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Eq ACVS Phase 1 > Ch.18 Balanced Inhalation Anaesthesia > Flashcards

Ch.18 Balanced Inhalation Anaesthesia Flashcards

1
Q

Goal of equine anaesthesia

A

Maintenance of good intraoperative cardiopulmonary function, followed by calm pain-free and co-ordinated anaesthetic recovery

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2
Q

What is believed to be the cause of foal deaths when using inhalant drugs (iso, servo, des) for induction

A

Rapid uptake of newer, less soluble inhaled agents in young animals with an immature cardiopulmonary system.

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3
Q

What is drug potency represented by?

A

MAC
Minimum alveolar concentration -
end tidal alveolar concentration of inhalation anaesthetic that prevents movement in 50% of subjects in response to a noxious stimulus.

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4
Q

MAC of Halothane

A

0.88%

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5
Q

MAC of Isoflurane

A

1.31%

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6
Q

MAC of Sevoflurane

A

2.31%

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7
Q

MAC of Desflurane

A

7.6%

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8
Q

How are Iso, sevo and des metabolised and at what rate

A

Liver
ISO - 0.2%
SEVO - 3-5%
DES - 0.02%

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9
Q

How do iso, sevo and des decrease blood pressure

A

Decreased peripheral resistance

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10
Q

How does Desflurane affect CO at 1 MAC

A

Does not depress CO

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11
Q

What plasma levels of lidocaine are required to reduce the MAC of Halothane by 50-70%

A

> 5ug/ml

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12
Q

Lidocaine at 1.3mg/kg over 15mins followed by 50ug/kg/min decreased the MAC of Sevo by what %

A

27%

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13
Q

At what plasma levels are signs of ataxia seen in the standing horse

A

1.85-4.53ug/ml

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14
Q

Intra op lidocaine protocol dose

A

0.65-1.3 mg/kg over 15 - 20mins
Followed by CRI 25 - 50 ug/kg/min

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15
Q

Intra op CRI rate of Medetomidine

A

3.5 ug/kg/hr

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16
Q

Intra op CRI rate of Dexmedetomidine

A

1.75 ug/kg/hr

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17
Q

Intra op CRI rate of Xylazine

A

0.3 - 0.6 mg/kg/hr

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18
Q

Intra op CRI rate of Detomidine

A

10 ug/kg/hr

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19
Q

Intra op CRI rate of Romifidine

A

18 -40 ug/kg/hr

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20
Q

Intra op CRI rate of Ketamine

A

0.5 - 1 mg/kg/hr

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21
Q

Intra op CRI rate of S (+) Ketamine

A

0.5 - 1 mg/kg/hr

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22
Q

What is the maximum length of time a Ketamine CRI is advised for owing to rough recoveries

A

1.5 hours

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23
Q

Which horses are at risk of toxicosis following lidocaine

A

Ones with compromised cardiovascular function with resultant reduced liver blood flow and metabolism

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24
Q

How does lidocaine decrease the MAC of inhalant anaesthetics

A

Dose dependently

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25
Q

How do Alpha 2 adrenoreceptor agonists decrease the MAC of inhalant anaesthetics

A

Dose dependently

26
Q

For how long does the bolus of alpha 2 adrenoreceptor agonists negatively impact cardiopulmonary function in the anaesthetised horse

A

20 -120 mins

27
Q

Which alpha 2 adrenoreceptor agonists have the shortest half life

A

Medetomidine and dexmedetomidine

28
Q

For how long does the bolus of alpha 2 adrenoreceptor agonists negatively impact cardiopulmonary function in the standing sedated horse

A

10 mins

29
Q

Which has a better anaesthetic recovery Medetomidine CRI or Dexmedetomidine CRI

A

Dexmedetomidine

30
Q

How does recovery following a lidocaine balanced anaesthesia compare to medetomidine balanced

A

Medetomidine recovery is longer but of better quality

31
Q

How does management of a lidocaine balanced anaesthesia compare to medetomidine balanced

A

Medetomidine - fewer drugs administered during the anaesthesia

32
Q

How does monitoring a horse’s eye differ when balancing anaesthesia with medetomidine

A

Brisker eye reflexes
Only nystagmus may indicate the horse is light

33
Q

How does xylazine 1mg/kg/hr CRI in balanced anaesthesia affect the cardiovascular system and recovery

A

HR Lower
BP Higher
Recoveries longer but better quality

34
Q

On average Alpha 2 adrenoreceptor agonists reduce MAC by what%

A

30%

35
Q

What is the currently licensed form of Ketamine?

A

Racemic mixture of S-Ketamine and R-Ketamine

36
Q

What is postoperative wind up

A

A state of reactivity of the cns that can occur following tissue damage leading to maintenance of pain even after the injury has healed

37
Q

What duration of ketamine infusion has been associated with undesirable excitatory CNS effects

A

Over 1 - 2 hours
or
repetitive IV boluses

38
Q

Describe the emergence reactions associated with ketamine

A

Muscle tremor and rigidity
Mydriasis
Oculogyric movements
Sweating
Excitation
Ataxia
Schizophrenia like behaviour

39
Q

What is accountable for emergence reactions when using Ketamine

A

Plasma conc
Length of drug infusion
Formation of S-norketamine

40
Q

How to minimise emergence rxns when using ketamine

A

Lower dose
Gradual decrease to stop 15/20 mins before end of sx
Alpha 2 adrenoreceptor agonists for recovery

or use 1.1mg/kg IV S-Ketamine
and maintain on CRI AT 0.5 mg/kg/hr with iso and oxygen

41
Q

What is associated with better recovery when combined with guafenesin Racemic Ketamine or S-Ketamine

A

S-Ketamine

42
Q

Experimental studies of opiod use during inhalant anaesthesia shows what changes in MAC

A

No change

Except for high doses of Fentanyl

43
Q

Changes in MAC from Morphine CRI

A

None

44
Q

Effects of 0.02 mg/kg Butorphanol on anaesthesia when combined with Iso

A

Deeper anaesthesia
Sympathetic stimulation caused by sx is blunted

45
Q

Former name of Guaifenesin

A

Glyceryl Guaiacolate

46
Q

Advantages of using Guaifenesin

A

Potentiates other sedatives/anaesthetics drug

Good relaxation of laryngeal and pharyngeal muscles

Relaxation of skeletal mm

Does not affect diaphragmatic or respiratory function

No effect on CO or BP

47
Q

What is the dose range of Guaifenesin

A

50 - 100 mg/kg

48
Q

Risks of Guaifenesin use

A

Irritant to vessels

10% Guaifenesin very high risk (7/7) of thrombus formation and reports of hemolysis

49
Q

Do benzodiazepines have analgesic properties?

A

No but they potentiate analgesic properties of co-administered drugs

50
Q

Risks of using benzodiazepines intra-operatively and how to avoid

A

Ataxia after standing in recovery

Reverse using benzodiazepine antagonist such as flumazenil

51
Q

How is lidocaine metabolized

A

By the liver

52
Q

True or False
Lidocaine has a long half life?

A

False

53
Q

In healthy awake horses, lidocaine toxicity has been observed in plasma levels exceeding..

A

1.85 - 4.35 ug/ml

54
Q

True or False
Alpha 2 adrenoreceptor agonists are potent analgesics

A

True

55
Q

True or False
Medetomidine has a short half life

A

True

56
Q

Does Ketamine depress CO

A

No

Causes sympathetic stimulation which may help maintain cardiac function when anaesthetised

57
Q

Does Guafenisin have a wide or narrow window of safety

A

wide

58
Q

Where does Guaifenesin elicit its affects

A

Brain stem - potentiating other sedative and anaesthetic drugs

59
Q

Does Guaifenesin affect respiratory function

A

No effect on diaphragm or resp function when used in clinical doses of 50-100mg/kg

60
Q

What % Guaifenesin has been assoicated with Hemolysis

A

10%

Eq ACVS Phase 1 (72 decks)

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