Exam 1: Lecture 6: Anesthesia Monitoring Equiptment Flashcards
What does the effect ASA PS scores increasing have on mortality rates?
increases mortality rates
Which ASA PS level(s) have a mortality rate of 0.12%
1 and 2
Which ASA PS level(s) have a mortality rate of 2.9%
3
Which ASA PS level(s) have a mortality rate of 17.33%
5
Which ASA PS level(s) have a mortality rate of 7.68%
level 4
ASA PS levels ? have an increased risk of death and severe hypothermia in dogs, cats, rabbits, and pigs
greater than or equal to an ASA PS level of 3
Post-op death accounts for what percent of anesthesia related deaths?
47-64%
Up until what day in horses can anesthesia related death be blamed on the vet?
7 days
Up until what day in small animals can anesthesia related death be blamed on the vet?
48 hours
(2 days)
Finish the following:
ACVAA Monitoring Guidlines
- Ensure adequate ?
- Ensure adequate ?
- Ensure ventilation is adequately ?
- Ensure body temperature does not deviate from ?
- Maintain legal records of significant events and enchance recognition of trends in monitored parameters
- Ensure responsible person is aware of patient status at all times during anesthesia and recovery and is prepared to intervene when needed to alert vet in charge of the status
- Ensure adequte blood flow
- Ensure adequte arterial blood oxygneation
- Ensure ventilation is adequately maintained
- Ensure body temperature does not seriously deviate from normal
- Maintain legal record of significant events and enhance recognition of trends in monitored parameters
- Ensure responsible person is aware of patients status at all times during anesthesia and recovery and is prepared to intervene when needed or to alert vet incharge about the changes in status
What basic monitoring should be done for a patient under anesthesia?
- Anesthesic depth signs
- Heart rate, rhythm, and pulse quality
- Respiratory rate and effort
- Noninvasive blood pressure
- temperature
- Mucous membrane color
- capillary refill time
- Pulse Oximetry (Spo2)
- End tital carbon dioxide (ETCO2) = capnography
All of these techniques are noninvasive, easy to use and provide reliable information about patients status
What anesthetic depth signs should we especially be using
- eye position
- muscle relaxation
- respiratory rate and pattern
- Response to stimulation
- Jaw tone and anal tone
never rely on just one of these signs, but multiple
What is the best sign to use when monitoring a patient under anesthesia?
You (The doctor)
How can we gather Heart rate and Rhythm on a patient under anesthesia?
- Palpate pulses or feel the heart beating
- Esophageal stethoscope
- Ultrasonic Doppler to detect sound of blood flow in the artery using the doppler shift principle
- ECG
- SpO2
What device can be used to monitor an animal under anesthesia that can detect the sound of blood flow in the artery
Ultrasonic Doppler
Which finger do you never use to get an animals pulse and why?
Never use your thumb, because it also has a pulse and you dont want to confuse the two
What is the normal systolic pressure in animals?
80 mmHg
If you get the animals systolic and diastolic pressure what did you just measure?
HR
Which pressure is the difference between systolic and diastolic pressure
Pulse Pressure
What are the sites in SA to feel pulse pressure
Femoral a
radial a
lingual a
What are the sites in LA to feel pulse pressure
Facial a
transverse a
facial a
metatarsal a
digital a
auricular a
femoral a
coccygeal a
On the ECG what represents Atrial depolarization
P wave
On the ECG what represents Ventricular Depolarization
QRS Complex
On the ECG what represents ventricluar repolarization
T wave
What is number 1
R wave
What is number 2
QRS complex
What is number 3
PR segment
What is number 4
P wave
What is number 5
PR interval
What is number 6
Q wave
What is number 7
S wave
What is number 8
ST segment
What is number 9
T wave
What is number 10
QT Interval
What are the clinical uses for an ECG besides HR and rhythm?
- Morphology of wave to locate disease
- Cardiac oxygenation and adequate perfusion
- Electrolyte abnormalities
If you have an increased in K+ what effect will it have on the ECG reading?
Increase in the T wave
How reliable is the ECG
- Pulseless electrical activity (PEA)
- Double counting
- Electrical interference
What does it mean to have pulseless electrical activity (PEA)
- May have electrical activity, but no mechanical activity
How do you place leads for an ECG on a small animal?
White lead = ?
Black lead = ?
Red lead = ?
White lead = right elbow
Black lead = left elbow
Red lead = Left stifle or abdomen
What lead do we use on small animal ECG?
Lead II
How do you place leads for an ECG on Large animals?
White lead = ?
Black lead = ?
Red lead = ?
White lead = right jugular furrow
Black lead = Left axilla region
Red lead = Any site remote from the heart
What lead do we use for large animals ECG
lead 1 or base apex
In Base Apex or Lead 1 ECG which electrical activity points away from + electrode
Large negative R waves
In Base Apex or Lead 1 ECG which wave is variable in horses
Variable P wave morphology
What is the reason for using Lead 1 or Base apex in large animals?
Accentuates the P wave, so it is easier to identify changes in morphology
When getting respiratory rate and effort what do you observe while the patient is under anesthesia?
- Patients thorax
- Movement of the reservoir bag
What two things can a respirometer determine in a pt under anesthesia?
- Tidal volume (TV)
- Minute volume
T/F: Capnograph can NOT display RR
Flase, it can
How can we effectively assess respiration while the pt is under anesthesia?
SpO2
- pulse Ox
What are two non-invasive non-indirect methods to get blood pressure
Doppler
Oscillometric
What device is used to inflate the cuff to occulde blood flow in the artery, as the pressure in the cuff is released the doppler detects the return of blood flow by reflection of sound waves from moving RBCs
Doppler
What items are needed for noninvasive blood pressure collection?
Sphygmomanometer
Ultrasonic doppler flow detector
with piezoeeletric crystal probe
ultrasound gel
+/- tape
Keep doppler reading _______ to be sure patient is not hypotensive
above 90 mmHg
In cats, which machine best collets SAP?
Oscillometric
Doppler and optical plethysmogrpahy can also detect, just not as good
Which BP machine in cats best predict direct MAP (Mean material pressure)
Doppler and OP
What device uses blood flow through the arteries vibrations in the arterial wall = translated to air in the blood pressure cuff = detected and transduced into electrical signals to produce a reading?
Oscillometric blood pressure
What is normal systolic pressure in animals
120 mmHg
What is normal diastolic pressure in animals
80 mmHg
What is the mean pressure of BP in animals?
around 90 mmHg
What is the advantages of Doppler machines?
- Audible pulse rate and rhythm
- Some technical skills required to place, but able to quickly obtain SAP (systolic Arterial pressure)
What heart sounds does the SAP show using the doppler machine
1st heart sound
What are the disadvantages of using a Doppler machine to get BP
- Does not give you MAP or DAP
- Not as accurate as direct BP, especially as patient becomes hypotensive
- Accuracy affected by selecting correct cuff size
What are the advantages of using Oscillometeric BP machine?
- Easy to place on the limb
- Some can be set to automatically
- Determines HR, SAP, MAP, and DAP
- Actual pressure reading takes longer than doppler
What are the disadvantages of using an Oscillometeric machine for BP?
Not as accurate as doppler method, especially in the following situations
- Hypotensive patient
- Small patients
- Patient movements
- Arrhythmias
- Vasoconstriction
Where can you place thermometers for temperature monitoring
Rectal
Esophagus
Intrnasally
What area of the body is not considered accurate for temperature monitoring
Axillary region
How do you assess patient perfusion in animals
- EX: gums, vulva
Mucous membrane color
capillary refill time
What is the normal CRT in animals?
1 to 2 seconds
What is the normal color for a patients mucous membrane
Pale pink to pink
What are abnormal mucous membrane colors in animals?
Pale to white / gray
Cyanotic
brick red
brown
yellow
petechiation
T/F: Some drugs may cause decrease blood perfusion in animals = decreased MM and CRT
true
What machine can be used to indirectly estimate % oxygen saturation of hemoglobin (Hb)
SpO2
Define the use of an SpO2 machine
indirectly estimates % oxygen saturation of Hb (Hemoglobin)
T/F: SpO2 can also show pulse rate (plethsmograph) true
true
Spectrophotometric device is applied over non-haired skin with _______ blood flow?
Pulsatile
What are some good areas to place a SpO2 probe?
- nonhaired skin
- light skin / lower pigmentation
- Good blow flow
Red and infrared light are absorbed (Similar / differently) by oxygenated and reduced (deoxygenated) hemoglobin. What is presented on the screen?
The difference is calculated and the % Hb saturation is displayed numerically
What does a SpO2 monitor use to gain the difference between oxygen and deoxygenated blood
Emitter and photordector (sensor)
What are the two types of SpO2 probes
Transmission
Reflectance
SpO2 of 90% PaO2 of 60 mmHg = Severe?
Hypoxemia
- need to intervene soon / ASAP to keep SpO2 around 95%
Ideally, would prefer the SpO2 reading to be _______ = PaO2 of 80 mmHg (considered mild hypoxemia)
equal to or greater than 95%
What effects accuracy of SpO2?
- Poor circulation due to vasoconstriction, hypotension, hypothermia
- Movement artifact
- Pigmentation
- Tissue thickness
- Anemia
- Carbon monoxide xyanide poisoning = falsely highly reading
- Methemoglobinemia = reads in the mid 80’s
- Ambient light
What tool can be used to measure Inspired and Expired CO2 concentration?
Capnography
Hypoventilaiton or hyperventilation?
Increased ECTO2
Hypoventilation
Hypoventilaiton or hyperventilation?
- Caused by malignant hyperthermia?
Hypoventilation
Hypoventilaiton or hyperventilation?
Decreased ETCO2
hyperventilation
Hypoventilaiton or hyperventilation?
- Caused by hypothermia, decreased CO, disconnection and airway obstruction
Hyperventilation
On the capnography where do you measure EtCO2
B(Beta)
What is number 1 described as on the capnography
Respiratory baseline (Should be 0 mmHg)
What is number 2 described as on the capnography
Expiratory upstroke
What is number 3 described as on the capnography
Alveolar Plateau
What is number 0 described as on the capnography
Inspiratory downstroke
What does a capnography measure?
Measures the end title
What is the normal value for EtCO2?
35 to 45 mmHg
On the capnography what does A-B stand for?
Baseline
On the capnography, what does B-C stand for?
Expiratory upstroke
On the capnography, what does C-D stand for?
Expiratory Plateau
On the capnography, what does D stand for?
End-Tidal volume
On the capnography, what does D-E stand for?
Inspiration
_______ produced in cells from metabolism = carried to the lungs = exhaled
CO2
ETCO2 relies on absorption of ____ light by CO2 molecules concentration of CO2 determined by comparing measured absorbance with a known standard
Infrared
ETCO2 relies on the absorption of which light source by CO2 molecules?
Infrared light
T/F: Capnography is not a good monitoring tool because:
- RR and estimation of PaCO2
- Diagnose diconnection or lead
- V/Q mismatch , Alveolar dead space, bronchoconstriction, airway obstruction, decreased CO
- Return of spontaneous circulation during CPR
Flase, it is a good monitoring tool
T/F: During recovery, you do not have to monitor the animal unless they are sick?
Flase, you still need to monitor the animals, you just don’t have to record vital signs
- For routine cases just visual monitoring along with ausculatation with a stethoscope and rectal temp are utilized
- Unstable cases or those at risk of complications need to be continuous monitoring in an ICU setting
What is the normal temperature in dogs, cats, horses and ruminants?
98 to 102.5
What is the normal HR for dogs?
50-160
What is the normal HR for cats
100-200
What is the normal HR for Horses
28-50
- foals up to 80
What is the normal HR for Ruminants
48-90 cows
60-150 sheep or goats
What is the respiratory rate for most adult species
10-20
In all species EXCEPT for Equine, what is defined as the MAP?
- Hypotension
Less than 60
In all species EXCEPT for Equine, what is defined as the SAP
- Hypotension
Less than 80
What should you keep Equine blood pressure (MAP)
greater than 70
What is the normal SpO2 for all species
95-100
What is the normal ETCO2 (mmHg) for all species?
35-45 mmHg
What are some advanced monitoring techniques that we can use for patients under anesthesia?
- Invasive blood pressure
- Blood gases and lactate
- Blood glucose levels
- Nerve stimulator
- Gas analyzer
- Pleth variability index
- Cardiac output
- Central venous pressure
- Urine output
- Eletroencephalogram
- Bispectral index
- Co-oximetry
Record vitals every _______ to ______ minutes. if you are unable to do this make a comment on why this was not performed
5 to 10 minutes
What is the gold standard for monitoring blood pressure and is better than indirect monitoring
Direct BP monitoring
How is organ perfusion determined using IBP
determined by MAP
How is coronary perfusion determined using IBP?
determined by DAP
What can you use to flush arterial cathers out with when usin direct or IBP?
Heparinized saline
What is the normal urine production in dogs and cats?
0.5 to 2 mL/kg/hr
What is the gold standard for assessing oxygenation (PaO2) and ventilation (PaCO2) status in a patient?
Arterial blood gas
Increased lactate levels of ______ due to severe hypoperfusion in patient = tissue oxygen deficiency
greater than 5 mmol/L
T/F: Blood glucose meters can be used in all species and humans
False! use species specific blood glucose meters
What device can be used when a neuromuscular blockage agent is used to determine level of blockade and recovery from blockade at the end of the procedure
Peripheral nerve stimulator
What device can be used to determine the end-tidal concentration of various anesthetic gases? this is the important number to look at for comparing to known MAC values and helping to correlate with anesthetic depths?
Gas analyzer
What does a PVI (Pleth Variability index) measure ?
The dynamic changes in the ammplitude of the pulse oximeter waveform during one or more complete respiratory cycles, then expressed as a percentage
What does Cardiac output monitoring determine
CO = HR x SV
Volume of blood being pumped by the heart within one minute
What does CVP (Central Venous pressure) measure?
Hydrostatic pressure within the intrathoracic vena cava = right atrial (RA) pressure
What is the EEG value while an animal is under general anesthesia?
around 40-60
What does an EEG record?
Brain activity
