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anesthesiology > Anesthetizing for dzs (Shih) > Flashcards

Anesthetizing for dzs (Shih) Flashcards

1
Q

Upper airway dz patients considerations

A
  • prone to hypoxia
  • distress (catecholamine)
  • prone to obstruction
    • pulmonary edema
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2
Q

TX for pulmonary edema

A
  • furosemide
  • open trachea
  • don’t give lots of fluids
  • give some O2
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3
Q

With pulmonary disease if possible

A
  • correct underlying dz before sx
    • AB
    • furosemide
    • etc
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4
Q

propofol decresases

A

ciliary moveoment in airways

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5
Q

Pulmonary dz

concerns

A
  1. hypoventilation & hypoxia
  2. most drugs decrease ventilation
  3. change in compliance
  4. increase pulmonary resistance
  5. accumulate secretion
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6
Q

Pulm dz

Pre-op assessment

A
  1. Hx and Rx
  2. Chest radiographs
  3. Pulse Ox, Blood gas
  4. Exercise tolerance: 60 second walk
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7
Q

Pulm dz

Drugs

A
  1. premed: low sedation
  2. induction
    • avoid increase in O2 demand
    • avoid apnea
  3. pre-oxygenate (5 min)
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8
Q

Anesthesia plan for Pulm Dz

A

2 phase: SLOW then FAST

  1. pre-oxygenate (5 min)
  2. low dose opioid (butorph or meth)
  3. Cerenia
  4. THEN induction Propofol and FAST FAST FAST
    • inflate cuff
    • rapid sequence induction
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9
Q

Pulm Dz

Monitoring and recovery

A
  • monitor
    • capnograph
    • pulse ox
    • blood gas
  • recovery
    • low stress, high O2: nasal delivery as good as O2 cage
    • patient position (patient confort)
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10
Q

Worst thing to do for a HCM (heart dz patient)

A

tachycardia

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11
Q

HCM in cats

A
  • 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
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12
Q

Outflow obstruction

A
  • Worst LVOT
    • Tachycardia
    • inc contractility
    • vasodilation
      *
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13
Q

Dexmedetomidine worst drug ever for heart dz except…..

A
  • HCM cats
    • causes bradycardia
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14
Q

Ketamine plus HCM

A

gonna break your heart…LOL

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15
Q

Dexmedetomidine + HCM

A

Let me give your heart a break!

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16
Q

HCM cat anesthetic plan

A
  • Pre oxygenate
  • place IV catheter
  • Reduce stress
17
Q

Old evil cat give

A

alfaxalone IM

18
Q

Anesthesia for HCM cat

A
  • Dexmedetomidine and butorphanol
  • etomidate
  • propofol and midazolam
  • fentanyl
19
Q

Recovery of HCM cat

A
  • recovery in calm environment
  • monitor BP & HR q 1 hr
  • STRESS IS YOUR ENEMY
20
Q

Goal in mitral valve disease

A
  • maximize foward flow
    • vasodilation is better
    • some tachycardia ok
  • Preoxygenate
  • low volume fluid therapy
21
Q

Drugs for mitral valve regurge

A
  • acepromazine and butorphanol atropine
  • Etomidate or alfaxalone
  • ketamine midazolam or propofol midazolam
  • dec inhalents if possible
22
Q

HCM summary

A
  • mild decrease in HR and mild vasoconstriction decreases risk of LVOT
23
Q

Mitral regurg summary

A
  • mild increase in heart rate and mild vasodilation improves cardiac performance
24
Q

Dogs with porto systemic shunts have no

A
  • protein
  • can’t metabolize drugs
  • can’t break down ammonias
25
Q

Solution for liver shunt dogs

A
  • give 30% less normal dose
  • use drugs that don’t need the liver
26
Q

liver disease concerns

A
  • low metabolism
  • dec protein production
    • oncotic
    • clotting
    • free fraction drugs
  • decrease glucose store
  • hypoxia
27
Q

Liver disease

Labwork

A
  • chemistry profile
  • US, neuro exam
  • clotting factors

*low protein = oncotic, clotting, free fraction drugs

28
Q

Liver dz drug considerations

A
  • use drugs that are reversible
  • use short acting drugs
  • use drugs that don’t need liver for metabolism
29
Q

Drugs for liver dz patients

A
  • opioids, midazolam
  • propofol
  • remifentanyl + isoflurane
  • Fluid: FFP, Hetastarch, Glucose
30
Q

Liver failure/PSS summary

A
  • propofol is a good induction agent
31
Q

Brain dz concerns

A
  • intra crania pressure (ICP)
    • drugs
    • positioning
    • vomiting, cough, gag
    • CO2, O2, BP
32
Q

Brain disease drug considerations

A
  • avoid drugs that cause
    • vomiting
    • sedation
      • hypoventilation
    • inc ICP
      • ketamine
      • halothane
33
Q

Summary for brain neoplasia

A

Bad induction agent would be KETAMINE

34
Q

Brain disease drug considerations

A
  • Low dose opioid IV
  • Thiopental, diazepam
  • Isoflurane or sevoflurane
    • both cause vasodilation and inc ICP
    • if very sick Shih uses just propofol drip

anesthesiology (14 decks)

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