Analgesia Techniques Flashcards
What are the classes/types we use for paraenternal analgesia?
NSAIDS
CRI drugs
What do we use for local/regional anestheisa?
select nerve blocks
Eipdural, lumbosacral caudal epidural
wound infusion catheters
List the 6 common NSAIDS
Carprofen Deramaxx Meloxicam Robenacoxib Phenylbutazone Flunixin
What is Fentanyl?
Dogs, cats Intra-Op analgesia **Dose dependent/MAC sparing (up to 65%) 'one' dimensional analgesia watchout for bradycardia
What is MLK?
Morphine, Lidocaine, Ketamine
multimodal analgesia
What pain pathways does morphine block?
Transduction
Modulation
Preception
What type of apin is morphine useful for?
Visceral pain
______ is the backbone of mist/all analgesic protocols
Morphine
Lidocaine blocks which pain pathways?
transduction, transmission, modulation
Why is lidocaine included in multimodal analgesia?
anti inflammatory, central analgesia properties with CRI
decrease cardiac/cerebral ischemia- reperfusion injury
How does lidocaine prevent cardiac/cerebral ischemia- reperfusion injury (mechanism)
prevents intracellular Na+ overload & through its anti-inflammatory properties
Ketamine blocks ____ pain from____
somatic pain from bones, joints, ligaments skin
Ketamine modualtes the spinal pathways via:
Blocks NMDA receptors
decreases central sensitization/wind up
Prevents secondary hyperalgesia
Chronic pain
Describe the mechanism of Ketamine central sensitization:
frequent/sever activation of Alpha-Delta nociceptors
increased exitatory neurotransmitters (glutamate/subs P)
activates NMDA, NK, AMPA receptors
increased signal molecules, gene expression, neuroplasticity
When the Alpha-Beta mechanoreceptors are activated, NON-painful stimuli contribute to the pain response, a condition known as _____
Secondary Hyperalgesia
How does Ketamine offer neuroprotection?
via NMDA blockade
decrease Ca influx =>
increased cell intergrity, survival, regeneration
T/F MLK is commonly used at ISU, and given as a either a CRI or SQ Bolus
FALSE
DO NOT BOLUS THIS
What is the CRI for MLK ?
Infuse @ 5mls/kg/hr for first hr
then reduce to 2.5 mls/kg/hr
T/f MLK is not very effective at MAC sparing
FALSE
decreases the MAC of ISO by 45%
many patients on
T/F Because of its MAC sparing effects, patients on MLK should be monitored closely
TRUE, monitor EtCO2
have IPPV available
Describe how to recover animals from MLK
Wean from IPPV, monitor EtCO2
10 min O2 support after vaporizer off
Monitor SpO2, keep above >93-95% w/ o2 supplementation
+/- partial reversal if prolonged O2 dependence
What reversal agent would you use for MLK?
butorphanol, given in 0.2 ml increments
What is the difference between MLK and HLK
one letter dumb ass
Hydropmorphone
What ‘benefits’ does hydromorphone offer in sedation
Clinical impression-
less sedation, more vocalization/dysphoria at recovery
What is in the concoction F + LK?
Fentanyl, lidocaine, ketamine
What is the benefit of F+LK
more control/titration of opiod dose
retain multi-multiple neuroprotective and/or anti-inflammatory effects of L&K
use Fentanyl in syringe pump, add LK to IV fluid
