Equine Anesthesia Flashcards

1
Q

What are stallions prone to when on acepromazine

A

Penile prolapse / priapism

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2
Q

What does Xylazine cause in the third trimester of pregnancy when administered

A

Abortion

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3
Q

What is the normal HR, RR, and temperature of horses

A

HR - 28-40bpm
RR - 8-16bpm
Temp - 99.5-101.3 F

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4
Q

What are normal HR, RR, and Temp of donkeys

A

HR - 35-50bpm
RR - 12-28bpm
Temp - 97.2-100F

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5
Q

Where do you typically place a venous catherization and what do you use

A

-Jugular vein
-Aseptic technique with a 12gauge catheter and suture to skin with nylon

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6
Q

What do you do to prep a horse for anesthesia

A

-Fast for 4-6 hours
-withhold water for 2 hours
-rinse mouth with pressurized water (removes any foreign material that would attach to endotracheal tube and become a contaminate)
-remove horseshoes if they have it

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7
Q

What are some premedications

A

-Alpha-2 agonist -> potential sedatives with some analgesic effect
*Xylaxine, detomidine, romifidine
-Acepromazine -> mild sedative (anxiolytic), can cause penile prolapse
-Opioids
*Butorphanol -> most common analgesic
*mu agonist (Hydromorphone, methadone, morphine) -> severe pain
-Flunixine meglumine -> analgesic
-Meloxicam -> analgesic
-muscle relaxants
*centrally acting - Benzodiazepines, GGE, Gabapentin
*peripherally acting - dantrolene (on skeletal muscle), non-depolarizing blockers and depolarizing blockers

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8
Q

What is the best option of premedications to cause sedation/analgesia in the horse but may cause reduced GI motility -> colic

A

Mu agonist opioids and alpha-2

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9
Q

What is a common muscle relaxant used primarily in horses

A

-Guaifenesin (GGE/GG)
*muscle relaxant before induction - given at high volumes so you admin with a flutter valve to be able to give it all
-causes skeletal muscle to relax with minimal cardiovascular and respiratory effects
**Component of TIVE or PIVA for maintenance anesthetic

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10
Q

Why has GGE been replaced largely by benzodiazepines

A

-it’s a powder which is inconvenient because you have to dilute it and that adds a potential for it to get contaminated
-might cause thrombophlebitis at high concentrations

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11
Q

What do you consider when giving premeds to horses

A

Horses should be in an induction/recovery box, have padded stall, quiet environment,
Horse is restrained properly and there is communication within the team
Give premed drugs - produced enough sedation and relaxation before inducing anesthesia

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12
Q

What is the inducing agent of choice in horses

A

Ketamine

**make sure you give muscle relaxant first

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13
Q

What is needed to intubate a horse and what is the technique used

A

-26mm diameter ET tube, mouth gag/ bite block to keep jaws apart
-ensure the neck is extended and tube is lubricated
-Intubate BLINDLY
-then inflate cuff

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14
Q

What do you have to keep in mind when positioning a horse on the theatre table

A

-keep them only one lateral recumbency throughout
-move slowly when you changing body position
-cushion the head, neck, shoulders, and pelvis
-stretch and spread limbs apart
-protect eyes from trauma, pressure

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15
Q

What is the oxygen flow rate for induction and maintenance

A

-After induction and at end of six- 20ml/kg/min
-Maintenance- 10ml/kg/min

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16
Q

What is required for maintenance of anesthesia

A

-Large animal circle anesthetic circuit
-Mechanical ventilation (IPPV)
-Dobutamine CRI to maintain of arterial blood pressure
-use of local anesthetic drugs as much as possible
-sevoflurane or isoflurane
-PIVA
*causes MAC reduction, provides analgesia, adverse effect reduction
*use Ketamine, medetomidine, lidocaine
-TIVA
*superior analgesia, less cardiovascular depression, decreases sx stress, lowers morbidity/mortality
*alpha 2, muscle relaxant, ketamine (xylazine, GGE, ketamine)

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17
Q

How do you measure anesthetic depth in a horse

A

-look at CNS reflex
*surgical plane - weak palpebral reflex and anal tone, no response to noxious stimulus
*too light - lacrimation, nystagmus, movement, blinking, cornealcreflex present, tachycardia, tachypnea
*too deep - absent palpebral reflex, absent corneal reflex, dry cornea, bradypnea, apnea, bradycardia, hypotension

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18
Q

What are some common complications of anesthesia in horses

A

-Hypoventilation
*maintain ETCO2 around 35-45mmHg
*give mechanical ventilation if procedure is longer than 45 minutes
-Hypotension
*give crystaloids or colloids as needed
*dobutamine CRI - standard of care (POs inotrope)
-others ephedrine (pos inotrop) or phenylephrine (peripheral vasoconstriction)

19
Q

What is risky about horses recovering from anesthesia and what should you do to minimize it

A

-excitable flight and myopathy risk
-provide soft padding, no slip recovery boxes
Sedate with alpha 2 agonist to delay standing attempts
-give butorphanol if additional analgesia/sedation is needed
-extubation after swallowing reflex or if they had an invasive upper airway sx then exubate after standing to prevent blood obstruction
-give supplemental oxygen to minimize hypoxemia risk
-temp control

20
Q

What are the two general categories of recovery technique

A

-unassisted
*generally in healthy horses and for short anesthetic events
-Assisted recovery
*for old, weak, ill patients; long procedures or othropedic procedures

21
Q

What are the different assisted recovery techniques

A

-Manual assistance = hand recovery inside box
*foals and small equine where one person is at the head with the halter and another at the tail
-Head and tail ropes
*inside or out of box with ropes attached to rings on the wall
-inflatable air cushion
*stops horse from standing on the air filled bed and you can deflate when they are totally awake. This also minimizes nerve compression but takes a while to clean up afterward
-Sling recovery
*used for extremely debilitated patients and those with fractures
-pool raft system
*not commonly available and expensive but it’s used for orthopedic repairs

22
Q

When are horses considered hypotensive

A

MAP <70mmHg
SAP < 90mmHg

23
Q

How would you treat hypotension in horses

A

-treat underlying cause
-reduce anesthetic drug rate
-fluids -
*crystalloids 10ml/kg, colloids 5ml/kg, blood if hemorrhagic
-cardio active drugs - dobutamine and ephedrine

24
Q

What is one of the most common causes of morbidity/mortality of horse anesthesia and what are the different types

A

-myopathies!
*w/ rhabdomyolysis
-compartmentalism myopathy
- malignant hyperthermia
*w/o rhabdomyolysis
-hyperkaelemic periodic paresis

25
Q

What are some clinpath signs there are a myopathy

A

-myoglobinurinuria and hyperglobulinaemia
- elevated muscle enzymes - CK, AST, LDH
-electrolyte changes - increased P and K, decreased Na, Cl, and Ca
-elevated BUN and creatinine
Inflammation leukogram

26
Q

What are predisposing factors, signs and symptoms, and treatment of compartmental myopathy

A

-predisposing factors - muscle and nerve tissue ischemia associated with poor perfusion (hypotension, prolonged recumbency, halothane maintenance, improper positioning)
-signs - pain, paresis, paralysis, pallor, pulselessness, poikilothermia, failure to stand on FORELIMB AND HINDLIMB, tense and firm muscles, renal failure and myoglobinuria
Treat - fluids, analgesics, muscle relaxants, sedatives, DMSO (oxygen radical scavenger), physiotherapy, decompression

27
Q

What are predisposing factors, signs and symptoms, and treatment of malignant hyperthermia

A

-predisposing factor - mutation in ryanodine (RyR1) gene causing dysfunctional release of excessive calcium into sarcoplasmic which is agitated by halothane anesthetic, stress, depolarizing muscle relaxant, improper positioning
-signs - hyperthermia, hypercapnea, lactic acidosis (profuse sweating, tachy0nea, tachycardia, prolapse of third eyelid, flared nostrils, muscle rigidity and twitching)
-prevention is better than treatment
*prevent - correct positioning and padding, give dantrolene, maintain blood pressure
*treat - dantrolene, water/alcohol baths, Acepromazine, sodium bicarb

28
Q

What are predisposing factors, signs and symptoms, and treatment of hyperkelemic period paralysis (HYPP)

A

-predisposed- Quarter horses (& appaloosas) rare genetic trait resulting in a failure of sodium channels to deactivate cause excessive Na influx and K outflux, triggered by stress, transport, sedation, and anesthesia
-signs - challenge to intubate, respiratory distress, laryngeal paralysis, swaying, staggering, dog-sitting, recumbency, prolapse of eyelid
-Treat - INCREASE K EXCRETION -> acetazolamide, dextrose, calcium gluconate,

29
Q

What is a common concurrent complication with myopathy and how would you treat it

A

-neuropathy
-prevent and treat with
*correct positioning, padding, remove head halter during anesthesia, maintain normal BP, symptomatic treatment

30
Q

What are some (other) complications that can occur in horses

A

-Nasal edema
*caused by gravity restricting diameter of nostrils
*treat with phenylephrine into nostrils, place nasal tube until they stand, oxygen supplement
-excitement during recover
*can hurt themselves
*minimize stimulation during recovery, sedate with romifidine or other alpha-2 to delaying standing
-Full bladder
*may cause them to stand faster/ suddenly
*urinary catheter for long anesthetic procedures
-post sx pain
*give NSAIDs, alpha-2, opioids before recovery
-weakness during recovery
* can be due to hypocalcemia, hypokalemia, hypoglycemia and anemia
*check blood work and correct abnormalities

31
Q

Do you separate the foal from its mother during premedication

A

No- premedicate in presence of dam to ease restraint

32
Q

What premed can you give to sedate foals but causes excitement in adults

A

Benzodiazepines

33
Q

What methods can you do to induce anesthesia in foals

A

-inhalation (face mask or nasotracheal) - isoflurane or sevoflurane
-injection - propofol or ketamine

34
Q

Can you do unassisted recovery with a foal

A

No they usually need some human physical support
*delay them getting up manually
*support head and pull on tail base once up

35
Q

Are donkeys fight or flight animals

A

They are fight animals

36
Q

Are donkeys more or less prone to excitement during induction or recovery periods than horses

A

Less prone

37
Q

Compared to horses how do donkies react to premed sedatives, anesthetics and analgesic

A

-more resistant so increase dose by 30%

38
Q

What drug are donkeys more susceptible to than horses

A

GGE

39
Q

How long would you starve a 1 week old foal going for a patent Urachus repair surgery

A

DO NOT STARVE - does not have significant glycogen reserves and can go into a negative glucose balance

40
Q

What are 5 physiological complications that a foal is predisposed to during anesthesia compared to adults

A

-Hypoglycemia - check BG and supplement with glucose IV
-Hypotension - monitor BP - give IV fluids and cardio-active drugs
-Hypothermia - heat supplementation
-Hypoventalation - assisted ventilation
-Hyperkaelemia - correct using fluids and insulin

-also low anesthetic requirements and delayed recovery

41
Q

What is the lowest a foal blood pressure can go and still be normal

A

MAP low as 50-55mmHg

42
Q

What is the heart rate of foals

A

60-80bpm

43
Q

What is a good anesthetic protocol for foals

A

-premed - diazepam or midazolam or both
-Induce -
*inj - propofol or ketamine
*inhalant anesthesia via nasal-tracheal tube
-maintenance- isoflurane or sevoflurane
-analgesia- butorphanol