Anesthesia and Disease Flashcards
upper airway disease
prone to hypoxia
distress (catecholamine)
prone to obstruction
(pulmonary edema)
=preoxygenate for ~ 5 minutes to reach max level
pulmonary disease
- chest trauma-pneumothorax
- upper airway obstruction
- pneumonia/pulmonary edema
- correct underlying disease!!
- hypoventilation and hypoxia
- most drugs decrease ventilation
- change in compliance
- increase in pulmonary resistance
- accumulate secretions
pre-operative assessment for pulmonary disease
hx and rx
chest radiographs
pulse ox (awake), blood gas
exercise intolerance (60 second walk)
how to manage pulmonary disease for anesthesia
- premedication- low sedation (slow)
- pre-oxygenate for ~ 5 minutes
-
induction (fast)
- avoid increase in O2 demand and apnea
- inflate cuff, rapid sequence induction
- low dose opioid, propofol
- monitor with capnograph, pulse ox, and blood gas
- recovery: low stress, high O2, positioning
during anesthesia, what would be worse for a patient with HCM?
vasoconstriction
vasodilation
bradycardia
tachycardia
tachycardia
anesthesia for a cat with HCM
- HCM is most common heart disease in cats
- 15% don’t show clinical signs
- stiff ventricle and poor diastolic function
-
left ventricle outflow tract obstruction (LVO)
- avoid tachycardia, increasing contractility and vasodilation
- atropine, opioids, etomidate
pre-anesthetic care for HCM patient
- pre-oxygenate
- place IV catheter
- reduce stress!
recovery for HCM patient after anesthesia
- recovery in calm environment
- monitor BP and HR for about an hour (if cat is compliant)
anesthesia and cardiac disease (mitral valve disease)
- premedication, pre-oxygenate
- induction
- avoid bradycardia and vasoconstriction
- fluid therapy-low volume
- reduce stress!
- opioids, dex, etomidate
for HCM cats, a mild __________ in HR and mild ___________ decrease risk of LVOT
decrease
vasoconstriction
for MR dogs, a mild _________ in HR and mild _____________ improve cardiac performance
increase
vasodilation
liver disease and anesthesia
- portosystemic shunt (PSS) or intoxication
- low metabolism
- decease protein production
- decrease glucose stores
- hypoxia
pre-operative assessment for liver disease
u/s
neuro exam
chemistry profile (protein!!)
clotting factors
type of anesthetic drugs to use with liver disease
- use drugs that are reversible, short acting and don’t need liver for metabolism
- opioids, midazolam
- propofol***
- remifentanyl + isoflurane
- fluids: fresh frozen plasma (FFP), hetastarch, glucose
brain disease and anesthesia
- head trauma, brain mass
-
concerns
- seizures
-
intracranial pressure (ICP)
- drugs, positioning, vomiting, cough gag, CO2, O2, BP
pre-operative assessment for brain disease
- hx, rx
- hydration status, electrolyte panel
- Cushing’s reflex: low HR, high BP
what type of drugs to avoid with brain disease:
drugs that cause: vomiting, sedation (hypoventilation), increased ICP (ketamine, halothane)
types of anesthetic drugs to use with brain disease
- low dose opioid IV
- thiopental, diazepam
- isoflurane or sevoflurane (vasodilation)
- ketamine is the only induction with analgesic properties
