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Board Review 2020 > Anesthesia analgesia > Flashcards

Anesthesia analgesia Flashcards

1
Q

Epidural Meds: What is the onset of action, duration of analgesia +/- duration of motor inhibition for lidocaine

A

Dogs Onset: 4-6 min
Hrs analgesia: 1 hr
Motor: 60-120 min

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2
Q

Epidural Meds: What is the onset of action, duration of analgesia +/- duration of motor inhibition for 0.5% bupivicaine

A

Dogs Onset: 5-15 min
Hrs analgesia: >2 hr
Motor: 65-240 min

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3
Q

Epidural Meds: What is the onset of action, duration of analgesia +/- duration of motor inhibition for 0.75% ropivicaine

A

Dogs Onset: 7-15min
Hrs analgesia: 1.5-2.5 hr
Motor: 90-150 min

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4
Q

Epidural Meds: What is the onset of action, duration of analgesia +/- duration of motor inhibition morphine PF

A

Dogs Onset: 40-90 min

Hrs analgesia: 12-24

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5
Q

Epidural Meds: What is the onset of action, duration of analgesia +/- duration of motor inhibition buprenorphine

A

Dogs Onset: < 60 min

Hrs analgesia: >/= 24 hr

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6
Q

Epidural Meds: What is the onset of action, duration of analgesia +/- duration of motor inhibition dexmeitomidine

A

Dogs Onset: < 15 min

Hrs analgesia: 4.5 hrs

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7
Q

JAVMA 2017 What are fentanyl at 6 mcg/kg/hr and Lidocaine at 6 mg/kg/hr effects of sevoflurane in dogs

A

alone or in combination reduce MAC

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8
Q

JAVMA 2017 What effect did hypotension during hemilamenectomy have out outcome post operatively

A

Did not have any effect on motor function or urinary continence

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9
Q

JAVMA 2017 What effect did transdermal lidocaine patchs have on OVH dogs

A

No additional benifit to morphine and carprofen in OVH

Not systemically absorbed

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10
Q

JAVMA 2017 What is the anesthetic death rate in cats/dogs

A

Cats: 11/10,000

Dogs 5/10,000

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11
Q

JAVMA 2017 What increased the risk of death in dogs and cats during anesthesia

A

Both: increased age, non elective procedures
Dogs: Exam not recorded (267 x) Abnormal HCT (5.5 x)
Cats: Absent SPO2 (34 x)
Under weight dogs 15 x more likely to die

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12
Q

2017 JAVMA In a multideminsenial composite pain score what percent disagreement for those that needed rescue analgesia

A

6.1%

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13
Q

JVECC 2017 What increased risk of GER

A

Intrabdominal surgery, change in body position, increased length of anesthesia

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14
Q

JVECC 2017 What increased risk of post anesthesia vomiting

A

Change in ventilation mode during anesthesia, length of anesthesia, synthetic colloid to tx hypotension

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15
Q

JVECC 2017 What increased risk of post anesthesia diarrhea- univariate model

A

increased length of anesthesia, change in ventilation mode, hypoxemia

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16
Q

JAVMA 2017 What if any benefit did diphenhydramine have prior to MCT excision

A

No CV or respiratory benefit over placebo in isoflurane dogs

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17
Q

JVIM 2017 What effect did Omeprazole have after two doses prior to anesthesia in cats

A

Increased gastric and esophageal pH

Had 33% of GER during anesthesia

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18
Q

What is the MOA of Robenocoxib and potential benifits

A

Selective Cox-2 inhibitor; cleared from central body compartment but remains in inflamed tissues

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19
Q

What is the nocecptive pathway

A

Transduction: noxious stimuli at the periphery
Transmission of stimulus to the dorsal horn of the spinal cord
Modulation / central integration of the signal at the CNS level
Projection to the brain via the spinothalmic tracts
Perception

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20
Q

What do A beta nerve fibers do

A

Touch, hair movement- myelin

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21
Q

What do A delta type I fibers do

A

‘first pain’ prick, Higher heat threshold

Thin myelin

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22
Q

What do A delta type II fibers do

A

Pain due to heat

Think myelin

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23
Q

What do C fibers do

A

slow pain

no myelin

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24
Q

What is the MOA of gabapentin

A

Gaba analogue

Voltage gated calcium channels on excitatory neuros

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25
Q

What is the MOA of tramadol

A

Weak mu opiod effects, norepinephrine and sterotonin reuptake inhibition and binding of alpha 2 adrenergic receptors in the pain pathway

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26
Q

Amantadine MOA

A

Modulates CNS dopamine

NMDSA antagonist

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27
Q

Amitriptyline MOA

A

Tricyclic antidepressant by inhibiting reuptake of the neurotransmitters serotonin norepinephrine and to lesser extent dopamine

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28
Q

Flupirtine MOA– Not available in U.S.

A

amino pyridine drug classified as a selective neuronal potassium channel opener
G-protein regulate inwardly rectyfing K+ channels
Indirectly inhibits NMDA

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29
Q

Tapentadol MOA

A

Morphine (mu opoid receptor) agonist and noradrenaline reuptake inhibitor. In people less mu by 50x but more potent for pain due to 2 mechanisms of action. Orally absorbed well.

30
Q

Maorpitant for pain MOA

A

Selective neurokinin-1 receptor antagonist

Substance P shares NK-1 receptor

31
Q

Buprenorphine MOA

A

Partial Mu agonist

32
Q

Butorphanol MOA

A

Kappa agonist; Mu antagonist

33
Q

Fentanyl MOA and what others others

A

Mu agonist

oxymorhone, methadone, remifentanyl, hydromorphone

34
Q

Methadone MOA

A

Mu agonist

Also reported to be NMDA antagonist and alpha 2 antagonist

35
Q

Morphine MOA

A

Mu and delta agonist

36
Q

Naloxone MOA

A

Kappa and Mu antagonist

37
Q

How do opioids cause respiratory depression

A

Have does dependent increase in PaCO2 due to decrease in minute volume

38
Q

What are some negative effects (potential positive in some cases) of opioids

A 
Suppress cough reflex
Respiratory depression
Dogs- reset thermoregulatory center
Opioid incuded hyperalgesia (more painful with increasing doses)
Urine retention
Bradycardia
Vomiting, nausea, defecation
Morphine rapid IV- histamine release
39
Q

Ketamine MOA

A

NMDA receptor antagonist: disscoative anesthetic

40
Q

What are three benefits to ketamine for pain

A

Reduce acute somatic and visceral pain
improve opioid sparing, prevent opioid tolerance
May reduce pro-inflammatory cytokines
Lacks cardiorespiratory depression

41
Q

Propofol MOA

A

Hypnotic agent: positive modulation of the inhibitory function of the neurotransmitter GABA through GABA-a receptors

42
Q

What are negative side effects of propofol

A

Dose dependent

vasodilation, respiratory depression, decreased cardiac output

43
Q

Aflaxalone MOA

A

Neurosteroid that enhances the actions of GABAa

44
Q

What are the negative side effects of alfaxalone

A

May cause less (but still some) vasodilation and Decrease in CO compared to propofol

45
Q

What are negative side effects of ketamine

A

Myclonous, dysphoria, increased ICP, pain at injection site

46
Q

Which patients should you avoid Ketamine

A

where increased contractility and HR may be determintal such as HCM and tachyarrhythmias

47
Q

JAVMA 2018 What is the increased risk associated with brachycephalics and anesthesia

A

1.57 x more likely for perianesthetic and 4 x more likely for post anesthetic complications
Every 30 minutes of anesthesia increase 18% of perianesthetic complications
Complications decrease 2% of complications with every 1 kg increase in body weight

48
Q

Vet Journal 2018 What effect of did a lose dose (0.5 mcg/kg/hr) have on CV during anesthesia

A

Had minimal effect on HR and BP with no clear benefit.

Loading dose did decrease heart rate by 25% so authors recommended to consider loading over longer time 10-15 min

49
Q

What is a TAP block

A

Transversus abdominal plane block
Between obliqous internus abdominal muscle and transversus adominous muscle
Where the ventral nerve branches of T 10, 11, 12 run
5 cm lateral from mid line at subcostl site and mid abdominal site on each side. 0.25 ml/kg per site dilute if needed to get larger volume

50
Q

Define central sensitization

A

increase in excitability of neurons in the central nociceptive pathways to normal or subthreshold input
Manifests as altered pain sensitivity

51
Q

How does norepinephrine work in the descending pain pathway

A

modulates nociception via alpha 2 receptor

52
Q

How does seritonin 5-HT work in the descending pain pathway

A

involved in descending modulation

53
Q

How does dopamine work in the descending pain pathway

A

inhibiting nociception

54
Q

How does Mg work in the descending pain pathway

A

NMDA receptor antagonist
Mediated reduction in IL-6 and TNF Alpha
Not recommended for pain

55
Q

AJVR 2018 Which opioid in addition to dexmeditomidine was best for sedation and noception

A

Sedation: mepiridone and methadone
Noceptive: butorphanol, methadone, morphine, nalbuphine
0.5 mg/kg doses

56
Q

2018 AJVR Was there a benefit for 0.4 Fio2 with nitrogen over > 0.9 Fio2 for dogs undergoing OVH

A

No observed benifit

57
Q

2018 AJVR What was noted about laryngeal block and intratesticular block with lidocaine

A

Both have additive affect to total dose in cats.

Should aim to give a total dose of less than 5 mg/kg

58
Q

2018 AJVR How long is it recommended to store perservative free alfaxalone

A

7 days with a closed system transfer device and refrigerator.

59
Q

JAVMA 2018 Tramadol at 5 mg/kg q 8 hrs was it a benifit for OA

A

No clinical benifit

60
Q

JAVMA 2018 Tramadol for cats at what dose improved activity scores in geriatic OA cats

A

2 mg/kg. higher doses resulted in side effects of euphoria, dysphoria sedation and decreased appetite.

61
Q

2019 AJVR In cats under isoflurane anesthesia with dexmed sedation what effect did atipamizole have

A

at 1/2 or full dose it was ineffective to increase HR and CO but did result in lower MAP than compared to saline

62
Q

AJVR 2019 what was the MOA proposed for the reason that atipamizole does not alter CO or HR in isolfurane anesthized cats with dexmed sedation

A

Inhalant anesthetics ability to mute baroreflexes

63
Q

AJVR 2019 What effect was noted in dogs give Gabapentin 20 mg/kg 2 hrs prior to anesthesia

A

Isoflurane MAC sparring with no effect on hemodynamic and vital variables

64
Q

AJVR 2019 What was the bioavailability of naloxone via an atomizer

A

32% effectiveness is unknown

65
Q

JAVMA 2019 Greyhounds with repeated HyperK

A

Resolves post anesthesia.. Noted on ECG

66
Q

JAVMA 2019 How does the charcoal air filtration position alter waste anesthetic gas

A

Low did not matter position

High (1 L/min O2 @ 5% vaporizer) all canisters in horizontal position than vertical

67
Q

What is the ocular cardiac reflex

A

manipulations of the eye or increase interocular pressure result in bradycardia

68
Q

2019 JAVMA What resulted in less ocular cardiac reflex during enucleation

A

retrobulbar nerve block decreased prevalence but not anticholergic drugs during enucleation

69
Q

2019 JAVMA What provided additional pain management to carprofen with enucleation

A

absorable gelatin hemostatic sponge soaked in 1% ropivicaine

70
Q

AJVR 2019 What was noted with sedation and duration with 20 mcg/kg of injectable dexmeditomidine given oral transmucosal

A

Resulted in similar sedation and prolonged duration despite bioavailability of 11%

71
Q

What is the MOA of vitinoxan

A

alpha 2 antagonist in periphry as does not cross BB

72
Q

2019 AJVR what was the effect of metidomidine in dogs with vitinoxan administered atipamazole

A

atipamiazole falied to restore HR and cardiac index in metitomidine only dogs but did in the vit+met

Board Review 2020 (37 decks)

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