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Suregery exam > Anaesthesiology pastq Surgery 1 > Flashcards

Anaesthesiology pastq Surgery 1 Flashcards

1
Q

Anaesthesia: breed dispositions?

  1. Greyhound
  2. Dobermann
  3. Staffie/greyhound/haflinger
A
  1. NO thiopental (no fatty tissue for redistribution), recumbency.
  2. DCMP, blood clotting disorder
  3. sensitive to alpha 2 agonists
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2
Q

Anaesthesia: breed dispositions?

  1. Boxer
  2. Brachycephalic breeds
  3. Large breeds and individuals:
  4. Warmblood type and individuals
A
  1. No phenothiazine. Causes hypotension
  2. pre-oxygenation, short induction, fast intubation, late extubation
  3. Sensitive to hypoxia
  4. decreased effect of sedatives, higher metabolic rate
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3
Q

Positive effects of premedication?

A
  1. Decreased pain, stress, fear, accident risk
  2. Decreased anaesthetic dosage, side effects, material expenditure and costs
  3. Elimination of excitation stage, balanced anaesthesia
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4
Q

What is true according to induction?

A 
IV access (vein cannulation) – reasons; drug admin, fluid therapy, emergencies
Small animals: v. cephalica + saphena (v. jugularis). Induction using injectable (or inhalants):
anaesthetics with moderate (or NO) side effects, rapid onset, short duration or counter-actable. The
patient reaches an unconscious, indubitable status. Endotracheal tube introduction.
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5
Q

Elderly patients

A

Lengthened circulation time (delayed anaesthetic effect), decrease water content of cells, increased
fat content and lower compensation capacity

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6
Q

Stages of narcosis:

A
  1. Analgesia = induction phase
  2. Exitationis = excitatory phase
  3. Tolerantiae = surgical narcosis (divided into: superficial, surgical tolerance and deep)
  4. Asphyxiae = overdose, asphyxia (suffocation)
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7
Q

Antagonists:

  1. Opioids
  2. Alfa2
  3. Benzo
A
  1. Opioids/morph – Naloxone (also Naltrexone)
  2. Alpha2 – Atipamezole (also Yohimbine)
  3. Benzodiazepine – Flumazenil
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8
Q

What is the definition of recovery?

A

Ending anaesthetic administration (elimination)

Extubation (after the return of swallowing and coughing reflexes)

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9
Q

Capnograph:

A

Capnograph = graphic display of values on time chart. CO2 determination in air exhaled. Supervise
respiratory frequency, etCO2 and inhalant anaesthetic conconcentration, circuit pressure and tidal
minute volume (et = end tidal).
1. End tidal CO2 level correlates with arterial CO2 press (paCO2): paCO2 > etCO2.
2. Small animals: 5mmHg difference.
3. Horse: 5-20 mmHg difference.
4. Can be measured from sideflow or mainflow

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10
Q

Mixing circuit vaporizer:

A

Most inhalational anaesthetics are liquid (volatile): converted to gas state in vaporizer, can be
precisely admin
Vaporizing: temperature dependent (stronger at higher temp), requires energy (takes in heat from
environment), different anaesthetics – different gas pressure (requires purpose-built vaporizers)

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11
Q

Mixing system vaporizer:

A

Anaesthetic administration of modern vaporizers is not influenced by: flow rate, surrounding
environmental temperature, air pressure, temperature fluctuations during vaporizing, press
fluctuations during respiration or ventilation
Vaporizers can be classed as two main types: Injectable or variable-bypass.

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12
Q

Pain:

A

Complex, multidimensional negative experience (subjective). No linear correlation btw degree of
pathological changes and intensity of pain. Pain sensation strengthened by fear and stress. Parallel
nociceptive effects add up (superposition)

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13
Q

Characteristics of pain:

A
  1. Physiological (to prevent injury), pathological (due to actual injury)
  2. Origin: organic (somatic, visceral, neuropathic), psychogenic
  3. Intensity (strength)
  4. Duration of sensation: acute or chronic
  5. Localization (unusually sensitive: tooth pulp, cornea, serous membrane, head, thorax,
    perineum, periosteum)
  6. Modality (quality): mechanical, heat, chemical
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14
Q

Pathological pain:

A
  1. Hyperalgesia: small pain provocation, result in large pain sensation
  2. Allodynia: no pain provocation, but pain sensation occurs
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15
Q

Values: pulse-oxymetry and capnometry:

A

Ideal SpO2 value = 100%.
Normal: 100-97% (measure 02 saturation % of Hb). <90% = hypoxia
CO2 determination in air exhaled from endotracheal tube or nose.
Normal: etCO2 = 35-45 mmHg. Concentration: V%

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16
Q

Anaesthesia, foals?

A

Sedation/premedication: Benzodiazepine (diazepam, midazolam) in neonates
Alpha-2 agonist (Xylazine, Detomidine, Medetomidine, Romifidine)
Induction:
„ Light: inhalations or IV (Ketamine + Diazepam)
„ Deep: Ketamine + Diazepam + alpha-2 agonist, or Propofol.
Maintenance:
„ Inhalation
„ PIVA: Isoflurane + Ketamine + Lidocaine
„ TIVA (total IV anesthetics)

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17
Q

Can cattle and horse get the same drugs?

A

yes

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18
Q

Premedication:

A
  1. Acepromazine + Butorphanol
  2. Medetomidine + Butorphanol
  3. Medetomidine + Ketamine + Butorphanol
  4. Midazolam + Butorphanol
  5. Diazepam + Butorphanol
  6. Fentanyl
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19
Q

Induction:

A

Propofol IV, Ketamine + Diazepam IV
Ultra-short barbiturates, steroids (and inhalational) are also useful for induction
Inhalational: Isoflurane, Sevoflurane
Total IV: Propofol + Fentanyl

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20
Q

What is the most dangerous with anaesthesia on horse?

A

That the horse is recumbent on back for so long, the danger in laying down and waking/getting up

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21
Q

ASA (American society of Anaesthesiologists) – risk categories?

A

ASA 1: Healthy, symptom free. And/or: 6 weeks – 5 years
ASA 2: Mild systemic disease, no functional disorder apparent. And/or: 6 weeks – 5-8 years
ASA 3: Severe systemic disease with visible functional impairment, but not life threatening. And/or: 8-
10 years
ASA 4: Severe systemic disease, constant threat to patients life. And/or: 0-3 days, over 10 years
ASA 5: Moribund status, patient likely to die within 24 hours, with or without surgery
E (emergency): No time for classification (CEPOD 1).

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22
Q

Induction drugs?

A 
NMDA (N-methyl D-aspartate) agonist, phenyl thiazine
Ketamine + Midazolam
Tiletamine + Solezopan
Guaiphenesin (gge)
Propofol
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23
Q

Pre-operative antibiotics procedures?

A

Indicated in orthopaedic surgery

30 min prior to surgery, single dose to reach sufficient tissue levels, second dose lasting for 3 hours

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24
Q

When to use Antibiotics?

A

Surgery > 90 min, implantation, infections, orthopaedics, oesophageal, dirty surgery’s like faecal or
urine contamination etc

25
Q

Anaesthesia of young/ paediatric patients

A

Heart: immature innervation, low min volume, weak vasomotor, low BP
Lung: decreased alveolar surface area, increased respiratory rate and min tidal volume.

26
Q

Anaesthesia of old/geriatric patients

A

Avoid Ketamine and alpha 2 agonists
Decreased respiration, venous reflux from abdominal organs
Heart: decreased min volume and BP
Lengthened circulation time (delayed anaesthetic effect)

27
Q

O2 level?

A

97-100%

28
Q

Consequence of pCO2 < 60 mmHg

A

Cyanosis, brain damage

29
Q

What is not an effect of NSAIDs?

A

Increase intra ocular pressure

30
Q

Intubation is difficult in?

A

More difficult in cattle than horses

31
Q

Liver patients contraindicated meds?

A 
No ketamine in dogs
No diazepam
No methoxyflurane
No Halothane
Fentanyl is recommended
Opioids glucuronic conjugation is delayed or rebound
32
Q

Drug when spinal injury?

A

Methylprednisolone

33
Q

Which part is not included in the anaesthesia machine? Mixing system or pulseoximeter?

A

Pulsoximeter

34
Q

Pulseoxymetry, influenced by:

A

Bilirubineamia, environmental temperature, peripheral circulation, hypovolaemia, poor tissue
perfusion, hypotension, shock, vasoconstriction, movement, direct pressure on the sensor, hair,
pigment, thick tissue, carbohaemoglobin (measure as oxyhaemoglobin) and methaemoglobinaemia

35
Q

What is not good for preoperative analgesia?

A

Fenotiazine and Butorphanone derivatives

NSAIDs, opioids, α2-agonists, dissociative anesthetics and local anesthetics are used.

36
Q

Intraoperative anaesthesia uses only?

A

Maintenance inhalational drugs, Isoflurane and Sevoflurane

37
Q

In patients with decreased kidney perfusion we can give?

A

Propofol and inhalation anaesthetic. No alpha2 agonist

38
Q

Ketamine not given in patients with?

A

Heart problems, glaucoma , head trauma patients and hyperthyroidism

39
Q

Swine Anaesthesia

A

Susceptible to ventricular arrhythmias, fragile pulmonary tissue, stress sensitive, anaesthesia very
risky.

40
Q

Pain management (Which is FALSE)

  • a: preemptive (prophylactic analgesia)
  • b: multimodal (multiple aproch) analgesia
  • c: no gap should appear during therapy
  • d: not important in small animals but in adults
A

D

41
Q

Praeoperative anlalgetics (which is FALSE)

  • a: local
  • b: phenothiazine, butryrophen derivatives
  • c: opioids + NSAID´s
  • d: alpha2agonists + NMDA antagonists
A

B

42
Q

Antagonisis (which is FALSE)

  • a: diazepam – flumazenil
  • b: propofol – dantrolen
  • c: fentaly - naloxon
  • d: dexmedetomidine – atipamezole
A

B

43
Q

Physical characteristics of young patients (which is FALSE)
- a: immature vegetative innervation of heart, weak vasomotiric funktion
- b. small alveolar surface, high o2 demand
- c. blood-brain barrier is less permeable puppys untill 4 weeks of age
require higher doses
- d. fragile fluid haemostasis; immature glomerular filtration until 2 weeks,
immature tubular funktion until 6 week

A

C

44
Q

Physical characteristics of old patients (Which is FALSE)

  • a: increased vital capacity, resp. Frequency and compliance
  • b: small compensation reseve of heart an circulatuion
  • c: decreased glomerular flitration rate
  • d: decreased pararenal function
A

A

45
Q

Which statement is false
-a: Phenothiazine should be used with care in stallions
-b: Phenothiazines are not usabel in shock patient
-c: Midazolam is an adequate drug to trat tetanus in horses
-d: Phenothiazines are given most frequently to colic horse to reduce
visceral pain

A

D

46
Q

Which statement is false
-a: ACP given to a horse i. M in the premedication decreases the intrapoerative
mortality rate
-b: Anesthetized foals without premedication have greater intrapoerative mortality
risk
-c: inhalalational anesthesia induces greater stress response than i.v. Anesthesis
(TIVA)
-d: More postoperative complications can be manifested using balance
anesthesia (PIVA)

A

D

47
Q

Which statement is false?
- a. Inhalalational anesthetic drugs usually decrease the arterial blood pressure
- b. the shorter the time of anesthesia, the fewer complications can maifest intraor
postoperatively
- c. Propofol has shorter context- sensitive half-life than short acting barbiturate
- d. Only the indirect measurement of the arterial blood pressure is
abailable in anesthetised horses

A

D

48
Q

ACP… (Which is FALSE)
-a: recommended for young, healthy, restless, aggressive patients
-b: has antiarrhytmic effect and decreases the threshold to seizures
-c: use higher doses because lower doses notably elongate the duration of
action
-d: depression of the thermoregulation center can lead to hypo/hyperthermia

A

C

49
Q

Propofol (which is FALSE)
-a: recomended for induction and maintenace; has good hypnotic and muscle
relaxant effect
-b: general dose: 0,5 mg/ bwkg i.v (it is 5mg/bwkg)
-c: has short duration of action, wide therapeutic range, is not cummulative, may
be redoses or continiously applicated
-d: resp. Depression may evolve in case of high doses or rappid application

A

B

50
Q

Mixing systhem of anaesthetic mashine (whcich is FALSE)

  • a: absorband canister with sodaline
  • b: gas source, pressure reducing valve, mannometer
  • c: flowmeter
  • d: vaporiser
A

A

51
Q

Parameters of ventilation (which is FALSE)

  • a. respiratory volume: 10-15 ml/bwkg , frequency: 10-15/ min
  • b. PEEP: not used routinely (also correct in lecture notes)
  • c. EtCO2: 35- 45 mmHg/ spO2: 100-97 %
  • d. inhalalation : exhalation Time ratio: 2/1 – 8/1
A

D

52
Q 
Which statement is false
- a. The main advantages of balanced anaesthesia (PIVA) are the decrease in
cardio-respiratory depression and increase of analgesia (true)
- b. Lidocaine administered iv. to an anaesthesised horse increases the risk
to postoperative... […ileus??? → Wrong: reduces the risk of PO- Ileus!]?
- c. Ketamine, lidocaine, alpha2agonists can be given in balanced anaesthesia
(PIVA) in horses (true)
- d. lidocaine administered iv. helps to prevent ishemic and reperfusion injuries
in horses (true)
A

B

53
Q

which is false
- a. Ketamine can not be given to a standing horse to relive the pain
- b. lidocaine can be given to a standing horse to relive the pain (true)
- c. lidocaine adminitered i.v. can have adverse effect to the CNS of a horse (true)
- d. neurophathy can develop due to inadequat positioning during anaesthesia
(true)

A

A

54
Q

Which is false
- a. neonatal foals will be expected to have higher? mac for inhalational
aneastehics than adults (false) [neonatal foals lower doses, BUT older foals
higher doses!!!])
- b. Hyperkalemic pariodic paralysis can accure in sertain horse beeds during
general anaesthesia (true HYPP in quarter horses)
- c. alpha2agonists are not used in the premedication of sick neonatal foals (true)
- d. it is important to prevent hypotermia and hyperglycaemia in the
anaesthetised neonatal (To increase body temp.→increased metabolic rate→
hypoxemia, hypoglycemia can develop earlier than in adults.)

A

A

55
Q

which statement is false concerning bovine anaesthesia?
- a. for premedication benzodiazepine can be used (benzodiazepines poor
effect,not approved)
- b. regional i.v anaesthesia can be favourable in certain limb surgery (true)
- c. intubation of cattels is more difficult than….…that of horses? (true)
- d. cattels regurate mostly in dorals reccumbency (Under general an. Should be
intubated!! Danger of aspiration, left lateral recumbency have lower incidence
of regurgitation, mostly in dorsal recumbency.)

A

A

56
Q

which statement is false
-a. inhalational anaesthetic drugs usually decrease the arterial blood pressure
-b: the shorter the time of anesthesia, the fewer complications can manifest intraor
postoperatively
-c: propofol has shorter context- sensitive half- live than short- acting barbiturates
-d: only the indirect measremet of the arterial boold pressure is availavle in
anesthetises horse (false)

A

D

57
Q

Pain (which is FALSE)
-a: complex, multidimensional negative experience
-b: Pain sensation is not influenced by fear and stress
-c: the is no linear correlation between the level of pathological changes and
intensity of pain
-d: parallel nociceptive effects add up

A

B

58
Q

Recovery (choose wrong answer)
-a: stop application of anastehtic durgs or use antagonists
-b: remove intratracheal tube, after the return of swallowing relex
-c: if there is no dangerous amount of fluid in the oral cavity remove the
tube with inflated cuff
-d: monitoring of the patient is recomended in the complete recovery period

A

C

59
Q

Stadium analgesiae (choose wrong answer)

  • a: maximal pupildialtion no cornial tensoin
  • b: transition towards an unconcious state
  • c: increasing imobilisation
  • d: coughing reflex is present, intubation is not possible
A

A

Suregery exam (3 decks)

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