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Anesthesia & Analgesia > Anesthesia of the Dog & Cat > Flashcards

Anesthesia of the Dog & Cat Flashcards

1
Q

What are the 5 steps of anesthesia?

A
  1. pre-anesthetic evaluation & patient preparation
  2. pre-anesthetic medication
  3. anesthetic induction
  4. maintenance & monitoring
  5. recovery
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2
Q

What does patient assessment entail?

A
  • full physical exam
  • medical history
  • basic hematology
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3
Q

What should you take into consideration in a full physical exam while assessing a patient for anesthesia?

A
  • age
  • temperament (pre-hospital: gabapentin, trazadone…)
  • breed (brachycephalic, greyhounds…)
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4
Q

What should you take into consideration in a medical history while assessing a patient for anesthesia?

A
  • past problems, previous adverse drug responses
  • anesthetic events
  • present problems - medication
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5
Q

What should you take into consideration in basic hematology while assessing a patient for anesthesia?

A

PCV, TP, BUN, Gluc

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6
Q

What assessment & diagnostic tests should you do when assessing an older/sick patient for anesthesia?

A
  • CBC, serum chemistry, u/a advisable (in older or ill patients or on the basis of the physical exam & history)
  • radiograph thorax (trauma, respiratory problems)
  • ECG, echocardiography (murmurs, arrhythmias)
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7
Q

With older or sick patients when should you delay anesthesia until?

A
  • further assessment is performed
  • patient is stabilized
  • anesthetic risk is established
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8
Q

What should you communicate to a client prior to anesthesia?

A
  • anesthetic risk
  • set expectations
  • patient preparation starts at home
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9
Q

What are prehospital anxiety drugs & how are they given?

A
  • trazadone & gabapentin
  • PO, 2 hours prior to drop off
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10
Q

What are the categories in the ASA physical status classification?

A
  • ASA 1: normal healthy patient
  • ASA 2: mild systemic disease - no functional limitations
  • ASA 3: severe systemic disease - definite functional limitation
  • ASA 4: severe systemic disease that is a constant threat to life
  • ASA 5: moribund, not expected to survive w/o operation
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11
Q

What are the rules for food & water prior to anesthesia?

A
  • allow free access to water (esp in older animals & those w/ increased fluid requirements)
  • recommend fasting before anesthesia (young animals require shorter fasting times - hypoglycemia; 6-16 wks: 4 hrs; older than 16 wks: 6-8 hrs)
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12
Q

What information is important for anesthesia protocol?

A
  • physical exam
  • age
  • temperament
  • surgical procedure
  • clinical setting
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13
Q

What 4 types of drugs should be included in an anesthetic protocol?

A
  • premed: sedative + opioid
  • induction
  • maintenance: inhalant +/- opioid +/- local anesthetic
  • post operative pain management: NSAID, opioid
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14
Q

What are the aims of premedication?

A
  • sedation & anxiolysis (fear free)
  • facilitate animal handling
  • balanced anesthetic technique
  • analgesia
  • smooth & quiet recovery
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15
Q

What can you use for a premedication?

A

Opioid (hydromorphone, methadone, butorphanol, buprenorphine) + sedative (acepromazine, dexmedetomidine, midazolam) +/- anticholinergic (atropine, glycopyrrolate)
- do not co-administer an anticholinergic w/ dexmedetomidine

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16
Q

What is the premedication protocol for calm dogs (ASA 1-2)?

A
  • Acepromazine + hydromorphone
    OR
  • dexmedetomidine + hydromorphone
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17
Q

What is the premedication protocol for excited, agitated dogs (ASA 1-2)?

A
  • acepromazine + dexmedetomidine + hydromorphone
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18
Q

What is the premedication protocol for aggressive dogs (ASA 1-2)?

A
  • acepromazine + dexmedetomidine + hydromorphone + ketamine
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19
Q

What is the premedication protocol for cats (ASA 1-2)?

A

dexmedetomidine + hydromorphone

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20
Q

What do you use for the heavy sedation of cats?

A
  1. Kitty magic (Dexmedetomidine + ketamine + butorphanol (opioid))
  2. dexmedetomidine + midazolam + butorphanol
  3. alfaxalone + butorphanol + midazolam
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21
Q

What should you remember about heavy sedation (kitty magic) of cats?

A
  • for more reliable sedation used a ketamine-based protocol
  • provides general anesthesia for invasive short procedures
  • monitor patient!
  • provide life support
22
Q

Karl, 6 m male DSH was given Midazolam, Butorphanol, Isoflurane as needed, & lidocaine intra-testicular block for castration. What is wrong here?

A
  • midazolam can cause excitement in young, healthy animals
  • on these meds Karl is excited, hyperactive, & unrestrainable
23
Q

young cat given midazolam + butorphanol causing excitement & o will be back in 2 hours to pick him up, which drug can we use to sedate him? a) reverse midazolam w/ flumazenil b) dexmedetomidine c) ketamine d) alfaxalone e) acepromazine ?

A

topped up w/ dexmedetomidine & then place catheter to proceed w/ induction

a) will get rid of side effect but he will not be sedated enough to perform neuter
c) would need high dose of ketamine to override midazolam & this is heavy sedation for such a quick procedure
d) again would need a higher dose
e) not a great sedative in cats & takes 1/2 hr to work

24
Q

What is on the pre-induction part of the anesthetic safety checklist?

A
  • patient NAME, owner CONSENT & PROCEDURE confirmed
  • IV CANNULA placed & patent
  • AIRWAY EQUIPMENT available & functioning
  • ET CUFFS checked
  • ANESTHETIC MACHINE checked today
  • adequate OXYGEN for proposed procedure
  • BREATHING SYSTEM connected, leak free, & APL VALVE OPEN
  • person assigned to MONITOR patient
  • RISKS identified & COMMUNICATED
  • EMERGENCY INTERVENTIONS available
25
Q

What is on the pre-procedure - time out part of the anesthetic safety checklist?

A
  • patient NAME & PROCEDURE confirmed
  • DEPTH of anesthesia appropriate
  • SAFETY CONCERNS COMMUNICATED
26
Q

What is on the recovery part of the anesthetic safety checklist?

A
  • SAFETY CONCERNS COMMUNICATED (airway, breathing, circulation (fluid balance), body temperature, & pain)
  • ASSESSMENT & INTERVENTION PLAN confirmed
  • ANALGESIC PLAN confirmed
  • person assigned to MONITOR patient
27
Q

What is included in the equipment check prior to anesthetic induction?

A
  • ensure ET tubes/intubation aids are readily available
  • monitoring equipment
  • anesthesia machine (select appropriate breathing system, perform leak test, check: oxygen, inhalant, CO2 absorbent, waste scavenging)
28
Q

How do you prepare a patient for anesthetic induction?

A
  • venous access - catheter placement
  • stabilize hemodynamically instable patients
  • check HR, pulse quality, & respiratory rate
  • connect monitoring equipment (appropriate for disease condition)
  • pre-oxygenation: reduces risk of hypoxemia
  • quiet enviro
29
Q

How do you induce anesthesia in a dog and drugs used?

A
  • propofol, alfaxalone, ketamine/diazepam
  • administer to effect
30
Q

What do we not want to do to induce anesthesia in dogs anymore?

A

mask induction w/ isoflurane or sevoflurane

31
Q

How do you induce anesthesia in a cat and drugs used?

A
  • propofol, alfaxalone, ketamine/diazepam
  • administer to effect
32
Q

What do we not want to do to induce anesthesia in cats anymore?

A

mask/chamber induction w/ isoflurane or sevoflurane

33
Q

What are the ABCs of Anesthesia Induction?

A
  1. Airway (intubation, secure tube, inflate cuff)
  2. Breathing (auscultation for bilateral lung sounds while manually ventilating, check for spontaneous ventilation)
  3. Circulation (auscultation of heartbeat)
  4. Depth & Drugs (assess depth of anesthesia, turn on vaporizer)
  5. Equipment (blood pressure, eye lube very last on list (lube prior to induction))
  6. Fluids
34
Q

What should you check on an ET tube prior to use?

A
  • check tube for patency
  • check cuff for leaks
35
Q

What should you remember about ET tube intubation?

A
  • have multiple ET tube sizes available
  • laryngoscope, tie, cuff syringe
  • pre-measure ET tube length (incisor teeth to thoracic inlet)
36
Q

What is the technique to intubate a dog?

A
  • can be performed in sternal, lateral, or dorsal
  • apply slight coating of lube (improves cuff’s ability to seal)
  • open the dog’s mouth, pull tongue forward gently
  • straighten head & neck, extend tongue
  • put tip of laryngoscope blade on base of tongue, NOT on epiglottis
  • insert ET tube under visualization
  • inflate cuff while checking for leaks
  • secure tube
37
Q

How do you intubate a cat?

A
  • more difficult than dog: small oropharynx & prone to laryngospasm
  • local anesthetic (lidocaine) useful to prevent laryngospasm (lidocaine spray or lidocaine neat 2%)
38
Q

How do you confirm endotracheal intubation?

A
  • direct visualization (use laryngoscope)
  • rebreathing bag
  • chest excursions
  • palpation of ONE trachea below the larynx
  • capnograph
  • GOLD STANDARD: auscultation of both sides of the animal’s chest during manual ventilation
39
Q

What does A stand for in the ABCs of anesthesia induction?

A

Airway establishment
- intubation
- securing the ET tube
- inflation of the ET tube cuff
- confirmation of endotracheal intubation

40
Q

What does D stand for in the ABCs of anesthesia induction?

A

Depth & Drugs
- check depth of anesthesia (eye position, palpebral reflex, jaw tone)
- based on patient’s depth, turn on vaporizer

41
Q

What does E stand for in the ABCs of anesthesia induction?

A

Equipment
- apply monitoring equipment
- doppler 1st: audible signal
- monitor blood pressure
- assess patient
- adjust vaporizer setting

42
Q

What does F stand for in the ABCs of anesthesia induction?

A

Fluids
- correction of normal ongoing fluid losses
- support of cardiovascular function
- countering of potential negative physiologic effects
- maintaining patent IV catheter

43
Q

What fluid rate should be used during anesthesia?

A

New guidelines:
- Cats: 3 mL/kg/hr
- Dogs: 5 mL/kg/hr
old way of 10 mL/kg/hr is NOT evidence based

44
Q

What is important about the recovery/postoperative period?

A
  • CRITICAL PHASE OF ANESTHESIA
  • 47% (dogs) & 60% (cats) of all anesthetic related deaths are w/in 1st 3 hours of recovery
  • continued monitoring & patient support is important
45
Q

What should you remember about extubation in small animals?

A
  • after dental surgery check the oral cavity for fluid
  • dont untie the tube until patient has reached the final recovery spot
  • ET-tube cuff should not be deflated until just before extubation
46
Q

When do you extubate dogs?

A

on return of swallowing reflex

47
Q

When do you extubate cats?

A
  • cats need to be extubated sooner than dogs
  • on return of good palpebral reflex or ear flick reflex
  • prone to laryngospasm or laryngeal edema
48
Q

What is the optimal recovery time?

A

w/in 10 to 30 mins of the end of the anesthesia

49
Q

What are common complications during anesthetic recovery?

A
  • emergence delirium
  • dysphoria
  • pain
  • delayed recovery
50
Q

During recovery, when should patients be closely observed until?

A

until they are alert, normothermic, & ambulatory

51
Q

How can you ensure patient comfort during anesthetic recovery?

A
  • limit environmental stress (noise, bright lights)
  • prevent hypothermia
  • prevent urinary bladder distension
  • assess pain & provide adequate pain management
52
Q

How can you provide supportive care during anesthetic recovery?

A
  • oxygen
  • fluids
  • heating
  • eye lube

Anesthesia & Analgesia (30 decks)

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