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Anesthesiology > Anesthesia & Disease > Flashcards

Anesthesia & Disease Flashcards

1
Q

What is the ASA status of a patient with mild mitral valve insufficiency that is asymptomatic?

A

ASA II

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2
Q

What is the ASA status of a patient with mitral valve insufficiency in addition to well-managed diabetes mellitus and hyperadrenocorticism?

A

ASA III (multiple systemic diseases)

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3
Q

Patients with low-grade second degree AV block may be able to be anesthetized with relative safety if they respond well to what?

A

Vagolytic agents, such as atropine and glycopyrrolate

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4
Q

What is your pre-med plan for a patient with CV irregularities?

A
  • Benzos + opioids - although avoid opioids in an animal with a conduction abnormality and requires pacemaker placement
  • Avoid alpha2s except for potentially in cats w/ HCM
  • Alfaxalone - good choice for small animals w/ cardiac dz (esp cats)
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5
Q

What are 3 inhalant-induced cardiac changes?

A
  • Decr contractility
  • Decr cardiac output
  • Hypotension
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6
Q

Describe features of HCM

A
  • Poor diastolic function
  • Myocardial ischemia esp. w/ exertion
  • Arrhythmias and clots
  • Cardiac murmur and possible outflow tract obstruction
  • Thickening of ventricular free wall & septum
  • Inability of coronary circulation to supply O2 to myocardium
  • Stretching and distortion of AV valves
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7
Q

What are 4 clinical effects of HCM on the heart?

A
  • Elevated end-diastolic pressures
  • Incr sympathetic tone
  • Tachycardia and incr contractility
  • Low systemic pressures that lower resistance thru LVOT obstruction
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8
Q

What drug should you NOT ever give to a cat with HCM?

A

Ketamine! Incr heart rate and causes myocardial ischemia

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9
Q

What things should you keep in mind when preparing a cat with HCM for anesthesia induction?

A
  • Minimize stress on myocardium
  • Max O2 delivery to myocardium
  • Max diastolic function
  • Prevent fluid overload
  • Prevent LV outflow obstruction
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10
Q

HCM Pre-Op

A
  • Minimize stress and provide analgesia
  • Treat any possible hypovolemia or dehydration pre-op
  • Drugs:
    • Opioids - provide analgesia w/ min CV effects
    • Benzos - anxiolytics w/ min CV effects
    • Alfaxalone - added sedation for aggressive cats (can give IM)
    • Dexmed - reduces severity of LVOT obstruction
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11
Q

HCM Intra-Op Protocol

A
  • Preoxygenate with minimal stress
  • Give etomidate (min CV effects)
  • Conservative fluid tx
  • Minimize inhalant MAC
  • Give phenylephrine

*NO KETAMINE OR DOPAMINE

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12
Q

What is the main anesthetic goal of degenerative valve disease and how do we do this?

A
  • Promote forward blood flow and minimize regurgitation into atria
  • Optimize CO
  • Incr Preload, decr afterload
  • Incr HR
  • Incr contractility
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13
Q

DVD Pre-Op Protocol

A
  • Minimize stress and provide analgesia
  • Tx any possible hypovolemia or dehydration pre-op
  • Drugs:
    • Opioids - provides analgesia w/ min CV effects
    • Benzos - anxiolytics w/ min CV effects
    • Anticholinergic - incr HR and CO
    • Ace - decr SVR

*NO DEXMED

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14
Q

DVD Intra-Op Protocol

A
  • Preoxygenate with minimal stress
  • Conservative fluidity therapy
  • Minimize inhalant MAC
  • Drugs: Etomidate, Ketamine, Dobutamine, Dopamine

*NO PHENYLEPHRINE

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15
Q

What should be your general considerations for anesthesia when dealing with generalized heart disease?

A
  • Preoxygenate and monitor oxygenation
  • Conservative fluid therapy (2-3 ml/kg/hr)
  • Monitor BP and ECG carefully, tx underlying arrhythmias
  • Use lowest possible amt of inhalant - consider opioid/lidocaine CRIs
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16
Q

Heart Disease Post-Op Protocol

A
  • Continue monitoring and tx for arrhythmias
  • Correct hypothermia
  • Tx any lingering hypovolemia/hypotension
  • Provide adequate analgesia
17
Q

What are some clinical effects of liver disease on anesthetic drugs?

A
  • Prolonged and more profound drug effect
  • More available free drug and decr oncotic support
  • Incr likelihood of intra-op bleeding
  • Incr drug sensitivity
  • Hypoglycemia
18
Q

What are you anesthetic goals when dealing with a patient with liver disease?

A
  • Avoid excessive drug doses
  • favor reversible drugs that promote liver blood flow
  • compensate for low albumin, glucose, clotting factors
19
Q

What are some anesthetic consideration you should have for patients with liver disease perioperatively?

A
  • Getting MDB, ammonia, BG, PT/aPTT
  • Maintain normal BP and body temp
  • Start dosing low
  • Drugs:
    • Remifentanil - not metabolized by liver (esterases)
    • Isoflurane - favors liver blood flow
    • Propofol - drug of choice - some extra hepatic metabolism
    • avoid drugs with high protein biding and are non-reversible!
20
Q

What is our main concern when anesthetizing patients with neurological disease?

A

Elevated ICP

21
Q

What principle states that the brain and other structures are in a fixed space?

A

Monroe-Kellie Principle

22
Q

Cerebral perfusion pressure is dictated by what two factors?

A

Mean arterial pressure and intracranial pressure

CPP = MAP - ICP

23
Q

What is the physiological process of ICP increase causing cerebral ischemia?

A

Incr in ICP > decr in CPP > decr in CBF > incr in ischemia > incr in edema and tissue pressure > incr in ICP

24
Q

Elevated ICP: Anesthetic Considerations

A
  • Maintain BP to prevent worsening cerebral ischemia
  • Permissive hypothermia: lower cerebral metabolic rate
  • Smooth intubation: avoid coughing/vomiting
  • Maintain Eucapnia: ETCO2 = 30-35 mmHg
25
Q

Why is it really important to maintain normal ventilation for patients with elevated ICP?

A

To maintain eucapnia (ETCO2 = 30-35 mmHg) to prevent excess blood flow to the brain to try and compensate for changes in CO2

26
Q

What are some anesthetic considerations for patients with elevated ICP?

A

Maintain normal BG - high BG > worse prognosis

Elevate head SLIGHTLY - avoid jugular compression

Tx for seizures - expect prolonged recoveries

27
Q

What is your drug protocol for patients with elevated ICP?

A
  • Midazolam - benzo
  • maropitant - prevent emesis
  • mannitol - reduce cerebral edema
  • propofol - min effects on ICP, can be CRI

* avoid inhalants

28
Q

What is the biggest thing you should keep in mind when anesthetizing a patient with chronic renal insufficiency?

A

Should be normovolemic with electrolytes corrected BEFORE anesthesia! Also get base BP

29
Q

What are the effects of chronic renal insufficiency on pharmacokinetics?

A
  • Hypoproteinemia - incr in portion of available free drug in highly-bound drugs
  • Decr renal elimination - prolonged effects of drugs and metabolites excreted primarily by kidneys
  • Azotemia alters BBB permeability - more profound drug effect
30
Q

What are your anesthetic goals for patients with CRI?

A
  • Max renal blood flow:
    • Maintain MAP > 60mmHg
    • use inotropes to incr CO
    • Aggressive fluid tx
    • Min use of inhalants w/ balanced technique
    • Use reversible drugs w/ min CV effects - opioids and benzos
31
Q

When is the most dangerous time for anesthetizing a patient with respiratory disease?

A

Induction and recovery

32
Q

What are some general considerations to have when anesthetizing a patient with respiratory disease?

A
  • Minimize stress
  • Oxygen support
  • Sedation: min resp depression (ace, butorphanol)
  • Quickly control airway and ventilate
  • Be prepared with alpha2s and antiemetics
33
Q

What general considerations should you have in recovering a patient with resp disease?

A
  • Continue O2 support
  • Monitor oxygenation
  • Drain chest tube
  • Place in sternal recumbency
  • Suction oropharynx/esophagus
  • Be prepared to intubate!
34
Q

What things should you keep in mind when treating a patient with diaphragmatic hernias?

A
  • Elevate head above body
  • Acute dz: ventilate aggressively
  • Chronic dz: conservative ventilation
  • Consider maneuvers to recruits collapsed alveoli:
    • PEEP valve, recruitment maneuvers
35
Q

How can the pathology of organ systems affect anesthesia?

A
  • Alter drug pharmacokinetics (delayed ADME)
  • Alter drug pharmacodynamics (incr toxicity, alter potency, change effects)
  • Little reserve capacity to respond to anesthetic challenge
  • Alter normal physiology
  • Alter anesthetic management
  • Alter fluid requirements

Anesthesiology (12 decks)

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