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VTNE Review > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

ASA Scale

A

American Society of Anesthesiologists
* assessment for anesthetic risk
* scale I-V; also E

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2
Q

ASA Scale
I

A

Minimal risk
* normal / healthy patient
* routine: spays and neuters

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3
Q

ASA Scale
II

A

Slight risk
* mild systemic issues
* cruciate repairs / neonates and geriatrics

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4
Q

ASA Scale
III

A

Moderate risk
* moderate systemic issues / disease with mild C/S
* murmurs, anemia, ect

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5
Q

ASA Scale
IV

A

High risk
* severe systemic issues that are life threatening
* shock or gastric torsion

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6
Q

ASA Scale
V

A

Extreme risk
* surgery to save life - will die otherwise
* shock / organ failure / trauma

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7
Q

ASA Scale
E

A

Emergency
* any previous risk class presenting for immediate surgery

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8
Q

Preanesthetic Drugs
Classes

A
  • Anticholinergics
  • Tranquilizers / Sedatives
  • Opioids
  • Neuroleptanalgesics
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9
Q

Anticholinergics

A

Block actions of PNS (acetylcholine)
* Atropine and Glycopyrrolate
* prevent / treat bradycardia
* may cause tachycardia - do not give if preexisting heart condition
* mydriatic (dilates pupils)
* slows GI movement - don’t use if constipated
* not for use in rabbits

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10
Q

Atropine

A
  • Anticholinergic
  • Faster and more potent than Glycopyrrolate
  • Crosses blood-brain and placental barriers
  • IV = ventricular arrhythmias
  • Reversed with physostigmine
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11
Q

Glycopyrrolate

A
  • Anticholinergic
  • Slower and less potent than Atropine, but works longer
  • Does not cross blood-brain or placental barriers
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12
Q

Tranquilizers / Sedatives

A
  • Tranquilizer: calms anxiety without necessarily sedating
  • Sedation: reduces mental activity
  • Phenothiazines
  • Benzodiazepines
  • Butyrophenones
  • Alpha 2 Agonists
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13
Q

Phenothiazines

A
  • Tranquilizers / Sedatives
  • Block dopamine receptors in brain
  • No analgesia
  • Depression effects
  • Can cause penile paralysis in horses
  • Example: acepromazine
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14
Q

Benzodiazepines

A
  • Tranquilizers / Sedatives
  • Bind to GABA receptors in brain - reduces brain activity
  • Metabolized in liver - do not use if has condition
  • Examples: Diazepam / Midazolam
  • Reversed with Flumazenil
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15
Q

Diazepam

A
  • Benzodiazepine
  • Not water soluble - do not mix with others
  • Not taken well IM
  • Can increase appetite in cats and ruminants
  • Combine with Ketmaine for induction
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16
Q

Midazolam

A
  • Benzodiazepine
  • Water soluble - can be mixed with others
  • Can be given IM or IV
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17
Q

Alpha 2 Agonists

A
  • Tranquilizers / Sedatives
  • Stimulates receptors to reduce norepinephrine release
  • CNS depression
  • Depressed RR and HR (pale MM)
  • Profound sedation with moderate analgesia
  • Can be added with opioids to enhance sedation / analgesia
  • Examples: Xylazine and Dexmedetomidine
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18
Q

Xylazine

A
  • Alpha 2 Agonist
  • Trade Name: Rompun
  • Used in both large and small animals - common for large
  • Reversal: Yohimbine
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19
Q

Dexmedetomidine

A
  • Alpha 2 Agonist
  • Trade Name: Dexdomitor
  • Can be used as CRI
  • Reversal: Atipamezole (Antisedan)
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20
Q

Opioids

A

Classified depending on what receptor they effect in brain
* receptors: mu, delta, kappa
* most are Schedule II drugs
* used for analgesia / anesthesia / CRI
* depression of HR and RR dose dependant

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21
Q

Opioids
Pure (mu) Agonist

A

Stimulate all opioid receptors
* morphine
* hydromorphone
* fentanyl

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22
Q

Opioids
Mixed Agonists-Antagonists

A

Block one type of receptor while stimulating another
* butorphanol
* buprenorphine

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23
Q

Opioids
Pure Antagonists

A

Reverse effects of pure and mixed agonists
* provide little effect of their own
* naloxone

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24
Q

Neuroleptanalgesics

A

Any combination of an opioid analgesic and a tranquilizer
* enhances CNS depression effects from both
* mix drugs or give separately
* used when heavy sedation for short periods needed or cases of cardiac / shock

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25
Q

Barbiturates

A
  • Cause sedation / muscle relaxation
  • CNS depression - works on neurons and GABA
  • Nonreversible - give to effect
  • Metabolized via liver
  • Examples: Pentobarbital and Thiopental
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26
Q

Pentobarbital

A
  • Barbiturate
  • Previously used for anesthesia - now common for seizure control
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27
Q

Nonbarbiturate Anesthetic Drugs

A
  • Propofol
  • Alfaxalone
  • Fentanyl
  • Guaifenesin
28
Q

Propofol

A
  • Nonbarbiturate Anesthetic Drug
  • Binds to GABA - depresses CNS
  • Poor analgesia
  • Crosses placental barrier
29
Q

Alfaxalone

A
  • Nonbarbiturate Anesthetic Drug
  • Binds to GABA - depresses CNS
  • No analgesia
  • Use in dogs and cats only
  • Safe to combine with any preanesthetic but do not give IV with others
30
Q

Fentanyl

A
  • Nonbarbiturate Anesthetic Drug
  • Primarily used for analgesia - used as neuroleptanalgesic
  • Safe for high risk - does not depress RR or HR
31
Q

Guaifenesin

A
  • Nonbarbiturate Anesthetic Drug
  • Blocks transmission of spinal cord and brain
  • Common in large animals for muscle relaxation
  • Minimal HR and RR effects
  • Crosses placental barrier - minimal effects
32
Q

Dissociative Anesthetics

A

Induces unconscious and conscious brain functions - dissociate from one’s environment
* cateleptic state via CNS excitement
* some analgesia
* examples: Ketamine and Tiletamine

33
Q

MAC

A

Minimum Alveolar Concentration
* potency of inhalant anesthetic agents
* lower MAC = more potent = lower concentration needed

34
Q

Inhalation Anesthetic Drugs

A

Produce general anesthesia in all species
* minimal depression on RR and HR
* some analgesia
* Examples: Isoflurane / Sevoflurane / Desflurane

35
Q

Isoflurane

A
  • Purple label on bottle
  • Least expensive
  • Lowest MAC
36
Q

Sevoflurane

A
  • Yellow label on bottle
  • Faster induction / recovery than Isoflurane
  • More expensive than Isoflurane
  • Ideal for avian species
37
Q

Desflurane

A
  • Blue label on bottle
  • Fastest acting inhalation agent
  • Highest MAC - less potent
  • Expensive
38
Q

Measuring ET Tube

A

Measured from tip of nose to thoracic inlet

39
Q

Breathing Circuits

A
  • Circle System
  • Bain System
40
Q

Circle System
Breathing Circuit

A

Standard re-breathing circuit
* uses Y tube
* excessive weight and dead space - not ideal for smaller patients

41
Q

Universal F-circuit
Breathing Circuit

A

Modified circle system
* inspiration hose inside expiration hose

42
Q

Bain System
Breathing Circuit

A

One tube inside another tube
* non-rebreathing system
* ideal for smaller patients

43
Q

Monitoring CNS
Signs

A
  • Eye Position
  • Palpebral Reflex
  • Corneal Reflex
  • Pupil Size
  • Pedal Reflex
  • Jaw Tone
44
Q

Monitor CNS
Eye Position

A

Eyes rotate ventromedially during Stage 3 Plane 2 of anesthesia
* central position = too light or too deep

45
Q

Monitor CNS
Palpebral Reflex

A

Observation for blink
* reflexes slow in Stage 2 Plane 2 of anesthesia

46
Q

Monitor CNS
Corneal Reflex

A

Done via light touching or sterile drops to cornea
* should be present under anesthesia
* absence = anesthesia overdose
* done as a last resort to monitor patient status

47
Q

Monitor CNS
Pupil Size

A
  • Light, non-surgical plane = dilated
  • Light, surgical plane = constricted
  • Deep plane = dilated
  • Be aware, some drugs cause pupil dilation (Atropine)
48
Q

Monitor CNS
Pedal Reflex

A

Pain response
* done by pinching skin between toes
* normal (while awake) = pull away
* weak / absent with anesthesia

49
Q

Blood Pressure
Monitoring

A
  • Noninvasive System: indirect readings; taken every few minutes
  • Invasive System: direct readings via arterial line; continuous
  • BP cuff should fit 40-60% around the limb
50
Q

Respiratory Rate
During Anesthesia

A
  • Very light plane: irregular depth and rate
  • Surgical plane: rate and depth regular
  • Deep plane: shallow and rapid breathing (paradoxical breathing)
51
Q

Paradoxical Breathing

A

Breathing appears “opposite” how you should see it
* abdomen rises, chest falls during inspiration

52
Q

Hypoventilation

A

Respiratory acidosis
* increased CO2

53
Q

Hyperventilation

A

Respiratory alkalosis
* decreased CO2

54
Q

Stages of Anesthesia

A
  • Range from Stage 1 - Stage 4
  • Ideally should have smooth induction from Stage 1 to Stage 3, quickly passing Stage 2
55
Q

Stages of Anesthesia
Stage 1

A

Induction Stage
* loss of pain
* sensations dulled
* voluntary movement
* pupils dilate going into Stage 2

56
Q

Stages of Anesthesia
Stage 2

A

Excitement Stage
* involuntary muscle movement
* reflexes present - may be exaggerated
* dilated pupils
* panting or breath holding

57
Q

Stages of Anesthesia
Stage 3

A

Surgical Stage
* regular respiration
* constricting pupils
* palpebral reflex gone
* subdivided into 4 planes

58
Q

Stages of Anesthesia
Stage 3
Plane 1

A
  • Eyes start to roll
  • Normal HR and BP
  • Muscle tone present
59
Q

Stages of Anesthesia
Stage 3
Plane 2

A

Ideal Surgical Plane
* regular respiration
* eyes fixed; slight rotation ventrally
* reflexes absent

60
Q

Stages of Anesthesia
Stage 3
Plane 3

A
  • Decreased RR - may be irregular
  • Eyes fixed / centrally rotated
  • Pupils dilating
  • Decreased BP - no response to pain stimulation
61
Q

Stages of Anesthesia
Stage 3
Plane 4

A
  • Progressive respiratory paralysis
  • Reflexes gone
  • Pupils dilated
  • HR and BP significantly low
  • Jerky breaths
  • Pale MM / prolonged CRT
62
Q

Stages of Anesthesia
Stage 4

A

Medullary Paralysis Stage
* apnea
* cardiac arrest

63
Q

Rebreather
Bag Size

A
  • 0.5 L = <6 kg
  • 1 L = 6 - 16 kg
  • 2 L = 16 - 35 kg
  • 3 L = >35 kg
64
Q

Acid-Base Balance

A
  • Looks at pH of the body
  • Acidosis vs Alkalosis
  • Metabolic vs Respiratory
  • Maintained by: chemical buffers / respiratory system / renal system
65
Q

Respiratory Acidosis

A

CO2 production greater than excreted
* increased CO2 = gained acid = lowered pH

66
Q

Respiratory Alkalosis

A

CO2 excretion greater than production
* decreased CO2 = gain in bases

67
Q

Metabolic Acidosis

A

Excess base: lactic acid gain
* from decreased tissue perfusion
* treatable: replacement with crystalloids

VTNE Review (31 decks)

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