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FA2 Anesthesiology > Lecture 20 11/19/24 > Flashcards

Lecture 20 11/19/24 Flashcards

1
Q

What are the components of brachycephalic syndrome?

A

-elongated soft palate
-stenotic nares
-everted laryngeal saccules
-hypoplastic trachea

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2
Q

What are brachycephalic dogs prone to?

A

-dyspnea
-respiratory complications
-aspiration pneumonia
-esophagitis
-hypertrophic gastropathy
-gastroduodenal inflammation
-ulceration

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3
Q

What are the anesthetic concerns with brachycephalics?

A

-upper airway redundant soft tissue relaxation
-dyspnea/hypoventilation
-stenotic upper airway/hypoplastic trachea
-smaller/collapsed trachea
-higher resistance to airflow
-prone to vagal response
-subclinical aspiration pneumonia

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4
Q

What are the preanesthetic planning steps for brachycephalic dogs?

A

-physical exam
-bloodwork
-chest x-ray
-avoid stress and strenuous physical restraint
-avoid heavy sedation without intubation

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5
Q

What are the characteristics of anticholinergics as premeds?

A

-prevent bradycardia
-decrease GI and resp. secretions

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6
Q

Which premeds are used in brachycephalics in addition to anticholinergics?

A

-antiemetics/prokinetics
-antacids
-steroids
-analgesics/opioids

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7
Q

What are the considerations that should be accounted for when inducing a bracycephalic?

A

-pre-oxygenate first
-have smaller than usual ET tubes available
-use ketamine/benzos or propofol/benzos

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8
Q

How should anesthesia be maintained in brachycephalics?

A

PIVA

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9
Q

Which local/regional anesthesia techniques are used in brachycephalics?

A

-line/field block
-nerve block
-epidural

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10
Q

Which monitoring is most important for brachycephalics?

A

cardiovascular and respiratory monitoring

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11
Q

What are the characteristics of recovery for brachycephalics?

A

-delayed extubation
-sternal positioning
-heliox (He + O2) has less resistance to flow
-steroids/neosynephrine
-continue with O2 support and pain control

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12
Q

What are the characteristics of gastric dilation volvulus?

A

-serious and potentially fatal
-distention and twisting
-unproductive retching
-dehydration
-pH imbalances

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13
Q

What are the respiratory effects of GDV?

A

-hypoventilation
-hypoxemia
-impaired uptake of inhalational anesthetics

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14
Q

What are the cardiovascular effects of GDV?

A

-occlusion of caudal vena cava
-reduction in venous return
-less cardiac output
-less tissue perfusion
-anaerobic respiration
-acidemia

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15
Q

What are the preanesthetic planning considerations for GDV patients?

A

-extensive homeostatic stabilization
-sternal positioning
-intensive oxygenation
-emergency decompression (stomach tube, percutaneous)
-intensive fluid therapy

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16
Q

Which drugs are used for GDV premedication and induction?

A

-drugs with minimal CV and resp effects
-opioids given slowly via IV
-ketamine/alfaxalone/etomidate/fentanyl combined with a benzo

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17
Q

Why is lidocaine used for PIVA in GDV cases?

A

-analgesic
-anti-inflammatory
-anti-arrhythmic
-ROS scavenger
-prokinetic

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18
Q

In addition to PIVA, how else should anesthesia be maintained/supported for GDV patients?

A

-assisted ventilation
-inotropic support

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19
Q

Which monitoring tools should be used in GDV patients?

A

-ECG
-BP
-EtCO2
-electrolytes
-blood gas analysis

20
Q

What are the steps of pre-anesthetic care for cardiac patients?

A

-delay anesthesia for 2 weeks after starting a new cardiac med.
-do not discontinue cardiac meds
-obtain complete history and physical exam
-obtain chest x-rays and echo.
-lab work; focus on PCV, total protein, creatinine, UA, and electrolytes
-monitor; arterial blood pressure, ECG, pulse ox

21
Q

What are the characteristics of anesthetic pre-meds in cardiac patients?

A

-pre-oxygenate
-no anticholinergic use
-use opioid + sedative neurolept analgesia

22
Q

What are the characteristics of ketamine as an induction agent for cardiac patients?

A

-does not depress CV system
-anesthetic and analgesic
-used in cardiac ASA 1 and 2 cases
-titrate dose to effect
-only use in sufficiently sedated animals
-use with a muscle relaxant

23
Q

Why are propofol and alfaxan not great options for induction in cardiac patients?

A

-CV depression: lowers CO and SVR while increasing HR
-causes apnea and resp. depression
-no analgesic properties

24
Q

What are the characteristics of etomidate?

A

-minimal cardiopulmonary depression
-used in patients with an ASA greater than 2
-good for CHF, cardiomyopathy, and poor contractility patients
-no analgesic properties
-short anesthetic time
-use with benzos to prevent excitement, myoclonus, vomiting, and apnea

25
Q

What are the characteristics of anesthetic maintenance for cardiac patients?

A

-use PIVA to minimize inhalant conc.
-use local/regional blocks
-minimize fluid admin.
-monitor ABP, CVP, ECG, EtCO2, and pulse ox intensively

26
Q

What are the pathophysiologic changes that occur with diabetes mellitus?

A

-polyuria and renal dysfunction
-acid-base abnormalities
-muscle weakness
-neurologic/altered mentation
-hypoventilation/hypotension
-immunosuppression
-hepatomegaly and lipidosis
-cataracts

27
Q

What are the preoperative steps for diabetes patients?

A

-schedule surgery first thing
-fast for less than 6 hours
-check blood glucose prior to anesthesia
-administer 1/2 the normal insulin dose
-monitor BG every 30 to 60 minutes afterwards
-administer dextrose if hypoglycemic

28
Q

Why are opioids the premed of choice over alpha2s in diabetes patients?

A

alpha2 agonists block insulin release and cause hyperglycemia

29
Q

Which medication combos are used for induction in diabetes patients?

A

-propofol + benzo
-ketamine + benzo

30
Q

Which aspects of monitoring are most important for diabetes patients?

A

-cardiovascular
-resp.
-blood glucose

31
Q

What are the pathologic changes that occur with Cushing’s?

A

-PU/PD
-dehydration
-electrolyte imbalances
-liver and kidney disease
-decreased drug metabolism
-pyometra
-diabetes
-hepatomegaly/pot-bellied abdomen
-hypoventilation
-lethargy
-muscle wasting
-weakness
-delayed recovery

32
Q

How does Cushing’s impact other body systems?

A

-hypertension
-congestive heart failure
-lower cardiac output
-hypercoagulability
-electrolyte disturbances
-immunosuppression

33
Q

How is the cardiovascular system evaluated in Cushing’s patients pre-anesthesia?

A

-auscultation
ECG
-blood pressure
-echo
-chest x-ray

34
Q

What other pre-anesthesia steps are taken in Cushing’s patients in addition to CV system eval?

A

-CBC
-serum chem
-pre-oxygenation

35
Q

Which premeds should be avoided in Cushing’s patients?

A

-alpha2s: cause hypertension
-acepromazine: longer duration of action, causes hypotension

36
Q

Which premeds can be used in Cushing’s patients?

A

opioids; CV friendly, easily metabolized

37
Q

Which medications/combos can be used to induce Cushing’s patients?

A

-propofol + benzo
-alfaxan
-propofol + ketamine
-ketamine + benzo
-hydromorphone or fentanyl + benzo

38
Q

What are the steps of Cushing’s patient anesthesia maintenane?

A

-PIVA with inhalant and injectable
-ventilatory support
-multimodal analgesia
-intensive CV and resp. monitoring/support

39
Q

What are the clinical signs of hypothyroidism?

A

-dull hair coat and hair loss
-mental dullness
-weight gain

40
Q

Which concurrent conditions can complicate hypothyroidism?

A

-laryngeal paralysis
-megaesophagus

41
Q

What are the anesthetic concerns in unregulated hypothyroidism cases?

A

-lower metabolic rate
-lower drug clearance
-lower temp.
-lower drug requirements
-more adverse effects
-longer recoveries
-decreased stroke volume and heart rate
-less responsive CV system
-higher risk of hypotension and bradycardia

42
Q

What is the goal for premedication in hypothyroidism patients?

A

use drugs with shorter duration of action and repeat doses as needed

43
Q

Which drugs are used as premeds in hypothyroidism patients?

A

-fentanyl/remifentanil
-hydromorphone
-glycopyrrolate

44
Q

What are the goals of anesthesia induction in hypothyroidism patients?

A

-use drugs with less CV depressant effects
-use reversible drugs

45
Q

Which drug combos are used to induce hypothyroidism patients?

A

-propofol/alfaxalone combined with ketamine or benzo
-ketamine + benzo combination

46
Q

What is the goal of anesthetic maintenance in hypothyroidism patients?

A

use TIVA or PIVA to lower the conc. of inhalant anesthetics and reduce CV adverse effects

47
Q

Which monitoring and support measures are used for hypothyroidism patients?

A

-ECG
-blood pressure
-capnography
-pulse ox
-temp.
-fluids
-heat support
-ventilatory and CV support

FA2 Anesthesiology (21 decks)

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