excessive AF exam 2 Flashcards by Farren Ann

T/F

remove a cats endotracheal tube slightly earlier to avoid laryngospasm

TRUE

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how to remove an endotracheal tube if regurg occurs

Postural drainage (nose low)
Suction
Swab posterior pharynx with gauze before awakening – use long sponge forceps in larger animals
Remove ET tube with cuff inflated

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if there was no regurgitation how do you remove the et tube

deflate endotracheal

tube cuff, remove after swallow or cough

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commonly develop upper airway obstruction in recovery

brachycephalics

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T/F

pain lowers the cardiac workload

FALSE - increases

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how can you differentiate a painful patient vs a dysphoric one

give a short acting opioid like fentanyl

A painful patient will quiet with additional opioids
A dysphoric patient will become more distressed with additional opioids

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what breeds are more susceptible to dysphoria

huskies and malamutes

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if there is a reaction to palpation of the surgical site is this behaviour pain or dysphoria

pain

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category drug that will treat pain and dysphoria

alpha 2 agonist

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consequences of short term hypothermia

 Increased O2 demand
 Prolonged recovery
 Discomfort

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consequences of long term hypothermia

delayed healing and infection

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T/F

a heating pad is an effective tool for preventing hypothermia

FALSE – never use a heating pad they are dangerous

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T/F

when a patient was hypoventilating you should remove the ET tube earlier than normal

FALSE – keep in longer and give IPPV as needed

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2 ways to dx hypoxemia

 Pulse oximetry

 Arterial blood gas

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what are 2 common causes of hypoxemia

hypoventilation - airway obstruction

V/Q mismatch

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why should mouth gags be avoided in cats

compromises cerebral arterial blood flow

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this animal often tries to stand before they are ready and causes a lot of problems

horses

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T/F

aspiration and regurg are not common in horses to the ET can be removed earlier

TRUE

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why is airway obstruction a complication in horses

they are OBLIGATE NASAL breathers

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horse triple dip

guaifenesin, ketamine, xylazine

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give this additionally to horses who are healthy anxious or high-strung patients needing additional sedation

Acepromazine

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main stay for equine pain relief and has a long duation

NSAIDS

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Short duration, concern for ileus

May be better for somatic pain in horses

morphine

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commonly used for visceral pain in horses and is short acting

butorphanol

or alpha 2 agonists - colic

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REQUIRED for sick equine patients or those with respiratory compromise

supplemental O2

check horses for nasal edema during recovery and give this drug intranasally

phenylephrine

T/F | check horse bloodwork during recovery so you can correct the disturbances as the patient is recovering

FALSE -- do it all while on the table

major complications in ruminant anesthesia

bloat reguritation aspiration

dogs develop antibodies how many days after their first blood transfusion

5-7 days

dog breed with prolonged recovery to thiobarbiturates

sighthounds

this dog breed has possible sensitivity to acepromazine

boxers

mu agonists that are least likely to cause vomiting

Fentanyl, methadone

what premed classes do you give a dog/cat IM before the catheter placement

opioid and sedative

Recommended to give with IM premeds when removing a | mast cell tumor

H1 antihistamine |  Diphenhydramine

T/F | histamine causes vasoconstriciton

false -- vasodilation

May be given 30 minutes before opioid to decrease risk of vomiting

NK1 receptor antagonist | Maropitant (Cerenia)

causes moderate sedation and hypotension

Acepromazine

causes marked sedation and hypertension, reflex bradycardia, decreased cardiac output

Dexdomitor

May cause sedation in young, old, sick patients and is Cardiovascular and respiratory sparing

benzodiazepines

Used for patients with pre-existing high vagal tone premedication

anticholinergics

T/F | place the laryngoscope on the epiglottis

FALSE

why are brachycephalic dogs harder to intubate

long soft palate

how far do you advance the ETT

to the thoracic inlet

do not give CRI because it can cause adrenal suppression

etomidate

dog blood vol

Blood volume is ~90 mL/kg

IV crystalloid fluids given to dogs

LRS, Plasmalyte-A, Norm-R

what rate do you give IV fluids to dogs

10 mL/kg/hr

drugs used in healthy hypotensive dog

Dopamine, dobutamine, ephedrine most common

drugs used in very sick hypotensive dogs

Norepinephrine and vasopressin

T/F | reguritation is common in cats but not dogs

false -- opposite

T/F | vomiting after premed will increase the risk of regurgitation

FALSE

Give before surgery to increase gastric pH and lower risk of regurigation

Proton pump inhibitors (PPIs) – Omeprazole or esomeprazole

have been shown to decrease incidence of gastroesophageal reflux (GER) in anesthetized dogs

prokinetic drugs -- Metoclopramide or cisapride

T/F | cats with asthma will cough

cat breed that gets hypertrophic cardiomyopathy (HCM)

maine coon - if you hear a murmur get a cardiologist

results in good visceral analgesia and can be given transmucosally (TM) by the owner at home for cats

buprenorphine

All opioids can cause post-operative _______ in cats.

hyperthermia

T/F | dexmedetomidine causes vasodilation

false -- vasoconstriction

IM combinations will provide immobilization for fractious cats

Alfaxalone or ketamine

what is kitty magic

Ketamine + alpha-2 agonist + opioid

issue with repeated doses of propofol in cats

heinz body anemia

MAC in cats

MAC is higher in cats (iso 1.4- 1.6)

Causes severe cardiovascular depression in cats when administered IV

lidocaine

T/F | cats can get the first blood transfusion free

MUST be typed and cross-matched before the first transfusion

Type __ cats reciving type ___ blood can be fatal

B getting A

cats have increased renal issues to this drug category

NSAIDS

what alpha 2 drugs are common for horse anesthesia

xylazine, detomidine, romifidine, medetomidine

what muscle relaxant is most common in horses

GGE

what is the hyponotic used in horses

ketamin

Combinationofinhalationalandintravenousdrugs | • Attainmentof‘balancedanesthesia’

PIVA

T/F | piva has more cardiovascular depression than TIVA

true

T/F | the triple dip falls under PIVA

false - TIVA

Horse triple dip | GGE + Ketamine + ____ or ______

xylazine or romifidine

what boluses do you top up the horse triple dip with intermittently

Ketamine about 0.4 mg/kg | Diazepam / Midazolam 0.1 mg/kg

what 2 reflexes can you check to tell if a horse is in the surgical plane of anesthesia

palpebral reflex, anal tone will both be weak

T/F | a horse is showing lacrimation and nystagmus, so we know it is in the surgical plane of anesthesia `

FALSE -- too light if lacrimation, nystagmus, movement

T/F | IPPV can help hyperventilation

FALSE - hypoventilation

what lead are horses

ECG lead 1

My horse has no palpebral or cornel reflex - surgical plane?/?

no - too deep will also have dry corneas and bradycardia and hypotension

where are horses intubated and why

nasal - obligate nasal breathers

T/F | make sure to flip horse to opposite recumbency during recovery

FALSE

MAP < 70 mmHg; SAP < 90 mmHg | in a horse this is ??

HYPOTENSION reduce anesthetic rate address underlying problem give cvs drugs like dobutamine, phenylephrine and volume resuscitation

in a myopathy what will the CBC show

inflammatory leukogram

predisposing factors of compartmental myopathy

Muscle and nerve tissue ischemia associated with inadequate perfusion - heavily muscled horses - halothane!! - persistently low MAP - poor positioning in surgery

6 Ps of compartmental myopathy

``` Pain paresis paralysis pallor, pulselessness, poikilothermia ```

after anesthesia your horse's muscles feel very hard and seem painful, he also is having trouble standing on a front limb??

compartmental myopathy Myoglobinuria and subsequent renal failure are also seen

procedure to decompress during compartmental myopathy

fasciotomy

how can you symptomatically treat compartmental myopaghy

``` fluids • analgesics, muscle relaxants &/or sedatives • oxygen radical scavengers: DMSO • physiotherapy • TLC ```

Life-threatening skeletal muscle pharmaco-genetic disease in horses, humans, pigs..

malignant hyperthermia

what is the mutation that causes malignant hyperthermia in horse

Mutations in ryanodine (RyR1) gene cause dysfunctional release of excessive calcium into sarcoplasm

what are clinical signs of malignant hyperthermia

Hyper-metabolicstate:hyperthermia,hypercapnea, lactic acidosis profuse sweating muscle rigidity & twitching myoglobinuria death & per-acute rigor mortis

drug tx for malignant hyperthermia

DANTROLENE

Rare genetic trait that affects Quarter horses to fail in deactivating Na channels

Hyperkelemic Period Paralysis (HYPP)

what can trigger episodes of Hyperkelemic Period Paralysis (HYPP)

transportation stress sedation anesthesia

how can HYPP be treated

``` Increase K excretion by  acetazolamide  dextrose  Ca gluconate  TLC ```

what horse nerves get neuropathy in anesthesia

Nerves on dependent weight bearing parts -- facial and radial common from pressure and ischemia is possible prevent by padding and maintaining BP

T//F | neuropathy is incredibly painful to horses

false

T/F | Premedication in presence of mother for foal

TRUE

T/F | benzodiazepam is more effective in horses than in foals for sedation

FALSE -- Benzodiazepine a very effective sedative in | foals versus adult horses (~excitement)

induction drugs for foals

Propofol, Ketamine

maintenance drugs for faols

iso/sevo

what do you increase dose by for donkeys

30%

how long are food and water withheld from pigs

food 12-24 hours | water 2-4

why is ETT placement hard in pigs

Poor visualization, limited potential to open mouth, narrow glottis for body size, laryngospams

what breed of pig gets malignant hyperthermia most

landrance

T/F | IM injections in pigs are needed for restraint

TRUE

where are IM injections in pigs placed

Shoulder/neck, semimembranosus, or semitendinosus muscle; avoid thick fat deposits

swine immobilization drugs

Ketamine 5-10mg/kg and midazolam 0.2-0.5mg/kg IM

where is most realistic for pig catheter

auricular vein

induction drugs : swine

Ketamine 10mg/kg IM  Ketamine 5mg/kg IV  Ketamine/xylazine combos  Telazol (tiletamine combined with zolazepam)  Thiopentone 10mg/kg IV

position for ETT placement in pig

dorsal or sternal recumbency

anatomical swine that makes intubation harder

Laryngotracheal junction curve

T/F | in swine maintenance you can use propofol CRI

TRUE

what three places can you assess to make sure pig in in surgical depth

palpebral and corneal reflexes, jaw tone (muscle relaxation)

analgesia for pigs in recovery

NSAIDS or opioids

T/F | potbelly pigs are more susceptible to MH

false - large white pigs are

T/F | lactic acidosis is a sign of malignant hyperthermia in pigs

true

how do you treat the acidosis in malignant hyperthermia

na bicarbonate

why do lab animals not need fasted

hypoglycemia

what do lab animals do that indicates stress

```  Grooming (appearance)  Posture – hunch  Appetite  level of activity  Aggression  Vocalization  Facial expression  Response to handling ```

most commonly used injectable anesthetic in lab animals

ketamine - combo with alpha 2 agonists or midazolam

T/F | relatively low drug doses are used in lab animal anesthesia

FALSE - high doses are required

drugs commonly used for lab animal sedation

alpha 2 agonists - dex/xylazine | benzodiazepam - midazolm

what circuit is used in lab animal maintenance

Small volume non-rebreathing circuits with iso or seva

lab animal analgesics

``` Opioids --Bupenorphine --Butorphanol --Tramadol?? NSAIDs  Carprofen  Meloxicam ```

what are these | Snakes, lizards, crocodilians, chelonians, amphibians

ectotherms

T/F | ectotherms have a low anaerobic tolerance and so they can hold their breath a long time

FALSE -- this means they have a HIGH anaerobic tolerance

what kind of heart do ectotherms have

3-chambered heart (lizards, chelonians, snakes) | 2 atria plus 1 ventricle

in ectotherms why should you avoid IM injections to the caudal part of the body

avoid IM injections in caudal body parts as they may cause nephrotoxicity and/or be rapidly excreted

T/F | ectotherms have a muscular diaphgram

false - no diaphragm

T/F | ecotherms have complete cartilaginous tracheal rings

TRUE

how much of a turtle body mass is the shell

50%

injectable anesthestics used on snakes

ketamine and metomidine

how do you reverse metomidine

atipamezole

whats a chelonian

turtle

drugs for turtle anesthesita

ketamine and propofol

what does a crocodile jaw do when paralyized

top opems

Depolarizing neuromuscular blocker – causes depolarization of muscle fiber making it resistant to any further stimulation by acetylcholine (ACh)

Succinylcholine

what is the reversal agent for Succinylcholine

none

Gallamine is used on what species for anesthsia

crocs

T/F | with Gallamine there is no pain felt and the animal in unconcious

FALSE -it is a paralytic | animal still conscious and feels pain

how long does Gallamine immobilize the patient

up to 24 hours - temp dependent

how do you reverse gallamine

Reverse with neostigmine | -- give atropine with to prevent excessive parasympathetic stimulation

how do you recover the crocodile

Place animal on dry land facing water after reversal

T/F | keep frogs and toads MOIST all through anesthesia

true

how long should fish be fasted

Fast for 12-24 hours

T/F | fish are at risk for regurgitation

TRUE

anesthesia opions for fish

MS-222 immersion | inhalation anesthetic flow-by

how are fish recovered from anesthesia

Recovery: transfer to aerated anesthetic-free recovery tanks/chambers

what is the most important thing in wildlife anesthesia

safety

how far can a pole syringe go

3-4 meters

how far do blow pipes go

10-15m

how far do dart projections go

up to 50 m

how far can a dart pistol go

5-60 m

how far can a dart rifle go

25 m

what are dart projectors powered by

``` compressed gas (CO2, air, butane) explosive charge (powder) ```

what is the aim of dart projectors

Aim is to cause minimal tissue trauma with appropriate impact for drug delivery

4 causes of dart failure

1. dart failure 2. drug failure 3. dart aerodynamics 4. animal injury

immobilizers of wildlife

potent opioids and cyclo-hexamines

common tranquilizers in wildlife

phenothiazines and | butyrophenones

common wildlife sedatives

alpha 2-adrenergic agonists and benzodiazepines

what are these -Etorphine (M99)  Carfentanil  Thiafentanyl (A3080)

hightly potent opioids used in wiildlife anesthesia

what wildlife species are sensitive to opioids

White rhinoceros, Giraffe, Hippopotamus, Impala, Mini antelope, Waterbuck

T/F | potent opioids are safe to use in all wild life and are necessary to keep them sedated

FALSE -- can cause life threatening respiratory depression in sensitive species

how are potent wild life opioids partially reversed

butorphanol

Recurrence of signs of opioid induction and sedation in varied time after administration of opioid antagonist

Renarcotization

what are signs of Renarcotization

Signs: high-stepping, star-gazing, pacing, decreased response to stimuli, sedation; may become recumbent

Most commonly used agents for induction of general anesthesia in feral carnivores

Dissociative drugs (cyclohexamines)  Ketamine (Ketaset)  Tiletamine (in Telazol)

T/F | ketamine has a higher potency than Tiletamine

FALSE -- telazol is higher

Common adverse effects of their use in game capture include expression of extrapyramidal signs (ataxia, allotriophagia, torticollis, tremors, star-gazing)

tranquilizers

T/F | midazolam is a water soluble sedative

TRUE

T/F | Diazepam can be mixed only with ketamine in a syringe

yes

reversales of xylazine

yohimbine or atipamazole

Which one causes ataxia: | romifidine, xylazine, detomidate

romifidine

what two sedatives are commonly used in herbivores

detomidate and romifidine

what species is this drug combo for | Ketamine or Telazol with alpha-adrenergic agonists or benzodiazepines

primates

what wild species is this drug combo for: | Potent Opioids combined with Tranquillizers or Ketamine or Telazol with alpha-adrenergic agonists or benzodiazepines

smaller animals like antelopes

what can happen to the white rhinos with drug combos involving opioids

Muscle tremors, muscle rigidity, hypoxemia, hyperthermia common with opioids

what is special about the elephant

obligate nasal breathers and have no pleural space

immobilization drugs for elephant

Etorphine + azaperone

Muscle breakdown due to overexertion, usually due to capture/restraint

capture myopathy -- minimize animals stress

4 recognized capture myopathy syndromes

Acute death syndrome (w/in 3-4 hrs)  hyperthermia, acidosis, hyperkalemia, hypoglycemia Delayed peracute death syndrome  death 1 day post-capture d/t Vfib Ataxic-myoglobinuric syndrome  acute renal failure, death in 4-5 days Muscle-rupture syndrome  hyper-flexion of hocks 1-2 days post-capture

2 functional components of the birds respiratory system

ventilation and gaseous exvhange

T/F | birds have a diaphrgam

false

T/F | birds have no epiglottis or vocal cords

TRUE

T/F | both inspiration and expiration are an active process in birds

TRUE

why is oxygen extraction more efficient in birds

counter-current (versus concurrent in mammalian) flow of air and blood which allows continuous exchange along the parabronchi also cross current!!

how many chambers in an avian heart

Unique to avian and reptilian circulation

renal portal system

how do birds cool

panting and gular flutter

with hold food | birds < 200g BW

no fasting longer than 2 hours

psittacines (400-1000g BW) fasting

4-6 hours

raptors, Ratites fasting

6-12 hours

IM sites for most flying birds

pectoral mm

IM sites for non flying birds

thigh mm

T/F | birds absorb premeds well subcutaneously

false

IV premed birds sites

medial metatarsus brachial vein right jugular vein

intraosseous injection sites for birds

proximal ulna  tibiotarsus

ETT on birds

not cuffed

why does Principle of minimum alveolar concentration (MAC) not apply in birds

they dont have alveoli

ETCO2 in anesthetized birds

30-45 mmHg in anesthetized birds

you see these signs after a blood transfusion?? | fever, urticarial, angioedema, pruritus, tachypnea

allergic reaction!! stop transfusion, diphenhydramine +/- Dexamethasone +/- epinephrine (in severe cases), restart transfusion at a slower rate

you see these signs during blood transfusion | sudden tachycardia, hypotension, cardiac arrest, collapse

anaphylactic shock | stop transfusion, initiate symptomatic support (CPR?), epinephrine and Dexamethasone

you see these signs during blood transfusion | tachypnea, fever, hemoglobinemia, hemoglobinuria, shock

acute hemolysis | stop transfusion, Dexamethasone, saline diuresis, maintain BP (80-100mmHg SAP // dopamine

during transfusion temp rise by over 1 degree C, bradycardia

stop transfusion, Dexamethasone and ketoprofen, could restart at slower rate in 15 minutes Febrile reaction; non-hemolytic

what does a circulatory volume overload look like in transfusions

tachypnea, pulmonary edema, polyuria

what 2 factors does cardiac output depend on

HR and SV

what 3 factors does sv depend on

depends on preload, afterload, and contractility

increased afterload ____ contractility

decreases

_____receptors are antagonized by NMBDs

nicotinic Ach

clinical indication for anticholinergics

Bradycardia secondary to increased vagal tone

why are anticholinergics a concern in horses and ruminants

they can cause colic/ileus

T/F | atropine crosses the BBB and placenta

true

which causes more tachycardia | glycopyrrolate or atropine

atropine

Which is used more in emergency cases: | glycopyrrolate or atropine

atropine

T/F | glycopryrolate crosses the BBB and placenta

FALSE

Used for ventricular arrhythmias – VPCs, Vtach

lidocaine

Used for severe sinus or supraventricular tachycardia

beta blockers

α overstimulation

vasoconstriction, decreased perfusion, increased cardiac workload

β-1 overstimulation

tachyarrhythmia, increased myocardial O2 demand

β-2 overstimulation

vasodilation, decreased preload

Common first-line treatment for hypotension in cats

dopamine

drug with Dose-dependentreceptoragonism

dopamine

indications for epinephrine

CPR or anaphylactic shock

T/F | phenylephrine α-1 agonist ONLY

true

Useful topically for nasal edema in horses

phenylephrine

Causes splenic contraction – used to treat nephrosplenic entrapment in horses

phenylephrine

Primarily ß1 agonist that causes increased inotropy, minimal effects on chronotropy

dobutamine

ANTIDIURETIC HORMONE

vasopressin

T/F | vasopressin may cause profound vasoconstriction and tissue ischemia

TRUE

what comes first | cardiac arrest or respiratory arrest

resp -- if treated fast can prevent cardiac arrest NICE

why should we not use doxapram to treat respiratory arrest

increases cerebral O2 demand

underlying cause of cardiac arrest

inadequate cardiac oxygenation

Goal of ____ is to maximize myocardial and cerebral oxygenation

CPR

T/F | cpr has a poor success rate in dogs and cats and is even worse under anesthesia

FALSE - better under anesthesia

Order is repeated back to the requestor to avoid misunderstanding or not hearing

closed loop communication

most important part of basic life support

chest compressions

an apneic unresponsive patient should only be assesed for how long before starting chest compressions

5-10 seconds

T/F | chest compressions: 3 minute uninterrupted cycles

FALSE - 2 minutes cycles 100-120 per minutes

Cardiac pump theory compressions are used in what animals

cats and small dogs

Thoracic pump theory compressions are used in what animals

larged deep chest dogs

ventilate CPR pateints at ___ breaths/min

what are shockable rhythms

Vfib / Pulseless Vtach

reverse opioids

naloxone

flumazenil will reverse what

benzodiazepines

T/F | opioids are longer acting than NSAIDS

fase

indications for NSAIDS

mild chronic pain | peri-surgical pain

inhibits phospholipase preventing formation of | arachdonic acid from cell membrane phospholipids

steroids

T/F | use steroids in combo with NSAIDS for pain control

FALSE - contraindicated

act by inhibit cyclooxygenase (COX)

NSAIDS

T/F | cox -1 is inducible

false - cox 2 is

where can COX 2 be found

in damaged or inflammed tissues --tissue – monocytes, macrophages, neutrophils

T/F | COX1 inhibition prevents pain, fever analgesia

FALSE -- cox2

proton pump inhibitor which is very effective at reducing gastric secretions

omeprazole

what age can you start using NSAIDS and why

4 weeks old | wait for nephrogenesis to be done

T/F | NSAIDS are good for cats

false -- toxicity

Robenacoxib is a cox 2 ____ inhibitor

selective

what is carprofen

COX-2 preferential inhibitor

what is meloxicam

COX-2 selective inhibitor

still commonly used in horses, risk of GIT ulcers and renal toxicity -- non selective COX inhibitor

phenylbutazone

non selective cox inhibitor mostly for colic pain in horses

FLunixine meglunine

cat with haemolytic anemia, cyanosis, fever, facial edema, vomiting

aspirin toxicity -- very fatal

Reversible occupation of nicotinic cholinergic receptors by drugs that prevent neuromuscular transmission (i.e. muscle movement) by restricting ACh access to these receptor sites.

neuromuscular blockade

NMBD indications

microscopic opthalmic, thoracic, hernia sx

T/F | NMBD facilitats IPPv

true

T/F | NMBD = absolute muscle relaxation

true

T/F | depolarizing NMBD are competetive

false -- non competetive

Do NMBD cross the BBB or placenta

no they are water soluble

Succinycholine is the only depolarizing NMBD in clinical use

true

T/F | Atracurium will not cause histamine release

false

First of the NMBDs free of cardiovascular adverse effects

Vecuronium -- amino steroid group

what nerves can you stimulate to monitor NMBD in dogs and cats

 Peroneal nerve  Ulna nerve

what nerves can you stimulate to monitor NMBD in horses

facial and Superficial peroneal nerve

2 drugs to reverse NMBD

edrophonium (preferable: faster onset and less adverse effects)  neostigmine

First local anesthetic

cocaine

MOA of local anesthetics

Bind to sodium channels in nerve membranes and slows rate of depolarization

T/F | all local anesthetics are weak acids

false - weak bases

T/F | a lower pk will result in a faster local anesthetic onset

true

higher protein binding and higher lipid solubility of local anesthetics

higher potenct and longer duration

ONLY local anesthetic that may be given IV or used for intravenous regional anesthesia

lidocaine

local anesthetic with HIGHEST cardiovascular toxicity

bupivicaine

local anesthetic Uses: nerve block, intra-articular (common in large animal

mepivicaine

T/F | local anesthetics have Fastest absorption with intercostal blocks

TRUE

which is more likely to accumulate esters or amides

amides

T/F | amides function is dependent on liver function

TRUE bc metoabolized ther e

added to local anesthesia to prolong duration of a block

epinephrine

T/F | toxicity is addative

true

T/F | aryngeal spray for intubation caused severe methemoglobinemia in cats

TRU

__________ versions should be used for epidurals and spinal anesthesia

Preservative-free

what is the first sign of toxicity with bupivicaine

first sign is cardiovascular collapse --> death

what local anesthetic do most allergic reactions occur

Occur most commonly with procaine in Procaine Penicillin G

goal of local anesthesia

Provides analgesia before, during, and after procedure

which fibers are blocked first

Generally, smaller diameter fibers and those with less myelination are blocked first

what nerve fibers control pain

A-δ and C fibers

lies between the dura and vertebrae

epidural space

epidural contraindications

```  Coagulopathy  Hypovolemia  Infection at injection site  Neoplasia at injection site  Anatomy (inability to palpate landmarks)  Sepsis ```

what is a major adverse effect of local anesthetics

hypotension!! | Block of sympathetic trunk could decreased vascular tone

Normal response to a noxious stimulus, producing protective behavioural responses to potential or actual tissue damage

physiologic pain

sudden onset of pain, which may be severe but disappears when the stimulus is removed

acute pain

pain that lasts several weeks to months and persists beyond the expected healing time

chronic pain

originates from damage to bone, joint, muscle, or skin; well localized

somatic pain

originates from internal organs – stretching or twisting of viscera, mesenteries, and ligaments; poorly localized

visceral pain

originates from injury to the peripheral or central nervous system

neuropathic pain

originates from tissue damage

inflammatory pain

referred pain

originates from one part of the body but perceived as occurring in another

peripheral pain receptors activated by a stimulus

transduction

signal communicated via Aδ and C-nerve fibers to spinal cord

transmission

nociceptive input modified at the spinal cord

modulation

Conscious recognition of pain at the cerebral cortex

perception

respond to Stretching, compression, crushing

mechanoreceptors

respond to heat and cold

thermoreceptors

Aδ-fibers

 Myelinated, fast transmission |  Acute, accurately localized, sharp, and rapid onset pain

C - fibers

 Nonmyelinated, slow transmission |  Chronic, diffuse, dull, burning, aching pain

Terminates at the thalamus and somatosensory cortex

Spinothalamic tract

Spinothalamic tract can be tested by ...

skin pinch

this tract transmits easily localized superficial pain

Spinothalamic tract

Terminates in the reticular formation

Spinoreticular tract

Spinoreticular tract function is tested by

hemostats across base of toenail – stimulates periosteum

this tract Transmits deep and visceral pain

spinoreticular

what merdiates head pain

trigeminal nerve

T/F unmanaged pain could cause hypercoagulability, risk of thrombosis

truw

psychological consequences of unmanaged pain

ANXIETY, FEAR, SUFFERING

Pain evoked by a stimulus that does not normally cause pain

allodynia

An increased or exaggerated response to a stimulus that is normally painful (heightened sense of pain)

hyperalgesia primary at site of injury secondary in surrounding undamaged tissues

An increase in the activity, excitability, and responsiveness of peripheral nerve terminals, leading to primary hyperalgesia

peripheral sensitization

Summation of painful stimulation IN THE SPINAL CORD, mediated by C-fibers. Contributes to central sensitization

wind up

An increase in nerve excitability and responsiveness in the central nervous system, particularly the spinal cord, leading to primary and secondary hyperalgesia, and allodynia

central sensitization

Loss of sensitivity to pain

analgesia

The use of multiple drugs acting by different mechanisms to produce analgesia

multimodal analgesia

preemptive analgesia

The administration of analgesic therapy before painful stimulation, used to PREVENT WINDUP

inferred by observation of deviations from normal behaviour, signs of stress, and physiologic responses

pain

T/F | animals that limp are shifting weight to the limb that hurts

false

Praying position in dogs indicated

abdomonal pain

what are signs of pain in a horse

dilated nostrils and tense muzzle

untreated pain in horses could lead to

ileus / colic

Bruxism

teeth grinding - sign of pain in ruminants

T/F | Peripheral and central sensitization are prevented by general anesthesia

FALSE - are not

Mainstay treatment for perioperative pain

opioids

opioid given pO

tramadol

opioid that can be given transmucosally

buprenorphine

Mu antagonist, kappa agonist

butorphanol

T/F | tramadol Inhibits serotonin reuptake

TRUEEE oral, weak mu opioid, not indicated as sole agent

binds to NMDA receptors and facilitates pain transmission

glutamate

T/F | ketamine can be used CRI for adjuct anesthsia

TRUE

T/F | An induction dose of ketamine will NOT provide adequate analgesia for any surgical procedure

TRUE

Provide potent analgesia in horses

alpha 2 agonists

has been shown to increase risk of anesthetic death in dogs

xylazine

Used primarily for neuropathic and chronic pain (modulation)

gabapentin

T/F | opioids are continued post op and NSAIDS are not

false - reversed