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Anesthesia -Scott Newman & Janet King > Anesthesia Final Review: Janet > Flashcards

Anesthesia Final Review: Janet Flashcards

1
Q

What is the surgical fluid rate and how often do we record this on the anesthesia form?

A

10mls/kg/hr

every 15 min.

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2
Q

What is the hypotensive fluid rate?

A

3-5mls/kg as a bolus

or double surgery fluids (20ml/kg/hr) for 15min.

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3
Q

Rebreathing system requirement and steps

A

> 7kg

  1. attach Y tubing
  2. attach res. bag
  3. scavenge
  4. open pop-off
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4
Q

Non-rebreathing system requirement and steps

A

<7kg

  1. attach fresh gas to outlet port on vaporizer
  2. scavenge directly to scavenge system
  3. pop off open
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5
Q

O2 flow rates & minimum rate

A

> 7kg= 30ml/kg/min
<7kg=200ml/kg/min
Never less than 500mls/min

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6
Q

Equation for finding how much O2 you have in your tank

A

psi X 0.3= liters of O2

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7
Q

CO2 absorbing granules should be used no more than ____ or until they ____.

A

6-8hours

Turn blue/become brittle

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8
Q

2 Types of scavenge systems

A

Passive or Active

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9
Q

____ scavenges can be used for up to ____ or until weight gain of ____.

A

Passive
12 hours
50grams

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10
Q

Steps to pressure checking system.

A 
Set up rebreathing system
Cover Y tubing 
Close pop-off
Inflate res. bag 
Build pressure to 20cm H2O on manometer
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11
Q

When pressure checking the pressure manometer should not fall ____ in ____.

A

Should not fall more than 5 cm in 30 seconds

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12
Q

How to calculate res. bag size

A

60mls/kg (round up to next whole liter)

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13
Q

How do you measure for length of ET tube?

A

Tip of nose to thoracic inlet

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14
Q

When intubating cats, you may need what 2 things to help?

A

Lidocaine lube and stylet

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15
Q

Esophageal stethoscope is measured from ___ to ____

A

tip of nose to mid-sternum

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16
Q

The esophageal stethoscope measures ___ and should be recorded every ___.

A

HR, every 5 min.

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17
Q

Class 1 anesthetic risk

A

EXCELLENT
Elective procedure only
Normal healthy patient

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18
Q

Class 2 anesthetic risk

A 
GOOD
Brachy/sighthound
Slight to mild dz.
Well controlled dz. 
Simple fracture
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19
Q

Class 3 anesthetic risk

A 
FAIR 
Moderate systemic dz. 
1 or more controlled dz. 
Moderate dehydration/fever
Moderate fracture
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20
Q

Class 4 anesthetic risk

A

POOR
Surgery must be done to save life of patient
Severe systemic dz/dehyrdation/fever

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21
Q

Class 5 anesthetic risk

A

GUARDED
Close to death
Patient not expected to live with or without surgery

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22
Q

PA Physical exam should consist of what 6 values?

A 
T
P
R
Weight
MM/CRT
Body condition
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23
Q

What 2 PA physical exam values are important to know before surgery?

A

Temperature– fever may indicate infection and hypothermia pt. will not need as much GA

Weight– accuracy is important for doses

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24
Q

Why is patient history a good thing to have?

A

Duration of problem– sooner= better
Concurrent diseases– fix first
Anesthesia history– any previous issues?

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25
Q

Which 2 breeds are at a higher anesthetic risk?

A

Brachycephalics and sighthounds

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26
Q

An obese patient should be dosed based on their ____ and an anorexic patent should be dosed based on their ____.

A

Ideal weight

True weight

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27
Q

An aggressive patient would be at a higher risk due to ____.

A

Increased stress and inability to get PA info

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28
Q

What is the bare minimum PA lab work?

A

PCV & TP (red top tube)

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29
Q

What 4 things does a blood chemistry include?

A

GLU
BUN/Creat
ALT/Alk.Phos
TP

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30
Q

PCV diagnoses ____ and evaluates ___ and gives you____ status

A

Anemia
O2 carrying capacity
Hydration

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31
Q

TP gives you ____ status, ____, and ____.

A

Hydration status
Blood loss
Liver info

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32
Q

___ will always drop before ___.

A

TP drops before PCV

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33
Q

Name the anticholinergics

A

Atropine

Glycopyrrolate

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34
Q

Anticholinergics block function of ____ & the ____ nerve.

A

acetylcholine

vagus nerve

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35
Q

Main side effects of anticholinergics

A 
SLURED<3 
Decreased salivary secretions 
Decreased lacrimal secretions
Mydriasis in cats 
Increased heart rate
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36
Q

What is the MAIN reason for use of anticholinergics?

A

Prevent bradycardia

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37
Q 
Atropine Sulfate:
Brand name
Family
Duration
Common use
A 
Atropine
Anticholinergic
60-90min. 
Increases heart rate and prevents bradycardia 
Commonly used for emergency HR increaser
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38
Q 
Glycopyrrolate
Brand name
Family
Duration
Common use
A

Robinul-V
Anticholinergic
4 hours
Less likely to cause tachycardia

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39
Q

You should NOT use anticholinergics if your patient is ___.

A

Tachycardic
has CHF
Hyperthyroid

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40
Q

2 types of tranquilizers

A

Phenothiazine & Benzodiazepine

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41
Q

Phenothiazine tranquilizer:
Brand name
Side effects
Route

A

Acepromazine (Promace)

Vasodilation (decreased BP)
NOT reversible
PO,SQ,IM,IV

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42
Q

Acepromazine is most commonly used for its ____ properties, but it also prevents ____ and is a ____.

A

Calming/Relaxing
Vomiting
Antiarrythmic

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43
Q

Maximum dose = 3grams in ____.

A

Acepromazine

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44
Q

Acepromazine usually lasts ____ hours, but up to ___ in some.

A

4-8hours

24hours

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45
Q

Name the Benzodiazepine tranquilizers

A

Diazepam- Valium
Midazolam- Versed
Zolazepam- in Telazol

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46
Q

What is the Benzo tranquilizer reversal agent?

A

Flumazenil

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47
Q

Benzodiazepine tranquilizers are used for ___ but have no ____. They are also a ____ and appetite stimulant in cats.

A

Calming & antianxiety
Analgesia
Anticonvulsant

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48
Q

Diazepam is given ____ and is best as a _____.

A

(Benzodiazepine tranq) Valium
IV, slowly
Combo drug

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49
Q

Midazolam is ___ so it can be mixed with other drugs easily and its route is ____.

A

(Benzodiazepine tranq) Versed
Water soluble
IM or SQ

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50
Q

Zolazepam is combined with ____ in ____. It can be used as a sole agent for ____ procedures or ____.

A

(Benzodiazepine tranq)
Tiletamine in Telazol
Short
Induction agent

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51
Q

Which tranquilizers are not usually used alone due to possible excitement & minimal sedation?

A

Benzodiazepine tranquilizers

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52
Q

Name the 3 Alpha-2 agonists (sedatives)

A

Xylazine- Rompun
Medetomidine- Domitor
Dexmedetomidine- Dexdomitor

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53
Q

Alpha-2s (are/are not) controlled. They produce ____, _____, & _____. But they also cause ____ and ____ causing pale MM and decrease in temp.

A

are NOT controlled
Analgesia, sedation & muscle relaxation
Vomiting
Peripheral vasoconstriction

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54
Q

Xylazine is reversed with ____.

And is mainly used in ____ patients.

A

Alpha-2 (Rompun)
Yohimbine (Yobine)
Young, healthy patients

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55
Q

Medetomidine (____) is reversed with ____ and is dosed by ____.

A

Alpha-2 (Domitor)
Atipamezole (Antisedan)
Weight chart

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56
Q

Dexmedetomidine (____) is reversed with ____.

A

Alpha-2 (Dexdomitor)

Atipamezole (Antisedan)

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57
Q

____ are given BEFORE giving Alpha-2s to prevent adverse cardio effects

A

Anticholinergics

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58
Q

What are the most effect drugs for pain?

A

Opioids

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59
Q

What is the most common side effect of opioids?

A

Respiratory side effects
Vomiting
CNS depression

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60
Q

What are opioids reversed with?

A

Naloxone HCl (Narcan)

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61
Q

Morphine is a ____ and has a ___ duration.

Given ____ only.

A

(Duramorph)
Pure agonist opioid
4 hour duration (4+ in cats)
IM/SQ

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62
Q

Hydromorphone is a ____ opioid and has a ____ duration. It is also less likely to cause ____.

A

(Dilaudid)
Pure agonist opioid
4 hour duration
Vomiting

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63
Q

Oxymorphone is a ____ opioid, has a ____ duration, and is more expensive.

A

(Numorphan)
Pure agonist opioid
3-4 hour

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64
Q

Fentanyl has a ____ duration and is a ____ opioid.

A

30min.

Pure agonist opioid

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65
Q

Fentanyl & Fentanyl patch brand name

A

Sublimaze

Duragesic

66
Q

Butorphanol is a ____ opioid and provides some ____ and analgesia. It has a ____ duration.

A

(Torbugesic)
Mixed opioid
some sedation
1-4 hour duration

67
Q

Buprenorphine is a ____ ____ opioid and provides analgesia for ____ pain. Has a ____ duration and can be given ____ in cats

A

Partial agonist opioid
mild-moderate
6-8 hour
OTM

68
Q

What are some common PA neuroleptoanalgesics

A

Acepromazine & Butorphanol
Diazepam & Hydromorphone
Versed & Fentanyl

69
Q

What are 2 types of barbiturates and their main use?

A

Phenobarbitol- anticonvulsant

Pentobarbitol- euthanasia agent

70
Q

Cyclohexamines (are/are not) controlled and (are/are not) reversible.

A

ARE controlled

ARE NOT reversible

71
Q

Cyclohexamines mode of action?

A

CNS stimulation (disrupts/scrambles nervous system pathways)

72
Q

What are some side effects of cyclohexamines?

A

Lowers seizure threshold
Increased sensitivity to sound/light
Hallucinations during recovery
Tachycardia and increased BP

73
Q

____ have the side effect of apneustic respirations & Propofol a side effect of ____ respirations.

A

Cyclohexamines

Transient apneustic

74
Q

What are the 4 benefits of ET intubation

A

Establish airway
Prevents aspiration
IPPV
Decrease gas exposure to personnel

75
Q

What does ET ID mean?

A

ET internal diameter– measured in mm

76
Q

What are some possible complications with over-inflation of the ET tube cuff?

A

Compression of the lumen
Pressure necrosis
Tearing/rupture of the trachea

77
Q

What are some tools to assist with intubation?

A

Stylet (felines)
Lidocaine on vocal folds (felines)
Laryngoscope

78
Q

What are 3 reasons why Benzodiazepines & Cyclohexamines are a good combo drug?

A

Cyclohexamines & Benzodiazepines

  1. Decreased seizure thresh.– Benzos are an anticonvusant
  2. Rough recovery– Smoother with Benzo
  3. Catalepsy– muscle relaxaion from Benzos
79
Q

Cyclohexamines cause an ___ in heart rate so ____ should be used instead of ____.

A

Increase
Glyco instead of Atropine
(milder on heart)

80
Q

Cyclohexamines have what effect on the eyes?

A

Nystagmus in cats

Open, dilated & central

81
Q

How are cyclohexamines metabolized?

A 
Dogs= liver 
Cats= excreted by kidneys
82
Q

What is the most common induction agent used?

A

Ketamine

83
Q

IV vs. IM ketamine

A

IV= faster onset and recovery, decreased dose, no tissue irritation

IM= longer duration, common in fractious/wild animals

84
Q

Duration of IV & IM ketamine

A 
IV= 3-10 min. 
IM= Dog: 20-30  Cat:30-60min.
85
Q

Ketamine-Diazepam should be given ____ only because ____ is not water soluble.

A

IV

Diazepam

86
Q

Tiletamine is a newer ____ found in ____.

A

dissociative

Telazol

87
Q

Propofol is a common ____ _____ and can be used as sole agent for short procedure.

A

IV induction agent

88
Q

Propofol:
Controlled?
Analgesia?
Reversible?

A

NO
NO
& NO
(but is metabolized quickly)

89
Q

What is the main cardiovascular effect of Propofol & how can this be minimized?

A

Hypotension immediately after injection– Vasodilation

Give IV fluids to minimize

90
Q

When giving Propofol you should pre-oxygenate due to the ____.

A

transient apnea

91
Q

Duration & complete recovery time of Propofol

A

Duration= 5-10min.

Complete recovery= 20-30min.

92
Q

Etomidate has ___ analgesia & (is/is not) controlled

A

NO

NOT CONTROLLED

93
Q

What is the best choice induction agent for high risk patients?

A

Etomidate

94
Q

Etomidate is given ___ and may cause ____.

A

IV

pain/irritation– give with fluids

95
Q

What is GGE & who is it commonly used in?

A

Guaifenesin

Muscle relaxant in large animals

96
Q

What can be used in sick/debilitated patients as an induction agent that CAN NOT be used as induction in normal healthy patients?

A

Neuroleptanalgesics

97
Q

Color for ISO & SEVO

A 
Iso= Purple
Sevo= Yellow
98
Q

3 Physical properties of inhalant anesthetics

A

Vapor pressure
Solubility
MAC value

99
Q

Vapor pressure measures what?

A

The tendency of anesthetic to go from liquid to gas

100
Q

High vapor pressure want to ____.

A

Be a gas

Evaporate easily

101
Q

Solubility provides info on ____.

A

Speed of induction, depth change, and recovery

102
Q

Low solubility = ____ gas

High solubility = ____ gas.

A 
Low= fast
High= slow
103
Q

List the gases from low solubility to high solubility

A

Sevoflurane-fastest
Iso
Halo
Methoxyflurane-slowest

104
Q

Inhalants with low solubility allow for ___ in stages/planes of anesthesia & ____ recovery.

A

Quick changes

rapid

105
Q

What does MAC stand for?

A

Minimum Alveolar Concentration

106
Q

What is MAC?

A

The minimum alveolar concentration of a gas that produces no response to surgical stimulation in 50% of patients

107
Q

MAC gives an indication of ____

A

Potency

108
Q

The higher the MAC, the ___ the gas.

A

Less potent

109
Q

List the gases from low to high MAC

A

Methoxyflurane- most potent
Halothane
Isoflurane
Sevoflurane- least potent

110
Q

Halothane has ____ vapor pressure

A

High

111
Q

Isoflurane has ____ vapor pressure & ___ solubility

A

High vapor pressure

Low solubility

112
Q

Isoflurane has rapid ____ & ____.

A

Changes in depth & rapid recovery

113
Q

Induction & maintenance % Iso & Sevo

A 
Iso= induction-2.5% maint-1.5-2.5%
Sevo= induction-4% maint-2.5-4%
114
Q

Effects of Iso

A

Cardiovascular depression
Respiratory depression
0.2% metabolized by liver
Excellent muscle relaxation

115
Q

Effects of Sevo

A

3% metabolized
Cardiovascular depression
Respiratory depression
Moderate muscle relaxation

116
Q

Sevo vapor pressure, solubility, & MAC

A

High vapor pressure
Lowest solubility (fastest gas)
Highest MAC– least potent higher vaporizer settings

117
Q

Sevo has less ____ than Iso

A

pungent odor

118
Q

What is the main benefit of induction chambers?

A

Little physical restraint

119
Q

Route of PA drugs

A

IM or SQ

120
Q

Induction agents are given ____ and this is to ____

A

to effect

have the ability to intubate patient

121
Q

List how you would hook up patient after intubating

A

Turn on oxygen
Attach breathing system to ET tube
Watch for respirations
Once patient is breathing, turn on gas

122
Q

After hooking up patient to the anesthesia machine what are the following steps?

A 
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
123
Q

What 5 vitals are recorded every 5 min?

A 
Heart Rate
Resp. Rate
Blood Pressure
O2 saturation 
ETCO2
124
Q

What 2 things are recorded every 15min?

A

Fluids

Temperature

125
Q

What should ALWAYS be monitored during anesthesia?

A

CRT/MM color
Palpebral
Eye placement
Jaw tone etc…

126
Q

A ___ is used to monitor electrical activity of the heart

A

ECG

127
Q

You should ventilate at least once every ____ during anesthesia to prevent what 2 things?

A

5 min.

Atelectasis & hypercapnia

128
Q

How do you ventilate a patient?

A 
Close pop off
Squeeze res bag 
Watch manometer & never exceed 20cmH2O 
or until you feel resistance
Open pop off
129
Q

Heart rate under anesthesia usually ranges between ____rpm

A

60-120bpm

130
Q

What are some causes of tachycardia

A 
Too light-- increase gas
Pain-- opioids 
Sx stimulation 
Hypoxia 
Hypotension 
Anemia 
Hypovolemia 
Cardiac Dz.
131
Q

Bradycardia values under anesthesia

A

Large dog= <100bpm

132
Q

Causes of bradycardia

A 
Too deep-- decrease gas 
Drugs-- reversal 
Vagal stimulation-- Atropine
Hypothermia 
Hyperkalemia
133
Q

2 reasons for prolonged CRT or pale MM

A
  1. Peripheral vasoconstriction
    • alpha-2s
    • hypothermia
    • pain
  2. Decreased tissue vasoconstriction
    • Too deep
    • Hypotension
    • Bradycardia
    • Heart failure
134
Q

Cyanosis = _____.

What is the intervention?

A

Hypoxia
Check RR
Check ET tube placement/plugs/kinks
Increase ventilations & maybe flow rate

135
Q

Respiratory rates usually range between ____ under anesthesia

A

8-30rpm

136
Q

Hypoventilation = decreased ____ & ____

A

RR & Tidal volume

137
Q

Causes of hypoventilation

A

Too deep
Obese patient
Tilted table
–Increase ventilations for all–may need to decrease gas

138
Q

Hyperventilation = ____.

Causes

A 
Increased RR
Too light-- increase gas 
Surgical stimulation
Pain-- analgesics 
Hypercapnia
139
Q

What is the most common causes of arrhythmias?

A

Hypoxia

Increase ventilations and turn down gas

140
Q

What are some signs that your patient is too light?

A 
Increased HR, RR, BP
Patient movement 
Palpebral
Eyes central
Tight jaw tone
141
Q

What should you do if your patient starts waking up?

A

Turn up vaporizer and ventilate & or give more induction IV drug

142
Q

What are some signs that your patient is too deep?

A 
Shallow respirations <8rpm 
Pale/cyanotic MM 
Increased CRT 
Bradycardia 
Weak/absent pulse
Hypotension 
All reflexes absent 
Slack muscle tone
143
Q

Doppler measures

A

Systolic BP and Pulse

144
Q

Oscillometric measures

A

Systolic, Diastolic, & MAP

145
Q

Normal systolic=
Normal diastolic=
Normal MAP=

A 
Systolic= 100-160mmHg
Diastolic= 60-100mmHg
MAP= 80-120mmHg
146
Q

Hypotensive systolic=

Hypotensive MAP=

A

Systolic= <60mmHg

147
Q

Causes of hypotension

A

Too deep– decrease gas
Drugs (vasodilation) –increase fluids
Blood loss– Dopamine, Dobutamine, Ephedrine

148
Q

Capnograph measures

A

ETCO2
Insp.CO2
RR

149
Q

ETCO2 should range between ____

InspCO2 should range between ____

A

35-45mmHg

0-5mmHg

150
Q

Decreased ETCO2 causes

A

Hyperventilation– increase depth or give more induction drug
Tube in esophagus– fix it!
Cardiopulmonary/Resp. arrest– ventilate/CPR

151
Q

Increased ETCO2 causes are usually due to ____. so you should ____.

A

respiratory depression causing hypoventilation

INCREASE VENTILATIONS!

152
Q

Increased ETCO2 can lead to ____.

Decreased ETCO2 can lead to ____.

A

Respiratory alkalosis

Respiratory acidosis

153
Q

If you have a increased InspCO2 you should ____

A

Check for expired soda lime granules (RB)

Increase O2 flow rate (NRB)

154
Q

Pulse Ox measures

A

O2 saturation of Hgb (% of Hgb saturated with O2)

Pulse

155
Q

Pulse Ox values should be around ____ under anesthesia because ____.

A

98-100%

They are breathing 100% oxygen

156
Q

Borderline hypoxia =

Cyanosis becomes apparent when O2 sat fall below __.

A

90-95%

Cyanosis apparent <85%

157
Q

Causes of decreased O2 sats.

A 
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!

158
Q

During the maintenance phase, monitor as many parameters as possible and turn down gas percents in ____ when at a good anesthetic level.

A

0.5% increments

159
Q

What could be wrong if your patient is not staying anesthetized?

A

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)

160
Q

End of procedure steps:

A

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

161
Q

What is closely monitored during recovery?

A

Temperature
MM color/CRT
Pulse
RR

Anesthesia -Scott Newman & Janet King (13 decks)

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