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Anesthesia Flashcards

1
Q

An internal pressure regulator on the anesthesia machine reduces the carrier gas pressure from that in the tank or wall outlet to _____ pounds per square inch (PSI).

A

50

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2
Q

Respiratory acidosis occurs when hypoventilation causes ________ or an __________ in the blood PaCO2. The compensatory response to this condition is increased renal excretion of ______ which results in ___________ extracellular HCO3−.

A

hypercapnia, or an increase
H+
increased

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3
Q

What is a possible cause of transudative pericardial effusion?

A
  • Congestive heart failure
  • Peritoneopericardial diaphragmatic hernia
  • Hypoalbuminemia
  • Increased vascular permeability

Other causes include .

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4
Q

Define exudative pericardial effusion based on total protein and total nucleated cell count.

A

Total protein >2.5 g/dL; total nucleated cell count >5000 cells/µL

Exudate results from infectious or noninfectious pericarditis.

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5
Q

What are some infectious agents that can cause exudative pericardial effusion?

A

Bacterial, fungal, or viral

Examples include feline infectious peritonitis and feline cardiomyopathy.

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6
Q

Which fungal agent is noted to cause pericarditis in dogs in the southwestern United States?

A

Coccidioides immitis

Fungal pericarditis is unusual, but this agent is an exception.

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7
Q

What is a suspected cause of bacterial pericardial effusion in dogs?

A

Grass awn migration

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8
Q

List some causes of hemorrhagic pericardial effusion.

A
  • Trauma
  • Neoplasia
  • Anticoagulant intoxication
  • Rupture of the left atrium secondary to mitral valve disease

These conditions can lead to bleeding into the pericardial space.

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9
Q

What is the formula for Respiratory Minute Volume (MV)?

A

Respiratory Rate x Tidal Volume

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10
Q

What is the estimated tidal volume in mL/kg?

A

15 mL/kg

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11
Q

What is the recommended gas flow rate for a nonrebreathing system in relation to Minute Volume (MV)?

A

At least 3 times MV

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12
Q

What are possible complications of epidural injections?

A
  • Injection of local anesthetic into the vertebral sinuses
  • Respiratory depression and paralysis and dogs and cats caused by drug overdose
  • Temperature may fall in small animals because they are unable to shiver

These complications highlight the risks associated with epidural anesthesia.

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13
Q

What respiratory issues can occur in dogs and cats due to drug overdose?

A

Respiratory depression and paralysis

This condition is serious and can lead to inadequate breathing.

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14
Q

The drug must migrate to _______ to produce complete respiratory paralysis from blockade of the phrenic nerves.

A

approximately C5 or C7

Phrenic Nerve C5, C6, C7

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15
Q

What physiological change may occur in small animals due to inability to shiver?

A

Temperature may fall

This can lead to hypothermia in susceptible animals.

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16
Q

What nerve blockade is responsible for respiratory paralysis?

A

Phrenic nerves

The phrenic nerves are crucial for diaphragm function and breathing.

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17
Q

Injection of local anesthetic into the vertebral sinuses can lead to:

A
  • Vomiting
  • Tremors
  • Decreased blood pressure caused by peripheral vasodilation
  • Convulsions
  • Paralysis
  • Lack of intended effect
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18
Q

What increases with ventilation perfusion mismatch (V/Q)?

A

Increased ventilation and decreased perfusion

V/Q mismatch can lead to various respiratory issues and is a critical concept in understanding pulmonary function.

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19
Q

What is the function of one-way valves in an anesthesia machine?

A

Prevent immediate rebreathing of exhaled gas

One-way valves ensure that exhaled gases do not return to the patient, thus maintaining the integrity of the anesthetic circuit.

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20
Q
A
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21
Q

What surface does a reverse-cutting needle have the cutting surface on?

A

Convex surface

Reverse-cutting needles create a unique triangular hole.

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22
Q

What shape does the hole created by a reverse-cutting needle have?

A

Triangular hole

The triangular hole has a flat edge.

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23
Q

The flat edge of the hole created by a reverse-cutting needle is _______ to the incision.

A

Parallel

This design helps in reducing tissue trauma.

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24
Q

What is the tidal volume (TV) setting range for mechanical ventilators?

A

10-20 mL/kg

Tidal volume refers to the amount of air delivered to the lungs with each breath.

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25
Q

Recommended Chlorhex duration ____ minutes.
vs.
Alcohol-based hand rub solutions have similar efficacy w/in ____ minutes. Gold standard!

A

3-5 minutes
1.5-2 minutes

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26
Q

What is the recommended respiratory rate (RR) for mechanical ventilators?

A

8-12 breaths per minute

This rate helps ensure adequate ventilation without causing respiratory alkalosis.

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27
Q

What is the recommended respiratory rate (RR) for mechanical ventilators?

A

8-12 breaths per minute

This rate helps ensure adequate ventilation without causing respiratory alkalosis.

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28
Q

What is the peak inspiratory pressure (PIP) range for mechanical ventilators?

A

10-20 cm H2O

PIP is the maximum pressure applied to the airways during inhalation.

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29
Q

What is the typical inspiratory/expiratory (I/E) ratio for mechanical ventilation?

A

1:2

This ratio helps maintain optimal gas exchange during mechanical ventilation.

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30
Q

What does CO2 react with to form carbonic acid on the surface of granules?

Soda Lime

A

Water

This reaction is crucial for the function of Soda Lime in absorbing CO2.

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31
Q

When should Soda Lime be changed?

Soda Lime

A

Whenever rebreathing of CO2 by patient is observed on capnograph

This indicates that the granules are no longer effectively removing CO2.

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32
Q

What happens to Soda Lime granules at higher fresh gas flow?

Soda Lime

A

Granules may lose water to evaporation

This can make them less effective for CO2 removal.

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33
Q

Fill in the blank: CO2 reacts with water to form _______ on the surface of granules.

Soda Lime

A

[carbonic acid]

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34
Q

True or False: Minimal regeneration of Soda Lime occurs over time.

Soda Lime

A

True

This suggests that Soda Lime has a limited lifespan and needs to be monitored.

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35
Q

What is the consequence of using Soda Lime granules that have lost water?

Soda Lime

A

They become less effective for CO2 removal

Maintaining adequate hydration of the granules is essential for their function.

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36
Q

What is the relationship between fresh gas flow and the effectiveness of Soda Lime?

Soda Lime

A

Higher fresh gas flow can lead to reduced effectiveness due to evaporation of water

This highlights the importance of managing gas flow rates in anesthesia.

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37
Q

What does a rebreathing system allow?

Rebreathing System

A

Rebreathing of exhaled gases minus CO2

This system recycles gases that have been exhaled, excluding carbon dioxide.

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38
Q

What does the amount of rebreathing in a rebreathing system depend on?

Rebreathing System

A

Fresh gas flow rate

The rate at which fresh gas is supplied affects how much exhaled gas is rebreathed.

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39
Q

What do nonrebreathing systems rely on?

Nonrebreathing System

A

Relatively HIGH fresh gas flow rates to remove CO2

Nonrebreathing systems require higher flow rates to ensure that carbon dioxide is effectively removed from the gas mixture.

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40
Q

Are Touhy needles:
* uninsulated or insulated
* curved or straight at the tip
* sharp or not sharp

A
  • Uninsulated or insulated
  • Curved at the distal tip
  • Not as sharp
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41
Q

Touhy needles are used for?

A

epidural or perineural catheters

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42
Q

Name the Pain Nerves

A

A-alpha - proprioception
A-beta - touch
A-delta - pain (mechanical and thermal)
C - pain (mechanical, thermal, chemical)
Unmyelinated

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43
Q

How/where to block thoracic limb cat?

A

Brachial plexus C6-T1 VENTRAL BRANCHES

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44
Q

What are the ventral branches of the brachial plexus?

A

Suprascapular, subscapular, axillary, musculocutaneous, radial, median, ulnar nerves

The specific spinal levels for each nerve are: Suprascapular + subscapular (C6-7), axillary + musculocutaneous (C6-8), radial (C6-T2), median (C7-T1), ulnar (C8-T2)

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45
Q

What is Regional or Nerve Block Anesthesia?

A

Injection of LRA (local regonal anesthesia) adjacent to a peripheral nerve to temporarily block conduction.

This results in the temporary interruption of sensory afferent and/or motor efferent activity.

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46
Q

What are the major landmarks for brachial plexus block?

A

Scapulohumeral joint, acromion, greater tubercle, jugular vein

These landmarks are critical for proper needle placement during the procedure.

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47
Q

Where is the puncture site located for brachial plexus block?

A

Cranial to the acromion and medial to the subscapularis muscle

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48
Q

What is the direction of needle advancement during brachial plexus block?

A

Medial to the scapula in a caudal direction

This technique helps ensure proper placement of the anesthetic agent.

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49
Q

Fill in the blank: The spinal levels for the axillary and musculocutaneous nerves are _______.

A

C6-8

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50
Q

True or False: The radial nerve spans from C6 to T2.

A

True

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51
Q

The phases of end-tidal capnograph waveform?

A

Phase 1: Inspiratory Baseline
Phase 2 : Rise (expiratory upstroke)
Phase 3 : Alveolar Plateau
Phase 4 : inspiratory downstroke

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52
Q

What happens to the capnograph waveform with hypoventilation?

A

Elevated plateau

Increase in horizontal portion, which is elevation of plateau (phase 3)

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53
Q

Wit

What happens to the capnograph waveform with rebreathing CO2?

A

Elevated baseline (phase 1)

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54
Q

What happens to the capnograph waveform with hyperventilation?

A

Decrease plateau

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55
Q

What is the difference from PCO2 vs PaCO2?

A

PCO2 refers to the partial pressure of carbon dioxide, while PaCO2 specifically indicates the partial pressure of carbon dioxide in arterial blood

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56
Q

What happens with drugs in a hypoproteinemic patient?

A
  • Increased amount of circulating free drug
  • Propofol: much smaller dose needed for effect
  • Opioids and benzos need much smaller dose
  • Inhalants are not affected
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57
Q

What type of neuromuscular blocker is Atracurium?

A

Nondepolarizing Neuromuscular blocker

Blocks acetylcholine (Ach) at the neuromuscular junction (NMJ)

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58
Q

What are the cardiovascular effects of Atracurium at normal doses?

A

Minimal cardiovascular effects

Large doses can stimulate histamine release

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59
Q

Is Atracurium safe for patients with hepatic and renal diseases?

A

Yes

It is indicated for use in patients with these conditions

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60
Q

Does Atracurium provide analgesia or sedation?

A

No

It does not provide pain relief or sedation

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61
Q

What is the onset time for Atracurium when administered intravenously?

A

3-5 minutes

It takes this time to achieve initial effects

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62
Q

How long does the central eye position last after Atracurium administration?

A

20 to 30 minutes

This duration is important for surgical procedures

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63
Q

Is reversal of Atracurium blockade usually necessary?

What drug is used to reverse?

A

Rarely necessary

Neostigmine, an acetylcholinesterase inhibitor

Due to its relatively low dose and short duration of action

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64
Q

What effect does Atracurium have on intraocular pressure?

A

Prevents increases in intraocular pressure

This is due to extraocular muscle contraction

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65
Q

What type of neuromuscular blocker is Succinylcholine?

A

Depolarizing

It mimics acetylcholine at the NMJ

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66
Q

What is a notable side effect of Succinylcholine?

A

Triggers malignant hyperthermia

It can also cause reported muscular pain following administration

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67
Q

What is the mechanism of action (MOA) of Endrophium?

A

Inhibits acetylcholinesterases

This increases acetylcholine at the NMJ

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68
Q

What can Endrophium potentially cause?

A

Cholinergic crisis

This is a result of increased acetylcholine levels.
Characterized by excessive acetylcholine (ACh) accumulation, leading to symptoms like muscle weakness, salivation, and respiratory distress.

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69
Q

Which drugs are inhibitors of acetylcholinesterase?

A

Neostigmine & Edrophonium

These drugs increase levels of acetylcholine at the NMJ

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70
Q

What does ASA stand for in the context of physical status classification?

A

American Society of Anesthesiologists

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71
Q

What is ASA level 1 classified as?

A

Normal healthy patients

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72
Q

Provide examples of ASA level 1.

A
  • No discernible disease
  • Animals entered for ovariohysterectomy
  • Ear trim
  • Caudectomy
  • Castration
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73
Q

What is ASA level 2 classified as?

A

Patients with mild systemic disease

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74
Q

Provide examples of ASA level 2.

A
  • Skin tumor
  • Fracture without shock
  • Uncomplicated hernia
  • Cryptorchidectomy
  • Localized infection
  • Compensated cardiac disease
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75
Q

What is ASA level 3 classified as?

A

Patients with severe systemic disease

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76
Q

Provide examples of ASA level 3.

A
  • Fever
  • Dehydration
  • Anemia
  • Cachexia
  • Moderate hypovolemia
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77
Q

What is ASA level 4 classified as?

A

Patients with severe systemic disease that is a constant threat to life

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78
Q

Provide examples of ASA level 4.

A
  • Uremia
  • Toxemia
  • Severe dehydration and hypovolemia
  • Anemia
  • Cardiac decompensation
  • Emaciation
  • High fever
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79
Q

What is ASA level 5 classified as?

A

Moribund patients not with or without operation

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80
Q

Provide examples of ASA level 5.

A
  • Extreme shock and dehydration
  • Terminal expected to survive 1 day malignancy or infection
  • Severe trauma
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81
Q

What ASA level for:
* Hx of CHF ____
* Current failure ____
* Renal failure ____

A
  • Hx of CHF = 3
  • Current failure = 4
  • Renal failure = 3
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82
Q

What is the function of soda lime in a rebreathing system?

A

Incorporates a CO2 absorbent to remove CO2 from the system and allow exhaled gases to be safely inhaled again

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83
Q

What are the main components of soda lime?

A

Combination of sodium hydroxide, potassium hydroxide, water, calcium hydroxide

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84
Q

What is the primary component of soda lime?

A

Na(OH)2 - sodium hydroxide

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85
Q

What type of reaction occurs in soda lime and what are its products?

A

Exothermic reaction producing H2O, Na2CO3, and heat

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86
Q

What is the intermediate compound formed during the reaction in soda lime?

A

Carbonic acid

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87
Q

What materials are included in soda lime to give hardness to the granules?

A

Silica and kieselguhr

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88
Q

What is the optimal moisture content required in soda lime for CO2 absorption?

A

14-19% H2O

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89
Q

What are the two types of regulation of vapor output in vaporizers?

A
  • Variable bypass (MC)
  • Measured flow

Variable bypass is more common, while measured flow is rare.

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90
Q

List the methods of vaporization used in vaporizers.

A
  • Flow-over (MC)
  • Bubble-through
  • Direct injection

These methods describe how the vapor is generated and delivered.

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91
Q

What are the two locations where vaporizers can be placed in the circuit?

A
  • Out of circuit (MC)
  • Rarely integrated

The placement affects how the vapor is utilized in the system.

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92
Q

What is a unique feature of Desfluorane vaporization?

A

Externally warmed vaporizer with gas phase injected into carrier gas

This specificity distinguishes Desfluorane from other agents.

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93
Q

True or False: Measured flow vaporizers are more common than variable bypass vaporizers.

A

False

Variable bypass is the more common type.

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94
Q

What is the primary purpose of rebreathing systems?

A

To remove CO2 from the system and allow exhaled gases to be safely inhaled again

This is achieved using a CO2 absorbent like soda lime.

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95
Q

What type of patients are rebreathing systems reserved for?

A

Patients >5kg

This indicates that rebreathing systems are not typically used for smaller patients.

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96
Q

What is the function of one-way valves in rebreathing systems?

A

To prevent immediate rebreathing of exhaled gas

This enables unidirectional flow of gases.

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97
Q

What components are incorporated in rebreathing systems?

A
  • CO2 absorbent (e.g., soda lime)
  • One-way valves
  • Reservoir bag
  • Pressure gauge
  • Pop-off valve
  • Breathing tubes

These components work together to facilitate safe gas exchange and ventilation.

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98
Q

Fill in the blank: Rebreathing systems incorporate a _______ to remove CO2 from the system.

A

CO2 absorbent

Soda lime is a common type of CO2 absorbent used.

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99
Q

True or False: Rebreathing systems allow for immediate rebreathing of exhaled gases.

A

False

One-way valves prevent immediate rebreathing.

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100
Q

What is the role of the reservoir bag in rebreathing systems?

A

To allow positive pressure ventilation

This helps in delivering the necessary airflow to the patient.

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101
Q

What is the significance of the pop-off valve in rebreathing systems?

A

To prevent overpressure in the system

It ensures safety by allowing excess gas to escape.

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102
Q

Adjustable pressure‐limiting (APL) valve = “pop-off”

A
  • Releases anesthetic gases into the scavenging system
  • Provide pressure control in the breathing circuit during manual ventilation
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103
Q

What is the actual name of the “pop-off”?

A

Adjustable pressure‐limiting (APL) valve

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104
Q

Fill in the Blank: Internal pressure regulator on ax machine reduces the carrier gas pressure from that in the tank or wall outlet to ____ PSI.

105
Q

Fill in the Blank: Oxygen tanks are ____ in color in the US.

106
Q

The green tanks come in E and H. What are there PSI and volume?

A

E (mini sized tanks) 1900 PSI - 660 L
H (full sized tanks) 2200 PSI - 6900 L

107
Q

What is the purpose of a non-rebreathing system?

A

Prevents rebreathing of CO2 by using high fresh gas flow rates

High fresh gas flow rates are essential to ensure that CO2 does not accumulate in the breathing circuit.

108
Q

What is the required gas flow rate for a non-rebreathing system?

A

150-300 ml/kg/min

This range is necessary to effectively prevent CO2 rebreathing.

109
Q

What is the minimum fresh gas flow rate in relation to minute respiratory volume?

A

At least 3 times the minute respiratory volume

Minute volume (MV) is calculated as MV = RR x TV, where TV is approximately 15 ml/kg.

110
Q

What is the approximate tidal volume (TV) in ml/kg?

A

~15 ml/kg

Tidal volume is the amount of air inhaled or exhaled in a single breath.

111
Q

For which weight range does a non-rebreathing system work best?

A

Less than 3-5 kg

Non-rebreathing systems are particularly effective for smaller patients.

112
Q

What is the reservoir bag capacity for rebreathing systems?

A

5-10 times the tidal volume (10-20 mL/kg)

The reservoir bag size is crucial for accommodating the patient’s breathing needs.

113
Q

What substance is used in rebreathing systems to absorb CO2?

A

Soda lime

Soda lime is a common absorbent used in rebreathing systems to eliminate CO2 from the exhaled gases.

114
Q

Place the local anesthestic in order of chrondrotoxic levels (less to greatest)?

Mepivacaine, Bupivacaine, Ropivacaine

A

Ropivacaine < Mepivacaine< Bupivacaine

Repeated administration leads to Chondromalacia

115
Q

What is the dosage of Glyco for IV administration?

A

0.01 mg/kg IV, 0.005 mg/kg IV

Glyco is administered intravenously at these specific dosages.

116
Q

Does Glyco cross the blood-brain barrier (BBB) or placenta?

A

No, Glyco is poorly lipid soluble and does not cross the BBB or placenta

This characteristic differentiates it from atropine.

117
Q

How does the onset time of Glyco compare to that of atropine?

A

Glyco has a slower onset (5 min IV) compared to atropine (1 min)

This indicates that atropine acts more quickly than Glyco.

118
Q

How long do cardiovascular effects last with Glyco compared to atropine?

A

CV effects last for approximately 1 hour longer with Glyco

This suggests that Glyco has a prolonged effect on cardiovascular parameters.

119
Q

How does the potency of Glyco compare to atropine?

A

Glyco is 4 times more potent than atropine (0.04 mg/kg CPA or half dose anesth)

This means a smaller dose of Glyco is required to achieve similar effects.

120
Q

What are the central nervous system (CNS) effects of Glyco?

A

Glyco has no CNS or ocular effects

In contrast, atropine can cross the BBB and cause mild sedation.

121
Q

What is one effect of Glyco on gastric pH?

A

Increases gastric pH by increasing gastric acid secretions

Atropine does not have this effect.

122
Q

What is a shared effect of Glyco and atropine?

A

Both decrease GI motility

This indicates that both agents can affect gastrointestinal function.

123
Q

What effect do both Glyco and atropine have on lower esophageal tone?

A

Both reduce lower esophageal tone

This can lead to increased gastroesophageal reflux.

124
Q

What is a contraindication for the use of Glyco?

A

Not for use due to reflex brady from alpha 2 agonists

This indicates that Glyco should be avoided in specific clinical situations.

125
Q

What can epinephrine do to local block?

A
  • Local: Prolong lidocaine by up to 3h
  • Epidurals increase duration, rostral spread, faster onset
126
Q

What is the onset time of Lidocaine when administered subcutaneously (SQ)?

A

~5 minutes

127
Q

What is the duration of action for Lidocaine?

A

45 to 60 minutes

128
Q

In what forms can Lidocaine be used?

A
  • Nerve block
  • Epidural
  • IV
  • SQ
129
Q

What effect does Lidocaine have on MAC?

A

Decreases MAC

130
Q

What is one of the uses of IV Lidocaine?

A
  • Preventing postoperative ileus
  • Stimulates GI motility
131
Q

What is a ‘Bier block’?

A

IV regional anesthesia

132
Q

How is a Bier block performed?

A
  • Apply esmarch bandage to exsanguinate the limb
  • Place tourniquet
  • Give lidocaine IV distal
133
Q

What is the toxic dose of Lidocaine for cats?

A

greater than 6 mg/kg

134
Q

What is the toxic dose of Lidocaine for dogs?

A

greater than 8 mg/kg

135
Q

What are some initial signs of Lidocaine toxicity?

A
  • Vomiting
  • Ileus
  • Nausea
  • Regurge
136
Q

What are the CNS effects of Lidocaine toxicity?

A
  • Dull mentation
  • Seizures
137
Q

What cardiac issues can Lidocaine toxicity cause?

A
  • Decreased contractility
  • Arrhythmia
  • Death
138
Q

What is the duration of action of Bupivacaine?

A

6-8 hours

Bupivacaine has a longer duration due to its lipophilicity.

139
Q

What is the onset time for Bupivacaine?

A

Up to 45 minutes

The onset time is affected by pKa and protein binding.

140
Q

Is Bupivacaine safe for intravenous administration?

A

No

Bupivacaine is never given IV due to risk of cardiotoxicity.

141
Q

What is the potential consequence of accidental IV administration of Bupivacaine?

A

Cardiac arrest

Intralipid may help in case of accidental IV administration.

142
Q

What routes can Bupivacaine be safely administered?

A

SQ, epidurally, or in chest tube

These routes avoid the risks associated with IV administration.

143
Q

What is the toxic dose of Bupivacaine for cats?

A

> 2 mg/kg

Dosage above this can lead to toxicity in cats.

144
Q

What is the toxic dose of Bupivacaine for dogs?

A

> 4 mg/kg

Dosage above this can lead to toxicity in dogs.

145
Q

How does the potency of Bupivacaine compare to Lidocaine?

A

4x as potent

Bupivacaine is significantly more potent than lidocaine.

146
Q

Dopamine’s MOA

A

alpha/ beta adrenergic

  • Low dose→ Vasodilation (dopaminergic activity)
  • Intermediate dose → B receptors → ↑ Cardiac contractility & HR
  • High dose → primarily alpha → Vasoconstriction
  • Alpha and beta adrenergic receptors are crucial components of the sympathetic nervous system, mediating various physiological responses like vasoconstriction (alpha) and vasodilation/cardiac stimulation (beta)
147
Q

Dopamine counteracts ____ during anesthesia.

A

Can use dopamine to counteract vasodilation (hypotension) due to local anesthesia.

148
Q

Is dopamine inotropic or chronotropic?

A

High doses of dopamine produce both inotropic and chronotropic effects.

Inotropic affects = cardaic force/ strength

Chronotrpic affects = HR (fast/slow)

149
Q

Fill in the Blank: NMDA (N-methyl-D-aspartate) receptors are ____ receptors that mediate excitatory neurotransmission.

A

glutamate receptor

150
Q

Fill in the Blank: GABA (gamma-aminobutyric acid) is the primary ____ neurotransmitter in the brain

A

inhibitory neurotransmitter

151
Q

Discuss adrenergic and dopaminergic receptor distributions, effects, and mechanisms of action

152
Q

What is the mechanism of action (MOA) of Dobutamine?

A
  • Stimulates beta-1 receptors in the heart, leading to increased heart rate (positive chronotropy) and contractility (positive inotropy). Leads to increased cardiac output and stroke volume.
  • Weaker effects and less pronouced on beta-2 receptors, which can cause vasodilation, and alpha-1 receptors, which can cause vasoconstriction.
153
Q

What is the primary effect of Dobutamine on cardiac contractility?

A

Strong increase in cardiac contractility

154
Q

Does Dobutamine cause norepinephrine release?

A

Does NOT cause NE release (like Dopamine)

155
Q

What potential side effect may Dobutamine induce in cats?

A

May induce seizures in cats

156
Q

What type of chronotropic effect does B1 have?

A

Positive Chronotrope leading to ↑HR (mild) and inotrophic affect (contractility)

157
Q

Mechanism of Action of Vasopressin?

A

Antidiuretic Hormone

H- ormone that plays a crucial role in regulating water balance and bloo

ADH is also known as Arginine Vasopressin (AVP)

158
Q

What type of receptors does vasopressin act on as a vasopressor?

A

Nonadrenergic V1 receptors

159
Q

In what situation may vasopressin be necessary to maintain blood pressure?

A

Vasoplegic shock associated with sepsis

160
Q

What is the typical dosage range for vasopressin to maintain blood pressure?

A

0.1 to 1.0 mU/kg/min

161
Q

What triggers the release of vasopressin during hypovolemia?

A

Decrease in blood pressure or blood volume

Low-pressure stretch receptors and baroreceptors are stimulated and trigger the release

162
Q

What are the two main effects of vasopressin in conditions of low blood volume?

A
  • Increases water retention
  • Exerts a powerful vasoconstrictor effect
163
Q

What is desmopressin?

A

A synthetic analogue of vasopressin

DDAVP

164
Q

What effect does desmopressin have on von Willebrand factor (vWf)?

A

Causes subendothelial vWf release

DDAVP

165
Q

Can Doxapram trigger an abnormal glottis to open?

A

No

May be administered to highlight laryngeal function but some dogs will develop severe glottic constriction, resulting in upper airway obstruction

166
Q

What is Doxapram?

A

A central nervous stimulant

167
Q

What effect does Doxapram have on respiratory rate?

A

Increases respiratory rate

Increases tidal volume

168
Q

Which part of the brain does Doxapram increase electrical activity in?

A

Inspiratory and expiratory centers of the medulla

Can stimulate respiration by reflex activitation of cartotid and aortic chemoreceptors

169
Q

What is the approach used for the Maxillary N.?

A
  • Infraorbital approach
  • Intraoral caudal
  • Ventral of the rostral Zygomatic arch

A, Infraorbital.B, Maxillary.C, Ophthalmic.D, Mental.E, Mandibular alveolar.

170
Q

Where is the mandibular foramen located in relation to the teeth?

A

Between M3 and angular process

A, Infraorbital.B, Maxillary.C, Ophthalmic.D, Mental.E, Mandibular alveolar.

171
Q

What is the location of the mental foramen for the Inferior alveolar n.?

A

Between K9 and PM1 at 45 degrees

A, Infraorbital.B, Maxillary.C, Ophthalmic.D, Mental.E, Mandibular alveolar.

172
Q

Why should you avoided alpha 2-agonist in patients with heart disease?

A

Alpha 2-agonists can compromise cardiac output (CO) and myocardial oxygen (O2) delivery.

173
Q

Which cardiac condition should Ketamine not be used in?

A

hypertrophic cardiomyopathy (HCM)

Ketamine can exacerbate symptoms in patients with HCM.

174
Q

When can anticholinergics be used in patients with heart disease?

A

Should not be used, unless symptomatic bradyarrhythmia

Anticholinergics can increase myocardial O2 demand due to potential tachyarrhythmias.

175
Q

Should lidocaine CRI be used in patients with a 3rd degree block?

176
Q

What drugs should be avoided with adrenal cases?

A
  • Ketamine
  • Acepromazine: can causeα-antagonism = complicate sympathetic tone control
  • α2-agonist: decrease central sympathetic outflow for pheochromocytoma unpredictable effect

µ-opioid and benzo are preferred

177
Q

Drugs to avoid with respiratory cases?

A

Avoid Beta blockers (bronchoconstriction)

Beta-blockers are a class of medications that block the effects of adrenaline (epinephrine) and noradrenaline (norepinephrine) on the body.

178
Q

Drugs to avoid with renal cases?

A
  • No NSAIDs
  • Ketamine, Benzos, Opioids, Acepromazine all of them renal excretion =prolong effects
  • Avoid ⍺-2s in obstructed cases bc ↑ urine output
  • No epidurals w/ severe uremia (PLT dysfunction)
179
Q

Why would you avoid epidurals in uremic patients?

A

May have PLT dysfunction

180
Q

Drugs to avoid with Septic cases?

A
  • NO ACE OR ⍺-2s (CV changes)
  • Etomidate – adrenal suppression (if used give Dex SP)
181
Q

What is malignant hyperthermia (MH)?

A

A rare, inherited disorder that causes a severe, life-threatening reaction to certain anesthetics and muscle relaxants used during surgery

MH is characterized by a hypermetabolic state leading to various physiological disturbances.

182
Q

What are the key symptoms of malignant hyperthermia?

A

Hypercarbia, hyperthermia, muscle rigidity, cardiac arrhythmias, and can lead to death

These symptoms arise due to excessive calcium release and increased metabolic activity.

183
Q

Which cellular defect is associated with malignant hyperthermia?

A

Defect in the Ryanodine Receptor (RYR1)

This receptor is crucial for Ca induced Ca release in muscle cells.

184
Q

What is the first sign of malignant hyperthermia?

A

Abrupt increase in CO2 from increased metabolism

This is followed by an increase in temperature and heart rate.

185
Q

What are the trigger agents for malignant hyperthermia?

A

Succinylcholine (depolarizing muscle relaxent) and Halothane (Sevoflurane, Isoflurane)

These agents can provoke a hypermetabolic crisis in susceptible individuals.

186
Q

What is the primary therapy for malignant hyperthermia?

A

D/C inhalants and administer IV Dantrolene

Dantrolene stabilizes the sarcoplasmic reticulum membrane and decreases calcium release.

187
Q

What does Dantrolene do in the context of malignant hyperthermia?

A

Stabilizes sarcoplasmic reticulum membrane and decreases calcium release

This action helps to mitigate the severe muscle rigidity and metabolic crisis.

188
Q

What is TIVA and how is it used in malignant hyperthermia?

A

Total Intravenous Anesthesia (TIVA) with propofol and oxygen delivery with a well-flushed system

This technique avoids the use of inhalational agents that could trigger MH.

189
Q

How can patients be pretreated for elective surgeries to prevent malignant hyperthermia?

A

Oral dantrolene for 1 week prior

This pre-treatment can help reduce the risk of MH during anesthesia.

190
Q

What should be assumed about relatives of individuals with malignant hyperthermia?

A

They may also have the disorder

It is an inherited condition, so genetic counseling may be necessary.

191
Q

What is Alfaxalone?

A

Steroid anesthetic which enhances GABA and glycine mediated CNS depression

Alfaxalone is used for its anesthetic properties in veterinary medicine.

192
Q

How is Alfaxalone administered?

A

Neutral solution can go IV or IM but only stored 6 hours

Alfaxalone’s stability limits its storage and usage timeframe.

193
Q

How does Alfaxalone compare to propofol?

A
  • Alfaxalone has less apnea compared to Propofol
  • Can use like propofol → rapid metabolism

Both are used for inducing anesthesia but differ in their metabolic pathways.

194
Q

What are the cardiovascular and respiratory effects of Alfaxalone?

A

Cardiac and respiratory depressive

Use with caution in patients with pre-existing conditions affecting these systems.

195
Q

What is the incidence of apnea with Alfaxalone compared to propofol?

A

Apnea, less than propofol

This indicates a potentially safer profile in terms of respiratory depression.

196
Q

What is the drug schedule classification of Alfaxalone?

A

Schedule IV

This classification affects its regulation and use in clinical settings.

197
Q

Fill in the Blank: Patients that have ____ should avoided using Alfaxalone?

A

DCM

DCM refers to dilated cardiomyopathy, a condition that may be exacerbated by the drug’s effects.

198
Q

What is the primary route of metabolism for Propofol?

A

EXTRA-hepatic metabolism

Metabolism occurs outside the liver.

199
Q

Propofol is ____ acting and causes ____ and ____ if given as a bolus.

A
  • Fast acting
  • Hypotension (secondary to vasodilation) and Apnea

It has a rapid onset of effects.

200
Q

True or False: Propofol causes oxidative damage to RBC in cats.

A

Yes, but the Oxidative damage to RBC is not clinically significant and does not lead to anemia.

201
Q

True or False: Propofol cause spinal myoclonus?

A

True

Spinal myoclonus, is a movement disorder characterized by sudden, brief, involuntary muscle jerks or twitches, involuntary muscle contractions (aka myoclonus) originating from the spinal cord, often involving specific segments.

202
Q

What conditions can Propofol be used to treat?

A

Refractory status epilepticus and reduces intracranial pressure

It is utilized in critical care situations.

203
Q

Is Propofol considered a controlled substance in the United States?

A

Yes, in some states

Regulations may vary by state.

204
Q

What happens to the tissue when Propofol is administered perivascularly?

A

Nothing to the tissues. It does not cause tissue damage

This route is safe for administration.

205
Q

What is the potency of Methadone compared to morphine?

A

2x

Methadone is a 𝜇 agonist and NMDA blocker, causing less excitatory response in cats.

206
Q

What is the potency of Hydro compared to morphine?

A

8x

Hydro is a 𝜇 agonist.

207
Q

What is the potency of Oxymorphone compared to morphine?

A

10x

Oxymorphone is a 𝜇 agonist.

208
Q

What is the potency of Buprenorphine compared to morphine?

A

40x

Buprenorphine is a Partial 𝜇 agonist.

209
Q

What is the potency of Fentanyl compared to morphine?

A

100x

Fentanyl is a 𝜇 agonist.

210
Q

What is the potency of Meperidine compared to morphine?

A

10x less

Meperidine is a 𝜇 agonist and causes more histamine release.

211
Q

Does Buprenorphine has a plateau effect?

A

Yes.

Ceiling effect, higher doses just last longer.

212
Q

Methadone

A

A mu agonist and an NMDA receptor antagonist which causes fewer excitatory responses in cats

Less excitatory effects in cat’s vs dogs
2x as potent as morphine

213
Q

What is the effect of a mixture of helium and oxygen (heliox) on respiratory effort?

A

It reduces respiratory effort by having lower resistance to flow than either room air or 100% oxygen.

Increases tendency to laminar flow and reduces resistance to turbulent flow.

214
Q

What is the ratio of helium to oxygen used?

A

70:30 ratio of helium to oxygen.

Prevent fires caused by laser ignition

215
Q

What are the three main types of one lung ventilation?

A
  1. Double-lumen tubes (DLTs)
  2. Bronchial blockers (BBs)
  3. Single-lumen tubes (SLTs)

Standard long ETT are less desirable

216
Q

With DLT one lung ventilation what is a limiting factor?

A

Size
DLTs limited to 5-20 kg

Confirm placement with a bronchoscope +/- thorascopic assistance – then ventilate each lung field and listen

217
Q

What is the purpose of a breathing/rebreathing bag?

A

Provides compliant reservoir of gas that changes volume with the patient’s inspiration/expiration

218
Q

What is the ideal volume for a rebreathing bag?

A

10-20 mL/kg (5-10x tidal volume) ≈ Vmin

10-20 mL/kg

219
Q

Why should a rebreathing bag not be too large?

A

It becomes difficult to observe the bag moving with breathing

220
Q

What are the cardiovascular effects of opioids?

A

Minor direct effects

Opioids primarily cause bradycardia through centrally mediated increased parasympathetic nervous system activity.

221
Q

What can happen if a bolus of opioids is administered?

A

Bradycardia due to centrally mediated ↑ PSNS activity

This effect can be blocked by anticholinergics.

222
Q

Can opoids lead to histamine release?

A

Yes.

IV use can cause vasodilation, tachycardia, and hypotension, especially with Meperidine and Morphine.

223
Q

How much can opioid administration decrease MAC?

A

By 40-60%

MAC stands for Minimum Alveolar Concentration, a measure of anesthetic potency.

224
Q

Whether locals are administered in the central neuraxis (epidurally, intrathecally), or systemically all

A
  • ** Inhibit K+ and Ca2+ channels** at the level of the dorsal horn of the spinal cord
  • inhibit substance P binding and evoked ↑ intracellular Ca2+
  • inhibit glutamatergic transmission in the spinal dorsal horn neurons – reducing NMDA and neurokinin-mediated postsynaptic depolarization
225
Q

What is the effect of low lipophilicity on the duration of action (DoA) of drugs?

A

Drugs with low lipophilicity have a longer duration of action (DoA)

Example: Morphine is cited as a drug with low lipophilicity.

226
Q

How does lipid solubility and protein binding affect systemic absorption of drugs?

A

Greater lipid solubility and protein binding result in lower systemic absorption

This implies that drugs that are more lipid-soluble and strongly bound to proteins may not be absorbed as effectively into the systemic circulation.

227
Q

How do local anesthetics work?

A
  1. Vasodilation occurs first →
  2. Loss of sensation of temperature →
  3. Loss of sensation of sharp pain →
  4. Loss of sensation of light touch →
  5. Loss of motor activity
228
Q

Fill in the Blank: ____ opioids, when given epidurally, have a slower onset of analgesia and a longer duration of effectiveness compared to more lipophilic opioids.

A

lipophilic opioids

229
Q

Fill in the Blank: Lipophilic opioids, when given epidurally, have a ____ onset of analgesia and a ____ duration of effectiveness compared to more lipophilic opioids.

A

Slower onset
Longer duration

230
Q

What can epidural anesthesia cause?

A

Sympathetic blockade and hypotension

This means the sympathetic nervous system’s function is impaired, leading to low blood pressure.

231
Q

What should be given to offset hypotension caused by epidural anesthesia?

A

IV fluids

Administering intravenous fluids helps to increase blood volume and blood pressure.

232
Q

Giving a large volume with a long-lasting local anesthetic can lead to?

A

Result in paralysis of the intercostal nerves, leading to impaired respiration

Intercostal nerves are responsible for the movement of the chest wall.

233
Q

What medication can be used to counteract vasodilation due to local anesthesia?

A

Dopamine

Dopamine can help restore vascular tone and improve blood pressure.

234
Q

What is the perferred benzodiazepine for dogs with hepatic dysfunction?

A

Midazolam

MOA- enhance GABA - gamma-aminobutyric acid (inhibitory neurotransmitter)

235
Q

Where do epidural injections go?

A

Epidural Space

The procedure involves palpating the wings of the ilium and the dorsal spinous processes of L7 and S1, and advancing through supraspinous and interspinous ligaments.

236
Q

What is the order of lipophilicity for the following drugs: Buprenorphine, Fentanyl, Hydro, Morphine?

A

Buprenorphine > Fentanyl > Hydro > Morphine

This ranking indicates the relative solubility of these drugs in lipids.

237
Q

Why is morphine preferred for epidural analgesia?

A

Because of its relatively low lipophilicity

Morphine provides analgesia for 12 to 24 hours by this route.

238
Q

True or False: Fentanyl is commonly used in epidurals.

A

False

Fentanyl is very lipid soluble and not used in epidurals.

239
Q

Contraindications for a epidurals?

A

C – coagulopathy
H – hypotension, hypovolemia
I – infection, inflammation
N – neoplasia
A – anatomical abnormality

240
Q

Adverse effect of epidurals?

A
  • neural damage or neurotoxicity,
  • infection,
  • subarachnoid, spinal, or subdural injection,
  • IV injection,
  • hypotension,
  • bradycardia,
  • Horner’s syndrome,
  • resp depression,
  • total spinal anesthesia,
  • toxicity,
  • urinary retention

Thoracic breathing – if a large volume is use affecting diaphragm (Paralysis)

241
Q

Ketamine MOA?

A
  • Acts on NMDA, opioid, monoaminergic, and muscarinic receptors
  • Noncompetitive antagonists at NMDA R
  • Act at mu, delta, and kappa opioid Rs

Also interact with votlage gated Ca channels

243
Q

True or False: Ketamine safe to use w/ epidural.

A

True

Better somatic (vs. visceral) pain control

244
Q

Does Ketamine have better somatic pain control or visceral pain control?

A

Better Somatic pain control

245
Q

Tramadol

A
  • Weak µ agonist
  • Analgesic properties through inhibition of reuptake of Serotonin and NE (adrenergic receptor effects within CNS)

Motablized in liver and excreted renally. Is 30% excrete unchanged in kidneys.

246
Q

What percent of the Tramadol is excreted unchanged via the kidney’s?

247
Q

MAC of isoflurane, sevoflurane and desflurane?

A

“MAC” (Minimum Alveolar Concentration) is the minimum alveolar concentration of an inhaled anesthetic required to prevent movement in response to a standardized noxious stimulus in 50% of patients

248
Q

What begins Stage III of anesthesia?

A

Cessation of muscular movement and onset of regular pattern of breathing

This stage is crucial for surgical procedures.

249
Q

What is the goal plane for anesthesia?

A

Plane 2

Plane 3 is also acceptable but indicates a deeper level of anesthesia.

250
Q

At what plane does the palpebral reflex disappear?

A

Plane 2 (light-medium)

The palpebral reflex is an important indicator of anesthesia depth.

251
Q

At what plane does the pupillary light reflex (PLR) disappear?

A

Plane 3 (deep medium)

Loss of PLR indicates a deeper level of anesthesia.

252
Q

Fill in the blank: Stage III of anesthesia is characterized by _______.

A

cessation of muscular movement

This is a key feature that allows for surgical intervention.

253
Q

True or False: Plane 3 of anesthesia is considered too deep for surgical procedures.

A

False

Plane 3 is acceptable but indicates a deeper level of anesthesia.

254
Q

What does end-tidal CO2 provide an estimate of?

A

Arterial CO2

255
Q

What is required to deliver CO2 to the alveoli?

A

Perfusion of the alveoli

256
Q

How can end-tidal CO2 monitoring be used in clinical settings?

A

To indicate changes in pulmonary perfusion and cardiac output

257
Q

What are the three factors associated with end-tidal CO2 monitoring?

A
  • Ventilation
  • Leak
  • Arrest

Consider this:
* CO2 Production
* Alveolar Ventilation
* Pulmonary perfusion
* Apparatus malfunctioning (Leak)
* Arrest

258
Q

End-tidal CO2 is typically ____ mmHg less than PaCO2.

Anki PI (22 decks)

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