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Surgical biology and methods > Anesthesia > Flashcards

Anesthesia Flashcards

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1
Q

Do drugs that are lipid soluble take more or less time to reach a steady state?

A

More time as they redistribute to the tissues more readily

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2
Q

What are the three groups of organs/tissues based on the perspective of general anesthetic action?

A
  1. Vessel rich group - receive up to 75% of blood flow (kidneys, heart, brain)
  2. Muscle group
  3. Vessel poor group (fat)
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3
Q

What determines the time taken to reach steady state of an inhalant anesthetic agent?

A

Minute ventilation, cardiac output, speed of redistribution, elimination.

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4
Q

What is the rule of 6 technique for CRIs?

A
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5
Q

What is the saturated vapor pressure of an inhalant agent?

A

The pressure at which the gas of the anesthetic agent is in equilibrium with the liquid agent (as occurs in the vaporizer chamber)

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6
Q

What is the effect of warmer weather or higher altitudes on vaporizer output?

A

May increase output

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7
Q

What is the most common type of vaporizer used in clinical practice?

A

Out of circuit, variable bypass, flow over, temperature compensated, agent specific

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8
Q

What is the major difference between out of circuit and in-circuit vaporizers?

A

Vaporizer output will be affected by respiratory minute volume for in-circuit systems

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9
Q

What is unique about the desflurane vaporizer?

A

Desflurane is almost a gas at standard temp and pressure (boiling point of 23.5 degrees). Vaporizer is consequently heated to convert to gaseous state and gas is then injected into the carrier gas

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10
Q

How does soda lime act to remove CO2 from a rebreathing system?

A

Soda lime is composed of sodium, potassium and calcium hydroxide, and water. The CO2 interacts with water to form carbonic acid. This then dissociates to free protons and carbonate. This reacts with the strong bases to form water, heat and calcium carbonate.

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11
Q

When should the CO2 absorbent be changed in a rebreathing system?

A

Whenever CO2 rebreathing is observed on the capnograph

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12
Q

What are two ways in which the inspired inhalant anesthetic concentration can be increased in a rebreathing circuit?

A

Increase the vaporizer setting, increase the fresh gas flow

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13
Q

What is the minimum oxygen flow required for a rebreathing system?

A

10 x body weight (kg) (or the metabolic oxygen demand of the patient)

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14
Q

What size patient should a rebreathing system be used in?

A

> 5 kg (due to dead space at the junction of the inspiratory/expiratory breathing tubes that may cause rebreathing in small patients)

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15
Q

What is the recommended fresh gas flow for nonrebreathing system?

A

Three times the patients respiratory minute volume: MV = respiratory rate x tidal volume (estimated tidal volume =15ml/kg)

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16
Q

How long does hypoxia take to develop in a patient breathing room air following apnea or obstruction?

A

30 seconds. This is increased to 5 minutes with preoxygenation with 100% oxygen.

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17
Q

What gas can be added to oxygen to reduce alveolar collapse?

A

A mixture of 40%:air reduces alveolar collapse as the nitrogen in air is less readily absorbed by alveoli and provides structural support

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18
Q

What can be added to oxygen to reduce flammability of the carrier gas?

A

Helium (70:30 ratio with oxygen). Requires special flow-meter

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19
Q

What are the tank colours for the commonly used anesthetic carrier gases?

A
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20
Q

What are the main cycling types of anesthetic ventilators?

A

Time-, volume- or pressure- (volume and pressure are most commonly used)

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21
Q

What is a reasonable starting tidal volume for a volume cycled ventilator?

A

10-15 ml/kg

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22
Q

What is a reasonable starting peak inspiratory pressure for a pressure-cycled ventilator?

A

12 mmHg

23
Q

What physical examination findings can be used to assess anesthetic depth?

A
24
Q

Does anemia or hypoxemia have a greater effect on blood oxygen content?

A

Anemia - because the volume of dissolved oxygen in blood is low. PaO2 only starts to have a significant impact on CaO2 at pressures less than 70 mmHg

25
Q

What is the normal BP in an awake dog/cat?

A

125/85 (98)

26
Q

What diastolic BP may result in poor coronary artery perfusion>?

A

40 mmHg

27
Q

How does a Doppler ultrasonic flow probe function?

A

An ultrasonic wave is emitted, interacts with the blood altering the frequency, this is then transduced in an audible noise

28
Q

What vessels are most commonly used for doppler placement?

A

Thoracic limb: radial artery
Pelvic limb: plantar metatarsal artery
Tail: coccygeal

29
Q

What vessels are most frequently used for arterial catheter placement?

A

Dorsal pedal and coccygeal

30
Q

Do Doppler and oscillometric BP monitors work in the face of arrhythmias?

A

Doppler does, oscillometric may not (are relies on regular oscillations during blood flow)

31
Q

What is the normal PaCO2 in an awake patient?

A

Between 35 and 45 mmHg

32
Q

What is the definition of hypercarbia?

A

PaCO2 > 55 mmHg

33
Q

Why can end tidal CO2 be used as an accurate marker for PaCO2?

A

CO2 is rapidly and readily absorbed across the alveoli. Therefore alveolar CO2 should equal arterial CO2 concentrations. Air at the end of expiration should be composed almost entirely of alveolar CO2 and can therefore be used as a surrogate for PaCO2.

34
Q

Can end tidal CO2 be used to monitor perfusion?

A

Yes, because alveolar CO2 concentration relies on adequate perfusion of the lungs and CO2 transport

35
Q

Interpret various capnograph read-outs

A
36
Q

What does pulse oximetry measure?

A

The difference in concentration between oxyhemoglobin and deoxyhemoglobin using infrared light in pulsatile blood

37
Q

What is the ideal PaO2 at room air?

A

110 mmHg which corresponds to a hemoglobin saturation of 100%.

38
Q

What is PaO2 is considered hypoxemia?

A

<60 mmHg, corresponding to 90% hemoglobin saturation

39
Q

What should the PaO2 of a patient breathing 100% oxygen be?

A

500 mmHg

40
Q

What is the normal CVP in small animals?

A

0-8 cmH20, or 0-5 mmHg

41
Q

How much can opioid use reduce the inhalational anesthetic requirement?

A

40 - 60%

42
Q

What is neuroleptanalgesia?

A

The combination of opioids and tranquilizers that results in both sedation and analgesia

43
Q

What is minimum alveolar concentration?

A

The concentration of anesthetic that is required to prevent purposeful movement in response to a standard painful stimulus in 50% of normal patients

44
Q

Compare the MAC of common inhalational anesthetics?

A
45
Q

What is the concentration of anesthetic required to typically prevent movement during surgery?

A

1.2 to 1.5 times MAC

46
Q

What is the effect of hypothermia on MAC?

A

Reduction in MAC by 5% for each degree celsius

47
Q

Do more or less soluble inhalation anesthetic agents result in faster induction, recovery and change in depth of anesthesia?

A

Less soluble agents (such as desflurane) as they saturate the blood more quickly

48
Q

Describe the ASA levels

A
49
Q

What is the Branham reflex?

A

An abrupt decrease in heart rate observed after PDA occlusion due to a sudden increase in afterload

50
Q

Is hypoxemia or hypercapnea more common in instances of V/Q mismatch?

A

Hypoxemia as CO2 has a much higher diffusing capacity

51
Q

What is positive end expiratory pressure?

A

Useful in patients with pulmonary parenchymal disease and hypoxemia. Used to help maintain alveoli open between breathes and can improve oxygenation and limit alveolar cycling

52
Q

In instances of fibrosing pleuritis what sort of mechanical ventilation should be used to prevent pneumothorax?

A

Pressure limited at low pressure (<10 cm H2O)

53
Q

In animals with chronic atelectasis should negative pleural pressure be reintroduced quickly or gradually?

A

Gradually to prevent reexpansion pulmonary edema

54
Q
A

Surgical biology and methods (11 decks)

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