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final prep Flashcards

1
Q

define anesthesia

A

loss of sedation - one extreme in a continuum level of CNS depression

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2
Q

first inhalant anesthetic used?

A

diethyl ether

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3
Q

define general anesthesia

A

reversible state of unconsciousness, immobility and muscle relaxation

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4
Q

define surgical anesthesia

A

a stage of GA, analgesia and muscle relaxation

must be maximum effect to eliminate pain and movement during procedure

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5
Q

what is the biggest difference between general anesthesia and surgical anesthesia?

A

the level of pain control

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6
Q

define sedation

A

CNS depression, drowsiness, drug-induced

various levels from slightly aware to unaware of surroundings, aroused by noxious stimuli

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7
Q

when would we use sedation over anesthesia?

A

minor procedures

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8
Q

define tranquilization

A

calmness but not sleeping - patient is reluctant to move but still aware of surroundings

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9
Q

define hypnosis

A

drug-induced sleeplike state

impairs patient’s ability to respond to stimuli but can be aroused with sufficient stimulation

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10
Q

define narcosis

A

drug-induced state caused by narcotics - patient is not easily aroused

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11
Q

define local anesthesia

A

targets a small/specific area of the body

loss of sensation by drug infiltrated into the desired area

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12
Q

define regional anesthesia

A

loss of sensation to a limited area of the body

i.e. nerve blocks, epidurals and dental blocks

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13
Q

define balanced anesthesia or multimodal therapy

A

using multiple drugs in smaller quantities to maximize benefit

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14
Q

what are some advantages to using an endotracheal tube during anesthesia?

A 
open airway
less anatomical dead space 
precision administration of anesthetic agent 
prevent aspiration 
respond to respiratory emergency 
monitor respiration
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15
Q

what are the different types of endotracheal tubes available?

A

murphy tubes - beveled end w/ side holes

cole tubes - no side hole or cuff (birds and reptiles)

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16
Q

what type of ETT do we use here?

A

murphy tubes

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17
Q

what is the difference between a high volume/low pressure cuff and a low volume/high pressure cuff?

A

high vol/low pressure distribute pressure evenly where low vol/high pressure exert high pressure to only a small animal - this is a high risk for tissue damage

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18
Q

why would you want to make sure the ET tube is in the middle branch of the lungs?

A

if the ET tube is too deep it can cause atelectasis or CO2 buildup

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19
Q

what patients might you choose a supraglottic airway device over an ET tube with?

A

rabbits primarily, available for cats also

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20
Q

what is unique about SADs?

A

they allow airway management without invading the tracheal lumen

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21
Q

what are the two kinds of laryngoscope blades?

A

miller - straight

mcintosh - curved

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22
Q

what four components make up the anesthetic machine?

A
  1. compressed gas supply
  2. anesthetic vaporizer
  3. breathing circuit
  4. scavenger system
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23
Q

what level of oxygenation is necessary to maintain cellular metabolism under anesthesia?

A

30%

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24
Q

how do you know the flow of compressed gas will stop completely?

A

when the valve stem is turned completely clockwise

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25
Q

what safety issues do we associate with compressed gas?

A

combustibility
yoke attachment - must be attached properly
high pressure release
proper storage

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26
Q

what does the tank pressure gauge do?

A

indicates the pressure of gas remaining in a compressed gas cylinder - measured in psi

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27
Q

what does the pressure reducing valve do? is it okay to adjust?

A

reduces outgoing pressure to a constant usable level to 40-40 psi
NEVER touch the pressure reducing valve

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28
Q

is 40-50 psi a safe level for a patient to receive oxygen?

A

NO must be further reduced by the flowmeter to be safe for patient

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29
Q

what does the line pressure gauge do?

A

indicates pressure in the gas line between the pressure-reducing valve and flowmeter

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30
Q

what should the line pressure gauge read if the tank is open?

A

40-50psi

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31
Q

what does the flowmeter do?

A

indicates the gas flow expressed in L/min

reduces pressure of gas to 15 psi

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32
Q

what does the oxygen flush valve do?

A

delivers a short, large burst of pure oxygen directly into the rebreathing circuit/common gas outlet

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33
Q

why should you NEVER touch the oxygen flush while your patient is attached?

A

the flush valve bypasses the vaporizer and flowmeter so the pressure will KILL YOUR PATIENT

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34
Q

why would you use your oxygen flush valve?

A

leak test

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35
Q

what does the vaporizer do?

A

converts liquid anesthetic to a gaseous state

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36
Q

where does the mixture of oxygen and inhalant anesthesia go to be delivered to the breathing circuit?

A

vaporizer outlet port

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37
Q

what is the mixture of oxygen and anesthetic gas called?

A

fresh gas

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38
Q

what are the induction and maintenance rates for isoflurane?

A

induction: 3-5%
maintenance: 1.5-2.5%

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39
Q

how might multimodal therapy effect the induction and maintenance rates of your iso?

A

multimodal decreases the rates as you will need less of each drug

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40
Q

what does the breathing circuit do?

A

carries anesthetic gas and oxygen from the fresh gas inlet to the patient
conveys expired gases away from the patient

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41
Q

what are the different types of breathing circuits?

A

rebreathing

nonrebreathing

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42
Q

what type of patient would you use a rebreathing circuit for?

A

a patient >7 kg

all but very small

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43
Q

t/f - with a rebreathing system exhaled air will not be inhaled again

A

false - a rebreathing system removes carbon dioxide from exhaled air and it is inhaled again with added oxygen and anesthetic

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44
Q

what type of patient would you use a non-rebreathing circuit for?

A

the little guys! <7 kg

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45
Q

where does the fresh gas that reaches the patient come from in a non-rebreathing system?

A

directly from the vaporizer

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46
Q

do you need a CO2 absorber cannister for non-rebreathing? why/why not?

A

no - none of the exhaled air will be reinhaled by the patient

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47
Q

is it easier to control anesthetic depth with a rebreathing or non-rebreathing circuit?

A

non-rebreathing as they are not rebreathing anything - adjustments made ot the flowmeter/vaporizer will affect your patient quicker

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48
Q

which system has a high gas volume, rebreathing or non-rebreathing?

A

non-rebreathing

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49
Q

what is dead space?

A

gas that is inspired at every breath but does not participate in gas exchange

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50
Q

why would we want to reduce dead space in our surgical patients?

A

to ensure the maximum amount of air reaches the alveoli

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51
Q

what is included in the animal’s dead space?

A

mouth to alveoli

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52
Q

what is the mechanical dead space?

A

animal’s mouth to the machine

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53
Q

what can cause resistance?

A

valves
abosrber cannister
hose length/diameter

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54
Q

would a smaller hose diameter increase or decrease resistance?

A

increase

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55
Q

what might happen if you let your tubes just hang off of the table while the patient is intubated?

A

you may cause circuit drag which can lead to extubation of the patient

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56
Q

what do the unidirectional valves do?

A

control the direction of gas flow

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57
Q

how can unidirectional valves assist in intubation?

A

can look at the valves to see if ETT is in the trachea - if it was placed wrong the valves will not flutter with inspiration and expiration

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58
Q

what does the pop-off valve do?

A

allows excess carrier and anesthetic gases to exit the breathing circuit and enter the scavenge system
prevents excessive pressure or volume of gases in the circuit

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59
Q

when are the ONLY times you can use your pop-off?

A

manual ventilation

leak test

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60
Q

what will happen if you forget to open the pop-off after manual ventilation and your patient is still attached?

A

they will die - too much pressure for the patient to breathe out

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61
Q

what are some reasons to manually ventilate your patient?

A

prevent atelectasis (ventilate every 5-10min)
force fresh gas into alveoli to normalize gas exchange
normalize resp rate - make sure they are getting enough gas
when patient is apneic to prevent them from waking up (they are holding their breath so not receiving any gas)

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62
Q

do you use the pressure manometer in both non-rebreathing and rebreathing systems?

A

no - only specific for rebreathing

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63
Q

what does the pressure manometer do?

A

indicates pressure of gases WITHIN the breathing circuit

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64
Q

what units are used for the pressure manometer?

A

cmH20
mmHg
kPa

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65
Q

what level do you not want to exceed on the pressure manometer when manually ventilating?

A

20cmH20

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66
Q

what does an air intake valve do? do all machines have one?

A

admits room air into the circuit if there is presence of negative pressure in the circuit (collapsed reservoir bag)
not all machines have this function

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67
Q

what does a universal control arm contain?

A 
pop-off valve
pressure manometer 
scavenger attachment 
reservoir bag attachment 
bain attachment
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68
Q

what are the 3 types of scavenging systems we discussed?

A

passive
active
activated charcoal

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69
Q

how does a passive scavenge work?

A

uses the expiratory effort of the patient - no active suction

70
Q

how does an active scavenge work?

A

suction created by vacuum/fan - need to monitor reservoir bag to ensure there isn’t a vacuum created there

71
Q

how does an activated charcoal canister work?

A

used only when no active or passive system available - can be portable with use of an E-tank

72
Q

what system would you use an F circuit with?

A

rebreathing

73
Q

what is the benefit of coaxial tubing?

A

allows expired air to warm the inspired air
maintains humidity
prevents heat loss

74
Q

what system would you use with a coaxial bain?

A

non-rebreathing

75
Q

what system is used for an aryes t-piece?

A

non-rebreathing

76
Q

how do you know what size reservoir bag to use?

A

tidal volume x 6

tidal volume is 10-20 ml/kg

77
Q

what is the minimum flow rate? why?

A

500ml

vaporizer is not guaranteed under 500ml

78
Q

how do you calculate flow rate for a mask?

A

30 x tidal volume

79
Q

what is the flow rate for a chamber?

A

5 L/min

80
Q

what is the induction flow rate for a rebreathing system?

A

50-100 ml/kg/min

81
Q

what is the maintenance flow rate for a rebreathing system?

A

20-40 ml/kg/min

82
Q

what is the maintenance flow rate for a non-rebreathing system?

A

200-300 ml/kg/min

83
Q

what is an anesthetic agent?

A

any drug used to induce a loss of sensation with or without consciousness

84
Q

what is an adjunct?

A

a drug that is not a true anesthetic - it is used during anesthesia to produce other desired effects such as sedation, muscle relaxation, analgesia REVERSAL neuromuscular blockade or parasympathetic blockage

85
Q

is it ethical to use inhalant anesthetics on their own?

A

no - they provide no pain control

86
Q

what is vapor pressure?

A

the tendency of an inhalation anesthetic to v aporize to its gaseous state

87
Q

what are volatile agents?

A

halogenated compounds - soflurane, sevoflurane, etc.

88
Q

what is the blood-gas partition coefficient?

A

the measure of the solubility of an inhalation anesthetic in blood as compared to alveolar gas (air)
indicates the speed of induction and recovery for an inhalant anesthetic

89
Q

what would you expect with a low blood-gas partition coefficient?

A

faster expected induction and recovery
inhalant tends to remain in gas phase
agent is more soluble in alveolar gas than in blood at equilibrium
agent is less soluble in blood

90
Q

do you want a high blood-gas partition coefficient or a low blood-gas partition coefficient?

A

low

91
Q

t/f - with a low blood-gas partition coefficient there will be a steep diffusion gradient between alveoli and tissues

A

true

92
Q

what does MAC stand for?

A

minimum alveolar concentration

93
Q

what is minimum alveolar concentration?

A

the potency of a drug

the lower the MAC the more potent the anesthetic and lower vaporizer setting

94
Q

what patient specifics can alter MAC?

A 
age
metabolic activity 
body 
temperature 
disease 
stress
pregnancy 
other drugs 
etc
95
Q

what do agonists do?

A

bind to and stimulate target tissue

most anesthetic agents and adjuncts

96
Q

what do antagonists do?

A

bind to target tissue without stimulating

reversal agents

97
Q

what common drug class falls under partial agonists and agonist-antagonists?

A

opioids

98
Q

what do partial agonists do to pure agonists?

A

block

99
Q

what are the step by step instructions for intubating dogs and cats?

A

preoxygenate for 3 min with mask or flow by oxygen
administer the IV induction to effect
position your patient in sternal recumbency
assess depth of anesthesia (muscle tone before jaw tone - prevents bites)

100
Q

where should you place your laryngoscope in the throat of your feline patient?

A

tip of laryngoscope just rostral to the epiglottis and pressed down

101
Q

what special consideration needs to be made for cats in regards to intubation?

A

laryngospasm

102
Q

how do you inflate the cuff?

A

inflate with a syringe in 0.5 ml increments until no leak is heard

103
Q

what is referred to as the “fourth vital sign”

A

pain

104
Q

what is a nociceptor?

A

a sensory neuron that responds to damaging or possibly damaging stimuli by sending possible threat signals to the spinal cord and brain

105
Q

what is the pain pathway?

A

transduction
transmission
modulation
perception

106
Q

what are the consequences of untreated pain?

A

catabolism and wasting
immune system suppression
inflammation and delayed wound healing with stress secondary to pain
anesthetic risk and increased anesthesia doses

107
Q

what is primary hyperalgesia?

A

peripheral hypersensitivity

108
Q

what is secondary hyperalgesia?

A

CNS hypersensitivity or windup

109
Q

what physiological changes can be caused by pain?

A

catabolic state and wasting

sympathetic stimulation leading to cardiac arrhythmias

110
Q

what is preemptive analgesia?

A

administration of pain medication before the pain occurs

111
Q

should opioids be used on their own?

A

not often - can cause excitable wake up

112
Q

what gastrointestinal effects will you see with opioid use?

A

initial increased motility (nausea, vomiting, defecation) followed by a slow down in motility (ileus, colic, constipation)

113
Q

what are the common opioids?

A 
morphine 
oxymorphone 
hydromorphone 
methadone 
fentanyl 
butorphenol
114
Q

what kind of pain is morphine used for?

A

moderate to severe visceral and somatic pain

115
Q

t/f - morphine can cause excitement and dysphoria in horses and cats

A

true

116
Q

what ocular changes might you see with morphine administration in dogs and cats?

A

dogs - miosis

cats - mydriasis

117
Q

t/f - oxymorphone has a shorter duration of effect than morphine

A

false - oxymorphone has a longer duration of effect

118
Q

what special characteristic does butorphanol have?

A

can be used to reverse effects of hydromorphone, morphine, fentanyl

119
Q

is butorphanol sufficient analgesic for surgical pain?

A

no

120
Q

t/f - buprenorphine is used for moderate to severe pain

A

false - buprenorphine is used for mild to moderate pain

121
Q

what are potential adverse reactions associated with opioids postop?

A 
respiratory depression 
bradycardia 
excitement 
apprehension 
hypersalivation 
mydriases 
excessive sedation 
panting 
increased sensitivity to sound 
urinary retention 
gastrointestinal effects
122
Q

what are steroidal anti-inflammatory drugs?

A

glucocorticoids

123
Q

what are the short-acting glucocorticoids

A

hydrocortisones

124
Q

intermediate acting glucocorticoids?

A

prednisone, prednisolone

125
Q

long acting glucocorticoids?

A

dexamethasone (lots of side effects)

126
Q

what conditions can occur with overuse of glucocorticoids?

A

cushing’s disease
diabetes mellitus
heart failure

127
Q

what patient should never receive NSAIDs?

A

patients on steroids!

128
Q

what is gabapentin useful for?

A

chronic pain in dogs and cats unresponsive to NSAIDs x

129
Q

what is a good combination of drugs for animals with arthritis and liver/kidney disease?

A

gabapentin, tramadol, buprenorphine

130
Q

what added benefits are seen when lidocaine/epinephrine are administered together?

A

local vasoconstriction producing a reduction in bleeding and longer duration of action

131
Q

what happens to a local anesthetic near inflammation or infection?

A

effectiveness is decreased

132
Q

where does an infraorbital block effect the mouth?

A

upper lip and skin of upper lip

133
Q

inferior alveolar block?

A

lower jaw teeth of specific cside with buccal and labial mucosa, skin of lower lip

134
Q

mental block?

A

mandibular incisors on the side of the block

135
Q

maxillary block?

A

maxilla and maxillary teeth of side that is blocked, roof of nasal cavity, skin of lateral part of nose

136
Q

what are the four dental blocks?

A

infraorbital
inferior alveolar
mental
maxillary

137
Q

what are the vital signs?

A 
homeostatic mechanisms response to anesthesia 
heart rate 
heart rhythm 
respiratory rate and depth 
mucous membrane colour 
capillary refill time 
pulse strength 
blood pressure 
body temperature
138
Q

what will the patient’s reflexes look like if they are at a light depth of anesthesia?

A 
eye position - central/rotated 
pupil size - normal 
pupil response - positive to light 
muscle tone - good 
reflex response - poor swallowing/others present but reduced
139
Q

what will the patient look like at a moderate plane of anesthesia?

A 
eye position - ventrally rotated 
pupil size - slightly dilated 
pupil response - sluggish 
muscle tone - relaxed 
reflex response - corneal present w/ others absent
140
Q

what will a patient look like at a deep plane of anesthesia?

A 
eye position - central 
pupil size - moderately dilated 
pupil response - sluggish/absent 
muscle tone - greatly reduced 
reflex response - all diminished or absent
141
Q

what is the palpebral reflex?

A

the blink reflex in response to a light touch at the medial or lateral canthus
light - present
medium - lost

142
Q

what is the corneal reflex?

A

retraction of eyeball within orbit and/or a blink in response to corneal stimulation
light - present
medium - present
deep or excessive - lost

143
Q

what is the pedal reflex?

A

check by firmly pinching digit - observe if animal retracts leg/paw
light - present
medium - lost

144
Q

what is the PLR?

A

papillary light reflex - shine a light into the eye, both pupils should constrict even though light is only shining in one
light - present
medium - present
deep - lost

145
Q

what is the dazzle reflex?

A

blink response to bright light shone on retinas

very early - lost

146
Q

how many stages of anesthesia are there? which has multiple planes?

A

there are four stages

stage three is divided into four planes

147
Q

what is stage 1 anesthesia?

A

period of voluntary movement, patient begins to lose consciousness
stage ends with loss of ability to stand and recumbency

148
Q

what is stage 2 anesthesia?

A

period of involuntary movement aka excitement stage
actions are not under conscious control
stage ends with muscle relaxation, decreased resp rate and decreased reflex activity

149
Q

what is stage 3 anesthesia?

A

period of surgical anesthesia

divided into four separate planes

150
Q

what is stage 3 plane 1?

A

not adequate for surgery
eyeballs begin to rotate
ETT can be passed and connected
reflexes present but decreased

151
Q

what is stage 3 plane 2?

A 
suitable depth for most procedures 
BP and HR slightly decreased 
relaxed muscle tone 
pedal and swallowing reflexes absent 
ventromedial eye position 
PLR sluggish
152
Q

what is stage 3 plane 3?

A

deep anesthesia
too deep ofr most procedures
central eyeballs
reflexes totally absent

153
Q

what should you do if your patient is too deep?

A

manual ventilation
decrease ISO
if becomes too light add a local or opioid

154
Q

what happens at stage 3 plane 4?

A 
early anesthetic overdose 
abdominal breathing 
fully dilated pupils 
marked cardiovascular depression 
flaccid muscle tone 
all reflexes absent 
EMERGENCY!!
155
Q

what causes bradycardia?

A

depressant effect of most anesthetics
alpha2s and opioids
excessive anesthetic depth
adverse effect of drugs

156
Q

what causes tachycardia?

A 
anticholinergics and cycloheximines 
inadequate anesthetic depth 
pain 
hypotension 
blood loss/shock 
hypoxemia and hypercapnia (high CO2 levels)
157
Q

what does a first degree A-V heart block look like?

A

prolonged P-R interval

158
Q

what does a second degree A-V heart block look like?

A

occasional missing QRS complexes

159
Q

what does a third degree A-V heart block look like?

A

randomly irregular P-R intervals

160
Q

supraventricular premature complexes?

A

one more normal QRS complexes closely following the previous QRS complex

161
Q

what is the absolute minimum MAP you should have?

A

60

162
Q

what is MAP the best indicator of?

A

tissue perfusion

163
Q

what is osciollometric blood pressure monitoring?

A

cuff inflated over artery

MAP is most accurate this way

164
Q

what is the doppler blood pressure monitor?

A

detects blood flow by emitting ultrasound signal that hits blood in the artery
sphygmomanometer inflates cuff until above when pulse is no longer audible
slowly decrease pressure in cuff - first time you hear pulse is systolic BP

165
Q

what is PaO2?

A

partial pressure

norm - 80-120 mmHg

166
Q

what is SaO2

A

percent oxygen saturation

norm - >95%

167
Q

what kind of relationship do partial pressure and oxygen saturation share?

A

non linear direct relationship

as one decreases so does the other but not at the same rate

168
Q

which decreases faster, partial pressure or oxygen saturation?

A

partial pressure

169
Q

what can low PaO2 and SaO2 indicate during anesthesia?

A

hypoxemia

need for oxygen supplementation or assisted ventilation

170
Q

what does a pulse oximeter do?

A

measures the saturation of hemoglobin and the HR

171
Q

what is a normal pulse ox reading?

A

> 95%
hypoxemic - <90-95%
therapy required @ <90%
medical emergency @ <85% for more than 30 seconds

172
Q

what are the two different kinds of pulse oximeter probes?

A

transmission - clothespin configuration

refelective - placed in esophagus or rectum

SGT (5 decks)

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