Anesthesia and Disease Flashcards
4 ways to optimize cardiac output
- increase preload
- increase HR
- decrease afterload
- increasing contractility
Pre-op anesthesia considerations for a liver disease patient
- MDB
- ammonia
- blood glucose
- PT/aPTT
- fluids
- fresh frozen plasma
- hetastarch
- dextrose
7 anesthetic considerations for patients with elevated ICP
- maintain BP to prevent worsening cerbral ischemia
- permissive hypothermia: lower cerebral metabolic rate
- smooth intubation (avoid coughing and avoid vomiting)
- maintain Eucapnia
- elevate head slightly (avoid jugular compression)
- treat for seizures
- expect prolonged recoveries
____________ is the most dangerous part of anesthesia for patients with respiratory disease
induction and recovery
General considerations for cardiac patients under general anesthesia (5)
- preoxygenate and monitor oxygenation
- conservative fluid therapy (2-3 mL/kg/hr)
- use lowest possible amount of inhalent (consider opioid/lidocaine CRIs)
- monitor BP and ECG
- treat underlying arrhythmias
you should avoid using _____ in a patient with a conduction abnormality requiring a pacemaker placement until the patient is successfully paced
opiods, especially full u agonists
Main anesthetic goal of degenerative valve disease
Promote forward blood flow and
minimize regurgitation into atria
4 anesthetic goals with liver disease patients
- avoid excessive drug doses
- favor reversible drugs
- promote liver blood flow
- compensate for low albumin, glucose, and clotting factors
Goals during anesthesia for a patient with Hypertrophic Cardiomyopathy (5)
- Minimize stress on myocardium
- Maximize oxygen delivery to
myocardium
• Maximize diastolic function
• Prevent fluid overload
• Prevent left ventricular outflow
obstruction
3 considerations for patients with a diaphragmatic hernia
- elevate head above the body
- acute disease (ventilate aggressively) v. chronic disease (conservative ventilation)
- consider maneuvers to recruit collapsed alveoli (PEEP and recruitment maneuvers)
Should avoid drugs that are ____ and _____ in patients with liver disease
- high protein binding
- non-reversible
anesthetic considerations for patients with liver disease
- start dosing low
- consider propofol
- Morphine
- remifentanil
4 general considerations for respiratory disease patients undergoing anesthesia
- minimize stress
- oxygen support
- sedation: minimal respiratory depression
- quickly control airway and ventilate
Potential complications in a chronic renal disease patient (9)
- anemia
- electrolyte imbalances
- dehydration
- azotemia
- low serum protein
- metabolic acidosis
- chronic vomiting and inappetance
- coagulopathies
- hypertension
2 drugs contraindicated in a DVD patient
- acepromazine
- phenylephrine
HCM treatment pre-op (6)
- minimize stress and provide analgesia
- treat any possible hypovolemia or dehydration pre-op
- opiods (analgesia with min. CV effects)
- alfaxan (added sedation for aggressive cats)
- benzodiazepines (anxiolysis with min. CV effects)
- Dexmed (reduces severity of LVOT obstruction)
3 pharmakokinetic effects of chronic renal failure
- hypoproteinemia (increase portion of available free drug in highly-bound drugs)
- decreased renal elimination (prolonged effects of drugs and metabolites excreted primarily by the kidneys)
- azotemia alters BBB permeability (more profound drug effect)
4 drugs you should NOT give a patient with HCM
- atropine
- acepromazine
- Ketamine
- dopamine
General post-op considerations for heart disease patients (5)
- minimize stress and catecholamine release
- continue monitoring & treatment for arrhythmias
- treat any lingering hypovolemia or hypotension
- correct hypothermia
- provide adequate analgesia
anesthetic goals of Chronic Renal disease patients
- maximize renal blood flow
- use reversible drugs with minimal CV effects (opioids & benzos)
3 inhalant induced cardiac changes
- decreased contractility
- decreased CO
- hypotension
5 normal functions of the liver
- drug metabolism
- protein production
- production of clotting factors
- toxin removal
- glucose metabolism
Problems associated with Hypertrophic Cardiomyopathy
- poor diastolic function
- myocardial ischemia (especially with exertion)
- arrhythmias & clots
- cardiac murmur & possible outflow tract obstruction
- thickening of ventricular free wall & septum
- inabilityof coronary circulation to supply oxygen to myocardium
- stretching and distortion of AV valves
Pre-op protocol for DVD patients
- minimize stress and provide analgesia
- treat any hypovolemia or dehydration
- opiods
- benzos
- anticholinergics (increase HR and CO)
5 potential complications of anesthesia associated with liver disease
- prolonged and more profound drug effect
- more available free drug & decreased oncotic support
- increased likelihood of intra-op bleeding
- increased drug sensitivity
- hypoglycemia
General considerations for patients with respiratory disease recovering from anesthesia (6)
- continue O2 support
- monitor oxygenation
- drain chest tube
- place in sternal recumbency
- suction oropharynx/esophagus
- be prepared to intubate!!
in a patient with elevated ICP, _______ should be avoided entirely
inhalents
intra-op protocol for a patient with DVD
- preoxygenate with minimal stress
- conservative fluid therapy
- minimize inhalent MAC
- Etomidine
- Ketamine
- Dobutamine
3 methods of maximizing renal blood flow for chronic renal disease patients under anesthesia
- use ionotropes to increase cardiac output
- aggressive fluid therapy
- minimize the use of inhalants with blaanced techniques
