Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Anesthesia > Emergency Anesthesia > Flashcards

Emergency Anesthesia Flashcards

1
Q

What are the 3 classes of sedatives most commonly used in the emergency setting?

A

Benzos, alpha 2s, and phenothiazines (+ opioids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some pros of using a phenothiazine (such as ace) for sedation?

A
  • Reliable sedation
  • may increase threshold for arryhthmias
  • antiemetic (centrally antidopaminergic)
  • prevents histamine release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some cons to using a phenothiazine (such as ace) for sedation?

A
  • Not reversible
  • Hypotension (alpha blockade, vasodilation)
  • Platelet aggregation inhibitor
  • long acting, esp. with liver dz
  • mild resp depressant
  • no analgesia
  • Minimal sedation in cats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some pros of using an alpha 2 agonist (such as dexmed or xylazine) for sedation?

A
  • Excellent sedation
  • Excellent muscle relaxant
  • Mild analgesia
  • Reversible with atipamezole or yohimbine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some cons to using an alpha 2 agonist (such as dexmed or xylazine) for sedation?

A
  • Hypertension (alpha 1/2 stim, vasoconstriction), followed by hypotension (central symp blockade resulting in decr in CO)
  • Severe bradycardia (reflex bradycardia and central symp blockade)
  • May cause emesis
  • 1st/2nd/3rd degree AV block
  • Depresses resp center
  • Promotes diuresis
  • Inhibitis insulin, may produce hyperglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some pros to using a benzo for sedation?

A
  • Minimal CV effects
  • Amnestic
  • Midaz = water soluble, can be given IM/SQ
  • MAC sparing
  • Reversible w/ Flumazenil
  • Anticonvulsant
  • Good muscle relaxant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some cons of using a benzo for sedation?

A
  • May cause excitement in cats/some dogs
  • Prolonged effects w/ liver insufficiency
  • Diazepam not water soluble - ONLY IV
  • No analgesia
  • Controlled substances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Combining what two types of agents creates neuroleptanalgesia?

A

Opioids and a tranquilizer or sedative (typically a benzo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the pros to using a full mu agonist as an emergency sedative?

A
  • Excellent analgesia
  • Reversible w/ naloxone, naltrexone
  • Mild cardiopulm effects (bradycardia, decr RR, dose dependent)
  • Synergistic w/ tranqs/sedatives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the cons of using a full mu agonist as an emergency sedative?

A
  • Dysphoria/excessive sedation
  • panting/hyperthermia in cats
  • decr GI motility
  • Controlled drugs
  • Vomiting
  • Excitement/aggression in some cats
  • Resp depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the pros to using a partial mu agonist as an emergency sedative?

A
  • Less dysphoria than full mus
  • Less resp/GI effects than full mus
  • Butorphanol can be used as partial reversal agent
  • Buprenorphine is long lasting and can be given transmucosally in cats
  • Good analgesic effect w/o significant dysphoria in cats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the cons of using a partial mu agonist as an emergency sedative?

A
  • Less analgesia provided than with full mu
  • butorphanol is short acting
  • controlled drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T or F: Etomidate is a great choice as an induction agent in all emergency patients

A

False; etomidate is actually contraindicated in many emergency patients because it can suppress adrenal function for up to 6 hours following a single dose and the stress response is often necessary for survival in emergent patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What induction agent can cause direct myocardial depression in patients with catecholamine depletion?

A

Ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the cons of using an opioid and a benzo as induction agents (neuroleptanalgesia)?

A
  • Swallowing reflex maintained
  • Noise-sensitive during induction
  • Use of controlled drug
  • Only effective in dogs and cats w/ severe CB or neuro depression
  • Resp depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When using the Doppler method to measure blood pressure, what does the value most closely represent in dogs vs. cats?

A
  • Dogs - systolic arterial pressure
  • Cats - MAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A sudden decline in end-tidal CO2 in the face of normal ventilation could indicate what?

A

A drop in CO, a loss of perfusion to the lungs (PTE), or cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What types of patients should you strongly consider administering blood products to prior to anesthesia?

A
  • Patients with acute blood loss
  • Patients showing clinical signs of decr O2 delivery (tachycardia, tachypnea, lethargy, weakness)
  • Elevated plasma lactate levels
  • PCV <20%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If administering whole blood, approximately 2 ml/kg of whole blood can be expected to raise the PCV by what percentage?

A

1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the formula for calculating the amount of pRBCs to give a patient suffering from acute blood loss?

A

pRBCs (ml) = [(PCVdesired – PCVpatient)/PCVdonor] x 80 x weight(kg).

21
Q

What two cardiac arrhythmias are most commonly seen with splenic disease?

A

VPCs and Vtach

22
Q

What two induction agents should be often be avoided in a patient presenting with a hemoabdomen?

A
  • Ketamine - may exacerbate ventricular arrhythmias
  • Propofol - causes splenic engorgement, avoid if spleen is source of hemorrhage
23
Q

What is meant by ‘permissive hypotension?’

A
  • One aims to perfume the organs with some sort of minimum BP (70-80 mmHg systolic or 50 mmHg for MAP) to limit volume of resuscitation fluid required and hemodilution occurrence
  • aimed in pursuit of hemostasis rather than BP
24
Q

What are the recommendations for induction to place a pacemaker?

A
  • Temporary pacemaker: opioid + benzo
  • Permanent pacemaker: etomidate + midazolam (+/- ketamine)
25
Q

Why might you not want to use PEEP and recruitment maneuvers in a patient already experiencing hypovolemic shock?

A
  • Because both may severely depresss venous return and cardiac output
26
Q

What is the recommended pre-med protocol for a lar par patient?

A
  • Butrophanol + ace or low-dose dexmed
27
Q

What are a few analgesic agents that can be used in the post-op period following a laryngeal tie back surgery to avoid opioids?

A

Ketamine, lidocaine, and NSAIDs

28
Q

What are some principles to keep in mind when coming up with an anesthetic plan for a TBI patient?

A
  • Patients are very sensitive to anesthetics and a lower dose of sedatives is required (if at all)
  • benzos = preferred sedative d/t anti-seizure properities
  • opioids are contraindicated (cause vomiting, resp depression, elevated ICP)
  • ketamine should be avoided - causes elevated cerebral oxygen consumption
  • Inhalants can cause dose dependent intracranial vasodilation, hypoventilation, and ICP elevations
  • should be ventilated - end tidal CO2 between 30-35 mmHg
  • should be kept mildly hypothermic (96-98F)
29
Q

What is the anesthetic agent of choice for TBIs?

A

Propofol, typically TIVA

30
Q

What is the Cushing’s reflex?

A

A sudden elevation in BP followed by a reduction in heart rate than may indicate elevated ICP

31
Q

If you note a Cushing’s reflex in a patient, what should you administer?

A

2-4 ml/kg of hypertonic saline to reduce cerebral edema and decrease ICP

32
Q

What drugs should be used for analgesic management and anesthesia for animals with spinal injuries?

A

Opioids with systemic lidocaine or low-dose ketamine, as well as antiemetics (IVDD dogs at risk for aspiration pneumonia)

33
Q

What is the most common arrhythmia seen in a GDV dog?

A

Vtach, but can also see Afib and SVT

34
Q

What are the physical parameters of early sepsis?

A
  • Tachypnea
  • Bounding pulses
  • CRT <1 s
  • Red MM
  • Mental depression
  • Hyperthermia
35
Q

What are the physical parameters of late sepsis?

A
  • Tachypnea
  • Thready pulses
  • CRT >2 s
  • Pale MM
  • Stupor, coma
  • Hypothermia
  • Organ failure
36
Q

Fluid resuscitation in a septic patient should aim for what parameters?

A
  • MAP of >65 mmHg
  • adequate urine output
  • maintain normal pH
37
Q

What are the goals of anesthetizing patients with sepsis?

A

Maximizing oxygen delivery to multiple organs (kidneys, liver, heart, brain) and optimizing renal function

38
Q

The anesthetic protocol for septic patients can include and avoid which drugs?

A

Can include:

  • drugs that maintain CV stability (opioids, benzos)
  • inhalants to lower MAC
  • systemic lidocaine (be careful)
  • low-dose ketamine
  • PPV

Avoid:

  • Etomidate (b/c it depresses the HPA axis)
39
Q

Sedation, if absolutely necessary, for a parturient animal prior to a C-section should include what?

A
  • Opioids +/- a benzo
    • Morphine has lowest lipid solubility so cross placenta slowest, but can cause resp depression in fetuses
  • AVOID ace (widespread dilation in shock patients) and xylazine (high fetal mortality rate)
40
Q

What considerations should you have when performing an epidural on a pregnant animal?

A
  • Typically performed under GA
  • take 15-20 minutes to reach peak effect
  • Total volume should be reduced by 20-30%
41
Q

What is the best method of induction of pregnant animals?

A

Propofol (or Alfaxalone)

  • masking down and ketamine are contraindicated
42
Q

What ECG changes might you see in the case of a uroabdomen/uroperitoneum?

A
  • Narrowing and ‘tenting’ of T waves
  • Shortening of QT interval
  • Prolonged PR interval
  • Widening QRS complex
  • Arrhythmias: Vfib or V asystole
43
Q

What type of fluids should be used for fluid resuscitation in uroabdomen patients?

A

Isotonic crystalloids - LRS (small amount of K) or 0.9% NaCl (although lacks a buffer)

44
Q

What are some treatments of hyperkalemia?

A
  • Dextrose +/- insulin
  • Sodium bicarbonate (refractory hyperK, good for treating metabolic acidosis)
  • Calcium gluconate (cardioprotective- modifies threshold potential)
45
Q

Why is positive pressure ventilation recommended in uroabdomen patient anesthesia?

A
  • To prevent hypercapnia and consequent respiratory acidosis, as acidemia favors extracellular movement of K and can worsen preexisting hyperK
46
Q

What should be avoided to prevent sudden increases in IOP, particularly in ocular anesthetic patients?

A
  • Vomiting/regurg
  • Stress/struggling
  • Gagging/coughing
  • Occluding jugulars or placing substantial pressure on neck
  • Traumatic or forceful intubation
  • Lowering the head below the rest of the body
  • Putting pressure on eyelids (ie. Face mask)
  • hypoxemia and hypercapnia
47
Q

What are the preferred analgesics for ocular procedures?

A
  • Opioids + antiemetics
  • Ace or dexmed (remember alpha 2s can also cause vomiting)
48
Q

What are some considerations for induction agents used in ocular procedures?

A
  • Ketamine ONLY if given with a benzo
  • Propofol ONLY if given with a benzo
  • Etomidate can cause myoclonus, resulting in increased IOP
  • Alfaxolone can also cause IOP increase
49
Q

What is the oculo-cardiac reflex?

A

Caused by pressure or traction on eyeball, resulting in the development of bradycardia and bradyarrhythmias due to stimulation of the trigeminal and vagus nerves

  • can treat persistent bradycardia with anticholinergic (atropine)

Clinical Anesthesia (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions