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Anesthesiology JK > EVERYTHING ELSE FOR EXAM II WITHOUT PAIN STUFF + ACUPUCTURE > Flashcards

EVERYTHING ELSE FOR EXAM II WITHOUT PAIN STUFF + ACUPUCTURE Flashcards

1
Q

Most important characteristic of NMBDs?

A

Water soluble (less likely to cross BBB/placenta; adsorb GI)

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2
Q

What is the difference between depolarizing NMBDs and non-depolarizing NMBDs?

A

Depolarizing: AGONIST (contraction)

Non-depolarizing: ANTAGONIST (stabilizes muscle membrane)

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3
Q

Order of muscle relaxation

A

Eyes (@ a low dose) > Larynx > Diaphragm (most resistant)

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4
Q

Why is usage of NMBDs an animal welfare issue?

A

Complete paralysis of striated muscles while conscious is retained; No analgesia; Spontaneous respiration ceases.

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5
Q

What are NMBDs used for?

A

POSITION THE EYEBALL CENTRALLY.

Intraocular or corneal surgeries.

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6
Q

T/F. NMBDs can be used as a sole agent of analgesia.

A

FALSE FALSE FALSE. Extremely distressing even without pain!

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7
Q

T/F. Balanced anesthesia provides reduced MAC in vet med compared to human med.

A

False. MORE MAC used because NMBDs are usually used to stop reflex movements in humans whereas vet med uses MAC to achieve this (Vet med uses more inhalants)

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8
Q

What are the most important drugs that potentiate NMBD effect? What are other factors that potentiate NMBD effect?

A

Inhalational anesthetics.

Hypothermia, electrolyte abnormalities, age.

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9
Q

Which drug of NMBDs causes the most histamine release? What does histamine release cause?

A

Atracurium (Non-depolarizing NMBD)

Bronchoconstriction, vasodilation, negative inotropy, tachycardia.

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10
Q

T/F. Side effects of ANS are most commonly caused with modern NMBDs.

A

False. Unlikely with modern NMBDs.

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11
Q

T/F. Impossible to be sure that residual blocking effects are not present only by examining CS of NMBDs.

A

True.

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12
Q

What are the two equipments necessary to monitor peripheral nerves?

A

Electronic equipment (stimulate nerves and elicit a motor response; placed over a motor nerve), Accelerometer (quantify extend of movement; placed on a moving body part).

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13
Q

What is the acceptable neuromuscular recovery for Train of Four (TOF)? (how well muscles are functioning during recovery0

A

greater or equal to 0.9

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14
Q

Which one is not used in vet med anymore? Depolarizing or non-depolarizing NMBDs?

A

Depolarizing (Succinylcholine)

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15
Q

What is the difference between phase I and phase II in Depolarizing?

A

Phase I: sodium channels remain closed > Prolonged contraction of muscles (muscle fasciculation).
Phase II: Comes back to depolarization gradually (Similar to Non-depolarizing)

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16
Q

Which are intermediate acting non-depolarizing drugs?

A

Atracurium, Cistracurium, Rocuronium, Vecuronium

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17
Q

What is “Hofmann elimination” of non-depolarizing drugs?

A

Depends on plasma pH and temp.

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18
Q

What is Laudanosine?

A

Metabolite of Atracurium and Cisatracurium.

Decreases seizure threshold and histamine release at a high dose.

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19
Q

Which of the intermediate acting depolarizing drugs has a specific antagonist drug?

A

Rocruonium > Sugammadex.

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20
Q

T/F. Need to keep end tidal ISO to 0.8-1% for non-depoalrizing drugs.

A

True

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21
Q

When you are evaluating joint function, goniometer is often used. What does goniometer measure?

A

Joint flexion (if increased in angle > more flexibility > a good outcome).

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22
Q

What is the indication of cryotherapy? What is the indication of heat therapy?

A

Cryotherapy: acute phase tissue injury (reduce blood flow).

Heat therapy: AFTER acute inflammatory of healing has resolved (vasodilation, acceleration of enzymes).

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23
Q

What is the difference between passive range of motion and active range of motion?

A

Passive range of motion: What you are doing to the patient (immediate post-sx; STRETCHING).
Active range of motion: What the patient is doing (INCREASE JOINT FLEXION).

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24
Q

Why is low-level laser therapy used?

A

Provides analgesia and improved wound healing.

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25
Q

Which therapy provides GATE THEORY? What is gate theory?

A

Electrical stimulation.

Stimulation of A-beta fibers and inhibition of C fibers.

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26
Q

Distribution of Fluids. ICF and ECF (intravascular and interstitial). Intravascular is PLASMA (NOT whole blood)

A

ICF: 40%
ECF: 20% (intravascular 5% and interstitial 15%)

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27
Q

Where is Na+ located? K+? Protein? (ICF or ECF)

A

Na: ECF
K: ICF
Protein: intravascular (IVF)

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28
Q

What is the difference between osmotic pressure and osmoles?

A

Osmotic pressure: pressure required to prevent water movement.
Osmoles: number of particles per kg of water.

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29
Q

T/F. Osmolality of solution: categorized on their effect on proteins.

A

False. RED CELL VOLUME.

Isotonic, Hypotonic, Hypertonic

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30
Q

Edema forms when albumin is LESS than

A

Less than 1.5g/dL

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31
Q

Fluid of choice. First line of tx of shock.

A

Balanced electrolyte solutions (LRS, Nomosol), 0.9% NaCl (physiological saline)

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32
Q

Which fluids are not generally appropriate for peri-op use?

A

Maintenance solutions and dextrose solutions.

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33
Q

What is the indicative use of hypertonic saline?

A

To enhance cardiac function (quick IV volume expansion, severe shock, head injury with elevated ICP).

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34
Q

When are colioids (fluids) indicated?

A

Albumin level is less than 1.5 or TP is less than 3.5g/dL

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35
Q

What are the two types of colloid solutions?

A

Hetastarch and vetstarch.

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36
Q

What is a concern with colloid solution?

A

Renal failure in septic patients.

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37
Q

Fluid rate for crystalloid for maintenance

A

10 mL/kg/hr

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38
Q

Fluid rate for hypotension

A

10 mL/kg boluses within 15 minutes

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39
Q

In order to replace blood loss immediately, which two fluids are used?

A

Crystalloids (x3 the volume of lost blood) or colloids (exact volume)

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40
Q

Where is Alpha 1/2 adrenergic receptors located? What is the main effect? What are two drugs that produce the effect?

A

Posy synaptic of blood vessels (SNS).
Vasoconstriction.
Phenylephrine, epinephrine

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41
Q

What are the main effects of BETA1 agonist on the heart?

A

Inotropic, Chronotropic, lusitropic (relaxation), dromotopic (conduction of velocity AV)

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42
Q

What are the main effects of BETA2 agonist on the heart?

A

Minor Inotropic, vasodilation (muscle, airways, uterus, gut)

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43
Q

What are the main effects of BETA3 agonist on the heart?

A

Negative intropy/relaxation, adipose tissue.

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44
Q

What is the difference between Nicotinic and muscuranic receptors?

A

Nicotinic: mediate a fast synaptic transmission of the neurotransmitter (CNS, NMBJ).
Muscuranic: mediate a slow metabolic response via second messenger cascades (Heart, glands, endothelium, smooth m.)

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45
Q

What are examples of nicotinic agonist? What are examples of muscuranic agonists?

A

Nicotinic: Nicotine, Carbachol
Muscuranic: Behanechol, pilocarpine

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46
Q

What are atropine and glycopyrrolates?

A

Anticholinergic/antimuscuranic (parasympatholytics, vagolytics)

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47
Q

T/F. Atropine has a slower onset and longer duration than glycopyrrolate.

A

False. Atropine has a faster onset and shorter duration.

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48
Q

When are anticholinergics indicated?

A

Anti-sialagogue, reversal agents of NMBJ are used, 2nd degree AV block.
(DEPRESSANT EFFECT ON GI > Careful in horses and ruminants).

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49
Q

Which drugs have BETA1/2 effects?

A

Dobutamine, dopamine, isoproterenol > INCREASE BP/CO

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50
Q

Which drug has BETA2 effects

A

Terbutaline (airway dilatation)

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51
Q

T/F. Dopamine and Dobutamine are IM ONLY. Use at a lower dose to have Beta1/2 effect because they’re very potent.

A

False. IV ONLY!
Use at a moderate dose.
(Isoproterenol is the most potent for BETA1/20.

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52
Q

T/F. Opioids (fentanyl) cause bradycardia. Atropine can be used unless it’s due to 3rd AV block. Then beta1 agonists/pacemaker can be used.

A

True.

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53
Q

Which drugs are used to compensate vasodilation due to AcP, propofol, Iso, epidural with bupivacaine?

A 
Alpha agonists (increase SVR): phenylephrine, NE, ephedrine.
Beta agonists (increase SV/CO): Dopamine, Dobutamine, Ephedrine (mixed alpha/beta), Epi.
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54
Q

Which drug used for dental extractions FOR CATS?

A

Dopamine infusion

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55
Q

Which drugs are used for chip fracture in GELDINGS?

A

Dobutamine infusion and Ephedrine.

Must have adequate volume if increasing contractility

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56
Q

What are the vasoconstrictors (INCREASE BP)?

A

Norepi, Epi, Argining Vasopressin

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57
Q

Which drug is used for renal disease with hypertension (elevated BP) in dogs and cats

A

Diltiazem (Ca+ channel blocker and angiotensin converting enzyme inhibitors)

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58
Q

Which drug is used for hyperthyroid with HCM in cats?

A

Beta blockers (Esmolol IV) > reduces HR and contractility

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59
Q

Which drugs are used to compensate for Hypertension?

A

Hydralazine (arterial dilators) and nitroprusside (venous dilator), Prazocin and Diltiazem.

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60
Q

What is the difference between respiratory arrest and apnea?

A

Apnea: temporary cessation-hypercarbia > lead to resp. arrest.
Resp. arrest: pathological process (patient cannot initiate a breath).

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61
Q

T/F. Animals with upper airway emergencies are acute emergencies.

A

True.

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62
Q

T/F. Acepromazine (sedative) should be used to reduce stress in acute resp. emergencies.

A

True.

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63
Q

T/F. Atropine is contraindicated in pneumothorax even if HR is decreasing.

A

False. Atropine can be used.

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64
Q

Signs of Cardiopulmonary arrest. At what pressure does ETCO2 diminish?

A

Less than 10-15 mmHg

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65
Q

What are signs of Cardiopulmonary arrest?

A

Not breathing, no heart beat, No corneal reflex, Wide palpebral fissures, dilated pupil (later stagE), Cyanosis.

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66
Q

What to do immediately if arrest during anesthesia? (usually recognized immediately)

A

Turn off anesthesia, Start compressions, ventilate @ 10bpm, have monitors attached to patient.

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67
Q

What are some causes of arrest during anesthesia?

A

Closed pop-off, air/fat emboli during sx, drug reaction, hemorrhage/shock, electrolyte disturbance, fatal arrhythmia.

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68
Q

What to do immediately when patient entering hospital in arrest?

A

Animals to the table (attach EVERYTHING to monitor), COMPRESSIONS, Mouth to snout until intubate, get history, call for help.

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69
Q

What are some causes of arrest when the patient walks in?

A

Underlying disease (history).

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70
Q

T/F. CIRCULATION is the most important in CPA.

A

True (unless due to respiratory failure0

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71
Q

What is the difference between thoracic pump theory and cardiac pump theory in closed chest compression?

A

Thoracic pump theory: hands over the highest point of thorax (push hard and fast; do not hyperventilate; larger dogs).
Cardiac pump theory: hands over the heart with thumb and fingers to message heart (similar to open chest CPR; small patients).

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72
Q

When is open chest CPR indicated?

A

Closed chest CPR is not effective after 5-10 minutes (esp. in large dogs).
During abdominal sx, cardiac tamponade, pleural effusion, chest trauma/rib fractures, diaphragmatic hernia.

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73
Q

How do you assess quality of compressions?

A

ETCO2>15mmHg (doing good!).

Doppler secured to artery (helpful when circulation returns).

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74
Q

What are some key points about compressions during arrest?

A

Ventilate @ 10bpm (DO NOT HYPERVENTILATE > let it recoil so blood flows).
Compressions not be interrupted.
Inspiratory time: 1 sec
Expiratory time: 5-6 sec

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75
Q

What pressures are predictor of RETURN OF SPONTANEOUS CIRCULATION?

A

Dogs: >15mmHg
Cats: >20mmHg

76
Q

T/F. Asystole can occur after administration of epinephrine.

A

False. Vent. fib can occur after administration of epinephrine.

77
Q

What is the ECG cardiac arrest called when it has a wide/bizarre QRS, no perceptible heart function, and commonly occurs after euthanasia?

A

Pulseless Electrical Activity (PEA).

Poor prognosis than one of higher rate.

78
Q

Which drugs are used in case of asystole or PEA?

A

Vasopressors (epi and vasopressins) > vasonconstricts to increase coronary and cerebral perfusion pressure.
Low dose of epi and then vasopressin with no interruption of compression (except 10s to access ECG).
Atropine for possible vagal cause of asystole.

79
Q

What additional things are needed for cardiac arrest besides drugs?

A 
IV fluids (colloids for hypovolemic shock)
NaHCO3 (NOT ROUTINE) > given in severe metabolic acidosis.
Ca gluconate (ONLY arrest due to hypocalcemia, Ca channel blocker toxicosis, inhalants).
Reversal agents.
80
Q

Defibrillation. What do to?

A

Epi first and then defib immediately.
Gel on paddles, dogs on dorsal.
If 1st shock fails > continue compressions for at least 2 minutes + more epi > repeat shock.
Increasing energy 50% for successive shock.

81
Q

Return of Spontaneous Circulation. Want to maintain PaCO2, BP, and PaO2 @ what pressure?

A

PaCO2: 35-50mmHg
BP: 70mmHg
PaO2: 90-110mmHg (with minimum FiO2)

82
Q

T/F. If spontaneous breathing has not returned within 6-12 hours, then it’s a poor prognosis.

A

True

83
Q

What is MOA of local anesthetics?

A

Bind to Na channels in nerve membrane > slow rate of depolarization.

84
Q

What are the characteristics of local anesthetics

A

Weak bases. Lower pK > faster onset.

Fast absorption with intercostal blocks.

85
Q

Commonly used Amides (local anesthetics)?

A

Lidocaine, Bupivacaine, Mepivacaine, Ropivacaine, Prilocaine

86
Q

Commonly used Esters (local anesthetics)?

A

Procaine, Tetracaine/proparacaine, Benzocaine

87
Q

T/F. Bupivacaine is the only local anesthetic that can be given IV or IVRA.

A

False. Lidocaine.

88
Q

T/F. Bupivacaine causes the highest CV toxicity when given IV.

A

True

89
Q

T/F. Ropivacaine is used with lidocaine in EMLA cream.

A

False. Prilocaine used with lidocaine.

90
Q

What is the indication of Procaine Penicillin G, Tetracaine/Proparacaine, Benzocaine?

A

Procaine penicillin G: large animals.
Tetracaine/Proparacaine: ophthalmic prep.
Benzocaine: laryngeal spray for intubation.

91
Q

T/F. Esters require metabolism by liver enzymes, whereas, Amides do not require metabolism by the liver enzymes but produce metabolites (PABA) that cause allergic reactions.

A

False.
Esters: do not require liver metabolism but produce PABA.
Amides: requires liver metabolism.

92
Q

Which drugs can be added to local anesthetics?

A

Epi: prolong duration of block.
Bicarb: faster onset and longer duration; less sting on injection.
Can add two local anesthetics together (lidocaine + bupivacaine) but may cause increased toxicity.

93
Q

Which local anesthetics cause methemoglobinemia?

A

Benzocaine and prilocaine (many species).

Benzocaine and tetracaine (cats).

94
Q

Which local anesthetics cause chondrotoxicity?

A

Bupivacaine (most damaging) and Mepivacaine (least damaging > used for equine lameness).

95
Q

Which local anesthetics cause neurotoxicity?

A

When injected directly into the nerve (rare).
Spinal lidocaine worse than bupivacaine.
PRESERVATIVE: free versions should be used for epidurals and spinal anesthesia.

96
Q

Which local anesthetics cause Systemic toxicity? (WHAT WE’RE WORRIED ABOUT)

A

Lidocaine (CV signs comes later).

Bupivacaine (CV signs come first).

97
Q

Risk factors of local anesthetics.

A

IV injection.
Increased absorption (intercostal > epidural > brachial plexus).
Patient factors.

98
Q

Allergic reaction most commonly seen with which drug? least commonly seen with which drug? How do you treat allergic reactions?

A

Most common: PPG
Least common: Amide anesthetics
Treat with epi, fluids, airway maintenance.

99
Q

What are the goals of local anesthetics?

A

Analgesia before, during, after procedure; MAC spring; prevents central sensitization; multimodal anesthesia.

100
Q

Order of nerve blocks.

A 
Beta fibers (preganglionic sympathetic) > A-Delta and C fiber (pain) and A-gamma (proprioception) > Alpha-beta (touch, pressure) > A-alpha (motor).
Exception: Brachial plexus block (motor first before sensory).
101
Q

Which is the most appropriate for local anesthetic toxicity?

A

Lipid emulsion

102
Q

What are the effects of NSAIDS?

A

Analgesia, anti-inflammatory, antipyretic.

103
Q

What is the clinical use of NSAIDs?

A

Mild to moderate post op pain for days (PO).

104
Q

What is MOA of NSAIDS?

A

Inhibits COX > inhibits PG derivatives > inhibits PGs, prostacyclines, thromboxanes.
These mediate inflammation and pain.

105
Q

What are the characteristics of COX-1?

A

Constitutive (constantly synthesized), important for normal function of GI tract, PLTs, kidneys,.

106
Q

T/F. Inhibition of COX-1 is desirable whereas inhibition of COX-2 is undesirable.

A

False. Inhibition of COX-2 is desirable.

107
Q

What are the characteristics of COX-2?

A

Inducible, produced in response to inflammation (pain).

108
Q

What are the side effects of NSAIDS?

A

The largest group of vet drugs having adverse effects reported to FDA.
Renal damage (decreased perfusion) > hypovolemia, hypotension (PGs keep renal blood flow and GFR UP).
Dangerous under anesthesia, dehydration, acute bleeding.

109
Q

T/F. Safer to give NSAIDs right before the end of sx or during recovery > opioid analgesia is provided at least from induction until beginning of NSAID analgesia.

A

True.

110
Q

NSAIDs are contraindicated in?

A

hypovolemia, hypotension, kidney diseases, hemostatic abnormality, pregnancy, very young/old, concomitant glucocorticoid therapy.

111
Q

Chronic therapy of NSAIDs

A

Arthritis, cystitis, dermatitis, gingivitis, cancer.
Patient selection, regular lab works (blood and urine), calculate dose for lean BW (lowest dose should be given for the shortest necessary duration).

112
Q

Which NSAIDs are approved in dogs? Cats?

A

Dogs: Carprofen, Meloxicam, Robenacoxib
Cats: Meloxicam (most common), Robenacoxib.

113
Q

Which drugs are preferential COX-2 inhibitors? Which drugs are selective COX-2 inhibitors?

A

Preferential: Carprofen (renal damage possible), Meloxicam.
Selective: Robenacoxib, Other coxibs

114
Q

Which drugs are non-selective COX inhibitors?

A

Phenylbutazone, Flunixin meglumine, Ketoprofen, Acetylsalicylic acid (Aspirin), Acetaminophen (Tylenol).

115
Q

Which of the non-selective COX inhibitor drug has serious side effects?

A

Acetylsalicylic acid (aspirin): not FDA approved; cheap analgesia in dogs; small doses in cats with HCM as antithrombotic agents.

116
Q

Which of the non-selective COX inhibitor drug causes methemoglobinemia in cats?

A

Acetaminophen (tylenol).

NOT APPROVED FOR VET MED.

117
Q

DOC. Deep chested dog for gastropexy (OHE) > prevent a future GDV. Predmed/induction? Acute, severe pain? Mild, moderate pain? Mild pain? Immediate post op? Home?

A

Predmed/induction: Hydro + opioid + NSAIDs.
Acute, severe pain: Morphine
Mild, moderate pain: buprenorphine
Mild (visceral) pain: butorphanol
Immediate post-op: Hydro then butorphanol.
Home: Tramadol + Carprofen + GI protectant

118
Q

DOC. Herniation sx. Premed/induction? Intra-op analgesia? Severe pain? Home?

A

Premed/induction: Hydro + Ketamine + Midazolam.
Intra-op analgesia: Fentanyl CRI + ketamine.
Severe pain: Ketamine
Home: Tramadol, gabapentin

119
Q

DOC. Chronic stifle pain > TPLO. Premed/induction? L-S epidural (first choice)? Femoral/sciatic nerve block advantage over epidural?

A

Premed/Induction: Ace + Hydro; propofol + ketamine.
L-S epidural: Bupivicaine + Morphine
Femoral/Sciatic n. block blocks motor function in one leg, no urinary retention, more complete analgesia.

120
Q

DOC. Anterior Cruciate rupture (less invasive than TPLO). Premed/induction? Epidural L-S? Post-op? Home?

A

Premed/induction: Ace + morphine; propofol + Iso; Fentanyl bolus.
Epidural L-S: Morphine + Mepivicaine
Post-op: Hydro/buprenorphine if epidural not effective.
Home: Tramadol, carprofen.

121
Q

DOC. Declaw. Premed/induction? RUMM? Post-op?

A

Premed/induction: Dexmedetomidine, hydro, ketamine; alfaxalone, Iso/O2.
RUMM: Bupivicaine
Post-op: Fentanyl patch or buprenorphine IM then PO gabapentin or Meloxicam.

122
Q

DOC. Femur fracture. Which drugs are used prior and during sx?

A

Pure agonist opioid; Bupivacaine (ICU); fentanyl CRI + ketamine.
Epidural: Morphine + bupivacaine.
Intra-op: Fentanyl + ketamine.

123
Q

What are high potency anesthetic drugs used in wildlife?

A

Etrophine, Thiafentanil, Carfentanil; Ketamine; Telazol

124
Q

What are the side effects of potent anesthetics drugs in wildlife?

A

Excitation (hyperthermia, capture myopathy), Regurgitation/V+, resp. depression (hypoxemia, hypercapnia), muscle rigidity, RENARCOTIZATION.

125
Q

What is Renarcotization?

A

When half life of agonist drug is longer than that of antagonist drug.

126
Q

What are antagonists to wildlife anesthetics?

A

Naltrexone (preferred: prevent renarcotization), Naloxone, Diprenorphine (Etorphine antagonist).

127
Q

T/F. Elephants always need to be on sternal recumbency under anesthesia/recovery.

A

False. LATERAL! (they can’t breathe)

128
Q

What are the 4 recognized syndromes of exertional myopathy?

A

Acute death syndrome, Delayed peracute death syndrome, Ataxic-myoglobinuric syndrome, Muscle-rupture syndrome.

129
Q

What is the main difference between peripheral and central regional anesthesia?

A

Peripheral: individual nerves, plexus, intercostal, paravertebral.
Central: EPIDURAL (between dura and vertebrae).

130
Q

What is central (neuraxial) regional anesthesia contraindicatted in?

A

Coagulopathy, hypovolemia, infection at injected site, neoplasia at injected site, anatomy, sepsis.

131
Q

What is indicated in central (neuraxial) regional anesthetics?

A

Tail/perineum, hindlimb, abdominal/thoracic sx.

132
Q

What is the main side effect in using regional anesthetics?

A

HYPOTENSION.

motor paralysis BIG in HORSES

133
Q

What is the difference between EMLA cream and Lidoderm?

A

EMLA cream: IV placements in jumpy patients (requires occlusive dressing and 60 minutes before full onset).
Lidoderm (Lidocaine patch): Along incision after closure (not a complete block).

134
Q

What is Intravenous regional anesthetics (IVRA; Bier Block) used for? Which drug is used? small ans.

A

Distal extremity.

Lidocaine ONLY!

135
Q

What are SIX blocks used for HEAD nerve block? small ans.

A

Retrobulbar block, Dental block, Maxillary nerve block, Intraorbital nerve block, inferior alveolar block, mental block.

136
Q

What is the indication for retrobulbar block? Which is the most commonly used technique? small ans.

A

Enucleation, evisceration/prosthesis, intraocular sx. (Block CN 3, 4, 5, 6, PSNS)
Inferior-temporal palpebral technique commonly used.

137
Q

What does maxillary nerve block indicative of? small ans.

A

Sensory branch of CN V (ipsilateral maxilla, teeth, soft tissues, nasal mucosa).

138
Q

What is infraorbital n. block indicated in? small ans.

A

Branch of maxillary (CN2).

3rd premolar and teeth rostral (extraoral/intraoral approach).

139
Q

What is inferior alveolar block indicated in? small ans.

A

Branch of mandibular (CN3).
Mendibular teeth, rostral lower lip and intermandibular space (extraoral/intraoral approach).
Lingual n. (sensory to rostral 2/3 tongue).

140
Q

What is mental block indicated in? Small ans.

A

Middle mental n. (branch of inferior alveolar).

Rostral lower lip ONLY (extraoral/intraoral approach).

141
Q

What are FOUR blocks used for THORACIC LIMB? small ans.

A

Cervical paravertebral block, brachial plexus block, RUMM block, Declaw block.

142
Q

Cervical paravertebral block indication? small ans.

A

Difficult/less common.

Entire thoracic limb (including scapula and thoracic limb). C7-T1.

143
Q

Brachial plexus block indication? small ans.

A

Thoracic limb distal to elbow.

C6 (suprascapular), C7 (musculocutaneous), C8 (radial), T1 (median and ulnar).

144
Q

RUMM block indication? Small ans.

A

Distal thoracic limb including carpus.
Radial, ulnar, median, and musculocutaneous nerves.
Requires 2 injections sites (medial and lateral).

145
Q

Declaw block indication? Which drug is used? Small ans.

A

Distal radial, ulnar, median.
Can do a ring around the nerve (one on dorsal and two on palmar).
Drug: Bupivicaine.

146
Q

What are the TWO blocks used for PELVIC LIMB? Small ans.

A

Femoral/Sciatic (distal to mid-femur).

Intercostal: thoracotomy, rib fractures (caudal; block @ 5 spaces).

147
Q

T/F. With a high epidural volume, more cranial drug spread, which is a concern for sympathetic blockade and hypotension with local anesthetics.

A

True.

148
Q

Which drugs are commonly used as epidurals?

A

Bupivacaine + morphine.

Morphine is less lipid soluble (more cranial spread; longer duration; analgesia to thoracic wall and limbs).

149
Q

What are THREE blocks used for Equine eye?

A

Auriculopalpebral nerve block, Supraorbital nerve block, retrobulbar block (same as small ans).

150
Q

Indication of Auriculpalpebral local block in large animals?

A

Paralysis of orbicularis oculi m. (close eyes).
Motor block ONLY.
Ophthalmic exam.

151
Q

Indication of supraorbital nerve block in horses?

A

Sensory to middle 2/3 of upper eyelid and palpebral motor.

Placement of sub-palpebral lavage catheter

152
Q

Which TWO dental blocks are used for equine? Indications?

A

Infraorbital block, mental nerve block.
Infrorbital: upper lip/nose, teeth rostral to 1st molar, maxillary sinus, roof of nasal cavity.
Mental: Lower lip.

153
Q

T/F. In order to use epidurals in horses, we inject between vertebrae of proximal tail (1st coccygeal) to avoid loss of hindlimb motor function.

A

True.

154
Q

T/F. Local anesthetics are used as epidurals in equine.

A

False! local anesthetics will cause motor block.

155
Q

Which drugs are used as epidurals in large animals?

A

Local anesthetics with volume control, alpha-2 agonists, morphine (analgesia; intra-articular or epidural catheter), Detomidine + morphine (EXCELLENT ANALGESIA FOR HINDLIMB PAIN).

156
Q

Castration in large animals. Local anesthetics.

A

Lidocaine into each testicle.

157
Q

What is one block used for ruminant eye that is not used in horses?

A

Peterson block: same as retrobulbar but requires more skill.

158
Q

What are 2 methods used for ruminant flank laparotomy?

A

Infiltration (line block, inverted L block).

Regional (proximal paravertebral, distal paravertebral).

159
Q

Which drug is used for line block and inverted L block in ruminants for Ruminant fank laparotomy?

A

Lidocaine.

160
Q

Dog with Osteosarcoma. Amputation needed (neuropathic pain). Which drug needed for peripheral n. injury to decrease central sensitization? Infusion catheter with which local anesthetics? Home with most important drug?

A

Peripheral n. injury: lidocaine CRI
Infusion catheter: Bupivicaine
home: Amantadine (NMDA antagonist)

161
Q

TB with a chip fracture. Which class of drugs for analgesia? Which drug is instilled once the joint capsule is closed?

A

Analgesia: Alpha 2 agonists (dexmedetomidine).
Instillation: Morphine

162
Q

Which is the best choice for CRI for pain?

A

Fentanyl

163
Q

T/F. Antidepressants are effective in chronic pain.

A

True.

164
Q

Indication of ketamine? Indication of lidocaine?

A

Ketamine: neuropathic, severe pain.
Lidocaine: neuropathic

165
Q

T/F. Blood transfusion is the process of transferring blood or blood-based products from one individual into the circulatory system of another individual of the same species.

A

True.

166
Q

T/F. The loss of 50% of hb may be fatal but the loss of 50% of the circulating volume may not be.

A

False. Loss of 50% of circulating volume is fatal.

167
Q

If TP is less than 3.5, what type of blood do you want to use? If TP is more than 3.5, what type of blood do you want to use?

A

Less than 3.5: fresh whole blood.

More than 3.5: packed red cells.

168
Q

T/F. Acute blood loss when more then 5% of blood volume.

A

False. More than 20%.

169
Q

T/F. CS are more important than arbitrary trigger values when considering transfusion.

A

True.

170
Q

T/F. Acute blood loss will always change PCV and tP values.

A

False. Acute blood loss may not change PCV and TP values.

171
Q

How do you estimate blood loss?

A

(PCV of suctioned fluid x V. in canister)/Pre-op patient PCV.

172
Q

How much blood to give?

A

([PCV required - PCV recipient] x blood V. of recipient)/PCV of donor

173
Q

T/F. increasing plasma albumin content will not be effective if using FFP (Fresh Frozen Plasma) and may need to use concentrated albumin.

A

True.

174
Q

What is the best way to provide coagulation factors?

A

Cryoprecipitate

175
Q

What are other ways to provide coagulation factors?

A

Fresh whole blood, Fresh plasma, Fresh Frozen plasma

176
Q

What is the best way to provide functional platelets? Transfuse in how many hours?

A

Use fresh whole blood (PLTs adhere to glass).

Transfuse within 8 hours.

177
Q

What are the two types of blood collection?

A

Closed: specific storage conditions and duration apply.
Open: use blood within 12 hours.

178
Q

How do transfusion reactions occur?

A

Blood type incompatibility, allergic reaction (anaphylaxis)

179
Q

What are other side effects of transfusion?

A

Circulatory overload, Acute Lung Injury, Hypocalcemia, Sepsis, Transmission of Infectious diseases.

180
Q

T/F. Give blood ONLY when absolutely necessary to save life.

A

True.

181
Q

What are two types of reactions of blood type incompatibility?

A 
Acute reaction (life threatening): hemolysis, agglutination.
Slow reaction: Decreased RBC life span (few days).
182
Q

What are the signs of acute reaction?

A

Wheals, urticaria, fever, pain (injection site).

Less signs under anesthesia!

183
Q

Treatment of acute reactions.

A

Stop transfusion!

Depending on CS: Epi IV, antihistamine IV, corticosteroids IV, fluids, O2, analgesia.

184
Q

T/F. 1st incompatible transfusion may cause acute transfusion reaction in dogs.

A

False.

2nd will! (dogs do not have naturally occurring Abs).

185
Q

T/F. Blood typing is compulsory in cats.

A

True.

186
Q

What is cross matching? How is this done?

A

Serological compatibility.

Based on agglutination reaction.

187
Q

What is the difference between major and minor cross match?

A

Major: donor RBC + recipient plasma.
Minor: Recipient RBC + donor plasma.

Anesthesiology JK (2 decks)

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