Final Flashcards
why is anemia/GI bleeds a concern w/ anesthesia?
PCV affects CaO2 which impacts DO2
why is GI stasis/ileus a concern w/ drugs
can predispose to rupture, peritonitis, and torsion, colic GDV
what GI function should you worry about if considering giving oral meds?
decreased absorption
How does pain affect anesthetic choices
more drug may be required b/c more neuro activity
pain predisposes to ileus/stasis
Common GI complications induced by anesthesia/surgery/analgesics (x8)
megacolon GDV constipation from ileus/GI stasis emesis/nausea gastroesophageal reflux diarrhea & gas distention GI ischemia aspiration pneumonia
what does post-op ileus predispose to?
colic, GDV, constipation
what drug class are emetics for dogs? for cats?
dogs - opiods
cats - alpha 2’s
most effective antiemetic for drug-induced emesis, and best for treating nausea
Maropitant
what does gastroesophageal reflux predispose to?
esophagitis, aspiration pneumonia progressing to esophageal stricture (poor/guarded prognosis)
how do you prevent GI reflux?
gi protectants (sucralfate, antacids)
lavage esophagus
balloon stricture
how do you avoid GI tract ischemia? Why are we worried about GI ischemia?
- maintain BP - hypotension decreases GI bloodflow b/c non-essential organ
- concern is mucosa death allowing bact/toxin translocation
When do you not fast an animal for anesthesia?
young, diabetic, or emergency
2 components involved in pain response
sensory - nociception
affective - pain perception
concerns with acute pain (x4)
- predisposes to chronic and/or maladaptive pain, cardiac dysrhythmias
- affects sleep/normal func
- facilitates catabolic state
- emotional component
how does treatment vary for acute vs. chronic pain
acute - eliminate pain
chronic - quality of life, not elimination
steps for pain assessment (x5)
- observe w/o interaction
- observe while interacting
- observe while freely moving
- response to palpation
- scoring system
how do you assess pain/nociception in an anesthetized patient? (x4)
- patient conscious response or reflex (anesthetic plane)
- increased RR
- increased BP (usually early response)
- increased HR
allodynia
something is painful that didn’t used to be (e.g. sunburn)
chronic pain
- extends beyond expected time to heal, no physiological benefit
- chronic pain scores include activity level, focus on QOL
how does emotion affect pain
emotional toll can worsen pain
anxiety, stress, depression, anger, fatigue
what is the point of pre-emptive analgesia?
- treat for anticipated level of pain ahead of time
- potentially more effective at managing pain vs. starting after stim has occurred
What pre med drugs are often used with pre-emptive sedation and analgesia?
- alpha 2’s - most common sedative/analgesic for emergencies, drug of choice for EQ
- Ace or benzo’s - but no analgesia
- Opioids but lots of side effects
- NSAID’s
NSAID’s and analgesia
Most common analgesic in vet med
Can predispose to renal dz, GI ulcers, liver dz
Meloxicam, Robenacoxib in cats
Grapiprant/Galliprant for adult dogs w/ OA
drugs often given for systemic analgesia during GA
opioids + CRI of fentanyl, ketamine, lidocaine or dexmedetomidine
Drugs commonly used for acute pain management (x7)
opioids alpha 2's ketamine lidocaine NSAID's or steroids PO - gabapentin, tramadol
Behavior drugs that may help w/ pain management
anxiolytics
anti-depressants
sleep enhancers
muscle relaxers
how do local anesthetic doses differ between dogs and cats?
cats more sensitive, need 1/2 to 1/3 of the dose
infiltration analgesia
most common local anesthesia technique
inject around painful site
what are options for longer continuous local infiltration anesthesia?
balloon pump + diffusion catheter
nocita/bupivicane - currently dog only, lasts 3-4 days
ring block
SQ local anesthesia all the way around a limb
not as profound block as nerve block, but good for laceration repair etc.
Bier block aka IVRA (intravenous regional anesthesia)
tourniquet limb, then give IV anesthesia of lidocaine
only limitation is time - tourniquet causing ischemia
also minimizes blood loss
local anesthetics MOA
block voltage-gated Na channels
stop AP’s and motor func
epidural
most “global” of local anesthetic techniques
usually local anesthetic + adjuvant like opioids
affects ability to stand/walk and causes urinary retention
Common location for an epidural
in caudal lumbar or cranial caudal spaces
why is lidocaine used in bier block
b/c if ineffective tourniquet and anesthetic goes systemic, lidocaine is least cardiotoxic vs. other local anesthetics
best pre-med drugs to give for a mitral/tricuspid valve dz dog
opioids
benzo’s
+/- anticholinergics - would be helpful for MMV
pre-med drugs to avoid for a MVD dog
Acepromazine or alpha 2’s
if had to give one, choose Ace b/c it decreases afterload (thus decreases regurge)
Options for induction of an MVD dog
opioid + benzo (e.g fentanyl + diazepam)
propofol/alfaxalone/etomidate
low dose ketamine
How to maintain an MVD dog during anesthesia
inhaled anesthetic combine w/ CRI to keep IA at low dose (other wise get vasodilation, decreased contractility)
CRI - fentanyl, lidocaine, or low dose ketamine
How would you counter bradycardia/hypotension in a valve dz dog
positive inotrope or anticholinergic to increase contractility (need to counter chamber hypertrophy)
NOT vasoconstrictor - will increase afterload, thus regurge
T/F it’s ok to give an anticholinergic in at cat w/ HCM
False
increased contractility + decreased ventricular size = decreased CO
How would you counter bradycardia/hypotension in a HCM cat
vasoconstrictor (like phenylephrine) to avoid changing contractility
can use inotrope or anticholinergic to bring up HR
pre-med drugs to avoid for a HCM cat
Acepromazine or alpha 2’s
if had to give one, choose Dexmedetomidine b/c it decreases HR some (allows for more filling time)
Induction commonly used for HCM cats
Etomidate b/c minimal CV effects
Minimum pre-op workup for a cardiac dz patient
PE + auscultation
CBC, Chem
Chest rads
If warranted: ECG, echocardiography (gold standard)
What additional drug should you plan for a dog with pulmonary stenosis
treatment is ballooning
have antiarrhythmic like lidocaine on board
Why is gappirant/galliprant different from other NSAID’s
blocks PGEP4, not cox
