Exam 1 - Emergent Procedural Anesthesia Flashcards by Madeleine Swindell

what is the goal of sedation?

safely provide maximum patient comfort to perform a stressful procedure

to cause minimal complications to the patient & minimal risk to the staff involved

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what are some examples when sedation alone may not be the best option compared to general anesthesia?

major invasive painful procedures

fractious patients that may pose a safety risk for staff

patients at high risk for aspiration

procedures in the oral cavity

endoscopy & gastroscopy

high-risk critically ill patients

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what are the limitations of sedation?

arousable patients

protective reflexes are delayed

intubation not possible

limited oxygen & ventilatory support isn’t possible

limited monitoring

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what are the most common potential complications seen in emergent procedural anesthesia? how are they managed?

hypoxemia - oxygen supplementation

apnea - intubation & assisted ventilation

aspiration pneumonia - decrease the risk of regurgitation/vomiting with fasting & anti-emetics, place head higher than the stomach with mouth down to drain any content or use suction

bradycardia with hypotension - anticholinergics (glycopyrrolate & atropine) and/or drug reversal

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what are the statistics of the risk of death associated with anesthesia & sedation in humans, healthy dogs, & healthy cats?

humans - 0.005%

healthy dogs - 0.009%

healthy cats - 0.11%

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how many times does the risk of death increase for urgent/emergency anesthesia/sedation in sick dogs & cats?

dogs - 5X risk

cats - 10X risk

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what are some examples when we may use just sedation for a patient?

diagnostic imaging

transport & handling

minor procedures with minimal pain

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what does sedation provide to our patients?

induces a sleep-like state, relaxes the animal, reduces anxiety, & decreases their reflexes

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is sedation safer than general anesthesia?

not necessarily - you can’t intervene with ventilatory support because no intubation, limited monitoring & support compared to general anesthesia

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what are the big differences between sedation & general anesthesia?

sedation - animal is sleepy but still arousable, delayed protective reflexes, can’t intubate, limited support, & limited monitoring

general anesthesia - animal is unconscious, no protective reflexes, can intubate the patient, can provide full support & monitoring

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what equipment should you have set up for an emergency sedation?

oxygen, monitoring supplies, supplies for intubation & ventilation, emergency drugs & antagonists worked up

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what should be done as far as patient prep for an emergency sedation?

get the animal’s clinical history & PE

stabilization & anesthesia

IV catheter placement

minimize risk of aspiration

draw up a sedation plan

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what parameters should you be monitoring for a patient that is under emergency sedation/anesthesia?

level of sedation

respiratory rate & effort

SpO2

ETCO2 capnograph trends

ECG & heart rate

pulse rate & quality

blood pressure

mucus membrane color & CRT

patient temperature

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what should help you guide you when deciding drug choices for emergency sedation/anesthesia?

balanced sedation

administration - IV or IM

faster onset of action & shorter duration

start with low doses & pick drugs that can be antagonized/reversed

locoregional anesthesia if possible

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what drugs are commonly used for sedation in emergency sedation/anesthesia?

alpha-2 agonists

opioids

benzodiazepines

alfaxalone

dissociative agents

propofol

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which opioid is best for mild pain? what about severe pain?

mild pain - butorphanol, mu antagonist & kappa agonist

severe pain - mu agonists, methadone, hydromorphone, & fentanyl

mild to moderate pain - mu partial agonist, buprenorphine

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what are some indications for using opioids in emergency sedation/anesthesia?

analgesia

sedation

anti-tussive

has an antagonist - naloxone

can be given IV/IM/CRI

what are some indications for using benzodiazepines such as midazolam & diazepam in emergency sedation/anesthesia?

muscle relaxation

minimal cardiovascular effects

anti-convulsants

has an antagonist - flumazenil

can be given IV/IM/CRI

what are some indications for using alpha-2 agonists, such as dexmedetomidine & medetomidine + vatinoxan, in emergency sedation/anesthesia?

sedation

analgesia

muscle relaxation

has an antagonist - atipamezole

can be given IV/IM/CRI

should you use acepromazine in a patient with questionable cardiovascular stability? why?

no - it causes peripheral vasodilation & drops BP & body temp

what are some indications for using acepromazine in emergency sedation/anesthesia?

tranquilization

muscle relaxation

some anti-emetic effects

can be given IV/IM

what are some indications for using propofol in emergency sedation/anesthesia?

low dose needed for sedation

muscle relaxation

IV exclusive

anti-convulsant effects

what are some indications for using alfaxalone in emergency sedation/anesthesia?

low dose needed for sedation

muscle relaxation

IV/IM/CRI

may see tremors during recovery

what are some indications for using dissociative agents, such as ketamine & telazol, in emergency sedation/anesthesia?

low dose needed for sedation

analgesia

telazol is useful in fractious cats

can be given IV/IM/SC/IP/CRI/transmucosal

what are some patient factors that may complicate emergency sedation/anesthesia?

fractious or fearful patient very painful animal animal has a heart murmur

what are some considerations you should think about prior to using opioids in emergency sedation/anesthesia?

decreases heart rate dysphoria respiratory depression may cause nausea/regurgitation/vomiting

what are some considerations you should think about prior to using benzodiazepines such as midazolam & diazepam in emergency sedation/anesthesia?

no analgesia provided unpredictable effect when given alone respiratory depression

what are some considerations you should think about prior to using acepromazine in emergency sedation/anesthesia?

avoid giving to patients with cardiovascular instability causes peripheral vasodilation decreases BP & body temperature splenic relaxation prolonged onset of action & duration no analgesia no reversal

what are some considerations you should think about prior to using propofol or alfaxalone in emergency sedation/anesthesia?

IV must be given slow to effect to avoid causing apnea potential to accidentally induce anesthesia dose-dependent respiratory & cardiovascular depression no reversal no analgesia

what are some considerations you should think about prior to using dissociative agents, such as ketamine & telazol, in emergency sedation/anesthesia?

may need to combine with a muscle relaxant sympathetic cardiovascular stimulation apneustic breathing potential to induce anesthesia may see excitation during recovery pain on IM injection no reversal

what are the main differences between deep sedation & general anesthesia?

deep sedation - patient can still be arousable especially following repeated or very painful stimuli, delayed but present protective reflexes general anesthesia - absent purposeful responses, absent spontaneous posture, & absent protective reflexes

what is included in stabilizing your emergency sedation patient prior to the start of the procedure?

fluid balance & cardiovascular status should be assessed & corrected/supplemented

what is the benefit of placing an IV catheter in your patient for emergency sedation/anesthesia?

essential to allow for the slow administration to effect of drugs so that the minimal amount is used IV administration provides a more rapid onset & shorter duration of action

why use a pulse oximeter on your patient for emergency sedation/anesthesia?

SpO2 indicates the presence & severity of hypoxemia earlier than cyanosis <95% or cyanosis prompts immediate assessment for the need of intubation, 100% oxygen, & ventilation

what is the onset of action of acepromazine?

15 minutes following IV administration - less preferable for emergency situations because it is so prolonged

what side effects are associated with dexmedetomidine?

bradycardia, bradyarrhythmia, & biphasic effect on blood pressure (vasoconstriction followed by a normal or low blood pressure)

what two groups of drugs used for emergency sedation/anesthesia have limited cardiovascular effects?

opioids & benzodiazepines

why should you not use ketamine in a patient with head trauma?

ketamine causes the release of catecholamines which increase the heart rate, blood pressure, & intracranial pressure

what drugs would you use for an emergency sedation of a patient with a heart murmur?

combo of benzodiazepine & opioid - minimal cardiovascular effects

what drugs would you use for an emergency sedation of a very painful patient?

mu-opioid for pain, dexmedetomidine, & ketamine

what drugs would you use for an emergency sedation of a fractious/fearful patient?

alfaxalone or ketamine - induction agents that you can give IM to produce a more reliable sedation