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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
What is the MOA of tramadol
Weak mu opiod effects, norepinephrine and sterotonin reuptake inhibition and binding of alpha 2 adrenergic receptors in the pain pathway
26
Amantadine MOA
Modulates CNS dopamine | NMDSA antagonist
27
Amitriptyline MOA
Tricyclic antidepressant by inhibiting reuptake of the neurotransmitters serotonin norepinephrine and to lesser extent dopamine
28
Flupirtine MOA-- Not available in U.S.
amino pyridine drug classified as a selective neuronal potassium channel opener G-protein regulate inwardly rectyfing K+ channels Indirectly inhibits NMDA
29
Tapentadol MOA
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
Maorpitant for pain MOA
Selective neurokinin-1 receptor antagonist | Substance P shares NK-1 receptor
31
Buprenorphine MOA
Partial Mu agonist
32
Butorphanol MOA
Kappa agonist; Mu antagonist
33
Fentanyl MOA and what others others
Mu agonist | oxymorhone, methadone, remifentanyl, hydromorphone
34
Methadone MOA
Mu agonist | Also reported to be NMDA antagonist and alpha 2 antagonist
35
Morphine MOA
Mu and delta agonist
36
Naloxone MOA
Kappa and Mu antagonist
37
How do opioids cause respiratory depression
Have does dependent increase in PaCO2 due to decrease in minute volume
38
What are some negative effects (potential positive in some cases) of opioids
``` 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
Ketamine MOA
NMDA receptor antagonist: disscoative anesthetic
40
What are three benefits to ketamine for pain
Reduce acute somatic and visceral pain improve opioid sparing, prevent opioid tolerance May reduce pro-inflammatory cytokines Lacks cardiorespiratory depression
41
Propofol MOA
Hypnotic agent: positive modulation of the inhibitory function of the neurotransmitter GABA through GABA-a receptors
42
What are negative side effects of propofol
Dose dependent | vasodilation, respiratory depression, decreased cardiac output
43
Aflaxalone MOA
Neurosteroid that enhances the actions of GABAa
44
What are the negative side effects of alfaxalone
May cause less (but still some) vasodilation and Decrease in CO compared to propofol
45
What are negative side effects of ketamine
Myclonous, dysphoria, increased ICP, pain at injection site
46
Which patients should you avoid Ketamine
where increased contractility and HR may be determintal such as HCM and tachyarrhythmias
47
JAVMA 2018 What is the increased risk associated with brachycephalics and anesthesia
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
Vet Journal 2018 What effect of did a lose dose (0.5 mcg/kg/hr) have on CV during anesthesia
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
What is a TAP block
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
Define central sensitization
increase in excitability of neurons in the central nociceptive pathways to normal or subthreshold input Manifests as altered pain sensitivity
51
How does norepinephrine work in the descending pain pathway
modulates nociception via alpha 2 receptor
52
How does seritonin 5-HT work in the descending pain pathway
involved in descending modulation
53
How does dopamine work in the descending pain pathway
inhibiting nociception
54
How does Mg work in the descending pain pathway
NMDA receptor antagonist Mediated reduction in IL-6 and TNF Alpha Not recommended for pain
55
AJVR 2018 Which opioid in addition to dexmeditomidine was best for sedation and noception
Sedation: mepiridone and methadone Noceptive: butorphanol, methadone, morphine, nalbuphine 0.5 mg/kg doses
56
2018 AJVR Was there a benefit for 0.4 Fio2 with nitrogen over > 0.9 Fio2 for dogs undergoing OVH
No observed benifit
57
2018 AJVR What was noted about laryngeal block and intratesticular block with lidocaine
Both have additive affect to total dose in cats. | Should aim to give a total dose of less than 5 mg/kg
58
2018 AJVR How long is it recommended to store perservative free alfaxalone
7 days with a closed system transfer device and refrigerator.
59
JAVMA 2018 Tramadol at 5 mg/kg q 8 hrs was it a benifit for OA
No clinical benifit
60
JAVMA 2018 Tramadol for cats at what dose improved activity scores in geriatic OA cats
2 mg/kg. higher doses resulted in side effects of euphoria, dysphoria sedation and decreased appetite.
61
2019 AJVR In cats under isoflurane anesthesia with dexmed sedation what effect did atipamizole have
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
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
Inhalant anesthetics ability to mute baroreflexes
63
AJVR 2019 What effect was noted in dogs give Gabapentin 20 mg/kg 2 hrs prior to anesthesia
Isoflurane MAC sparring with no effect on hemodynamic and vital variables
64
AJVR 2019 What was the bioavailability of naloxone via an atomizer
32% effectiveness is unknown
65
JAVMA 2019 Greyhounds with repeated HyperK
Resolves post anesthesia.. Noted on ECG
66
JAVMA 2019 How does the charcoal air filtration position alter waste anesthetic gas
Low did not matter position | High (1 L/min O2 @ 5% vaporizer) all canisters in horizontal position than vertical
67
What is the ocular cardiac reflex
manipulations of the eye or increase interocular pressure result in bradycardia
68
2019 JAVMA What resulted in less ocular cardiac reflex during enucleation
retrobulbar nerve block decreased prevalence but not anticholergic drugs during enucleation
69
2019 JAVMA What provided additional pain management to carprofen with enucleation
absorable gelatin hemostatic sponge soaked in 1% ropivicaine
70
AJVR 2019 What was noted with sedation and duration with 20 mcg/kg of injectable dexmeditomidine given oral transmucosal
Resulted in similar sedation and prolonged duration despite bioavailability of 11%
71
What is the MOA of vitinoxan
alpha 2 antagonist in periphry as does not cross BB
72
2019 AJVR what was the effect of metidomidine in dogs with vitinoxan administered atipamazole
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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