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Basic Info > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

ASA 1 and example

A

Healthy
Elective SX- spay/neuter

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2
Q

ASA II

A

Mild systemic disease
Mass removal, uncomplicated ortho procedure, well controlled diabetic

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3
Q

ASA III and example

A

Severe systemic disease
Cardiac dysfunction, poorly controlled DM, mild anemia, early renal disease

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4
Q

ASA IV and example

A

Severe disease this is constant life threat
Hemoabdomen, sepsis, FB, shock, hypovolemia

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5
Q

ASA V and example

A

Moribund patient who is not expected to survive without operations
MAssive trauma, multiorgan dysfunciton

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6
Q

What is the grimace scale

A

Discriminates painful vs nonpainful
five action units - eyes, ears, muzzle whiskers, head position in cats

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7
Q

What is the UNESP Botucatu MCPS

A

First pain scale to be validated for post-op pain in cats
Looks at 10 different variables
Recuse analgesia required if total >7/30

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8
Q

What is Glasgow

A

Pain scale for cats
Can be applied to any pain
Rescue analgesia >5/20

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9
Q

What is transduction

A

conversion of noxious stimulus into electrical energy by peripheral nociceptor
Mechanical pain to electrical

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10
Q

Transmission

A

impulse propagation from the site of the oral injury through the CN V

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11
Q

Modulation

A

When neurons from the pain fibers synapse with nociceptive neurons in the medulla

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12
Q

What is wind up pain

A

Peripheral sensitization remains untreated and the exacerbation of intensity of the nociception
Glutamate binds to NMDA = increase pain (this is why ketamine helps with wind up)

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13
Q

What analgesics affect transduction, transmission and modulation

A
  1. Transduction - local anesthetic, opiod, NSAID, Steroids
  2. Transmission - local anesthetics, Alpha2 Agonist
  3. Modulation - local anesthetic, alpha 2 agonist, opiods, NMDA antagonist, anticonvulsants, NSAID
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14
Q

How does hyperalgesia, analgesia, allodynia effect pain and the stimulus curve

A
  1. hyperalgesia - increase responsiveness, shift curve to the left
  2. Analgesia- decreases response, shiftst curve to the right and flattens it
  3. Allodynia - innocuous stimuli begin to elicit pain, shifts curve to the farthest left
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15
Q

What is the purpose of the anesthesia machine and circuit

A

safe delivery of inhalants and O2 with removal of CO2 and excess gases

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16
Q

What is normal tidal volume

A

10-15ml/kg

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17
Q

What is solubility (anesthetic gas)

A

Usually expressed as coefficient known as ostwalds coefficient
The greater blood gas partition coefficient = great solubility in the blood
increased solubility = longer induction recovery times

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18
Q

What is the most to least soluble anesthetic gases

A

Halothane>ISO>SEVO>Nitrous oxide>Desflurane

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19
Q

Inhalant effects on the body

A

CNS - depression via inhibitory GABA, NMDA, AMPA
Resp - depression
CV - Decrease CO, hypotension, vasodilation
Kidney - decrease renal BF
Liver - mild
Malignant hyperthermia

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20
Q

Minimum alveolar concentration

A

of inhalant: produces no response in 50% of animals exposed to noxious stimulus
1MAC = light anesthesia
1.5MAC = surgical
2MAC = deep
0.5MAC = awake

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21
Q

MAC of Sevo vs Iso

A

Sevo = 2.3
Iso = 1.3

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22
Q

What are the 4 stages of anesthesia

A

1 = induction to loss of consciousness
2 = excitement, spontaneous muscle movement
3 = end of spont muscle mvt and regular breathing
3a= light, regular breathing, pupil size normal, ventromedial, some response
3b= medium, shallow breathing, moderate pupil size, ventromedial, minimal palpebral, no response
3c= deep, jerky breathing, dilated and central pulse, decreased corneal reflex
4 = extreme CNS depression and respiratory arrest

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23
Q

How much of the body is water

A

55-60%

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24
Q

Blood volume is about how much? how to calculate transfusion

A

90ml/kg
ml of donor blood = recipient blood volume x desired PCV - active pcv/pcv of donor

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25
Q

P wave seen on ECG

A

atrial depolarization

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26
Q

PR interval represents

A

atrial depolarization adn conduction of AV node

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27
Q

QRS complex represents

A

ventricular depolarization

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28
Q

TT represents on ECG

A

repolarization

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29
Q
A

AV block type 1: if r is far from P

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30
Q
A

second degree av block type 1: wenkenback: PR gets longer, longer, drops

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31
Q
A

Second degree av block type 2: mobitz: P waves dont produce QRS response. Intermittent QRS dropped

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32
Q
A

3rd degree av block: P and Q dont agree

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33
Q
A

Sinus arrhythmia

34
Q
A

Ventricular enlargement alters QRS
VPC

35
Q
A

Ventricular enlargement alters QRS
ventricular Tachy

36
Q

Hypoventilation causes

A

increased CO2
Respiratory acidosis
hypo-ventilating to increase bicarb

37
Q

Hyperventilation causes

A

Decreased CO2
Respiratory alkalosis
trying to decrease bicarb

38
Q

What are the 4 phases of capnography

A

1 = dead space
2 = expiratory
3 = alveolar plateau
4 = Inspiratory

39
Q

What is normal end tidal CO2

A

35-45mmHg
>45 = hypoventilation

40
Q
A

Normal

41
Q
A

Hypoventilation

42
Q
A

Obstruction

43
Q
A

Check equipment

44
Q
A

endotracheal cuff

45
Q
A

hyperventilation

46
Q

What happens with hyperkalemia

A

bradycardia
peaked t waves
prolonged PR
Loss p waves
Wide QRS

47
Q

What happens with lidocaine toxicity

A

5- muscle twitching
10 - seizures
15- unconsciousness
20+ = seizure, coma, resp arrest, cv depression

48
Q

Is MAC lower or higher for neonates

A

Lower

49
Q

What are the 4 types of anaphylactic reactions

A

1 - immediate
2 - cytotoxic
3 - immune complex
4 - delayed

50
Q

Atropine and glyco are what types of drugs

A

Anticholinergics
Atropine - crosses BBB, can see av block, fast
Glyco - doesnt cross BBB, slower, decrease saliva
Both act on smooth muscle relaxation

51
Q

What do adrenergic receptors do

A

improve cardiac output by increasing HR and SV
Increase BP by vasoconstriction

52
Q

What do the adrenergic receptors work on (A1, A2, B1, B2, B3)

A

Alpha = contraction
Beta = relaxation
A1= contract smooth muscle
A2= nerve terminals
B1= heart and kidney
B2= smooth muscle relax
B3= adipose tissue

53
Q

What are the MOA for Norepi vs Epi

A

Epi = high affinity for beta receptors, increase CO
Norepi = high affinity for alpha receptors, primarily used for hypotension due to decreased vascular resistance

54
Q

Dopamine vs dobutamine

A

Dopamine = alpha and beta receptors, 5-20mcg/kg/min
Dobutamine = beta receptors agonist, used for low CO, 10mcg/kg/min

55
Q

what is CO

A

CO = SV + HR

56
Q

What is naloxone, atipamezole, flumazenil reverse

A

naloxone = opiod
atipamizole = alpha 2 agonist
Flumazenil = Benzodiazepine

57
Q

Maximum dose of Lidocaine/bupivicaine

A

Bup = 2mg/kg
Lidocaine = 3-5mg/kg

58
Q

Projection vs perception

A

Projection = dorsal horn to cortex
Perception = realizing painful stimuli

59
Q

Evaporation, conduction, convection, radiation loss

A

Evaporation = dissipatiton of heat via moistture to gas
Conduction = transfer between 2 objections
Convection = transfer within fluids
Radiation = through electromagnetic waves

60
Q

Half life

A

Time for plasma concentration to decrease by 50%

61
Q

MOA of Nerve Block

A

Blocks NA channels
70% or 3 nodes of ranvier
lipophilic, hyrdophilic joined by ester or amide linkage
acidic environment causes longer onset due to ionization

62
Q

Adverse effect of bupivicaine and other NB

A

cardiotoxic (more so bup)
CNS issues
Methemoglobinemia –tx methylene blue

63
Q

Toxic dose of lidocaine vs bupivicaine

A

Lido = 10mg/kg
Bupivicaine = 2mg/kg

64
Q

IO blocks what

A

Desensitizes teeth, maxilla, incisive bone, upper lip, oral mucosa
**extent depends on how caudal the needle is

65
Q

MX NB blacks what

A

Desensitizes maxilla, incisive bone, palate, maxillary teeth, gingiva, oral mucosa, nasal mucosa (partially), skin

66
Q

Inferior alveolar blocks what

A

Desensitizes mandibular body, mandibular teeth, surrounding oral mucosa, lower lip

67
Q

Mental foramen (middle) blocks what

A

Desensitizes rostral lower lip & oral mucosa if the foramen is not entered
Desensitizes incisor, canine, & most rostral premolar teeth if foramen is entered; desensitization is partial even then

68
Q

Major Palatine block what

A

Desensitizes soft tissues & bone of hard palate rostral to the block on the ipsilateral side

69
Q

What is the order from shortest to longest acting local anesthetics (lido, bup, mepiv, ropiv)

A

Lido = 2 hour
Mepiv = 2-4 hr
Bupiv = 4-6 hours
Ropiv = 6+ hour

70
Q

What are examples of alpha 2 adrenoreceptor agonist and their reversal

A

Dexmedetomine and medetomidine
Reversal = atipamezole

71
Q

What is an example of alpha 2 agonist and reversal

A

Xylazine
Reversal - atipamezole
Sedation, analgesia, muscle relaxant, decrease MAC

72
Q

Example of Benzodiazepine and reversal

A

Diazepam and midazolam
Reversal - flumazenile
Anxiolytic/anticonvulsant - depresses thr limbic system through GABA

73
Q

Example of Phenothiazine

A

Acepromazine
Dopamine receptor agonist and is metabolized through the liver

74
Q

Neuroactive steroid

A

Alfaxalone
Inhibits GABA

75
Q

Anticholinergic agents

A

Atropine and Glyco

76
Q

Hypnotic alkyl phenol

A

Propofol
interaction with GABA potentiating the gaba induced chloride

77
Q

Ketamine

A

Interacts with multiple binding sites including NMDA & non-NMDA glutamate receptors, nicotinic & muscarinic cholinergic, monoaminergic & opioid receptors
Inhibits voltage-dependent sodium & calcium channels

78
Q

Cerenia

A

Antiemetic and prokinetic
Maropitant is an NK-1 receptor antagonist that blocks the action of substance P in the central nervous system as well as at peripheral NK-1 receptors in the GI tract

79
Q

Metoclopramide

A

Antiemetic
MOA not well understood

80
Q

what are the three classes of opiod receptors and MOA

A

Activity at opioid receptors located in the CNS & peripheral sites (ganglia & peripheral nerve endings)
3 classes of opioid receptors:
Mu (MOP)
Delta (DOP)
Kappa (KOP)

81
Q

What are the four classification of opiod and examples of each

A
  1. Agonists
    High affinity for mu
    Morphine, pethidine, hydromorphone, methadone, fentanyl, sufentanil, alfentanil, remifentanil, codeine
    Tramadol is a weak mu agonist
  2. Partial Agonists
    Do not have full intrinsic activity at the mu receptor
    Buprenorphine
  3. Mixed Agonist-Antagonists
    Act as agonists at some receptors and antagonists at others
    Affinity & intrinsic activity at the receptor site may vary
    Butorphanol
  4. Antagonists
    Reverse the effects of mu and kappa agonists because of their high affinity & low intrinsic activity
    Naloxone
82
Q

What is the pathway of desensitization of nerve blocks

A

B are desensitized first, then C, then A-delta, then A-beta. A-alpha are the largest nerves, so motor is blocked last/not at all. Re-sensitization happens in reverse order

Basic Info (16 decks)

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