Anesthesia Final Review: Janet Flashcards
What is the surgical fluid rate and how often do we record this on the anesthesia form?
10mls/kg/hr
every 15 min.
What is the hypotensive fluid rate?
3-5mls/kg as a bolus
or double surgery fluids (20ml/kg/hr) for 15min.
Rebreathing system requirement and steps
> 7kg
- attach Y tubing
- attach res. bag
- scavenge
- open pop-off
Non-rebreathing system requirement and steps
<7kg
- attach fresh gas to outlet port on vaporizer
- scavenge directly to scavenge system
- pop off open
O2 flow rates & minimum rate
> 7kg= 30ml/kg/min
<7kg=200ml/kg/min
Never less than 500mls/min
Equation for finding how much O2 you have in your tank
psi X 0.3= liters of O2
CO2 absorbing granules should be used no more than ____ or until they ____.
6-8hours
Turn blue/become brittle
2 Types of scavenge systems
Passive or Active
____ scavenges can be used for up to ____ or until weight gain of ____.
Passive
12 hours
50grams
Steps to pressure checking system.
Set up rebreathing system Cover Y tubing Close pop-off Inflate res. bag Build pressure to 20cm H2O on manometer
When pressure checking the pressure manometer should not fall ____ in ____.
Should not fall more than 5 cm in 30 seconds
How to calculate res. bag size
60mls/kg (round up to next whole liter)
How do you measure for length of ET tube?
Tip of nose to thoracic inlet
When intubating cats, you may need what 2 things to help?
Lidocaine lube and stylet
Esophageal stethoscope is measured from ___ to ____
tip of nose to mid-sternum
The esophageal stethoscope measures ___ and should be recorded every ___.
HR, every 5 min.
Class 1 anesthetic risk
EXCELLENT
Elective procedure only
Normal healthy patient
Class 2 anesthetic risk
GOOD Brachy/sighthound Slight to mild dz. Well controlled dz. Simple fracture
Class 3 anesthetic risk
FAIR Moderate systemic dz. 1 or more controlled dz. Moderate dehydration/fever Moderate fracture
Class 4 anesthetic risk
POOR
Surgery must be done to save life of patient
Severe systemic dz/dehyrdation/fever
Class 5 anesthetic risk
GUARDED
Close to death
Patient not expected to live with or without surgery
PA Physical exam should consist of what 6 values?
T P R Weight MM/CRT Body condition
What 2 PA physical exam values are important to know before surgery?
Temperature– fever may indicate infection and hypothermia pt. will not need as much GA
Weight– accuracy is important for doses
Why is patient history a good thing to have?
Duration of problem– sooner= better
Concurrent diseases– fix first
Anesthesia history– any previous issues?
Which 2 breeds are at a higher anesthetic risk?
Brachycephalics and sighthounds
An obese patient should be dosed based on their ____ and an anorexic patent should be dosed based on their ____.
Ideal weight
True weight
An aggressive patient would be at a higher risk due to ____.
Increased stress and inability to get PA info
What is the bare minimum PA lab work?
PCV & TP (red top tube)
What 4 things does a blood chemistry include?
GLU
BUN/Creat
ALT/Alk.Phos
TP
PCV diagnoses ____ and evaluates ___ and gives you____ status
Anemia
O2 carrying capacity
Hydration
TP gives you ____ status, ____, and ____.
Hydration status
Blood loss
Liver info
___ will always drop before ___.
TP drops before PCV
Name the anticholinergics
Atropine
Glycopyrrolate
Anticholinergics block function of ____ & the ____ nerve.
acetylcholine
vagus nerve
Main side effects of anticholinergics
SLURED<3 Decreased salivary secretions Decreased lacrimal secretions Mydriasis in cats Increased heart rate
What is the MAIN reason for use of anticholinergics?
Prevent bradycardia
Atropine Sulfate: Brand name Family Duration Common use
Atropine Anticholinergic 60-90min. Increases heart rate and prevents bradycardia Commonly used for emergency HR increaser
Glycopyrrolate Brand name Family Duration Common use
Robinul-V
Anticholinergic
4 hours
Less likely to cause tachycardia
You should NOT use anticholinergics if your patient is ___.
Tachycardic
has CHF
Hyperthyroid
2 types of tranquilizers
Phenothiazine & Benzodiazepine
Phenothiazine tranquilizer:
Brand name
Side effects
Route
Acepromazine (Promace)
Vasodilation (decreased BP)
NOT reversible
PO,SQ,IM,IV
Acepromazine is most commonly used for its ____ properties, but it also prevents ____ and is a ____.
Calming/Relaxing
Vomiting
Antiarrythmic
Maximum dose = 3grams in ____.
Acepromazine
Acepromazine usually lasts ____ hours, but up to ___ in some.
4-8hours
24hours
Name the Benzodiazepine tranquilizers
Diazepam- Valium
Midazolam- Versed
Zolazepam- in Telazol
What is the Benzo tranquilizer reversal agent?
Flumazenil
Benzodiazepine tranquilizers are used for ___ but have no ____. They are also a ____ and appetite stimulant in cats.
Calming & antianxiety
Analgesia
Anticonvulsant
Diazepam is given ____ and is best as a _____.
(Benzodiazepine tranq) Valium
IV, slowly
Combo drug
Midazolam is ___ so it can be mixed with other drugs easily and its route is ____.
(Benzodiazepine tranq) Versed
Water soluble
IM or SQ
Zolazepam is combined with ____ in ____. It can be used as a sole agent for ____ procedures or ____.
(Benzodiazepine tranq)
Tiletamine in Telazol
Short
Induction agent
Which tranquilizers are not usually used alone due to possible excitement & minimal sedation?
Benzodiazepine tranquilizers
Name the 3 Alpha-2 agonists (sedatives)
Xylazine- Rompun
Medetomidine- Domitor
Dexmedetomidine- Dexdomitor
Alpha-2s (are/are not) controlled. They produce ____, _____, & _____. But they also cause ____ and ____ causing pale MM and decrease in temp.
are NOT controlled
Analgesia, sedation & muscle relaxation
Vomiting
Peripheral vasoconstriction
Xylazine is reversed with ____.
And is mainly used in ____ patients.
Alpha-2 (Rompun)
Yohimbine (Yobine)
Young, healthy patients
Medetomidine (____) is reversed with ____ and is dosed by ____.
Alpha-2 (Domitor)
Atipamezole (Antisedan)
Weight chart
Dexmedetomidine (____) is reversed with ____.
Alpha-2 (Dexdomitor)
Atipamezole (Antisedan)
____ are given BEFORE giving Alpha-2s to prevent adverse cardio effects
Anticholinergics
What are the most effect drugs for pain?
Opioids
What is the most common side effect of opioids?
Respiratory side effects
Vomiting
CNS depression
What are opioids reversed with?
Naloxone HCl (Narcan)
Morphine is a ____ and has a ___ duration.
Given ____ only.
(Duramorph)
Pure agonist opioid
4 hour duration (4+ in cats)
IM/SQ
Hydromorphone is a ____ opioid and has a ____ duration. It is also less likely to cause ____.
(Dilaudid)
Pure agonist opioid
4 hour duration
Vomiting
Oxymorphone is a ____ opioid, has a ____ duration, and is more expensive.
(Numorphan)
Pure agonist opioid
3-4 hour
Fentanyl has a ____ duration and is a ____ opioid.
30min.
Pure agonist opioid
Fentanyl & Fentanyl patch brand name
Sublimaze
Duragesic
Butorphanol is a ____ opioid and provides some ____ and analgesia. It has a ____ duration.
(Torbugesic)
Mixed opioid
some sedation
1-4 hour duration
Buprenorphine is a ____ ____ opioid and provides analgesia for ____ pain. Has a ____ duration and can be given ____ in cats
Partial agonist opioid
mild-moderate
6-8 hour
OTM
What are some common PA neuroleptoanalgesics
Acepromazine & Butorphanol
Diazepam & Hydromorphone
Versed & Fentanyl
What are 2 types of barbiturates and their main use?
Phenobarbitol- anticonvulsant
Pentobarbitol- euthanasia agent
Cyclohexamines (are/are not) controlled and (are/are not) reversible.
ARE controlled
ARE NOT reversible
Cyclohexamines mode of action?
CNS stimulation (disrupts/scrambles nervous system pathways)
What are some side effects of cyclohexamines?
Lowers seizure threshold
Increased sensitivity to sound/light
Hallucinations during recovery
Tachycardia and increased BP
____ have the side effect of apneustic respirations & Propofol a side effect of ____ respirations.
Cyclohexamines
Transient apneustic
What are the 4 benefits of ET intubation
Establish airway
Prevents aspiration
IPPV
Decrease gas exposure to personnel
What does ET ID mean?
ET internal diameter– measured in mm
What are some possible complications with over-inflation of the ET tube cuff?
Compression of the lumen
Pressure necrosis
Tearing/rupture of the trachea
What are some tools to assist with intubation?
Stylet (felines)
Lidocaine on vocal folds (felines)
Laryngoscope
What are 3 reasons why Benzodiazepines & Cyclohexamines are a good combo drug?
Cyclohexamines & Benzodiazepines
- Decreased seizure thresh.– Benzos are an anticonvusant
- Rough recovery– Smoother with Benzo
- Catalepsy– muscle relaxaion from Benzos
Cyclohexamines cause an ___ in heart rate so ____ should be used instead of ____.
Increase
Glyco instead of Atropine
(milder on heart)
Cyclohexamines have what effect on the eyes?
Nystagmus in cats
Open, dilated & central
How are cyclohexamines metabolized?
Dogs= liver Cats= excreted by kidneys
What is the most common induction agent used?
Ketamine
IV vs. IM ketamine
IV= faster onset and recovery, decreased dose, no tissue irritation
IM= longer duration, common in fractious/wild animals
Duration of IV & IM ketamine
IV= 3-10 min. IM= Dog: 20-30 Cat:30-60min.
Ketamine-Diazepam should be given ____ only because ____ is not water soluble.
IV
Diazepam
Tiletamine is a newer ____ found in ____.
dissociative
Telazol
Propofol is a common ____ _____ and can be used as sole agent for short procedure.
IV induction agent
Propofol:
Controlled?
Analgesia?
Reversible?
NO
NO
& NO
(but is metabolized quickly)
What is the main cardiovascular effect of Propofol & how can this be minimized?
Hypotension immediately after injection– Vasodilation
Give IV fluids to minimize
When giving Propofol you should pre-oxygenate due to the ____.
transient apnea
Duration & complete recovery time of Propofol
Duration= 5-10min.
Complete recovery= 20-30min.
Etomidate has ___ analgesia & (is/is not) controlled
NO
NOT CONTROLLED
What is the best choice induction agent for high risk patients?
Etomidate
Etomidate is given ___ and may cause ____.
IV
pain/irritation– give with fluids
What is GGE & who is it commonly used in?
Guaifenesin
Muscle relaxant in large animals
What can be used in sick/debilitated patients as an induction agent that CAN NOT be used as induction in normal healthy patients?
Neuroleptanalgesics
Color for ISO & SEVO
Iso= Purple Sevo= Yellow
3 Physical properties of inhalant anesthetics
Vapor pressure
Solubility
MAC value
Vapor pressure measures what?
The tendency of anesthetic to go from liquid to gas
High vapor pressure want to ____.
Be a gas
Evaporate easily
Solubility provides info on ____.
Speed of induction, depth change, and recovery
Low solubility = ____ gas
High solubility = ____ gas.
Low= fast High= slow
List the gases from low solubility to high solubility
Sevoflurane-fastest
Iso
Halo
Methoxyflurane-slowest
Inhalants with low solubility allow for ___ in stages/planes of anesthesia & ____ recovery.
Quick changes
rapid
What does MAC stand for?
Minimum Alveolar Concentration
What is MAC?
The minimum alveolar concentration of a gas that produces no response to surgical stimulation in 50% of patients
MAC gives an indication of ____
Potency
The higher the MAC, the ___ the gas.
Less potent
List the gases from low to high MAC
Methoxyflurane- most potent
Halothane
Isoflurane
Sevoflurane- least potent
Halothane has ____ vapor pressure
High
Isoflurane has ____ vapor pressure & ___ solubility
High vapor pressure
Low solubility
Isoflurane has rapid ____ & ____.
Changes in depth & rapid recovery
Induction & maintenance % Iso & Sevo
Iso= induction-2.5% maint-1.5-2.5% Sevo= induction-4% maint-2.5-4%
Effects of Iso
Cardiovascular depression
Respiratory depression
0.2% metabolized by liver
Excellent muscle relaxation
Effects of Sevo
3% metabolized
Cardiovascular depression
Respiratory depression
Moderate muscle relaxation
Sevo vapor pressure, solubility, & MAC
High vapor pressure
Lowest solubility (fastest gas)
Highest MAC– least potent higher vaporizer settings
Sevo has less ____ than Iso
pungent odor
What is the main benefit of induction chambers?
Little physical restraint
Route of PA drugs
IM or SQ
Induction agents are given ____ and this is to ____
to effect
have the ability to intubate patient
List how you would hook up patient after intubating
Turn on oxygen
Attach breathing system to ET tube
Watch for respirations
Once patient is breathing, turn on gas
After hooking up patient to the anesthesia machine what are the following steps?
Pass esophageal stethoscope & obtain HR Watch res. bag and obtain RR (record on anesthesia for every 5min.) Ventilate & listen for leaky ET tube Inflate cuff if necessary Lube eyes & record as comment on anesthesia form
What 5 vitals are recorded every 5 min?
Heart Rate Resp. Rate Blood Pressure O2 saturation ETCO2
What 2 things are recorded every 15min?
Fluids
Temperature
What should ALWAYS be monitored during anesthesia?
CRT/MM color
Palpebral
Eye placement
Jaw tone etc…
A ___ is used to monitor electrical activity of the heart
ECG
You should ventilate at least once every ____ during anesthesia to prevent what 2 things?
5 min.
Atelectasis & hypercapnia
How do you ventilate a patient?
Close pop off Squeeze res bag Watch manometer & never exceed 20cmH2O or until you feel resistance Open pop off
Heart rate under anesthesia usually ranges between ____rpm
60-120bpm
What are some causes of tachycardia
Too light-- increase gas Pain-- opioids Sx stimulation Hypoxia Hypotension Anemia Hypovolemia Cardiac Dz.
Bradycardia values under anesthesia
Large dog= <100bpm
Causes of bradycardia
Too deep-- decrease gas Drugs-- reversal Vagal stimulation-- Atropine Hypothermia Hyperkalemia
2 reasons for prolonged CRT or pale MM
- Peripheral vasoconstriction
- alpha-2s
- hypothermia
- pain
- Decreased tissue vasoconstriction
- Too deep
- Hypotension
- Bradycardia
- Heart failure
Cyanosis = _____.
What is the intervention?
Hypoxia
Check RR
Check ET tube placement/plugs/kinks
Increase ventilations & maybe flow rate
Respiratory rates usually range between ____ under anesthesia
8-30rpm
Hypoventilation = decreased ____ & ____
RR & Tidal volume
Causes of hypoventilation
Too deep
Obese patient
Tilted table
–Increase ventilations for all–may need to decrease gas
Hyperventilation = ____.
Causes
Increased RR Too light-- increase gas Surgical stimulation Pain-- analgesics Hypercapnia
What is the most common causes of arrhythmias?
Hypoxia
Increase ventilations and turn down gas
What are some signs that your patient is too light?
Increased HR, RR, BP Patient movement Palpebral Eyes central Tight jaw tone
What should you do if your patient starts waking up?
Turn up vaporizer and ventilate & or give more induction IV drug
What are some signs that your patient is too deep?
Shallow respirations <8rpm Pale/cyanotic MM Increased CRT Bradycardia Weak/absent pulse Hypotension All reflexes absent Slack muscle tone
Doppler measures
Systolic BP and Pulse
Oscillometric measures
Systolic, Diastolic, & MAP
Normal systolic=
Normal diastolic=
Normal MAP=
Systolic= 100-160mmHg Diastolic= 60-100mmHg MAP= 80-120mmHg
Hypotensive systolic=
Hypotensive MAP=
Systolic= <60mmHg
Causes of hypotension
Too deep– decrease gas
Drugs (vasodilation) –increase fluids
Blood loss– Dopamine, Dobutamine, Ephedrine
Capnograph measures
ETCO2
Insp.CO2
RR
ETCO2 should range between ____
InspCO2 should range between ____
35-45mmHg
0-5mmHg
Decreased ETCO2 causes
Hyperventilation– increase depth or give more induction drug
Tube in esophagus– fix it!
Cardiopulmonary/Resp. arrest– ventilate/CPR
Increased ETCO2 causes are usually due to ____. so you should ____.
respiratory depression causing hypoventilation
INCREASE VENTILATIONS!
Increased ETCO2 can lead to ____.
Decreased ETCO2 can lead to ____.
Respiratory alkalosis
Respiratory acidosis
If you have a increased InspCO2 you should ____
Check for expired soda lime granules (RB)
Increase O2 flow rate (NRB)
Pulse Ox measures
O2 saturation of Hgb (% of Hgb saturated with O2)
Pulse
Pulse Ox values should be around ____ under anesthesia because ____.
98-100%
They are breathing 100% oxygen
Borderline hypoxia =
Cyanosis becomes apparent when O2 sat fall below __.
90-95%
Cyanosis apparent <85%
Causes of decreased O2 sats.
Probe problems Peripheral vasoconstriction ET tube placement/plug/kinked O2 tank empty O2 flow rate too low Bradycardia VQ mismatch
Intervention= GET OXYGEN TO PATIENT!
During the maintenance phase, monitor as many parameters as possible and turn down gas percents in ____ when at a good anesthetic level.
0.5% increments
What could be wrong if your patient is not staying anesthetized?
ET tube not in trachea
Cuff may need to be inflated (gas can leak around)
Oxygen may be off or rate not high enough to carry gas
Vaporizer may need more liquid
Machine may be hooked up wrong
O2 flush valve being used too often (delivering 100% Oxygen)
End of procedure steps:
Turn off vaporizer
Try to allow patient to breathe 100% O2 for up to 5min.
Disconnect patient from machine
Turn off oxygen
Be ready to deflate cuff on ET tube
Extubate after 2 good, successive swallows
Continue to monitor during recovery
What is closely monitored during recovery?
Temperature
MM color/CRT
Pulse
RR