Chapter 9 - Powerpoint Condensed Flashcards
True or False: Any time saved by skipping steps in surgical patient preparation is often offset managing problems that could’ve been prevented
True
What 4 components make up a basic Anesthetic Protocol?
- Includes calculated dosages, routes and order of administration
- calculated, checked and re-checked doses, oxygen flow rates and fluid administration rates
- use patient minimum database, physical status and procedure to influence protocol
- modified protocol for ill, pediatric or otherwise compromised animals
What are some examples of physiological abnormalities that need to be corrected before anesthesia?
Dehydration, Hypotension and Anemia
A bolus drug must be given ______ enough to produce a short-term stage 3 plane 1 anesthesia to intubate (slowly or quickly)
quickly
True or false: The quicker we can get intubation completed and move to inhalant anesthesia for maintenance, the faster the recovery will be and the safer the process will be
True
When giving anesthetic induction agents by ______ administration, the anesthetic depth will increase, peak and then gradually decrease
IM
True or False: Once an IM injection has been given for induction, the anesthetist has little control over changes in depth. If the depth is too light we can add more, but if the depth is excessive there is nothing to be done until the patient comes out naturally
True
IM induction is not ideal in ______ patients
geriatric
The technique used for short procedures (less than 10 mins) requiring general anesthesia typically includes:
IV injection and an Ultra-Short-Acting Agent such as Propofol or Etomidate
TIVA stands for ________ and meanst the patient is induced “to effect” and given additional boluses every ___ to ___ minutes as needed to maintain surgical anesthesia
Total Intravenous Anesthesia, 3-5 mins
The most commonly used agent for TIVA techniques is:
Propofol
What are 3 factors that may slow down the rate at which a patient is induced via Mask?
Patients respiration, Agent used and carrier gas flow rate, type and volume of breathing circuit
Sometimes during a struggle in induction via Mask, the animal will ____
Breath hold
True or False: The best technique for masking an animal for induction is introducing the mask quickly with a high flow rate to knock them out as quick as possible
False. A struggle will happen and breath holding will occur. The best way is to introduce the mask slowly with Oxygen only at first, then introduce anesthetic at 0.5% increments over 10-15 seconds each. Then turn it up high to pass the excitatory stage quickly
The most commonly used method of inducing and maintaining anesthesia in small animals includes:
IV induction and Inhalant maintenance
What equipment needs to be checked in preparation BEFORE induction begins?
Intubation equipment, syringes/needles/fluids, heating equipment, anesthetic machine, crash cart with emergency drugs
True or False: It is best to give the entire calculated dose of anesthetic induction IV
False. It is best to give about half, and try and intubate, if patient isnt ready then give the rest to effect
What is titration?
IV drugs given as a series of bolus injections and discontinued when desired effect is reached
With mask induction, it is hard to monitor what 3 parameters through the mask?
CRT, MM and Ocular indicators of anesthetic depth
True or False: It is appropriate to mask an un-sedated patient down for induction
False. This will produce a struggle and cause the release of epinephrine, and further struggle will come to induction and recovery. Use only on calm or sedated patients
What are the disadvantages of induction via Chamber?
Stress, trauma, vomiting, airway blockage
Hard to monitor patient
Exposes personnel to waste anesthetic gasses
True or False: The dose required for IM induction is generally about half the dose needed for IV induction
False. It is twice the corresponding dose.
True or false: When IM induction drugs peaks and the patient is still too light, an additional drug must be administered to get the patient to the point of intubation
True
The ET tube conducts anesthetic gas directly from oral cavity to trachea and by passes the ____ and ____
nares and pharynx
ET tubes help decrease anatomic dead space therefore reducing the risk of _______
atelectasis
What equipment is needed for ET intubation? (8)
- 3 ET tubes of slightly different diameters
- 2 foot length of IV tubing or rolled gauze to secure the ET tube in place
- Gauze sponge to grasp the tongue
- 12 mL syringe to inflate the cuff
- Stylette for narrow diameter tubes
- Lidocaine spray to control laryngospasm in cats
- Laryngoscope with appropriate blade and a light source
- Lubricant for the end of the tube
Ideally, you should choose an ET tube size so that the length extends from the tip of the nose to the _____
thoracic inlet
When selecting the appropriate diameter of ET tube, it must be small enough not to cause _____ injury and large enough to provide a _____ with an inflated cuff
Tracheal, seal
It is best to check the ET tube cuffs for leaks by:
Inflating them 10 minutes prior to intubation and ensuring they are still inflated
When the ET tube is placed correctly, the tube will begin to _______ from within, then the patient is placed in ______ recumbency
Fog, lateral
What are 3 ways you can confirm correct ET tube placement?
Watch the reservoir bag, unidirectional valve motion, patient coughs during intubation, fogging of tube during exhalation
You should inflate the ET tube cuff until leaking just ceases at a breathing circuit pressure of _______
20 cm of water
Laryngospasm is common in cats, swine and small ruminants and it makes intubation very difficult, which could lead to ____ or ______
Cyanosis or hypoxemia
Forcing the ET tube into the Glottis can cause life-threatening complications including:
Tracheal rupture, pneumothorax and pneumomedistinum
Despite all precautions, some intubated patients will develop minor tracheal irritation. Owners should be warned that it is common for animals to _____ for 1-2 days after anesthesia
Cough
An alternatvive to ET intubation is ______
Supraglotic Airway Devices (SAD)
What are the advantages of using SAD’s instead of ET tubes?
Increases efficacy of anesthetic gas delivery, redused anatomical dead space, reduced risk of laryngeal trauma
True or False: When rotating an intubated patient, it is best practice to temporarily disconnect the ET tube from the anesthetic machine
True. Rolling or twisting an animal while it is still connected to the circuit may cause ET tube to twist or collapse, resulting in airway obstruction or lacerated trachea
_______ should be instilled into th eyes of an anesthetized patient every 2-3 hours to increase patient comfort
Artificial tears or corneal lubricant
True or false: Patient breed can influence the length and quality of the recovery period
true
If a patient in the recovery stage is shivering even while under heating elements, the anesthetist can administer _______
direct oxygen
True or false: During extubation it is best to remove the tube straight out and slightly upward
False. It is best to remove the tube in the same arch that it went in
True or False: Remove the IV catheter as soon as the vaporizer is shut off and anesthetic is discontinued
False. Leave IV catheter in until patient is FULLY awake in case of emergency
The _______ stage of anesthesia is often the most dangerous even for healthy animals
recovery
After dental cleaning, oral surgery or any other procedure in which blood or other fluids are present in the oral cavity, what is the best way to remove the ET tube?
Leave the cuff slightly inflated during removal to sweep out fluid and prevent it from entering airway
A recovering patient should be turned every 10-15 mins to prevent _______
Hypostatic congestion: Pooling of blood in the dependent lung and tissues
What is a laryngospasm?
Reflex closure of the glottis in response to contact with object/substance
2 ways to prevent Laryngospasm are to wait for the glottis to open before intubating and _________
spray with lidocaine
