • If given with alpha-2 agonist must wait 40 minutes before reversing
  • Minimal muscle relaxation
  • Normally combined with benzodiaepine (midazolam) for muscle relaxation
  • Administered IV or IM
  • Absorbed through MM’s so care taken when administering
  • Metabolised by the liver but contraindicated in patients with liver disease
  • Fast onset & lasts 20-40 minutes
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9
Q

What are the principles of effective CPR and IPPV?

A
  • Reassess patient every 2 minutes
  • Change over time maximum of 10 seconds
  • Ratio 30:2 of chest compressions:breaths
  • Compress chest by 1/3
  • Compress chest between 4th and 5th intercostal space
  • Patient in right lateral on a hard surface
  • Aim for 100-120 compressions a minute
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10
Q

Identify the properties of Phenols (Propofol)

A
  • Painful if goes perivascularly
  • Not water soluble so dissolved in emulsion
  • if it doesn’t contain a preservative it must be discarded after 12 hours
  • Administered IV
  • Given slowly as apnoea is common
  • Potent vasodilator so hypotension may occur
  • Only provides narcosis and relaxation
  • Binds strongly to proteins so care taken if patient hypoalbumnaemia as won’t bind and can cause toxicity
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11
Q

What are the properties of sevoflurane?

A
  • Very low blood gas solubility (fast onset)
  • Not irritant to mucosa
  • Licensed for cats and dogs (can be used for other patients on the cascade)
  • Normal range 3.3-3.8%
  • Expensive
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12
Q

What are the properties of Isoflurane?

A
  • Licensed for cats, dogs, horses and other equidae, birds, reptiles and small mammals
  • Irritant to mucous membranes
  • Low blood gas solubility
  • Normal range 1.5-2.5%
  • Unpleasant smell
  • Very little metabolised so non toxic
  • HR maintained but vasodilation so hypotension seen
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13
Q

What are the properties of halothane?

A
  • No longer used (expired 2018)
  • Decomposed by UV light so kept in dark bottle
  • Contains thymol (preservative) which can build up in vapouriser and effect function
  • Poor analgesia
  • Moderate muscle relaxation
  • Reduces hepatic blood flow so if patient given drugs metabolised by the liver it will reduce effect
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14
Q

What are the properties of nitrous oxide?

A
  • Insoluble in blood so rapidly enters & leaves blood stream
  • Analgesic effects
  • Diffuses in gas filled areas so limited use
  • Used mainly in orthopaedics for additional analgesia
  • Rapid recovery as less volatile agent used
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15
Q

What does the pulse oximetry measure?

A

Arterial Oxygen satuation

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16
Q

Discuss the use and limitations of using pulse oximetry

A

Use:

  • Cheap
  • Non-invasive
  • Easy to interpret
  • Gives pulse rate
  • Readings below 95% must be investigated

Limitations:

  • Must be on pigmented skin
  • Prone to error due to clip
  • Calculates using red and inferred light
  • Readings below 70% may be inaccurate
17
Q

What are the expected systolic blood pressure ranges for:

  1. Dogs
  2. Cats
  3. Rabbits
A
  1. 90-140
  2. 80-140 mmHg (millimetre of Mercury - for all)
  3. 70-170
18
Q

What is the capnograph used to measure?

A

End Tidal CO2

19
Q

What is the normal range considered to be for capnography?

A

35-45 mmHg

20
Q

What are the properties of a circle circuit?

A
  • In common use
  • Low flow rate therefore cheaper
  • Heat and moisture conservation
  • Unidirectional valve
  • Suitable for IPPV
  • Sodalime removes CO2
  • Maintenance flow rate set at 10ml/kg/min
  • 2 litre bag
  • Patient >10kg
21
Q

What are the properties of the Humphrey ADE circuit?

A
  • Low flow rate therefore cheaper
  • Can be used on range of weights (0-100kg)
  • Semi-closed mode for 0-7kg (without sodalime), Recycling mode for 7-100kg (with sodalime)
  • Components:
  • APL valve
  • Resevoir bag
  • Lever to sert mode (upwards = spontaneous & uses bag, downwards = controlled & uses ventilator)
  • sodalime canister (patient > 7kg)
  • Ventilator port
22
Q

What are the types of pre-medications used in practice?

A
  • Alpha-2 adrenoreceptor agonists
  • Opiods
  • NSAIDS
  • Atropine
  • ACP
23
Q

What are the properties & side effects of ACP?

A

Properties:

  • Sedation
  • CNS depression (inhibition of dopamine)
  • Altered mood and removal of fear
  • Over-sensitivity in some breeds
  • -Anti-emetic effect
  • Smooth muscle spasmolytic

Side effects:

  • Hypotension
  • hypothermia
  • Cardiac dysrythmia (IV administration)
  • Decreased seizure threshold
24
Q

What are the properties and side effects of Alpha-2 adrenoreceptor agonists?

A

Properties:

  • Depression of CNS
  • Dose dependent sedation, analgesia and muscle relaxation
  • Used with Butorphanol
  • Effects on CV system
  • Animals may appear deeply sedated but react
  • RR falls but arterial blood gases maintained
  • Can be reversed (IM)

Side effects:

  • Decreased RR
  • Marked effect on CV system
25
Q

What are the properties of Opiods?

A

-Stimulation of Mu, Kappa and Delta receptors results in analgesia, respiratory depression miosis, reduced GI motility and euphoria
-Sometimes used in isolation as pre-medication (high risk patients)
Commonly used with ACP (lower doses can be used)
-Provides analgesia, sedation and relaxation
-Can be pure or partial

26
Q

What are the properties & side effects of atropine

A

Properties:

  • Not commonly used now, previously used as sedation
  • Used now in specific cases
  • Brachycephalic patients
  • Reduces salivation and secretions

Side effects:

  • Dry mouth
  • Tachycardia
  • Cardiac arrhythmias
  • Confusion
  • Mydriasis
27
Q

What are the cranial nerve reflexes and how do you observe them? (12 marks)

A
  1. Palpebral - touch corner of eye
  2. Corneal - touch eyeball (usually euthanasia)
  3. Eye position - Look at eye, observe VENTROMEDIAL position
  4. Pupillary - size, use torch (if very dilated indicates very deep)
  5. Jaw tone - pull jaw & feel for resistance
  6. Tongue curl - look for positive tongue curl (tongue curl comes back before swallow)
28
Q

What are the 3 methods of measuring blood pressure and how do they work?

A
  1. Doppler - Doppler probe placed over digital artery, inflate cuff proximal to probe & continue to inflate until doppler sound stops. Deflate cuff until first sound from Doppler is audible (Take 6 readings and discard the first, then average)
  2. Oscillometric - Cuff is mechanically inflated and deflated and recognises the small change in pressure, usually an ECG reader
  3. Direct Arterial - catheter placed into a peripheral artery and connected to a pressure transducer with a saline filled line (more common in EQ)
29
Q

Compare the use of phenols in cats and dogs

A

Dogs:

  • Rapidly metabolised by the liver & lungs so fast recovery
  • Can be used in patients with liver disease
  • Can be used as maintenance
  • Can be used in seizuring dogs

Cats:

  • Liver not capable of detoxifying quickly so recovery longer
  • Not used in patients with liver disease (put on fluids if not alternative)
30
Q

What drugs may be administered during CPR and why would they be used?

A
  • Adrenaline = Causes vasoconstriction & redirection of blood from the peripheries, increases cardiac contractility, causes bronchodilation (optimises air intake)
  • Atropine = Increase HR, used in bradycardic patients
  • Lidocaine = Used as antiarrhythmic in cases of ventricular arrhythmia
31
Q

What are the types of compressions that can be performed during CPR and how are they performed?

A
  1. Cardiac pump - head slightly down, arms placed at 4th-5th intercostal space, arms extended & elbows locked, forced applied by bending at the wrist
  2. Thoracic pump - medium to large dogs & barrel chested, chest compressed at widest point to increase thoracic pressure, leading to forward blood flow and compression of heart
  3. Interposed abdominal compression - abdomen manually compressed during relaxation phase of chest compressions to increase venous return

Can also place in dorsal recumbency and compress sternum for dogs with wide thorax (eg bulldogs)

32
Q

What are the properties of steroids induction agents (Alfaxalone)?

A
  • No analgesic properties
  • Minimal cardiorespiratory depression
  • Apnoea may occur post induction
  • No pain on injection
  • Good muscle relaxation
  • Uneventful recovery
  • Rapidly metabolised by liver of cats & dogs
  • Suitable as maintenance with top ups or as CRI
  • Muscle twitching may be seen after induction or on recovery
33
Q

Name the types of inhalation agents (5 marks)

A
  • Isoflurane
  • Sevoflurane
  • Halothane
  • Nitrous Oxide
  • Desflurane
34
Q

Outline how anaesthetic drugs can effect the brain and nervous system (3 marks)

A
  • Drugs must be lipophillic to cross the blood brain barrier
  • Combine to a variety of receptors in the CNS
  • Depression of CNS causes unconsciousness
35
Q

Outline the difference between respiratory cycle and respiration (4 marks)

A
  • Respiratory cycle has 2 phases (inspiratory and expiratory)
  • Respiration is process of gas exchange and has 2 processes (external and internal)
  • External is the respiratory cycle
  • Internal is the O2 used to release energy & happens at a cellular level

Surgical and Anaesthesia nursing (3 decks)

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