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Vet. Anesthesiology & Sx proc. > Anesthetic Problems & Emergencies > Flashcards

Anesthetic Problems & Emergencies Flashcards

1
Q

Most common human errors in anesthesia

A

-poor planning (missed hx/PE concerns)
-inexperience (drug, machine, response, etc.)
-drug overdose (P weight error, calc. error, wrong drug/conc./route)
-distraction/inattentiveness/fatigue

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2
Q

Most common equipment problems in anesthesia

A

1.Incomplete breathing circuits
2.CO2 absorbent exhaustion
3.Empty O2 tank
4.ET tube
5.Vaporizer problems
6.Pop-off valve left closed

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3
Q

Formula for calculating how much O2 left in E tank

A

psi x 0.3

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4
Q

Formula for calculating how much O2 left in H tank

A

psi x 3

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5
Q

Concerns for using acepromazine in anesthesia and how to correct

A

lowers seizure threshold, hypotension; dopamine and fluids

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6
Q

Concerns for using dexmedetomidine in anesthesia and how to correct

A

CVS depression (bradycardia); atropine, reverse

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7
Q

Concerns for using buprenorphine in anesthesia and how to correct

A

Respiratory depression; naloxone, doxapram

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8
Q

Concerns for using propofol and how to correct

A

apnea; prevent by titrating 1/3-1/4 then by 10%

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9
Q

Concerns for using ketamine in anesthesia

A

eye position reflexes, disorientation and slow recovery in cats, contraindicated w/ head trauma

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10
Q

Patient factors effecting anesthesia

A

-Geriatric, Pediatric
-Lean, obese patients
-Breed-linked risks
-Cardiac patients
-Renal and hepatic disease
-Endocrine disorders

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11
Q

What should be done for geriatric and pediatric patients

A

decrease dosages of drugs by 1/2-1/3

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12
Q

How should you calculate drugs for obese animals

A

use ideal body weight

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13
Q

What should be done for brachycephalic breeds

A

rapid induction, pre-oxygenate, delay extubation

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14
Q

What should you avoid in thin animals and sighthounds

A

barbiturates

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15
Q

What should be done for patients with renal disease

A

decrease drug dosages, rehydrate prior

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16
Q

The following should be done for _ patients
-Shorter fasting
-Dextrose (5ml/kg/hr)
-Decrease drug dosages

A

pediatric

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17
Q

What is the most common anesthetic complication

A

Hypotension

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18
Q

What systolic BP is considered hypotensive

A

<90mmHg

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19
Q

What Mean BP is considered hypotensive

A

<60-70mmHg

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20
Q

The following are causes of _
-Hypovolemia
-Excessive peripheral vasodilation
-Bradycardia or other arrhythmia’s
-Decrease cardiac output (contractility, cardiac failure)
-“Too deep” = overdose
-Hypothermia

A

Hypotension

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21
Q

The following are ways to correct _
-Decrease anesthetic depth
-Warm patient
-Fluid therapy bolus
-Anticholinergics (atropine)
-Sympathomimetic (+ionotropic) drugs- Dobutamine, Ephedrine, Dopamine

A

Hypotension

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22
Q

How to make a dopamine or dobutamine drip

A

kg x 6= _mg to add to 100ml fluid

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23
Q

Dopamine or dobutamine drip should be infused at

A

1ml/hr= 1mcg/kg/min

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24
Q

Signs of fluid overload

A

-crackles/wheezes
-serous nasal discharge
-increase RR/RE
-coughing

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25
Q

Crystalloids will leave the IV space within

A

2 hours

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26
Q

The following are causes of _
-Anesthesia, drug induced (too light/deep)
-Hypoventilation & Electrolyte imbalances (acidosis, hypoxia, hypercapnia)
-Vagal stimulation
-Heart trauma, GDV
-Breed (boxers)

A

Cardiac rhythm abnormalities

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27
Q

Rates considered bradycardia

A

-Dog <60bpm
-Cat <100bpm
-LA <25bpm

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28
Q

The following are causes of _
-Too deep
-Opioid drugs
-Alpha 2 agonists
-Severe hypotension
-Vagal stimulation
-Hypothermia

A

Bradycardia

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29
Q

Rates for tachycardia in dogs

A

Standard: >160bpm
Giant breeds: >140bpm
Toy breeds: >180bpm
Puppies: >220bpm

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30
Q

The following are causes of _
-Light anesthesia
-pain
-Hypotension
-Hypoxia
-Shock
-Hyperthermia

A

Tachycardia

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31
Q

Symptoms of arrhythmias

A

-irregular pulse rate or strength
-irregular heart sounds and ECG
-pallor, cyanosis, increased CRT

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32
Q

Tx of arrhythmias

A

prevent, correct cause

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33
Q

Ventilation is the correction for

A

Hypoxia and respiratory acidosis

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34
Q

Respiratory depression leads to _

A

hypoventilation

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35
Q

Hypoventilation leads to

A

hypoxemia

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36
Q

Respiratory emergencies

A

Inadequate ventilation and/or abnormal blood gas values (PaCO2 & PaO2)

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37
Q

Signs of respiratory emergencies

A

-apnea or dyspnea
-tachypnea
-cyanosis

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38
Q

The following is identification of _
-RR <6bpm
-Decrease tidal volume
-PaCO2 >45mmHg
-Blood gas analysis

A

hypoventilation

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39
Q

The following are causes of _
-Drugs and anesthetic depth
-Equipment
-Positioning
-Lung/pleural disease
-CNS disease
-Hypothermia

A

Hypoventilation

40
Q

How to correct hypoventilation

A

-check equipment
-decrease inhalant
-reverse opioids
-correct body temp.
-initiate intermittent positive pressure ventilation (IPPV)

41
Q

Examples of parenchymal exchange disease

A

pneumonia, pulmonary edema or contusion

42
Q

Correction of parenchymal exchange diseases

A

-Pre-op meds
-Pre-oxygenate
-Intermittent Positive pressure ventilation (15-20cm H2O= MAX

43
Q

Examples of pleural cavity disease

A

diaphragmatic hernia, pleural effusion, pneumothorax

44
Q

Results of pleural cavity diseases

A

hypoxemia, cardiac arrest

45
Q

Correction of pleural cavity diseases

A

thoracocentesis, thoracostomy tube

46
Q

Respiratory arrest should be corrected in - minutes

A

1-3

47
Q

Indications for ventilation

A

-prolonged apnea
-severe hypoventilation
-intrathoracic surgery
-others

48
Q

What should you do to wean off ventilation

A

-Lighten anesthesia
-Decrease RR to 4-6brpm
-Warm and stimulate P
-Provide analgesia

49
Q

Consequences of hypothermia

A

metabolic acidosis, hypoxia, bradycardia

50
Q

Signs of malignant hyperthermia

A

increased temp. and HR, muscle rigidity

51
Q

Tx of malignant hyperthermia

A

D/C anesthesia, drugs, cool body

52
Q

Malignant hyperthermia is common in some _

A

swine lines

53
Q

_ _ is an acute adverse reaction to anesthesia, especially inhalants

A

Malignant hyperthermia

54
Q

Anesthetized patients less tolerant of _ _

A

blood loss

55
Q

A _% blood volume loss= crisis

A

20%

56
Q

4x4 gauze can hold _ml of blood

A

10ml

57
Q

3x3 gauze can hold _ml of blood

A

6ml

58
Q

Blood volume formula for dogs

A

90ml/kg

59
Q

Blood volume loss formula for cats

A

70ml/kg

60
Q

The following are tx of _ _
1. Replace w/ LRS @ 3x volume lost or
2.Replace w/ hetastarch @ 1x volume lost or
3.Hypertonic saline (7.5%) @ 4ml/kr (only in emergency) or
4.Whole blood, PCV monitoring

A

blood loss

61
Q

Tx/resolution to not being able to keep P anesthetized

A

5P’s, assess equipment, assess patient

62
Q

What are the 5 P’s

A

prior planning prevents poor performance

63
Q

Tx/ resolution for P being too deep

A

Decrease or turn off vaporizer, ventilate patient, antagonize drugs, 5P’s

64
Q

Biggest anesthetic complications

A

-Hypotension
-Hypoventilation
-Hypothermia
-Bradycardia

65
Q

Most common occurrence of _ is in head-down surgical positions and in ruminants

A

regurgitation

66
Q

Tx of regurgitation

A

-immediate placement of cuffed ET tube
-clean out regurgitated material w/ suction

67
Q

Vomiting during or after anesthesia is common in

A

brachycephalic dogs or non fasted animals

68
Q

Signs of vomiting during or after anesthesia

A

airway obstruction leading to dyspnea/cyanosis, bronchospasm

69
Q

Tx of vomiting during or after anesthesia

A

-intubation and suction if unconscious
-lower head and clean oral cavity if conscious

70
Q

Seizures are seen with

A

ketamine admin., after dx procedures (myelography), or preexisting conditions

71
Q

Tx of seizures

A

reduce stimuli, postoperative analgesia, diazepam or propofol, monitor for hyperthermia

72
Q

What does excitement look like and when is it seen

A

spontaneous paddling and vocalization; seen after barbiturate anesthesia or high opioid doses

73
Q

Dyspnea in cats is usually caused by

A

laryngospasm sometimes triggered by removal of the ET tube

74
Q

_ _ in cats may result from repeated intubation attempts

A

laryngeal edema

75
Q

Dyspnea in cats is easier to _ than _

A

prevent; treat

76
Q

The following are causes of _ _
-Impaired renal or hepatic function
-Hypothermia
-Patient susceptibility to anesthetic agent
-Breed variation
-Coexisting disorder
-Prolonged anesthesia or deep anesthesia

A

prolonged recovery

77
Q

Ps having a C-section are at risk for

A

blood loss and shock during sx

78
Q

Physiologic effects of pregnancy

A

anemia and impaired BP regulation

79
Q

Supportive measures for c-section

A

-IVC and fluids
-Decrease anesthetic agent dosages
-Preoxygenate
-Monitor (SaO2, PaO2, ETCO2, BP)

80
Q

If PCV normal in pregnant patients, may indicate _

A

dehydration

81
Q

Anesthesia options for C-section

A

Neuroleptanalgesia + Epidural
General anesthesia

82
Q

What drug should not be used as a premed for C-section

A

ace

83
Q

_ induction is not recommended for c-section because dam not intubated (aspiration), maternal excitement, length of time for induction and environmental pollution

A

Mask

84
Q

Drugs that cross the _ will also cross the placenta

A

BBB

85
Q

_ will not cross placenta so should not be used for bradycardia in c-section

A

glycopyrrolate

86
Q

What should be done for apnea in neonates

A

intubate with 16-18g IVC and gently bag every 5 seconds

87
Q

What should be done if no HR in neonate

A

epi via umbilical

88
Q

Avoid _ in patients with seizures and include /

A

ace; valium/midazolam

89
Q

Why should lower dosages be used in meningitis

A

BBB more permeable

90
Q

What should be avoided with head trauma patients

A

ketamine and opioids

91
Q

What must be done prior to anesthesia in trauma patient with respiratory problems

A

remove air/fluid

92
Q

Oxygen delivery methods for trauma patient with respiratory problems

A

flow by (50-100ml/kg/min)
nasal catheters (10ml/kg/min)
oxygen collars

93
Q

Head down patient positions before and during anesthesia should be avoided in patients with _ _

A

diaphragmatic hernia

94
Q

A rebreathing circuit is a _ _ system

A

low flow

95
Q

A non rebreathing circuit is a _ _ system

A

high flow

Vet. Anesthesiology & Sx proc. (14 decks)

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