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Phase 1 Boards Prep - EQ > Anesthesia and Analgesia > Flashcards

Anesthesia and Analgesia Flashcards

1
Q

In Henry’s 2014 study “Evaluation and clinical use of an intraoral inferior alveolar nerve block in the horse,” what was the only complication noted and how often were recheck examinations performed?

Pusterla, Verstraete. EVJ 2014

A

Abscessation of pterygoid fossa 1 horse
24h, 2 weeks, 4 weeks post op

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2
Q

In Henry’s 2014 study “Evaluation and clinical use of an intraoral inferior alveolar nerve block in the horse,” what percent of blocks were clinically successful?

Pusterla, Verstraete. EVJ 2014

A

100%

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3
Q

In Henry’s 2014 study “Evaluation and clinical use of an intraoral inferior alveolar nerve block in the horse,” the black arrow highligths what structure and an intraoral IANB should be performed what direction in relation to that structure?

Pusterla, Verstraete. EVJ 2014

A

Black arrow: palatoglossal arch
Injection should be lateral to the palatoglossal arch

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4
Q

In the image below what do the black arrow heads, black arrow, green arrow and white arrow represent?

Henry. “Evaluation and clinical use of an intraoral inferior alveolar nerve block in the horse,” EVJ 2014

A

Black arrowheads: Facial nerve branches
Black arrow: inferior alveolar artery
Green arrow: Mylohyoid nerve
White arrow: Lingual branch of trigeminal nerve

The white arrowheads are the cut edge of the mandible

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5
Q

What nerve is depicted by the white arrow?

Rice, JVD 2017, issue 2, Step by Step Regional Nerve Blocks for Equine Dentistry

A

Maxillary nerve

Rice recommended 10-20ml here

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6
Q

What are the landmarks to palpate for the infraorbital nerve block?

Rice, JVD 2017, issue 2, Step by Step Regional Nerve Blocks for Equine Dentistry

A

Palpation landmarks for the infraorbital nerve block include the nasoincisive notch (white-dashed arrow) and the rostral border of the facial crest (black-dashed arrow).1

Rice recommends 3 ml here

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7
Q

Manual elevation of what muscle facilitates placing the needle within the mental foramen to block the nerve?

Rice, JVD 2017, issue 2, Step by Step Regional Nerve Blocks for Equine Dentistry

A

depressor labii inferioris muscle

Rice recommends 3 ml here

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8
Q

What volume of anesthetic agent is recommended for the mandibular nerve block in this step by step?

Rice, JVD 2017, issue 2, Step by Step Regional Nerve Blocks for Equine Dentistry

A

Intraoral approach: 10ml
Extraoral approach: 10-12ml

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9
Q

In Muller’s 2017 study “Effect of butorphanol, midazolam or ketamine on romifidine based sedation in horses during standing cheek tooth removal”, which sedation group was best at reducing chewing behavior?
A. Romifidine
B. Romifidine with butorphanol
C. Romifidine with midazolam
D. Romidifidine with ketamine

BMC Vet Res 2017

A

C. Romifidine with midazolam

probably related to the relaxation of the masticatory muscles caused by midazolam

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10
Q

In Muller’s 2017 study “Effect of butorphanol, midazolam or ketamine on romifidine based sedation in horses during standing cheek tooth removal”, which sedation group needed the most additional boli of romifidine?
A. Romifidine
B. Romifidine with butorphanol
C. Romifidine with midazolam
D. Romidifidine with ketamine

BMC Vet Res 2017

A

A. Romifidine

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11
Q

In Johnson’s 2019 JVD study on an US guided inferior alveolar nerve block, what is depicted by the red and blue arrows (this is the right side of the horse)

JVD 2019 issue 1

A

Blue: mandibular nerve
Red: lingual nerve

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12
Q

In Tanner’s 2019 study “A Retrospective Study of the Incidence and Management of Complications Associated with Regional Nerve Blocks in Equine Dental Patients” what was the incidence of complications with nerve blocks, and what was the most common complication?

JVD 2019 issue 1

A

2.96%
Hematoma

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13
Q

In Johnson’s 2019 study “Ultrasound-Guided Inferior Alveolar Nerve Block in the Horse: Assessment of the Extraoral Approach in Cadavers”, what % of lingual nerve staining was noted when 2.5ml volume was used? what % when 5 ml used?

JVD 2019 issue 1

A

2.5ml: Lingual nerve stained in 5/8 (62.5%) of the injections
5ml: Lingual nerve stained in 4/8 (50%) injections

Overall success of staining the inferior alveolar nerve was 75% and 65% respectively for the volumes

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14
Q

In Johnson’s 2019 study “Ultrasound-Guided Inferior Alveolar Nerve Block in the Horse: Assessment of the Extraoral Approach in Cadavers”, what % success was noted on CT for 2.5ml volume and 5 ml volume respectively?

JVD 2019 issue 1

A

Smaller injection volume (2.5ml) successful in 75% injection compared to larger injection volume (5ml) 87.5% cases

Overall success 81% on CT – differed from overall success 68.8% for dissection of methylene blue staining

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15
Q

In Gozalo-Marcilla’s 2019 paper “Sedative and antinociceptive effects of different detomidine constant rate infusions, with or without methadone in standing horses,” which protocol produced the most intense and persistent antinociceptive effects?

EVJ 2019

A

Higher detomidine dose combined with methadone (DHM)

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16
Q

In Gozalo-Marcilla’s 2019 paper “Sedative and antinociceptive effects of different detomidine constant rate infusions, with or without methadone in standing horses,” what protocols lead to reduced gastrointestinal motility and for what duration?

EVJ 2019

A

All treatments reduced gastrointestinal motility
scores returned to baseline sooner for the low dose detomidine and low dose detomidine plus methadone groups

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17
Q

In Weber’s 2019 study “Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen,” what variable was associated with higher canal filling %?
A. volume 10 ml
B. volume 15 ml
C. age
D. legnth of needle

EVE 2019

A

C. age

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18
Q

In Weber’s 2019 study “Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen,” what % of canals had complete legnth filling associated with the 10 ml volume and 15 ml volume respectively? Was this stat significant?

EVE 2019

A

10 ml volume: 90%
15 ml volume: 70%
Not statistically signficant

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19
Q

In Weber’s 2019 study “Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen,” what % of the canal was filled by the 10ml volume?

EVE 2019

A

86.9%

So 90% of the blocks were filled 86.9% in volume

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20
Q

In Weber’s 2019 study “Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen,” what % of the canal was filled by the 15ml volume?

EVE 2019

A

74%

So 70% of the blocks were filled 74% in volume

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21
Q

In Rawlinson’s 2018 study “Evaluation of the equine mental foramen block: cadaveric and in vivo injectate diffusion,” what technique was determined to be most efficacious?

Vet Anes 2018

A

T2 → needle inserted in a dorsolateral to ventromedial direction with shaft of needle 40 degrees lateral to the parasagittal plane of the lateral mandible and 25 degrees dorsal to the dorsal plane of incisive-premolar interproximal space to depth of 1cm into canal

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22
Q

In Rawlinson’s 2018 study “Evaluation of the equine mental foramen block: cadaveric and in vivo injectate diffusion,” what pattern of injectate distribution and needle placement was seen for T1 vs T2?

Vet Anes 2018

A

Bolus patterns associated with T2
Thread patterns with T1
All T2 needle tips intracanal
All T1 needle tips embedded in bone

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23
Q

In Rawlinson’s 2018 study “Evaluation of the equine mental foramen block: cadaveric and in vivo injectate diffusion,” why was the 5ml injectate volume found to be superior?

Vet Anes 2018

A

The 5ml volume terminated in the caudal canal in 50% (6/12) vs 3ml volume 25% (3/12)

no difference between injectate volumes on distance traveled within canal, diffusion pattern and length of circumferential nerve staining

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24
Q

Rawlinson’s 2018 study “Evaluation of the equine mental foramen block: cadaveric and in vivo injectate diffusion,” cites the critical length of nerve exposed to a local anesthetic to reduce or block impulse conduction as how many miilimeters of exposed nerve?

Vet Anes 2018

A

6 to > 30mm

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25
Q

Rawlinson’s 2018 study “Evaluation of the equine mental foramen block: cadaveric and in vivo injectate diffusion,” suggest that what percent of mental nerve blocks will be effective?

Vet Anes 2018

A

30-60%

30% based on in vivo testing, 60% based on cadaveric testing

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26
Q

Rawlinson’s 2018 study “Evaluation of the equine mental foramen block: cadaveric and in vivo injectate diffusion,” sites that how many nodes of Ranvier must be blocked to achieve anesthesia of myelinated nerves?

A

3 (internodal length for mammalian fibers ~1mm)

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27
Q

In Best’s study “A blinded crossover study design to evaluate midazolam as an adjunct for equine standing sedation for routine oral examinations” what was the outcome between the midaz group and placebo group?

Best 2024 J Eq Vet Science

A

There were no significant differences in any of the single or overall sedation scores between treatment groups or within individual horses (P=0.3).

Trends towards improvement of some assessed characteristics of sedation, including decreased tongue movement and less resistance to acceptance of speculum were observed.

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28
Q

Nervous horses may benefit from which anxiolytic drug prior to dental procedures?
A. Tramadol
B. Trazodone
C. Detomidine
D. Ketamine

Easley Textbook, ch 23

A

Trazodone

Dose 2.5-10mg/kg orally twice daily. Recommend testing dose a few days prior to procedure
Acepromazine is another anxiolytic given IV 20-30 minutes prior to procedure

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29
Q

Which of the following are common side effects of alpha-2-agonists?
A. Tachycardia, hypotension, decreased GI motility, and polyuria
B. Tachycardia, hypertension, decreased GI motility, and anuria
C. Bradycardia, hypotension, increased GI motility, and polyuria
D. Bradycardia, hypertension, decreased GI motility, and polyuria

Easley Textbook, ch 23

A

D. Bradycardia, hypertension, decreased GI motility, and polyuria

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30
Q

What is the duration of the following opioids?

Buprenorphine
Morphine
Butorphanol

Easley Textbook, ch 23

A

Buprenorphine duration is 8-12 hours
Morphine duration 4-6 hours
Butorphanol duration 30-60 min

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31
Q

Lidocaine is commonly used for its analgesic, anti-inflammatory, and antiendotoxaemic properties. However, toxicity is possible; whatis a sign of toxicity and a good indicator lidocaine infusion should be stopped?

Easley Textbook, ch 23

A

Muscle fasciculation

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32
Q

What are the following locoregional anaesthetic drug time to onset and durations:

Lidocaine
Mepivicaine
Bupivicaine

Easley Textbook, ch 23

A

Lidocaine - < 2 min, 1-2 hours
Mepivicaine - <2 min, 1.5-3 hr
Bupivicaine - 5-10 min, 3-8 hours

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33
Q

Maxillary nerve block desensitizes which structures?

Easley Texbook, ch 23

A

Ipsilateral maxillary teeth and gingiva, soft tissues rostral to infraorbital foramen, and nasal vestibule
+/- lacrimal nerve → lubricate ipsilateral eye every 30 minutes during procedure

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34
Q

The infraorbital nerve block desensitizes which structures?

Easley Texbook, ch 23

A

Ipsilateral maxillary teeth and gingiva, soft tissues rostral to infraorbital foramen, and nasal vestibule
If only passed slightly into foramen, doesn’t always anaesthetise molars

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35
Q

The inferior alveolar nerve block desensitizes which structures?

Easley Texbook, ch 23

A

Ipsilateral mandibular alveolar mucosa, teeth, gingiva, skin and labial mucosa rostral to mental foramen

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36
Q

The mental foramen nerve block desensitizes which structures?

Easley Textbook, ch 23

A

ipsilateral alveolar mucosa, incisors and canine teeth, and labial mucosa, skin, and gingiva rostral to mental foramen
Mental nerve block desensitizes only the ipsilateral lower lip

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37
Q

What are some nerve block complications for the maxillary nerve block?

Easley Textbook, ch 23

A

retrobulbar hematoma, decreased lacrimation of ipsilateral eye

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38
Q

What are some nerve block complications for the infraorbital nerve block?

Easley Textbook, ch 23

A

puncture of adjacent blood vessels, abscess

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39
Q

What are some nerve block complications for the inferior alveolar nerve block?

Easley Textbook, ch 23

A

lingual anaesthesia, abscess, lingual trauma

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40
Q

What are some nerve block complications for the mental nerve block?

Easley Textbook, ch 23

A

abscess, muzzle trauma

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41
Q

In McAndrews’ study “Evaluation of Three Methods of Sensory Function Testing for the Assessment of Successful Maxillary Nerve Blockade in Horses,” what was the success rate of the maxillary nerve blocks?

JVD 2023

A

73% success rate

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42
Q

In McAndrews’ study “Evaluation of Three Methods of Sensory Function Testing for the Assessment of Successful Maxillary Nerve Blockade in Horses” what nerve stimulation techniques were more reliable?

JVD 2023

A

Needle prick and nostril clamping with a hemostate

gingival algometry not as reliable

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43
Q

According to Easley 2022 what are the reported advantages of standing sedation over general anesthesia for dental procedures?

Chp 23

A

Decreased surgical hemorrhage
increased client compliance
improved access to both sides of head
reduced frustration with endotracheal tube positioning

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44
Q

What is the mechanism of action of trazodone?

Easley 2022, chp 23

A

Serotonin receptor antagonist/reuptake inhibitor
anxiolytic drug

recommended dosing 2.5-10mg/kg PO q12h

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45
Q

What are common cardiac side effects of alpha-2 agonists?

Easley 2022, chp 23

A

Bradycardia (second degree AV block most common bradyarrhythmia)
Decreases cardiac output –> initial increase in peripheral vascular resistance leading to hypertension followed by normo to hypotension

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46
Q

What are common non-cardiac side effects of alpha-2 agonists?

Easley 2022, chp 23

A

Hyperglycemia
polyuria
decreased GI motility
ataxia

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47
Q

What are uncommon possible complications associated with alpha-2 agonists?

Easley 2022, Chp 23

A

Paradoxical aggression –> effects on alpha-1 adrenergic receptors, more common with xylazine followed by detomidine (lower alpha-1: alpha-2 selectivity)
Respiratory distress –> occurs in febrile horses sedated with alpha-2s, tachypnea leading to respiratory distress

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48
Q

Combining alpha-2 agonists with opioids results in what percent reduction of each drug dose alone?

Easley 2022, Chp 23

A

near 50%

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49
Q

What is the duration of action of butorphanol and what side effect is it associated with?

Easley 2022

A

30 minutes to 1 hour
Head twitching

Marly 2014, Clarke 1991

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50
Q

What is the duration of action of morphine and what dose should not be exceeded in a 4 hour period?

Easley 2022, Chp 23

A

duration 4-6 hours
0.2mg/kg over 4 hour period max dose

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51
Q

What occurs when morphine is administered IV quickly?

Easley 2022, chp 23

A

Histamine release
Excitement

should be given slowly

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51
Q

What is the onset and duration of buprenorphine?

Easley 2022, Chp 23

A

onset 45-60 minutes for peak effect
druation 8-12 hours

Provides adequate sedation and analgesia but may have more side effects and postop complications compared to morphine

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52
Q

What are the advantages and disadvantages with using midazolam for standing sedation procedure?

Easley 2022, Chp 23

A

Advantages: reduction in chewing activity and tongue movements
Disadvantages: significantly more ataxic (likely due to muscle relaxation properties), midazolam alone causes severe excitement

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53
Q

What kind of needles are recommended for nerve blocks?

Easley 2022, Chp 23

A

Tuohy –> rounded bevel with offset cutting edges that push vasculature and nerves away from cutting edge

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54
Q

In Synder’s 2016 study “Effects of buprenorphine added to bupivacaine infraorbital nerve block on isoflurane minimum alveolar concentration using a model for acutre dental/oral surgical pain in dogs,” what was the duration of action for the infraorbital nerve blocks?

JVD 2016

A

36-48 hours

1ml of 0.5% bupivacaine with 0.3ml of 0.3mg/ml buprenorphine

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55
Q

What can be used to deliver topical anesthetics?

Easley 2022, Chp 23

A

Catheter
Laryngo-tracheal mucosal atomizer

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56
Q

How far caudal to the point where the facial crest dorsally deviates to become part of the rostral zygomatic arch should the injection site for the extraperiorbital fat body insertion technique (EFBI) be placed?

Easley 2022, chp 23

A

2-3cm

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57
Q

In Nannarone’s 2016 study “Retrograde maxillary nerve perineural injection: A tomographic and anatomical evaluation of the infraorbital canal and evaluation of the needle type and size in equine cadavers,” what was the median infraorbital foramen hieght and width?

The Vet J 2016

A

median height 1.2cm
median width 0.6cm

infraorbital foramen is ellipitcal shaped

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58
Q

In Nannarone’s 2016 study “Retrograde maxillary nerve perineural injection: A tomographic and anatomical evaluation of the infraorbital canal and evaluation of the needle type and size in equine cadavers,” what was the described shape of infraorbital canal and what was the median length?

The Vet J 2016

A

Serpentine
median length 13.6cm

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59
Q

In Nannarone’s 2016 study “Retrograde maxillary nerve perineural injection: A tomographic and anatomical evaluation of the infraorbital canal and evaluation of the needle type and size in equine cadavers,” how was obstruction to passage of a 21 gauge Tuohy needle into the infraorbital canal resolved?

The Vet J 2016

A

Retracting the needle 0.5-1cm and slightly rotating needle when advancing

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60
Q

Describe the maxillary nerve block via infraorbital canal technique described by Nannarone in their 2016 paper “Retrograde maxillary nerve perineural injection: A tomographic and anatomical evaluation of the infraorbital canal and evaluation of the needle type and size in equine cadavers.”

The Vet J 2016

A

Manual elevation of the levator labii superioris muscle and infraorbital nerve
insertion of a 19G x 8cm Tuohy needle with bevel directed laterally along floor of infraorbital foramen with careful rotation until entire needle inserted
10ml injected

Quincke needles found to be more difficult to insert (straight sharp tip)

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61
Q

In Weber’s 2019 study “Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen,” needle insertion how far into the infraorbital canal with what volume of injectate adequately filled the infraorbital canal to the maxillary foramen?

Equine Vet Educ 2019.

A

3cm
10ml

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62
Q

In Weber’s 2019 study “Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen,” increased retrograde rostral leakage and into the maxillary sinus was greater with what volume of injectate?

Equine Vet Educ 2019

A

15ml

tested 15ml vs 10ml inserting both 3cm into canal with 22G 3cm long needle

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63
Q

What are the landmarks for finding the infraorbital foramen?

Easley 2022. chp 23

A

line between the nasoincisive notch and point of the facial crest
displace the levator nasolabialis muscle and palpate the infraorbital foramen 1-2cm caudal to midpoint of line

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64
Q

In Harding’s 2012 study “Comparison of two approaches to performing an inferior alveolar nerve block in the horse,” what two methods were evaluated, what were the reported success rates for each, and was the difference stat sig?

Aust Vet J 2012

A

Angled vs vertical
angled success rate 73%
vertical success rate 59%
No stat sig difference between the two

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65
Q

Henry’s 2014 study “Evaluation and clinical use of an intraoral inferior alveolar nerve block in the horse,” showed that location of the mandibular foramen can vary up to how many mm from the third molar tooth and how many mm from the ventral border of the mandible? How about from the rostral edge of the ramus?

EVJ 2014

A

59 +/- 7.7mm caudal to third molar tooth

123 +/- 9.4mm from ventral surface of mandible

36 +/- 4.7mm from rostral edge of ramus

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66
Q

In Easley’s 2022 text, what landmarks are suggested for localizing the mandibular foramen from an extraoral approach?

chp 23

A

line drawn 1cm dorsal to the alveolar crest of the mandibular premolars and a line between the lateral mandibular condyle and the ventral aspect of the mandible where the facial vein is located

these modifications eliminate reliance on eye position and dental height which vary with age and breed

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67
Q

What the difference between the mental nerve block and the mental foramen block?

Easley 2022, chp 23

A

mental nerve block targets only the mental nerve rostral to the foramen so only desensitizes the ipsilateral lower lip
mental foramen block targets the rostral inferior alveolar nerve and mendtal nerves so desensitizes the lower lip and dental structures

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68
Q

In Rawlinson’s 2018 study “Anatomic analysis of the equine mental foramen and rostral mandibula canal using computed tomography,” where was the mental foramen located along the mandible?

Vet Anaesth Analg 2018

A

2/3rd the distance along the incisor-premolar interdental space from the third incisor and 1/3rds the height of the mandible from the dorsal surface of the interdental space

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69
Q

In Rawlinson’s 2018 study “Anatomic analysis of the equine mental foramen and rostral mandibula canal using computed tomography,” what was the mean mental foramen size and what morphological variations were seen?

Vet Anaesth Analg 2018

A

mean size 6.4mm x 5.6mm
bifurcated (n=1) and double foramina (n=3) observed

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70
Q

In Rawlinson’s 2018 study “Anatomic analysis of the equine mental foramen and rostral mandibula canal using computed tomography,” what were the mean angles of the mental foramen into the mandibular canal in transverse, sagittal and dorsal planes respectively?

Vet Anaesth Analg 2018

A

transverse: 68 degrees
sagittal: 28 degrees
dorsal: 41 degrees

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71
Q

In Rawlinson’s 2018 study “Anatomic analysis of the equine mental foramen and rostral mandibula canal using computed tomography,” the rostral mandibular canal was found to have varying levels of circumferential mineralization with what percent of canals having no visible bony walls to the level fo the second premolar? Lack of mineralization was more common in what age of horses?

Vet Anaesth Analg 2018

A

~30%
older horses

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72
Q

When performing an extraoral mental foramen block, what muscle is retracted dorsally?

Easley 2022, chp 23

A

depressor labii inferioris

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73
Q

Cardiac arrest can occur with the maxillary nerve block if the local anesthetic is injected into what structure?

Easley 2022, Chp 23

A

Dural cuff of the optic nerve

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74
Q

In Tanner’s 2019 study “A Retrospective Study of the Incidence and Management of Complications Associated with Regional Nerve Blocks in Equine Dental Patients” what is the reported incidence of lingual trauma 24 hours post injection for the inferior alveolar nerve block?

JVD 2019

A

4%

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75
Q

What is the mortality rate for elective, non-emergency general anesthesia procedures for equine patients as compared to dogs?

Easley 2022, chp 23

A

equine 1%
dogs 0.1%

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76
Q

What percentage of equine general anesthesia fatalities are associated with recovery and what are the most common causes of fatalities in that peroid?

Easley 2022, chp 23.

A

Over a third
fractures and myopathies

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77
Q

What inhalants are favored in lengthy dental procedures and why?

Easley 2022, chp 23

A

sevoflurane and desflurane
due to their low solubility coefficients –> faster clearance and recovery times

78
Q

What mean arterial pressure should the blood pressure be kept at and above?

Easley 2022, chp 23

A

75mmHg

79
Q

Why should arterial blood gases be evaluated intermittently in horses under GA?

Easley 2022, chp 23

A

Pulse oximetry and capnography may not be very accurate in the horse
pulse oximetry tends to underestimate hemoglobin saturation
ET-PaCO2 differences can be 15mmHg

80
Q

Overextension of the head can result in what complication?

Easley 2022, chp 23

A

Laryngeal paralysis –> increased risk for upper airway obstruction in recovery

81
Q

In Potter’s 2016 study “Preliminary investigation comparing a detomidine continuous rate infusion combined with either morphine or buprenorphine for standing sedation in horses,” which treatment group had stat sig higher intraoperative sedation scores?

Vet Anaesth Analg 2016

A

Buprenorphine

No differences in ataxia scores, heart rate, or overall adequacy of sedation

82
Q

In Potter’s 2016 study “Preliminary investigation comparing a detomidine continuous rate infusion combined with either morphine or buprenorphine for standing sedation in horses,” what treatment group had at least one postoperative complication in all cases and which treatment group had no postoperative complications?

Vet Anaesth Analg 2016

A

Buprenorphine all had complications
Morphine all had no complications

83
Q

In Stauffer’s 2017 paper “Maxillary nerve blocks in horses: an experimental comparison of surface landmark and ultrasound-guided techniques,” what were the success rates with surface landmarks, standard ultrasound guidance, and SonixGPS guidance?

Vet Anaesth Analg 2017

A

Surface landmarks 50%
Standard ultrasound guidance 65%
SonixGPS 83%

84
Q

In Stauffer’s 2017 paper “Maxillary nerve blocks in horses: an experimental comparison of surface landmark and ultrasound-guided techniques,” what was the overall complication rate and what stat sig differences in complication rates were present?

Vet Anaesth Analg 2017

A

complication rate 54%
No sig difference in complication rate found between the three methods

85
Q

In Tanner’s 2019 study “A Retrospective Study of the Incidence and Management of Complications Associated with Regional Nerve Blocks in Equine Dental Patients” what nerve block had no reported complications?

JVD 2019

A

infraorbital

86
Q

In Iacopetti’s 2015 study “The Inferior Alveolar Nerve of the Horse: Course and Anatomical Relationship with Mandibular Cheek Teeth,” in 95% of horses where does the nerve change directions between the mesial root of one tooth and the distal root of another?

Anat Histo Embryol 2015

A

Between the mesial root of M1 and the distal root of PM4

87
Q

In Iacopetti’s 2015 study “The Inferior Alveolar Nerve of the Horse: Course and Anatomical Relationship with Mandibular Cheek Teeth,” where does the inferior alveolar nerve course relative to the apices of the molar teeth vs the premolar teeth?

Anat Histo Embryol 2015

A

IAN ventral to the apices of the molar teeth
PM4: lingual to roots and coronal to the apices
PM2, PM3: lingual to roots and in proximity to the apices

88
Q

Which of the following is correct regarding cardiac output?
A. Bradycardia diminishes cardiac output by reducing stroke volume
B. Tachycardia diminishes cardiac output by reducing stroke volume
C. Afterload impedance to cardiac output is a common problem under GA
D. Cardiac output determines systemic vasomotor tone

Lumb and Jones

A

B. Tachycardia diminishes cardiac output by reducing stroke volume

89
Q

Stroke volume is determined by what two factors?

Lumb and Jones

A

Preload
Myocardial contractility

90
Q

Cardiac output is determined by what two factors?

Lumb and Jones

A

Heart rate
Stroke volume

91
Q

What two factors determine blood pressure?

Lumb and Jones

A

Cardiac output
Peripheral vasomotor tone

92
Q

What is the important determinant of peripheral tissue perfusion?

Lumb and Jones

A

Peripheral vasomotor tone

93
Q

What is the important determinant of brain and heart perfusion?

Lumb and Jones

A

Arterial blood pressure

94
Q

What two factors determine blood oxygen content?

Lumb and Jones

A

Hemoglobin concentration
Oxygenation

95
Q

What two factors determine oxygen delivery?

Lumb and Jones

A

Oxygen content
Cardiac output

96
Q

What eyeball positions are associated with light and deep and light-medium to deep-medium anesthetic depth respectively?

Lumb and Jones

A

Light and deep: central
light-medium and deep-medium: rotated medioventrally

97
Q

At what heart rate or below should horses be treated for bradycardia?

Lumb and Jones

A

< 25 bpm

98
Q

What are common causes of bradycardia that are not responsive to pharmacological treatment?

Lumb and Jones

A

Severe hypothermia
Cardiac conduction abnormalities
Severe myocardial hypoxemia

99
Q

What classes of drugs are used to treat bradycardia?

Lumb and Jones

A

anticholinergics
sympathomimetics

100
Q

What factors were associated with increased risk of death for horses undergoing acute emergency abdominal surgery?

Lumb and Jones

A

Long duration of anesthesia
Hypotension

101
Q

What is the internal diameter of a size 6 endotracheal tube?

Lumb and Jones

A

6mm

Tube sizing often reflects the internal diameter of the tube

102
Q

What type of endotracheal tube is most commonly used in large and small animals?

Lumb and Jones

A

cuffed Murphy type tube

103
Q

What is the purpose of the Murphy eye/hole in a Murphy endotracheal tube?

Lumb and Jones

A

To provide an alternative route for gas flow if the beveled opening became occluded

104
Q

What muscles are incised to perform a tracheotomy?

Equine Surgery 5th edition.

A

Cutaneous colli (more superficial)
paired sternothyrohyoideus muscles

105
Q

What direction should a tracheotomy incision be made in and what percent of the tracheal circumference should the tracheotomy incision not exceed?

Equine Surgery 5th edition

A

the annular ligament should be incised parallel to the orientation of the rings
should not exceed 50% of the tracheal circumference

parallel to rings incision prevents postsurgical tracheal collapse and granulation tissue formation

106
Q

Systolic blood pressure is primarily determined by what cardiovascular factors?

Lumb and Jones

A

Stroke volume
Arterial system compliance

107
Q

Diastolic pressure is primarily determined by what cardiovascular factors?

Lumb and Jones

A

Vasomotor tone
Heart rate

108
Q

How is cardiac preload clinically assessed?

Lumb and Jones

A

End diastolic diameter via echocardiography
Diameter of posterior vena cava via chest rads
Ease of jugular vein distension

109
Q

In horses what can be used as a surrogate marker of central venous pressure?

Lumb and Jones

A

Jugular venous pressure

110
Q

What is the normal central venous pressure of laterally recumbent vs dorsally recumbent or standing horses?

Lumb and Jones

A

laterally recumbent: 15-20 cmH2O
dorsally recumbent or standing: 5-10cmH2)

111
Q

Positive pressure ventilation impedes what cardiovascular factors?

Lumb and Jones

A

Intrathoracic venous return
diastolic filling of the heart
stroke volume

112
Q

Large and small stroke volumes are associated with what pulse and pulse pressure waveform characteristics?

Lumb and Jones

A

Bounding pulse → tall, wide waveform → likely associated with large stroke volume
Thready pulse → short, narrow waveform → small stroke volume

113
Q

What causes hemoglobin concentration to decrease during general anesthesia?

Lumb and Jones

A

Anesthetic induced vaso and splenic dilation
Administration of non-hemoglobin containing fluids
Intraoperative blood loss

114
Q

Decreased fractional shortening is indicative of what change to contractility?

Lumb and Jones

A

Decreased

115
Q

What causes vasoconstriction?

Lumb and Jones

A

hypovolemia
heart failure
hypothermia
vasoconstrictor drug administration

116
Q

What causes vasodilation?

Lumb and Jones

A

Systemic inflammatory response
hyperthermia
administration of vasodilator drugs

117
Q

What breathing pattern is described as cycling between hyperventilation and hypoventilation, and may be seen in a healthy anesthetized horse?

Lumb and Jones

A

Cheyne-Stokes breathing

118
Q

Which capnograph indicates that the sample port is too close to fresh gas inflow?

Lumb and Jones

A

c.

119
Q

Which capnograph is indicative of excessive alveolar deadspace (hypovolemia, thromboembolism)?

Lumb and Jones

A

e.)

120
Q

Which capnograph is indicative of deadspace rebreathing?

Lumb and Jones

A

f.)

121
Q

An increased arterial-venous PCO2 gradient suggests what in terms of tissue perfusion?

Lumb and Jones

A

Decreased tissue perfusion

122
Q

How would you troubleshoot the following capnograph?

A

There is a slant to the upstroke portion of the expiratory phase of the breathing cycle - this may indicate a kinked endotracheal tube, an obstructed endotracheal tube, partial airway obstruction or bronchospasm.

123
Q

How would you troubleshoot the following capnograph?

Lumb and Jones

A

The baseline is not returning to zero, there may be exhausted CO2 absorbing granules, incompetent or absent unidirectional valves, decreased oxygen flow rate in a non-rebreathing circuit, or damaged non-rebreathing circuits.

124
Q

How would you troubleshoot the following capnograph?

A

There is no plateau or an abnormal downstroke present on inhalation –> check the endotracheal tube cuff!

125
Q

What is the lowest body temperature not associated with detrimental effects?

Lumb and Jones

A

96F

126
Q

What body temperatures can cause ventricular fibrillation?

Lumb and Jones

A

72-74F

127
Q

What body temperatures cause marked CNS depression?

Lumb and Jones

A

82-86F

Shivering will not occur → require artificial rewarming
Atrial arrhythmias may occur, O2 consumption reduced to 50%, heart rate + cardiac output about 35-40% of normal, arterial blood pressure to about 60%, cerebral metabolism ~25%

128
Q

Cell damage starts at what hyperthermic temperature?

Lumb and Jones

A

108F

Oxygen delivery can no longer keep up with incr metabolism and O2 consumption

129
Q

What is the difference between a tranquilizer and a sedative?

Lumb and Jones

A

Tranquilizers induce a feeling of calm but do not reduce overall response to external stimuli like a sedative

130
Q

Phenothiazines work on what receptors?

Lumb and Jones

A

Adrenergic
Muscarinic
Dopaminergic
Serotonergic
Histamine

131
Q

What is the mechanism of action for the sedative effects of phenothiazines?

Lumb and Jones

A

dopamine receptor (D2) blockage

132
Q

Acepromazine (sedative) 0.1mg/kg IV decreases mean aortic pressure and cardiac output by what percents respectively?

Lumb and Jones

A

aortic pressure 20-30%
Cardiac output 10-15%

133
Q

What is the mechanism of action of benzodiazepines?

Lumb and Jones

A

Ehance GABA receptor’s affinity for GABA

increased chloride conductance and hyperpolarization of postsynaptic cell membranes. (alpha1 and alpha 2 subunits)

134
Q

What is the mechanism of action for alpha-2 agonists?

Lumb and Jones

A

binding receptors in the nociceptive pathways in the brainstem and dorsal horn of the spinal cord
afferent input modulated and reduces norepinephrine release (presynaptic inhibition) and occupancy of those receptors (postsynaptic inhibition)

135
Q

What is the mechanism of action for bradycardia by alpha 2 adrenergic receptor agonists?

Lumb and Jones

A

Increased systemic vascular resistance
Reduced central symphathetic outflow

136
Q

What is the onset and duration of action of xylazine?

Lumb and Jones

A

Onset 5-10 minutes
Duration 30-60 minutes

137
Q

What is the onset and duration of detomidine?

Lumb and Jones

A

onset 5 minutes
duration 1 hour

138
Q

How does the onset to peak sedation and duration of romifidine compare to xylazine and detomidine?

Lumb and Jones

A

longer onset and duration (15 minutes to peak sedation)

139
Q

What adrenergic receptor antagonists are typically used for dexmedetomidine and xylazine respectively?

Lumb and Jones

A

Dexmedetomidine: atipamezole
Xylazine: yohimbine, tolazine

140
Q

What is the definition of potency?

Lumb and Jones

A

the relative dose needed to elicit a response

Not related to duration of effect or efficacy

141
Q

What is first pass metabolism?

Lumb and Jones

A

The intestinal lining and liver biotransform a portion of the medication into a form that is not systemically effective

142
Q

Systemic opioid doses are most effective at decreasing nociception of which nerve fibers?

A

C fibers (slow conducting, unmyelinated nerves associated with dull aching pain)

less effective on A delta fibers (fast conducting, myelinated nerves associated with sharp, discrete pain)

143
Q

Opioids tend to cause what change to pupil diameter in horses and cats?

Lumb and Jones

A

Mydriasis

144
Q

Morphine and butorphanol tend to impair coordination of motility of what parts of the gastrointestinal tract specifically?

Lumb and Jones

A

Morphine: colon
Butorphanol: jejunum

145
Q

What opioid receptors ehance urine production?

Lumb and Jones

A

kappa

146
Q

What is the mechanism of action for urine retention with opioid use?

Lumb and Jones

A

Decrease in detrusor muscle contraction
Increased tone of urinary sphincters
Inhibition of micturition

147
Q

Cats and horses tend to experience what thermoregulation response to opioid use?

Lumb and Jones

A

Hyperthermia

148
Q

Which opioid is effective as an NMDA antagonist?

Lumb and Jones

A

Methadone

more effective analgesic for chronic and refractory pain

149
Q

What opioid has reported hyperesthesia, muscle fasciculations, sweating and adverse CV effects reported in horses?

Lumb and Jones

A

Meperidine (pethidine)

150
Q

Buprenorphine is how many times more potent than morphine?

Lumb and Jones

A

25 times

151
Q

What is the IV onset to action of buprenorphine and the duration of action?

Lumb and Jones

A

20 minutes
4-12 hours (dependent on route)

152
Q

Oral transmucosal route of buprenorphine is effective in what species?

Lumb and Jones

A

Dogs and cats
not horses

153
Q

What opioid receptors does butorphanol act on?

Lumb and Jones

A

Mu antagonist to partial mu agonist
kappa agonist

154
Q

Naloxone works primarily on what opioid receptors?

Lumb and Jones

A

mu antagonist

155
Q

What is dantrolene used to treat?

Lumb and Jones

A

Malignant hyperthermia
Rhabdomyalosis

156
Q

What are the general effects of guaifenesin?

Lumb and Jones

A

Centrally acting skeletal muscle relaxant with sedative properties
Co-administered with anesthetic agents for induction and maintenance of general anesthesia

157
Q

What are the properties/effects of methocarbamol?

Lumb and Jones

A

centrally acting muscle relaxant that selectively inhibits spinal and supraspinal polysynaptic reflexes through its action on interneurons without direct effects on skeletal muscle

158
Q

What is the molecular mechanism of action of local anesthetics?

Lumb and Jones

A

Primary ion channel blockers
Blockade of inward sodium currents through voltage gated sodium channels which impedes membrane depolarization and nerve excitation and conduction

Also block voltage dependent potassium and calcium channels
act on intracellular G-protein coupled receptors

159
Q

What percent of sodium conductance at 3 or more nodes of Ranvier of a myelinated nerve fiber must be blocked to achieve local anesthesia?

Lumb and Jones

A

> 84%

160
Q

What is the chemical structure of lidocaine, mepivacaine and bupivacaine?

Lumb and Jones

A

amino-amides

metabolized by the liver

161
Q

What effects have been shown when alpha-2 adrenergic receptor agonists are added to local anesthetics?

Lumb and Jones

A

Shorter onset
longer duration of sensory and motor block
enhanced block quality, lower pain scores, decreased systemic opioid requirement

162
Q

What are the signs and results of cardiac toxicity secondary to local anesthetics?

Lumb and Jones

A

Prolonged PR and QRS intervals, hypotension, bradycardia, respiratory arrest, asystole

163
Q

What is allodynia?

Lumb and Jones

A

Pain due to a stimulus which does not normally provoke pain.

164
Q

What is the only class of analgesic drugs that prevent nociception transmission?

Lumb and Jones

A

Local anesthetics

165
Q

Does COX1 or COX2 act centrally?

Lumb and Jones

A

COX1- antinociceptive effects at level of the brain, spinal cord

166
Q

Which classes of analgesics prevent generation of noxious stimuli?

A

Local anesthetics
NSAIDs

Opioids modulate pain by increasing the pain threshold but do not prevent generation of noxious stimul

167
Q

What arrhythmia does high dose dobutamine cause?

A

Ventricular tachycardia

168
Q

What are the reported complication after maxillary nerve block?

Easley ch 29

A

Retrobulbar hematoma
Globe prolapse
Horner’s signs

169
Q

Laceration of the tongue can be a complication of which nerve block?

Easley ch 29

A

Inferior alveolar

170
Q

What are possible causes of this ETCO2 waveform?

Equine Anesthesia, Hubbel, ch 8

A
171
Q

What are the possible causes of this ETCO2 waveform?

Equine Anesthesia, Hubbel, ch 8

A
172
Q

What possible causes are there for this ETCO2 waveform?

Equine Anesthesia, Hubbel, ch 8

A
173
Q

What causes are there for this waveform ETCO2?

Equine Anesthesia, Hubbel, ch 8

A
174
Q

Name this ECG

Equine Anesthesia, Hubbel, ch 3

A

Sinus arrhythmia

175
Q

Name this ECG

Equine Anesthesia, Hubbel, ch 3

A

Sinus tachycardia. Note the shortening of the P wave, PR, and QT intervals; the depression of the PR segment; and the elevation of the ST-T wave—all of which are physiologic changes observed with tachycardia.

176
Q

Name this ECG

Equine Anesthesia, Hubbel, ch 3

A

2nd degree AV block (p waves without QRS)

Common in horses sedated with alpha-2s

177
Q

Name this ECG

Equine Anesthesia, Hubbel, ch 3

A

Sinus arrest - give atropine to restore

178
Q

What are the ECGs in A and B

Equine Anesthesia, Hubbel, ch 3

A

A. Atrial tachycardia
B. Atrial flutter

A - Regular abnormal P waves (P’) are evident through-
out the strip, with many superimposed on the QRS and T complexes. Most of ectopic P waves are blocked in
the AV node and are not conducted to the ventricles.

B - Atrial activity is characterized by
saw-toothed flutter waves (F) occurring at a rapid rate and regular intervals.

179
Q

Name this ECG

Equine Anesthesia, Hubbel, ch 3

A

Ventricular tachycardia

180
Q

What can cause this ECG reading?

Equine Anesthesia, Hubbel, ch 3

A

Hyperkalemia produced atrial standstill, a ventricular conduction disturbance (wide QRS), and ST-T abnormalities

181
Q

How does the choice in inotropic drugs dopamine and dobutamine differ?

Equine Anesthesia, Hubbel, ch 3

A

Dopamine is preferred for treating bradycardia and hypotension

Dobutamine is preferred for treating hypotension without bradycardia

Both used for bradycardia!

182
Q

What are side effects of dobutamine?

Equine Anesthesia, Hubbel, ch 3

A

Dose-dependent effects
Vasoconstriction
Tachycardia
Ventricular arrhythmias

183
Q

How does hematocrit differ in donkeys compared to horses?

Equine Anesthesia, Hubbel, ch 18 (Nora Matthews)

A

Donkeys are adapted to the desert; increases in hematocrit, commonly seen with dehydration in horses, do not occur until donkeys are approximately 30% dehydrated

184
Q

What condition are donkeys predisposed to when anorexic?

Equine Anesthesia, Hubbel, ch 18 (Nora Matthews)

A

Hyperlipidemia

185
Q

How does the jugular vein differ in donkeys to horses when trying to get venous access?

Equine Anesthesia, Hubbel, ch 18 (Nora Matthews)

A

Cutaneous colli muscle is a sheet of fascia, and the skin is thicker

Needles should be angled more perpendicular to the skin in donkeys

186
Q

How does the facial artery differ in donkeys?

Equine Anesthesia, Hubbel, ch 18 (Nora Matthews)

A

the anatomy of the branches of the facial artery
(i.e., the artery that is located under the temporal crest) makes it difficult to place an arterial catheter in that location

187
Q

How do vitals differ in donkeys compared to horses?

Equine Anesthesia, Hubbel, ch 18 (Nora Matthews)

A

HR response to exercise/pain the same
Body temp may increase higher in donkeys in warm climates or exercise
Resp rates higher in donkeys - 20 to 30 breaths/min is normal at rest

HR most reliable to indicate pain in a donkey as they are so stoic

188
Q

How does sedative dosing differ for mules and donkeys?

Equine Anesthesia, Hubbel, ch 18 (Nora Matthews)

A

same drugs as horses
mules require 50% more drug than donkeys or horses to achieve adequate sedation

Ketamine after sedation with an a2-agonist is generally acceptable but is metabolized more rapidly in donkeys and mules than in horses

ketamine - Faster metabolism in conjunction with a more
rapid distribution phase results in higher doses and more frequent readministration

189
Q

How shoud your combination for GKX differ for donkeys?

Equine Anesthesia, Hubbel, ch 18 (Nora Matthews)

A

Increase the concentration of ketamine - 2 g/L rather than 1g/L in the horse

190
Q

what nerves innervate the TMJ, and what block(s) should be performed for a condylectomy?

Sanders EVE 2014

A

branches of maxillary (zygomaticotemporal and zygomaticofacial) and the mandibular (auriculotemporal) nerves

Perform both ipsilateral maxillary and mandibular nerve blocks

Facilitated a standing condylectomy in this case report

191
Q

What is the genetic defect of concern with HYPP? And how prevalent is it?

Doherty, Manual of Equine Anesthesia and Analgesia

A

Defect in NA-K pump
Excess Na –> Increased serum K+
Less negative resting potential –> triggered more (why muscle fasciculations are 1st sign)

0.4% American QH; 2% registered QH

192
Q

What clinical signs during anesthesia would make you susptect HYPP?

Doherty, Manual of Equine Anesthesia and Analgesia

A

Prolonged recovery = #1
Muscle fasciculations
ECG changes: inc amplitude T wave, wide QRS, dec amplitude P wave)
Tachycardia –> bradycardia
Hyperthermia

193
Q

What muscle is being lifted here in Rice’s JVD step by step?

JVD 2017

A

levator labii superioris muscle

Different than muscle listed in Ch 23 of Easley 2022!

Phase 1 Boards Prep - EQ (11 decks)

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