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

Lecture 29: Peri-Anesthesia Monitoring and Complications- III Flashcards

1
Q

What is the goal of maintaining BP under anesthesia

A

Maintains good oxygen delivery (DO2) throughout peri-anesthesia period

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2
Q

What MAP do you want to maintain in small animals

A

60mmHg

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3
Q

What MAP do you want to maintain in large animals

A

70mmHg

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4
Q

What are the pros and cons of non-invasive BP

A

Pros
- easy to use, non invasive
Cons
- lower accuracy, non-continuous, Doppler only measures systolic

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5
Q

What are the pros and cons of invasive BP

A

Pros
- reliable (gold standard)
- continuous
Cons
- invasive, Complications (hemorrhage, infection, phlebitis, pain, thrombosis), skills required

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6
Q

What is the mechanism of oscillometer

A

High pressure to occlude arterial blood and then gradually deflate cough and measure systolic, mean and diastolic based on sounds heard

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7
Q

What is the most and least accurate measurements from oscillometer

A

Most: MAP
Least: diastolic

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8
Q

How do you measure/ choose appropriate cuff size

A

Width of the cuff should be 30-40% of the circumference

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9
Q

If the cuff is too big you will get a __reading

A

Falsely low

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10
Q

If the cuff is too small you will get a ___reading

A

Falsely high

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11
Q

The cuff should be placed at the same level as ___

A

Base of the heart

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12
Q

If you place the cuff lower than the base of the heart you will get __values

A

High

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13
Q

If you place cuff higher than base of the heart you will get ___values

A

Lower

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14
Q

The cuff should not be placed on a __

A

Joint

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15
Q

Where should cuff be placed on pig

A

Metatarsal

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16
Q

What should be lined up with line on cuff

A

artery

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17
Q

What can you compare BP from cuff to, to assess accuracy

A

HR measured from cuff should be close to ECG lead HR

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18
Q

Which screen shows an accurate vs inaccurate BP reading and how do you know

A

Left: inaccurate because pulse from cuff is 55 whereas ECG is 174
Right: accurate pulse from cuff is 117 and ECG is 120

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19
Q

Dopplers only measure __pressure

A

Systolic

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20
Q

In what species is the Doppler systolic pressure close to MAP

A

Cats

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21
Q

Why is Doppler advantageous

A

Continuous monitoring of its sounder- quicker realization of sudden change in circulation status

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22
Q

T or F: invasive BP should be used even for routine elective procedures in clinically healthy patients

A

False

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23
Q

What species is an invasive BP routine when under GA

A

Horses

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24
Q

Where do you do arterial catheter/ invasive BP for dogs and cats

A

Dorsal pedal artery

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25
Where do you do arterial catheter/ invasive BP for pigs
Auricular artery
26
Where do you do arterial catheter/ invasive BP for horses
Facial artery, transverse facial artery, metatarsal artery
27
Where do you do arterial catheter/ invasive BP for ruminants
Articular artery
28
What is the most common anesthetic complication
Hypotension
29
What is the first thing you should do/ change to fix hypotension
Turn down inhalant
30
What is formula for BP
Co x SVR
31
What is formula for SV
Preload x compliance x contractility/ SVR
32
what is formula for CO
SV x HR
33
What are the 5 differential diagnosis for hypotension
1. Decrease SVR 2. Decrease HR 3. Decrease Preload 4. Decrease compliance 5. Decrease contractility
34
What are some causes of decrease SVR
1. Anesthetics- most common 2. Acepromazine 3. Septic shock 4. Anaphylactic shock
35
How do you assess SVR clinically
MM
36
What is tx for decrease SVR
1. Decrease anesthetic (first) 2. Vasopressor- NE, phenylephrine
37
What is color of MM for vasodilation
Bright red
38
What is MM for vasoconstriction or anemia
Pale
39
What are some causes of decrease HR under ax
1. Anesthetics 2. Opioids 3. B-blockers 4. Ca2+ channel blocker 5. Alpha 2 agonist 6. Cardiac dx (AV block)
40
What is tx for decrease HR under ax
1. Anticholinergics (most effective) 2. Decrease anesthetic 3. Reduce opioid infusion 4. Pacemaker
41
What are some causes of decreased preload
1. Dehydration 2. Blood loss 3. Decrease SVR
42
What is tx for decrease preload
1. Decrease anesthetic 2. Fluid 3. Vasopressor
43
Why do you not want to replace blood during hemorrhage until bleeding is controlled
Fluids will thin blood—> increase velocity—> increase bleeding
44
How can you diagnose a decrease in preload leading to hypotension
1. Fluid challenge- fluid bolus at 5mL/kg
45
T or F: If the fluid bolus is ineffective/ no change you should give more
False- not doing anything
46
If a fluid bolus is effective for a few minutes against hypotension what can you give next
Colloid
47
What is the standard fluid for patients
Isotonic crystalloid (LRS, Norm-R, P-lyte)
48
What is fluid rate for dogs
5mL/kg/hr
49
What is fluid rate for cats
3mL/kg/hr
50
If you have <10% blood volume loss what fluid type do you give
Crystalloid
51
If you have 10-20% blood volume loss what fluid do you give
Colloid
52
If you have >20% blood volume loss what fluid do you give
Transfusion
53
What % of dogs body weight is made of blood
8%, 80mL/kg
54
What % of cats body weight is made of blood
7%, 70mL/kg
55
Ex: 12yr, mixed breed with BW=37kg, blood volume loss of 900mL what is % blood loss and what fluid type would you give
Total blood volume: 37kg(80mL/kg)= 2960mL % loss: 900mL/2960mL- 30.4% >20% blood loss- transfusion
56
What is the effective of vasodilation of effective circulation volume
Decreases it
57
A decrease in SVR has what effect on preload
Decreases it
58
__causes marked decrease in SVR
Inhalants
59
What is tx for decrease preload
1. Decrease inhalant 2. Vasopressor
60
Why do you not want to you a Vasopressor if a patient is vasoconstricted but hypotensive
Tissue ischemia with too much vasoconstriction
61
What is another word for compliance
Lusitropy
62
What causes a decrease in compliance
1. Pericardial effusion 2. HCM
63
What is tx for decrease in compliance
1. Pericardiocentesis 2. Decrease anesthetic
64
What is another word for contractility
Ionotropy
65
What are the causes of decrease contractility
1. Anesthetics 2. B-blocker 3. Ca2+ channel blocker 4. DCM
66
What is tx for decreased contractility
1. Decrease anesthetic 2. Give dobutamine or dopamine
67
What can you use to evaluate contractility under ax
SPO2 waveform, contour analysis
68
Which one shows good vs decreased contractility
Right: decreased Left: good

Pharmacology II (36 decks)

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