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VM 737 Anesthesia > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

concerns for rums under anesthesia

A

salivation
regurgitation/aspiration - fast, extubate w/ cuff inflated
bloat - decreases lung vol
hypoventilation, V/Q mismatch - ventilate
size - myo/neuropathies
temperament - more sotic, suited for standing procedures

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2
Q

how do you pad a ruminant under anesthesia?

A

larynx higher than oral cavity and rumen

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3
Q

What’s important for injections in rum

A

if IM - neck or shoulder (protect meat)

pilot hole through tough skin

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4
Q

Xylazine and ruminants

A
  • recumbency concern for standing procedure
  • sensitivity: goat>sheep>cattle>EQine
  • 3rd trimester abortion - avoid in pregos
  • avoid in sheep (resp issues)
  • reverse w/ tolazoline or yohimbine
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5
Q

Benzos and ruminants

A

good for calves, small rum
alpha 2’s for adult cows preferred
minimal cv depression

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6
Q

Opioids and Induction agents used in rum

A

Morphine, butorphanol
Ketamine (+xylazine + diazepam), guaifenesin
propofol = apnea risk

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7
Q

Ket-stun

A

special drug combo for standing sedation ~45 min

Butorphanol, Xylazine, Ketamine

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8
Q

Rum characteristics under anesthesia

A

eyes - jelly bean sized pupils, rotated ventrally and medially
hypertensive

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9
Q

where do you place a catheter in an SAC?

A

high on neck - further from carotid but thicker skin requires pilot hole

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10
Q

concerns for SAC and anesthesia

A 
salivation, regurge, aspiration - fast
bloat
intubation - laryngospasm
position - nose to sky, larynx high
recovery - obligate nasal breathers, soft palate displacement
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11
Q

Concerns for pigs and anesthesia

A
  • size variation = dose variation
  • venous access hard - ears, IM injection in neck
  • short necks, diverticular = difficult intubation
  • malignant hyperthermia
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12
Q

sedation vs. chemical restraint

A

sedation - calm, awake, but arousable

restraint - progress from sedation, tranquilization

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13
Q

Acepromazine

A
  • calming in 30 min
  • no analgesia
  • hypotension, maybe worsens seizures, paraphimosis in stallions
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14
Q

Benzo’s (Midaz and Diza)

A
  • midaz preferred (water soluble, absorbs via IM/SQ)
  • reversed by flumazenil
  • good adjunct b/c CV safe, amensic but alone causes excitement
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15
Q

Alpha 2 agonists (Xylazine, Dexmetdetomidine, Detomidine, Romifidine)

A
  • analgesic, heavy sedation, m relaxation
  • bradycardia, AV block - only give to healthy animals
  • GI effects, sudden arousal
  • reversible
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16
Q

Opioids

A
  • not sedative in EQ, don’t use
  • morphine most sedating, fentanyl least
  • CV safe
  • dysphoria, panting
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17
Q

Ketamine/Telazol

A

can enhance sedation, give light anesthesia

telazol for fractious pets

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18
Q

Propofol or alfaxalone

A

heavy sedation to general anesthesia

give supp oxygen

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19
Q

Concerns when anesthetizing a pregnant patient

A

maternal safety
effects on neonate, oxygen delivery to fetus
risk of abortion

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20
Q

CV changes during pregnancy

A
  • Increased blood vol (plasma) based on fetus #
  • Increased CO (both SV, HR) but decreased SVR to maintain BP
  • delayed baroreceptor compensatory response
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21
Q

What is the concern w/ hypotension during pregnancy

A
  • uteroplacental perfusion is pressure dependent

- hypotension = decreased perfusion to fetus

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22
Q

respiratory changes during pregnancy

A
  • pregnancy displaces diaphragm = decreased TLC, FRC = increased risk of hypoxia (preoxygenate!)
  • increased progesterone = increased sensitivity to PaCO2 = compensatory ventilation sooner = increased o2 consumption
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23
Q

Other physiologic changes during pregnancy

A
  • decreased anesthetic requirement (d/t progesterone, GABA, hormones)
  • increased sensitivity to drugs (overdose risk)
  • higher regurge/aspiration risk
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24
Q

fetal phys during pregnancy

A
  • affected by drugs that can cross bbb
  • decreased hepatic enz = longer drug effect
  • fetal blood supply has lower PaO2, higher hgb affinity
  • blood goes to liver first - drugs partially metabolized
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25
Q

Recommendations for anesthetizing preggos

A
  • correct blood vol deficits ahead
  • maintain BP
  • preoxygenate
  • rapidly secure airway
  • minimize drug doses & time under
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26
Q

Premed for preggos

A

SA - opioids, anticholinergics
LA - alpha 2 agonists
Rum/camelid - benzos (propofol) or not used

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27
Q

Induction for preggos

A

IV (over IA) w/ 15 mins for redistribution
SA - propofol, alfaxalone
LA - ketamine +/- propofol

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28
Q

Maintenance for preggos

A

low dose IA (minimized neonate depression)
mechanical ventilation
avoid nitrous oxide

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29
Q

Post-op pain for preggos

A

Line/incision block - esp. if C-section

Morphine epidural, systemic opioids, or NSAIDs - but time against nursing

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30
Q

How to resuscitate a neonate

A
  • Ideally 1 person per baby
  • Remove membranes, clear oropharynx secretions
  • anatognistic drugs sublingual or umbilical v.
  • rub chest vigorously to stim respiration
  • supp oxygen, heat
  • maybe Doxapram to increase breathing, not start it initially
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31
Q

Concerns for neonates based on their phys

A
  • fewer liver enz = decreased metabolic capacity
  • reduced glycogen stores = hypoglycemia risk
  • greater SA to bw ratio = heat loss risk
  • immature symp NS = lower BP, lower contractility & CO
  • weak muscles = decreased FRC, more thoraicic compliance
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32
Q

Concerns when anesthetizing neonates

A
  • decreased ability to metabolize drugs
  • hypoglycemia
  • hypothermia
  • bradycardia, hypotension
  • hypoventilation
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33
Q

What kind of drugs do you use to anesthetize neonates

A

short acting, reversible - IA’s, propofol, opioids

Ephedrine if BP drops

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34
Q

What’s key about shock and trauma patients

A

Likely in or about to be in compensatory shock - will crash if anesthetize now - STABILIZE FIRST

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35
Q

Types of thoracic injuries seen w/ trauma

A

lung contusions
pneumothorax
myocardial contusion
diaphragmatic hernia

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36
Q

Lung contusions

A
  • common
  • take 12-24 hrs to appear
  • prone to atelectasis (lung collapse), hypoxemia/hypoventilation
  • give PPV, but increased risk of barotrauma
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37
Q

Pneumothorax

A
  • common, can be open or closed form

- risk of atelectasis, hypoxemia, tension pneumothorax

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38
Q

What’s the concern w/ tension pneumothorax

A

some air leaks out w/ each breath –> builds up cavity P –> lung compression = decreased venous return, SV/CO, hypotension –> CV collapse

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39
Q

Signs of tension pneumothorax during anesthesia

A
  • decreased lung compliance
  • sudden decrease in BP (b/c decreased venous return)
  • stop PPV, do emergency thoracocentesis
40
Q

What’s the concern about myocardial contusions

A
  • arrhythmias, which may be worsened under anesthesia
  • ECG!
  • avoid arrhythmogenic drugs - alpha 2’s, thiopental, halothane
41
Q

What’s the concern about diaphragmatic hernia

A

abdomen in chest compression lungs

decreased FRC –> atelectasis, hypoxemia

42
Q

Ruptured bladder

A

common
urine leaks into abdomen
azotemia, electrolytes - hyponatremia/chloremia, hyperkalemia

43
Q

What’s the concern w/ ruptured bladder causing hyperkalemia?

A
  • raises resting membrane potential - triggers systole more often
  • can –> arrhythmias (V fib, asystole), bradycardia
44
Q

How to treat hyperkalemia

A
  • give CA to resolve conduction, not hyperkalemia
  • drain urine (catheter)
  • NaHCO3, insulin or dextrose to normalize K
45
Q

What are the concerns w/ head trauma

A

Increased ICP

Anesthesia could alter blood flow to brain

46
Q

Signs of increased ICP

A

decreased mentation
small pupils
Cushing’s response - hypertension, bradycardia
sometimes altered breathing

47
Q

Head trauma and anesthesia

A
  • intubation can spike ICP (b/c cough, give lidocaine)
  • low dose drugs to minimize cerebral autoreg effects
  • PPV to maintain PaCO2
  • avoid ketamine, alpha 2’s b/c increase ICP
48
Q

Lab values to keep track of in an anesthetized trauma patient

A

Hgb
Acid/base
electrolytes - K, Ca
Oxygenation/ventilation parameters

49
Q

Common drug combos for trauma anesthesia induction

A

Fentanyl + midaz/diaz
Etomidate + midaz/diaz - most CV/resp sparing, use for cats
Avoid ketamine in head traumas b/c increase ICP
Propofol/alfaxalone - decrease ICP but hypotension, apnea are concerns

50
Q

What breeds are actually sensitive to anesthesia?

A
  • greyhounds and thiobarbiturates - delayed recover d/t liver metab
  • collies and MDR1/p-glycoprotein - Ace, torb
  • boxers and acepromazine (anecdotal collapse)
  • brachycephalics
51
Q

T/F: opioids always cause excitation/dysphoria in cats

A

False, only high dose, not clinical doses

but only use to treat for pain in cats, not to sedate

52
Q

T/F: Butorphanol is an excellent analgesic

A

False: only treats mild pain, short acting (1-2 hrs)

53
Q

T/F: Hydromorphone and Morphine are equally efficacious at providing analgesia

A

True, but potency varies
Hydro - lower dose needed than morphine to achieve same effects
Fentanyl more potent than hydro or morphine

54
Q

T/F: alpha 2 agonists have severe CV effects

A

True, even for low doses

Dexmedetomidine can decrease CO up to 50%

55
Q

T/F: Propofol is the safest induction drug

A

False, actually very similar to thiopental in CV and resp effects

56
Q

T/F: Iso is better than Sevo

A

False - clinically very similar

Sevo has slightly faster induction/recovery b/c lower solubility

57
Q

T/F: Pulse quality does not indicate BP and tissue perfusion

A

True - only indicates systole/diastole differen

58
Q

T/F: hypotension is a concern for any anesthetized patient

A

True

59
Q

What are the clinical signs of hypotension in an anesthetized patient

A

There are none - must measure!

60
Q

T/F: Bradycardia means patient is too deep

A

False

Common causes: hypothermia, vagal stimulation, opioids, alpha 2’s

61
Q

What spp doesn’t have an epiglottis

A

birds, reptiles

62
Q

Spp w/ an apical bronchus to R cranial lung lobe

A

rum, pigs

63
Q

Spp where ocular signs have little significance as an indicator of depth of anesthesia

A

llamas
EQ - nystagmus and palpebral
rum - ventral/medially rotates eyes

64
Q

Spp w/ complete tracheal rings

A

birds, some reptiles

65
Q

Spp w/ a ventral laryngeal diverticulum impacting intubation

A

pigs

66
Q

Spp w/ dive reflex

A

marine mammals, sea turtles/reptiles, diving birds

67
Q

Spp w/ sensitivity/lack of sensitivity to xylazine

A

rum most sensitive (low dose), pigs unsensitive (high dose)

68
Q

Spp in which a respiratory sinus arrhythmia is normal

A

dogs

69
Q

Spp that may be hypertensive during anesthesia

A

cattle, maybe wild ruminants

70
Q

Spp susceptible to malignant hyperthermia

A

pigs

71
Q

Spp that could vocalize w/ an ET tube in place

A

birds

72
Q

What drug do you avoid in a cat w/ hyperthyroid and concurrent hypertrophic cardiomyopathy?

A

Ketamine

73
Q

What drug class treats tachyarrhythmias assoc’d w/ hyperthyroidism in cats/

A

beta blockers

74
Q

Key pre-op management for anesthetizing an Addison doggo

A

glucocorticoid supp

75
Q

Hyperkalemia can manifest in what ECG change?

A

absence of P waves

76
Q

What drug has potential to increase blood glu?

A

Dexmedetomidine

77
Q

FS dog w/ diabetes, mod mitral valve murmur getting a dental w/ possible extractions. drug plan?

A

Torb, atropine, etomidate, midazolam, iso

78
Q

What is the goal of neuroanesthesia

A

prevent increasing ICP

79
Q

how do you not increase ICP during anesthesia?

A
  • Decrease cerebral metabolic rate by maintaining approp anesthetic depth
  • maintain low to normal paCO2, prevent hypoxemia
  • maintain MAP to prevent ischemia
  • maintain acid/base status
    maintain mild hypothermia - avoid hyperthermia, low metabolic rate
80
Q

What can you do if there is an increase in ICP during anesthesia?

A
  • decrease ECF via mannitol or furosemide

- glucocorticoids contraindicated for traumatic brain injury

81
Q

Clin signs of head trauma

A 
papilledema, anisocoria, strabismus
changed mentation
abnormal resp
opisthotonus
Cushing's reflex to ICP: bradycardia and hypertension
82
Q

What is the one drug that doesn’t decrease CMR (cerebral metabolic rate) and CBF (cerebral blood flow)?

A

Ketamine

increases CMR, slightly decreases CBF

83
Q

What is the concern w/ IA’s and neuroanesthesia?

A

CNS vasodilation as higher doses - avoid by using low dose, balanced anesthesia

84
Q

Concerns for spinal cord neuro procedures

A

long

concern for hypothermia, drug accum

85
Q

Spinal imaging and horses

A

weakness, ataxia

minimize alpha 2’s - use ketamine, benzo, propofol

86
Q

What’s important about post-op care for neuro patients?

A

neuro status may worsen after surgery d/t increased anxiety, pain
Want calm recovery! Sedate - phenothiazine, low dose alpha 2

87
Q

Between kidneys and liver, which once can regenerate?

A

Hepatocytes are regenerative to a point

kidney can’t regenerate nephrons

88
Q

Additional concerns for animals w/ renal dz

A

anemia
hypertension
electrolyte abnormalities
stage of renal dz

89
Q

Prepping a renal dz patient

A
  • prevent hypovolemia (anesthetics reduce GFR)
  • recheck electrolytes
  • correct anemia
90
Q

Anesthesia drugs to avoid for a renal patient

A
  • avoid Ace, alpha 2’s b/c decrease CO
  • maybe avoid ketamine - metabolized in kidneys in cats
  • maybe avoid sevo - make nephrotoxic compound
  • maybe avoid NSAID’s for post-op pain - alter PG synth which alters renal blood flow
91
Q

What’s the concern w/ lidocaine in renal or heptic dz patients?

A

cleared slowly in general, risk of buildup in dz’d patients - use low doses

92
Q

Concern for cats w/ urethral blockage & post-renal azotemia

A

hyperkalemia, acidemia
Give Ca, bicarb, insulin/dextrose before anesthesia
expect post-op diuresis - don’t let them dehydrate

93
Q

Prepping a hepatic dz patient

A
  • prevent hypovolemia
  • treat hepatic sequelae
  • treat coagulopathies
  • avoid hypoxemia
94
Q

what’s a good pre-med choice for liver dz patients?

A

Opioids - minimally metabolized, reversible, little CV effects
Avoid alpha 2’s, ace b/c CV effects and metabolized by liver

95
Q

What IA is contraindicated for liver dz?

A

Halothane

VM 737 Anesthesia (4 decks)

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