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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
Q

Where do you do arterial catheter/ invasive BP for pigs

A

Auricular artery

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26
Q

Where do you do arterial catheter/ invasive BP for horses

A

Facial artery, transverse facial artery, metatarsal artery

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27
Q

Where do you do arterial catheter/ invasive BP for ruminants

A

Articular artery

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28
Q

What is the most common anesthetic complication

A

Hypotension

29
Q

What is the first thing you should do/ change to fix hypotension

A

Turn down inhalant

30
Q

What is formula for BP

A

Co x SVR

31
Q

What is formula for SV

A

Preload x compliance x contractility/ SVR

32
Q

what is formula for CO

A

SV x HR

33
Q

What are the 5 differential diagnosis for hypotension

A
  1. Decrease SVR
  2. Decrease HR
  3. Decrease Preload
  4. Decrease compliance
  5. Decrease contractility
34
Q

What are some causes of decrease SVR

A
  1. Anesthetics- most common
  2. Acepromazine
  3. Septic shock
  4. Anaphylactic shock
35
Q

How do you assess SVR clinically

A

MM

36
Q

What is tx for decrease SVR

A
  1. Decrease anesthetic (first)
  2. Vasopressor- NE, phenylephrine
37
Q

What is color of MM for vasodilation

A

Bright red

38
Q

What is MM for vasoconstriction or anemia

A

Pale

39
Q

What are some causes of decrease HR under ax

A
  1. Anesthetics
  2. Opioids
  3. B-blockers
  4. Ca2+ channel blocker
  5. Alpha 2 agonist
  6. Cardiac dx (AV block)
40
Q

What is tx for decrease HR under ax

A
  1. Anticholinergics (most effective)
  2. Decrease anesthetic
  3. Reduce opioid infusion
  4. Pacemaker
41
Q

What are some causes of decreased preload

A
  1. Dehydration
  2. Blood loss
  3. Decrease SVR
42
Q

What is tx for decrease preload

A
  1. Decrease anesthetic
  2. Fluid
  3. Vasopressor
43
Q

Why do you not want to replace blood during hemorrhage until bleeding is controlled

A

Fluids will thin blood—> increase velocity—> increase bleeding

44
Q

How can you diagnose a decrease in preload leading to hypotension

A
  1. Fluid challenge- fluid bolus at 5mL/kg
45
Q

T or F: If the fluid bolus is ineffective/ no change you should give more

A

False- not doing anything

46
Q

If a fluid bolus is effective for a few minutes against hypotension what can you give next

A

Colloid

47
Q

What is the standard fluid for patients

A

Isotonic crystalloid (LRS, Norm-R, P-lyte)

48
Q

What is fluid rate for dogs

A

5mL/kg/hr

49
Q

What is fluid rate for cats

A

3mL/kg/hr

50
Q

If you have <10% blood volume loss what fluid type do you give

A

Crystalloid

51
Q

If you have 10-20% blood volume loss what fluid do you give

A

Colloid

52
Q

If you have >20% blood volume loss what fluid do you give

A

Transfusion

53
Q

What % of dogs body weight is made of blood

A

8%, 80mL/kg

54
Q

What % of cats body weight is made of blood

A

7%, 70mL/kg

55
Q

Ex: 12yr, mixed breed with BW=37kg, blood volume loss of 900mL what is % blood loss and what fluid type would you give

A

Total blood volume: 37kg(80mL/kg)= 2960mL

% loss: 900mL/2960mL- 30.4%

> 20% blood loss- transfusion

56
Q

What is the effective of vasodilation of effective circulation volume

A

Decreases it

57
Q

A decrease in SVR has what effect on preload

A

Decreases it

58
Q

__causes marked decrease in SVR

A

Inhalants

59
Q

What is tx for decrease preload

A
  1. Decrease inhalant
  2. Vasopressor
60
Q

Why do you not want to you a Vasopressor if a patient is vasoconstricted but hypotensive

A

Tissue ischemia with too much vasoconstriction

61
Q

What is another word for compliance

A

Lusitropy

62
Q

What causes a decrease in compliance

A
  1. Pericardial effusion
  2. HCM
63
Q

What is tx for decrease in compliance

A
  1. Pericardiocentesis
  2. Decrease anesthetic
64
Q

What is another word for contractility

A

Ionotropy

65
Q

What are the causes of decrease contractility

A
  1. Anesthetics
  2. B-blocker
  3. Ca2+ channel blocker
  4. DCM
66
Q

What is tx for decreased contractility

A
  1. Decrease anesthetic
  2. Give dobutamine or dopamine
67
Q

What can you use to evaluate contractility under ax

A

SPO2 waveform, contour analysis

68
Q

Which one shows good vs decreased contractility

A

Right: decreased
Left: good

Pharmacology II (36 decks)

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