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2025 Anesthesia > Exam 4: Lecture 28 - Sedation for Diagnostic and Therapeutic procedures > Flashcards

Exam 4: Lecture 28 - Sedation for Diagnostic and Therapeutic procedures Flashcards

1
Q

what does tranquilization mean

A

results in behavior changes and relief of anxiety. the patent appears calm, stress is reduced, and it may appear indifferent to minor pain

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2
Q

what does immobilization mean

A

term generally used in wildlife/exotic anesthesia that implies the patient is rendered incapable of movement

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3
Q

what does sedation mean

A

state characterized by central depression accompanied by drowsiness. Patient is generally unaware of its surrounds but responsive to painful stimuli

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4
Q

what does general anesthesia mean

A

drug-induced unconsciousness by controlled but reversible depression of the CNS. The patient is not aroused by noxious stimuli

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5
Q

what are the reasons for sedation or anesthesia

A

to provide analgesia, muscle relaxation and a lack of awareness in order to provide a safe surgical experience

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6
Q

other than the main reason for sedation or anesthesia (providing safe surgical experience), what are some other important uses

A
  1. restraint for exam
  2. safe transportation of wild and exotic animals
  3. diagnostic and therapeutic procedures
  4. euthanasia
  5. humane slaughter of food animals
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7
Q

how do we usually give a premed prior to inducing GA

A

depending on the practice it may be given IM or IV

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8
Q

an IM dose is generally ________ times what the IV dose would be

A

2x

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9
Q

_______ approach is common for premed prior to GA but species and patient dependent

A

neuroleptanalgesic

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10
Q

what are the characteristics of heavy sedation given prior to a diagnostic or therapeutic procedure

A

drugs may be given IM or IV, neuroleptanalgesic approach is commonly used, make a “rug” for the patient, and consider a reversal for short procedures

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11
Q

Why can patient handling be difficult

A

Many patients are stressed in the hospital setting AKA white coat syndrome

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12
Q

Animal handling skills of the staff can be outmatched by the animal leading to ______

A

Injury on personnel and themselves

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13
Q

What are some pre-existing painful conditions that patients may have

A
  1. OA
  2. Dental disease
  3. Otitis external
  4. Oncological pain
  5. Ophthalmic disease
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14
Q

What is fear free or low stress handling

A

Allows cats to associate positive experiences with the carrier

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15
Q

How do we use fear free / low stress handling

A
  1. Pay attention to body language
  2. Consider a separate waiting room for felines
  3. Feliway diffusers or spray
  4. Avoid reaching into carrier or shaking the cat out
  5. Place a non-slip pad on exam table and utilize a towel wrap
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16
Q

What do we do if fear free/low stress handling doesn’t work

A

Chemical restraint may be appropriate

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17
Q

What is important to remember about cats and their body language

A
  1. Important to distinguish between aggression vs nervousness vs excitement
  2. Must ready body language
  3. Remember cats are pray animals
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18
Q

What is an FAS scale for

A

To assign a stress/anxiety/fear level to the patient being evaluated

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19
Q

What are the 5 things to consider when deciding if a patent needs sedation

A
  1. Patient is showing visible signs of fear, anxiety, or stress
  2. Does the patient allow you to interact with them?
  3. Will the patient take a treat or toy?
  4. If the patent begins to resist during exam, if we give them a break will it help?
  5. Is struggling continues when exam is resumed, consider sedation
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20
Q

What are some of the medications that can be sent home with owners to give prior to an office visit

A
  1. Gabapentin
  2. Selio (dexmedetomidine gel)
  3. Trazodone
  4. Alprazolam (Xanax)
  5. Clonidine
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21
Q

What are the dosing instructions for gabapentin prior to an office visit

A

Cats: 200-300mg PO per CAT several hours prior to transport

Dogs: 40mg/kg PO

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22
Q

What is selio (dexmedetomidine gel)

A

A gel given to dogs with noise phobia/averson but can also be used prior to transport of an office visit

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23
Q

What are the instructions for trazodone prior to an office visit

A

Cats: 25-30mg per CAT
Dogs: 2-15 mg/kg PO

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24
Q

What are the instructions for alprazolam (Xanax) prior to an office visit

A

Dogs: 0.125-0.25mg/kg PO
Cats: 0.02-0.1mg/kg PO

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25
What are the instructions of giving clonidine prior to an office visit
Give 1.5 hours prior to a car ride or event
26
What is pregabalin
An oral solution to alleviate anxiety and stress associated with travel and vet visits
27
T/F: pregabalin oral solution is considered a sedative and is a schedule V controlled substance
FALSE! It is NOT classified as a sedative but IS a schedule V controlled substance
28
What is the dosing of pregabalin
5mg/kg PO given 1.5 hours prior to event
29
What are the effects of pregabalin and how long do they last
Lasts up to 6-7 hours… Minimal side effects - some cats may have ataxia and appear to sleep more once home
30
What should we always do / consider for oral medications for sedation
1. Warn owner of ALL potential complications 2. Patent may seem sedated until stimulation occurs 3. DONT give diazepam orally to cats because it causes hepatic necrosis
31
What is Dr. Ebner’s “chill protocol”
1. Evening before appt: gabapentin 20-25mg/kg PO 2. At least 1-2 hours prior to appt: combo of gaba (20-25mg/kg) and melatonin 3. 30 mins prior to appt: acepromazine (0.025-0.05mg/kg OTM)
32
What is a caution / effect when we use melatonin to consider
May cause hallucinations and worsen aggression in some patients
33
what is a multi-modal approach to analgesia
1. add a local anesthetic technique if pain anticipated during procedure 2. NSAIDs for treating inflammation and pain 3. ketamine CRI at sub-anesthetic doses for preventing wind-up pain or amantadine for oral administration
34
T/F: a multi-modal approach is needed help with stress and anxiety
true!
35
what is a neuroleptanalgesic approach
a sedative or tranquilizing drug + opioid causing a synergistic effect
36
what is a good drug for procedural sedation
zenalpha alone or with butorphanol IM
37
describe the characteristics of zenalpha
1. use in dogs with ASA I or II 2. do not use in cats 3. 5-15 min onset 4. 45 min duration 5. less profound CV effects and vomiting is unlikely 6. reversal typically not required
38
why should we use caution with benzodiazepines in moderately nervous, fearful, or fractious patients
paradoxical excitement may be seen
39
why should we use caution with acepromazine in moderately nervous, fearful, or fractious patients
many side effects, no reversal agent, unreliable sedation
40
what are some things that are helpful equipment
basket muzzle, squeeze cage, EZ-nabber, wild child cat chamber, feliway, towels, thick gloves
41
what is being shown here
oxygen supplementation via facemask
42
what are 6 things we should do/consider for the "difficult dog"
1. drugs will most likely be IM 2. select appropriate needle length in overweight/obese patients 3. keep patient in a quiet, darkened room 4. refrain from stimulating patient until drugs have taken effect 5. place IVC after sedation kicks in 6. consider addition of ketamine IM to the dexmedetomidine + hydromorphone/morphine combination
43
what are some other drugs we can use for the difficult dog
alfaxalone can be given IV or IM but the IM dose is variable can combine with alpha-2 agonist
44
what drugs do we use for the difficult cat (kitty magic)
ketamine (5mg/kg) + dexmedetomidine (10-20mu/kg) + butorphanol (0.2mg/kg) IM
45
other than the drugs for kitty magic, what drugs can we use for the difficult cat
dexmedetomidine + opioid telazol alfaxalone + opioid + midazolam
46
what drugs should we use for the difficult, old, and sick patient
midazolam is better than an alpha-2 agonist or acepromazine typically combine midazolam with morphone/hydromorphone can use alfaxalone with midazolam and opioid
47
what drugs should we avoid for sedation
1. ketamine alone 2. acepromazine alone 3. benzodiazepines in young/healthy patients 4. giving diazepam IM
48
what are the reversal agents for alpha-2 agonists
yohimbine, tolazoline, atipamezole
49
what is the reversal agent for benzodiazepines
flumazenil
50
what is the reversal agent for full mu-receptor opioid agonists
naloxone
51
how do controlled substance laws effect vet clinics and you
controlled substance act, DEA license, ordering and storage of controlled substances, controlled drug logs, refills/labeling/disposal
52
what is the definition of schedule I drugs
no currently accepted medical use and a high potential for abuse, most dangerous drugs of all drug schedules
53
what are examples of schedule I drugs
heroin, LSD, marijuana, ectasy, methaqualone, peyote
54
what is the definition of schedule II drugs
drugs with a high potential for abuse with use potentially leading to severe psychological or physical defense
55
what are examples of schedule II drugs
vicodin, cocaine, methamphetamine, pentobarbital, methadone, hydro, morphine, oxy, fentanyl, adderall, ritalin
56
what is the definition of schedule III drugs
moderate to low potential for physical and psychological dependence. abuse is potential is less than schedule I/II but more than IV
57
what are examples of schedule III drugs
tylenol with codeine, ketamine, telazol, thiopental, buprenorphine, anabolic steroids, testosterone
58
what is the definition of schedule IV drugs
drugs with a low potential for abuse and low risk of dependence
59
what are examples of schedule IV
alfaxalone, xanax, darvon, darvocet, diazepam, midazolam, ativan, talwin, ambien, tramadol, butorphanol, phenobarbital
60
what is the definition of schedule V drugs
drugs with lower potential for abuse than schedule IV and consist of preparations containing limited quantities of certain narcotics. schedule V drugs are generally used for anti-diarrheal, antitussive, and analgesic procedures
61
what are examples of schedule V drugs
robitussin AC, lomotil, motofen, lyrica, parepectolin
62
what are the 3 mechanisms for euthanasia
1. direct depression of neurons necessary for life function 2. hypoxia 3. physical disruption of brain activity
63
what is the ideal situation of euthanasia
should result in rapid loss of consciousness, followed by cardiac and respiratory arrest and subsequent loss of brain function
64
what are the 4 examples given in lecture of acceptable euthanasia
1. inhaled anesthetics 2. carbon monoxide or CO2 3. argon or nitrogen 4. barbiturates
65
what were the 3 examples of euth that are unacceptable UNLESS animal is unconscious under GA
KCl, MgSO4, MgCl2
66
what is the most commonly used drug for euthanasia
pentobarbital
67
how does pentobarbital cause euthanasia
death by severely depressing the medullary and vasomotor centers when administered in high doses. CV activity may persist for several mins so phenytoin added to increase CV depressant effects
68
what is the dose of pentobarbital if phenytoin is added for dogs/cats
1ml/4.5kg of BW
69
what is the dose of pentobarbital for large animal
10-15mL per 100lbs of BW
70
when can we NOT use pentobarbital for euth
in animals intended for food purposes
71
what is the pre-euth protocol from lap of love for dogs (mL per 10lbs)
0.1 ketamine + 0.05 xylazine + 0.1 acepromazine + 0.05 butorphanol
72
what is the pre-euth protocol from lap of love for cats (mL per cat OR mL per 10lbs)
0.1 ml tiletamine-zolazepam that has been reconstituted with 2.5 mL of ketamine and 2.5 mL of acepromazine
73
how do we confirm death
lack of pulse, breathing, corneal reflex, or response to firm toe pinch, inability to hear breath or heart sounds with stethoscope, graying mm or rigor mortis
74
T/F: death must be confirmed before disposal of body
true!!
75
body disposal must be handled in accordance with __1___ and ___2___ laws
1. state 2. local
76
what are the 5 recommendations of US fish and wildlife service to prevent secondary poisioning
1. incineration 2. bury deeply (if law permits) 3. prevent scavenger access to local landfills 4. educate clients and include warning about disposal on euth consent form 5. tag animal and outer bags with prominent poison tags
77
what are some physical signs that someone may be using an opiate
1. noticeable elation/euphoria 2. marked sedation/drowsiness 3. confusion 4. constricted pupils 5. slowed breathing 6. intermittent nodding off/loss of consciousness 7. constipation
78
what are other signs of opiate abuse
1. DR shopping 2. shifting or dramatically changing moods 3. extra pill bottles turning up in trash 4. social withdrawal/isolation 5. sudden financial problems
79
what are the withdrawal symptoms
1. headache 2. nausea and vomiting 3. diarrhea 4. sweating 5. fatigue 6. anxiety 7. inability to sleep
80
what are the 2 biggest take aways for sedation
1. involve entire team and owner to have greater success 2. may be better for some patients to induce GA rather than heavy sedation

2025 Anesthesia (29 decks)

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