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Anaesthesia > Intraoperative Support and Care > Flashcards

Intraoperative Support and Care Flashcards

1
Q

general care

A

positioning
nursing care
eye care

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2
Q

respiratory support - aims

A

avoid hypoventilation, hypoxaemia, hypercapnia + maintain blood oxygen content

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3
Q

Hypoxaemia and Hypoxia - causes

A 
↓FiO2 
Hypoventilation 
V/Q mismatch 
Cardiovascular depression 
Anaemia 
Increased O2 demand - pyrexia, ↑BMR
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4
Q

hypercapnia - define

A

incr CO2

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5
Q

hypercapnia - causes

A

Hypoventilation
rebreathing of exhaled gas
↑BMR

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6
Q

hypercapnia - effects

A 
Tachycardia 
Hypertension 
Cardiac arrhythmias 
Increased intracranial pressure 
Cardiovascular depression at very high levels 
Respiratory acidosis
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7
Q

hypoxaemia and hypoxia - treatment

A

Check anaesthetic depth
Check airway
Increase FiO2 (if possible)
Ensure no rebreathing of CO2
Ventilate (Intermittent Positive Pressure Ventilation – IPPV)
Consider using albuterol (Ventolin) in horses - bronchodilator - incr ventilation

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8
Q

IPPV - define

A

intermittent positive pressure ventilation

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9
Q

IPPV - effects

A

Intrapleural pressures remain above zero throughout
respiratory cycle
Decr venous return decr cardiac output
Worse with high pressures and long inspiratory times
worse in hypovolaemic animals or those in heart failure

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10
Q

causes of hypoperfusion

A

Extremes of heart rate, disturbances of rhythm
Poor stroke volume - Poor ventricular filling (low preload), Poor myocardial contractility, High vascular resistance (afterload)

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11
Q

bradycardia - causes

A

High vagal tone
Electrolyte and acid-base disturbances (esp high K+)
Hypothermia
Drugs (potent mu-agonist opioids, α2 agonists)
Response to hypertension
Bradyarrhythmias

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12
Q

bradycardia - treatment

A

Check monitored parameters and anaesthetic depth
Remember α2 agonists = bradycardia
Beware raised intracranial pressure as a cause
atropine
Glycopyrrolate

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13
Q

tachycardia - causes

A

High circulating catecholamines – pain, hypotension, hypovolaemia, hypoxia, hypercapnia
Hyperthermia
Anaemia
Drugs (sympathomimetics, parasympatholytics)
Tachyarrhythmias
dehydration - due to stress

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14
Q

tachycardia - treatment

A

Check monitored parameters and anaesthetic depth

Rule out or treat underlying cause

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15
Q

AV block - treatment

A

Atropine or glycopyrrolate

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16
Q

Ventricular arrhythmias - treatment

A

Lidocaine

17
Q

fluids

A

crystalloid fluids common - CSL most common as it’s balanced
May need rapid bolus in emergency situation
Plasma
Fresh whole blood (FWB)
Packed red blood cells (PRBC)
Human serum albumin (HSA)

18
Q

blood volume loss - which fluid to give

A

Up to 10% total blood volume loss – Crystalloid
10-25% total blood volume loss – Colloid
> 25% total blood volume loss – Blood
PCV < 20% or [Hb] < 10g/dl – Blood or PRBCs

19
Q

dopamine

A

positive inotrope
DA receptors at low concs, but at higher
concs also acts on α1 and β1 receptors
Not used in horses – causes more tachycardia

20
Q

dobutamine

A

positive inotrope
Acts mainly on β1 receptors
Effects in peripheral vasculature tend to cancel out, so overall has +ve inotropic effect with minimal
effect on vascular resistance
Only mild chronotropic effects + less arrhythmogenic than dopamine

21
Q

effects of hypothermia

A

Reduced requirement for anaesthetics (5% reduction in MAC for every degree C reduction)
Alters pharmacokinetics + pharmacodynamics of drugs - prolonged recovery
Incr blood loss (incr clotting times)
Shivering incr oxygen demand in recovery
Incr incidence of surgical wound infection

22
Q

temperature support

A

Rebreathing circuits
Heat and moisture exchangers (HMEs)
Warm IV fluids
Bubble wrap, foil blankets, leg wraps, heated water blankets, warm air blowers
Warm operating theatre
Warm lavage of body cavities, stomach, bladder, colon

23
Q

increased intercranial pressure (ICP)

A 
Impending death 
‘Last ditch’ attempt to maintain perfusion 
↑ Blood pressure 
Bradycardia 
(Respiratory changes if not ventilated)
24
Q

increased intercranial pressure (ICP) - treament

A

Hyperventilate as emergency measure (if anaesthetized)
Mannitol – osmotic effects also reduce blood viscosity which improves blood flow + oxygen delivery
Hypertonic saline
Furosemide – may be synergistic with mannitol

Anaesthesia (7 decks)

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