Anesthesia questions Flashcards
In an article about the “risk of anesthetic mortality in dogs and cats: an observational cohort study of 3546 cases” (Bille et al 2012), which of the following is FALSE a. The death rate of healthy animals (ASA I and II) was 0.12% b. The main factor associated with increased odds of anesthetic death in ASA categories III and over was poor health status c. The nature and length of the procedure was associated with higher death rates d. Although not significant, cats had a higher tendency for death during anesthesia compared with dogs
C is FALSE only poor health status (ASA 3,4,5) and premed + thiopental + isoflurane protocol was significantly associated with risk of death in Bille paper
In an article about “the risk of passive regurgitation during general anesthesia in a population of referred dogs in the UK by Lamata et al 2012; which of the following is TRUE a. Overall risk of regurgitation was 4.7% b. Breeds with the largest number of regurgitation were Labradors, german shepherds and mixed breeds which were significantly heavier than controls c. The major procedure group associated with regurgitation were dental related d. NSAIDS were not associated with the presence of regurgitation
C! those breeds were the largest # of regurgitation overall rate was 0.63%-0.96% (lower is removing patients with reason to regurg) NSAIDS were associated with regurg Orthopedic procedures were associated with 26X risk of regurg!
In “evaluation of risk factors for development of corneal ulcer after nonocular surgery in dogs: 14 cases by Park et al 2013, which of the following is true: a. 6 breeds were overrepresented including Maltese, Dachshund, Labrador, French bull dog and Weimaraner b. Duration of anesthesia was not found to be a significant risk factor c. Small skull was not found to be a significant risk factor d. Neurosurgery was found to be a significant risk factor
D: Neurosurgery was a risk factor! small skull, duration of anesthesia, fentanyl patch all associated with increased risk breeds were maltese, shih tzu, cocker, ckcs, pekingese, min pin and yorkie but didnt so skull shape, just size
What is the anti-emetic mechanism of maropitant citrate and how long does it take to reach peak plasma levels when given 1mg/kg subcutaneously? a. Neurokinin-1 antagonist, 45 minutes b. Neurokinin-1 agonist, 115 minutes c. Substance P agonist, 45 minutes d. Substance P antagonist, 115 minutes
Neurokinin-1 antagonist, 45 minutes works centrally and peripherally as anti-emetic substance P is main neurotransmitter involved in vomiting
What profile of drug and dose would be the least likely to cause vomiting in dogs when given intramuscularly? a. Low lipid solubility, low dose b. Low lipid solubility, high dose c. Highly lipid soluble, low dose d. Highly lipid soluble, high dose
high lipid solubility (methadone) and high doses are less likely to cause vomiting
In an article about the ‘effects of opiods and anesthetic drugs on body temperature in cats” by Posner 2010, which of the following is true? a. Administration of ketamine or isoflurane in addition to hydromorphone produces significant increases in body temperatures compared with hydromorphone alone b. All drugs used caused significant elevations from baseline c. All doses of hydromorphone evaluated caused significant temperature elevations and elevations were found to be dose dependent d. Postoperative temperature elevations were moderate to severe and many required therapeutic intervention
B- all drugs tested caused significant temp elevation from baseline (hydromorphone, buprenorphine, butorphanol,morphine, ketamine, ketamine and hydro) -Iso and ketamine didnt make significant different -none needed intervention, highest temp was 105 -temp elevation not related to dose
Which of the following is FALSE regarding risk of anesthetic complications in brachycephalic dogs according to Gruenheid 2018 a. Risk of intra-anesthetic complications was lower with Orthopedics being the presenting service compared to dentistry or soft tissue surgery b. Risk of peri-anesthetic complications was higher in dogs >40 kgs c. Risk of peri-anesthetic complications was higher with longer duration of anesthesia d. Risk of post-anesthetic complications increased with increasing ASA status
FALSE: Risk of peri-anesthetic complications was higher in dogs >40 kgs being bigger is better but not a cutoff and for intra-operative and peri-operative risk
Risk of post-anesthetic complications in dogs was shown to be related to what factors according to Gruinheid el at 2018? a. Brachycephalic skull type, history of brachycephalic airway surgery, body weight b. Brachycephalic skull type, body weight, invasiveness of surgery c. Brachycephalic skull type, ASA status, invasiveness of surgery, anesthetic induction agent d. Brachycephalic skull, body weight, duration of anesthesia, attending hospital service
c. Brachycephalic skull type, ASA status, invasiveness of surgery, anesthetic induction agent D: those are associated with INTRA or PERI operative risk of anesthetic complication brachycephalics associated with increased risk of 1.57X intra and 4.33X POST
Which of the following was true when studying the role of dosing interval in relation to hydromorphone induced nausea and vomiting in dogs? a. Maropitant administered 1mg/kg SQ 15 minutes prior to hydromorphone led to a significant decrease in nausea signs b. Maropitant administered 1mg/kg SQ 30 minutes prior to hydromorphone led to no episodes of nausea c. Maropitant administered 1mg/kg SQ 45 minutes prior to hydromorphone led to a significant decrease of nausea signs d. Maropitant administered 1mg/kg SQ 60 minutes prior to hydromorphone led to a significant decrease of nausea signs
D- you must give maropitant 60 minutes prior to hydro to have decrease in nausea if you give it 15 minutes prior- you have significant decrease in VOMITING if you give it 30/45/60 minutes prior you have no vomiting but HAVE to wait 60 minutes to decrease nausea
1What was the most common presenting clinical sign in cats with tracheal rupture according to Hardie (JAVMA 1999)? a. Dyspnea b. Tachypnea c. Subcutaneous emphysema d. Coughing
subcutaneous emphysema in 16/16!
Hardie reported that in cats with tracheal ruptures, what type of injury is most common? a. Puncture like tear, left side where trachealis muscle attaches to tracheal cartilage b. Linear tear, right side in trachealis muscle c. Linear tear, left side in trachealis muscle d. Linear tear, left side where trachealis muscle attaches to tracheal cartilage
D. linear tear, where cuff was, at attachment of trachealis muscle to tracheal cartilage
Why was it theorized that the oral transmucosal route could favor uptake of dexmedetomidine and buprenorphine in “Sedative and antinociceptive effects of dexmedetomidine and buprenorphine after oral transmucosal or intramuscular administration in cats” a. The acidic oral environment should favor the unionized dexmedetomidine and buprenorphine b. The alkaline oral environment should favor the unionized dexmedetomidine and buprenorphine c. The acidic oral environment should favor the ionized dexmedetomidine and buprenorphine d. The acidic oral environment should favor the ionized dexmedetomidine and buprenorphine
B! The alkaline oral environment should favor the unionized dexmedetomidine and buprenorphine the mouth has excellent venous draining that BYPASSES the first pass liver
What difference was noted between cats given 40mcg/kg dexmedetomidine and 20mcg/kg buprenorphine OTM versus IM? a. The OTM group had a significantly higher rate of vomiting b. The IM group had significantly longer sedative effects c. The OTM group had significantly less anti-nociceptive effects d. No difference was found between OTM and IM in terms of sedative or anti-nociceptive effects
No difference found in sedative or anti-nociceptive effects! biggest side effect was vomiting
Orotracheal intubation has been shown to induce transient hypertension in dogs with an induction protocol of what drug/drug combination? a. Propofol b. Ketamine c. Propofol-Ketamine d. Propofol-Glycoprrylate
Ketamine! Ketamine 5mg/kg IV and diazepam 0.2mg/kg IV group had transient mild hypertension at T30 after induction That was not seen in the propofol 4mg/kg IV group or the propofol-ketamine group
At what level is the mandibular canal furthest from the alveolar crest? a. PM4 and M1 b. M1 and M2 c. PM3 and PM4 d. PM2 and PM3
PM4 and M1 it is the most ventral then
At which region does the canal become closer to the vestibular surface than the lingual? a. Molar region b. Premolar region c. Caudal mental foramen d. Middle mental foramen
molar region
What was shown to decrease risk of anesthetic/sedation related death in cats according to Brodbelt 2008? a. Use of IV fluids b. Endotracheal intubation c. Pulse oximetry and pulse monitoring d. Primary care hospital versus specialty hospital
pulse ox and pulse monitoring!! IV fluids and endotracheal intubation increased risk didnt look at hospital type
What was shown to increase risk of anesthetic /sedation related death in cats according to Brodbelt in the CEPSAF study? a. Intact female cats, cats <2kg, increasing ASA status, major procedures b. Intact female cats, brachycephalic cats, increasing ASA status, more urgent procedure c. IV fluids, endotracheal intubation, increasing ASA status, more urgent procedure, major procedures d. IV fluids, lack of endotracheal intubation, increasing ASA status, more urgent procedure, major procedures
c. IV fluids, endotracheal intubation, increasing ASA status, more urgent procedure, major procedures no sex or breed significance weight: <2kg or >6kg increased risk of death
Which of the following is correct according to Pascoe in “the effects of lidocaine or a lidocaine bupivacaine mixture administered into the infraorbital canal in dogs” a. 1mL of Lidocaine 2% effectively blocked the maxillary 4th premolar in the majority of dogs b. 1mL of Lidocaine 2%+Bupivacaine 0.5% had a longer onset time compared to lidocaine 2% alone for blocking the maxillary canine c. 1mL of Lidocaine 2% and lidocaine 2% + bupivacaine 0.5% both blocked the maxillary canine in all dogs with the L:B mixture lasting 3X as long d. 1mL of Lidocaine 2% and lidocaine 2% + bupivacaine 0.5% both blocked the maxillary canine in all dogs with L:B mixture lasting 277 minutes
d. 1mL of Lidocaine 2% and lidocaine 2% + bupivacaine 0.5% both blocked the maxillary canine in all dogs with L:B mixture lasting 277 minutes Lidocaine=120min L+B=277minutes both worked in <10min in 6/6 both worked (<15% REMP) in 5 minutes in 5/6 dogs
- What nerve innervates the maxillary 2nd molar? a. Infraorbital b. Maxillary c. Caudal superior alveolar nerve d. Caudal labial alveolar nerve
caudal superior alveolar nerve
In the paper “Effect of dosing interval on efficacy of maropitant for prevention of hydromorphone-induced vomiting and signs of nausea in dogs” by Kraus in JAVMA 2014 what dosing interval significantly decreased nausea? a)15min b)30min c)45min d)60min
60minutes! have to wait 60 to decrease nausea
From the article “effects of buprenorphine added to bupivacaine infraorbital nerve blocks on isoflurane minimum alveolar concentration using a model for acute dental/oral surgical pain in dogs” by Snyder et al JVD 2016” which of the following is false a. Both groups caused a significant reduction in MAC of isoflurane b. The BupBup group had significantly more dogs with significant mac reduction at 96hours post block c. The addition of buprenorphine may not have been significant due to lack of peripheral mu upregulation in study patients d. None of the dogs in the BUPV group had MAC reduction at 96 hours post block
The BupBup group had significantly more dogs with significant mac reduction at 96hours post block NOT significant bupbup had 2 dogs still blocked at 96 versus 0 dogs blocked at 96 hours but not significant 19%bupbup and 23%bupiv
what is the pathway of pain from the oral cavity to the brain?
Transduction –> transmission –> modulation Nociception via trigeminal afferentnerve includes nerve fibers of A delta, and C type fibers transmit to nucleus caudalis in medulla Glutamate and substance P bind to their receptors on those neurons
what is transduction
conversion of noxious stimulus to electrical energy by peripheral nociceptor
what is primary versus secondary hyperalgesia?
hyperalgesia=greatly enhanced nociceptor response peripheral sensitization at the site=primary due to sensitizing soup secondary=pain around the site from non-noxious stimulus
what is allodynia?
feeling pain from something that isnt usually painful (touch) due to secondary hyperalgesia
what is central versus peripheral sensitization?
central sensitization=if peripheral isnt treated, then windup that sends increased frequency and intensity of pain signal to the brain peripheral sensitiziation= hyperalgesia at site
What benefit did Jones and Fransson find in “Evaluation of the effectiveness of preoperative administration of maropitant citrate and metoclopramide hydrochloride in preventing postoperative clinical gastroesophageal reflux in dogs” in JAVMA 2019: a. Dogs who had non-abdominal surgery did benefit from the intervention b. Dogs with a history of vomiting and regurgitation showed a significant benefit from the intervention c. Male dogs, Obese dogs, Dogs that underwent GI surgery and Dogs that required a dexmedetomidine CRI benefited from the intervention d. No benefit from the intervention was seen
D. No benefit was seen from the intervention the intervention was cerenia 1mg/kg SQ 45 min prior to premed and metoclopramide CRI 2mg/kg/day at induction IV male dogs, obese, gi sx and dexmedetomidine cri after had INCREASED significant risk of GER post op regardless of intervention
Matthews et al reported in JAVMA 2017 which of the following: a. The majority of dogs and cats died intra-operatively compared to immediately post operatively or after discharge b. Cats and dogs were equally likely to have anesthetic or sedation related death c. They did not report a relationship between age and anesthetic death risk d. Dogs that did not have a pre-anesthetic physical exam recorded had increased odds of anesthetic death
d. Dogs that did not have a pre-anesthetic physical exam recorded had increased odds of anesthetic death Cats were more likely to die than dogs (cats 0.11% died versus dogs 0.05% died) cats and dogs both died after discharge most commonly there was relationship between age and death risk for dogs and cats
Cats that received maxillary and inferior alveolar nerve blocks prior to dental extractions exhibited which of the following compared to cats that did not receive dental blocks per Aguiar et al JFMS 2015? a. Cats that received blocks had lower pain scores at 2 and 4 hours post-procedure b. Cats that did not receive blocks required rescue pain medication post-procedure c. Cats that received blocks ate significantly sooner than cats that didn’t receive blocks d. There was no significant difference between cats if they only received inferior alveolar blocks
true: a. Cats that received blocks had lower pain scores at 2 and 4 hours post-procedure -they also had lower HR, SAP, ISO after extractions than control -didnt look at eating time -didnt compare location of blocks
- In Krug JVD 2011, area of desensitization following mental nerve block in dogs, which of the following is true? a. Soft tissues were more reliably blocked than hard tissues b. The most reliably desensitized tooth was the ipsilateral third incisor c. The most reliably desensitized tooth was the ipsilateral third premolar d. An algometer was used to standardize forces and temperatures applied to the teeth during testing
c. The most reliably desensitized tooth was the ipsilateral third premolar smaller than expected area, went as far into middle mental as possible with 25g, variable, p3 and p4 most blocked but still bad really apical pdl has highest nerve density of pdl
In “Area of Desensitization Following Mental Nerve Block in Dogs” by W. Krug & J. Losey (2011), which was the only tooth blocked in 100% of cases and for which stimulus was this true? a. I3, pressure at mucogingival line b. PM3, cold stimulus c. I3, cold stimulus d. PM3, pressure at mucogingival line
pm3 cold stimulus
In “Area of Desensitization Following Mental Nerve Block in Dogs” by W. Krug & J. Losey (2011), which of the following is NOT true regarding suggestions as to why there was incomplete blockade of dentoalveolar structures and associated soft tissue following application of the mental nerve block? a. Collateral innervation and anastomoses between CNV and CNVII b. Saltatory conduction of myelinated nerves may have allowed signals to “jump nodes” c. Overestimation of effect due to anaesthetic agents d. Small volume of anaesthetic agent
c. Overestimation of effect due to anaesthetic agents probably not-butorphanol, ace
What are the four types of body heat loss?
Conduction, convection, radiation, evaporation
What is evaporation heat loss?
dissipation of heat when moisture turns to gas -through anesthetic system, surgical prep, wet patient
What is conductive heat loss?
when body heat is transferred from patient to surgical table. Increases with wet patient
What is radiation heat loss?
thermal and infrared energy being given off -affected by room temp (lower room temp means more radiation loss)
What is convection heat loss?
*major loss in human anesthesia patients -inhalation of dry cold anesthetic gases and by circulating air flow
Forced air blankets minimized heat loss via a. Conduction and radiation b. Convection and radiation c. Evaporation and convection d. Conduction and radiation
Convection and radiation! minimized cold air flow around them and makes ambient temp better around them
What is the physiologic reason for increased body core heat lost in the first hour of anesthesia? a. Physiologic systems react to the hypothalamus thermoregulation the quickest in the first hour of anesthesia b. Decreased sympathetic tone leads to peripheral vasodilation so core heat goes to periphery c. Decreased sympathetic tone leads to peripheral vasoconstriction in the first hour so core heat goes to the periphery
b. Decreased sympathetic tone leads to peripheral vasodilation so core heat goes to periphery hypothalamus is thermoregulation
In Krug “Area of desensitization following mental nerve block in dogs JVD 2011”, which of the following is NOT a reason proposed by the authors for the lack of total desensitization in the hard and soft tissues of the rostral mandible after administration of the middle mental nerve block? a. the digastricus nerve branching from the mandibular or inferior alveolar nerves anastomoses with the ventral buccal branch of CN VII and provides cutaneous innervation to the ventral lip and cheek b. Anatomical factors preventing blockage of the nerve fibers exiting the mandible at the caudal mental foramen c. Redundant or collateral innervation from nearby branches of the trigeminal nerve d. fibers from the contralateral mandibular nerve overlap rostrally imparting sensation to tissue that is unilaterally anesthetized
a. the digastricus nerve branching from the mandibular or inferior alveolar nerves anastomoses with the ventral buccal branch of CN VII and provides cutaneous innervation to the ventral lip and cheek -they did suggest collateral supply and contralteraal supply and that nerves that leave the caudal mental foramen could also give supply which would prevent anesthesia
In Kukanich “Outpatient oral analgesics in dogs and cats beyond NSAIDS: an evidence based approach Vet Clin 2015” which of the following drugs was significantly better than placebo in controlling pain in dogs in a controlled study? a. oral gabapentin b. Oral amitriptylline c. Oral methadone d. oral tramadol
d. oral tramadol
Bradycardia associated with severe hypothermia during anesthesia is characterized on ECG by: a. prolonged ST segment with normal QRS and T waves b. second degree (Mobitz 1) AV block c. prolonged PR interval, widening of the QRS complex and lengthening of the ST segment d. prolonged QT interval
c. Prolonged PR interval, wide QRS and lengthening of ST segment
As reported by Mitchell in 2000 “trachel rupture associated with intubation in cats: 20 cases”, what was the mainstay of medical therapy in medically managed cats? a. Oxygen supplementation b. Respiratory monitoring c. Cage rest d. antibiotics and how many medically managed cats survived in mitchells?
Cage rest! 20% needs oxygen supplementation all medical mgmt cats survived (15/15) 90% survival overall (2 died-1 before intervention and 1 after sx)
What is the trigeminovagal reflex?
reflex via stimulation of the trigeminal nerve (tongue-lingual n, mandibles-mandibular n) that leads to motor nucleus of vagus that leads to bradycardia, asystole, death via anti-inotropy and anti-chronotropy in the myocardium
what is the most common situation to cause trigeminovagal reflex in vet med?
Ophthalmic surgeries
what has been shown to decrease the incidence and severity of trigeminovagal reflex?
local nerve blocks
what size should a doppler cuff be?
what happens if too big?
too small?
cuff should be 40% of circumference
too loose= false low
too tight=false high
