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Anaesthesia > Clinical Monitoring During Anaesthesia - Capnography > Flashcards

Clinical Monitoring During Anaesthesia - Capnography Flashcards

1
Q

Why monitor anaesthesia?

A
  • to prevent P responses to Sx stimulation
  • to detect abnormalities before they turn into major complications
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2
Q

by ensuring tissue perfusion & oxygenation, we can…

A
  • prevent worsening of subclin dz & improve P outcome
  • reduce morbidity & mortality assoc’d w/ anaesthesia
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3
Q

When is the highest risk period for patients surrounding anaesthesia?

A

during the recovery period

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4
Q

When monitoring anaesthesia, what do you specifically monitor?

A
  1. CV system
  2. resp system
  3. depth of anaesthesia
  4. body temp
  5. fluid balance
  6. anaesthetic equipment
  7. recovery
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5
Q

What reflexes in the dog/cat are monitored during anaesthesia?

A
  • flexor withdrawal/pedal
  • palpebral
  • position of the eye
  • eye mvmt
  • ear flick (cat)
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6
Q

How do you determine in small animals adequate anaesthetic depth?

A
  • HR, RR, BP stable
  • Neg flexor withdrawal reflex
  • Eyes: no palpebral reflex, ventral rotation, no nystagmus
  • minimal jaw tone
  • no movement
  • neg ear flick
  • pink MM
  • CRT <2 sec
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7
Q

How do you know an animal is too light

A
  • eye central
  • increased HR/BP/RR
  • increased jaw tone
    +/- palpebral
    +/- pale mm
    Nystagmus in horses (VERY LIGHT)
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8
Q

how do you know an animal is too deep?

A
  • eye central
  • decreased HR, BP, RR
  • no palpebral, jaw tone
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9
Q

When monitoring and determining depth of anaesthesia, you notice a central eye. Your patient was given ketamine as part of its premed IM and was maintained on CRI of ketamine. Is this normal?

A

Ketamine will result in a central eye so this cannot be used to determine depth.
This does NOT occur & of concern if used as an induction agent (duration of action 10-20 mins)

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10
Q

A respiratory monitor

A

“bleeps” each time the P breathes but DOES NOT tell you anything about efficiency of respirations/ventilation/etc.

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11
Q

If an animal is hypothermic in recovery and shivering, it will

A

increase Oxygen demand by 400% so need about 85% Oxygen to not become hypoxaemic

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12
Q

Why are IV fluids administered?

A

inhalants & maintenance w/ propofol/alfaxalone –> vasodilation occurs, circ blood vol is not enough –> relative hypovolaemia

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13
Q

What does capnograph measure?

A

End-tidal (Et) & inhaled (Fi) CO2

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14
Q

Normal Et value

A

4.6-6 kPa (35-45 mmHg)

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15
Q

Normal Fi value

A

0 –> do NOT want any inhalation of CO2 in most conditions

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16
Q

capnographs produce a wave form which is useful to

A

diagnose respiratory problems

17
Q

CO2 is an end-product of…

A

metabolism, then sent to lungs for exhalation

18
Q

Levels of CO2 depend on…

A

cell metabolic rate, perfusion of lungs, ventilation
& can be used to diagnose issues w/ breathing system

19
Q

Capnography monitors…

A

ventilation, circulation, metabolism

20
Q

End-tidal or exhaled CO2 equates w/

A

alveolar & arterial CO2
UNLESS VQ mismatch or other issues

21
Q

Increased inspired CO2 (Fi) indicates

A

equipment is faulty

22
Q

capnography provides range of info including:

A
  • CO2 production (metabolism)
  • pulmonary perfusion & CO
  • alveolar ventilation
  • breathing system & other equipment issues
  • efficiency of CPR
  • warns of impending cardiac arrest
23
Q

when looking at a capnograph, how do you determine hypercapnia is occurring? Clinically, what is happening physiologically in the patient?

A

EtCO2 > 6kPa
ventilation is not keeping up w/ expelling CO2 at the appropriate rate –> build up of CO2

24
Q

What is the most common cause of hypercapnia?

A

decreased alveolar ventilation due to: too deep anaesthesia, geriatric, obesity, pregnancy, space-occupying masses, muscle weakness, laparoscopy, endoscopy (expansion of abd contents), pain

25
Q

What is the 2nd most common cause of hypercapnia

A

Equipment failure causing rebreathing of CO2 –> exhausted soda lime, dysfxning unidirectional valves, too low FGF, equipment dead space

26
Q

What are other causes of hypercapnia aside from the most common ones?

A

increased metabolic rate –> hyperthermia, hyperthyroidism, seizures, etc

27
Q

What are the 4 main causes of hypocapnia?

A
  • decreased metabolism
  • decreased perfusion
  • increased alveolar ventilation
  • equipment problems
28
Q

Remember: if you suspect that the hypocapnia seen on a capnograph is due to decreased cardiac output, it is…

A

an emergency

29
Q

Explain the 4 phases of a capnograph trace?

A

I: exhaling anatomical dead space gas, no CO2
II: alveolar air w/ CO2 joins dead space air
III: exhaling only alveolar gas
0: inhalation, normal CO2 drops & majority should be 0 CO2 during this time; if not, then is inhaling CO2

30
Q

What kind of trace is this?

A

Normal capnograph trace

31
Q

What kind of trace is this? Is it normal or abnormal?

A

Cardiogenic oscillations
Normal trace

32
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

abnormal
hypoventilation
P hypoventilated so hypercarbic

33
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

Abnormal
Bronchoconstriction or partial airway obstruction/kink
Expiration difficult/restricted leading to accumulation of CO2

34
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

Patient fighting the ventilator
Abnormal
Patient is trying to inhale in the middle of ventilation

35
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

Rapidly decreasing EtCO2
Abnormal
indicates cardiac arrest, rapidly failing cardiac output; OR leak in cuff or breathing system not connected

36
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

Leaky ETT Cuff
Abnormal
when exhaling, the CO2 majority exits into the room around the tube, so lower EtCO2 than what is being exhaled

37
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

Abnormal
Rebreathing of CO2 in a circle system due to leaky valves
leaky valve so circle fails which is unidirectional flow of gas, then can no longer airflow properly so P breathing in CO2
when not reaching baseline during inspiration = massive rebreathing of CO2

38
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

Rebreathing of CO2 in a non-rebreathing system
abnormal
insufficient FGF on non-rebreathing
Gap on baseline = rebreathing CO2

39
Q

What kind of trace is this? Is it normal or abnormal? What is happening to the patient?

A

Oesophageal intubation
abnormal
breathing, not no CO2; if you see this and know p is breathing, you intubated in the wrong tube and need to reintubate

Anaesthesia (24 decks)

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