Anesthesia Flashcards
Describe the risk level and criteria for each of the ASA classifications. Give an example of a condition for each level.
4 JG
ASA I: Minimal risk; Normal healthy patient; Patients undergoing elective procedure such as spay, neuter, or declaw
ASA II: Low risk; Patient with mild systemic disease; Neonatal, geriatric, or obese patients, mild dehydration, low grade heart murmur
ASA III: Moderate risk; Patient with severe systemic disease; Anemia, moderate dehydration, compensated major organ disease
ASA IV: High risk; Patient with severe systemic disease that is a constant threat to life; Ruptured bladder, internal hemorrhage, pneumothorax, pyometra
ASA V: Extreme risk; Moribund patient that is not expected to survive without the operation; Severe head trauma, pulmonary embolus, GDV, end-stage major organ failure
ASA VI: N/A; A declared brain-dead patient whose organs are being removed for donor purposes; This classification is not used in veterinary patients
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 929)
Anesthetic drugs work by binding to specific receptors on or inside the cells of target tissues in the central or peripheral nervous system. Describe how agonists, antagonists, partial agonists, and mixed agonist-antagonists interact with receptors to produce their effects.
4 JG
Agonists: drugs that bind to receptors and exert one or more effects
Antagonists: drugs that block or reverse the action of the corresponding agonist; also referred to as reversal agents
Partial agonists: Drugs that bind to receptors and exert a partial or milder effect than an agonist
Mixed agonist-antagonists: drugs that partially reverse the effect of a pure agonist
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 929)
What are the fasting recommendations for dogs and cats, horses, cattle, small ruminants, and neonates and pediatric patients (less that 8 weeks old) in regards to both food and water?
4 JG
Cats and Dogs: (Food: 8-12 hours unless under 2 kg, fasting times should be shorter); (Water: 2-4 hours)
Horses: (Food: 8-12 hours); (Water: 0-2 hours)
Cattle: (Food: 24-48 hours); (Water: 8-12 hours)
Small Ruminants: (Food:12-18 hours); (Water: 8-12 hours)
Neonates and pediatric patients: should not be fasted from food or water
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 928)
What steps should be taken to reduce heat loss during all anesthetic procedures?
4 JG
Do not allow the patient’s body to contact stainless steel.
Place a heat-retaining surface under the patient, such as a warm-water circulating blanket, a blanket, a towel, or lambs’ wool.
During preparation of the surgery site, avoid the use of alcohol as a rinsing agent and avoid wetting the hair excessively.
Avoid excessively low ambient temperatures in the surgical suite.
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 952)
How can we confirm proper placement of the endotracheal tube in our patients?
4 JG
Revisualize the larynx to confirm successful intubation.
Watch for expansion and contraction of the reservoir bag as the animal breathes. (cats, dogs, and small ruminants)
Feel for air movement from the tube connector as the patient exhales.
Palpate the neck. If the tube is properly placed only one firm structure should be felt, if there are two, the ET tube is in the esophagus. The trachea should be the only structure palpated post placement.
If the patient is able to vocalize (cry or whine), the tube is not in the trachea.
When using an ETCO2 monitor, the presence of a normal waveform indicates proper placement.
Check that the motion of the unidirectional valves coincides with breathing, though this is not the most reliable form of confirmation.
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 947)
What are the four general systems anesthetic machines have and what do they do?
13, TN McCurnin 10th Ed
- Carrier gas supply: Delivers oxygen and other carrier gases to the patient at a controlled flow rate.
- Anesthetic vaporizer: Vaporizes a precise concentration of liquid inhalant anesthetic and mixes it with carrier gases.
- Breathing circuit: Delivers the anesthetic and oxygen mixture to the patient via endotracheal tube, mask, or chamber and conveys expired gases away from the patient.
- Scavenging system: Disposes of waste and excess anesthetic gases.
pg 937
What is a common complication that is encountered with cats upon intubation? How do you fix that?
13 TN McCurnin 10th Ed
Laryngospasm. These occur when the glottis forcibly closes during intubation and makes intubation difficult because the glottis cannot be safely forced open.
To fix: Should be done preemptively. Apply 2% lidocaine to the glottis prior to intubation to prevent glottis from shutting.
pg 947
What are the planes of anesthesia?
13 TN McCurnin 10th Ed
Stage I: Period of voluntary movement
Stage II: Period of involuntary movement.
Stage III: Period of surgical anesthesia
Stage IV: Period of anesthetic overdose
pg 949
What are the indicators of ventilation?
13 TN McCurnin 10th Ed
Respiratory rate, respiratory effort, tidal volume, capnography, and blood gas analysis
pg 951
What is an esophageal stethoscope used for?
13 TN McCurnin 10th Ed
This device is not capable of determining heart rhythm, but it can be used to determine possible arrhythmias by noting changes in heart rate, irregularity, or interruptions to heart sounds.
pg 953
What type of drug is Etomidate?
Hypnotic
DM,12, McCurnin 10th Ed. Pg. 934
Supraglottic Airway Devices (SAD)
Often used in cats and rabbits: seals around laryngeal opening without invading tracheal lumen
DM,12, McCurnin 10th Ed. Pg. 935
Other name for pop-off valve
Adjustable pressure-limiting (APL) valve
DM,12, McCurnin 10th Ed. Pg. 938
T or F: ET intubation in equine medicine is performed blindly because the larynx is impossible to see
True
DM,12, McCurnin 10th Ed. Pg. 946
Mechanical dead space VS. Anatomical dead space
Mechanical: y-piece, ETT extending beyond mouth, capnograph
Anatomical: mouth, nasal passages, pharynx, trachea, bronchi
DM,12, McCurnin 10th Ed. Pg. 945
What is the difference between general anesthesia and local anesthesia?
General anesthesia is characterized by unconsciousness and insensibility to feeling and pain induced by administration of anesthetic agents given alone or in combination. Local anesthesia is the loss of sensation in a localized body part or region induced by administration of a drug or other agent without loss of consciousness.
Student #11, JM
McCurnin 10th edition, page: 927
What is neuroleptanalgesia?
Neuroleptanalgesia is a state of profound sedation and analgesia produced by simultaneous administration of an opioid and a tranquilizer.
Student #11, JM
McCurnin 10th edition, page: 927-928
What is the difference between sedation and tranquilization?
Sedation is a state of calm or drowsiness. Tranquilization is a state of relaxation and reduced anxiety.
Student #11, JM
McCurnin 10th edition, page: 927
What are some adverse effects of anticholinergics?
Tachycardia, cardiac arrhythmias, bronchodilation, mydriasis, ileus.
Student #11, JM
McCurnin 10th edition, page: 929
What abnormalities must be corrected to stabilize the patient before the anesthetic is administered?
Dehydration, hypovolemia, anemia, cardiac arrhythmias, respiratory compromise, major organ failure, electrolyte/acid-base imbalance
Student #11, JM
McCurnin 10th edition, page: 928
Why is it important to monitor respiratory rate and depth carefully, especially for the first 1-2 minutes after the initial injection of propofol?
Respiratory depression, including apnea, may occur and can be severe after rapid injection or with high doses.
Student #10, AM
McCurnin 10th edition, page: 932
True or false: Alfaxalone may be given intramuscularly in cats and dogs for heavy sedation or light anesthesia?
True
Student #10, AM
McCurnin 10th edition, page: 933
What are dissociatives typically used in combination with to induce and maintain anesthesia and to provide analgesia?
Opioids and tranquilizers
Student #10, AM
McCurnin 10th edition, page: 933
What are some of the main advantages of sevoflurane?
Rapid induction, recovery, and changes in anesthetic depth associated with this agent
Student #10, AM
McCurnin 10th edition, page: 934
What is the only barbiturate-class general anesthetic still in regular use?
Pentobarbital sodium
Student #10, AM
McCurnin 10th edition, page: 934
What class of controlled substance is propofol?
Class IV controlled substance
Student #6, MH
Mccurnin 10th edition, page 932
What is the RMV and what does it stand for?
RMV stands for respiratory minute volume, and it is 200 mL/kg/minute. Although output will decrease slightly as a result of dilution effect by expired gases, so the dial can be set higher in this instance.
Student #6, MH
Mccurnin’s 10th edition. page 940
What is tidal volume and what is the normal?
Tidal volume is the amount of air that passes into or out of the lungs during a normal breath.
The normal TV is 10-15 mL/kg body weight.
Student #6, MH
Mccurnin’s 10th edition, page 943
What are some of our induction drugs and what happens at the induction phase?
Induction drugs include ketamine, diazepam, propofol, alfaxalone, neuroleptanalgesia, and inhalant anesthetics such as isoflurane, halothane, and sevoflurane.
During induction phase the animal is taken from a level of consciousness to a level of unconsciousness.
Student #6, MH
Mccurnin’s 10th edition, page 957
What does a pulse oximeter measure where is it placed and what are the Normal’s?
A pulse Oximeter detects the changes in the oxygen saturation of hemoglobin. This is done by a red and Infared wavelength light that is passed through or reflected off of a tissue bed, detected by a sensor and then analyzed.
You can place a pulse oximeter on any thin hairless tissue such as the prepuce, vulva, pinna, toe webbing, and tongue.
The normal of oxygen saturation should be kept at greater than 95%. Between 90%-95% indicates desaturation and you need to start looking for the cause. Below 90% indicates hypoxemia and you must treat. Saturation below 85% for longer than 30 seconds indicates a medical emergency.
Student #6, MH
Mccurnin’s 10th edition, page 955
Who chooses the protocols for both small and large animal anesthesia?
The attending veterinarian.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 48816 of 67848 (1 out of 5 cards)
What is the first step of the preanesthetic procedure in horses? (After patient assessment) What is the common anatomical placement of this step?
The placement of an IV catheter. This is almost always placed in one of the jugular veins.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 48825 of 67848 (2 out of 5 cards)
After catheterization, what is the next step of an equine preanesthetic period? What equipment is needed?
Rinsing the horse’s mouth out with a dose syringe. The dose syringe is placed between the cheek and the teeth on each side of the mouth to flush out feed material.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 48825 of 67848 (3 out of 5 cards)
What are the common induction cocktails typically used to induce ruminants?
- ketamine and diazepam or midazolam
- ketamine and guaifenesin
- telazol
TM, #7, McCurnin’s (electronic version) 10th ed. Location 49066 of 67848 (4 out of 5 cards)
What percentage of a equine xylazine dose do ruminants require?
At most 10 percent of an equine dose because ruminants are especially sensitive to xylazine.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 49066 of 67848 (5 out of 5 cards)
Atelectasis is
Hypoventilation leading to decreased gas exchange and hypoxemia
McCurnin’s 10th Ed, 952
#5 ZZ
What drugs should you avoid in animals with kidney disease?
Alpha-2 agonists, and ketamine in blocked cats
McCurnin’s 10th Ed, 962
#5 ZZ
What are the common signs in equine patients that they have entered the recovery stage?
Nystagmus of the eye, and paddling legs, and being able to move the anesthetist off the neck.
McCurnin’s 10th Ed, 965-966
#5 ZZ
What is the unique indication of recovery in ruminants?
Eructation (burping)
McCurnin’s 10th Ed, 969
#5 ZZ
T or F:
Ketamine and Diazepam/midazolam can be mixed in the same syringe?
True.
McCurnin’s 10th Ed, 930
#5 ZZ
What is the definition of general anesthesia?
Characterized by unconsciousness and insensibility to feeling and pain induced by administration of anesthetic agents given alone or in combination. General anesthesia provides an environment in which general surgery or other painful procedures can be performed without the danger of patient movement or injury to personnel.
Student: #2, AF
McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 30, Page 927)
What are some advantages to endotracheal tube intubation?
- Helps maintain an open airway
- Allows inhalant anesthetics to be administered precisely
- Prevents pulmonary aspiration of stomach contents, blood, fluid, or other debris
- Permits careful observation of respiratory rate and respiratory depth
- Allows the anesthetist the ability to ventilate the patient when needed
Student: #2, AF
McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 30, Page 945)
What is the normal respiratory rate for horses when they’re awake/at rest versus anesthetized?
- Normal HR when awake/at rest: 30 – 45 bpm
- Normal HR when anesthetized: 28 – 40 bpm
- Report to a veterinarian if HR is less than 25 or greater than 60
Student: #2, AF
McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 30, Page 951)
What is the gas percentage used for inhalant anesthetics for chamber inductions?
- Isoflurane: 3 to 5%, being delivered simultaneously with 5L/minute of oxygen
- Sevoflurane: 4 to 6%, being delivered simultaneously with 5L/minute of oxygen
Student: #2, AF
McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 30, Page 959)
What are some causes of excessive depth of anesthesia with patients?
- Excessively high vaporizer settings
- Equipment problems/malfunction
- Pre-existing medical problems
Student: #2, AF
McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 30, Page 970)
What does a Doppler ultrasound monitor detect?
The Doppler ultrasound monitor is a device that detects the flow of blood through small arteries and converts this motion into an audible sound.
McCurnin 10th Edition page
Student #3, AF
Card 1
How may Opioids be classified?
Opioids may be classified as agonists, partial agonists, mixed agonist-antagonists, and antagonists.
McCurnin 10th Edition page 931
Student #3, AF
Card 2
When pressure checking a Rebreathing system on an anesthesia machine, what pressure must the machine hold for 10 seconds?
30 centimeters of water (cm H20)
McCurnin 10th Edition page 938
Student #3, AF
Card 3
Why are Non-rebreathing systems used for patients who weigh less than 6 kilograms?
Non-rebreathing systems do not resist air movement and are generally used for very small patients because they minimize the work required to breathe. In contrast, rebreathing systems resist air movement, thus impairing the ability of very small patients to move gases through the circuit.
McCurnin 10th Edition page 941
Student #3, AF
Card 4
For induction of general anesthesia, what amount of propofol in gernera is titrated or “given to effect?
Usually about 25% of the total calculated dose is given every 30 seconds until the patient is relaxed enough to intubate.
#1 CE
McCurnin 10th Edition pg 932
Which benzodiazepine can only be mixed in the same syringe as ketamine?
Diazepam can only be mixed with ketamine in the same syringe.
#1 CE
McCurnin 10th Edition pg 930
What are some disadvantages of halogenated anesthetics?
Halogenated anesthetics can cause hypothermia, respiratory depression, and hypotension.
#1 CE
McCurnin 10th Edition pg 934
What are some rules to follow in terms of safety when usuing compressed gas cylinders?
Compressed gas cylinders like o2 tanks must never be left unsupported or on their sides unattended, along with never removing the valve or index pins. Finally, keep eyes and skin clear of the valve port and never opertate an o2 tank around a source of ignition.
#1 CE
McCurnin 10th Edition pg 938
Where are some areas a doppler ultrasound probe can be placed on a patient like a dog?
The probe can be placed on the ventral aspect on the base of the tail, as well as proximal to the metacarpal and the metatarsal pads.
#1CE
McCurnin 10th Edition pg 955
How often during a procedure should the patient’s eyes be lubricated?
8 JM
Every 90 mins
McCurnin 10th Ed pg 960
If a patient begins retching or vomiting at any time during general anesthesia, what steps should be taken?
The patient’s head should be quickly positioned lower than the body to allow the vomit to flow out. When the vomiting is done the oral cavity and pharynx should be cleaned and suctioned.
#8 JM
McCurnin 10th Ed pg 971
Ruminants not properly fasted before surgery are at a higher risk for this condition
8 JM
Bloat.
McCurnin 10th ed pg 967
A full E tank of oxygen contains about how many liters of oxygen?
8 JM
660 L
McCurnin 10th ed pg 939
This anticholinergic lasts longer than atropine and causes less arrhythmias than atropine
JM
Glycopyrrolate
McCurnin 10th ed pg 929
what should we do if a patient is experiencing prolonged recovery?
support w/ IV fluids
good nursing care
measures to treat hypothermia
administration of reversal agents
if indicated, careful monitoring
RP #9, McCurnin 10th Ed pg 971
how many times should we “bag” a patient if we are manually breathing for them?
2-10 times per minute until normal respirations resume
the low end should be used if apnea is secondary to hyperventilation to allow normalization of CO2 levels
RP #9, McCurnin 10th Ed pg 971
what are 3 types of oximeters and where can they be placed?
- transmission probe: ear, tongue, lips and flank fold
- reflective probe: taped to ventral surface of tail base
- C- probe (also a transmission probe): skin fold between Achilles tendon or tibia
RP #9, McCurnin 10th Ed pg 958
what reflexes and other indicators indicate surgical anesthesia depth?
palpebral reflex: decreased or absent
swallowing reflex: absent
pedal reflex: absent
corneal reflex: present
muscle tone: moderate
eyeball position: usually ventromedial
pupil size: gradually larger
PLR: gradually unresponsive
RP #9, McCurnin 10th Ed pg 953
what degree (angle) should we place caudal aspect of the body? Why?
no greater than 15 degrees to prevent pressure on the diaphragm
RP #9, McCurnin 10th Ed pg 960
how often should sterile lube be applied to the eyes?
every 90 mins
RP #9, McCurnin 10th Ed pg 960
