L7: Anesthesia And Disease (Shih)

Question 1

Most important thing to monitor in chronic urinary obstruction cat

Answer 1

ECG; main concerns - brady arrhythmia due to hyperK

don’t give dexmed (alpha 2 agonists) if worried about arrhythmias and bradycardia

Question 2

Tx of hyperkalemia in urinary obstruction

Answer 2

• Ca gluconate (does not lower K itself, but gets rid of associated CS): 3ml per cat
• dextrose + fluids
• insulin
• sodium bicarb
• terbutaline (most efficient but most expensive)

Question 3

Ca gluconate does NOT decrease serum potassium ***

Answer 3

:) (works on CS only)

Question 4

Drugs to give cat to pass catheter, if needed

Answer 4

*sedation only*
Butorphanol
Midazolam
Ketamine
Local anesthetic (low volume epidural)

Question 5

During anesthesia, what would be worst for cat with HCM?

Answer 5

Vasodilation (causes all blood to leave the ventricle at same time)
Tachycardia

Question 6

Properties of HCM

Answer 6

• most commonly diagnosed cardiac dz in cats
• stiff ventricle w/ poor diastolic function
• LV outflow tract obstruction (LVOT)
• 15% asymptomatic
• heart constricts so fast that fast moving blood sucks leaflet from mitral valve to cover the opening to the aorta

Question 7

Compounding factors in perioperative mortality in SA anesthesia***

Answer 7

• Cardiovascular (pump or circulatory failure, hypovolemia)
• Pre-existing organ failure
• brachiocephalic breeds
• geriatric patient

Question 8

Bad drug for HCM cat.

Answer 8

Ketamine

-increases LVOT

Question 9

Good drug for HCM cat and why***

Answer 9

Dexmedetomidine

• decreases HR
• causes vasoconstriction
• bad in any other animal with heart dz!

Question 10

Things that make LVOT worse in CATS

Answer 10

• tachycardia
• inc. contractility
• vasodilation

Question 11

Mitral valve disease

Answer 11

blood flows back into LA instead of going to aorta –> pulmonary edema

• aim to reduce retrograde flow by vasodilating aorta
• tachycardia better than bradycardia in dogs; bradycardia better for cats

Question 12

Anesthesia for HCM cats

Answer 12

• give opioids, dexmed, and fentanyl to decrease use of inhalants
• etomidate good for induction b/c decreases HR and CO (can also use alfaxalone or propofol)

Question 13

anesthetic protocol for mitral valve disease in dogs***

Answer 13

• preoxygenate
• premed with etomidate or alphaxolone
• AVOID bradycardia and vasoconstriction at induction
• a mild INCREASE in HR and mild VASODILATION improve cardiac performance***

Question 14

Renal toxicity of sevo not clinically relevant if high O2 flow used; must be given for long time at high dose to be nephrotoxic***

Answer 14

:)

Question 15

Avoid NSAIDs in renal patients

Answer 15

Prevent kidney from vasodilating –> hypoxic injury –> renal failure

Question 16

Hemodynamic support in CKF

Answer 16

Fluids
Inotropic agents (renal vasodilators)
-dopamine*
-fenoldopam

*unequally vasodilates glomeruli -> not good

Question 17

Fenoldopam infusion creates mild vasodilation and improves renal perfusion***

Answer 17

Better than dopamine, because it only feeds the afferent receptor

Question 18

PSS effect on liver

Answer 18

• decreases ability for liver to metabolize things
• decreases protein production (dec. clotting factors, oncotic pressure)
• decreases glucose

Question 19

Type of drugs to use in p with liver dz

Answer 19

-reversible, short-acting, don’t use liver metabolism

• opioids, midazolam (reversible)
• propofol = best induction drug (no liver metabolism)***
• remifentanil + iso
• fluids: FFP, hetastarch, glucose

Question 20

Easy to become hypovolemic, dehydrated, hypocalcemic, hypotensive, low blood sugar during pregnancy

Answer 20

:)

Question 21

Best induction drug for C section**

Answer 21

Propofol

Question 22

Physiologic changes during preg

Answer 22

Inc. abd. Pressure
Dec. FRC, GI tone
Sinus congestion
Dec. CO

*must decrease epidural dose by 30%

Question 23

Good pre-op practices before C section

Answer 23

• check electrolytes
• preoxygenate
• give fluid bolus to help with CO

Question 24

Chance of survivng hemoabdomen w/ medical mgmt only

Answer 24

40-50%

Question 25

Risk of giving too much fluids to poly trauma case***

Answer 25

- hemodilution, loss of clotting factors - inc. BP will dislodge existing clots - aim for permissive hypotension: MAP ~ 60 - if have to tx hypovolemic shock, start with hypertonic saline at 2 ml/kg*** (if needs more, give 20 ml/kg of crystalloids up to 3x, then blood products)

Question 26

Mortality rate of septic shock

Answer 26

50% with TIME MANAGEMENT - give fluids, inotropes, and abx in first hour! - mortality increases by 7% every hour you wait

Question 27

Cerebral pressure (CPP) = ***

Answer 27

CPP = MAP - ICP - high ICP fights blood pressure trying to push blood into brain - Inc. MAP with HSA, inotropes - Dec. ICP with cerenia, steroids, mannitol?

Question 28

When are steroids helpful in head trauma cases?

Answer 28

If given BEFORE the trauma occurs, or right after iatrogenic trauma -otherwise, causes hyperglycemia --> free radical production in the brain

Question 29

Best induction for polytrauma/head trauma p?***

Answer 29

Propofol | -reduces oxygen consumption of the brain

Question 30

Best induction choice for hypovolemic shock?***

Answer 30

Ket/diaz | -raises BP without too much trauma

Question 31

Best induction for septic shock p?

Answer 31

Ket/diazepam | -may dec. cytokines in sepsis

Question 32

Why should etomidate NOT be used in polytrauma cases for induction?**

Answer 32

Inhibits adrenal glands, which you need in a stressful event

Question 33

Other good drugs in polytrauma

Answer 33

``` Midazolam Fentanyl Hydromorphone Alfaxalone Etc. ```

Question 34

Analgesia in polytrauma cases

Answer 34

- opioid infusion - auxiliary drugs (ie. Ketamine) - local anesthetics (ie. Lidocaine)