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Veterinary Medicine > Anaesthesia (SA) > Flashcards

Anaesthesia (SA) Flashcards

1
Q

What is an ASA grade I patient?

A

Normal and Healthy

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2
Q

What is an ASA grade II patient?

A

Mild systemic Disease

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3
Q

What is an ASA grade III patient?

A

Severe systemic Dz

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4
Q

What is an ASA grade IV patient?

A

Severe systemic Dz that is a constant threat to life

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5
Q

What is an ASA grade V patient?

A

Moribund - will not survive without surgery

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6
Q

What is an ASA grade E patient?

A

Emergency

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7
Q

What is the difference between pain an nociception?

A

Pain is recognised by the brain at a cortical level.

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8
Q

What are the four stages of nociception?

A

Transduction
Transmission
Modulation
Perception

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9
Q

What is “transduction”? (with regard to nociception)

A

Conversion of stimulus into AP by nerve end receptors

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10
Q

How is stimulus intensity conveyed during “transduction” of nociception?

A

frequency of AP generation

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11
Q

What is “transmission”? (with regard to nociception)

A

Conduction of impulses to/from CNS.

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12
Q

Where do sensory impulses enter the CNS?

A

Dorsal Root

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13
Q

Where do motor impulses exit the CNS?

A

Ventral Root

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14
Q

What is “modulation”? (with regard to nociception)

A

Amplification/suppression of nociceptive input at spinal cord level

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15
Q

How does modulation of nociception take place?

A

Aletered neuronal sensitivity/altered neurotransmitter release

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16
Q

What is “perception”? (with regard to nociception)

A

Processing, integration and recognition of stimulus in HIGHER centres. MUST BE CONSCIOUS.

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17
Q

What is acute pain often associated with?

A

Tissue Damage (or the threat of)

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18
Q

What is chronic pain?

A

Pain which persists beyond the expected course. NO purpose or clear end-point.

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19
Q

Define Neuropathic Pain

A

Pain caused by nervous system dysfunction

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20
Q

Define Allodynia

A

Perception of pain when a normally non-noxious stimulus is applied

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21
Q

Define Hyperalgesia

A

An excessive reaction to a noxious stimulus

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22
Q

Which sensory neurons are “low threshold sensory nerves”?

A

A Beta

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23
Q

Which sensory neurons are “medium threshold pain nerves”?

A

A Delta

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24
Q

Which sensory neurons are “high threshold pain nerves”?

A

C

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25
Q

Which are the principal neurotransmitters involved with central modulation?

A

Serotonin

Nor-adrenaline

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26
Q

How can we reduce pain sensitisation?

A

Avoid experience of pain

Treat Pain aggressively

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27
Q

Which Analgesics work at the nerve terminal level?

A

NSAIDs
Local Anaesthetics
Opiates

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28
Q

Which analgesics work in the dorsal horn of the spinal cord?

A 
NSAIDs
Opiates
NMDA antagonists
Ca Channel Blockers
Tramadol
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29
Q

Which analgesics work in the brainstem/cerebrum?

A 
NSAIDs
Opiates
NMDA antagonists
Ca Channel Blockers
Tramadol
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30
Q

What are the 7 classes of drugs for acute pain?

A

NO PLANT

NSAID
Opiate
Paracetamol
Local Anaesthetics
Alpha 2 Agonists
NMDA antagonist
Tramadol
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31
Q

Name 6 drugs that may be used to treat chronic pain. (not NO PLANT)

A 
Gabapentin
Amantidine
Anti-depressants
Green-lipped mussel
Elk Velvet Antler
Capsacin
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32
Q

What are the 4 goals of sedation?

A

Relive Anxiety
Ease Handling
Analgesia
Decrease Muscle Tone

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33
Q

What are the 3 formulations of ACP?

A

2mg/ml
5mg/ml
10mg/ml

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34
Q

What is an appropriate dose for ACP in the dog?

A

0.01-0.05mg/kg (lower if IV/large dog)

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35
Q

What is an appropriate dose for ACP in the cat/

A

0.03-0.07mg/kg

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36
Q

How is ACP administered?

A

IM/IV/SC in smallies

IM ONLY IN HORSES

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37
Q

What is the time to onset for ACP?

A

30min

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38
Q

How long is the duration of ACP?

A

3-8h

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39
Q

How does ACP work?

A

anti-dopaminergic

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40
Q

How does ACP interact with other sedatives?

A

Potentiates their CNS depression

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41
Q

How does ACP cause vasodilation?

A

Alpha 1 adrenergic blockade

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42
Q

How does ACP affect respiratory function?

A

Not much EXCEPT pharyngeal relaxation (bad for brachys)

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43
Q

Describe the hepatic/renal toxicity of ACP

A

Not Applicable - no direct effects

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44
Q

What are some potentially beneficial off-target effects of ACP?

A

Anti-emetic

Anti-histaminic

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45
Q

What CV SE would make ACP contraindicated in boxers and brahcycephalics?

A

Can cause syncope

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46
Q

What Haem/biochem abnormality may ACP cause?

A

Decreased PCV

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47
Q

What analgesic effect does ACP offer?

A

NONE!

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48
Q

Where is ACP metabolised?

A

Liver - no significant metabolites

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49
Q

At high doses, what symptoms may ACP trigger?

A

Extrapyramidal - rigidity/tremors

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50
Q

Which drug is CI’ed with ACP?

A

Epinephrine - Beta agonist so will cause even more vasodilation/hypotension

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51
Q

Which alpha two agonists may be used in cats and dogs?

A

Medetomidine

Dexmdetomidine

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52
Q

Which alpha 2 agonists may be used in horses?

A

Xylazine
Detomidine
Romifidine
(+medetomidine)

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53
Q

Via which route are a2 agonists administered?

A

IM/SC/IV

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54
Q

How to alpha 2 agonists initiate sedation?

A

agonists of alpha 2 in locus coeruleus in the brainstem

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55
Q

How do a2 agonists affect administration of other sedatives?

A

REDUCE DOSE!

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56
Q

Describe the CV effects following a2 agonist administration.

A

Initial vasoconstriction
Reflex Bradycardia
Vasodilation

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57
Q

How do a2 agonists affect the respiratory system?

A

Reduce RR

May alter R pattern

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58
Q

What analgesic effect does an a2 agonist have?

A

Good - but sedative lasts 2-3x longer.

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59
Q

How do alpha 2 agonists affect the kidneys?

A

Cause diuresis

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60
Q

How do alpha 2 agonists affect GI motility?

A

Decrease it

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61
Q

How do alpha 2 agonists affect blood sugar?

A

Cause hyperglycaemia - decrease insulin secretion

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62
Q

Where are a2 agonists metabolised?

A

Liver

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63
Q

Name the alpha 2 antagonist commonly used.

A

Atipamezole

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64
Q

In which animals are A2 agonists CI’ed?

A

DCM

MVD

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65
Q

Which benzodiazepines are commonly used in veterinary anaesthesia?

A

Midazolam

Diazepam

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66
Q

Which benzodiazepines are licenced for veterinary anaesthesia?

A

None

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67
Q

What dosage is used for benzodiazepines as part of an anaesthesia protocol?

A

0.2mg/kg

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68
Q

What dosage is used for benzodiazepines to control seizures?

A

0.5mg/kg

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69
Q

via which route can midazolam but NOT diazepam be given?

A

IM

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70
Q

via which route can diazepam but NOT midazolam be given?

A

Oral (not in cats)

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71
Q

How long does onset of benzodiazepines take following administration?

A

Minutes

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72
Q

Which benzodiazpine has the shorter DOA and faster onset?

A

Midazolam

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73
Q

How do benzodiazepines induce sedation?

A

Binding to specific sites on GABA receptor in brain and SC

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74
Q

What effect do benzodiazepines have on the heart (at a normal dose)?

A

minimal

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75
Q

What are the potential CVS side effects caused by the propylene glycol found in diazepam?

A

Haemolysis, CV arrhythmias and hypotension

76
Q

What effect do benzodiazepines have on the resp system?

A

Minimal but will enhance effect of other drugs

77
Q

What is an occasional liver SE of benzodiazepine use in cats?

A

Fulminant Hepatic Failure

78
Q

Which haem/biochem abnormality would increase the free fraction of benzodiazepines, leading to a greater effect?

A

Hypoproteinaemia

79
Q

In which animals are benzodiazepines CI’ed?

A

PSS
Severe Hepatic disease
Hepatic Encephalopathy

80
Q

What may occur if benzodiazepines are given to young, excitable animals w/o sedation?

A

Excitement

Disinhibition

81
Q

Why is diazepam less suitable than midazolam for infusion? (2)

A

Many active metabolites that may undergo enterohepatic recycling/accumulation
AND
May bind to some plastics

82
Q

Name 2 drugs that may reverse the action of benzodiazepines?

A

Flumazenil

Surmazenil

83
Q

Name two commonly used veterinary barbiturates.

A

Thiopental

Pentobarbital

84
Q

What class of drug does alfaxalone come under?

A

Neurosteroid

85
Q

Which class of drug does propofol fall under?

A

Phenol

86
Q

Name the most common phencyclidine derivative used in veterinary medicine.

A

Ketamine

87
Q

Which barbiturate is “ultra-short” acting and how long does it last?

A

Thiopental

5-15min

88
Q

Which barbiturate is “short” acting and how long does it last?

A

Pentobarbital

45-90min

89
Q

How long does reconstituted thiopental last?

A

6d

90
Q

What is the pH of thiopental and why is this significant?

A

10.5 - very irritant so IV only and CARE with extrvasation

91
Q

What is the site of action for thiopental?

A

GABAa

92
Q

What is the onset for thiopental and why?

A

20-40s

V lipid soluble so crosses BBB easily

93
Q

How does thiopental cause arrhythmias?

A

Causes myocardial sensitisation to catecholamines

94
Q

What direct effect does thiopental have on the heart?

A

Myocardial depression - negative inotrope

95
Q

What effect does thiopental have on BP?

A

Vasodilator so causes hypotension

96
Q

How is thiopental cerebroprotective?

A

Decreased cerebral metabolic rate and blood flow

97
Q

What are the two occasions thipental is used?

A

Top Up boluses (esp horses)

Induction if intracranial disease

98
Q

In which species is alfaxalone licenced?

A

Dogs and Cats

99
Q

What is the pH of alfaxalone?

A

6.5-7 (non irritant)

100
Q

What is the site of action of alfaxalone?

A

GABAa receptor

101
Q

What CVS effects does administration of alfaxalone have?

A

Vasodilation with REFLEX tachycardia.

102
Q

What is a potential surgical benefit of using alfaxalone?

A

Good Muscle Relaxation

103
Q

Describe the analgesic properties of alfaxalone

A

None

104
Q

Via what route is alfaxalone administered?

A

IM or IV

105
Q

What is the dose of alfaxalone for dogs?

A

2mg/kg

106
Q

What is the dose of alfaxalone for cats?

A

2-3mg/kg

107
Q

What is alfaxalone used for?

A

Induction/maintenance of smallies
OR
Sedation

108
Q

In what species is propofol licenced?

A

Dogs and Cats

109
Q

What is the site of action for propfol?

A

GABAa receptor?

110
Q

What is the pH of Propofol?

A

7.8

111
Q

What CVS effects does administration of propofol have?

A

Mildly negative inotrope
Vasodilation
Hypotension

112
Q

How is propofol cerebroprotective?

A

Decreased cerebral metabolic rate and blood flow

113
Q

Describe the analgesic properties of propofol.

A

none

114
Q

What must be noted about propofol administration in cats?

A

CAN ACCUMULATE

115
Q

How is propofol metabolised?

A

Rapidly in the liver.

ALSO lung, kidney and GI

116
Q

What common side effect is seen with propofol administration in cats?

A

Heinz Body Anaemia

117
Q

What is the reccomended dose for propofol?

A

2-6mg/kg

118
Q

How should propofol be administered?

A

IV!!! ONLY!

119
Q

Which species is ketamine licenced in?

A

Cats, Dogs and Horses

120
Q

What is the pH of ketamine?

A

4

121
Q

Which isomer of ketamine is more potent?

A

S(+) > R (-)

122
Q

What is the site of action for ketamine?

A

NDMA receptor - antagonist

123
Q

What is the onset of action for ketamine?

A

1-2min

124
Q

What is the overall effect of ketamine on the CVS?

A

Sympathetic activation (inc HR, CO, BP)

125
Q

Why is the overall CVS effect of ketamine counter-intuitive?

A

Directly depresses myocardium - would not expect inc CO

126
Q

What is the effect of Ketamine of the resp system?

A

minimal resp depression but strange breathing pattern

127
Q

How does ketamine increase ICP?

A

promotes cerebral blood flow

128
Q

How does ketamine increase IOP?

A

increases extraocular muscle tone

129
Q

Why should ketamine be administered alongside a benzodiazepine?

A

Poor muscle relaxant

130
Q

How is ketamine metabolised?

A

In the liver - to norketamine

EXCEPT IN CATS! urinary excretion unchanged.

131
Q

how is ketamine administered? which route is preferable and why?

A

IV or IM

IM can be painful so IV preferable

132
Q

What is the dose for induction using ketamine in:
a) dogs
b) cats
C) horses?

A

Dog: 2.5mg/kg

Cat: 3-5mg/kg

Horse: 2.2mg/kg

133
Q

What is the dose for analgesia using ketamine?

A

0.1-0.5mg/kg

134
Q

What is the difference between ketamine and tiletamine?

A

Tiletamine has a longer DOA

135
Q

What is the pH of tiletamine and why is this significant?

A

2-3.5 PAINFUL

136
Q

What receptor does Tiletamine act on?

A

NDMA

137
Q

When do we use Tiletamine?

A

Zoo/Wild animal darting

138
Q

What is the dosage for tiletamine induciton?

A

5-7mg/kg

139
Q

What route is tiletamine administered by?

A

IM or IV

140
Q

What are the two extracellular compartments?

A

Interstitial

Intravascular

141
Q

What % of body weight is Intracellular fluid?

A

40%

142
Q

What % of body weight is extracellular fluid?

A

20%

143
Q

What % of body weight is Interstitial fluid?

A

15%

144
Q

What % of canine/equine body weight is plasma?

A

8-9%

145
Q

What % of feline/rabbit/ruminant body weight is plasma?

A

6-7%

146
Q

What are the 4 types of fluid loss?

A

Pure Water
Water and electrolytes
Water, electrolytes & protein
Blood

147
Q

What fluids should be used to replace water?

A

Crystalloid - Low Na+

5% glucose or 4% glucose + NaCl

148
Q

What fluids should be used to replace ECF?

A

Balanced Crystalloid (Hartmanns or 0.9% NaCl)

149
Q

What fluids should be used to replace ECF with protein?

A

Colloids

150
Q

What fluids should be used to replace blood?

A

Colloid + Crystalloid

Blood

151
Q

What are the signs of <5% dehydration?

A

None

152
Q

What are the signs of 5-7% dehydration?

A

Tacky/dry oral MMs, Normal/Dec skin turgor

153
Q

What are the signs of 8-10% dehydration?

A

V. dry oral MM
Dull/sunken eyes
Loss of skin turgor

154
Q

What are the signs of 10-12% dehydration?

A

Dry MM,
Sunk eyes
Loss of turgor
Altered mentation

155
Q

What are the signs of 12-15% dehydration?

A

All signs of lower level dehydration

+ dying

156
Q

What does CRT give us an indication of?

A

Blood volume

Capillary tone

157
Q

What does a CRT <1s indicate?

A

Poor Perfusion or Hypovolaemia

158
Q

What does a CRT >2s indicate?

A

Septic Shock

159
Q

What is the equation for calculating BP?

A

BP = SV x HR

160
Q

What should normal systolic BP range be?

A

90-160

161
Q

What should normal MAP range be?

A

60-140

162
Q

What is the normal RR for a dog/cat?

A

10-30bpm

163
Q

Which drug(s) may cause tachypnoea?

A

Methadone

164
Q

Which drug(s) may cause bradypnoea?

A

Isoflurane, propofol, fentanyl

165
Q

What is the consequence of increased dead space?

A

Hypoventilation leading to hypercapnia and tachypnoea

166
Q

What is the normal range of expiratory CO2?

A

35-45mmHg

167
Q

What value should PaO2 be above?

A

96%

168
Q

What is the normal temperature range for a dog?

A

37.5-39 Degrees celsius

169
Q

Which drug should be avoided if there is a worry of hypothermia and why?

A

ACP - vasodilation and reset of hypothermic threshold

170
Q

What should the cuff size be for oscillometric BP?

A

40% of circumf of limb

171
Q

What are 4 potential complications of invasive BP monitoring?

A

Infection
Thrombosis
Embolism
Haemorrhage

172
Q

Which negative inotrope may be given as a CRI to manage BP?

A

Dobutamine ( B1 adrenergic agonist - CARDIOSELECTIVE)

173
Q

Which + inotrope can be used in a dose-dependent fashion to control BP?

A

Dopamine

174
Q

Which 2 drugs can be used to induce vasoconstriction?

A

Phenylephrine

Nor-adrenaline

175
Q

What % of blood volume does the venous system hold?

A

60%

176
Q

Where does oedema usually build up in venous overload?

A

Limbs

Under Jaw

177
Q

Why does GA tend to cause hypercapnia?

A

Reduced medulla sensitivity

178
Q

What type of acid/base abnormality is caused by uncorrected hypercapnia?

A

Respiratory Acidosis

179
Q

What capnographic sign demonstrates rebreathing?

A

Progressive increase in respiratory baseline

180
Q

What are 3 possible causes of rebreathing Co2?

A

Exhausted soda lime
Low FGF in non-rebreathing system
Leaking expiratory valve

181
Q

What capnographic sign demonstrates hypoventilation?

A

Progressive increase in Alveolar Plateau.

182
Q

What can we do to correct hypoventilation under GA?

A

Reduce Depth
IPPV
Check intubation

183
Q

Oscillations in the inspiratory downstroke are caused by what?

A

Cardiac oscillation

184
Q

What capnographic sign may indicate increased expiratory resistance?

A

Slow transition to plateau from expiratory upstroke

185
Q

What are 4 possible causes of pulse oximetry error?

A

Hair/ambient light reduces accuracy
Non-pigmented skin required
Motion = error
Clip exsanguinates thin tissue

Veterinary Medicine (68 decks)

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