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SA Anesthesiology > L7: Anesthesia And Disease (Shih) > Flashcards

L7: Anesthesia And Disease (Shih) Flashcards

1
Q

Most important thing to monitor in chronic urinary obstruction cat

A

ECG; main concerns - brady arrhythmia due to hyperK

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

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2
Q

Tx of hyperkalemia in urinary obstruction

A
  • 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)
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3
Q

Ca gluconate does NOT decrease serum potassium ***

A

:) (works on CS only)

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4
Q

Drugs to give cat to pass catheter, if needed

A 
*sedation only*
Butorphanol
Midazolam
Ketamine
Local anesthetic (low volume epidural)
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5
Q

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

A

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

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6
Q

Properties of HCM

A
  • 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
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7
Q

Compounding factors in perioperative mortality in SA anesthesia***

A
  • Cardiovascular (pump or circulatory failure, hypovolemia)
  • Pre-existing organ failure
  • brachiocephalic breeds
  • geriatric patient
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8
Q

Bad drug for HCM cat.

A

Ketamine

-increases LVOT

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9
Q

Good drug for HCM cat and why***

A

Dexmedetomidine

  • decreases HR
  • causes vasoconstriction
  • bad in any other animal with heart dz!
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10
Q

Things that make LVOT worse in CATS

A
  • tachycardia
  • inc. contractility
  • vasodilation
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11
Q

Mitral valve disease

A

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
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12
Q

Anesthesia for HCM cats

A
  • 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)
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13
Q

anesthetic protocol for mitral valve disease in dogs***

A
  • preoxygenate
  • premed with etomidate or alphaxolone
  • AVOID bradycardia and vasoconstriction at induction
  • a mild INCREASE in HR and mild VASODILATION improve cardiac performance***
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14
Q

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

A

:)

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15
Q

Avoid NSAIDs in renal patients

A

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

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16
Q

Hemodynamic support in CKF

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

*unequally vasodilates glomeruli -> not good

17
Q

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

A

Better than dopamine, because it only feeds the afferent receptor

18
Q

PSS effect on liver

A
  • decreases ability for liver to metabolize things
  • decreases protein production (dec. clotting factors, oncotic pressure)
  • decreases glucose
19
Q

Type of drugs to use in p with liver dz

A

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

  • opioids, midazolam (reversible)
  • propofol = best induction drug (no liver metabolism)***
  • remifentanil + iso
  • fluids: FFP, hetastarch, glucose
20
Q

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

A

:)

21
Q

Best induction drug for C section**

A

Propofol

22
Q

Physiologic changes during preg

A

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

*must decrease epidural dose by 30%

23
Q

Good pre-op practices before C section

A
  • check electrolytes
  • preoxygenate
  • give fluid bolus to help with CO
24
Q

Chance of survivng hemoabdomen w/ medical mgmt only

A

40-50%

25
Q

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

A
  • 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)
26
Q

Mortality rate of septic shock

A

50% with TIME MANAGEMENT

  • give fluids, inotropes, and abx in first hour!
  • mortality increases by 7% every hour you wait
27
Q

Cerebral pressure (CPP) = ***

A

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?
28
Q

When are steroids helpful in head trauma cases?

A

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

29
Q

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

A

Propofol

-reduces oxygen consumption of the brain

30
Q

Best induction choice for hypovolemic shock?***

A

Ket/diaz

-raises BP without too much trauma

31
Q

Best induction for septic shock p?

A

Ket/diazepam

-may dec. cytokines in sepsis

32
Q

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

A

Inhibits adrenal glands, which you need in a stressful event

33
Q

Other good drugs in polytrauma

A 
Midazolam
Fentanyl
Hydromorphone
Alfaxalone
Etc.
34
Q

Analgesia in polytrauma cases

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

SA Anesthesiology (12 decks)

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