GI 14: ANAESTHESIA Flashcards
Functions of the liver
Metabolism & excretion of drugs
Glucose metabolism & storage
Production of clotting factors
Production of plasma proteins -> albumin
Heat production
Oncotic pressure msintenance
What [broad]type of analgesia should be given for liver disease?
multimodal
what is the broad reason for using multimodal analgesia and anesthesia
Lowers the needed dose of each drug and reduces the risk of side effects
how does liver disease alter pharmacokinetics?
Hypoalbuminemia -> increased fraction of free drug -> increased effects and side effects
what 3 things need extra care to be monitored during anesthesia for liver disease
glucose
haemostasis
temperature
why si it important to monitor haemostasis in liver anaesthesia?
Depletion of clotting factors
Thrombocytopenia
Increased risk of hemorrhage
3 Ideal characteristics for drugs used in liver disease anesthesia
Short acting
extra-hepatic metabolism
antagonists available
2 types of fluids to be used for liver disease
Hartmann’s
Lactated Ringers
pancreatitis tx requries agressive ________
Analgesia
What are some principles of anaesthetic management in GI disease?
emergency!
stabalise prior to anaesthesia
dehydration
electrolyte disturbances
V/D, weihgt loss
anaemia
low plasma protien
acid-base disturbances
What are fasting guidelines for GI surgery?
no food 8-12 hrs
water up until premed
risk factors for Gastroesophageal reflux
Abdominal surgery
position
drugs that reduce lower esophageal sphincter tone
brachycephalic breeds
What medication can reduce the SEVERITY of gastrosophageal reflux?
proton-pump inhibitors [reduce acididty]
3 Endoscopy considerations
Provide analgesia
Excessive abdominal distention
Life-threatening vagal stimulation
What can excessive abdominal distention lead to during endoscopy?
Hypoventilation and hypotension.
What happens when GI wall stretch receptors are activated?
what should you do next?
Life-threatening vagal stimulation occurs, leading to bradycardia.
Stop procedure and administer atropine IV.
What is the treatment for septic peritonitis in GI disease and anesthesia?
Aggressive fluid resuscitation
early antibiotics (e.g., amoxiclav)
blood pressure support
pre-oxygenate, premedication with opioids, monitor glucose.
What type of drugs should be avoided in septic peritonitis treatment?
Avoid NSAIDs (analgesic drugs).
They can cause hypoproteinemia and further GIT compromise.
How long must GDV patients be monitored post-operatively?
Patients must be monitored for 3 days due to risk of sudden death
What cardiac issue can arise post-operatively in GDV patients?
Cardiac arrhythmias can lead to sudden death.
When should intraoperative arrhythmias be treated?
When heart rate is very rapid (>180 bpm for long periods)
when abnormal complexes are present
when associated w hypotension/pulse deficits
What indicates the need to treat abnormal complexes during anesthesia?
When abnormal complexes are frequent (15/min or 15 consecutively).
What additional conditions warrant treatment of intraoperative arrhythmias?
When associated with hypotension or pulse deficits.
What is a concerning pattern of VPCs that requires treatment?
When VPCs are multiform, polymorphic, or critically close together
