Jane's Pain (and sleep) Flashcards
describe
whats up?
Whats up?
Whats up?
equipment: soda lime, valves, leak
Whats up?
Whats up?
Whats up?
1st degree AV block
Whats up?
Second degree AV block Mobitz 2
Characteristic is PR is always the same when conducted
Whats up?
Second degree AV block Mobitz type I
Characteristic is PR gets longer and longer until an impulse is not conducted
Whats up?
3rd degree AV block
No p wave conducted, ventricle takes over
Whats up?
Bundle branch block. Beats are atrial in origin, but wide (normal ) QRS
Whats up?
junctional escape. Beats are normal in morphology, but no P waves/ begins at junction b/w A and V
What’s up?
VPC’s. no particular arrhythmia
What’s up?
atrial fibrillation
wiggly PR interval, no P wave and normal complexes
What’s up?
Vtach
or idiopathic ventricular
What is the max dose of lidocaine in the dog and the cat?
Dog 5 mg/kg
cat 3 mg/kg
What is the max dose of mepivicaine in the dog and the cat?
Dog 5 mg/kg
Cat 2.5 mg/kg
What is the max dose of Bupivicaine in the dog and the cat?
Dog 2.5 mg/kg
Cat 1.5 mg/kg
What is the max dose of Bupivicaine AND lidocaine mixed in the dog and the cat?
1 mg/kg each in the same syringe
both dog and cat
What is the onset of action for lidocaine?
1-2 minutes
What is the onset of action for mepivicaine?
1.5-2 minutes
What is the onset of action for Bupivicaine?
6-10 minutes
(other souces say 15-45…)
What is the onset of action for Bupivicaine + lidocaine?
2-10 minutes
What is the expected duration of action for lidocaine?
0.5 - 2 hours
What is the expected duration of action for mepivicaine?
2-3 hours
What is the expected duration of action for Bupivicaine?
4-6 hours (6-8 in foramen)
What is the expected duration of action for Bupivicaine + lidocaine?
4-6 hours
(6-8 if in a foramen)
Whatr is the maximum volume per site in cats and dogs <6kg?
0.1-0.3mL
Whatr is the maximum volume per site in cats and dogs 6-25 kg?
0.3 - 0.6 mL
Whatr is the maximum volume per site in cats and dogs 25-40 kg?
0.6-0.8 mL
Whatr is the maximum volume per site in cats and dogs 40+ kg?
0.8-1.0 mL
Warne LN, Beths T, Holm M, Carter JE, Bauquier SH. Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats. Journal of the American Veterinary Medical Association. 2014;245(2):195.
What was the major finding?
- In phase 2 all cats in butorphanol group needed rescue analgesia at 20 minutes, while no cats in the buprenorphine group did. Data could not be analyzed futher than 20 minute score for this reason.
- Concluded buprenorphine more effective for pain relief in this setting
Snyder LBC, Snyder CJ, Hetzel S. Effects of Buprenorphine Added to Bupivacaine Infraorbital Nerve Blocks on Isoflurane Minimum Alveolar Concentration Using a Model for Acute Dental/Oral Surgical Pain in Dogs. Journal of Veterinary Dentistry. 2016;33(2):90-96.
What hapenned at 48h?
50% of dogs in the BupBup group
25% in the Bup group had MAC reduction
(NOT SIGNIFICANTLY DIFFERENT). Increasing sample size to 40 would have made it significant.
Snyder LBC, Snyder CJ, Hetzel S. Effects of Buprenorphine Added to Bupivacaine Infraorbital Nerve Blocks on Isoflurane Minimum Alveolar Concentration Using a Model for Acute Dental/Oral Surgical Pain in Dogs. Journal of Veterinary Dentistry. 2016;33(2):90-96.
What hapenned at 96h?
•At 96h, 2 dogs in Bupbup group still had MAC reduction
Krug W, Losey J. Area of Desensitization Following Mental Nerve Block in Dogs. Journal of Veterinary Dentistry. 2011;28(3):146-150.
What were the most reliably desensitized teeth and soft tissues?
- Most reliably desensitized:
- tooth was P3 (100%) P4 (83%);
- Best soft tissue desensitization was at I3 (57%) then P1, P3, P4 (43%);
- MCJ almost never blocked
Krug W, Losey J. Area of Desensitization Following Mental Nerve Block in Dogs. Journal of Veterinary Dentistry. 2011;28(3):146-150.
What were major reasons proposed for failure to desensitize?
- redundant collateral innervation;
- blocked canal dt anatomy;
- additional branches of CNV coming from buccal branch of mandibular n.;
- cross over of fibres from CNV on the other side;
- anastomoses between CNV and CNVII mean CNVII may have some sensory properties here;
- need to block 3 nodes for it to work (humans 1.8mm apart, so need to cover 6 mm of nerve)
- Mylohyoid nerve provides innervation to vetral lip and cheek and is not blocked
Ambros B, Alcorn J, Duke-Novakovski T, Livingston A, Dowling PM. Pharmacokinetics and pharmacodynamics of a constant rate infusion of fentanyl (5 μg/kg/h) in awake cats. American journal of veterinary research. 2014;75(8):716.
What were the side effects?
•Profuse salivation in 1 cat receiving fentanyl and mild sedation in the others.
Ambros B, Alcorn J, Duke-Novakovski T, Livingston A, Dowling PM. Pharmacokinetics and pharmacodynamics of a constant rate infusion of fentanyl (5 μg/kg/h) in awake cats. American journal of veterinary research. 2014;75(8):716.
What was the blood concentration for anti-nociception?
>1.33 ng/mL
Ambros B, Alcorn J, Duke-Novakovski T, Livingston A, Dowling PM. Pharmacokinetics and pharmacodynamics of a constant rate infusion of fentanyl (5 μg/kg/h) in awake cats. American journal of veterinary research. 2014;75(8):716.
What was found with blood concentration over time?
•Found that fentanyl did not accumulate in cats and plasma concentration decreased during the infusion at the rate of 5 ug/kg/hr
Volk H, Bayley K, Fiani N, Billson F. Ophthalmic complications following ocular penetration during routine dentistry in 13 cats. New Zealand Veterinary Journal. 2019;67(1):46-51.
What were the outcomes?
- 7/13 of cats underwent enucleation (54%)
- 1/13 cat euthanized due to eye issues (1/13)
- 5/13 cats managed medically and 4 still had persistent inflammation at last recheck;
- 1/13 of these euthanized for other reasons.
- 1/13 had resolution of active inflammation
Volk H, Bayley K, Fiani N, Billson F. Ophthalmic complications following ocular penetration during routine dentistry in 13 cats. New Zealand Veterinary Journal. 2019;67(1):46-51.
of cats that had a maxillary nerve block, how many did not have extractions in the region?
•Of cats getting a maxillary nerve block, 3/8 had only a canine tooth extracted
Volk H, Bayley K, Fiani N, Billson F. Ophthalmic complications following ocular penetration during routine dentistry in 13 cats. New Zealand Veterinary Journal. 2019;67(1):46-51.
How many cats did not have a nerve block?
5/13 had no nerve block performed
Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: Twenty cases. The Veterinary Journal. 2012;193(2):367-373.
In how many cats were mouth props used?
•A mouth gag was used in 16/20 cats
Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: Twenty cases. The Veterinary Journal. 2012;193(2):367-373.
In how many cats were there additional neurologic defeceits?
85%
Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: Twenty cases. The Veterinary Journal. 2012;193(2):367-373.
In how many cats was vision recovered?
70%
Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: Twenty cases. The Veterinary Journal. 2012;193(2):367-373.
In how many cats were neuro signs resolved?
10/17
2 had mild permanent defeceits
1 euthanized
Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: Twenty cases. The Veterinary Journal. 2012;193(2):367-373.
What was proposed to be compressed when the mouth was open wide?
•There is a maxillary rete (rete mirabile) which lies between the medial and lateral pterygoid muscles and the temporal muscle.
Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: Twenty cases. The Veterinary Journal. 2012;193(2):367-373.
Why does maxillary artery blood flow matter in cats?
no collateral circulation to brain. comes from maxillary artery.
Pharmacokinetics of buprenorphine after intravenous and oral transmucosal administration in guinea pigs (Cavia porcellus)
Miranda J. Sadar dvm Heather K. Knych dvm, phd Tracy L. Drazenovich dvm Joanne R. Paul-Murphy dvm
What was the main complication of Bupe in GP’s?
Can be very sedating but resolves in 6 hours.
Pharmacokinetics of buprenorphine after intravenous and oral transmucosal administration in guinea pigs (Cavia porcellus)
Miranda J. Sadar dvm Heather K. Knych dvm, phd Tracy L. Drazenovich dvm Joanne R. Paul-Murphy dvm
What were the recommended doses?
buprenorphine at 0.2 mg/kg
administered IV every 7 hours
OTM every 4 hours
to maintain a target plasma concentration of 1 ng/mL
Soukup JW, Snyder CJ. Transmylohyoid Orotracheal Intubation in Surgical Management of Canine Maxillofacial Fractures: An Alternative to Pharyngotomy Endotracheal Intubation. Veterinary Surgery. 2015;44(4):432-436.
Which vessel might be encountered? how to avoid?
small sublingual artery, which if incised would result in only minor hemorrhage
should be avoided by using blunt dissection through the mylohyoideus muscle
Matthews NS, Mohn TJ, Yang M, et al.
Factors associated with anesthetic-related death in dogs and cats in primary care veterinary hospitals. Journal of the American Veterinary Medical Association. 2017;250(6):655.
What is the overall risk for cats and dogs?
for cats 0.11%
For dogs 0.06%
Matthews NS, Mohn TJ, Yang M, et al.
Factors associated with anesthetic-related death in dogs and cats in primary care veterinary hospitals. Journal of the American Veterinary Medical Association. 2017;250(6):655.
What risk factors were important for risk in dogs?
•Non elective procedure
OR 90
•Age (square root)
OR 2
•Preanesthetic PE not recorded
OR 280
•Underweight BCS
OR 15
•Abnormal HCT
OR 5
Matthews NS, Mohn TJ, Yang M, et al.
Factors associated with anesthetic-related death in dogs and cats in primary care veterinary hospitals. Journal of the American Veterinary Medical Association. 2017;250(6):655.
What risk factors were important for risk in cats?
•Non-elective procedure
OR 5
•Age (square root)
OR 1.6
•Body weight (square root)
OR 7.5
•SPO2 not recorded
OR 5
Brodbelt DC, Blissitt KJ, Hammond RA, et al. The risk of death: the confidential enquiry into perioperative small animal fatalities. Veterinary anaesthesia and analgesia. 2008;35(5):365-373
What were the overall risk in dogs and cats?
Dogs were 0.17%
Cats were 0.24%
Brodbelt DC, Blissitt KJ, Hammond RA, et al. The risk of death: the confidential enquiry into perioperative small animal fatalities. Veterinary anaesthesia and analgesia. 2008;35(5):365-373
What was the risk in SICK dogs and cats?
Dogs 1.33%,
Cats 1.40%
Rabbits 7.37%
Brodbelt DC, Blissitt KJ, Hammond RA, et al. The risk of death: the confidential enquiry into perioperative small animal fatalities. Veterinary anaesthesia and analgesia. 2008;35(5):365-373
What were the risks in HEALTHY Dogs and cats?
Dogs 0.05%
Cats 0.11%
Rabbits 0.73%
Brodbelt DC, Blissitt KJ, Hammond RA, et al. The risk of death: the confidential enquiry into perioperative small animal fatalities. Veterinary anaesthesia and analgesia. 2008;35(5):365-373
How many deaths occurred post-op?
What was the most common time period?
Dogs 47%
Cats 61%
Rabbits 64%
Hypothermia and thermoregulation during anesthesia for the dental and oral surgery patient. Stepaniuk K, Brock N. J Vet Dent. 2008;25(4):279-283.
What ECG change is seen in severe hypothermia?
A prolonged PR interval, widening of the QRS complex and lengthening of the ST segment on an ECG can be seen in severe hypothermia
Hypothermia and thermoregulation during anesthesia for the dental and oral surgery patient. Stepaniuk K, Brock N. J Vet Dent. 2008;25(4):279-283.
How much does shivering increase myocardial oxygen demand?
400-500 %
According to Kögel B, Terlinden R, Schneider J.
Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs,
What are tramadol’s mechanism of action?
- activation of opioid receptors preferentially of the u-subtype
- Enhancement of the extra-cellular concentrations serotonin and noradrenaline by blocking reuptake
- additional release of serotonin
According to Kögel B, Terlinden R, Schneider J.
Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs,
What is tramadol’s active metabolite?
O-demethyl tramadol
According to Kögel B, Terlinden R, Schneider J.
Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs,
how was pain tested in these dogs?
tail flick test - used a hot heat lamp directed at the tail and measured delay in flick in response to heat condition
According to Kögel B, Terlinden R, Schneider J.
Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs,
how effective was tramadol at anti-nociception?
what about morphine and tapentadole?
tramadol did nothing - no response measurable
both of the others caused anti-nociception
According to Kögel B, Terlinden R, Schneider J.
Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs,
What was the conclusion with regards to tramadol’s efficacy for pain control and their reasons why?
No analgesic effect of IV tramadol
low concentration of the active metabolite O-demethyl tramadol (M1)
According to Martin-Flores M, Scrivani PV, Loew E, Gleed CA, Ludders JW. in
Maximal and submaximal mouth opening with mouth gags in cats: Implications for maxillary artery blood flow. The Veterinary Journal. 2014;200(1):60-64.
What was performed in this study?
•Prospective study using magnetic resonance angiography and ERG measurements in cats to look at maxillary artery bloodflow during mouth opening at different measurements
According to Martin-Flores M, Scrivani PV, Loew E, Gleed CA, Ludders JW. in
Maximal and submaximal mouth opening with mouth gags in cats: Implications for maxillary artery blood flow. The Veterinary Journal. 2014;200(1):60-64.
Why is this specifically relevant in cats?
Opening of the mouth can cause cerebral and retinal ischemia through compression of the maxillary arteries, which are the principal source of blood flow to the eyes and brain in cats
According to Martin-Flores M, Scrivani PV, Loew E, Gleed CA, Ludders JW. in
Maximal and submaximal mouth opening with mouth gags in cats: Implications for maxillary artery blood flow. The Veterinary Journal. 2014;200(1):60-64.
What is the anatomic mechanism at play when cats have their mouth opened too wide?
compression of the maxillary arteries
opening the mouth narrows the distance between the medial aspect of the angular process of the mandible and the rostrolateral border of the tympanic bulla;
the maxillary artery courses between these two osseous structures
According to Martin-Flores M, Scrivani PV, Loew E, Gleed CA, Ludders JW. in
Maximal and submaximal mouth opening with mouth gags in cats: Implications for maxillary artery blood flow. The Veterinary Journal. 2014;200(1):60-64.
What was found with the ERG?
A progressive reduction in both a and b waves of the ERG was observed in 1/6 cats, but only when the spring-loaded gag was placed on the right side
rest of cats had normal ERG
According to Martin-Flores M, Scrivani PV, Loew E, Gleed CA, Ludders JW. in
Maximal and submaximal mouth opening with mouth gags in cats: Implications for maxillary artery blood flow. The Veterinary Journal. 2014;200(1):60-64.
What was found with the MRA in the fully open cats? What was found with the 42mm gag?
•When the mouth was fully opened,
- normal signal intensity 2/6 cats,
- focally reduced signal intensity was detected bilaterally in 2/6 cats,
- diffusely reduce signal intensity was detected bilaterally in the remaining 2/6 cats
At 42mm
- 1/6 cats focally reduced intensity was detected ipsilateral to gag
