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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
Guaifenesin use in foals
>3-4 months 2-3ml/kg/min
26
Tube size for a 70-100kg and a 150-200kg foal
14-16mm 18-22mm
27
Fresh gas flow rate for a foal?
6ml/kg/min
28
Lidocaine CRI rate for foal
1.2-1.5mg/kg bolus 50ug/kg/min cri
29
Ketamine CRI rate for foals
50ug/kg/min for 45mins the 25ug/kg/min
30
Triple drip formulation and rate
5% Guaifenesin 250mg/1L Xylazine 1gram/1L Ketamine 2-3ml/kg/min
31
Minimally invasive methods for assessing CO in foals under GA
LidCO Lithium dilution technique NICO Non-invasive CO technique
32
An ETCO2 above what indicates hypoventilation
45mmHg
33
An ETCO2 below what indicated hyperventilation
35mmHg
34
Blood glucose levels below what may have negative consequences in the anaesthetised foal
40mg/dl
35
Which IV fluids are advised in the anaesthetised foal
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
In a systemically healthy foal undergoing GA what is the advised fluid rate
7.5-10ml/kg/hr
37
In a hypovolemic foal what is the advised fluid protocol
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
Colloid protocol in foals
Hetastarch 3ml/kg at a rate of 10ml/kg/hr supplementing crystalloid therapy
39
Pressure targeted ventilation
Peak inspiratory pressure is limited while volume is variable and dependent on lung mechanics
40
Volume targeted ventilation
Volume is limited and peak inspiratory pressure is variable Preferred method - less lung injury
41
Typical mechanical ventilation protocol in foals
Tidal volume: 6-8ml/kg Rate: 20-30min Peak flow: 60-90ml/min I:E Ratio: 1:2 Peak inspiratory pressure: 8-12cmH20
42
NSAID use in foals
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
Butorphanol use in foals
0.05mg/kg 1/2 life 2.1 hours Bioavailablility 66% double the 1/2 life and bioavailability as adults Also increases nursing
44
What plasma conc of butorphanol is required to have antinociceptive action
10ng/ml
45
Butorphanol CRI rate for analgesia.
13-25ug/kg/hr
46
Peak plasma conc of fentanyl following patch placement
14 +- 8 hours returned to baseline 12 hours after removal
47
Treatment of ventricular tachyarrhythmia
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
How is bradycardia addressed in foals
Atropine SA; 5-20ug/kg/iv or Ephedrine Sulfate 25-50ug/kg/iv Ephedrine HCl 5-10ug/kg/iv
49
Most frequent hemodynamic complication during anaesthesia
Systemic arterial hypotension
50
How to address hypotension
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
What % of foals experience hypercarbia under GA
20%
52
What % of foals experience hypoxia under GA
1%
53
When should return to foetal circulation be suspected
Newborn foal No cyanosis on presentation Desaturates during GA - SaO2<80% PaO2 decreasing 20-40mmHg despite 100% O2 flow mechanical ventilation
54
How to treat return to foetal circulation
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
What arrhythmia are most commonly associated with cardiac arrest in foals
PEA - Pulseless electrical activity Aystole
56
RECOVER procedure guidelines
1. Chest compressions 100/min 2. Ventilation support 3. Initiate ECG/ETCO2 4. Vascular access 5. Reversal agents
57
Which are the only drugs which have proven efficacy in cardiac arrest
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
Use of defibrillator
2j/kg then 4j/kg every 30-60secs
59
Uroperitoneum electrolyte abnormalities
Hyperkalemia Hypocloremia Hyponatremia also Increased serum creatinine
60
What type murmur is often auscultated in uroperitoneum foals
Type 2 systolic
61
What occurs once plasma K+ reaches 5mEq/mL
Progressive changes in the ECG - Flattening of P waves Widening of QRS complexes Tented T waves
62
How can serum K+ be decreased
Insulin 0.1-0.3 IU/Kg slowly iv in 2.5-5% dextrose over 30-45mins
63
Once K+ is decreased how is the uroperitonuem foal further stabilised
Low K+ fluids <5mEq/L Hypertonic saline may correct Na+ and Cl- deficit
64
At what Na+ concentrations do seizures occur
110mEq/L
65
Most common life threatening arrhythmia of uroperitoneum foals
3rd degree AV block
66
Tx for 3rd degree AV block
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
Average hemodynamic and resp parameters in foals
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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