GI anaesthesia

Question 1

what relays the sensory innervation of the head

Answer 1

mostly trigeminal nerve CN V

Question 2

What nerve is the infraorbital nerve a branch of

Answer 2

Maxillary branch of the trigeminal nerve CN 5

Question 3

An infraorbital block blocks what

Answer 3

rostral maxillary soft tissues

Question 4

what is the risk of introducing a needle into the intraorbital foramen in cats and brachys

Answer 4

globe penetration

Question 5

what is the SAN

Answer 5

superior alveolar nerve

Question 6

where does the SAN innervate

Answer 6

teeth and the bone adjacent to the teeth within the maxilla

Question 7

in the extra oral approach, where is the LA deposition on the maxillary nerve?

Answer 7

where it crosses the pterygopalatine fossa

Question 8

why is the extraoral approach preferred to the intra oral approach?

Answer 8

increased accuracy with no evidence of macroscopic damage

Question 9

what does the mandibular block target

Answer 9

the inferior alveolar nerve (IAN) is a branch of the mandibular nerve

Question 10

where is the rostral mandibular block placed

Answer 10

in the opening of the mental foramen of within it

Question 11

Tongue anaesthesia may occur with bilateral mandibular blocks and tongue trauma is possible, how would you identify this and how can it be prevented?

Answer 11

• use unilateral blocks instead
• short anaesthesia
• keep the tongue moist

Question 12

Local anaesthesia mixtures can be used (lidocaine plus bupivacaine) what are the advantages?

Answer 12

• Lidocaine has quicker onset and bupivacaine last longer
• Reduce volitale agent needed
• Better pain scoring

Question 13

What is the treatment for local anaesthesia toxicity?

Answer 13

IV lipid plus CPR

Question 14

What is the maximum volume of 2% lidocaine to administer to a 30 kg greyhound requiring extensive extractions on all dental arcades?

dose of lidocain in 2-4mg/kg

Answer 14

toxic dose = >4
4x 30 = 120mg in 2 %
2% = 2g per 100ml = 2000g in 100ml = 20mg per ml
120mg/20mg = 6ml

Question 15

what is the extra oral caudal mandibular block aiming for?

Answer 15

mandibular foramen for the inferior alveolar enrves

Question 16

Your colleague asks your opinion about the suitability of performing a extra oral caudal mandibular block for removal of the fractured PM1 & PM 2 on this lower arcade.

what would you say

Answer 16

No

Question 17

Recently you undertook 12 cat dentals over several days for a local rehoming centre. At the end of the week the centre call you to say 2 of the cats seem blind. What is the likely cause of this complication?

Answer 17

stretching of the maxillary artery- potntially from overstretching the jaw

Question 18

A 41kg male entire GSD is due in for evaluation of anal furunculosis under GA. The dog has a bite history, and cannot be examined in the consult room. Which of the following approaches do you employ

Answer 18

chill protocol - 3 drug the night before (trazodone, melatonin and gabapentin) then gabapentin in the morning with ACP

Question 19

Your team have successfully undertaken a partial rostral hemimandibulectomy on this shepherd dog . On the morning of day 3 the ward team report the dog is still reluctant to eat its normal kibble even with gravy. The dog is receiving meloxicam. The wound looks fine but the dog resists examination.
What do you suggest?

Answer 19

Offer frankfurter sausages and IM buprenorphine

Question 20

You have anaesthetised a ‘spicy’ cat (history of inappetence) for an exploratory laparotomy, and taken multiple biopsies from the GI tract, enlarged lymph nodes and an abnormal looking section of the liver. The cat received maropitant and methadone and dexmedetomidine for premed, alfaxalone for induction and sevoflurane for maintenance of anaesthesia. What post-operative analgesia regime do you decide to use. You have decided to keep the cat on intravenous fluid therapy over night.

Answer 20

IV as already has a cannula
- buprenorphine for good analgesia

Question 21

Barney the labrador has had vomiting and diarrhoea for several days. You decide Barney needs an exploratory laparotomy. What fluid do you decide to administer to him in the perioperative period?

Answer 21

Lactated Ringers Solution/ Hartmanns

Question 22

During Barney’s the labrador’s anaesthesia, the blood pressure drops to 88/38 (55) multiparameter monitor. You have moved the pulse oximeter probe and the value remains at 93%.
What do you do?

Answer 22

• reduce inhalation agent
• lactated ringer solution over 10 mins

note: give around 300ml

Question 23

Lucky is a 10 year old English Springer Spaniel with a recent history of lethargy, polydipsia and polyuria and dyschezia. Clinical examination, haematology and biochemistry are relatively unremarkable other than an elevated ionised calcium. Which of the following is most likely?

Answer 23

Anal sac adenocarcinoma

Question 24

Lucky has a Anal sac adenocarcinoma
Lucky is scheduled for thoracic and abdominal imaging and bilateral anal sacculactomy in the morning. What is the most appropriate overnight treatment fluids and why?

Answer 24

Saline -> Hartmanns/ LRS has calcium and already hypercalcaemic

Question 25

Which local block would you suggest is used for a dog undergoing a total ear canal ablation?

Answer 25

The great auricular and auriculotemporal nerve

Question 26

During anaesthesia for correction of a gastric dilation volvulus, you observe runs (6) of ventricular premature contractions as you are slowly untwisting the stomach. What do you ask your nurse/anaesthetist to do?

Answer 26

Administer a bolus of lidocaine

Question 27

Sydney the lurcher requires an upper canine removal due to an abscess. Which local block would you perform?

Answer 27

Caudal maxillary block