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Veterinary Surgery > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What are opiod receptors?

A

G coupled proteins

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2
Q

What are the endogenous opiod ligands?

A

Endorphins, enkephalins and dynorphins

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3
Q

How does activation of opiod receptors decrease neuronal activity?

A

Influk K+, decrease Ca+⇒

decreases release neurotransmittors (subsatance P, glutamate) in presynaptic cell ⇒

hyperpolarization of postsynaptic cell

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4
Q

How much does an opiod reduce the inhalent requirement?

A

40-60%

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5
Q

Potentcy of hydromorphone, oxymorphone, meperidine, methadone, fentanyl and buprenorphine in relation to morphine?

A

Hydro 8x greater

Oxymorphone 10x greater

Meperidine 10x less

Methadone 2x greater

Fentanyl 100x morphine

Buprenorphine 40x greater at the Mu agonist but binds to receptor without fully activating resulting reduced analgesia

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6
Q

Side effects of serotonin syndrome?

A

hyperthermia, anxiety, shock, rhabdomyolysis and ARF

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7
Q

MOA methadone?

A

Mu receptor agonist

NMDA receptor antagonist (N-methyl-D-aspartate)

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8
Q

What is unique about remifentanyl?

A

Metabolized by plasma esterases

No hepatic or renal metabolism

Very short half life - good for rapid awakening

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9
Q

MOA of naloxone

A

Binds competatively to Mu, Kappa, and Delta receptors

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10
Q

MOA benzodiazepines?

A

Enhance GABA (gamma-aminobutyric acid), an inhibitory NT

The GABA receptor allows Cl to enter the neuro, hyperpolarizing the cell and preventing action potentials.

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11
Q

What effects do benzodiazepines have?

A

muscle relaxation

narcosis

amnesia

no analgesia, cardio or respiratory depression

excitement = central disinhibitory effect

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12
Q

What are the active metabolites of diazepam and midazolam? How is this clinically relavent?

A

Diazepam = nordiazapem, oxazepam (both sedative with same duration as diazepam but slow clearence)

Midazolam = 1 hydroxymethyl midazolam (no activity)

Midazolam better for patients with hepatic dysfunction (ie decreased clearence)

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13
Q

What is acepromazine (drug class)?

A

phenothiazine

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14
Q

MOA acepromazine?

A

Depresses dopamine activity in the reticular activating system

alpha 1 receptor antagonist = vasodilation and hypotension and protective for some cardiac arrhythmias

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15
Q

Clinical effects of ACE?

A

moderate sedation

some muscle relaxation

no analgesia

antihistaminic

antiemetic

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16
Q

Dexmedetomidine MOA

A

Alpha 2 angonist = decrease Norepi release in CNS = sedation, analgesia and muscle relaxation

Peripheral alpha 1 agonist = vasocontriction, hypertension, arrhythmogenicity and paradoxical excitation

Hypertension = reflex bradycardia which can be compounded by decreased central sympathetic output = hypotension

Other SE: hyperglycemia, diuresis, respiratory depression

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17
Q

How does medetomidine effect cats different than dogs?

A

Dogs = hypertension and increased myocardial work

Cats = minimal hypertension; HR,CO,SV decrease alot

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18
Q

MOA propofol

A

GABA receptor agonist increasing inhibition throughout CNS

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19
Q

What is in propofol emulsion?

A

soybean oil, glycerol, egg lecithin

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20
Q

What is propofol infusion syndrome?

A

Occurs in people (not reported in animals)

Effects mitochondria - severe metabolic acidosis, refractory bradycardia, and rhabdomyolysis

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21
Q

MOA ketamine

A

NMDA receptor ANTAgonist - decrease dorsal horn windup

Dissociative anesthestic - separation between higher and unconcious function (eg muscle riditiy), maintains respiratory center sensitivity to CO2

Mild sympathomimetic (increased sympathetic) = may increase myocardial work, decrease CO

Bronchodilation

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22
Q

Clinical effects of ketamine?

A

Increase myocardial work

Decrease CO

Increase ICP

Increase intraocular pressure

Muscle rigidity

Laryngeal function maintained

Bronchodilation

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23
Q

How is ketamine eliminated?

A

Metabolized to active metabolic (norketamine) which is renally excreated (aka not good to use with severe renal disease as may be long to recover)

Only 50% converted in cats, rest excreated unchanged

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24
Q

What is telazol?

A

Tiletamine (like ketamine)

Zolazepam (benzo)

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25
Q

Drug class xylazine?

A

alpha 2 agonist

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26
Q

MOA barbituates?

What are common barbituates?

A

direct activation of GABA recpetor and modulates the effects of GABA

Thiopental (thiobarbituate) and pentobarbital (oxybarbituate)

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27
Q

What is etomidate and MOA?

A

imidazole derivative

Effects GABA receptor

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28
Q

Side effects etomidate?

A

hemolysis and shock at doses >5mg/kg

muscle rigidity and myoclonus (use benzo with)

Emesis

Adrenal supressoin for 6 hours - avoid in critically ill and give dose steroid

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29
Q

What is alphaxalone and MOA

A

Steroid anesthetic

Enhances GABA and glycine-mediated CNS depression

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30
Q

What is the defination of MAC?

A

conc of anesthetic (volume/volume %) needed to prevent movement from a noxious stimulus in 50% of animals

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31
Q

What is MAC-BAR?

A

MAC blockade of adrenergic response - conc that prevents cardiac response to pain

Usually higher than MAC, in cats 10% higher than MAC

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32
Q

What conc of MAC is generally required to prevent movement in all patients?

A

1.2-1.5 x MAC

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33
Q

How does temperature effect MAC?

A

Hypothermia decreases MAC by 5% for each degree C

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34
Q

Adverse effects of halogeated inhalent anesthetics?

A

Hypotension - decreaed SVR and CO

Respiratory depressent

increased ICP

disrupt thermoregulation

malignant hyperthermia

arrhythmias = sensitize myocardium to catecholamines

Bold are dose dependent

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35
Q

Absorbtion of inhalents depend on 4 things:list

A
  1. blood/gas solubility of inhalent: high, slower action
  2. CO: high, slower action
  3. Minute ventilation: high, faster
  4. Concentration gradient between blood and alevolus: greater gradient, faster absorption
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36
Q

Factors that effect length of recovery from inhalents?

A
  1. Fat
  2. Longer anesthesia = more redistribution
  3. Soluability of anesthetic
37
Q

MOA local anesthetics?

A

Dose and activity dependent (phasic)

Blockade of fast sodium channels on afferent n inhibiting nociceptive transmission

38
Q

Lidocaine and bupivicaine lipophilicity and dissociation constants (pka)?

A

Lidocaine: lipophilic, fast onset action (<5min), short duration 45-60 min

Bupivicaine: higher lipid soluability and protein binding, longer duration of action (6-8 hours), upto 45 minutes to take effect

Mepivacine effect between the 2

39
Q

What is a Bier block?

A

IV regional anesthesia

40
Q

What is the bandage that is applied for regional anesthesia or to enansuinate the foot?

A

Esmarch bandage

41
Q

Toxic dose of lidocaine in dogs and cats?

A

Dogs: >8mg/kg

Cats:>6mg/kg

42
Q

Toxic dose of bupivicaine?

A

Dogs: 4mg/kg

Cats: 2mg/kg

43
Q

Toxic effects of lidocaine?

A

Initial: GI - vomiting, regurg, ileus, nausea

Then: CNS - dull, siezures

Last Cardio - decreased contractility, arrythmia, death

44
Q

What is succinylcholine?

A

Depolarizing neuromuscular blocking agent

minics acetylcholine

malignant hyperthermia

45
Q

What is atracurium?

A

Non-depolarizing neuromuscular blockade

short duration

Hoffman elimination - indepent of renal or hepatic degredation

46
Q

MOA neostigmine and edrophonium?

A

Reverse neuromuscular blockade

Inhibit acytelcholinesterases

Can cause cholinergic crisis: salivation emesis, vomiting, bradycardia, death, therefore sometimes given with anticholenergic

47
Q

MOA anticholnergic agents (ace, glyco)?

A

Parasympatholytics = minimize vagal tone

High vagal tone = bradycardia

48
Q

What causes increased vagal tone?

A

endotracheal intubation

emesis

traction ocular orbit

manipulation hepatobiliary system

Brachycephalic breeds

Opiod drugs

49
Q

Describe the COX pathway

A
50
Q

Describe anti-inflammatory effects of NSAIDS

A
51
Q

Describe MOA NSAID side effects

A
52
Q

What is delta down?

A

Depression in arterial systolic pressure (collapsing of greater vessels) with IPPV

Seen with hypovolemia

53
Q

What are dobutamine and dopamine?

A

Positive ionotropes (increased cardiac contractility)

Beta adrenergic agonists

Chronotropic effects

DOPAMINE: increase SVR

54
Q

What is phenylephrine?

A

alpha adrenergic vasopressor

Can reverse vasodilation caused by other drugs

55
Q

What is vasopressin?

A

nonadrenergic pressor

Used for vasoplegic shock (low systemic vascular resistence and high cardiac output) during sepsis

56
Q

Describe the ASA status chart

A

I: no illness

II: mild compenstated systemic illness

III:moderate to severe compenstated systemic illness

IV: Disease that is constant threat to life

V: Moribund, no expected to survive

57
Q

What is the risk for anesthetic death?

A

1 in 500-1000

58
Q

What are drugs that sensitize the myocardium to catecholamine induced arrhymias?

A

halothane

thiopental

59
Q

What is an ideal fluid type for anesthesia for cardiac cases?

A

Isotonic, low sodium

0.45% NaCl with 2.5% dextrose

60
Q

What is the Branham reflex?

A

Occurs during lagation of a PDA - increased afterload causes bradycardia

61
Q

MOA phenoxybenzamine?

A

(non-selective/Alpha) adrenergic ANTAGonist - convalently bonds alpha receptors

Antagonist/partial agonist seritonin 5-HT2a receptor

62
Q

Doxopram use, dose and side effect?

A

Highlight laryngeal function (for eval LarPar)

1.1mg/kg IV

Severe glottic constriction

63
Q

What nasal oxygen rate is equivalent to 40% oxygen?

A

100ml/kg/min

64
Q

Oncotic pressure of Hetastarch?

A

29-32mmHg

65
Q

Normal oncotic pressure?

A

18-22mmHg

66
Q

What is the reversal agents for benzos?

A

Flumazenil

67
Q

What are drugs that are heavily protein bound (ie effected by hypoalbuminemia)?

A

Propofol

Benzo

Opiods

Liver disease/hypoalbuminemia will leave more free drug and the drugs will have a stronger effect

68
Q

Drugs to increased urine output, assuming adequate hydration (renal anesthesia)?

A

Mannitol - 0.5g/kg - also free radical scavenger that may help renal epithelial cell swelling

Furosemide - 0.2-2mg/kg IV, 0.66mg/kg/hr CRI

Dopamine - 2-5mcg/kg/min - increased output but not creatinine clearence

69
Q

What is the oncotic pressure of 25% human albumin and 16% canine albumin?

A

Human >200mmHg

Canine 98mmHg

70
Q

What is the maximum allowable intra-abdominal pressure for CO2 insuflation?

A

14 cm H20, greater compromise renal blood flow - prolonger >25 = anuria and ARF

71
Q

What are signs of an air embolism during anesthesia monitoring?

A

Sudden drop EtCO2

Drop BP

Drop pulse ox

Washing machine heart murmur

72
Q

Only drug shown to adversely effect neonate survival?

A

Xylazine

Although ketamine may be associated with decreased neonatal vigor

73
Q

What is the amount used for low epidural and a high epidural?

A

Low: 0.2ml/kg

High: 0.3ml/kg

74
Q

Inta-articular dose of perservative free morphine?

A

0.1mg/kg

75
Q

What is the maximum bupivicaine dose recommended for dental blocks in dogs and cats?

A

Dogs: 2.5mg/kg

Cats: 1mg/kg

76
Q

List the dental n. blocks?

A

Mental (rostral mandibular): mandibular second to third premolar rostral to the midline.

Infraorbital (rostral maxillary): maxillary third premolar rostral to the midline.

Inferior alveolar: mandibular third molar rostral to the midline.

Maxillary: last molar rostral to the midline, including the ipsilateral soft and hard palatal mucosa and bone

77
Q

What is the does of atricurium for ocular surgeries and how long does it last?

A

Dose 0.1mg/kg

Lasts 20-30 min

Use of a reversal often not necessary but can be directed by a n. stimulator

78
Q

What are the effects of inhalents, propofol, ketamine and thiopental on inraocular pressure?

A

Decrease: Inhalents

Increase: propofol, ketamine

Thiopental least effect

79
Q

4 causes of hypothermia during anesthesia?

A

Change in hypothalamic control of thermoregulation

immobility

vasodilation

cold surfaces/eviroment

80
Q

Consequences of hypothermia?

A

Prolonged recovery

delayed healing

decreased immunity

altered drug metabolism

cognitive depression

arrythmias

Altered coagulation (VCNA 2015)

hypotensoin (VCNA 2015)

81
Q

Four mechanism of heat loss?

A
  1. Evaporation - only lungs and feet
  2. Conduction - through cold surfaces (10%)
  3. Convective - contact cold air/eater (30%)
  4. Radiation - loss of heat via infrared energy (50%)
82
Q

How do Bair huggers prevent heat loss?

A

Via convection

83
Q

Methods to maintain temperature during sx?

A

Bair hugger

warm-water circulating pads

heat-mositure exchange unit on ET tube

low-flow or close anesthesia circuits with coxial rebreathing hoses

plastic wrap

fluid warmer

84
Q

What are the 5 cause of arterial hypoxemia?

A

VQ mismatch (most common)

hypoventilaiton

right-left anatomic shunt

decreased insipired O2

Diffusion barrier impairment

85
Q

Bronchodilators may help severe VQ mismatch. List bronchdilators.

A

Aminophylline

Albuterol

Terbutaline

86
Q

What is malignant hyperthemia?

A

Inherited condition - cellular ryanodine receptor

Dysregulation/excssive release of intracellular Ca++ release in muscles

causes: hypercarbia, hyperthermia, muscle spasms

confirm with muscle biopsies

87
Q

How do you treat malignat hyperthermia?

A

Stop inhalent, switch to propofol CRI and O2

Give dantrolene = stablize sarcoplasmic reticular membrane

88
Q

Drugs assoicated with malignant hyperthermia?

A

Inhalents, esp halothane

succinylcholine

89
Q
A

Veterinary Surgery (10 decks)

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