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VET433: Cardio/Respiratory > Anesthesia - Respiratory Patients > Flashcards

Anesthesia - Respiratory Patients Flashcards

1
Q

acepromazine - respiratory effects

A

minimal to none

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2
Q

how do anesthetic agents affect the respiratory system

A
  • hypoventilation
  • V/Q mismatch from atelectasis + depression of HPV (leading to hypooxygenation)
  • airway dilation
  • decreased secretions
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3
Q

dexmedetomidine - respiratory effects

A

minimal BUT potentiates the effects of other drugs

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4
Q

benzodiazepines - respiratory effects

A

minimal to none

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5
Q

opioids - respiratory effects

A

respiratory depression

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6
Q

anticholinergics - respiratory effects

A

bronchodilation (increased dead space)

decreased/thickened secretions

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7
Q

induction agents - respiratory effects

A

hypoventilation

propofol > alfaxalone > ketamine, etomidate

may cause apnea

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8
Q

inhalants - respiratory effects

A

hypoventilation
decreased response to hypoxemia
bronchodilation
decreased mucociliary clearance
decreased RR

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9
Q

ventilation and oxygenation measures to monitor

A
  • minute ventilation
  • PCO2
  • PO2
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10
Q

how to measure minute ventilation

A

MV = RR x TV

tidal volume - measured with Wright respirometer

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11
Q

normal minute ventilation, RR, and TV

A

MV: 150-250 mL/kg/min
RR: 15-20 bpm
TV: 10-20 mL/kg

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12
Q

what does PCO2 measure

A

adequacy of alveolar ventilation for the level of CO2 being produced by the body

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13
Q

how is PCO2 measured

A
  1. PaCO2 - gold standard
  2. capnography - best surrogate
  3. PvCO2 - acceptable surrogate
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14
Q

normal PaCO2 and when should hypoventilation be treated

A

40 mmHg

treatment should be considered when PaCO2 > 60 mmHg

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15
Q

what does PO2 measure

A

oxygenation

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16
Q

how is PO2 measured

A
  1. PaO2 - gold standard
  2. pulse oximetry (SpO2)
    - limited when patient is on 100% O2

can NOT use PvO2

17
Q

why is pulse oximetry not a reliable indicator of oxygenation status when on supplemental O2

A

If patient is receiving 100% O2 (FiO2 = 1), SpO2 will not read as being hypoxemic

PaO2 should be > 500 mmHg when FIO2 = 1
BUT
SpO2 will read 99-100% once PaO2 > 120, so patient can be poorly oxygenating (PaO2 = 121-499) without being read as hypoxemic

18
Q

normal PaO2, hypoxemia and severe hypoxemia

A

90-110 mmHg

hypoxemia: <80 mmHg
severe hypoxemia: <60 mmHg

19
Q

how to treat hypoventilation

A

IPPV - intermittent positive pressure ventilation

controlled (mechanical) ventilation

can NOT use assisted ventilation (bagging) because once bagging is stopped, the depressed respiratory center is still controlling PCO2 and the value will rise again

20
Q

how to treat V/Q mismatch

A

decrease BP

high CO2 is a sympathetic stimulant –> decreasing BP can decrease CO2

21
Q

how to treat poor oxygenation

A
  1. supplemental O2 - if low PiO2/FiO2 is the cause
  2. IPPV, recruitment maneuvers, PEEP - if V/Q mismatch is the cause
22
Q

when should thoracocentesis be performed prior to anesthesia

A

pneumothorax
pleural effusion

23
Q

when should thoracic radiographs be performed prior to anesthesia

A

all small dog trauma patients

large dogs if trauma is close to the chest

24
Q

when can IPPV not be used

A

pneumothorax

use permissive hypercapnia - allow PCO2 to be high in order to avoid mechanically ventilating

can do IPPV if continuous suction is in place

25
Q

when should IPPV always be used

A

pleural effusion
thoracotomy procedures

26
Q

anticipated problems associated with PLEURAL diseases

A

decreased ventilation
decreased oxygenation
decreased respiratory system compliance (atelectasis)

27
Q

what premedications should be used in PLEURAL disease patients

A
  • acepromazine
  • dexmedetomidine
  • benzodiazepine
  • opioids + anticholinergic

ONLY USE IF NEEDED

28
Q

what induction drugs should be used in PLEURAL disease patients

A

ketamine + midazolam

do NOT use propofol, alfaxalone, or opioid induction in pneumothorax due to respiratory depression

29
Q

what drugs should never be used in pneumothorax patients

A
  • propofol
  • alfaxalone
  • opioid induction
  • high dose opioids
30
Q

what balanced anesthesia drugs can be used in PLEURAL disease patients

A
  • opioids
  • ketamine
  • lidocaine
  • local/regional anesthesia
31
Q

what drugs should NOT be used in PULMONARY disease patients

A

anticholinergics

decrease and thicken secretions

32
Q

anticipated problems associated with PULMONARY diseases

A
  • poor oxygenation
  • risk of equipment cross contamination
33
Q

what premedications should be used in PULMONARY disease patients

A
  • acepromazine
  • dexmedetomidine
  • benzodiazepiene + opioid
  • opioid

ONLY IF NEEDED

34
Q

what induction drugs should be used in PULMONARY disease patients

A

propofol, ketamine, or etomidate
+ midazolam

do NOT use opioid or inhalant induction

VET433: Cardio/Respiratory (17 decks)

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