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Anesthesia > Elective Cases > Flashcards

Elective Cases Flashcards

1
Q

What ASA status would an otherwise healthy patient with unilateral cryptorchidism be considered? What pre-op blood work would be recommended?

A

ASA 1 —> cryptorchid testicle is not affecting the health of the patient

PCV/TS, serum biochemistry

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2
Q

What is the recommended IV fluid rate in dogs? What kind is recommended for a healthy dog undergoing a cryptorchid neuter?

A

5 mL/kg/hr

crystalloids

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3
Q

What are important components to IV premeds in a canine elective surgery?

A
  • Maropitant
  • Dexmedetomidine
  • Hydromorphone
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4
Q

What IV induction is recommended for canine elective surgeries? What maintenance is used?

A
  • ketamine: less cardiovascular effects, less propofol needed
  • propofol

isoflurane or sevoflurane

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5
Q

What analgesia plan is recommended for canine elective surgeries?

A
  • additional 1/2 dose of opioid used in premed (hydromorphone)
  • Nocita incisionally
  • Bupivacaine or Lidocaine intratesticular block on descended testicles
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6
Q

What are 3 important aspects to the post-operative plan in canine elective procedures?

A
  1. Acepromazine (slower onset) or Dexmedetomidine (faster) if needed for dysphoria
  2. Hydromorphone based on pain score
  3. Carprofen once fully recovered and oral TGH
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7
Q

What type of breathing circuit would be recommended for a healthy, 28 kg Golden Retriever undergoing an elective cryptorchid neuter?

A

rebreathing circuit

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8
Q

What are the 6 expected complications associated with a healthy canine elective cryptorchid neuter?

A
  1. hypoventilation - anesthesia-induced, laparoscopy causing insufflation of abdomen
  2. hypotension - anesthesia-induced, bradycardia due to anesthetics, especially with Dexmedetomidine and Hydrocodone
  3. bradycardia - only treat if BP is low!
  4. hypothermia
  5. hypoxemia - abdominal distension due to surgery impedes ability to expand lung/chest
  6. excitement at recovery - young and active dog, Trazodone + E-collar!
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9
Q

How are testicular blocks used in canine and feline patients?

A

Bupivacaine for longer procedures or Lidocaine for shorter and sooner surgeries pulled up in a 3 cc syringe with a 25g needle

  • CANINE = max 0.5 mL per testicle
  • FELINE = max 0.25 mL per testicle
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10
Q

Where is the testicular block performed?

A

embed needle in testicular tissue, avoiding pole due to vascularity

  • aspirate and, if no blood is present, inject appropriate amount —> testicle should expand, local will travel up the spermatic cord
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11
Q

A 6 y/o healthy and slightly obese DSH is presenting for a prophylactic dental. She has never had blood work done. A quick oral exam shows mild tartar.

What ASA status is this patient? What blood work should be done?

A

ASA 1 - no gingivitis, tartar is not affecting her health

full CBC (PCV/TS) and chemistry - no BW history, obese, possibility of renal disease (middle-aged cat)

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12
Q

What fluid rate is recommended for cats? What kind of fluid is used in a healthy feline elective procedure?

A

3 mL/kg/hr

crystalloids

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13
Q

What IV premeds are recommended for a healthy feline elective procedure?

A
  • Maropitant
  • Butorphanol - works better in cats, hydromorphone can cause post-op hypertermia
  • Midazolam
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14
Q

What IV induction is recommended for healthy 6.5 kg feline elective procedures? What maintenance is used? Breathing circuit?

A
  • Ketamine
  • Alfaxolone/Propofol

isoflurane or sevoflurane with a pediatric circuit on rebreathing circuit

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15
Q

What aspect of anesthesia maintenance is of concern in an obese patient?

A

may require ventilation —> more challenging to expand thorax = hypoventilation

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16
Q

When is an analgesia plan necessary for a routine dental? What medications can be used?

A

if extractions are required

  • dental blocks
  • Buprenorphine
  • NSAID: no renal disease noted
17
Q

What post-operative plan is recommended in healthy feline elective dentals? What is extractions are required?

A

Acepromazine +/- Dexmedetomidine for excitement

  • Buprenorphine
  • Robenacoxib - SQ if not administered during procedure, oral TGH
18
Q

What aren’t mouth gags as commonly used in dental procedures? In cats?

A

very uncomfortable, soreness

causes decreased cerebral blood flow and patients can wake up blind

19
Q

What are 6 anticipated complications associated with healthy feline dental procedures?

A
  1. hypoventilation - anesthesia-induced, obesity
  2. hypotension - anesthesia-induced, especially important due to susceptibility of developing renal disease
  3. bradycardia - can be decreased with mixed opioids
  4. hypothermia - smaller patients, water used with scaler
  5. hypoxemia
  6. excitement and hyperthermia at recovery
20
Q

What are the 2 most common causes of excitement and hyperthermia in feline patients following anesthesia? When is it treated?

A
  1. rebound effect due to hypothermia during procedure
  2. pure mu agonists, Buprenorphine, Ketamine

use benign neglect unless T > 104, then add more sedation, reverse pure mu agonist with Naloxone or Butorphanol

21
Q

How should dental blocks for procedures be determined? Which local is most commonly used? What should patients go home with?

A

depending on the region requiring extractions

Bupivacaine - gives time to perform extractions, give 10 mins for onset

NSAIDs +/- Buprenorphine (OTM or Zorbium)

22
Q

Why is it especially important to ensure a feline patient is eating 2-4 hrs post-operatively?

A

medications to go home are more likely to be PO, can advise owners to give favorite meals to encourage ingestion of medications

23
Q

Why is the timing of the use of NSAIDs controversial?

A
  • pre or intra-op = okay for ASA I and II and higher status if properly hydrated (RBF concerns!)
  • post-op = pre-existing hypovolemia, hypotension, surgical risk, coagulopathy

POST-OP - intraoperative hypotension + NSAID use impacts renal function, multimodal approach helps lower dosage —> mostly safe in routine patients

24
Q

How is hypotension, hypothermia, hypoventilation, bradycardia, and hypoxemia troubleshooted in routine cases?

A

HYPOTENSION - depends on HR - bradycardia should be treated first, fluid bolus

HYPOTHERMIA - want to avoid <97 degrees, warm patient

HYPOVENTILATION - ventilator, assisted breathing

BRADYCARDIA - treat with low BP!

HYPOXEMIA - common during induction

25
Q

What are the 3 most common causes of perioperative hypoxemia?

A
  1. no pre-oxygenation
  2. too fast induction agent
  3. improper ET tube placement or length
26
Q

How often should patients be monitored? What else is recorded?

A

every 5 mins

  • time of surgical incision(s)
  • dental radiographs
  • repositioning/moving
  • support drugs given
  • anesthesia machine type, ETT size, circuit type, type of IVC and location
  • quality of sedation and recovery
  • pain scoring

Anesthesia (40 decks)

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