Ch 21 - Anaesthesia Principles and Monitoring Flashcards

1
Q

Describe the 5 ASA grades

A
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2
Q

What is the rate of anaesthetic-related death in animals?

A

1 : 500 - 1000

Humans 1:10,000

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3
Q

What medications are contraindicated in animals with cardiac disease?

A
  • alpha-2 agonists
  • Acepromazine should only be used if they can tolderate vasodilation
  • Caution wth ketamine in HCM (increases sympathetic activity)
  • Propofol/alfax should be used cautiously due to vasodilation. Etomidate is ideal.
  • Some animals wont be able to tolerate gas vasodilation
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4
Q

What medications are contradicted in the face of thyroid disease?

A
  • Ketamine due to potential cardiomyopathy and possibility of thyroid storm
  • Avoid NSAIDs and maintain normal/slightly elevated BP due to potential for underlying renal disease
  • May have cardiomyopathy
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5
Q

What is the hypoxic pulmonary vasoconstriction?

A

A compensatory mechanism that results in vasoconstriction of the blood flow to the alveoli that do not have an adequate oxygen supply. Helps to balance a V/Q mismatch in awake patients

Inhalant anaesthetic agents impair or eliminate this compensatory mechanism causing V/Q mismatch to worsen in the anaesthetised patient

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6
Q

What are some potential benefits of ketamine when used on patients with airway disease?

A
  • Causing bronchodilation (good for allergic airway disease)
  • Maintains the respiratory center sinsitivty to PaCO2
  • Maintains respiration making is a useful induction agent
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7
Q

What considerations should be made when making a plan for a patient with liver disease?

A
  • Often require lower doses of drugs if hypoalbuminaemic as many anaesthetic drugs are highly protein bound to albumin
  • Propofol has extrahepatic metabolism and so is a good choice, as is remifentanyl (plasma esterase)
  • Inhalants undergo very little hepatic metabolism and are also a goof choice
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8
Q

List some drugs which are renally excreted and therefore effects may be prolonged in patients with renal disease

A
  • Ketamine
  • benzodiazepines
  • opioids
  • acepromazine
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9
Q

What anaesthetics should be avoided in renal disease?

A
  • Ketamine
  • Sevofluorane (Compound A)
  • Epidural contraindicated due to potential coagulopathies in severe uraemia
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10
Q

What are the main risks after relieveing a urinary obstruction?

A
  • Post-obstructive diuresis
  • Dialysis disequilibrium - seen if BUN drops rapidly causing a decrease in serum osmolality and associated fluid shifts resulting in cerebral oedema
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11
Q

What is the maximal allowable pressure during laparoscopy?
At what pressure is there an association with anuria and acute renal failure?

A

-14cmH20 maximum allowable
- 25cmH2O anuria, AKI

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12
Q

What patient positioning is used for laparoscopic surgeries?

A

Trendelenburg positioning (head-down)

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13
Q

What is the only anaesthetic drug which has been shown to adversely effect neonate survival in C-sections?

A

xylazine

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14
Q

For lumbosacral epidurals, what volume is appropriate for the HLs? For abdominal/thoracic?

A
  • 0.2ml/kg for HLs
  • 0.3ml/kg for abdomen/thorax
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15
Q

What considerations need to be made when anaesthetising for an ophtho procedure?

A
  • Maintaining central eye position (low dose neuromuscular blockade)
  • Avoiding spikes in IOP such as can be caused by propofol and ketamine
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16
Q

What are the effects of hypothermia?

A
  • Prolonged recovery
  • Decreased immune defense
  • Prolonged healing
  • Altered drug metabolism
  • Cognitive depression
  • Arrhythmias

Really Inadequate Heat Does Cool Animals

17
Q

List five possible caused of hypoxaemia

A
  • Hypoventilation
  • Right-to-left shunting
  • Decreased inspired oxygen
  • Diffusion barrier impairment
  • V/Q mismatch
18
Q

What are the effects of hypercarbia?

A
  • Initial hypertension, tachycardia and tachypnoea
  • Eventual sympathetic collapse causing bradycardia, ventricular arrhythmias and hypotension when over 85mmHg
19
Q

List some potential cause of hypercarbia?

A
  • Expired or exhausted absorbent
  • Malfunctioning expiratory valve
  • Inadequate flow rate in non-rebreathing system
  • Increased metabolism that can occur with hyperthermia or seizure
20
Q

What is the ideal tidal volume?

A

8-12ml/kg (should not exceed 15)