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VM 737 Anesthesia > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Methods to monitor oxygenation

A

Pulse oximeter
Blood gas (gold standard)
Cyanosis
Lactate

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2
Q

What does pulse ox monitor?

A

SaO2 (hgb saturation)

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3
Q

SaO2 numbers to know

A
  • > 95% sat = desired, PaO2 >80 mmHg
  • 90-95% sat = mild hypoxemia, Pa 60-80 mmHg
  • <90% sat = severe hypoxemia, Pa <60 mmHg
  • 70% SaO2 = PaO2 40 mmHg
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4
Q

What does blood gas measure?

A

PaO2, Pa/vCO2

Allows you to assess O2 exchange at alveoli via A-a gradient, P/F ratio

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5
Q

When does cyanosis occur?

A

When you already have a problem

PaO2 <40 mmHg

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6
Q

What does Lactate measure?

A

Indirect measure of anaerobic metabolism

Lactate increases w/ severe hypoxemia

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7
Q

Methods for monitoring ventilation

A

Capnograph/Capnometer
Blood gas
Acid/base balance

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8
Q

What’s normal end tidal (at end of exhale) Co2

A

30-45 mmHg

highest point of capnograph, D

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9
Q

What is the difference between blood PCo2 and end tidal CO2?

A

0-10 mmHg b/c mixes w/ dead space oxygen, Co2 gets diluted slightly

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10
Q

What is the difference between PaCO2 and PvCo2?

A

PvCo2 ~5 mmHg higher (very small diff)

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11
Q

Arterial and venous blood samples are comparable for ___ but not ___?

A

comparable for PCO2 but not PO2

should only use arterial samples for accurate PO2 measurement

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12
Q

Why can’t you use a capnograph/nometer for small <5 kg patients?

A

b/c on a bane circuit so higher O2 flow = further dilution of CO2, inaccurate measurement

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13
Q

What does acid/base balance measure

A

Indirect measure of Co2 conc b/c CO2 and bicarb are related
Hypoventilation –> high CO2, resp acidosis
Hyperventilation –> low CO2, resp alkalosis

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14
Q

Ways to monitor respiratory activity during anesthesia

A

Subjective/visually: Resp rate, pattern, rhythm, volume, effort

Respirometer/Ventilometer: tidal vol, minute ventilation

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15
Q

EQ diff’s w/ anesthesia

A
  • maintain a higher PCO2
  • greatly affected by position (V/Q mismatch)
  • cluster breathing normal, hypoventilation common
  • typically maintain lower HR (up to 40% decreased CO under anesthesia)
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16
Q

Cat diff’s w/ anesthesia

A
  • Maintain a lower PCO2
  • predisposed to airway obstruction (mucus, small airway)
  • hard to intubate
  • airways reactive, prone to trauma
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17
Q

Dog diff’s w/ anesthesia

A
  • depressed by opioids
  • predisposed to aspiration pneum.
  • brachycephalics
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18
Q

Lab animal diff’s w/ anesthesia

A
  • hard to intubate and monitor
  • affected by position
  • predisposed to airway obstruction (mucus, small airway)
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19
Q

marine mammal/ diver diff’s w/ anesthesia

A
  • diving reflex/breath holding
  • may drown w/ anesthesia or during recovery
  • hard to intubate
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20
Q

amphibian diff’s w/ anesthesia

A
  • skin breathers

- hard to intubate or monitor

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21
Q

bird diff’s w/ anesthesia

A
  • no alveoli, no diaphragm = ventilation required
  • for FRC
  • greatly affected by position, airway prone to obstruction (mucus)
  • hard to monitor, sensitive to inhalants
  • complete tracheal rings
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22
Q

Rum diff’s w/ anesthesia

A
  • hard to intubate
  • greatly affected by position
  • salivation = predisposed to asp. pneum.
  • higher resp rate but smaller tidal vol than EQ
  • often hypertensive w/ anesthesia
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23
Q

What’s important about sheep and anesthetic drugs?

A

alpha 2 agonists will cause hypoxemia

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24
Q

SAC diff’s w/ anesthesia

A
  • hard to intubate (mouths don’t open wide)
  • Good oxygenators
  • regurge/asp. pneum. risk
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25
Q

Pig diff’s w/ anesthesia

A
  • hard to intubate (90 deg larynx, small airway)
  • short necks (can intubate a bronchus)
  • unknown underlying dz possible
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26
Q

Oxygen delivery formula

A

DO2 = CO x CaO2 (oxygen content)

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27
Q

What determines CaO2

A

hgb conc, PaO2

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28
Q

Cardiac output formula

A

CO = SV x HR

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29
Q

Factors affecting SV

A

preload
afterload
contractility

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30
Q

Other factors affecting CO

A

arterial BP
blood vol
systemic vascular resistance

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31
Q

How can you increase SV during anesthesia?

A

increase preload (e.g. increase blood vol) but avoid excess (–> edema, pulmonary edema)

increase contractility (inotropic drugs)

decrease afterload (vasodilation) - not recommended b/c decreases BP/perfusion

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32
Q

How to increase HR during anesthesia?

A
  • sympathomimetics (ephedrine)

- parasympatholytics (atropine, glycopyrrolate)

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33
Q

If you wanted to increase CO during anesthesia, would you rather increase HR or SV?

A

SV

Increasing just HR decreases filling time, but increases work - only increases CO a bit

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34
Q

How to increase BP during anesthesia?

A

Modulate chatecholamine receptors

support blood volume

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35
Q

Catecholamine receptors actions

A

a1 - vasoconstriction (increase SVR)
a2 - vasoconstriction (increase SVR), bradycardia (decreased HR)
b1 receptors - tachycardia & increased contractility (increase CO)
b2 receptors - vasodilation (decrease SVR)

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36
Q

CV complications during anesthesia

A 
Bradycardia
Tachycardia
Decreased contractility
Rhythm disdurbances
Vasomotor (blood vessel) tone change
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37
Q

Treat bradycardia

A 
Fix cause of problem
Give anticholinergic (atropine, glycopyrrolate)
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38
Q

What drugs cause bradycardia

A

opioids
alpha 2 agonists
anticholinesterases

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39
Q

What drugs cause tachycardia

A

ketamine

anticholinergics (glyco, atropine)

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40
Q

Treat tachycardia

A

fix cause of problem

Beta-blockers as last resort (Esmolol)

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41
Q

Treat for decreased contractility

A

decrease anesthetic plane

Inotropes to increase contractility (Dobutamine, Dopamine, ephedrine)

42
Q

How to diagnose an arrhrythmia?

A

ECG

43
Q

What drugs cause vasodilation?

A

Propofol
Isoflorane
Acepromazine

44
Q

What drugs cause vasoconstriction?

A

alpha 2 agnoists

ketamine

45
Q

Treat vasodilation

A

Increase blood vol or CO

Give a vasopressor (vasoconstrictor) - Dopamine, phelephrine

46
Q

Treat vasoconstriction

A

Reverse or stop vasopressors

Give vasodilator - Ace, sodium nitroprusside, hydralazine, amlodipine

47
Q

PE indicators of cardiovascular function

A
  • demeanor, activity level, temp
  • dyspnea d/t decreased DO2 or pulmonary edema from heart failure
  • Pulse rate, rhythm, quality
  • mucus mem color
  • CRT
  • hydration status
  • ascultate
48
Q

Considerations about pulse pressure

A
  • not the same as BP
  • measures difference btwn systolic and diastolic pressures (similar P’s = weak pulse, big diff = strong pulse)
  • pulse may be absent when MAP <40 mmHg (hypotensive) but pulse pressure could still be nx
49
Q

Normal amount of water in the body & where it lives

A

60-80% of bodyweight
60% is intracellular
40% is extracellular (10% in extravascular, 30% interstitial)

50
Q

normal blood volume in the body

A

5-9% of bodyweight

51
Q

Ways to assess hydration

A
  • skin turgor
  • tacky mm
  • hemoconcentration (increased PCV, TP)
  • increased Cr, BUN (if severe), concentrated urine, low urine output
  • tachycardia
  • decreased bw, depression, lethargy
52
Q

Ways to monitor CV function during anesthesia

A
  • direct CO monitoring (gold standard)
  • HR
  • Arterial BP (important, early indicator of trouble)
53
Q

Blood Pressure formula

A

BP = CO x SVR (systemic vascular resistance)

54
Q

Normal SAP (systolic arterial pressure)

A

100-140 awake

>90 SA, >100LA anesthetized

55
Q

Normal MAP (mean arterial pressure)

A

80-120 awake

>60 SA, >70 LA anesthetized

56
Q

Normal DAP (diastolic arterial pressure)

A

60-80 awake

>50 anesthetized

57
Q

Ways to measure BP

A

Direct: arterial catheter (gold standard)
Indirect: doppler, oscilometric

58
Q

Cuff width for accurate estimate of BP

A

needs to be 40% limb circumference

too small width = overestimation, too big = underestimate

59
Q

Doppler vs. oscilometric

A

Doppler - has crystal, gives SAP only

Oscilo - no crystal or sphygmomanometer, SAP, MAP, & DAP given

60
Q

Why is hypotension bad?

A

oxygen delivery likely decreased

61
Q

Consequences of mild but prolonged hypotension

A

CNS damage
Renal & hepatic damage/failure
GI & muscle tissue necrosis

62
Q

Consequences of severe hypotension

A

severe CNs damage
severe myocardial damage
acute death

63
Q

Treat hypotension

A

Try to increase CO & tissue perfusion first (to maintain DO2)
Vasoconstriction could increase SVR, but could also decrease perfusion more - tricky

64
Q

Treat hypovolemia

A

Restore blood volume by crystalloids, colloids, blood products

65
Q

Risk of a too long ET tube

A

increased dead space

goes into a bronchus –> hypoxemia, hypoventilation, decreased anesthetic plane (common in pigs)

66
Q

Proper cuff inflation

A

Inflate cuff until don’t hear leak when squish bag to ~10-15 cmH2O PIP (SA, 20-30 for LA)
Should hear safety leak if squish bag to 20-30 cmH2O

67
Q

Consequences of cuff overinflation

A

trauma –> tracheal rupture, pneumothorax & pneumomedastinum
LA - trachea will collapse ET tube
ET tube obstructs itself

68
Q

Indications for mechanical ventilation

A

hypoventilation
hypoxemia
increase inhaled anesthetic depth
logistics

69
Q

With mechanical ventilation, how do you adjust inspiratory time?

A

larger animal = longer time

smaller animal = shorter time

70
Q

What’s normal tidal vol? Minute ventilation?

A

TV: 10-20 ml/kg
MV: 100-250 ml/kg/min

71
Q

How do neuromuscular blockers work?

A

block ACh receptors –> paralysis

Good for orthopedic, ophthalmic, CNS procedures or EQ deep abdomen procedures

72
Q

neuromuscular blocker drugs

A

Cis-atracurium, atracurium, vecuronium

73
Q

Key component for neuromuscular blockade

A

assisted ventilation & monitoring of paralysis

74
Q

Reversals for neurmuscular blockers

A

Edrophonium
Neostigmine (mg diagnostic)
suggamadex-Rocuronium
Physiostigmine (mg treatment)

75
Q

Risk w/ poor padding/placement during surgery

A

ischemia, post-op pain
nerve damage
rum - asp. pneum.
EQ - edema

76
Q

Why is thermoregulation important w/ anesthesia

A

decreases metabolic rate, thus heat –> hypothermia

occurs faster in younger (less E stores) or smaller animals (more SA)

77
Q

Consequences of hypothermia

A

prolonged recovery, prolonged drug metabolism
decreased MAC
Impaired coag, delayed wound healing
increased mortality rate

78
Q

When do you pull the ET tube

A

SA - strong swallow
Rum - sternal, holding head up
EQ - standing
Brachycephalics - as late as possible

79
Q

How do crystalloids treat dehydration

A

restore water & electrolytes, increase extracellular vol

80
Q

Types of crystalloids

A

LRS
physiologic saline (0.9% NaCl)
normosol
plasmalyte

81
Q

Water is normal daily water intake?

A

1-5 ml/kg/hr or 20-120 ml/kg/day

lower side for larger animals

82
Q

How much crystalloid is given to anesthetized patients (as a guideline)?

A

1-10 ml/kg/hr
Usually a conservative bolus first - 10-20 ml/kg
Expect it to move from intravascular to extravascular space in 30-45 mins

83
Q

How much of a bolus do you give for shock?

A

50-100 ml/kg

84
Q

Why would you use colloids over crystalloids

A

colloids have high oncotic pull, so stay in vasculature longer (6-48 hrs vs. <1 hr) BUT can fluid overload and other issues, so limit dose

85
Q

Types of colloids

A

Hetastarch, Dextran, Albumin, Oxyglobin

86
Q

When do you usually give blood products & how much do you give?

A

PCV <20 ot TP <3.5

Give 1-5 ml/kg/hr (faster if active bleed)

87
Q

how do you treat acidosis in an emergency

A

bicarbonate

bicab = bs x base deficit x 0.3

88
Q

How do you treat alkalosis in an emergency

A

physiologic saline

89
Q

How do you treat hypoglycemia

A

1-5% dex as needed

required glu = bs x 0.3 x (desired glu - current glu level)

90
Q

How do you treat hyperglycemia

A

insulin

91
Q

Expectations of resp func in EQ under anesthesia

A

hypoventilation - mechanical ventilation required
V/Q mismatch (impacted by recumbency)
leave ET tube in until STANDING (w/in 1 hr post anesthesia)

92
Q

EQ common protocol for sedation

A

alpha 2 agonist (Xylazine, detomadine, ___dine)
Ace - take edge off early on
+/- butorphanol or morphine

93
Q

EQ common induction protocol

A

Ketamine + diazepam/midazolam +/- guaifenesin

no propofol - wierd behaviors

94
Q

EQ common maintenance protocol

A

<1 hr = total IV: Triple Dip (XDK) or G/MKX

>1 hr = G/MKX, then CRI of K & X, then inhalant

95
Q

Monitoring EQ during inhaled anesthesia

A
  • must measure arterial BP (MAP should be >70 mmHg)
    d/t decreased CO & hypotension –> myopathy
  • must treat hypotension
  • ideally, ECG
  • take periodic blood gas (esp. w/ inhaled anesthetics) b/c pulse ox & capnograph less reliable in EQ
96
Q

Options for systemic EQ pain management

A
  • Alpha 2’s used commonly
  • opioids (but combined b/c cause excitation, ileus)
  • maybe lidocaine or ketamine CRI to decrease anesthetic requirement (and Ketamine improves CO)
97
Q

Options for local/regional blocks in EQ

A

local anesthetics for distal extremities only
Opioids (combined w/ alpha 2) - longer lasting
NSAIDs - traditionally used

98
Q

Why are opioids so commonly used in combo w/ other drugs for anesthesia?

A

analgesia
peri-operative sedation
large margin of cardiovascular safety
shorter acting drugs (e.g. fentanyl) decrease dose of IA needed & decrease risk of drug accum

99
Q

Who should you use opioids very cautiously in?

A

Horses

behavioral issues & ileus, inconsistent effects

100
Q

When would you use a ketamine CRI in combo w/ IA’s for anesthesia?

A
  • reduces windup

- reduces anesthetic requirement of IA’s

101
Q

hypercapnea causes

A

vasodilation and tachycardia

VM 737 Anesthesia (4 decks)

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