Chapter 20 - Anesthesia and Analgesia for foals Flashcards
1
Q
What is considered neonate?
A
0-1 month
2
Q
What is considered pediatric?
A
1-3 months
3
Q
What is considered juvenile
A
3 - 4 months
4
Q
Patients under 1 year old the perioperative moratlity rate is ___%
Older than 1 year old?
A
1.9% - baby
1% adult
5
Q
What is the definition of cardiac output?
A
Amount of blood ejected by heart per minute and is calculated as product of HR (min) and stroke volume (mL)
6
Q
Cariovascular: When they are neonate (<1month) they are dependent on HR or Stroke volume for cardiac output?
A
HR
7
Q
Cardiovascular pediatric (1-4mo) it is more HR or Stroke Volume?
Increased or decreased systemic vascular resistance?
A
More SV less HR dependent cardiac output
Increasing systemic vascular resistance
8
Q
In Neonate (<1mo) is this TRUE or FALSE?
High Respiratory Rate-dependent Volume per minute and low min, low VT (tidal volume)
A
True
9
Q
Neonates have higher or lower BBB permeability?
A
Higher
10
Q
In Pediatric juvenile (1-4mo) the Vmin and RR are higher or lower?
VT is is low, high or normal?
A
Higher minute ventilation volume (Vmin) and RR
Normal Volume Tidal
11
Q
Neonates have higher ECG (extracellular fluid volume) or lower?
A
Higher compartment circulating blood volume (CBV) and circulating plasma volume (CPV)
12
Q
neonates have high or low glycogen reserves?
A
Low glycogen reserves
13
Q
When does the liver starts to mature?
A
3-4 weeks
14
Q
The PCV in neonates if decreased is often due to what?
A
isoerythrolysis
15
Q
When does the PCV normalize, the WBC is the normal of adult and elevated serum enzyme activities are present?
A
Pediatric/juvenile foal of 1-4 months
16
Q
series of extracardiac shunts (ductus venosus, patent ductus arteriosus) and intracardiac communication (foramen ovale) are necessary for what in fetal stage?
A
To suply deoxygenated blood to the placenta and return oxygenated blood to systemic organs
17
Q
Oxygenated blood arriving in the fetus via the umbilical vein flows through the _________________________ (2 words) and _____________ (2 words) towards the ____________ side of the heart
A
ductus venosus and the caudal vena cava towards the right side of the heart
18
Q
Having entered the right atrium, most blood is diverted away from the noninflated lung to the _______ atrium via the _____________________ (2 words)
A
left atrium via the foramen ovale an opening in the atrial septum that connects both atria
19
Q
Only a small portion of the blood that entered the _____ atrium continues its path through the _______ ventricle into pulmonary artery
A
right atrium right ventricle
20
Q
from the pulmonary artery, it bypasses the lung by flowing through the patent ductus arteriosus into the __________
A
into the aorta a process that depends on the high pulmonary arterial resistance prevailing within the fetus’s not yet aerated lung
21
Q
At birth, the function of gas exchange is abruptly transferred from the placenta to the lungs by activation from systemic to _____________ circulation
A
pulmonary
22
Q
Due to aeration of the lungs a dramatic _______________ increase/decrease in pulmonary arterial resistance, thereby promoting blood flow through the pulmonary vasculature
A
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
23
Q
decrease in circulating __________________ that accompanies perinatal adaptation also promotes the closure of the ductus arteriosus over time.
A
prostaglandins
24
Q
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
A
Higher
25
Are heart murmurs normal in the first 3 to 5 days of life?
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
26
Define cardiac index (CI)
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).
27
CI is higher or lower in foals up to 2 to 3 monthscompared to adults
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
28
What is the incovenient ot give α2-adrenoceptor agonists in foals?
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
29
Systemic arterial blood pressure is higher or lower in early days of life?
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
30
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.
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.
31
Poney lung are more mature or less mature than horse lungs?
Poney lung are more mature
32
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
smaller
33
first week postpartum, O2 consumption how many mL/kg/min
6-8 mL/kg/min exceeds that of the adult horse by two- to threefold, requiring increased respiratory minute ventilation
34
FRC and tidal volume, newborn foals typically breath up to ____ to ____ times per minute,
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
35
newborn foal the total body water content in %
72 to 74% of total body mass and does not change over first 5 months of life
36
The extracellular fluid (ECF) compartment is about ______third larger in foals on a per kilogram body weight basis than in adults
The extracellular fluid (ECF) compartment is about one third larger in foals on a per kilogram body weight basis than in adults
37
because of the higher capillary permeability in the neonate yet greater systemic arterial blood pressures postpartum, intravascular water rapidly redistributes into the ______________________ (2 words)
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
38
Maintenance fluid rates in neonatal foals
80 to 120 mL/kg/day (3.5–5.0 mL/kg/h) is required in foals up to 1 month of age
39
Based on the Holliday-Segar formula, the daily fluid requirements can be calculated for each individual foal as:
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
40
Why is teh foal more susceptible to hypoglycemia?
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
41
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?
glucose<75mg/dL
42
What is the rectal temperature of foals
rectal temperature of foals ranges from 37.2°C to 38.6°C
43
equine neonates have the ability to generate heat through _______
shivering
44
Where is the principal site of drug metabolism?
Liver
45
At what time most of hepatic metabolic pathways are completely functioning?
6-12 weeks postpartum
46
Normal urine output in neonatal foals is reported to be
6 mL/kg/h but then decreases gradually over the subsequent 12 weeks of life
47
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
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
48
Blood volume in neonates is _____________higher/lower than in adults
Blood volume in neonates is higher than in adults (approximately 13%–15% of total body weight),
49
Marked hyperbilirubinemia in the first week of life is a common finding and can be attributed to ......
to an accelerated breakdown of neonatal erythrocytes and immature hepatic function
50
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?
as a result of hepatocellular maturation
51
Serum lactate concentrations are high immediately after birth. What value?
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).
52
Dosage midazolam (benzodiazepine) for sedation of neonate
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.
53
Dosage diazepam (benzodiazepine) for sedation of neonate
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.
54
Dosage lorazepam (benzodiazepine) for sedation of neonate
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.
55
Dosage climazolam (benzodiazepine) for sedation of neonate
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.
56
α2-Agonists (not preferred in neonates only >8w)
* Xylazine in neonates
Xylazine 0.2–0.5 mg/kg
57
Supplementation of α2-Agonists with morphine say dosage in neonates
morphine 0.03-0.06 mg/kg
58
Supplementation of α2-Agonists with L-methadone say dosage in neonates
L-methadone 0.05 mg/kg
59
Supplementation of α2-Agonists with burtphanol say dosage neonates
Butorphanol 0.05–0.1 mg/kg and in juvenile is 0.02-0.1 mg/kg
60
For induction you can use Injectable anesthetics (after sedation)
* Alfaxalone
* Ketamine
* Propofol say dosage of each
Alfaxalone 1.0–3.0 mg/kg
* Ketamine 2.0–2.5 mg/kg
* Propofol 2.0–2.5 mg/kg
61
TIVA in neonates is with propofol and in juvenile? say dosage
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−
62
Dosage of acepromazine alone for the mare
0.02-0.05 mg/kg IV/IM
63
Wha are the consequences of propylene glycol veichule in certai benzodiazepine such as diazepam lorazepam and climazolam?
can cause metabolic acidosis, nephrotoxicity, hyperosmolarity, and subsequent tissue irritation and hemolysis
64
benzodiazepine’s effects can be reversed at the end of the procedure using what?
Flumazenil 0.025-0.1 mg/kg IV
65
opiods’s effects can be reversed at the end of the procedure using
Naloxone (10-15 μg/kg IV), or levallorphan (Lorfan; 22 μg/kg IV),
66
xylazine effects can be reversed at the end of the procedure using
yohimbine or atipamezole
(Yocon; 0.1–0.2 mg/kg IM) or atipamezole (Antisedan; 0.05–
0.2 mg/kg IV/IM)
67
Advantage of using volatile anestehtic alone in neonates (1) both rapid uptake and elimination of the anesthetic via the lungs why?
(1) both rapid uptake and elimination of the anesthetic via the lungs because of high minute ventilation and CO;
68
volatile anesthetics have greater potency in early life?
yes isoflurane minimal alveolar concentration [MAC] of 0.84% in the equine neonate versus 1.3%–1.6% in adult horses)
69
Depending on the age and hence size of the animal,how many L rebreathing bags or bellows are sufficient?
3- to 5-L rebreathing bags or bellows are sufficient
70
Sevoflurane and desflurane are characterized by a _% and __% lower blood solubility than isoflurane,
Sevoflurane and desflurane are characterized by a 50% and 64% lower blood solubility than isoflurane,
71
ketamine lasts how much time
10 to 20 minutes
72
Thiopental in conjunctionwith benzodiazepine or guaifenesin is suitable for induction in foals with which type of conditions?
Seizures and brain trauma
73
Neonates and juveinle foals general anesthesia s maintained with isoflurane - wich MAC?
1.3-1.6% Iso or 2.3-2.8% Sevoflurane
74
What size is the nasotracheal tube in foals?
6-9mm ID
75
What size is the endotracheal tube?
8-14 mm ID
76
Bolus and infusion dosage of lidocaine
50 μg/kg/min after an IV bolus of 1.2–1.5 mg/kg
77
Triple drip refers to a combination of which drugs and what dosage?
Ketamine 1g/L
Xilazine 250 mg/L
Guaifenesin solution
Drip maintenace is 2 to 3 mL/kg/h
78
What are the parameters for monitoring anesthesia depth?
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
79
Mention the 4 peripheral arteries used for invasive method by catheterization
1 - facial
2 - transverse facial
3- auricular
4 - metatarsal artery
80
In critical ill foal what are the additional hemodynamic monitoring?
central venous pressure
urine output
cardiac output
81
What are the minimal invasive tx that have been developed to assess cardiac output?
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)
82
Where can you place the continuous monitoring of arterial hemoglobin oxygen saturation by pulse oximetry=
By nninvasive tx of clipe-type probe on the:
ear
tongue
nonpigmented skin
nonpigmented mucosa
83
The PaCo2 changes proportionately with metabolic activity and inversely with its _____________ (1word)
elimination (i.e., alveolar ventilation).
84
value in excess of 45 mm Hg (hypercapnia) indicates
hypoventilation,
85
alue below 35 mm Hg (hypocapnia) indicates
hyperventilation
86
limited glycogen reserves in the neonate make it susceptible to the development of hypoglycemia during prolonged anesthesia. When do we consider long?
>1–1.5 h
87
glucose levels below _____mg/dL may produce deleterious central nervous effects such as seizure activity, cerebral depression, and even permanent neuronal damage
40 mg/dL
88
blood glucose concentration has been identified as a prognostic indicator in critically ill neonatal foals - TRUE or FALSE
TRUE
89
temperature should be continuously monitored in 3 places name them
pharyngeal
esophageal
rectal
90
Systemically healthy normovolemic foal under GA the infusion rate taht has been reported as adequate to maintain an appropriate circulatory volume?
the maintenance rate of 3 to 5 mL/kg/h reported for foals.
91
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
30 to 60 minutes after infusion
92
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
50 to 80 mL/kg, typically given one third at a time followed by reassessment of the foal’s volume status
93
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.
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
94
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
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
95
Oxygen may be delivered via face mask, nasal cannulae, or a nasotracheal tube and at a rate of___ to ____ L/min.
Oxygen may be delivered via face mask, nasal cannulae, or a nasotracheal tube and at a rate of 5 to 10 L/min.
96
Why should oxygen be humidified?
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.
97
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
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
98
Among all different modes of mechanical (i.e., positive pressure) ventilation, controlled ____________________(2w) is the mode most commonly used during equine anesthesia in foals.
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.
99
Mechanical ventilation may be employed in two different modalities:
pressure-limited (targeted) or volume-limited (targeted) ventilation
100
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
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
101
It is not necessary to ventilate foals with 100% O2 - TRUE or FALSE
True
102
opioid agonist-antagonist butorphanol (0.05 mg/kg IV/IM) has been tested in newborn. The elimination half-life was__________ hours
the elimination half-life was 2.1 hours after IV injection
103
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
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
104
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
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
105
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)
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)
106
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
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
107
Lidocaine 30–___ μg/kg/min following 1.3–1.5 mg/kg IV loading dose
Lidocaine 30–50 μg/kg/min following 1.3–1.5 mg/kg IV loading dose
108
aDetomidine doses of 10–20 μg/kg have frequently been associated with significant
(brady-)arrhythmias
109
Intra-articular preservative-free morphine dosage to provide analgesia in foals affected by septic arthritis/synovitis
0.05 mg/Kg
110
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
after patch placement and plasma concentrations peaked after 14±8 hours and returned to baseline concentrations 12 hours after patch removal
111
atrioventricular conduction in bradyarrhythmias should be restored with waht?
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
112
Ventricular tachyarrhythmias are treated with
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)
113
If the lidocaine is unsucessful what should you use?
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.
114
In case of systemic arterial hypotension you should treat with
Volume-replacement therapy
115
In case of hypotension if Volume-replacement therapy fails what should you give?
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.
116
critically ill foals with severe gastrointestinal disease, blood vessels may become unresponsive to
catecholamines (dobutamine)
117
In case of non response to dobutamine what can you give?
vasopressin 0.0005–0.001 IU/kg/min)
118
dobutamine is a catecholamine with wich type of receptorS?
direct-acting inotropic agent and an adrenergic agonist that stimulates primarily the beta-1 adrenoceptor,
119
how does teh vasopressin work?
acting through V1 receptors on vascular smooth muscle, is required to adequately increase vasomotor tone and thereby diastolic arterial pressure
120
dobutamine is symphaticomimetic or parasymphaticomimetic
symphaticomimetic
121
Complete the sentence: hypoventilation is frequent, with _____% of the foals developing marked arterial hypercarbia (PaCO2 >65 mm Hg);
hypoventilation is frequent, with 20% of the foals developing marked arterial hypercarbia (PaCO2 >65 mm Hg);
122
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?
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
123
How to reverse this life-threatening situation of sudden desaturate without cyanosis?
Increasing the anesthetic depth in an attempt to reduce pulmonary vascular resistance
124
What drug can produce selective pulmonary arterial vasodilatation in foals with pulmonary arterial hypertension?
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
125
What are the arrhythmias most commonly associated with cardiac arrest in foals?
Pulseless electrical activity (PEA)
Asystole
126
PEA is also known as
flat lining that leads to cardiac arrest
127
Cardiopulmonary failure in foals has usually 2ary cause to 2 things, name them
systemic disease
anesthetic overdose
128
Causes of secondary cardiopulmonary arrest encountered in foals include 9 name them
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.
129
Name the CPR actions of 1 to 5 approach
(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.
130
what is teh rate of chest compressions? what position should be the foal?
100/min
RLRecumbency on firm surface
131
What is the rate of breaths in CPR?
A rate of 6 to 10 breaths per minute is sufficient.
132
Among all drugs tested in CPR, only two exhibit significant efficacy in all cardiac arrest situations: which ones?
Epinephrine0.01 to 0.02 mg/kg Ive every 2 - 3min and vasopressin 0.06 to 0.8 IU/kg given single dose
133
Epinephrine posses strong __________(1w) properties has been shown to improve coronary perfusion pressure during cardiac arrest
vasoconstrictive (via activation of α-adrenoceptors)
134
What are teh complications of epinephrine?
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
135
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
2 J/kg
136
During the period of cardiac arrest per se, large-volume fluid administration is contraindicated or indicated?
contraindicated
137
characteristic electrolyte abnormalities of foal with Uroperitoneum
hyponatremia, hyperkalemia, and hypochloremia—was thought to occur in conjunction with azotemia and metabolic acidosis, serum creatinine concentrations were always greatly elevated
138
In Uroperitoneum most foals develop respiratory distress with increased respiratory rate and respiratory effort as a result of significant a
abdominal distension
139
How do you stabilize the patient with uroperitoneum?
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
140
Once plasma K+ concentrations reach values in excess of 5.5 mEq/L, progressive changes in the ECG such as
Once plasma K+ concentrations reach values in excess of 5.5 mEq/L, progressive changes in the ECG such as
141
Serum K+ can be effectively decreased to clinically acceptable levels by administering regular ______
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
142
after initial blood volume restoraiton with physiologic saline or ______ __________ (2w) solutions low content in K+ content (≤5 mEq/L),
After initial blood volume restoration with **physiologic saline** or **isotonic crystalloid hypertonic saline** may be infused to correct the Na+ (and Cl−) deficit
143
At Na+ concentrations less than _____ mEq/L seizures frequently occur
At Na+ concentrations less than 110 mEq/L seizures frequently occur
144
Na+ deficit [in mEq] can be calculated as:
(normal serum Na+ [in mEq/L] − measured serum Na+ [in mEq/L]) × 0.4 body weight in kg
145
in the situations of a life-threatening metabolic acidosis (pH <7.2) administration of
in the situations of a life-threatening metabolic acidosis (pH <7.2) administration of sodium bicarbonate (Na+HCO3−) may become necessary.
146
The required dose of NaHCO3 is calculated based on the formula:
(-BE): -BE [in mEq/L] × 0.4 × body weight in kg
147
How do administer sodium bicarbonate? can you give total dose?
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
148
There is one drug contra-indicated in uroperitoneum cases. which one? why?
Use of α2-agonists (e.g., xylazine) should be avoided because of their respiratory depressant-, proarrhythmogenic- and diuresis-promoting properties
149
The most common life-threatening arrhythmia observed in foals with uremia and hyperkalemia is
third degree atrioventricular block
150
hyponatremia in uroperitoneum cases should corrected slowly to avoid what pathology?
central pontine myelinosis
151
third-degree AV block, may be precipitated by
surgical stimulation
152
third-degree AV block, how to treat?
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.
153
most frequently encountered abdominal diseases requiring an emergency laparotomy in young foals
Strangulated inguinal hernia, persistent meconium impaction, intestinal intussusception, and intestinal volvulus
154
rib fractures may account for as many as __7% of life-threatening fractures in foals younger than 6 months of age
37%
155
The fractures occur most commonly at the ___________ (2w) or the area immediately above it and are best detected with _______________ (1w).
The fractures occur most commonly at the costochondral junction or the area immediately above it and are best detected with ultrasonography.
156
Typically _______ or more ribs are affected, with those on the ______side of the chest (______ to eighth) most frequently involved.
Typically three or more ribs are affected, with those on the left side of the chest (third to eighth) most frequently involved.
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Typical complications (5) of dislocation of fractured ribs
hemothorax
pneumothorax
pulmonary laceration
acute parenchymal lung injury
Atelectasis formation
pleuritis
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Clinical signs (8) fx ribs commonly include
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
159
Preanesthetic emergency care of the foal with compromising thoracic trauma 5 things
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)
160
ketamine is the preferred induction agent over propofol and alfaxalone in this patient group, why?
propofol and alfaxalone are more likely producing apnea upon induction of anesthesia
161
Say the protocol of sedation and induction in case of thoracic trauma
Midazolam 0.2 mg/kg and butorphanol 0.2-0.3 mg/kg
ketamine 1-2 mg/kg
162
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?
Volume-limited positive pressure ventilation with or without positive end-expiratory pressure (PEEP)
Tidal volume 4-6 mL/kg
