Anesthesia Flashcards
What precautions should be taken during an aesthetic recovery in a patient who underwent an extensive oral procedure such as maxillectomy or Mandibulectomy?
The oral cavity and oral pharynx should be suctioned before extubation, extubate with cuff inflated, monitor for airway obstruction.
When should arrhythmias observed after GDV be treated? (4 possible situations)
“If the arrhythmias interfere with cardiac output (as noted by poor peripheral pulses), are multiform, have subsequent premature beats inscribed on the wave of the previous complex (R on T), or have a sustained ventricular rate above 160 beats per minute, the animal should be treated with IV drugs.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are the typical signs of lidocaine toxicity? What drugs can be used instead?
“Signs of lidocaine toxicity include muscle tremors, vomiting, and seizures; lidocaine therapy should be discontinued if these signs occur. Other possibly effective antiarrhythmic drugs are procainamide and sotalol. Procainamide may be given as an IV bolus, by continuous infusion, intramuscularly, or orally (see Box 18.29). Sotalol may be effective in animals that have not responded to lidocaine or procainamide.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What induction protocol would you use for a patient presenting with a GI obstruction who is severely hypovolemic but requires emergency surgery? What drug would you avoid?
“Because of cardiovascular compromise, induction with either ketamine and a benzodiazepine (e.g., midazolam or diazepam) or etomidate may be warranted. Propofol should be avoided because of the marked hypotension it causes in hypovolemic patients.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Consequences of intraopertive hypothermia (5)
“coagulopathy decreased drug metabolism impaired renal function poor wound healing cardiac arrhythmias”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Most common pathogens associated with peritonitis in dogs?
“E. coli, Enterococcus spp., and coagulase-positive Staphylococcus aureus. Although less frequently isolated, anaerobes are also common and may cause peritonitis”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Dopamine stimulates dopaminergic, beta-adrenergic and alpha adrenergic receptors at various rates. What is the biggest disadvantage associated with the use of this drug as a vasopressor?
“One of the biggest disadvantages to using dopamine as a vasopressor is that high doses need to be used. This results in a significantly higher incidence of cardiac arrhythmias. In septic patients that already have tachycardia, the beta effects of dopamine further increase the heart rate, causes arrhythmias, and increases cardiac work and oxygen requirements. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the receptor activity profile of norepinephrine
“Norepinephrine is a very potent α-1 agonist with moderate β-1 and no β-2 activity at infusion rates of 0.1 to 1 µg/kg per minute IV. As an α-agonist it produces arterial and venous vasoconstriction in all vascular beds.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What drug would you choose to treat a patient in circulatory failure due to decreased cardiac contractility? Why?
Dobutamine
“β-1 agonist with a small amount of β-2 activity (see Box 19.6). As such, it increases cardiac output by increasing cardiac contractility and heart rate, but the β-2 activity prevents it from causing a significant rise in blood pressure”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the preferred sedative to be administered to a patient with severe hepatic disease prior to the induction of general anesthesia? What commonly used drugs should you avoid?
Midazolam 
Avoid acepromazine, alpha-2 agonists, pancuronium.
In a patient with severe liver disease, which anesthetic induction agent would you choose? Why?
Propofol, because it relies on redistribution rather than liver metabolism for the initial recovery from the drug effect.
Alfaxalone can be used but
undergoes hepatic metabolism and requires a significant dose reduction.
Morphine can cause hypotension when administered to patients under general anesthesia. Why does this happen and how long does it usually take after injection?
Histamine release
Typically within five minutes of IV administration
What precaution must always be taken prior to inducing anesthesia with Etomidate? Why?
Administer a benzodiazepine IV to avoid myoclonus
What anesthetic consideration must be taken into account when providing analgesia with opioids to a patient who will undergo surgery for the correction of extrahepatic biliary obstruction?
“An additional concern in patients with obstructive biliary disease relates to the effect of mu-agonists (e.g., hydromorphone, morphine) on smooth muscle tone. In human beings with biliary obstruction, these drugs increase both sphincter tone and pain. Mixed agonist-antagonists (e.g., butorphanol; see Tables 12.1 and 13.2) may be preferable as premedicants and analgesics in these patients. After corrective surgery of the biliary obstruction, mu-agonists can be utilized for postoperative analgesia.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What drug should be avoided as an anesthetic induction agent in patients with hypoadrenocorticism? Why?
“Etomidate causes transient adrenal suppression and should be avoided in patients with hypoadrenocorticism and those in which postoperative hypoadrenocorticism is anticipated.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What veins are typically ligated while performing an adrenalectomy?
Phrenicoabdominal veins
Describe the pre-anesthetic and perianesthetic management of a diabetic dog undergoing surgery
“Blood glucose concentrations should ideally be maintained between 100 and 300 mg/dL during surgery. Hypoglycemia may occur if animals are given their regular insulin dose and if food is withheld before surgery; however, the stress of surgery usually results in hyperglycemia. Animals should be fed their normal diet the day before surgery, and their regular dose of insulin should be administered. Food should be withheld 6 to 8 hours before surgery or a small meal given after the morning insulin. Surgery should be performed in the morning. Blood glucose concentrations should be measured the morning of surgery. One to 2 hours before surgery, if the blood glucose concentration is between 150 and 300 mg/dL, the animal should receive one-half of its usual morning dose of insulin subcutaneously. Blood glucose should be checked at induction and hourly thereafter. If the blood glucose level is low, 0.45% saline and 2.5% dextrose (10–15 mL/kg for the first hour, then 5 mL/kg thereafter if blood and evaporative fluid losses are small) should be administered. If the blood glucose level is normal, administer lactated Ringer’s solution (at the same rate). Fluids should be changed to 5% dextrose and an additional small dose[…]”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Discribe the arterial blood supply to the pancreas
“The main blood supply to the left pancreatic lobe is provided via branches of the splenic artery; however, branches from the common hepatic and gastroduodenal arteries also supply portions of it. The main vessels of the right lobe of the pancreas are the pancreatic branches of the cranial and caudal pancreaticoduodenal arteries that anastomose in the gland. The cranial pancreaticoduodenal artery is a terminal branch of the hepatic artery; the caudal pancreaticoduodenal arises from the cranial mesenteric vessel. These vessels also provide branches that supply the duodenum. Because they are closely associated with the proximal portion of the right lobe of the pancreas, care must be taken not to damage these vessels during pancreatic surgery, or devitalization of the duodenum may occur.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Discribe the anatomy of the Pancreatic and Accessory pancreatic ducts in dogs and cats
Pancreatic duct - right lobe - smaller - opens into the Major duodenal papilla, adjacent to the common bile duct
Accessory duct - left lobe - larger - opens into the Minor duodenal papila
The pancreatic and accessory ducts often communicate within the gland, creating a single duct (accessory) that opens into the Minor duodenal papila.
The pancreatic duct is the principal and usually only duct in cats
Total pancreatectomy is infrequently performed in veterinary patients. Why? What would it entail?
“Total pancreatectomy is infrequently performed in veterinary patients. Removal of the pancreas without duodenectomy requires that pancreatic tissue be bluntly dissected from the pancreaticoduodenal vessels without damage to branches supplying the duodenum. This is difficult in animals with pancreatic disease because of adhesions, fibrosis, and edema. Therefore total pancreatectomy is usually performed in conjunction with resection and anastomosis of the proximal duodenum (i.e., Billroth II procedure), ligation of the common bile duct, and cholecystojejunostomy (see p. 574) and is associated with high rates of morbidity and mortality. Pancreatic drainage or omentalization is indicated in conditions (e.g., large abscesses or cysts) in which pancreatectomy is not feasible.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
