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Eq ACVS Phase 1 > Ch.20 Anaesthesia and Analgesia for Foals > Flashcards

Ch.20 Anaesthesia and Analgesia for Foals Flashcards

1
Q

At what age is a foal considered a neonate, paediatric, juvenile

A

0-1 month
1-3 months
3-4 months

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2
Q

When can foals be treated as young adults

A

When they have acquired mature cardiopulmonary function and metabolic pathways and can be safely weaned 3-5 months

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3
Q

On which side is the valve of the foramen oval located

A

Left

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4
Q

What promotes the closure of the ductus arteriosus over time

A

Decrease in circulating prostaglandins

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5
Q

How does the cardiac output of a neonate compare to an adult

A

CI is twice that of an adult
Stroke volume is 30% less than an adult
So the heart rate is much higher to maintain a higher CO

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6
Q

At what age does the foals HR near the same as an adult

A

4 months

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7
Q

At what age does the foals stroke volume increase and CI decrease

A

About 1 month

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8
Q

How do PaO2 and PaCO2 values of foals compare to adults

A

PaO2 values are lower as foals lack the ability to fully inflate their lungs as the parenchyma is not very compliant, it requires more negative pressure.

PaCO2 is similar to an adult

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9
Q

What is the O2 requirement of a neonate

A

6-8ml/kg/min
2-3 times more than adult

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10
Q

Resp rate of a neonate

A

60-89 bpm

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11
Q

What is auto-PEEP

A

Auto positive end expiratory pressure
Neonates close the upper airway at the end of expiration not allowing the lung to collapse easily

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12
Q

What is the total body water content of a foal

A

72-74% of its BW

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13
Q

How much milk in grams does a foal consume at 11-18 days and 30-44 days old

A

246g/kg
202g/kg

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14
Q

Maintenance fluid rate for foal

A

3.5-5ml/kg/hr
100ml/kg/day for first 10kg
50ml/kg/day for second 10kg
20-25ml/kg/day for remaining BW

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15
Q

How do foals kidneys compare with adult

A

Greater renal tubular internal surface for resorption but reduced renal concentrating ability

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16
Q

Normal urine output for foal <12weeks

A

6ml/kg/hr

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17
Q

Normal BUN for foal <3months

A

<2mmol/L (<6mg/dl)

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18
Q

What % of BW is the blood volume in foals <12weeks

A

13-15%

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19
Q

What are the risks of using diazepam for repeated bumps of sedation

A

Propylene glycol vehicle:
Metabolic Acidosis
Nephrotoxicity
hyperosmoliarity
Tissue irritation
hemolysis

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20
Q

MAC of iso in foal vs adult

A

Foal 0.84%
Adult 1.3-1.6%

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21
Q

plasma 1/2 life of alfaxalone in neonates

A

23 mins

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22
Q

Xylazine use in older foals has been shown to cause what specific changes unlike adult horses

A

No AV block typically
Hypothermia
No hypoinsulinemia
No hyperglycaemia

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23
Q

What dose of Xylazine is advised for 2-3 month old foals

A

0.2-0.3mg/kg/iv

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24
Q

What is the induction of choice for foal with seizures or brain trauma

A

Thiopental with a benzodiazepine or guaifenesin

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25
Q

Guaifenesin use in foals

A

> 3-4 months
2-3ml/kg/min

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26
Q

Tube size for a 70-100kg
and a 150-200kg foal

A

14-16mm
18-22mm

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27
Q

Fresh gas flow rate for a foal?

A

6ml/kg/min

28
Q

Lidocaine CRI rate for foal

A

1.2-1.5mg/kg bolus
50ug/kg/min cri

29
Q

Ketamine CRI rate for foals

A

50ug/kg/min for 45mins
the 25ug/kg/min

30
Q

Triple drip formulation and rate

A

5% Guaifenesin
250mg/1L Xylazine
1gram/1L Ketamine

2-3ml/kg/min

31
Q

Minimally invasive methods for assessing CO in foals under GA

A

LidCO Lithium dilution technique
NICO Non-invasive CO technique

32
Q

An ETCO2 above what indicates hypoventilation

A

45mmHg

33
Q

An ETCO2 below what indicated hyperventilation

A

35mmHg

34
Q

Blood glucose levels below what may have negative consequences in the anaesthetised foal

A

40mg/dl

35
Q

Which IV fluids are advised in the anaesthetised foal

A

Balanced electrolyte sole with strong ion difference SID 28-50 eg LRS, Plasmalyte, Normosol to avoid the acidifying effects of physiologic saline solution 0% or 5% dextrose in water

36
Q

In a systemically healthy foal undergoing GA what is the advised fluid rate

A

7.5-10ml/kg/hr

37
Q

In a hypovolemic foal what is the advised fluid protocol

A

Can go up to 5x the maintenance rate of 3-5ml/kg/hr

Usually 50-80ml/kg given 1/3 at a time reassessing regularly

38
Q

Colloid protocol in foals

A

Hetastarch 3ml/kg at a rate of 10ml/kg/hr supplementing crystalloid therapy

39
Q

Pressure targeted ventilation

A

Peak inspiratory pressure is limited while volume is variable and dependent on lung mechanics

40
Q

Volume targeted ventilation

A

Volume is limited and peak inspiratory pressure is variable

Preferred method - less lung injury

41
Q

Typical mechanical ventilation protocol in foals

A

Tidal volume: 6-8ml/kg
Rate: 20-30min
Peak flow: 60-90ml/min
I:E Ratio: 1:2
Peak inspiratory pressure: 8-12cmH20

42
Q

NSAID use in foals

A

Volume of distribution is greater so increase the dose to 1.5 times the adult dose but also increase the intervals as increased 1/2 life

43
Q

Butorphanol use in foals

A

0.05mg/kg
1/2 life 2.1 hours
Bioavailablility 66%
double the 1/2 life and bioavailability as adults
Also increases nursing

44
Q

What plasma conc of butorphanol is required to have antinociceptive action

A

10ng/ml

45
Q

Butorphanol CRI rate for analgesia.

A

13-25ug/kg/hr

46
Q

Peak plasma conc of fentanyl following patch placement

A

14 +- 8 hours
returned to baseline 12 hours after removal

47
Q

Treatment of ventricular tachyarrhythmia

A

Lidocaine bolus
1mg/kg/iv
subsequent doses of 0.5 - 0.75mg/kg as required
or
Quinidine Gluconate
0.5-2.2mg/kg IV every 10mins
or
Propranolol Hydrochloride
0.03-0.1mg/kg

48
Q

How is bradycardia addressed in foals

A

Atropine SA; 5-20ug/kg/iv
or
Ephedrine Sulfate 25-50ug/kg/iv
Ephedrine HCl 5-10ug/kg/iv

49
Q

Most frequent hemodynamic complication during anaesthesia

A

Systemic arterial hypotension

50
Q

How to address hypotension

A

Volume replacement therapy (<5 times the 3-5ml/kg/hr maintenance level)

Dobutamine 1-5ug/kg/min
Phenylephrine 0.1-3.0 ug/kg/min
Norepinephrine 0.05-1.5ug/kg/min

51
Q

What % of foals experience hypercarbia under GA

A

20%

52
Q

What % of foals experience hypoxia under GA

A

1%

53
Q

When should return to foetal circulation be suspected

A

Newborn foal
No cyanosis on presentation
Desaturates during GA - SaO2<80%
PaO2 decreasing 20-40mmHg despite 100% O2 flow mechanical ventilation

54
Q

How to treat return to foetal circulation

A

Increase anaesthetic depth to reduce pulmonary vascular resistance
Sildenafil Inj 0.5-2.5mg/kg/iv
(Type 5 phosphodiesterase inhibitor)
arterial vasodilation - decreases pulmonary hypertension

55
Q

What arrhythmia are most commonly associated with cardiac arrest in foals

A

PEA - Pulseless electrical activity
Aystole

56
Q

RECOVER procedure guidelines

A
  1. Chest compressions 100/min
  2. Ventilation support
  3. Initiate ECG/ETCO2
  4. Vascular access
  5. Reversal agents
57
Q

Which are the only drugs which have proven efficacy in cardiac arrest

A

Epinephrine - strong vasoconstriction
0.01-0.02mg/kg every 3 mins iv
if no iv 0.05-0.1mg/kg endotracheal diluted to 2cc in saline

Vasopressin - strong vasoconstrictor and high pressor
0.6-0.8IU/kg as a single dose
Effect may last 10-20mins

58
Q

Use of defibrillator

A

2j/kg then 4j/kg every 30-60secs

59
Q

Uroperitoneum electrolyte abnormalities

A

Hyperkalemia
Hypocloremia
Hyponatremia

also
Increased serum creatinine

60
Q

What type murmur is often auscultated in uroperitoneum foals

A

Type 2 systolic

61
Q

What occurs once plasma K+ reaches 5mEq/mL

A

Progressive changes in the ECG - Flattening of P waves
Widening of QRS complexes
Tented T waves

62
Q

How can serum K+ be decreased

A

Insulin 0.1-0.3 IU/Kg slowly iv in 2.5-5% dextrose over 30-45mins

63
Q

Once K+ is decreased how is the uroperitonuem foal further stabilised

A

Low K+ fluids <5mEq/L
Hypertonic saline may correct Na+ and Cl- deficit

64
Q

At what Na+ concentrations do seizures occur

A

110mEq/L

65
Q

Most common life threatening arrhythmia of uroperitoneum foals

A

3rd degree AV block

66
Q

Tx for 3rd degree AV block

A

Stop surgical stimulation
Atropine 20-40 ug/kg IV
and or
Ephedrine 25 - 50 ug/kg IV
if not effective
Epinephrine 10-20ug/kg IV
Closed chest massage

67
Q

Average hemodynamic and resp parameters in foals

A

HR 66 +-18
SAP 103 +- 14 mmHg
DAP 58 +- 12 mmHg
MAP 76 +- 12 mmHg
RR 9 +- 4

Eq ACVS Phase 1 (72 decks)

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