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Anesthesiology > Anesthesia and Disease > Flashcards

Anesthesia and Disease Flashcards

1
Q

4 ways to optimize cardiac output

A
  • increase preload
  • increase HR
  • decrease afterload
  • increasing contractility
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2
Q

Pre-op anesthesia considerations for a liver disease patient

A
  • MDB
  • ammonia
  • blood glucose
  • PT/aPTT
  • fluids
  • fresh frozen plasma
  • hetastarch
  • dextrose
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3
Q

7 anesthetic considerations for patients with elevated ICP

A
  • 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
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4
Q

____________ is the most dangerous part of anesthesia for patients with respiratory disease

A

induction and recovery

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5
Q

General considerations for cardiac patients under general anesthesia (5)

A
  • 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
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6
Q

you should avoid using _____ in a patient with a conduction abnormality requiring a pacemaker placement until the patient is successfully paced

A

opiods, especially full u agonists

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7
Q

Main anesthetic goal of degenerative valve disease

A

Promote forward blood flow and

minimize regurgitation into atria

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8
Q

4 anesthetic goals with liver disease patients

A
  • avoid excessive drug doses
  • favor reversible drugs
  • promote liver blood flow
  • compensate for low albumin, glucose, and clotting factors
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9
Q

Goals during anesthesia for a patient with Hypertrophic Cardiomyopathy (5)

A
  • Minimize stress on myocardium
  • Maximize oxygen delivery to
    myocardium
    • Maximize diastolic function
    • Prevent fluid overload
    • Prevent left ventricular outflow
    obstruction
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10
Q

3 considerations for patients with a diaphragmatic hernia

A
  • elevate head above the body
  • acute disease (ventilate aggressively) v. chronic disease (conservative ventilation)
  • consider maneuvers to recruit collapsed alveoli (PEEP and recruitment maneuvers)
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11
Q

Should avoid drugs that are ____ and _____ in patients with liver disease

A
  • high protein binding

- non-reversible

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12
Q

anesthetic considerations for patients with liver disease

A
  • start dosing low
  • consider propofol
  • Morphine
  • remifentanil
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13
Q

4 general considerations for respiratory disease patients undergoing anesthesia

A
  • minimize stress
  • oxygen support
  • sedation: minimal respiratory depression
  • quickly control airway and ventilate
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14
Q

Potential complications in a chronic renal disease patient (9)

A
  • anemia
  • electrolyte imbalances
  • dehydration
  • azotemia
  • low serum protein
  • metabolic acidosis
  • chronic vomiting and inappetance
  • coagulopathies
  • hypertension
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15
Q

2 drugs contraindicated in a DVD patient

A
  • acepromazine

- phenylephrine

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16
Q

HCM treatment pre-op (6)

A
  • 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)
17
Q

3 pharmakokinetic effects of chronic renal failure

A
  • 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)
18
Q

4 drugs you should NOT give a patient with HCM

A
  • atropine
  • acepromazine
  • Ketamine
  • dopamine
19
Q

General post-op considerations for heart disease patients (5)

A
  • minimize stress and catecholamine release
  • continue monitoring & treatment for arrhythmias
  • treat any lingering hypovolemia or hypotension
  • correct hypothermia
  • provide adequate analgesia
20
Q

anesthetic goals of Chronic Renal disease patients

A
  • maximize renal blood flow

- use reversible drugs with minimal CV effects (opioids & benzos)

21
Q

3 inhalant induced cardiac changes

A
  • decreased contractility
  • decreased CO
  • hypotension
22
Q

5 normal functions of the liver

A
  • drug metabolism
  • protein production
  • production of clotting factors
  • toxin removal
  • glucose metabolism
23
Q

Problems associated with Hypertrophic Cardiomyopathy

A
  • 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
24
Q

Pre-op protocol for DVD patients

A
  • minimize stress and provide analgesia
  • treat any hypovolemia or dehydration
  • opiods
  • benzos
  • anticholinergics (increase HR and CO)
25
Q

5 potential complications of anesthesia associated with liver disease

A
  • prolonged and more profound drug effect
  • more available free drug & decreased oncotic support
  • increased likelihood of intra-op bleeding
  • increased drug sensitivity
  • hypoglycemia
26
Q

General considerations for patients with respiratory disease recovering from anesthesia (6)

A
  • continue O2 support
  • monitor oxygenation
  • drain chest tube
  • place in sternal recumbency
  • suction oropharynx/esophagus
  • be prepared to intubate!!
27
Q

in a patient with elevated ICP, _______ should be avoided entirely

A

inhalents

28
Q

intra-op protocol for a patient with DVD

A
  • preoxygenate with minimal stress
  • conservative fluid therapy
  • minimize inhalent MAC
  • Etomidine
  • Ketamine
  • Dobutamine
29
Q

3 methods of maximizing renal blood flow for chronic renal disease patients under anesthesia

A
  • use ionotropes to increase cardiac output
  • aggressive fluid therapy
  • minimize the use of inhalants with blaanced techniques

Anesthesiology (13 decks)

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