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Breathing and Cir. Exam 1 > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What is general anesthesia?

A

Unconsciousness produced by a reversible and controlled depression of the CNS

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2
Q

What are three things you should consider in your patient assessment, outside of your physical exam findings?

A

Signalment, procedure to be performed, pre-existing diseases

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3
Q

What are the big four in terms of pre-anesthetic bloodwork?

A

PCV, TP, glucose, and BUN/Azo

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4
Q

When are ECGs more readily considered for pre-anesthetic workups?

A

When patients are 7 years of age and older

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5
Q

What can you do to quantify the amount of physiological reserve that a patient possesses at the time at which they are assessed for a surgical procedure?

A

Evaluate their ASA physical status

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6
Q

A patient is given an ASA I status, what does this mean?

A

Normal healthy patient, elective procedure

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7
Q

A patient is given an ASA IIIE status, what does this mean?

A

Mild to moderate systemic disease with clinical signs but under control, emergency procedure

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8
Q

(T/F) For an animal with pre-existing cardiovascular disease, fluid administration must be decreased.

A

True

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9
Q

What should be monitored for maintaining good renal blood flow when a patient has pre-existing renal disease?

A

MAP

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10
Q

What type of drugs increase urine production?

A

Alpha 2 agonists

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11
Q

What is an anesthesia drug that is excreted unchanged in the urine of cats?

A

Ketamine

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12
Q

What should be avoided in an animal with an intracranial mass that is innately increasing ICP?

A

Further increases

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13
Q

What can be done to avoid further increasing the ICP of a patient with an intracranial mass?

A

Decrease fluid rate, avoid hypoventilation, avoid drugs that increase ICP, use drugs that decrease ICP

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14
Q

What drug should be avoided in animals with a history of seizures who are undergoing anesthesia?

A

Ketamine

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15
Q

What class of drug are atropine and glycopyrrolate?

A

Anticholinergics

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16
Q

What class of drug are acepromazine, benzodiazepines, and alpha 2 agonists?

A

Tranquilizers/sedatives

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17
Q

What is the mechanism of action for anticholinergic drugs?

A

Competitive antagonist of acetylcholine at the muscarinic cholinergic receptors

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18
Q

Is the mechanism of action for anticholinergic drugs reversible?

A

Yes

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19
Q

Listed below are different parts of the body or body processes, give the effect atropine has on them.
- Heart rate
- Heart
- Respiratory
- Eyes
- GI tract

A
  • Heart rate (Increase)
  • Heart (Treatment for 2o AV block)
  • Respiratory (Bronchodilation)
  • Eyes (Mydriasis)
  • GI tract (Stasis)
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20
Q

(T/F) Atropine crosses both the blood brain barrier and the placenta.

A

True

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21
Q

Does glycopyrrolate, which has similar effects as atropine, cross the blood brain barrier or placenta?

A

No

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22
Q

Compared to atropine, glycopyrrolate has a _________ (shorter/longer) onset and duration of action.

A

Longer

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23
Q

Anticholinergics are used to decrease both respiratory secretions and salivation as well as prevent/treat what abnormality of the heart?

A

Bradycardia

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24
Q

When are anticholinergics contraindicated in terms of the effect it has on the heart?

A

When a patient has pre-existing tachycardia

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25
Q

Why are anticholinergics contraindicated in horses?

A

Can cause colic, still used in emergencies

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26
Q

What two chemicals does acepromazine block as its main mode of action?

A

Dopamine and serotonin

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27
Q

What type of receptors does acepromazine block?

A

Alpha 1 receptors

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28
Q

Acepromazine causes vasodilation by depression of vasomotor reflexes, blockage of peripheral alpha 1 adrenergic receptors, and causing direct relaxation of vascular smooth muscle, what side effect may it cause?

A

Hypotension

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29
Q

Acepromazine can cause reflex tachycardia, what does the tachycardia result from?

A

Results from the vasodilation, heart rate increases to keep cardiac output at a normal level

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30
Q

Acepromazine _________ (increases/decreases) myocardial sensitization to stimuli that would increase heart rhythm.

A

Decreases

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31
Q

What two CBC values does acepromazine affect?

A

Decreases PCV and TP

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32
Q

Acepromazine is an opioid ____________ (synergist/antagonist).

A

Synergist

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33
Q

(T/F) Acepromazine provides some analgesia to the patient.

A

F

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34
Q

Is acepromazine reversible?

A

No

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35
Q

What effect do benzodiazepines have on GABA receptors? (

A

ncreases their affinity for GABA and increases the frequency at which the channel opens

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36
Q

Overall, benzodiazepines _____________ (inhibit/potentiate) the inhibitory effects of GABA.

A

Potentiate

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37
Q

(T/F) The addition of 40% propylene glycol in diazepam solutions makes SQ and IM good routes of administration.

A

F, makes them bad routes of adm

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38
Q

(T/F) Diazepam is an anxiolytic.

A

True

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39
Q

Why is diazepam best for debilitated, old animals or foals < 1 month of age?

A

May cause paradoxical excitement in animals outside of those parameters, very reliable sedation for the parameters in the question

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40
Q

Which benzodiazepine is only used in a 1:1 mixture with tiletamine?

A

Zolazepam

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41
Q

What is the main advantage of midazolam?

A

Can be given SQ

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42
Q

What is the expensive, short acting, competitive antagonist for benzodiazepine drugs?

A

Flumazenil

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43
Q

What advantage do benzodiazepines have over acepromazine in terms of reversibility?

A

Reversible whereas acepromazine is not

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44
Q

What is the mechanism of action for alpha 2 receptor agonist drugs?

A

Binds to the presynaptic alpha 2 receptor → decreased release of norepinephrine

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45
Q

What effect does alpha-2 receptor agonists have on heart rate?

A

Causes bradycardia and 2o AV blocks

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46
Q

Is the biphasic effect that alpha-2 receptor agonists have on blood pressure (initial hypertension with subsequent hypotension) constant?

A

No, some patients will only have the initial hypertension while some will only have hypotension and then some will have the whole effect of increased hypertension with subsequent hypotension

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47
Q

What two things do alpha 2 receptor agonists decrease in relation to the respiratory system?

A

Decrease respiratory rate and tidal volume

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48
Q

Why might a pulse oximeter reading be low on a patient that was given alpha-2 receptor agonists?

A

Peripheral venous desaturation due to the peripheral vasoconstriction these drugs can cause

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49
Q

Do alpha-2 receptor agonists provide analgesia to the patient?

A

Yes

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50
Q

Besides the cardiorespiratory depression, what are two other disadvantages of using alpha-2 receptor agonists?

A

Causes emesis in cats and hyperglycemia, there are others but these were the two listed in the main disadvantages list

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51
Q

What is one of the biggest reasons why patients are premedicated prior to induction?

A

Decreases anesthetic requirements for both induction and maintenance

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52
Q

What effect does propofol have on the opening of chloride channels?

A

Increases the duration Cl channels are open

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53
Q

What is the result of the effect propofol has on chloride channels?

A

Hyperpolarization

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54
Q

Propofol causes ________ (hypo/hyper)tension.

A

Hypotension

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55
Q

Propofol __________ (decreases/increases) intracranial pressure and cerebral blood flow.

A

Decreases

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56
Q

Propofol causes a refractory __________ (increase/decrease) in heart rate.

A

Increase, in response to the vasodilation and possible hypotension

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57
Q

Propofol is a profound respiratory depressant and causes administration rate and dose-dependent apnea, what sign might be observed?

A

Cyanosis

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58
Q

(T/F) Multiple doses of propofol administered to a cat may cause Heinz body anemia.

A

True

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59
Q

Where is propofol rapidly redistributed to?

A

Vessel rich groups/organs such as the heart, kidneys, etc.

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60
Q

Where is propofol oxidatively metabolized?

A

Liver

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61
Q

Does metabolism of propofol rely entirely on the liver?

A

No, there is extrahepatic metabolism of propofol

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62
Q

Where is propofol excreted?

A

Kidney

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63
Q

Besides its cardiorespiratory depression, what are the disadvantages to using propofol?

A

Short shelf life and promotes bacterial growth, no analgesia, and myoclonus can occur

64
Q

What is added to propofol 28 that makes it last 28 days after opening?

A

Benzyl alcohol

65
Q

Can propofol 28 be used in feline patients?

A

Yes, benzyl alcohol may be toxic to cats but at repeated dosing, a single dose is okay

66
Q

What is a disadvantage of propofol 28 that propofol does not have?

A

Cannot be given as a constant rate infusion

67
Q

Why is etomidate painful on injection and can cause hemolysis at the site of injection?

A

Due to the solution base being propylene glycol

68
Q

The enhancement of the effect of GABA is an ________ (direct/indirect) effect of etomidate while the evocation of chloride currents in the absence of GABA is a __________ (direct/indirect) effect.

A

Enhancement of GABA - indirect, evocation of chloride - direct

69
Q

Etomidate __________ (increases/decreases) cerebral blood flow, intracranial pressure, and cerebral metabolic rate.

A

Decreases

70
Q

What is etomidate the drug of choice for in terms of its cardiovascular effects?

A

Has minimal cardiovascular effects, drug of choice for significant cardiovascular diseased patients and hemodynamically unstable patients

71
Q

What does etomidate decrease the synthesis of 3-4 hours after a single dose and of which the clinical significance is unknown?

A

Cortisol

72
Q

What negative effect does etomidate have that is apparent upon induction, primarily securing an airway?

A

Nausea, retching

73
Q

What results in the high osmolality of etomidate?

A

Hemolysis and hematuria

74
Q

What does ketamine cause a dissociation between?

A

Thalamocortical and limbic systems

75
Q

Does ketamine provide analgesia?

A

Yes

76
Q

What is the mechanism of action for ketamine?

A

Noncompetitive antagonist at NMDA receptor

77
Q

Ketamine is highly lipid soluble so it has a ________ (fast/slow) onset of action.

A

Fast

78
Q

(T/F) Ketamine may induce epileptiform EEG activity

A

True

79
Q

Ketamine __________ (increases/decreases) intracranial pressure, metabolic rate, and blood pressure.

A

Increases

80
Q

Ketamine _________ (increases/decreases) heart rate, cardiac output, and myocardial oxygen requirements.

A

Increases

81
Q

Which branch of the CNS does ketamine stimulate?

A

Sympathetic NS

82
Q

Ketamine causes ___________ (significant/no significant) respiratory depression but may __________ (increase/decrease) respiratory rate and tidal volume while ____________ (increasing/decreasing) tracheal-bronchiol secretions and salivation.

A

No significant respiratory depression, decreases respiratory rate and tidal volume, increases tracheal-bronchial secretions and salivation

83
Q

What can be used to prevent the hallucinations and delirium that can be caused by ketamine?

A

Sedatives/opioids

84
Q

Ketamine can cross the placenta and cause what in puppies?

A

Neurologic depression

85
Q

Where is ketamine metabolized and excreted?

A

Metabolized in the liver and excreted by the kidneys

86
Q

Tiletamine is only available in a 1:1 solution with what other drug?

A

Zolazepam

87
Q

What is the synthetic neuroactive steroid that enhances agonist binding to GABA receptors and has a similar molecular structure to progesterone?

A

Alfaxalone

88
Q

Alfaxalone lacks what negative effect that allows veterinarians to use it off-label in IM and SQ routes?

A

Does not cause perivascular damage

89
Q

Is alfaxalone safe for C-sections?

A

Yes, does cross placenta but has no effect on the fetuses

90
Q

Does alfaxalone provide analgesia?

A

No

91
Q

What are the benefits to administering a propofol-ketamine mixture?

A

Decreases side effects → cardiovascular effects are opposites so should neutralize in theory and less cardiorespiratory depression, lower dose of each drug, can be mixed in same syringe

92
Q

When might chemical restraint of a patient be indicated?

A

For diagnostic procedures, minor surgical procedures, anesthetic machine not available, cost concerns, inhalant anesthesia not possible, very aggressive patients

93
Q

What are some advantages to chemically restraining an animal?

A

No room contamination, anesthetic machine not needed, potentially reversible

94
Q

What are some disadvantages to chemically restraining an animal?

A

Can be too much or not enough, prolonged recovery, no control of airway, and monitoring is overlooked

95
Q

When is field anesthesia appropriate in large animal patients?

A

For simple procedures and healthy patients

96
Q

What administration is ideal for chemical restraint in large animals?

A

Intravenous

97
Q

In what two ways can chemical restraint be maintained?

A

Repeated boluses or constant rate infusion

98
Q

Acepromazine use in large animals usually provides _________ (strong/mild/weak) sedation and ________ (good/weak/no) analgesia.

A

Weak, no

99
Q

What two classes of drugs is acepromazine an adjuvant for?

A

Opioids and alpha-2 agonists

100
Q

Why should acepromazine be used carefully in stallions?

A

Can lead to priapism

101
Q

Acepromazine has a ________ (short/long) onset.

A

Long

102
Q

Administration of what along with alpha 2 agonists decreases a patient’s responsiveness and makes sedation more effective?

A

Opioids

103
Q

Do alpha-2 agonists provide analgesia?

A

Yes

104
Q

Alpha-2 agonists cause __________ (brady/tachycardia) and ___________ (hyper/hypotension).

A

Bradycardia and hypertension

105
Q

Alpha-2 agonists can cause ataxia in large animal patients but it is dependent on what?

A

Dose

106
Q

Which of the alpha-2 agonists (xylazine, detomidine, and romifidine) causes less ataxia?

A

Romifidine

107
Q

Which of the alpha-2 agonists is used more commonly for standing chemical restraint in horses?

A

Detomidine

108
Q

What is romifidine used more commonly for and in what species?

A

Premed in bovines

109
Q

Ruminant doses of alpha-2 agonists are how many times less than horses?

A

5-10x

110
Q

What problems can xylazine cause when administered to sheep?

A

Pulmonary edema and hypoxemia

111
Q

Tolazoline, yohimbine, or atipamezole have what relationship to alpha-2 agonists?

A

Reversal agents

112
Q

Opioids provide good __________ (analgesia/sedation) with minimal ___________ (analgesia/sedation).

A

Analgesia, sedation

113
Q

Opioids __________ (increase/decrease) the ataxia caused by alpha-2 agonists?

A

Increase

114
Q

What can opioids cause when given to an unsedated horse?

A

Excitement and/or increased locomotor activity

115
Q

Opioids __________ (decrease/increase) GI motility when given in high doses or for prolonged infusions.

A

Decrease

116
Q

How long does morphine provide analgesia when given epidurally?

A

8-20 hours

117
Q

What is used to reverse opioids?

A

Naloxone or naltrexone

118
Q

In which species are benzodiazepines (diazepam and midazolam) not used for sedation because it causes excitement?

A

Horses, specifically adult horses

119
Q

Although benzodiazepines provide very good sedation in ruminants, they provide no what?

A

Analgesia

120
Q

Which of the benzodiazepines (diazepam/midazolam) can be given IM or IV, while the other is only IV?

A

Midazolam can be given IV or IM, diazepam IV only

121
Q

What drug is the reversal agent for benzodiazepines?

A

Flumazenil

122
Q

Which drug is a central muscle relaxant that provides no analgesia, has minimal cardiorespiratory effects, and is mostly used to improve sedation and make anesthetic induction smooth?

A

Guaifenesin

123
Q

What drugs are used in a ‘triple dip’?

A

Ketamine, xylazine, and guaifenesin

124
Q

What drug is left out of the triple drip, deemed a ‘double drip’, for ruminant patients to minimize excessive sedation?

A

Xylazine

125
Q

Guaifenesin is an irritant to perivascular tissue and causes hemolysis at injection sites, what can this result in?

A

Necrosis

126
Q

Does ketamine provide analgesia in addition to sedation?

A

Yes

127
Q

Can ketamine be given IV, IM, or SQ?

A

Yes, all of the above

128
Q

Ketamine increases sympathetic tone which means it has what effect on heart rate, blood pressure, and cardiac output?

A

Increases those three things

129
Q

Can ketamine be reversed?

A

No

130
Q

What makes up the triad of anesthesia?

A

Muscle relaxation, analgesia, and unconsciousness

131
Q

What two characteristics does a drug need to have to have a rapid onset of action?

A

Fat soluble and crosses the blood-brain-barrier

132
Q

What are some benefits of injectable anesthesia?

A

Little equipment needed, easy to administer, rapid and smooth induction, relatively cheap, and no environmental pollution

133
Q

What are some disadvantages of injectable anesthesia?

A

Retrieval not possible, patient needs to be weighed accurately, high doses needed when given alone, potential for human abuse, and risk of self administration

134
Q

Why can obese patients take longer to wake up from anesthesia and may have residual effects that last longer than a not obese patient?

A

Fat stores lipophilic drugs, of which some anesthetics are, so they will have more storage of the drug than not obese patients

135
Q

What are the beginning and end of stage 1 of anesthesia?

A

Drug administration to loss of consciousness

136
Q

(T/F) Excited animals may voluntarily hold their breath for short periods of time during stage 1 of anesthesia

A

True

137
Q

The release of what chemical during stage 1 of anesthesia causes a strong, rapid heartbeat and pupillary dilation?

A

Epinephrine

138
Q

What are the beginning and end of stage II of anesthesia?

A

Loss of consciousness to onset of a regular breathing pattern

139
Q

Are animals still reactive to external stimuli during stage II of anesthesia?

A

Yes

140
Q

What stage of anesthesia is the stage in which surgery can be performed?

A

Stage III

141
Q

Patients are considered to be in light plane anesthesia until when?

A

Until eyeball movement ceases

142
Q

Which reflex should always be present in a live animal?

A

Corneal reflex

143
Q

What happens to the laryngeal and palpebral reflexes in a medium plane of anesthesia?

A

Laryngeal reflex - abolished, palpebral - sluggish

144
Q

A patient who has centered and dilated pupils, a weak corneal reflex, profound muscle relaxation, and increased respiration with diaphragmatic breathing would be considered to be in what plane of anesthesia?

A

Deep plane

145
Q

With what stage of anesthesia is extreme CNS depression associated?

A

Stage IV

146
Q

Withdrawal of the anesthetic and artificial respiration must be initiated before what event to be able to reverse a patient in anesthesia stage IV?

A

Needs to be initiated before myocardial collapse

147
Q

When should critical patients be instrumented in the anesthetic induction sequence and why?

A

The beginning, to allow for continuous monitoring throughout the induction process

148
Q

What are anesthetized patients at a higher risk for that support the idea of securing an airway?

A

Hypoxia, upper airway obstruction, respiratory depression

149
Q

What does securing an airway and using it as a route for inhalant anesthetic minimize?

A

Environmental and personnel contamination

150
Q

What is the purpose of preoxygenation?

A

Creation of an oxygen reservoir in the alveoli

151
Q

What are face masks used for in terms of oxygenation?

A

Preoxygenation or supplemental oxygen administration

152
Q

What type of ET tube would you use for a procedure that involves extreme flexion of the head/neck and/or compression of the trachea?

A

Reinforced/guarded ET tube

153
Q

What two species are supraglottic airway devices, V-GELs specifically for vet med, made for?

A

Cats and rabbits

154
Q

ou just intubated a patient and are confirming the ET tube placement, what might you look for?

A

Sustained EtCO2, condensation in the ET tube, chest excursion

155
Q

(T/F) The tie you use to secure the ET tube should be tight on the head and gentle on the tube.

A

F, other way around

Breathing and Cir. Exam 1 (8 decks)

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