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CVSOH BVSc3 > LS Anaesthesia > Flashcards

LS Anaesthesia Flashcards

1
Q

What is the definition of pain?

A

An unpleasant sensory and emotional experience associated with (actual or potential) tissue damage

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2
Q

What is the definition of nociception?

A

The neural process of encoding noxious stimuli

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3
Q

What is the difference between nociception and pain?

A

Nociception is the wiring part

Pain is how the patient interprets nociception

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4
Q

What is nociceptive pain?

A

Pain that arises from damage to non-neural tissue that activates nociceptors

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5
Q

What is neuropathic pain?

A

Pain caused by a lesion or disease of the somatosensory nervous system

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6
Q

What is hyperalgesia?

A

Increased pain from a stimulus that normally provokes pain

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7
Q

What is allodynia?

A

Pain due to a stimulus that does not normally provoke pain

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8
Q

What are the physiological signs associated with pain?

A

Increased HR, BP, temp, resp, stress hormones

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9
Q

What are behavioural signs of pain in cats and dogs?

A

Hunched
Pain face
Lack of grooming
Inappetence

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10
Q

What are different behavioural signs of pain in dogs?

A

Cats hide, dogs seek attention

Cats have fear aggression, dogs are submissive

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11
Q

What are behavioural signs of pain in rabbits?

A

Immobile, hunched
Depression and isolation
Eyes shut

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12
Q

What are behavioural signs of pain in horses?

A 
Low head
Vocalisation
Tail swishing and restless
Lame/limb lifting 
Hunched
Sweating
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13
Q

What are methods of scoring pain?

A

Composite pain scales
Numerical rating scale
Visual analogue scale
Simple descriptive scale

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14
Q

What is a method of monitoring chronic pain?

A

Client specific outcome measures - client chooses activities animal usually does

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15
Q

What is preventative analgesia?

A

Analgesia given before, during and after the surgery/procedure

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16
Q

Why do you give preventative analgesia?

A

To prevent upregulation of the nervous system from noxious stimuli

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17
Q

What is multimodal analgesia?

A

Using different classes of analgesic agents to block pain pathways

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18
Q

Why do you give multimodal analgesia?

A

More effective analgesia

Lower doses needed

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19
Q

What are the main analgesic agents?

A

Opioids
NSAIDS
a2 agonists - analgesic sedatives

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20
Q

What category of controlled drugs are opioids?

A

Full opioid agonists - schedule 2

Partial - schedule 3

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21
Q

What receptor do opioids target for analgesia?

A

Mu (backwards u) opioid receptor in the brain and spinal cord

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22
Q

What type of pain are opioids best for treating?

A

More for acute

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23
Q

What does potency mean?

A

The amount of drug needed to have an effect

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24
Q

What does efficacy mean?

A

The magnitude of the effect of a drug

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25
Q

What opioid has the highest potency and efficacy?

A

Fentanyl

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26
Q

What opioids are full mu agonists?

A

Fentanyl

Methadone

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27
Q

What opioids are partial agonists?

A

Buprenorphine

Butorphanol

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28
Q

What opioid is the longest acting?

A

Buprenorphine

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29
Q

What opioid is the shortest acting?

A

Fentanyl

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30
Q

What are side effects of opioids?

A

Resp depression
Sedation/excitation
Nausea and vomiting

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31
Q

What do NSAIDs inhibit?

A

Cyclooxygenase which inhibits prostaglandin production (inflammatory mediators)

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32
Q

Where are NSAIDs metabolised?

A

In the liver

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33
Q

What is the most common NSAID?

A

Meloxicam

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34
Q

What are side effects of NSAID use?

A

GI ulceration
Renal ischaemia
Vomiting and diarrhoea

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35
Q

What is always the ending of local anaesthetics?

A

-caine

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36
Q

How do local anaesthetics work?

A

Block voltage gated Na+ channels in nerves

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37
Q

What are the two types of linkages in local anaesthetics?

A

Ester

Amide

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38
Q

How can you tell if the local anaesthetic is an ester or an amide?

A

Esters have no i in the name before the caine whereas amides do

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39
Q

Which type of local anaesthetic is more stable?

A

Amide

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40
Q

Which type of local anaesthetic has a short plasma half life?

A

Ester

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41
Q

What are some side effects of local anaesthetics?

A

CNS toxicity
CV toxicity
Due to high doses

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42
Q

What local anaesthetics are used in small animals?

A

Lidocaine and bupivicaine

43
Q

What local anaesthetic is used in large animals?

A

Procaine

44
Q

What kind of drug is tramadol?

A

Centrally acting analgesic with multimodal action

45
Q

How should tramadol be used?

A

In dogs
Only injected
Co-analgesic - not alone

46
Q

What is amantadine sued for?

A

Antihyperalgesic

47
Q

What is epidural anaesthesia?

A

Anaesthetic injected into the epidural space

48
Q

What is spinal anaesthesia?

A

Anaesthetic injected directly into cerebrospinal fluid

49
Q

How are ester local anaesthetics metabolised?

A

Hydrolysis of ester link by plasma esterases

50
Q

How are amide local anaesthetics metabolised?

A

Broken down by cytochrome P450 enzymes

51
Q

What are the different formulations of local anaesthetics?

A

Solutions
Aerosol sprays
Topical patches

52
Q

What is baricity?

A

Weight of one substance compared to the same volume of another

53
Q

When is baricity an issue?

A

Need local anaesthetic to be heavier than cerebrospinal fluid so it doesnt spread up the epidural space too far so add glucose

54
Q

What is used to prolong the duration of action, reduce systemic absorption and reduce toxicity of local anaesthetics?

A

Adrenaline - vasoconstrictor

55
Q

What reduces plasma protein binding?

A

Lower pH

56
Q

How is toxicity linked to plasma protein binding?

A

Better binding to plasma proteins means longer duration of action and lower risk of toxicity

57
Q

What are used to help with seizures due to CNS toxicity?

A

Benzodiazepines

58
Q

Why are premeds used?

A

Balanced anaesthesia

Reduce stress and injury

59
Q

Which premed drugs have an analgesic action?

A

A2 agonists

Opioids

60
Q

What premed drugs work as a dopamine receptor antagonist?

A

Phenothiazines - ACP

61
Q

What premed drugs act on the GABA receptor?

A

Benzodiazepines

62
Q

What is ACP usually given with? Why?

A

Opioid

Provides analgesia as ACP doesnt

63
Q

How is ACP administered?

A

Subcut injection

64
Q

What effect does ACP have?

A

Sedation

Anxiolysis

65
Q

What is a potential side effect of ACP?

A

Fall in body temp as peripheral vasodilation

Decrease in blood pressure

66
Q

What is the duration of action of ACP?

A

4-6 hours - long

67
Q

How long does ACP take to have a clinical effect?

A

30-40 mins

68
Q

What is the antagonist of a2 agonists?

A

Atipamezole

69
Q

What effect do a2 agonists have on CV function?

A

Bradycardia

Reduced CO

70
Q

What effect do a2 agonists have on GI function?

A

Depress GI activity

Emetic - vomit

71
Q

What effect do a2 agonists have on pregnant animals?

A

Increase uterine contractility - abortion

Avoid in near term animals

72
Q

How long do a2 agonists take to have an effect?

A

5 mins - rapid

73
Q

What are the clinical effects of benzodiazepines?

A

Muscle relaxation
Anticonvulsant
Minor tranquilliser

74
Q

When should you give benzodiazepines as sedation?

A

Good in sick or young animals

Unreliable in healthy animals - excitement

75
Q

How are benzodiazepines administered?

A

Slow IV

76
Q

What is the reversal agent of benzodiazepines?

A

Flumazenil

77
Q

How does flumazenil work as a reversal agent?

A

Competitively antagonises benzodiazepines binding site

78
Q

What is an example of a butyrophenone?

A

Fluanisone

79
Q

How must fluanisone be administered?

A

In combination with opioid fentanyl

80
Q

What is the combination fluanisone and fentanyl licenced in?

A

Rabbits and small furries

81
Q

When is fluanisone and fentanyl used?

A

Minor surgery and diagnostic techniques - poor muscle relaxation

82
Q

What premeds are given to ASA grade 1 and 2?

A

ACP + opioid

a2 agonist + opioid

83
Q

What premeds are given to ASA grade 4 and 5?

A

Benzodiazepines + opioid
BDZ + ket
Opioid alone

84
Q

What are some safety issues with sedation?

A

NO control over airway

No option to deepen sedation without going to full GA

85
Q

What are two examples of a2 agonists?

A

(Dex)medetomidine

86
Q

What kind of sedation is the most likely to be reversed?

A

a2 agonists

87
Q

What should you do if there is a low SpO2 from pulse oximeter?

A

Check pulse ox
Check correctly intubated, no leak from cuff
Check breathing pattern - may need ventilation
Check for obstruction
Check machine works

88
Q

What are some causes of tachycardia in anaesthesia?

A

Inadequate depth of anaesthesia
Hypercapnia (increased CO2)
Hypovolaemia - need fluids
Drugs - directly

89
Q

What are some causes of bradycardia during anaesthesia?

A

Deep anaesthesia
Opioids and a2 agonists
Hypothermia

90
Q

What counts as hypotension?

A

Mean arterial pressure below 60mmHg

91
Q

What can cause hypotension during anaesthesia?

A

Drugs
Blood loss
Pre-existing condition

92
Q

What local anaesthetic is used for eye examination?

A

Proparacaine

93
Q

What local anaesthetic is used for an intratesticular block for castration?

A

Lidocaine

94
Q

What is used for topical anaesthetic on the larynx?

A

Lidocaine

95
Q

How is procaine licenced for administered in large animals?

A

Subcut injection

96
Q

What is the withdrawal period for procaine?

A

Zero

97
Q

What can be an issue with cornual nerve block in goats?

A

Have two branches of nerves - cornual nerve and cornual branch of intratrochlear nerve
Toxicity levels in kids

98
Q

What are the 3 different techniques of abdominal flank surgery local anaesthesia?

A

Paravertebral
Inverted L block
Local infiltration along incision site

99
Q

What nerves are desensitised in paravertebral block?

A

T13, L1 and L2

100
Q

What is found between the dorsal and ventral branches of the spinal nerves in a paravertebral block?

A

Intertransverse ligament

101
Q

How do you identify the first transverse process?

A

Count back from L5 transverse process

102
Q

Which way do you walk the needle off the transverse processes?

A

Forward off L1
Back off L1
Back off L2

103
Q

What are the disadvantages of an inverted L block?

A

Large amount of LA

Not as effective analgesia

104
Q

Where do you inject for a sacrococcygeal epidural?

A

Most movable space if pump tail up and down - sa5-co1

CVSOH BVSc3 (60 decks)

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