Chapter 19 - Anesthesia and Analgesia for foals

Question 1

What is considered neonate?

Answer 1

0-1 month

Question 2

What is considered pediatric?

Answer 2

1-3 months

Question 3

What is considered juvenile

Answer 3

3 - 4 months

Question 4

Patients under 1 year old the perioperative moratlity rate is ___%
Older than 1 year old?

Answer 4

1.9% - baby
1% adult

Question 5

What is the definition of cardiac output?

Answer 5

Amount of blood ejected by heart per minute and is calculated as product of HR (min) and stroke volume (mL)

Question 6

Cariovascular: When they are neonate (<1month) they are dependent on HR or Stroke volume for cardiac output?

Answer 6

HR

Question 7

Cardiovascular pediatric (1-4mo) it is more HR or Stroke Volume?
Increased or decreased systemic vascular resistance?

Answer 7

More SV less HR dependent cardiac output
Increasing systemic vascular resistance

Question 8

In Neonate (<1mo) is this TRUE or FALSE?
High Respiratory Rate-dependent Volume per minute and low min, low VT (tidal volume)

Answer 8

True

Question 9

In Neonate (<1mo) is this TRUE or FALSE? High O2 consumption but low PaO2

Question 10

Neonates have higher or lower BBB permeability?

Answer 10

Higher

Question 11

In Pediatric juvenile (1-4mo) the Vmin and RR are higher or lower?
VT is is low, high or normal?

Answer 11

Higher minute ventilation volume (Vmin) and RR
Normal Volume Tidal

Question 12

Neonates have higher ECG (extracellular fluid volume) or lower?

Answer 12

Higher compartment circulating blood volume (CBV) and circulating plasma volume (CPV)

Question 13

neonates have high or low glycogen reserves?

Answer 13

Low glycogen reserves

Question 14

In neonates the high body surface area predisposes to what?

Answer 14

Heat loss

Question 15

When does the liver starts to mature?

Answer 15

3-4 weeks

Question 16

The PCV in neonates if decreased is often due to what?

Answer 16

isoerythrolysis

Question 17

When does the PCV normalize, the WBC is the normal of adult and elevated serum enzyme activities are present?

Answer 17

Pediatric/juvenile foal of 1-4 months

Question 18

series of extracardiac shunts (ductus venosus, patent ductus arteriosus) and intracardiac communication (foramen ovale) are necessary for what in fetal stage?

Answer 18

To suply deoxygenated blood to the placenta and return oxygenated blood to systemic organs

Question 19

Oxygenated blood arriving in the fetus via the umbilical vein flows through the _________________________ (2 words) and _____________ (2 words) towards the ____________ side of the heart

Answer 19

ductus venosus and the caudal vena cava towards the right side of the heart

Question 20

Having entered the right atrium, most blood is diverted away from the noninflated lung to the _______ atrium via the _____________________ (2 words)

Answer 20

left atrium via the foramen ovale an opening in the atrial septum that connects both atria

Question 21

Only a small portion of the blood that entered the _____ atrium continues its path through the _______ ventricle into pulmonary artery

Answer 21

right atrium right ventricle

Question 22

from the pulmonary artery, it bypasses the lung by flowing through the patent ductus arteriosus into the __________

Answer 22

into the aorta a process that depends on the high pulmonary arterial resistance prevailing within the fetus’s not yet aerated lung

Question 23

At birth, the function of gas exchange is abruptly transferred from the placenta to the lungs by activation from systemic to _____________ circulation

Answer 23

pulmonary

Question 24

Due to aeration of the lungs a dramatic _______________ increase/decrease in pulmonary arterial resistance, thereby promoting blood flow through the pulmonary vasculature

Answer 24

decrease in pulmonary arterial resistance - As a result, the blood pressure in the left atrium increases relative to the pressure in the right atrium, pushing a valve that lies over the foramen ovale on the left side of the atrial septum against it and thus largely preventing any further right-to-left blood flow through the foramen ovale

Question 25

decrease in circulating __________________ that accompanies perinatal adaptation also promotes the closure of the ductus arteriosus over time.

Answer 25

prostaglandins

Question 26

Fulfilling the needs of metabolically highly active organs and tissues during early postnatal life, the CI in resting foals up to 2 to 3 months of age is markedly ___________ when compared to adults

Answer 26

Higher

Question 27

Are heart murmurs normal in the first 3 to 5 days of life?

Answer 27

yes, closing of the ductus arteriosus does not occur immediately at birth and therefore right-to-left shunting may continue; murmurs consistent with a patent ductus arteriosus may be auscultated and blood flow within the ductus arteriosus

Question 28

Define cardiac index (CI)

Answer 28

Cardiac output is the amount of blood ejected by heart per minute (min) and is calculates as the product of heart rate (min) and stroke volume (mL) and when normalized to body weight is reffered to as the cardiac index (CI) (mL/min/kg).

Question 29

CI is higher or lower in foals up to 2 to 3 monthscompared to adults

Answer 29

higher, average CI in foals is approximately twice that of adults, but the average stroke volume index 30% less –> that is why HR is high to maintain CO

Question 30

What is the incovenient ot give α2-adrenoceptor agonists in foals?

Answer 30

may compromise hemodynamic function to an extent that the neonate cannot tolerate. From 4 months of age onward, heart rates reach close to adult values and remain relatively stable throughout the remainder of the first yea

Question 31

Systemic arterial blood pressure is higher or lower in early days of life?

Answer 31

Lower, but pulse pressure amplitude is higher in the neonate compared to the adult owing to a lower vasomotor tone and hence systemic vascular resistance

Question 32

By 1 month of age foals tend to have a _________ CI and HR but a ______ SV and their mean arterial pressure increases during this period because of a marked__________in vascular resistance indicative of the maturing sympathetic branch of the autonomic nervous system.

Answer 32

By 1 month of age foals tend to have a lower CI and heart rate but a larger stroke volume, and their mean arterial pressure increases during this period because of a marked increase in vascular resistance indicative of the maturing sympathetic branch of the autonomic nervous system.

Question 33

Poney lung are more mature or less mature than horse lungs?

Answer 33

Poney lung are more mature

Question 34

In foals functional residual capacity (FRC; i.e., the gas volume left in the lung after a normal expiration) and tidal volumes are markedly _________than in the adult

Answer 34

smaller

Question 35

first week postpartum, O2 consumption how many mL/kg/min

Answer 35

6-8 mL/kg/min exceeds that of the adult horse by two- to threefold, requiring increased respiratory minute ventilation

Question 36

FRC and tidal volume, newborn foals typically breath up to ____ to ____ times per minute,

Answer 36

60-80 times per minute, which in the 4th to 6th week declines to 30 to 40 breaths per minute for the remainder of the first 3 months of life before gradually approaching adult values

Question 37

newborn foal the total body water content in %

Answer 37

72 to 74% of total body mass and does not change over first 5 months of life

Question 38

The extracellular fluid (ECF) compartment is about ______third larger in foals on a per kilogram body weight basis than in adults

Answer 38

The extracellular fluid (ECF) compartment is about one third larger in foals on a per kilogram body weight basis than in adults

Question 39

because of the higher capillary permeability in the neonate yet greater systemic arterial blood pressures postpartum, intravascular water rapidly redistributes into the ______________________ (2 words)

Answer 39

because of the higher capillary permeability in the neonate yet greater systemic arterial blood pressures postpartum, intravascular water rapidly redistributes into the interstitial space where it accumulates

Question 40

Maintenance fluid rates in neonatal foals

Answer 40

80 to 120 mL/kg/day (3.5–5.0 mL/kg/h) is required in foals up to 1 month of age

Question 41

Based on the Holliday-Segar formula, the daily fluid requirements can be calculated for each individual foal as:

Answer 41

100 mL/kg/day for the first 10 kg of body weight (BW) + 50 mL/kg/day for the second
10 kg of BW + 20 to 25 mL/kg/day for the remaining BW

Question 42

Why is teh foal more susceptible to hypoglycemia?

Answer 42

Glycogen reserves in liver and muscle are smaller in the newborn foal than in neonates of other species and last only for a few hours

Question 43

What is the value of hypoglicemia in foals poorer survival to hospital discharge and was commonly associated with sepsis, systemic inflammatory response syndrome (SIRS), and bacteremia?

Answer 43

glucose<75mg/dL

Question 44

What is the rectal temperature of foals

Answer 44

rectal temperature of foals ranges from 37.2°C to 38.6°C

Question 45

equine neonates have the ability to generate heat through _______

Answer 45

shivering

Question 46

Where is the principal site of drug metabolism?

Answer 46

Liver

Question 47

Name the primarily responsible for transforming lipophilic compounds less effective or inactive substances (phase I reactions)

Answer 47

cytochrome P450 enzyme system

Question 48

glucuronidation and other conjugation processes (phase II reactions) render the metabolites more ___________ (1word)

Answer 48

hydrophilic

Question 49

At what time most of hepatic metabolic pathways are completely functioning?

Answer 49

6-12 weeks postpartum

Question 50

Normal urine output in neonatal foals is reported to be

Answer 50

6 mL/kg/h but then decreases gradually over the subsequent 12 weeks of life

Question 51

normal urine specific gravity in newborn foals, after the first 24 hours postpartum, is usually ______________ (hypo/iso/hypersthenuric) and is reported to range from 1.001 to 1.027

Answer 51

normal urine specific gravity in newborn foals, after the first 24 hours postpartum, is usually hyposthenuric (<1.008) and is reported to range from 1.001 to 1.027

Question 52

Blood volume in neonates is _____________higher/lower than in adults

Answer 52

Blood volume in neonates is higher than in adults (approximately 13%–15% of total body weight),

Question 53

Marked hyperbilirubinemia in the first week of life is a common finding and can be attributed to ……

Answer 53

to an accelerated breakdown of neonatal erythrocytes and immature hepatic function

Question 54

Serum enzyme activities (including creatinine kinase, sorbitol dehydrogenase, γ-glutamyl transferase, lactate dehydrogenase, and aspartate aminotransferase) have been reported to be transiently elevated in the first few weeks after birth. Why?

Answer 54

as a result of hepatocellular maturation

Question 55

Serum lactate concentrations are high immediately after birth. What value?

Answer 55

Serum lactate concentrations are high immediately after birth (3–5 mmol/L), likely because of temporary tissue hypoperfusion and hypoxia, but then soon decrease to normal values (<2 mmol/L).

Question 56

Dosage midazolam (benzodiazepine) for sedation of neonate

Answer 56

0.05–0.1 mg/kg
If, however, sedation is required or the animal is older than 2 to 3 weeks, a benzodiazepine derivative is the preferred choice for lack of serious adverse cardiopulmonary effects.

Question 57

Dosage diazepam (benzodiazepine) for sedation of neonate

Answer 57

0.1–0.25 mg/kg
If, however, sedation is required or the animal is older than 2 to 3 weeks, a benzodiazepine derivative is the preferred choice for lack of serious adverse cardiopulmonary effects.

Question 58

Dosage lorazepam (benzodiazepine) for sedation of neonate

Answer 58

0.02–0.05 mg/kg If, however, sedation is required or the animal is older than 2 to 3 weeks, a benzodiazepine derivative is the preferred choice for lack of serious adverse cardiopulmonary effects.

Question 59

Dosage climazolam (benzodiazepine) for sedation of neonate

Answer 59

0.1–0.2 mg/kg
If, however, sedation is required or the animal is older than 2 to 3 weeks, a benzodiazepine derivative is the preferred choice for lack of serious adverse cardiopulmonary effects.

Question 60

α2-Agonists (not preferred in neonates only >8w)
* Xylazine in neonates

Answer 60

Xylazine 0.2–0.5 mg/kg

Question 61

Supplementation of α2-Agonists with morphine say dosage in neonates

Answer 61

morphine 0.03-0.06 mg/kg

Question 62

Supplementation of α2-Agonists with L-methadone say dosage in neonates

Answer 62

L-methadone 0.05 mg/kg

Question 63

Supplementation of α2-Agonists with burtphanol say dosage neonates

Answer 63

Butorphanol 0.05–0.1 mg/kg and in juvenile is 0.02-0.1 mg/kg

Question 64

For induction you can use Injectable anesthetics (after sedation)
* Alfaxalone
* Ketamine
* Propofol say dosage of each

Answer 64

Alfaxalone 1.0–3.0 mg/kg
* Ketamine 2.0–2.5 mg/kg
* Propofol 2.0–2.5 mg/kg

Question 65

TIVA in neonates is with propofol and in juvenile? say dosage

Answer 65

Propofol 0.2–0.4 mg/kg/min

Juvenile: TIVAa
* Triple-drip CRI
* Alfaxalone 0.03 mg/kg/min−1
* Propofol 0.1–0.3 mg kg/min−

Question 66

Dosage of acepromazine alone for the mare

Answer 66

0.02-0.05 mg/kg IV/IM

Question 67

Wha are the consequences of propylene glycol veichule in certai benzodiazepine such as diazepam lorazepam and climazolam?

Answer 67

can cause metabolic acidosis, nephrotoxicity, hyperosmolarity, and subsequent tissue irritation and hemolysis

Question 68

benzodiazepine’s effects can be reversed at the end of the procedure using what?

Answer 68

Flumazenil 0.025-0.1 mg/kg IV

Question 69

opiods’s effects can be reversed at the end of the procedure using

Answer 69

Naloxone (10-15 μg/kg IV), or levallorphan (Lorfan; 22 μg/kg IV),

Question 70

xylazine effects can be reversed at the end of the procedure using

Answer 70

yohimbine or atipamezole
(Yocon; 0.1–0.2 mg/kg IM) or atipamezole (Antisedan; 0.05–
0.2 mg/kg IV/IM)

Question 71

Advantage of using volatile anestehtic alone in neonates (1) both rapid uptake and elimination of the anesthetic via the lungs why?

Answer 71

(1) both rapid uptake and elimination of the anesthetic via the lungs because of high minute ventilation and CO;

Question 72

volatile anesthetics have greater potency in early life?

Answer 72

yes isoflurane minimal alveolar concentration [MAC] of 0.84% in the equine neonate versus 1.3%–1.6% in adult horses)

Question 73

does the elimination of the anesthetic occur independently of hepatic and renal function?

Answer 73

yes

Question 74

Depending on the age and hence size of the animal,how many L rebreathing bags or bellows are sufficient?

Answer 74

3- to 5-L rebreathing bags or bellows are sufficient

Question 75

Sevoflurane and desflurane are characterized by a _% and __% lower blood solubility than isoflurane,

Answer 75

Sevoflurane and desflurane are characterized by a 50% and 64% lower blood solubility than isoflurane,

Question 76

ketamine lasts how much time

Answer 76

10 to 20 minutes

Question 77

Thiopental in conjunctionwith benzodiazepine or guaifenesin is suitable for induction in foals with which type of conditions?

Answer 77

Seizures and brain trauma

Question 78

Neonates and juveinle foals general anesthesia s maintained with isoflurane - wich MAC?

Answer 78

1.3-1.6% Iso or 2.3-2.8% Sevoflurane

Question 79

What size is the nasotracheal tube in foals?

Answer 79

6-9mm ID

Question 80

What size is the endotracheal tube?

Answer 80

8-14 mm ID

Question 81

Bolus and infusion dosage of lidocaine

Answer 81

50 μg/kg/min after an IV bolus of 1.2–1.5 mg/kg

Question 82

Triple drip refers to a combination of which drugs and what dosage?

Answer 82

Ketamine 1g/L
Xilazine 250 mg/L
Guaifenesin solution
Drip maintenace is 2 to 3 mL/kg/h

Question 83

What are the parameters for monitoring anesthesia depth?

Answer 83

Physical signs such as
1 - position of the eye globe, 2 - nystagmus,
3 - degree of depression of protective eye reflexes (palpebral and corneal), 4 - presence or loss of swallowing reflex,
5 - rate and depth of breathing, lacrimation,
6 - skeletal muscle shivering/trembling or tightening,
7- anal sphincter reflex, as well as hemodynamic responses to noxious stimulation are commonly evaluated

Question 84

Mention the 4 peripheral arteries used for invasive method by catheterization

Answer 84

1 - facial
2 - transverse facial
3- auricular
4 - metatarsal artery

Question 85

In critical ill foal what are the additional hemodynamic monitoring?

Answer 85

central venous pressure
urine output
cardiac output

Question 86

What are the minimal invasive tx that have been developed to assess cardiac output?

Answer 86

Lithium dilution (LidCO) tx
Non invasive cardiac output tx NICO based on the FIck principle and partial rebreathing of Co2 and US velocity dilution tx (UCDO)

Question 87

Where can you place the continuous monitoring of arterial hemoglobin oxygen saturation by pulse oximetry=

Answer 87

By nninvasive tx of clipe-type probe on the:
ear
tongue
nonpigmented skin
nonpigmented mucosa

Question 88

The PaCo2 changes proportionately with metabolic activity and inversely with its _____________ (1word)

Answer 88

elimination (i.e., alveolar ventilation).

Question 89

value in excess of 45 mm Hg (hypercapnia) indicates

Answer 89

hypoventilation,

Question 90

alue below 35 mm Hg (hypocapnia) indicates

Answer 90

hyperventilation

Question 91

limited glycogen reserves in the neonate make it susceptible to the development of hypoglycemia during prolonged anesthesia. When do we consider long?

Answer 91

> 1–1.5 h

Question 93

glucose levels below _____mg/dL may produce deleterious central nervous effects such as seizure activity, cerebral depression, and even permanent neuronal damage

Answer 93

40 mg/dL

Question 94

blood glucose concentration has been identified as a prognostic indicator in critically ill neonatal foals - TRUE or FALSE

Answer 94

TRUE

Question 95

temperature should be continuously monitored in 3 places name them

Answer 95

pharyngeal
esophageal
rectal

Question 96

Systemically healthy normovolemic foal under GA the infusion rate taht has been reported as adequate to maintain an appropriate circulatory volume?

Answer 96

the maintenance rate of 3 to 5 mL/kg/h reported for foals.

Question 97

In adults, 20% to 50% (dependent, in part, on the state of hypovolemia and dehydration) of an isotonic fluid load is retained in the intravascular space ___ to ____ minutes after infusion

Answer 97

30 to 60 minutes after infusion

Question 98

The fluid load in neonates is much _______ (1w) where fluid rapidly accumulates in the interstitial space and escapes regulatory mechanisms of fluid homeostasis.

Answer 98

The fluid load in neonates is much _______ (1w) where fluid rapidly accumulates in the interstitial space and escapes regulatory mechanisms of fluid homeostasis. As a result, neonates retain infused fluids for a long time and do not handle large fluid loads well. The situation is further complicated by a decrease in urine output under anesthesia

Question 99

Dehydration and absolute hypovolemia as a result of persistent diarrhea, sepsis, septic shock, heat shock, or acute hemorrhage require immediate intravenous fluid substitution dosage mL/kg

Answer 99

50 to 80 mL/kg, typically given one third at a time followed by reassessment of the foal’s volume status

Question 100

Colloids, including synthetic solutions (e.g., dextrans, hetastarch, pentastarch), and plasma may be required if the TPP or albumin concentrations are ______and are used to supplement __________fluid therapy.

Answer 100

Colloids, including synthetic solutions (e.g., dextrans, hetastarch, pentastarch), and plasma may be required if the TPP or albumin concentrations are low crystalloid and are used to supplement crystalloid fluid therapy

Question 101

Hetastarch at doses of ___ mL/kg at a rate of ___ mL/kg/h supplements crystalloid fluid therapy under those circumstances for rapid volume support.

Question 102

hetastarch may be administered slowly (0.5–1.0 mL/kg/h) up to a dose of ____mL/kg/day for treatment in hypooncotic animals

Answer 102

hetastarch may be administered slowly (0.5–1.0 mL/kg/h) up to a dose of 10 mL/kg/day for treatment in hypooncotic animals

Question 103

Oxygen may be delivered via face mask, nasal cannulae, or a nasotracheal tube and at a rate of___ to ____ L/min.

Answer 103

Oxygen may be delivered via face mask, nasal cannulae, or a nasotracheal tube and at a rate of 5 to 10 L/min.

Question 104

Why should oxygen be humidified?

Answer 104

O2 should be humidified by means of a bubble humidifier to minimize nasal and tracheal mucosal irritation and avoidable water losses in the foal, if applied over several hours.

Question 105

What are the multiple factors may contribute to severe respiratory depression and impairment of pulmonary gas exchange leading to poor arterial oxygenation and CO2 retention

Answer 105

persistent pulmonary hypertension,
drug-induced central respiratory center depression,
reduced FRC, exhaustion of respiratory muscles from increased work of breathing,
immature lung, lung disease,
and airway obstruction

Question 106

Among all different modes of mechanical (i.e., positive pressure) ventilation, controlled ____________________(2w) is the mode most commonly used during equine anesthesia in foals.

Answer 106

Among all different modes of mechanical (i.e., positive pressure) ventilation, controlled mandatory ventilation (CMV) is the mode most commonly used during equine anesthesia in foals.

Question 107

Mechanical ventilation may be employed in two different modalities:

Answer 107

pressure-limited (targeted) or volume-limited (targeted) ventilation

Question 108

Mechanical ventilation in the neonatal foal are a tidal volume of __ to __ mL/kg, a rate of __ to ___ min(−1), a peak flow of ___ to ___ mL/min, I:E ratio of 1 : 2, and a peak inspiratory pressure of ___ to ___ cm H2O

Answer 108

Typical settings to begin mechanical ventilation in the neonatal foal are a tidal volume of 6 to 8 mL/kg, a rate of 20 to 30 min−1, a peak flow of 60 to 90 mL/min, I:E ratio of 1 : 2, and a peak inspiratory pressure of 8 to 12 cm H2O.47

Question 109

It is not necessary to ventilate foals with 100% O2 - TRUE or FALSE

Answer 109

True

Question 110

opioid agonist-antagonist butorphanol (0.05 mg/kg IV/IM) has been tested in newborn. The elimination half-life was__________ hours

Answer 110

the elimination half-life was 2.1 hours after IV injection

Question 111

butorphanol exhibits antinociceptive properties only after doses of _____ mg/kg and if plasma concentrations of the drug reach or exceed a threshold of ___ ng/mL

Answer 111

butorphanol exhibits antinociceptive properties only after doses of 0.1 mg/kg and if plasma concentrations of the drug reach or exceed a threshold of 10 ng/mL

Question 112

Name the dosages:
Flunixin meglumine IV/IM q 24–36 h
* ____mg/kg (foal <24 h)
* _____ mg/kg (foal 1–4 wks)
Phenylbutazone____mg/kg IV/PO q 12–24 h
Meloxicam ______ mg/kg IV q 8–12 h
Ketoprofen ____ mg/kg IV q 24 h
Ibuprofen ______ mg/kg IV/PO q 8 h

Answer 112

Flunixin meglumine IV/IM q 24–36 h
* 1.4 mg/kg (foal <24 h)
* 0.5–1.0 mg/kg (foal 1–4 wks)
Phenylbutazone 2.2 mg/kg IV/PO q 12–24 h
Meloxicam 0.5–0.6 mg/kg IV q 8–12 h
Ketoprofen 1–2 mg/kg IV q 24 h
Ibuprofen 10–20 mg/kg IV/PO q 8 h

Question 113

Name the dosages: Butorphanol ____-____ mg/kg IV
Butorphanol ___–___ mg/kg IM
Buprenorphine ____ mg/kg IM
Morphine __–___ mg/kg IV, IM
L-Methadone ____–___ mg/kg IV, IM
Transdermal fentanyl (____-μg/h patch)

Answer 113

Butorphanol 0.01–0.04 mg/kg IV
Butorphanol 0.02–0.08 mg/kg IM
Buprenorphine 0.01 mg/kg IM
Morphine 0.1–0.2 mg/kg IV, IM
L-Methadone 0.05–0.1 mg/kg IV, IM
Transdermal fentanyl (100-μg/h patch)

Question 114

Xylazine ___–___ mg/kg IV (use sparingly in foal colic because of adverse effects on cardiovascular and respiratory systems and GI motility)
Medetomidine ___–___μg/kg SQ
Dexmedetomidine ___–____ μg/kg SQ

Answer 114

Xylazine 0.1–0.5 mg/kg IV (use sparingly in foal colic because of adverse effects on cardiovascular and respiratory systems and GI motility)
Medetomidine 1–2 μg/kg SQ
Dexmedetomidine 0.5–1.0 μg/kg SQ

Question 115

Lidocaine 30–___ μg/kg/min following 1.3–1.5 mg/kg IV loading dose

Answer 115

Lidocaine 30–50 μg/kg/min following 1.3–1.5 mg/kg IV loading dose

Question 116

aDetomidine doses of 10–20 μg/kg have frequently been associated with significant

Answer 116

(brady-)arrhythmias

Question 117

Intra-articular preservative-free morphine dosage to provide analgesia in foals affected by septic arthritis/synovitis

Answer 117

0.05 mg/Kg

Question 118

Fentanyl patches have been tested and after patch placement and plasma concentrations peaked after ____±8 hours and returned to baseline concentrations ____ hours after patch removal

Answer 118

after patch placement and plasma concentrations peaked after 14±8 hours and returned to baseline concentrations 12 hours after patch removal

Question 119

atrioventricular conduction in bradyarrhythmias should be restored with waht?

Answer 119

Atropine 5–20 μg/kg IV and if doesn’t work
indirect sympathomimetic drug ephedrine 25–50 μg/kg IV
or epinephrine 5–10 μg/kg

Question 120

Ventricular tachyarrhythmias are treated with

Answer 120

lidocaine as an initial bolus of 1 mg/kg IV followed by subsequent IV doses of 0.5 to 0.75 mg/kg as required or by CRI (20–50 μg/kg/min)

Question 121

If the lidocaine is unsucessful what should you use?

Answer 121

quinidine gluconate (Quinidine Gluconate Injection, USP; 0.5–2.2 mg/kg IV every 10 min) or propranolol 0.03–0.1 mg/kg IV may be administered to control the dysrhythmia.

Question 122

In case of systemic arterial hypotension you should treat with

Answer 122

Volume-replacement therapy

Question 123

In case of hypotension if Volume-replacement therapy fails what should you give?

Answer 123

infusion of dobutamine 1arily used as a positive chronotropic agent in the neonate;
1–5 μg/kg/min
phenylephrine (0.1–3.0 μg/kg/min),
norepinephrine (0.05–1.5 μg/kg/min) titrated to effect or IV ephedrine injections at increments of 0.05–0.1 mg/kg are used to increase and maintain mean arterial blood pressures above 60 to 70 mm Hg.

Question 124

critically ill foals with severe gastrointestinal disease, blood vessels may become unresponsive to

Answer 124

catecholamines (dobutamine)

Question 125

In case of non response to dobutamine what can you give?

Answer 125

vasopressin 0.0005–0.001 IU/kg/min)

Question 126

dobutamine is a catecholamine with wich type of receptorS?

Answer 126

direct-acting inotropic agent and an adrenergic agonist that stimulates primarily the beta-1 adrenoceptor,

Question 127

how does teh vasopressin work?

Answer 127

acting through V1 receptors on vascular smooth muscle, is required to adequately increase vasomotor tone and thereby diastolic arterial pressure

Question 128

dobutamine is symphaticomimetic or parasymphaticomimetic

Answer 128

symphaticomimetic

Question 129

Complete the sentence: hypoventilation is frequent, with _____% of the foals developing marked arterial hypercarbia (PaCO2 >65 mm Hg);

Answer 129

hypoventilation is frequent, with 20% of the foals developing marked arterial hypercarbia (PaCO2 >65 mm Hg);

Question 130

What should you suspect in a foal that desaturate severly during anesthesia (SaO2 <80%) with PaO2 values decreasing 20 to 40 mm Hg despite being mechanically ventilated and inhaling 100% O2?

Answer 130

return to fetal circulation with persistent pulmonary arterial hypertension and massive right-to-left shunting of blood flow through the foramen ovale or ductus arteriosus

Question 131

How to reverse this life-threatening situation of sudden desaturate without cyanosis?

Answer 131

Increasing the anesthetic depth in an attempt to reduce pulmonary vascular resistance

Question 132

What drug can produce selective pulmonary arterial vasodilatation in foals with pulmonary arterial hypertension?

Answer 132

sildenafil (Sildenafil Injection, USP; slowly 0.5–
2.5 mg/kg IV), a type 5 phosphodiesterase inhibitor that produces selective pulmonary arterial vasodilatation and thus ameliorates clinical signs of pulmonary hypertension

Question 133

What are the arrhythmias most commonly associated with cardiac arrest in foals?

Answer 133

Pulseless electrical activity (PEA)
Asystole

Question 134

PEA is also known as

Answer 134

flat lining that leads to cardiac arrest

Question 135

Cardiopulmonary failure in foals has usually 2ary cause to 2 things, name them

Answer 135

systemic disease
anesthetic overdose

Question 136

Causes of secondary cardiopulmonary arrest encountered in foals include 9 name them

Answer 136

severe hypovolemia,
low cardiac output,
severe metabolic acidosis,
hyperkalemia (e.g., ruptured bladder),
vasovagal reflex,
severe hypoglycemia,
severe hypothermia,
septic shock/endotoxemia, and finally,
pulmonary arterial hypertension with return to fetal circulation and right-to-left shunting of blood, causing systemic tissue hypoxia.

Question 137

Name the 5 steps

Question 138

Name the CPR actions of 1 to 5 approach

Answer 138

(1) administration of chest compressions; (2) ventilation support; (3) initiation of ECG and ETCO2 monitoring; (4) obtaining vascular access for drug administration; and (5) administration of reversal agents if any anesthetic/sedative agents have been administered.

Question 139

what is teh rate of chest compressions? what position should be the foal?

Answer 139

100/min
RLRecumbency on firm surface

Question 140

What is the rate of breaths in CPR?

Answer 140

A rate of 6 to 10 breaths per minute is sufficient.

Question 141

Among all drugs tested in CPR, only two exhibit significant efficacy in all cardiac arrest situations: which ones?

Answer 141

Epinephrine0.01 to 0.02 mg/kg Ive every 2 - 3min and vasopressin 0.06 to 0.8 IU/kg given single dose

Question 142

Epinephrine posses strong __________(1w) properties has been shown to improve coronary perfusion pressure during cardiac arrest

Answer 142

vasoconstrictive (via activation of α-adrenoceptors)

Question 143

What are teh complications of epinephrine?

Answer 143

Complications of epinephrine administration include ventricular fibrillation (V-fib), pulseless ventricular tachycardia (V-Tach), and an increase in systemic vascular resistance, all increasing myocardial O2 demand and cardiac workload

Question 144

Electrical defibrillation is indicated at initial charge of _____J/Kg with subsequent defibrillations using a charge of 4 J/kg, delivered 30 to 60 seconds after each epinephrine administration until conversion to normal rhythm occurs

Answer 144

2 J/kg

Question 145

During the period of cardiac arrest per se, large-volume fluid administration is contraindicated or indicated?

Answer 145

contraindicated

Question 146

characteristic electrolyte abnormalities of foal with Uroperitoneum

Answer 146

hyponatremia, hyperkalemia, and hypochloremia—was thought to occur in conjunction with azotemia and metabolic acidosis, serum creatinine concentrations were always greatly elevated

Question 147

In Uroperitoneum most foals develop respiratory distress with increased respiratory rate and respiratory effort as a result of significant a

Answer 147

abdominal distension

Question 148

How do you stabilize the patient with uroperitoneum?

Answer 148

O2 supplementation via nasal insufflation or mask delivery, restoration of circulating blood volume, correction of electrolyte and acid-base abnormalities, and slow drainage of the peritoneal fluid by abdominocentesis

Question 149

Once plasma K+ concentrations reach values in excess of 5.5 mEq/L, progressive changes in the ECG such as

Answer 149

Once plasma K+ concentrations reach values in excess of 5.5 mEq/L, progressive changes in the ECG such as

Question 150

Serum K+ can be effectively decreased to clinically acceptable levels by administering regular ______

Answer 150

insulin at a dose of 0.1 to 0.3 IU/kg slowly IV in 2.5% to 5.0% dextrose over 30 to 45 minutes prior to induction of anesthesia

Question 151

after initial blood volume restoraiton with physiologic saline or ______ __________ (2w) solutions low content in K+ content (≤5 mEq/L),

Answer 151

After initial blood volume restoration with physiologic saline or isotonic crystalloid hypertonic saline may be infused to correct the Na+ (and Cl−) deficit

Question 152

At Na+ concentrations less than _____ mEq/L seizures frequently occur

Answer 152

At Na+ concentrations less than 110 mEq/L seizures frequently occur

Question 153

Na+ deficit [in mEq] can be calculated as:

Answer 153

(normal serum Na+ [in mEq/L] − measured serum Na+ [in mEq/L]) × 0.4 body weight in kg

Question 154

in the situations of a life-threatening metabolic acidosis (pH <7.2) administration of

Answer 154

in the situations of a life-threatening metabolic acidosis (pH <7.2) administration of sodium bicarbonate (Na+HCO3−) may become necessary.

Question 155

The required dose of NaHCO3 is calculated based on the formula:

Answer 155

(-BE): -BE [in mEq/L] × 0.4 × body weight in kg

Question 156

How do administer sodium bicarbonate? can you give total dose?

Answer 156

No, one half of the calculated bicarbonate dose should be administered first over 20 to 30 minutes and then a blood gas analysis repeated to assess the effect before the second half of the dose is
administere

Question 157

There is one drug contra-indicated in uroperitoneum cases. which one? why?

Answer 157

Use of α2-agonists (e.g., xylazine) should be avoided because of their respiratory depressant-, proarrhythmogenic- and diuresis-promoting properties

Question 158

The most common life-threatening arrhythmia observed in foals with uremia and hyperkalemia is

Answer 158

third degree atrioventricular block

Question 159

hyponatremia in uroperitoneum cases should corrected slowly to avoid what pathology?

Answer 159

central pontine myelinosis

Question 160

third-degree AV block, may be precipitated by

Answer 160

surgical stimulation

Question 161

third-degree AV block, how to treat?

Answer 161

administration of atropine at higher than usual doses (i.e., 20–40 μg/kg IV) and/or ephedrine (25–50 μg/kg IV) may resolve the arrhythmia. If not effective, epinephrine (10–20 μg/kg IV) and closed chest massage must be initiated.

Question 162

most frequently encountered abdominal diseases requiring an emergency laparotomy in young foals

Answer 162

Strangulated inguinal hernia, persistent meconium impaction, intestinal intussusception, and intestinal volvulus

Question 163

rib fractures may account for as many as __7% of life-threatening fractures in foals younger than 6 months of age

Answer 163

37%

Question 164

The fractures occur most commonly at the ___________ (2w) or the area immediately above it and are best detected with _______________ (1w).

Answer 164

The fractures occur most commonly at the costochondral junction or the area immediately above it and are best detected with ultrasonography.

Question 165

Typically _______ or more ribs are affected, with those on the ______side of the chest (______ to eighth) most frequently involved.

Answer 165

Typically three or more ribs are affected, with those on the left side of the chest (third to eighth) most frequently involved.

Question 166

Typical complications (5) of dislocation of fractured rivs

Answer 166

hemothorax
pneumothorax
pulmonary laceration
acute parenchymal lung injury
Atelectasis formation
pleuritis

Question 167

Clinical signs (8) commonly include

Answer 167

tachycardia, tachypnea, or respiratory distress because of pain and impaired pulmonary gas exchange causing hypoxemia and hypercapnia, subcutaneous emphysema, chest pain, anemia and hypovolemia if blood loss was significant, and mental depression

Question 168

Preanesthetic emergency care of the foal with compromising thoracic trauma 5 things

Answer 168

nasal insufflation of O2 (5–
10 L/min), IV fluid therapy with isotonic polyionic crystalloid solutions for circulatory volume replacement plus fresh frozen plasma or fresh whole blood for supplementation of red blood cells, coagulation factors and platelets when indicated, thoracocentesis to evacuate the chest in case of pneumothorax or hemothorax, and appropriate antiinflammatory and analgesic treatment (e.g., flunixin meglumine, methadone, butorphanol, lidocaine infusion)

Question 169

ketamine is the preferred induction agent over propofol and alfaxalone in this patient group, why?

Answer 169

propofol and alfaxalone are more likely producing apnea upon induction of anesthesia

Question 170

Say the protocol of sedation and induction in case of thoracic trauma

Answer 170

Midazolam 0.2 mg/kg and butorphanol 0.2-0.3 mg/kg
ketamine 1-2 mg/kg

Question 171

if the foal remains markedly hypercapnic (PaCO2 >65 mm Hg) and hypoxemic (PaO2 <55–60 mm Hg; SpO2 <85%) what type of ventilation should be used?

Answer 171

Volume-limited positive pressure ventilation with or without positive end-expiratory pressure (PEEP)
Tidal volume 4-6 mL/kg