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Anesthesia > chapter 2 > Flashcards

chapter 2 Flashcards

1
Q

Hypoxia

A

Low blood oxygen levels

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2
Q

Ileus

A

Intestinal obstruction caused by inhibition of bowel motility; also referred to as gastrointestinal stasis.

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3
Q

Infustion rate

A

The rate at which fluids should be administered expressed in milliliters per unit time. most often ml/hr

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4
Q

Inotropy

A

Force of heart muscle contraction

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5
Q

Intact

A

Possessing gonads. Not spayed or castrated.

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6
Q

lethargic

A

Depressed but still able to be aroused with minimal difficulty.

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7
Q

level of consciousness

A

The patient’s responsiveness to stimuli. how easily the patient can be aroused. often used to assess brain function.

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8
Q

macrodrip

A

A fluid administration set that delivers fluids at a rate of 10 or 15 drops per ml. Generally used for infusion rates equal to or more than 100ml/hr.

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9
Q

microdrip

A

A fluid administration set that delivers fluids at a rate of 60 drops per ml. Generally used for infusion rates less than 100ml/hr.

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10
Q

minimum patient database

A

A compilation of pertinent information from the patient history, physical exam and diagnostic tests. Used to diagnose and manage a case.

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11
Q

miosis

A

Constriction of the pupil of the eye; opposite of mydriasis.

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12
Q

moribund

A

Near death

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13
Q

obtunded

A

Depressed and unable to be fully aroused

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14
Q

oncotic pressure

A

Osmotic pressure provided by large molecular weight colloids such as albumin.

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15
Q

osmolarity

A

A measurement of the number of dissolved solute particles per unit water in body fluids. Usually expressed as osmoles or milliosmoles per liter (mOsm/L) of water.

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16
Q

osmotic pressure

A

The pressure required to prevent water flow through a semipermeable membrane from a region of lower solute concentration to a region of higher solute concentrations.

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17
Q

petechiae

A

Small or pinpoint purple discolorations of the skin or mucous membrane resulting from hemorrhage. Smaller than purpura.

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18
Q

physical status classification

A

A graded assessment of a patient’s physical condition. Used to plan patient management prior to administering anesthetics and to gauge patient risk.

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19
Q

purpura

A

Purple discolorations of the skin or mucous membrane caused by hemorrhage. Larger than petechiae.

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20
Q

regurgitation

A

Flow of stomach contents into the esophagus and mouth unaccompanied by retching; as distinguished from vomiting, which is a forceful expulsion of stomach contents into the esophagus and mouth preceded by retching.

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21
Q

reproductive status

A

Whether or not the patient has been spayed for or castrated. If intact whether or not the patient is being used for breeding. In the case of female patients, whether pregnant or not.

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22
Q

signalment

A

The species, breed, age, sex, and reproductive status of a patient.

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23
Q

sloughing

A

Separation of dead tissue from surrounding live tissue in a wound. Often used in reference to tissue death and loss secondary to drug induced damage.

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24
Q

solutes

A

An atom or molecule dissolved in body water

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25
Q

stridor

A

Noisy breathing caused by turbulent air flow in the upper airways.

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26
Q

stuporous

A

In a sleeplike state. Can be aroused only with a painful stimulus.

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27
Q

syncope

A

Fainting episodes caused by brain hypoxia

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28
Q

thrombocytopenia

A

Low platelet count

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29
Q

vasodilation

A

dilation of the blood vessels; the opposite of vasoconstriction.

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30
Q

vesicants

A

Drugs that damage tissue if injected perivascularly.

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31
Q

A drug induced state of calm in which the patient is reluctant to move and is aware of but unconcerned about its surroundings

A

Tranquilization

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32
Q

Regional anesthesia

A

A loss of sensation in a limited area of the body produced by administration of a local anesthetic or other agent in proximity to sensory nerve.

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33
Q

A sleeplike state from which the patient can be aroused with sufficient stimulation

A

Hypnosis

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34
Q

Balanced anesthesia

A

Administration of multiple drugs concurrently in smaller quantities tan would be required if each were given alone.

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35
Q

With sufficient stimulation a patient can be aroused from

A

sedation, narcosis, and general anesthesia

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36
Q

Do anesthetic agents have wide therapeutic indices

A

No

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37
Q

Crystalloid solutions

A

water and small molecular weight solutes that pass freely through the vascular endothelium.

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38
Q

What are the 5 types of crystalloids

A

Isotonic polyionic replacement solution
isotonic poly ionic maint. solution
Normal saline
hypertonic saline
Dextrose solution

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39
Q

What can be used as a vascular expander to increase blood pressure.

A

Fluid bolus

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40
Q

How much of a fluid bolus do you give for hypotension

A

between 10-20ml/kg

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41
Q

Colloid solutions

A

Contain large molecular weight solutions that don’t freely diffuse across the vascular endothelium.

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42
Q

What are two colloid solutiions

A

Blood products (plasma and whole blood)
Vetstarch don’t exceed 50ml/kg/day
Hextend- don’t exceed 20ml/kg/day
If the limits are exceeded it can cause clotting issues

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43
Q

Hemoglobin based Oxygen carrying solutions

A

Made from human or bovine RBCs used as blood substitutes to treat anemia or hemorrhage.

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44
Q

Hypertonic saline

A

Used for severe shock. Draws fluids into vascular space and temporarily helps increase blood pressure.

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45
Q

How to calculate infusion rate into ml/hr

A

Use the patient’s weight and prescribed rate.

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46
Q

What species are more sensitive to opioids

A

Horses and cats

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47
Q

What species requires a lower dose of lidocaine

A

Felines

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48
Q

What species is more resistant to effects of phenothiazine tranquilizers

A

Felines

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49
Q

Which species has a harder time recovering from inhalant anesthetics?

A

Horses

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50
Q

What drugs should be avoided in ruminants and why?

A

Anticholinergics because they can lead to airway occlusion and ruminants can regurgitate at any point.

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51
Q

What species is sensitive to xylazine and needs a tenth of what a horse gets?

A

ruminants

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52
Q

Cat’s can tolerate dissociative agents on their own but in what species do dissociative agents cause seizure like activity unless combined with another drug?

A

Canines

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53
Q

What animals are prone to respiratory. depression and dependent lung atelectasis. and require ventilatory26 support

A

Large animals

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54
Q

Which species requires measures of pad dependent areas when in lateral recumbency and why

A

Large animals because they get pressure necrosis of tissue when lying over pressure points like the shoulder and hip.

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55
Q

What species is most likely to fracture limbs during anesthetic recovery?

A

Horses

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56
Q

What types of animals are prone to hypoxia and hypercarbia caused by increased mechanical dead space?

A

Cats, small dogs, and small animal pediatric patients

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57
Q

What species are prone to airway blockages because of excess airway secretions?

A

Cats and ruminants

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58
Q

What species is prone to bloat under anesthesia?

A

Ruminants

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59
Q

What canine breeds are more sensitive to Acepromazine

A

Boxers and giant breeds

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60
Q

What canine breed is resistant to Acepromazine

A

Terriers

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61
Q

What breeds is it better to use a smaller endotracheal tube in?

A

Brachycephalic breeds

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62
Q

Sight hounds are sensitive to barbiturates (thiopental sodium) due to?

A

their slow metabolism of these agents and their lack of body fat.

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63
Q

What drug class should be used in caution in all animals

A

Barbiturates (thiopental sodium)

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64
Q

Which horse breed is sensitive to sedatives like large breed dogs and more likely to experience complications during recovery due to their body mass?

A

Draft Horses

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65
Q

Neonates

A

Up to 2 weeks old

66
Q

Pediatrics

A

2-8 weeks old

67
Q

What animals are less capable of metabolizing injectable drugs because the necessary liver pathways are not fully developed

A

Neonates and pediatrics

68
Q

What patients may be unable to tolerate normal doses of some drugs due to poor hepatic or renal function?

A

Geriatric patients

69
Q

What patients tend to bleed excessively due to the effects of estrogen on the clotting cascade.

A

Female animals in estrus due to having an enlarged uterus.

70
Q

What drug can cause penile prolapse in stallions which can lead to permanent injury or loss of breeding soundness?

A

acepromazine

71
Q

What drug can cause uterine contractions in the 3rd trimester in sheep and cattle?

A

Xylazine

72
Q

Sympathomimetics like Epi can increase the incidence of cardiac arrhythmia when given with what?

A

Dissociatives like xylazine and barbiturates

73
Q

What drugs can predispose patients to cardiac arrythmias and excessive responses to anticholinergics and central nervous system depression?

A

tricyclic antidepressants like amitriptyline and clopiramide

74
Q

What antibiotic can decrease biotransformation of barbiturate anesthetics leading to significantly prolonged recovery?

A

Chloramphenicol

75
Q

When given within 14 days of one another some monoamine oxidase inhibitors such as amitraz and selegiline may increase the effects of what?

A

Morphine and other opioids

76
Q

What drugs can increase CNS respiratory depression when given with opioids and other anesthetic agents that depress these body systems?

A

Antihistamines

77
Q

What could behavioral changes signify

A

CNS disease, pain, systemic illness, and many other conditions

78
Q

Exercise intolerance can signify

A

a variety of issues like heart disease, anemia, and musculoskeletal pain

79
Q

Fainting (syncope) can often indicate

A

hypoxemia, low BP, cardiac disease

80
Q

Seizing can often indicate

A

CNS disease, toxin ingestion, or metabolic disorders like hypoglycemia.

81
Q

Bleeding can signify

A

bruising, blood in urine or stool, prolonged bleeding after venipuncture or surgery can signify a clotting disorder and can increase intra operative and postoperative hemorrhage.

82
Q

Extra label drug use

A

using a drug to treat something it is not made for. A lot of anesthetics in vetmed are used in this way.

83
Q

What issues can cause problems when under anesthesia

A

Dehydration-hypotension, poor tissue perfusion, and kidney damage
Anemia- decreases oxygen carrying capacity of the blood and predisposes them to hypoxemia
Bruising on skin and mucous membranes in the absence of trauma- can indicate a clotting disorder
Respiratory or cardiovascular system abnormalities- increased risk of complications and can lead to death
Abnormalities of abdominal organs-enlarged liver or abnormally small kidneys may be associated with abnormal oxygen function and a reduced a ability to metabolize or excrete anesthetic agents.

84
Q

Calculate the body weight of horses

A

(kg)=heart girth (cm)^2 X length (cm)/11880

Hear girth=circumference of chest behind the point of the elbow
length= distance from the point on the shoulder to point of the pelvis

85
Q

What would administration of a drug using whole body weight to calculate the dose do

A

Cause an overdose

86
Q

Dehydration

A

<5%= not detectable
about 5%= (mild) minimal loss of skin turgor, semi dry mucous membranes, eyes normal
about 8%= Moderate loss of skin turgor, dry mm, weak rapid pulses, enophthalmos (depressed globes within orbits)
>10% Extremely dry mm, tachycardia and weak and thready pulses, hypotension, severe enophthalmos, altered level of consciousness.

87
Q

obtunded

A

depressed and can’t be fully aroused

88
Q

stuperous

A

sleeplike state and can be aroused only with painful stimuli

89
Q

Comatose

A

cannot be aroused and is unresponsive to all stimuli including pain.

90
Q

Vitals

A

Dog: temp 100-102.5, HR= 60-180, RR= 10-30
Cat: temp= 100-102.5, HR 120-240, RR 15-30
Horse: temp= 99=100.5, HR= 30-45, RR 8-20
Cow: temp= 100-102.5, HR= 60-80, RR 8-20
Sheep/goat: temp- 102-104, HR 60-90, RR 16-24

91
Q

Ecchymoses, purpura, and petechia on skin or mucous membranes should be noted if no trauma indicated because

A

I can indicate a clotting disorder.

92
Q

Azotemia

A

Can cause breath to smell like urine

93
Q

EENT

A

Eyes, ears, nose, throat

94
Q

Stridor can indicate what

A

An upper airway infection or obstruction

95
Q

Pupillary light reflex (PLR)

A

Pupils should be equal in diameter.

96
Q

Pupil restriction

A

Miosis (eye constriction) is normal failure to constrict in the presence of light is abnormal.

97
Q

Consensual reflexd

A

In normal patients the left pupil should constrict the same amount as the right pupil

98
Q

What besides obesity can cause a patients heart rate to sound muffled or less intense

A

Pericardial effusion or pleural effusion

99
Q

Hear rythms

A

Dogs: NSR or SA
Cats: NSR only
Horse: NSR, SA, or 1st, or 2nd degree (after rest) AV block
Cow: NSR, SA
Sheep/goat: NSR, SA
Rabbits, ferrets, rodents: NSR

100
Q

AV

A

Atrioventricular block

101
Q

NSR

A

Normal sinus rhythm- no irregular heartbeats or pauses between beats, rate can change due to excitement.

102
Q

SA

A

Sinus arrhythmia- rhythm where the heart rate cyclically increases during inspiration and decreases during expiration. Can be pronounced in young, healthy dogs, and can sound as if there are skipped or premature beats.

103
Q

Abnormal rhythms

A

can be differentiated from SA by watching respirations while listening to the heart. Abnormal rhythms are not associated with the breathing.

104
Q

1st degree atrioventricular heart block

A

Caused by a conduction delay through he AV node and is recognized by a prolonged PR interval. This rhythm causes no noticeable heart sound and can only be detected on electrocardiography.

105
Q

2nd degree atrioventricular heart block

A

Caused by a periodic block of electrical conduction through AV node and is recognized by missing QRS complexes on ECG tracing. On listening periodic pauses representing skips are audible. Not normal for more than one skipped beat in a row.

106
Q

Murmmers

A

listen over each value place stethoscope diaphragm into cranial most aspect of the left axilla because some mummers including those associated with patient ductus arteriosus are often only audible in this location.

107
Q

Pale MM or prolonged capillary refill time indicates

A

a decrease of perfusion from shock, vasoconstriction, hypotension, and a variety of other conditions like anemia.

108
Q

Cyanotic MM

A

reduced oxygen saturation (medical emergency).

109
Q

what other areas can you check the MM

A

conjunctiva of lower eyelid, entrance to vulva, or tip of prepuce

110
Q

Respiratory character

A

effort, relative length of inhalation and exhalation and regularity

111
Q

Normal respiratory cycle

A

inhale, immediately exhale, and then a brief rest before next inhalation. Exhalation should be twice as long as inhalation.

112
Q

Dyspneic patients

A

exhibit open mouth breathing flared nostrils, excessive panting, exaggerated chest or abdominal movements on inspiration, wheezing and reluctance to lay down. Extreme cases can show cyanosis.

113
Q

Listening to lungs

A

evaluate all 4 quadrants of the thorax (left and right anteroventral lunch fields, Right and left dorsal lung fields.

114
Q

What functions do the kidney’s play

A

regulation of electrolytes and water balance, BP, elimination of many anesthetics.

115
Q

Protein in urine (specific gravity)

A

Dogs=, <1.030
Cats= <1.025
In large animals run more tests to assess kidney function

116
Q

Abnormalities in macroscopic exam (color, clarity, odor)

A

Biochemical analysis and microscopic exam can reveal evidence of diabetes mellitus, liver or kidney disease, or other systemic disorders.

117
Q

Coagulation pannel

A

prothrombin time (Pt) and activated partial thromboplastin time (APTT) should be run in those that might have a preexisting coagulation disorder (end stage liver diseased0, or known breeds (Dobermans, rottweilers, and Scottish terriers).

118
Q

Buccal mucosal bleeding time

A

If time of bleeding is >15 min stop test remove gauze and apply pressure to cut.

119
Q

Patient classes (physical status classification)

A

PS1- normal healthy patient
PS2- mild systemic disease
PS3- severe systemic disease
PS4- Severe systemic disease that’s a constant threat to life
PS5- Moribund can’t live without surgery
PS6- brain death/organ donor

120
Q

Etomidate

A

can be used in stead of propofol in geriatric dogs with heart failure because its less likely to affect cardiac function adversely.

121
Q

What complications can non fasted patients have

A

Reflux into distal esophagus
aspiration into pulmonary tree
bloating in ruminants

122
Q

Esophageal reflex can cause

A

Irritation, inflammation, and in extreme cases severe tissue damage of distal esophagus resulting in stricture and is a common cause of post op nausea, dysphagia, vomiting and anorexia.

123
Q

pulmonary aspiration

A

patient vomits or regurges during a time when swallowing reflex is decreased or absent. Can lead to pneumonia, permanent disability, or death.

124
Q

Exceptions to having a patient fast

A

exotics and neonates

125
Q

Why leave the inflated tube in the patient until they swallow

A

to prevent aspiration

126
Q

Fasting times

A

Dogs= 8-12hrs
horses= 8-12hrs
cattle= 24 to 48hrs
small ruminants= 12-18hrs
neonates 0
pediatrics 0

127
Q

Catheter sizes

A

Small ruminants and pigs 16-25gage
Cattle and horses 12-16 gage

128
Q

How long should most IV medications be given over

A

15-60 seconds but sodium bicarbonate and potassium chloride should be given at a much slower rate.

129
Q

Anesthetic agents affect cardiopulmonary function by

A

decreasing the force of heart muscle contraction (entropy) and causes bradycardia.
Decrease blood flow cardiac output
relax muscle tone of blood vessels
increase intravascular volume (vasodilation)
decrease cardiac output and vasodilation=hypotension
decreased perfusion of tissues with blood fluids can help these issues.

130
Q

2/3 or 40% of body wight is

A

intracellular fluid

131
Q

15-30% of body weight in small animals is

A

extracellular fluid

132
Q

1/4 (5% of body weight) is

A

intravascular fluid (plasma)

133
Q

When blood cells added to blood volume

A

8-9% in dogs and large animals
6-7% in cats

134
Q

Calculate blood volume

A

80-90ml/kg for dogs and large animals
40-60ml/kg for cats

135
Q

Body fluids

A

solutes/atoms or molecules dissolved in body water.
Large molecular weight plasma proteins = colloids
Small nonionic particles= glucose and small proteins9

136
Q

Electrolytes

A

cations (migrate toward the cathode. during electrolysis)
Anions (migrate toward anode) negative charged

137
Q

Cations in body

A

NA, K, Mg, CA

138
Q

Anions in body

A

CL, HCO3 (bicarbonate), HPO4^2- HxPO4- (phosphates), and proteins.

139
Q

Prescribed fluid rate

A

Ordered by doctor
Expressed in ml/kg/hr

140
Q

infusion fluid rate

A

Rate at which fluids should be administered ml/hr. kg x prescribed rate

141
Q

delivery rate (fluid)

A

The number of drops of fluid that must fall inside the drip chamber of an administration set to deliver 1ml of fluid expressed in drops per ml gtt/ml

142
Q

drip rate

A

the rate at which fluids should be administered expressed in gtt/min. multiply infusion rate x conversion factor for hours to min x delivery rate.

143
Q

infusion time

A

total time over which fluids will be administered in hrs

144
Q

infusion volume

A

the total volume of fluids to be administered expressed in ml or L. multiply kg x prescribed rate x infusion time.

145
Q

Doctor orders IV fluids for a 55lb dog at a rate of 5ml/kg/hr for 1 hours surgery. What is the infusion rate in ml/hr?

A

55lb x kg/2.2 x 5ml/(kg/hr)= 125ml/hr

146
Q

Doctor orders iv fluids for treatment of shock in a 12lb cat at a rate of 55ml/kg. You are given 1/4 of the calculated dose rapidly. what is the infusion rate in mls.

A

12lb x kg/2.2lb x 55ml/kg x (1/4)= 75ml given rapidly

147
Q

Drip rate: 55lbdo requires an infusion rate of 125ml/h what administration set would you use and what is the drip rate?

A

125ml/hr x hr/60min x 15gtt/ml=31gtt

Choose macro administration set due to the infusion rate being greater than 100ml

148
Q

What duties does a vet tech have during the preanesthetic period.

A

help develop a minimum patient database, ensure fasting instructions were followed, place IVC, administer fluids, stabilize the patient, prepare equipment, administer medications.

149
Q

What is as important or more important than diagnostic tests in shaping patient management?

A

Getting a good history.

150
Q

What conditions that require treatment while the patient is under anesthesia and are physical findings that might influence anesthetic management?

A

Dehydration, anemia, abnormal bleeding, respiratory or cardiovascular system disease, kidney or liver dysfunction.

151
Q

What should be assessed prior to any procedure?

A

weight, body condition, hydration level, level of consciousness, vital signs, general conditions, and pain score.

152
Q

What must be presented to an owner before a procedure?

A

Consent form and fee estimate with signatures

153
Q

Are anesthetic protocols ideal for all patients?

A

No they need to be tailored to the needs of the patient.

154
Q

What should anesthetic protocols be based on?

A

previous or concurrent illness, nature of the procedure, and the urgency and preference of the vet.

155
Q

What diagnostics help to determine the patients ability to handle anesthesia?

A

CBC, chemistry, urinalysis, radiographs, and electrocardiography.

156
Q

What does placing a IVC help with?

A

safely administer IV anesthetics, provide fluid support, maintain anesthesia via CRI, and administer emergency drugs if needed.

157
Q

Crystalloids can be classified according to

A

the mix and quantity of solutes as replacement or maintenance; balanced or unbalanced; and isotonic, hypotonic, or hypertonic.

158
Q

When are crystalloids not used during anesthetic?

A

when plasma protein levels are less than 3.5g/dl, a PCV of less than 20%, and a low platelet count.

159
Q

What is the standard fluid rate during anesthesia.

A

10ml/kg/hr for the 1st hour and then 5ml/kg/hr for the rest of the procedure.

160
Q
A

Anesthesia (8 decks)

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