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Anesthesiology 398 and 466 > Lecture 1 Introduction > Flashcards

Lecture 1 Introduction Flashcards

1
Q

What is anesthesia?

A

loss of sensation to all or part of the body.

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2
Q

Define analgesia

A

without pain

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3
Q
  1. Define general anesthesia vs
  2. Analgesia or local anesthesia
A
  1. General Anesthesia: Animal is unconscious and unaware of its surroundings
  2. Analgesia or local anesthesia: Animal shows diminished or no perception of pain
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4
Q

What are the 4 general requirements for general anesthesia?

A
  1. temporary/reversible state of drug intoxication of the central nervous system where the patient neither perceives nor recalls the painful stimulus
  2. Physiology, pharmacology and pathology are the building blocks for the science behind anesthesia
  3. Adequate standard of monitoring
  4. Additional requirements:
    • Species differences in anatomy, pharmacologic effects and metabolism of drugs
    • Humane treatment – prevention of pain, relief from anxiety & stress, sympathetic handling
    • Prevention of injury to animal & personnel
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5
Q

During general anesthesia there is a temporary/reversible state of drug intoxication of the central nervous system where the patient neither perceives nor recalls the painful stimulus which consists of 5 requirements without harming the patient

A
  1. unconsciousness (hypnosis, narcosis)
  2. muscle relaxation
  3. lack of pain (analgesia)
  4. loss of memory (amnesia)
  5. suppression of reflexes (motor, autonomic)
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6
Q

What are the general principles of anesthesia

A
  1. Critical evaluation of history, physical examination & laboratory data => Know your patient!
  2. Stabilize & correct identified abnormalities, if possible, prior to anesthesia
  3. Be organized and efficient to minimize anesthesia time
  4. Select anesthetic protocol based on patient, existing abnormalities and to minimize adverse effects
  5. Identify & prepare for potential complications
  6. Establish intravenous access whenever possible
  7. Secure & maintain patent airway
  8. Use supplemental oxygen when indicated* and provide ventilatory support
  9. Monitor vital body systems (cardiovascular, respiratory & CNS)
  10. Identify & correct abnormalities that arise
  11. Continue monitoring & support thru recover period
  12. Use appropriate analgesia & sedation to minimize pain & distress
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7
Q

Why is pre-anesthetic patient evaluation important?

A
  1. Identifies individual risk factors
  2. Underlying physiologic abnormalities
  3. Contributes information for development of an individualized anesthetic plan
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8
Q
  1. What are the pre-anesthetic fasting requirements for adult dogs and cats?
  2. Less than 4 months of age?
  3. Water requirements?
A
  1. 6 to 12 hours fast
    • 6 hours may be sufficient
    • overnight fasting is recommended at this time (no food after 10pm)
  2. Fast ~4 hours up to 4 months of age
  3. Free access to water up until procedure
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9
Q

What are the consequences for inadequate fasting.

A

regurgitation and aspiration

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10
Q

Why are fasting recommendations different for pediatric patients?

A

risk of hypoglycemia

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11
Q
  1. What type of drug is Maropitant?
  2. Explain its use as a peri-operative medication.
A
  1. Maropitant (Cerenia) – Neurokinin-1 antagonist
  2. Prevents vomiting & signs of nausea associated with opioid drugs
    • Provides adjunct analgesia by blocking substance P
    • Faster return to feeding PO
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12
Q

Pre-anesthetic Fasting - Equine

A
  • 6 to 12 hour fast
  • Access to water
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13
Q

Because equines don’t vomit, why fast?

A

Weight of GI contents ↑pressure on diaphragm & limits lung expansion => ↓ ventilation results in ↓ arterial oxygen & ↑ arterial carbon dioxide levels => ventilation–perfusion mismatch

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14
Q
  1. Fasting Recommendations for cattle
  2. Sheep and goats
  3. Ruminants less than 4 weeks of age
A
  1. Cattle – 24- 48 hours food,
    • 12 – 24 water
  2. Sheep/goats – 12 – 24 hours food,
    • +/- water
  3. < 4 weeks fast only 2 – 4 hours, nursing, monogastric, less prone to regurgitation
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15
Q

Why fast ruminants?

A

Bloat => ↑pressure on diaphragm, limits lung expansion => ↓ ventilation results in ↓ arterial oxygen & ↑ arterial carbon dioxide levels => ventilation–perfusion mismatch

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16
Q

What are the 6 steps of anesthesia?

A
  1. Pre-anesthetic evaluation
  2. Premedication period
  3. Induction of anesthesia
  4. Maintenance
  5. Recovery
  6. Post-anesthetic period
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17
Q

What are the components of the pre-anesthetic minimum data base.

A
  1. Signalment
  2. History
  3. Physical Exam
  4. Laboratory & Diagnostic tests
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18
Q

What is in a signalment?

A
  1. Species
  2. Breed
  3. Age
  4. Sex/neuter status
  5. temperament
  6. Weight & body condition score
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19
Q

Think about species differences in temperment, handling, anatomy and physiology etc. that may affect the anesthetic management of the major species.

A
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20
Q

Give some examples of breed-specific anesthesia issues in dogs

A
  1. Brachycephalic breeds more prone to upper airway obstruction
  2. Greyhounds & drug metabolism
  3. Cavalier- Breed disposition to cardiac disease (Cavalier
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21
Q
  1. Give some examples of breed-specific anesthesia issues in cats
  2. Pigs
A
  1. Breed disposition to cardiac disease (Maine coon)
  2. Poland China, Landrace, Duroc pigs & malignant hyperthermia
22
Q

Give some examples of breed-specific anesthesia issues in horses

A
  • Quarterhorse and hyperkalemic periodic paralysis (HYPP)
  • Draft horses and laryngeal hemiplegia – 35%
23
Q

. Why might geriatric and pediatric patients have an increase in anesthetic risk?

A
  1. Geriatric patients may have ↑ anesthetic risk due to
    • less organ reserve, especially cardiovascular, liver, kidney
  2. Pediatric patients may have ↑ risk from
    • hypoglycemia,
    • hypothermia,
    • ↓ drug metabolism
24
Q

Why is sex/ neuter status important in anesthesia

A
  • Related to temperament
  • Sex related drug metabolism differences?
25
Q

How does temperment affect anesthetic management of a patient?

A
  • aggressive/fractious temperament
    • poses a danger to staff
    • limits pre-anesthetic examination
    • Need for more potent drugs, higher doses or combinations for aggressive or overly fearful animals
26
Q

What should be included in a thorough pre-anesthetic history?

A
  1. Diet, exercise, environment
  2. Past medical problems
  3. Current medications:
    • Identify all prescribed & over-the-counter medications (including aspirin) and supplements to avoid adverse drug interactions
  4. Past anesthesia => any complications?
27
Q

Explain the pre-emptive pain score.

A
  • Assigns level of pain to procedure/underlying disease
    • None, mild, moderate, severe
  • Allows for pre-emptive & intra-op analgesic plan
28
Q

How does the knowledge of the specific procedure assist with anesthetic planning?

A
  1. Evaluate the procedure’s level of invasiveness & duration
  2. Anticipated level of pain
  3. Risk of hemorrhage or other complications
29
Q

AFTER a complete physical exam, on which body systems should the pre-anesthetic evaluation focus?

A
  1. cardiovascular
  2. respiratory
  3. CNS
30
Q

What laboratory data will be needed on a Normal Healthy or with localized disease (<5 years old)

A

Big 4

  1. packed cell volume (PCV),
  2. total protein (TP),
  3. azostrip (kidney function)
  4. blood glucose (BG)
31
Q

what laboratory data will be needed on a > 5-7years

A

CBC, CHEM, urinalysis even if status I or II

32
Q

Why take radiographs?

A
  • Neoplasia – ‘met check’ – thoracic radiographs/CT
  • Heart disease/murmur–thoracic radiographs, echocardiogram
  • Trauma (HBC) – thoracic & abdomen radiographs
    • Pulmonary contusions, pneumothorax, diaphragmatic hernia
    • Urinary bladder rupture, hemoabdomen
33
Q

Know the Anesthesia Physical Status Classification (I-V) and be able to give an example of each

A
  1. I Healthy, no disease
    • spay,neuter
  2. II Healthy, localized or mild systemic disease
    • patellar lux., CCR
  3. III Moderate systemic disease
    • murmur, anemia
  4. IV Severe systemic disease, life threatening
    • heart, liver failure
  5. V Moribund, not expected to live >24hrs
    • multi-organ failure,
34
Q
  1. Anesthesia Physical Status is directly related to what?
  2. Is there a linear increase in risk in dogs and cats when their ASA status increases?
A
  1. Directly related to risk of peri-anesthetic death
  2. Not linear!
    • Class I – II = 0.12%, 4.8%
    • Class III – V (↑40x)
35
Q

Why is patient stabilization important prior to general anesthesia?

A

Anesthetic drugs alter normal physiology & ability to maintain homeostasis​

36
Q

What abnormalities should be corrected prior to anesthesia?

A
  1. rehydration, correction of acid/base & electrolyte abnormalities, anemia, hypoproteinemia
  2. Correct co-morbidities - pneumothorax
    • will help patient better compensate during anesthesia and surgery
37
Q

When is it appropriate to proceed directly to surgery despite an unstable patient?

A
  1. Elective outpatient procedure – excellent prognosis & PS I-II
  2. Continued blood loss – splenic tumor rupture, guttural pouch mycosis
  3. Acute abdomen – colon torsion colic or gastric dilatation/volvulus
38
Q

A complete anesthetic plan addresses what 6 components?

A
  1. pre- & post-anesthetic sedation/tranquilization
  2. perioperative analgesia – preemptive, intra-op & post-op
  3. induction & maintenance drugs
  4. ongoing physiologic support
  5. monitoring plan
  6. anticipation & response plan to adverse events or complications

Note: The plan is flexible to allow for patient responses during anesthesia

39
Q

What are the advantages (and disadvantages) of anesthetic premedication?

A

Advantages:

  • ↓ patient & staff stress
  • ease of handling
  • ↓ induction & inhalant anesthetic doses => ↓ dose dependent CV/resp depression
  • Pre-emptive analgesia

Disadvantages:

  • Bradycardia – alpha-2 agonists, opioids
  • Hypotension – acepromazine
  • Excitement/dysphoria – benzodiazepines
40
Q

Name the 3 sedative/tranquilizers used in canine pre-anesthetics and their drug class

A
  1. Acepromazine
  2. Dexmedetomidine
  3. Midazolam/Diazepam
41
Q

Which drugs are commonly used in combination for feline premedication or total injectable anesthesia?

A
  1. Dexmedetomidine
  2. An opoid
    • Butorphanol
    • Buprenorphine
    • Methadone
    • Hydromorphone
  3. +/- Ketamine or Telazol:
    • ↑ restraint (aggressive patients)
    • analgesia
    • total injectable anesthesia
42
Q

Name the drugs commonly used for equine premedication.

A
  1. Alpha-2 agonist
    • Xylazine, detomidine, romifidine
  2. Butorphanol
  3. Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Phenylbutazone, flunixin
43
Q

Premedication for cattle

A

may or may not need

  • Xylazine – 1/10 equine dose
  • Butorphanol – behavior changes such as restlessness & bellowing
44
Q

Premedication for goats and sheep

A
  • Butorphanol +/- Benzodiazepine
  • +/- xylazine – only healthy patients, can cause hypoxemia in sheep
45
Q
  1. What drugs can you use for anesthetic induction for dogs?
  2. Cats?
A
  1. Dogs
    • Propofol
    • ketamine/benzodiazepine
    • alfaxalone
  2. Cats – above or total injectable anesthesia
46
Q

What drugs are used for induction in horses

A
  • Ketamine/benzodiazepine,
  • +/- guafenasin (GG)
47
Q

What drugs are used for induction of cattle

Whats the common name?

A

Triple drip:

  1. guafenasin
  2. xylazine
  3. Ketamine
48
Q

What drugs are used for induction of sheep and goats

A

ketamine/benzodiazepine

49
Q

What are the considerations for anesthesia recovery?

A
  1. Sedation
  2. Analgesia
  3. Airway protection
  4. Hypoxemia
50
Q

Name the 6 most common anesthetic related complications

A
  1. Hypotension
  2. Cardiac arrhythmia
  3. Cardiac arrest
  4. Respiratory insufficiency => hypoventilation & hypoxemia
    • ↑ arterial carbon dioxide & ↓ arterial oxygen
  5. Hypothermia or hyperthermia
  6. Myopathy/neuropathy – equine, cattle
51
Q

What is/are ways to prevent/prepare for anesthetic complications?

A

PREVENTION

  1. Anticipate possible complications & PREPARE ahead of time
  2. Monitoring warns of changes in patient status
    • Allows early intervention before significant morbidity or mortality
  3. Pre-operative patient preparation plays a significant role
    • correct fluid, acid/base and electrolyte abnormalities, anemia and hypoalbuminemia
  4. IV catheter - fluid administration & emergency use
  5. Intubation - patent airway, positive pressure ventilation, prevents aspiration

Anesthesiology 398 and 466 (22 decks)

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