Anesthetizing for dzs (Shih) Flashcards
Upper airway dz patients considerations
- prone to hypoxia
- distress (catecholamine)
- prone to obstruction
- pulmonary edema
TX for pulmonary edema
- furosemide
- open trachea
- don’t give lots of fluids
- give some O2
With pulmonary disease if possible
- correct underlying dz before sx
- AB
- furosemide
- etc
propofol decresases
ciliary moveoment in airways
Pulmonary dz
concerns
- hypoventilation & hypoxia
- most drugs decrease ventilation
- change in compliance
- increase pulmonary resistance
- accumulate secretion
Pulm dz
Pre-op assessment
- Hx and Rx
- Chest radiographs
- Pulse Ox, Blood gas
- Exercise tolerance: 60 second walk
Pulm dz
Drugs
- premed: low sedation
- induction
- avoid increase in O2 demand
- avoid apnea
- pre-oxygenate (5 min)
Anesthesia plan for Pulm Dz
2 phase: SLOW then FAST
- pre-oxygenate (5 min)
- low dose opioid (butorph or meth)
- Cerenia
- THEN induction Propofol and FAST FAST FAST
- inflate cuff
- rapid sequence induction
Pulm Dz
Monitoring and recovery
- monitor
- capnograph
- pulse ox
- blood gas
- recovery
- low stress, high O2: nasal delivery as good as O2 cage
- patient position (patient confort)
Worst thing to do for a HCM (heart dz patient)
tachycardia
HCM in cats
- most commonly dx cardiac dz in cats
- stiff ventricle, poor diastolic function
- left ventricle outflow tract obstruction (LVOT)
- 15% of HCM cats have no clinical signs
Outflow obstruction
- Worst LVOT
- Tachycardia
- inc contractility
- vasodilation
*
Dexmedetomidine worst drug ever for heart dz except…..
- HCM cats
- causes bradycardia
Ketamine plus HCM
gonna break your heart…LOL
Dexmedetomidine + HCM
Let me give your heart a break!
HCM cat anesthetic plan
- Pre oxygenate
- place IV catheter
- Reduce stress
Old evil cat give
alfaxalone IM
Anesthesia for HCM cat
- Dexmedetomidine and butorphanol
- etomidate
- propofol and midazolam
- fentanyl
Recovery of HCM cat
- recovery in calm environment
- monitor BP & HR q 1 hr
- STRESS IS YOUR ENEMY
Goal in mitral valve disease
- maximize foward flow
- vasodilation is better
- some tachycardia ok
- Preoxygenate
- low volume fluid therapy
Drugs for mitral valve regurge
- acepromazine and butorphanol atropine
- Etomidate or alfaxalone
- ketamine midazolam or propofol midazolam
- dec inhalents if possible
HCM summary
- mild decrease in HR and mild vasoconstriction decreases risk of LVOT
Mitral regurg summary
- mild increase in heart rate and mild vasodilation improves cardiac performance
Dogs with porto systemic shunts have no
- protein
- can’t metabolize drugs
- can’t break down ammonias
Solution for liver shunt dogs
- give 30% less normal dose
- use drugs that don’t need the liver
liver disease concerns
- low metabolism
- dec protein production
- oncotic
- clotting
- free fraction drugs
- decrease glucose store
- hypoxia
Liver disease
Labwork
- chemistry profile
- US, neuro exam
- clotting factors
*low protein = oncotic, clotting, free fraction drugs
Liver dz drug considerations
- use drugs that are reversible
- use short acting drugs
- use drugs that don’t need liver for metabolism
Drugs for liver dz patients
- opioids, midazolam
- propofol
- remifentanyl + isoflurane
- Fluid: FFP, Hetastarch, Glucose
Liver failure/PSS summary
- propofol is a good induction agent
Brain dz concerns
- intra crania pressure (ICP)
- drugs
- positioning
- vomiting, cough, gag
- CO2, O2, BP
Brain disease drug considerations
- avoid drugs that cause
- vomiting
- sedation
- hypoventilation
- inc ICP
- ketamine
- halothane
Summary for brain neoplasia
Bad induction agent would be KETAMINE
Brain disease drug considerations
- Low dose opioid IV
- Thiopental, diazepam
- Isoflurane or sevoflurane
- both cause vasodilation and inc ICP
- if very sick Shih uses just propofol drip
