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VTS > Anesthesia & Analgesia > Flashcards

Anesthesia & Analgesia Flashcards

1
Q

Negative effects of tachycardia

A
  • Shortens diastolic time which leads to inadequate filling of the ventricles
  • Increases myocardial oxygen demands
  • Less time for the delivery of oxygen to the heart muscle via the coronary vessels
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2
Q

Anticholinergics

A
  • Reduce the effects of the PNS by blocking the action of acetylcholine at the muscarinic receptors of the PNS
  • Atropine and glyco
  • Common effects elicited from PNS: bradycardia, bronchospasm, tear and saliva production
  • Pupil constriction
  • They will only cause an increase in HR when the bradycardia is due to vagal stimulation
  • Avoid in patients with HCM
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3
Q

Gamma aminobutyric acid

A
  • One of the body’s main inhibitory neurotransmitters
  • Principal role is reducing neuronal excitability throughout the CNS
  • Benzodiazepines work by ENHANCING the release of GABA
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4
Q

Agonist

A
  • Has both affinity and efficacy
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5
Q

Partial agonist

A
  • Has affinity, but only partial efficacy
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6
Q

Opioids

A
  • Three types of receptors:
  • Mu 1: analgesia
  • Mu 2: respiratory depression, sedation
  • Can increase vagal tone and result in bradycardia
  • Metabolized by the liver
  • Agonism at mu receptor can lead to a decrease in urine production
  • Stimulation of kappa receptor can increase urine production due to release of ADH
  • Chronic administration of opioids is potentially immunosuppressive
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7
Q

Pure agonists

A
  • The most effective
  • Effects are cumulative
  • Fent, hydro, morphine, meripidine
  • Methadone
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8
Q

Which drug can cause histamine release if administered rapidly IV?

A

Meperidine and morphine

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9
Q

Can morphine be given to cats?

A
  • It is metabolzied through glucuronidation and cats have a decreased ability to metabolize drugs through this pathway, therefore morphine is LESS effective in cats
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10
Q

What is the only partial mu agonist used in vet med?

A
  • Buprenorphine
  • Has high affinity but does not have the same efficacy as full mu’s
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11
Q

Can bup be given TM to dogs?

A

TM absorption is excellent in cats but the acidic nature of dog saliva decreases its bioavailability to 30-50%

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12
Q

What class of drugs are butorphanol and nalbuphine?

A
  • Agonist/antagonist
  • Antagonises mu and agonises kappa
  • Torb provides strong pain control for horses and birds
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13
Q

How do alpha 2 adrenergic agonists exert their effects?

A
  • Activation of the peripheral post synaptic alpha 2 receptors results in vasoconstriction and a period of hypertension
  • The baroreceptor reflex responds to the initial hypertension with a reflex bradycardia
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14
Q

What effectls do A2 agonists have?

A
  • Inhibit ADH and insulin release which causes diuresis and a transient hyperglycaemia
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14
Q

Thiopental

A
  • Barbiturate
  • Causes dose dependent decrease in cerebral metabolic oxygen requirements, cerebral blood flow and ICP - good for head trauma
  • Transient bigeminy can be seen at induction
  • Will cause tissue sloughing if it goes SC
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14
Q

What neurological signs can be seen with propofol administration?

A
  • Tremors and opisthotonus
  • Thought to be the result of disinhibition of neural activity and are NOT seizures
  • Transient
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15
Q

Etomidate

A
  • Induction only, no analgesia
  • Acts through enhancement of GABA
  • Does not produce a hsitamine release
  • Minimal change in HR, BP, CO, or myocardial contractility
  • CPP is better maintained because of minimal effects on ABP
  • Inhibits adrenal function and causes cortical suppression
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16
Q

What class of drug is Ketamine?

A
  • NMDA receptor antagonist (Amantadine too!)
  • Increases ICP, IOP, and can potentiate seizures secondary to CNS stimulation
  • Excreted as an active metabolite in urine in cats
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17
Q

Blood gas partition coefficient

A
  • Provides info about the speed of anesthetic induction and recovery as well as how fast depth can be changed
  • High PC will have a slower onset and recovery than agents with low PC
  • Iso PC 1.5, Sevo 0.68
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18
Q

Inhalants move along__?

A
  • Partial pressure gradients
  • NOT concentration gradients
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19
Q

Minimum alveolar concentration (MAC)

A
  • The lowest concentration of inhalant needed to prevent a gross motor response in 50% of patients
  • A measure of potency
  • The more potent a volatile liquid, the lower the MAC
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20
Q

What are the two types of neuromuscular blocking agents?

A
  • Depolarizing
    • Succs (rapid onset of action)
  • Nondepolarizing
    • Atracurium, vecuronium, rocuronium
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21
Q

What drug can reverse non depolarizing agents?

A

Edrophonium or neostigmine

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22
Q

Atracurium is degraded by__?

A

Hoffman elimination
- Spontaneous degradation that is not dependent on hepatic metabolism or renal excretion
- At high levels, atracurium may cause histamine release

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23
Q

What two drugs may be useful in treating refractory seizures?

A
  • Ketamine
  • Lidocaine
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24
Q

Why is it important to provide IVF during surgery to a septic peritonitis patient?

A

The large amount of effusion into the abdomen due to increased vascular permeability will cause a reduction of intravascular volume

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25
Q

What test should be performed to assess hepatic function?

A
  • Bile acids
  • If inadequate, there will be a significant elevation
  • Should be low. Indicates that bile acids released from GB were adequately recaptured by the liver post meal
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26
Q

What bloodwork may indicate the inability of the liver to transform drugs?

A
  • Hypoalbuminemia
  • Hypoglycemia
  • Decreased cholesterol
  • Low BUN
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27
Q

Why are alpha 2s a good choice for insulinomas?

A
  • They increase BG by reducing insulin levels
28
Q

How is nitrous oxide eliminated?

A

Almost entirely by the lungs

29
Q

What kind of metabolism does propofol undergo?

A

Hepatic and extrahepatic

30
Q

Why are benzos a good choice for renal emergencies?

A

They have minimal effect on renal blood flow, GFR, BP

31
Q

What is norketamine?

A

The active metabolite of ketamine

32
Q

Why is a pregnant mother at risk of regurgitating?

A
  • The lower esophageal sphincter tone decreases
  • Gastric pH decreases
  • Gastric emptying and motility are impaired and intragastric pressures rise
33
Q

What should the fetal heart rates be?

A
  • 2x the mothers
  • > 160bpm
34
Q

What effect does hyperventilation have on fetal oxygen delivery?

A

Resulting hypocapnia results in alkalosis, reducing fetal O2 delivery by reducing O2 offloading (left shift in OHDC), and it decreases uterine blood flow

35
Q

What class of drug is not recommended for dystocias?

A

Alpha 2s

36
Q

What class of drug is best for dystocias?

A

Opioids

37
Q

What are some physiologic changes seen in pregnant dams?

A
  • Maternal BV and TBW increase to meet increased metabolic demands
  • HR, SV, CO, & CVP are increased to meet O2 demand
  • More susceptioble to hypoT due to blunted responses to changes in BP as a result of decreased baroreceptor activity
  • The displacement of the diaphragm bc of the uterus decreases TV & FRC
38
Q

Why are pregnant dams prone to quickly developing hypoxemia?

A
  • Reduced FRC results in decreased O2 reserves in lungs combined with increased O2 consumption
39
Q

What bloodwork changes can you see in pregnant dams?

A
  • Low BUN and Crea due to the increase in body water
40
Q

What two medications can be good for induction for ocular surgeries?

A
  • Ace (has antiemetic properties and appears to have minimal effect on IOP
  • Dexmed (provides deep sedation and appears to reduce IOP but may cause miosis)
41
Q

What are the four basic components of nociceptive pain pathway?

A
  • Transduction
  • Transmission
  • Modulation
  • Perception
42
Q

Delta fibers are…

A
  • Myelinated
  • Fast conducting
  • Localized, sharp pain
43
Q

C fibers are…

A
  • Unmyelinated
  • Slow conducting
  • Poorly localized, dull pain
44
Q

Somatic pain is…

A
  • Easy to localize
  • Superficial: high concentration of nerve endings
  • Deep: ligaments, tendons, bones, muscles. Scarcity of pain receptors in these areas produces a dull, aching, poorly localized pain of longer duration
45
Q

Visceral pain

A
  • Results from inflammation, distension, or stretching of internal organs
  • Not well localized
  • Scarcity of receptors = aching, cramping, deep pain, pressure
46
Q

Somatic and visceral pain are classed as…

A

Nociceptive pain

47
Q

Allodynia

A

Neurons in spine have trouble differentiating noxious stimuli from other stimuli, and non painful stimuli can become painful

48
Q

Why can’t cats and ferrets have paracetamol?

A

They lack adequate activity of the enzyme glucuronyl transferase, which is required to conjugate it to glucuronic acid for excretion

49
Q

COX 1 prostaglandins focus on what?

A
  • Gut (ONE gut)
50
Q

COX 2 prostaglandins focus on what?

A
  • Inflammation (TOO much inflammation)
51
Q

Where is the epidural space most accessible in dogs and cats?

A

L7-S1

52
Q

What is the active metabolite of hydrocodone?

A

Hydromorphone

53
Q

What is codeine metabolised to?

A

Morphine and codeine-6-glucuronide (CG6) in dogs

54
Q

Why is tramadol efficacy questionable?

A

Analgesia is provided through non opioid mechanisms in dogs as they do not produce high levels of metabolite o-desmethyltramadol (MI) that is largely responsible for the opioid effect

55
Q

What is the bioavailability of TM bup in cats?

A

Nearly 100%

56
Q

How do gabapentinoids provide analgesia?

A

By inhibiting calcium channels, thereby reducing excitatory neurotransmitter release

57
Q

Can the flush valve be used when the breathing circuit is connected to a patient?

A

No. The flush valve provides a direct connection between the intermediate and low pressure systems, and when depressed, bypasses the vaporizer and delivers oxygen at 35-75L/min directly to the patient

58
Q

What is the purpose of the unidirectional valves?

A
  • To allow an expired breath from the patient to be directed to the carbon dioxide absorbent and canister before cycling back to the patient
  • If the valves are not working, an expired breath containing high concentrations of CO2 would be rebreathed by the patient, leading to hypercapnia
59
Q

What is the purpose of the pop off valve?

A
  • To release anesthetic gases into the scavenging system, therefore should always be OPEN unless giving a breath
  • If left closed, the incoming gas will have nowhere to escape and pressure will rapidly build in patients lungs
60
Q

Rebreathing circuit

A
  • > 7kg
  • Circle rebreathing system: universal F circuit or corrugated hosing lead to Y piece
  • Expired breath circles through the LPS and has its CO2 removed before returning to the patient. In doing so, incoming inhalant concentration is diluted from the expired breath, leading to delays in depth change
  • Flow rate 10-25ml/kg/min
61
Q

Non rebreathing circuit

A
  • <7kg
  • Mapleson Circuits D (Bain) and F (Modified Jackson Rees)
  • These circuits do NOT utilize the LPS’s unidirectional valves and do NOT allow for rebreathing of expired gases
  • They bypass the CO2 absorbent and therefore require a high flow rate to push expired gas away from the patient to the scavenging system (200-300ml/kg/min)
  • Because the breath is not recycled, anesthetic depth change is much more rapid
62
Q

Hypothermia can lead to what 9 things?

A
  1. Cardiac arrythmias
  2. Hypotension
  3. Coagulopathy
  4. Sluggish blood flow
  5. Delayed recovery
  6. Impaired wound healing
  7. Increased risk for infection
  8. Altered drug metabolism
  9. Peripheral vasoconstriction leading to increased peripheral tissue acidosis secondary to anaerobic metabolism
63
Q

What does pleth variability index (PVI) show?

A
  • Measures variations in blood volume during resps based on changes in preload secondary to changes in intrathoracic pressure
  • Significant variations in the amplitude of the pulse waveform over time suggests the hypotensive patient is more likely to respond to fluid therapy if PVI >20
64
Q

What is transduction?

A

The conversion of physical energy into electrical energy by the nociceptor

65
Q

What is transmission?

A

The propagation of impulses in the nervous system

66
Q

What is modulation?

A

The amplification or suppression of nerve signals in the spinal cord

67
Q

What is perception?

A

The integration, processing, and recognition of nerve signals in the brain

68
Q

What PCV% is necessary for adequate oxygen carrying capacity and oxygen delivery?

A

> 25%

69
Q
A

VTS (17 decks)

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