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Pharmacology II > Lecture 29: Peri-anesthesia Monitoring and Complications-II > Flashcards

Lecture 29: Peri-anesthesia Monitoring and Complications-II Flashcards

1
Q

To evaluate HR under anesthesia it is very important to first know the ___

A

Resting heart rate of each patient

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2
Q

What is resting HR for large dogs under anesthesia

A

35-100bpm

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3
Q

What is resting HR for medium dogs under anesthesia

A

50-120bpm

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4
Q

What is resting HR for small dogs under anesthesia

A

80-150

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5
Q

What is resting heart rate for cats under anesthesia

A

90-160

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6
Q

What is resting HR for horses under anesthesia

A

25-45

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7
Q

If severely bradycardia or arrhythmia how long do you count to get accurate HR

A

20-30 seconds

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8
Q

What does ECG tell you

A

Only electrical signal not the function

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9
Q

What is the first monitoring equipment you place

A

Capnograph and/or pulse ox

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10
Q

What is the standard lead for small animals and where is it placed

A

Lead 2- placed between right arm and left leg

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11
Q

What is the standard lead for horses and cows

A

Base-apex lead

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12
Q

What is the deflection direction if traveling from - to +

A

Positive

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13
Q

What is deflection direction if traveling from + to -

A

Negative

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14
Q

Which animals is a negative deflection QRS normal for

A

cows, horses, and birds

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15
Q

T or F: you treat all arrhythmias

A

False

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16
Q

What is the most common arrhythmia under anesthesia

A

Sinus bradycardia

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17
Q

What is sinus bradycardia for cats under anesthesia

A

<90bpm

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18
Q

What is sinus bradycardia for small dogs (except dachshunds) under anesthesia

A

<80-100bpm

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19
Q

What is sinus bradycardia for medium dogs and mini dachshunds

A

<50-80bpm

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20
Q

What is sinus bradycardia for large dogs

A

<35-50bpm

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21
Q

Identify the arrhythmia

A

sinus bradycardia

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22
Q

What are the causes of sinus bradycardia

A
  1. Vagal
  2. Non-vagal
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23
Q

What are the vagal causes of sinus bradycardia

A

Anesthetic, opioids, sedatives, hypothermia, abdomen, neck, eye manipulation

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24
Q

What are the non-vagal causes of sinus bradycardia

A
  1. Cardiac dz
  2. Endocrine dz
  3. Neurological dz
  4. Electrolyte abnormality
  5. Beta-blocker, Ca2+ channel blocker
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25
Q

When do you treat sinus bradycardia

A

If hypotension or very young

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26
Q

Why do you need to treat sinus bradycardia in very young animals

A

They have a fixed SV (CO=SV xHR) so if decrease HR, decrease CO which will then decrease BP (BP=CO xSVR)

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27
Q

What is the treatment for sinus bradycardia that applies to both causes

A
  1. Decrease inhalant
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28
Q

What is tx for vagal bradycardia

A
  1. Atropine
  2. Glycopyrolate
    Anticholinergics
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29
Q

Atropine or glycopyrolate: most likely causes tachycardia

A

Atropine

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30
Q

Atropine or glycopyrolate: increase HR to high normal

A

Glyco

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31
Q

Which is not used for emergencies: atropine or glycopyrolate

A

Glyco

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32
Q

Why do you not want to use alpha 2 agonists with anticholinergics within 1hr of each other

A

Alpha 2 agonists will vasoconstrict and anticholinergics will increase HR—> increase resistance and workload on heart and can lead to cardiac arrest

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33
Q

You give dexmedetomidine, how long do you have to wait to give atropine?

A

60 minutes

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34
Q

T or F: anticholinergics can cause paradoxical bradycardia and/or AV block

A

True

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35
Q

T or F: paradoxical bradycardia likely resolves on own in few minutes

A

True

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36
Q

What is tx for non-vagal sinus bradycardia

A
  1. Isoproteronol
  2. Pacemaker
37
Q

What is sinus tachycardia in a cat

A

<180bpm

38
Q

What is sinus tachycardia in small dogs (except dachshunds)

A

<160

39
Q

What is sinus tachycardia in medium dogs and miniature dachshunds

A

> 140

40
Q

What is sinus tachycardia in large dogs

A

> 120-140

41
Q

Which wave is difficult to see in sinus tachycardia

A

P wave

42
Q

What arrhythmia is occurring

A

Sinus tachycardia

43
Q

Why is sinus tachycardia a problem

A

Shorter diastolic period leading to shorter ventricular filling time and less coronary perfusion. Decrease CO due to smaller SV

44
Q

What are the causes of sinus tachycardia

A
  1. High sympathetic tone
  2. Compensatory response (baroreceptor reflex)
45
Q

What are some causes of high sympathetic tone leading to sinus tachycardia

A
  1. Less than adequate depth of anesthesia
  2. Pain
46
Q

In high sympathetic tone sinus tachycardia what is relationship between BP and HR

A

Increase together

47
Q

What are some causes of compensatory response sinus tachycardia

A

Hypovolemia, hypotension

48
Q

What is the relationship of HR and BP in compensatory response sinus tachycardia

A

HR increases due to decrease BP

49
Q

What is tx for high sympathetic tone sinus tachycardia

A
  1. More analgesics
  2. Increase vaporizer
50
Q

What is tx for compensatory response sinus tachycardia

A
  1. Decrease inhalant
  2. Fluid bolus 5mL/kg
  3. Colloid
  4. Tx hypotension
51
Q

What drugs can be given to tx sinus tachycardia in high sympathetic and compensatory response

A
  1. Esmolol- beta-adrenergic antagonist
  2. Diltiazem- Ca2+ channel blocker
52
Q

What is happening during respiratory sinus arrhythmia

A
  1. During inspiration decrease in pleural pressure
  2. Increased venous return
  3. Increased atrial pressure
  4. Stretch receptor stimulation
  5. Increase HR
  6. Decrease HR on expiration
53
Q

What is this showing? Blue line- respiration

A

respiratory sinus arrhythmia

54
Q

T or F: treatment is necessary for respiratory sinus arrhythmia

A

True

55
Q

What is an AV block

A

Disturbance that affects the transmission of an atrial pulse to the ventricles

56
Q

What occurs in 1st degree AV block?

A
  1. Delayed transmission
  2. P-R interval is prolonged
57
Q

What are some causes of 1st degree AV block

A
  1. Vagal
  2. Non-vagal- beta blocker, Ca2+ channel blocker, electrolyte abnormality, underlying Heart dz
58
Q

T or F: no treatment is needed for first degree AV block

A

True

59
Q

What is 2nd degree AV block

A

Not all P waves are followed by QRS complex, occasional drops

60
Q

What is mobitz type I 2nd degree AV block

A

Vagal
Progressive prolongation of P-R intervals before the dropped beat

61
Q

What is Mobitz type II 2nd degree AV block

A

Pathological
No prolongation of P-R intervals before the dropped beat

62
Q
A
63
Q

What is tx for vagal/type I 2nd degree AV block

A

Anticholinergics (Glyco, atropine)

64
Q

What is tx for type II 2nd degree AV block

A

Pacemaker

65
Q

What is 3rd degree AV block

A

Complete AV dissociation, no relationship between P waves and QRS complex

66
Q

How does the QRS complex appear with 3rd degree AV block

A

Wide, bizarre, escape beats

67
Q

What is the cause of 3rd degree AV block

A

Pathological- heart disease, hyperkalemia, severe digoxin toxicity

68
Q

What is the ventricular rate if 3rd degree block is taking place near junction

A

40-60bpm

69
Q

What is the ventricular rate if 3rd degree AV block is taking place closer to ventricle

A

20-40bpm

70
Q

What species is often asymptomatic with 3rd degree AV block because of adequate ectopic pacemaker rate of 100-130

A

Cats

71
Q

What is tx for 3rd degree AV block

A
  1. Pacemaker
  2. Abort procedure if possible
72
Q

What type of AV block is this and what are the blue arrows

A

3rd degree AV block
Blue arrows: escape beats

73
Q

What type of AV block is this

A

1st degree

74
Q

What type of AV block is this

A

2nd degree- type I

75
Q

What are VPC’s

A

Depolarization of an ectopic focus that is more premature than the signal oriented at the SA node

Missing P wave, shorter R-R interval and wide and bizarre QRS

76
Q

What are the causes of VPC’s

A
  1. Re-entry (inflammatory, structural, toxic, infiltration, traumatic, ischemic heart dz)
  2. High sympathetic tone- GDV, pain, high stress
77
Q

What piece of monitoring equipment do you want to pay attention to for VPC’s besides ECG

A

Pulse ox wave form
AUC of each triangle= SV and will get smaller with VPC

78
Q

What kind of arrhythmia is this

A

VPC

79
Q

What is VTach

A

4 or more VPC’s occurring in succession at HR >160

80
Q

What do you do if you notice VTAC

A

Immediately check if patient has pulse, if no pulse start CPR

81
Q

If patient with VTach has a pulse, you treat if it is

A

Causing hypotension or getting worse

82
Q

What are some drugs used to tx VPC or VTach

A
  1. Lidocaine- Na+ channel blocker
  2. Procainamide- Class IA antiarrythmic
83
Q

What is accelerated idoventricular rhythm

A

Slow ventricular tachycardia <160

84
Q

What is cause of accelerated idioventricular rhythm

A

GDV, splenic disease

85
Q

What is wrong here

A

escape beats- normal safety system for SA and/or AV node failure

86
Q

What this

A

accelerated idioventricular rhythm- <160

87
Q

T or F: you treat an escape beat like a VPC

A

False, do not treat it as VPC it is a defect system and treating it as VPC can cause cardiac arrest

88
Q

If escape beat rhythm is not fast enough what can you give

A

Anticholinergics

Pharmacology II (36 decks)

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