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Anesthesia - Vic > chapter 7 > Flashcards

chapter 7 Flashcards

1
Q

What is an essential part of every patient evaluation, regardless of presenting complaint?

A

a pain assessment

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2
Q

nocieption?

A

detection by the nervous system of the potential for or the actual occurrence of tissue injury

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3
Q

physiologic pain?

A

the protective sensation of pain that occurs when there is no or minimal tissue injury (pain you would feel that would warn you that you touched something sharp)

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4
Q

pathologic pa[n?

A

pain that occurs after tissue injury

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5
Q

Pathologic pain based on duration can be classified in two ways, what are they?

A

acute (hours) or chronic (days to years)

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6
Q

Pathologic pain is often classified based on the?

A
  1. mechanism
  2. origin
  3. severity of pain
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7
Q

The mechanism of pain can be?

A
  • inflammation - (ie. after trauma or surgery)
  • nerve injury (neuropathic)
  • cancer
  • idiopathic (no identifiable cause)
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8
Q

Pain can originate from?

A

organs - visceral pain (pleuritis or colic)

musculoskeletal system - somatic pain

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9
Q

Somatic pain can be divided into what?

A

superficial (skin)
deep (joint, muscles, bones)
transmitted by both A delta and C fibers

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10
Q

Some diseases or surgeries may result in more than one of these types of pain, what are they?

A

abdominal surgery has components of somatic pain (skin and abdominal wall incisions) and visceral pain (organ manipulation and surgery)

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11
Q

Pain severity is often classified as?

A

none, mild, moderate, or severe

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12
Q

Pain is defined as?

A

an unpleasant sensory or emotional experience associated with actual or potential tissue damage

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13
Q

Analgesia?

A
  • the absence of the awareness of pain, achieved through the use of drugs or other modes of therapy
  • the relief of pain without loss of consciousness
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14
Q

What are the principles of analgesia - ethical and medical reasons that vets and techs have to follow?

A
  • must ensure analgesia is provided for every patient requiring it
  • must recognize procedures likely to be painful
  • must use techniques to minimize pain
  • must monitor behavior and physiologic variables as potential indicators or pain
  • technicians must bring animals requiring analgesia to the veterinarian’s attention
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15
Q

Untreated pain can negatively affect a patient’s?

A
  • behavior
  • physiology
  • metabolis
  • immune system
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16
Q

Chemicals released by inflammation or tissue damage?

A

prostaglandins, leukotrienes, bradykinin, proteolytic enzymes, histamine, potassium ions, serotonin

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17
Q

Nociception, or the pain pathway consists of four main steps, what are they?

A
  1. Transduction - transformation of noxious thermal, chemical, or mechanical stimuli into electrical signals called action potentials
  2. transmission - sensory impulses are conducted to the spinal cord
  3. modulation - in the spinal cord where fibers terminate, the impulses can be altered by other neurons, which either amplify or suppress them.
  4. perception - impulses are transmitted to the brain, where they are processed and recognized
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18
Q

What are action potentials?

A

electrical signals

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19
Q

Mutimodal therapy?

A

using several analgesic drugs, each with a different mechanism of action - results in lower doses, which increases safety

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20
Q

Sensory neurons located in the ?

A

peripheral tissue

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21
Q

Neurons in the spinal cord…?

A

convey and impulse to the brain

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22
Q

Neurons in the brain…?

A

convey the conscious sensation of pain

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23
Q

What are the 2 types of sensory neurons that transmit pain signals from peripheral tissues, spinal cord, and the brain?

A
  1. A delta fibers

2. C fibers

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24
Q

What do A delta fibers do?

A
  • transmit sharp discrete pain signals
  • pain is located to an exact spot
  • large myelinated neurons conduct signals rapidly
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25
Q

What do C fibers do?

A
  • transmit dull, aching or throbbing pain
  • sensations cannot be exactly localized
  • smaller, nonmyelinated neruons
  • visceral pain - cramping, burning, gnawing
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26
Q

What is the difference between nociception and pain?

A

consciousness This means that patients under a general anesthetic do not perceive pain. However, nocieption occurs even when an animal is in a state of unconciousness.

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27
Q

What is primary hyperalgesia?

A

peripheral hypersensitivity

28
Q

What is CNS hypersensitivity or windup?

A

centrally, in the spinal cord, neurons that are stimulated by constant nociceptive input from the periphery become hyperexcitable and sensitive to low-intensity stimuli that would not normally elicit a pain repsonse

29
Q

What is secondary hyperalgesia?

A

an area away from the initial injury

30
Q

What are some behavioral responses to pain in dogs?

A
  • vocalization, facial expression, body posture, guarding, self-mutilation, activity, attitude, appetite, urinary bowel habits, grooming, response to palpation
31
Q

Body posture is one behavioral response in dogs, what are some examples?

A
  • hunched, laterally recumbent
32
Q

Guarding is one behavioral response in dogs, what are some examples?

A
  • protecting wound, limping
33
Q

Vocalization is one behavioral response in dogs, what are some examples?

A

groan, growl, whimper, whine

34
Q

Facial expression is one behavioral response in dogs, what are some examples?

A

fixed stare, glazed appearance, ears back

35
Q

Self-mutilation is one behavioral response in dogs, what are some examples?

A
  • licking, chewing SX site or wound
36
Q

Activity is one behavioral response in dogs, what are some examples?

A
  • restless, restricted movement, trembling
37
Q

Attitude is one behavioral response in dogs, what are some examples?

A
  • increased aggression or fearfulness
38
Q

Appetite - is one behavioral response in dogs, what are some examples?

A

decrease

39
Q

Urinary bowel habits - is one behavioral response in dogs, what are some examples?

A
  • increased urination, lapses in house training, urinary retention
40
Q

grooming is one behavioral response in dogs, what are some examples?

A
  • loss of sheen in hair coat
41
Q

Response to palpation - is one behavioral response in dogs, what are some examples?

A
  • protecting, biting, vocalization, withdrawing
42
Q

Cats behavior responses to pain are?

A
  • vocalization, facial expression, body posture, guarding, self-mutilation, activity, attitude, appetite, urinary bowel habits, grooming, response to palpation
43
Q

Vocalization is one behavioral response in cats, what are some examples?

A

Groan, growl, purr

44
Q

Facial expression is one behavioral response in cats, what are some examples?

A

furrowed brow, squinted eyes

45
Q

Body posture is one behavioral response in cats, what are some examples?

A

sternal recumbency

46
Q

Guarding is one behavioral response in cats, what are some examples?

A

protecting wound, limping

47
Q

Self-mutilation is one behavioral response in cats, what are some examples?

A

licking and chewing SX site or wound

48
Q

Actiivty is one behavioral response in cats, what are some examples?

A

restricted movement, circling

49
Q

Urinary and Bowel habits is one behavioral response in cats, what are some examples?

A

failure to use the litter box

50
Q

Grooming is one behavioral response in cats, what are some examples?

A

failure to groom, unkempt appearance

51
Q

Response to palpation is one behavioral response in cats, what are some examples?

A

protecting, biting, scratching, vocalizing, withdrawing attempts to escape

52
Q

Anthropomorphizing?

A

projecting human emotions onto animals

53
Q

Preemptive analgesia?

A

providing analgesia before tissue injury - commonly achieved by adding an analgesic to the premedication before anesthetizing a patient for surgery
- prevents windup, which, through changes in the CNS from central sensitizaition, can lead to pain that last longer than anticipated

54
Q

What are some examples of irritating or mildly painful procedures?

A

urine scald, clipper burns, IV or urinary catherization, distended bladder, superficial lacerations, eyelid procedures, dental prophylaxis

55
Q

What are some examples of mildly to moderately painful procedures?

A

endoscopy with biopsy, dental extraction, arterial catheterization, aural hematoma, stabilized radial or tibial FX (fracture), castration, OHE, ear flush, cytotomy

56
Q

What are some examples of moderately to severely painful procedures?

A

localized burns, corneal ulcerations, enucleation, thoracic or lumbar disk SX, Onychectomy, stabilized femoral or humeral FX, pelvic FX, mastectomy, cranial adominal SX, anal sacculectomy

57
Q

What are some examples of severely painful procedures?

A

extensive burns, pancreatitis, total hip replacement, cervical disk SX, forelimb or hindlimb amputation, ear ablation, thoracotomy, laminectomy

58
Q

What are some methods of pain control?

A
  • endorphins -released by neurons when the body is traumatized or under stress - bind to opioid receptors - provide some analgesia
  • acupuncture
  • transcutaneous electric nerve stimulation
  • massage therapy
  • hot and cold therapy - for chronic and acute injuries
59
Q

Define emergence delirium?

A

pain

60
Q

more methods of pain control?

A

conscientious nursing care - keep animals clean and dry
- affording opportunities for defecation and urination bladder expression, catherterizaiton
- comfortable bedding
quiet surroundings
gentle reassurance
monitoring

61
Q

Pain control in the surgical patient should be available at every stage of hospitalization and treatment, what are those stages?

A
  • preanesthetic period
  • surgical procedure
  • immediate postoperative period
  • remainder of the hospital stay
  • patient’s return home
62
Q

What are the options of delivering analgesic drugs?

A

IV, IM, SC, epidural, local infiltration

63
Q

What are the methods (drugs) of delivering analgesic drugs?

A

opioids, NSAIDs, local anesthetic, combinations (multimodal therapy, balancec analgesia)
all governed by the severity and type of pain and the animal’s condition

64
Q

What are the advantages of administering analgesics?

A
  • before damage occurs
  • before patient has an awareness of pain
  • provides effective pain relief in recovering patients
  • allows a reduction in the amount of general anesthesia during SX
65
Q

Pharmacologic analgesia can be achieved through a variety of agents, what are they?

A

opioids, NSAIDs, alpha-2 agonists, ketamine, local anesthetics

Anesthesia - Vic (8 decks)

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