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Anesthesia Flashcards

1
Q

What are opiod receptors?

A

G coupled proteins

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2
Q

What are the endogenous opiod ligands?

A

Endorphins, enkephalins and dynorphins

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3
Q

How does activation of opiod receptors decrease neuronal activity?

A

Influk K+, decrease Ca+⇒

decreases release neurotransmittors (subsatance P, glutamate) in presynaptic cell ⇒

hyperpolarization of postsynaptic cell

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4
Q

How much does an opiod reduce the inhalent requirement?

A

40-60%

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5
Q

Potentcy of hydromorphone, oxymorphone, meperidine, methadone, fentanyl and buprenorphine in relation to morphine?

A

Hydro 8x greater

Oxymorphone 10x greater

Meperidine 10x less

Methadone 2x greater

Fentanyl 100x morphine

Buprenorphine 40x greater at the Mu agonist but binds to receptor without fully activating resulting reduced analgesia

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6
Q

Side effects of serotonin syndrome?

A

hyperthermia, anxiety, shock, rhabdomyolysis and ARF

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7
Q

MOA methadone?

A

Mu receptor agonist

NMDA receptor antagonist (N-methyl-D-aspartate)

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8
Q

What is unique about remifentanyl?

A

Metabolized by plasma esterases

No hepatic or renal metabolism

Very short half life - good for rapid awakening

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9
Q

MOA of naloxone

A

Binds competatively to Mu, Kappa, and Delta receptors

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10
Q

MOA benzodiazepines?

A

Enhance GABA (gamma-aminobutyric acid), an inhibitory NT

The GABA receptor allows Cl to enter the neuro, hyperpolarizing the cell and preventing action potentials.

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11
Q

What effects do benzodiazepines have?

A

muscle relaxation

narcosis

amnesia

no analgesia, cardio or respiratory depression

excitement = central disinhibitory effect

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12
Q

What are the active metabolites of diazepam and midazolam? How is this clinically relavent?

A

Diazepam = nordiazapem, oxazepam (both sedative with same duration as diazepam but slow clearence)

Midazolam = 1 hydroxymethyl midazolam (no activity)

Midazolam better for patients with hepatic dysfunction (ie decreased clearence)

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13
Q

What is acepromazine (drug class)?

A

phenothiazine

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14
Q

MOA acepromazine?

A

Depresses dopamine activity in the reticular activating system

alpha 1 receptor antagonist = vasodilation and hypotension and protective for some cardiac arrhythmias

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15
Q

Clinical effects of ACE?

A

moderate sedation

some muscle relaxation

no analgesia

antihistaminic

antiemetic

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16
Q

Dexmedetomidine MOA

A

Alpha 2 angonist = decrease Norepi release in CNS = sedation, analgesia and muscle relaxation

Peripheral alpha 1 agonist = vasocontriction, hypertension, arrhythmogenicity and paradoxical excitation

Hypertension = reflex bradycardia which can be compounded by decreased central sympathetic output = hypotension

Other SE: hyperglycemia, diuresis, respiratory depression

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17
Q

How does medetomidine effect cats different than dogs?

A

Dogs = hypertension and increased myocardial work

Cats = minimal hypertension; HR,CO,SV decrease alot

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18
Q

MOA propofol

A

GABA receptor agonist increasing inhibition throughout CNS

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19
Q

What is in propofol emulsion?

A

soybean oil, glycerol, egg lecithin

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20
Q

What is propofol infusion syndrome?

A

Occurs in people (not reported in animals)

Effects mitochondria - severe metabolic acidosis, refractory bradycardia, and rhabdomyolysis

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21
Q

MOA ketamine

A

NMDA receptor ANTAgonist - decrease dorsal horn windup

Dissociative anesthestic - separation between higher and unconcious function (eg muscle riditiy), maintains respiratory center sensitivity to CO2

Mild sympathomimetic (increased sympathetic) = may increase myocardial work, decrease CO

Bronchodilation

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22
Q

Clinical effects of ketamine?

A

Increase myocardial work

Decrease CO

Increase ICP

Increase intraocular pressure

Muscle rigidity

Laryngeal function maintained

Bronchodilation

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23
Q

How is ketamine eliminated?

A

Metabolized to active metabolic (norketamine) which is renally excreated (aka not good to use with severe renal disease as may be long to recover)

Only 50% converted in cats, rest excreated unchanged

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24
Q

What is telazol?

A

Tiletamine (like ketamine)

Zolazepam (benzo)

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25
Drug class xylazine?
alpha 2 agonist
26
MOA barbituates? What are common barbituates?
direct activation of GABA recpetor and modulates the effects of GABA Thiopental (thiobarbituate) and pentobarbital (oxybarbituate)
27
What is etomidate and MOA?
imidazole derivative Effects GABA receptor
28
Side effects etomidate?
hemolysis and shock at doses \>5mg/kg muscle rigidity and myoclonus (use benzo with) Emesis Adrenal supressoin for 6 hours - avoid in critically ill and give dose steroid
29
What is alphaxalone and MOA
Steroid anesthetic Enhances GABA and glycine-mediated CNS depression
30
What is the defination of MAC?
conc of anesthetic (volume/volume %) needed to prevent movement from a noxious stimulus in 50% of animals
31
What is MAC-BAR?
MAC blockade of adrenergic response - conc that prevents cardiac response to pain Usually higher than MAC, in cats 10% higher than MAC
32
What conc of MAC is generally required to prevent movement in all patients?
1.2-1.5 x MAC
33
How does temperature effect MAC?
Hypothermia decreases MAC by 5% for each degree C
34
Adverse effects of halogeated inhalent anesthetics?
**Hypotension - decreaed SVR and CO** **Respiratory depressent** **increased ICP** disrupt thermoregulation malignant hyperthermia arrhythmias = sensitize myocardium to catecholamines **Bold are dose dependent**
35
Absorbtion of inhalents depend on 4 things:list
1. blood/gas solubility of inhalent: high, slower action 2. CO: high, slower action 3. Minute ventilation: high, faster 4. Concentration gradient between blood and alevolus: greater gradient, faster absorption
36
Factors that effect length of recovery from inhalents?
1. Fat 2. Longer anesthesia = more redistribution 3. Soluability of anesthetic
37
MOA local anesthetics?
Dose and activity dependent (phasic) Blockade of fast sodium channels on afferent n inhibiting nociceptive transmission
38
Lidocaine and bupivicaine lipophilicity and dissociation constants (pka)?
Lidocaine: lipophilic, fast onset action (\<5min), short duration 45-60 min Bupivicaine: higher lipid soluability and protein binding, longer duration of action (6-8 hours), upto 45 minutes to take effect Mepivacine effect between the 2
39
What is a Bier block?
IV regional anesthesia
40
What is the bandage that is applied for regional anesthesia or to enansuinate the foot?
**Esmarch** bandage
41
Toxic dose of lidocaine in dogs and cats?
Dogs: \>8mg/kg Cats:\>6mg/kg
42
Toxic dose of bupivicaine?
Dogs: 4mg/kg Cats: 2mg/kg
43
Toxic effects of lidocaine?
Initial: GI - vomiting, regurg, ileus, nausea Then: CNS - dull, siezures Last Cardio - decreased contractility, arrythmia, death
44
What is succinylcholine?
Depolarizing neuromuscular blocking agent minics acetylcholine malignant hyperthermia
45
What is atracurium?
Non-depolarizing neuromuscular blockade short duration Hoffman elimination - indepent of renal or hepatic degredation
46
MOA neostigmine and edrophonium?
Reverse neuromuscular blockade Inhibit acytelcholinesterases Can cause cholinergic crisis: salivation emesis, vomiting, bradycardia, death, therefore sometimes given with anticholenergic
47
MOA anticholnergic agents (ace, glyco)?
Parasympatholytics = minimize vagal tone High vagal tone = bradycardia
48
What causes increased vagal tone?
endotracheal intubation emesis traction ocular orbit manipulation hepatobiliary system Brachycephalic breeds Opiod drugs
49
Describe the COX pathway
50
Describe anti-inflammatory effects of NSAIDS
51
Describe MOA NSAID side effects
52
What is delta down?
Depression in arterial systolic pressure (collapsing of greater vessels) with IPPV Seen with hypovolemia
53
What are dobutamine and dopamine?
Positive ionotropes (increased cardiac contractility) Beta adrenergic agonists Chronotropic effects DOPAMINE: increase SVR
54
What is phenylephrine?
alpha adrenergic vasopressor Can reverse vasodilation caused by other drugs
55
What is vasopressin?
nonadrenergic pressor Used for vasoplegic shock (low systemic vascular resistence and high cardiac output) during sepsis
56
Describe the ASA status chart
I: no illness II: mild compenstated systemic illness III:moderate to severe compenstated systemic illness IV: Disease that is constant threat to life V: Moribund, no expected to survive
57
What is the risk for anesthetic death?
1 in 500-1000
58
What are drugs that sensitize the myocardium to catecholamine induced arrhymias?
halothane thiopental
59
What is an ideal fluid type for anesthesia for cardiac cases?
Isotonic, low sodium 0.45% NaCl with 2.5% dextrose
60
What is the Branham reflex?
Occurs during lagation of a PDA - increased afterload causes bradycardia
61
MOA phenoxybenzamine?
(non-selective/Alpha) adrenergic ANTAGonist - convalently bonds alpha receptors Antagonist/partial agonist seritonin 5-HT2a receptor
62
Doxopram use, dose and side effect?
Highlight laryngeal function (for eval LarPar) 1.1mg/kg IV Severe glottic constriction
63
What nasal oxygen rate is equivalent to 40% oxygen?
100ml/kg/min
64
Oncotic pressure of Hetastarch?
29-32mmHg
65
Normal oncotic pressure?
18-22mmHg
66
What is the reversal agents for benzos?
Flumazenil
67
What are drugs that are heavily protein bound (ie effected by hypoalbuminemia)?
Propofol Benzo Opiods Liver disease/hypoalbuminemia will leave more free drug and the drugs will have a stronger effect
68
Drugs to increased urine output, assuming adequate hydration (renal anesthesia)?
Mannitol - 0.5g/kg - also free radical scavenger that may help renal epithelial cell swelling Furosemide - 0.2-2mg/kg IV, 0.66mg/kg/hr CRI Dopamine - 2-5mcg/kg/min - increased output but not creatinine clearence
69
What is the oncotic pressure of 25% human albumin and 16% canine albumin?
Human \>200mmHg Canine 98mmHg
70
What is the maximum allowable intra-abdominal pressure for CO2 insuflation?
14 **cm H20**, greater compromise renal blood flow - prolonger \>25 = anuria and ARF
71
What are signs of an air embolism during anesthesia monitoring?
Sudden drop EtCO2 Drop BP Drop pulse ox Washing machine heart murmur
72
Only drug shown to adversely effect neonate survival?
Xylazine Although ketamine may be associated with decreased neonatal vigor
73
What is the amount used for low epidural and a high epidural?
Low: 0.2ml/kg High: 0.3ml/kg
74
Inta-articular dose of perservative free morphine?
0.1mg/kg
75
What is the maximum bupivicaine dose recommended for dental blocks in dogs and cats?
Dogs: 2.5mg/kg Cats: 1mg/kg
76
List the dental n. blocks?
Mental (rostral mandibular): mandibular **second to third premolar** rostral to the midline. Infraorbital (rostral maxillary): maxillary **third premolar** rostral to the midline. Inferior alveolar: mandibular **third molar** rostral to the midline. Maxillary: **last molar** rostral to the midline, including the ipsilateral soft and hard palatal mucosa and bone
77
What is the does of atricurium for ocular surgeries and how long does it last?
Dose 0.1mg/kg Lasts 20-30 min Use of a reversal often not necessary but can be directed by a n. stimulator
78
What are the effects of inhalents, propofol, ketamine and thiopental on inraocular pressure?
Decrease: Inhalents Increase: propofol, ketamine Thiopental least effect
79
4 causes of hypothermia during anesthesia?
Change in hypothalamic control of thermoregulation immobility vasodilation cold surfaces/eviroment
80
Consequences of hypothermia?
Prolonged recovery delayed healing decreased immunity altered drug metabolism cognitive depression arrythmias Altered coagulation (VCNA 2015) hypotensoin (VCNA 2015)
81
Four mechanism of heat loss?
1. Evaporation - only lungs and feet 2. Conduction - through cold surfaces (10%) 3. Convective - contact cold air/eater (30%) 4. Radiation - loss of heat via infrared energy (50%)
82
How do Bair huggers prevent heat loss?
Via convection
83
Methods to maintain temperature during sx?
Bair hugger warm-water circulating pads heat-mositure exchange unit on ET tube low-flow or close anesthesia circuits with coxial rebreathing hoses plastic wrap fluid warmer
84
What are the 5 cause of arterial hypoxemia?
VQ mismatch (most common) hypoventilaiton right-left anatomic shunt decreased insipired O2 Diffusion barrier impairment
85
Bronchodilators may help severe VQ mismatch. List bronchdilators.
Aminophylline Albuterol Terbutaline
86
What is malignant hyperthemia?
Inherited condition - cellular ryanodine receptor Dysregulation/excssive release of intracellular Ca++ release in muscles causes: hypercarbia, hyperthermia, muscle spasms confirm with muscle biopsies
87
How do you treat malignat hyperthermia?
Stop inhalent, switch to propofol CRI and O2 Give dantrolene = stablize sarcoplasmic reticular membrane
88
Drugs assoicated with malignant hyperthermia?
Inhalents, esp halothane succinylcholine
89

Veterinary Surgery (10 decks)

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