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Anesthesiology > Managing Anesthetic Complications > Flashcards

Managing Anesthetic Complications Flashcards

1
Q

True or False: accidents are inevitable

A

True

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2
Q

True or False: risk can be managed

A

True

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3
Q

True or False: anesthetic risk is independent of procedural risk

A

False

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4
Q

What is increased perioperative risk associated with?

A

Smaller patients

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5
Q

Are mortality rates in cats better or worse than for dogs?

A

Worse. Dogs have an overall mortality rate of 0.17% and cats have a mortality rate of 0.24%

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6
Q

True or False: Compared to dogs or humans, Rabbits and Horses have lower anesthetic risk for elective procedures.

A

False. Horses have a 2% overall anesthetic risk rate and rabbits have a 1.39%

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7
Q

When do more than half of all dog and cat deaths occur?

A

During recovery

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8
Q

True or False: Technical solutions and strict procedural guidelines have eliminated accidents.

A

False, it has decreased, but not eliminated

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9
Q

What are the two types of errors committed in medicine?

A

Errors of ignorance: mistakes we make because we don’t know enough
Errors of ineptitude: mistakes we make because we don’t make proper use of what we do know

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10
Q

What are the two key elements which make a system vulnerable to accidents?

A

Complex interactions: Complexity can be due to uncertainty to proliferation or it can be intrinsic
Tight coupling: Where what happens in one part directly and quickly affects another

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11
Q

True or False: Systems exhibiting complex interactions and tight coupling are less likely to have accidents than systems exhibiting linear interactions and loose coupling.

A

False

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12
Q

What are three proven methods to prevent or reduce accidents?

A

Teamwork
Checklists
Team discussion before the procedure produces “activation phenomenon”

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13
Q

What is practical drift? Give an example.

A

Practical drift is the slow, steady uncoupling of local practice from best practice
This occurs when individuals try to meet operational requirements by making small adjustments in recommended procedures

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14
Q

What should be done if an elective OHE has a subnormal temperature prior to induction?

A

Stop and determine what is going on

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15
Q

True or False: “Bad” drugs/acute drug reactions are a major cause for anesthetic accidents.

A

False, it is rare for them to be the reason

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16
Q

Which anesthetic agent is MOST associated with intraoperative hypotension?

A

Inhaled anesthetics

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17
Q

What is the intravascular residence time for isotonic crystalloid solutions like Plasmalyte M or lactate Ringer’s solution?

A

30 minutes

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18
Q

What is the intravascular residence time for isotonic colloid solutions like Vetastarch or Hetastarch?

A

24 hours

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19
Q

True or False: Giving > 10 ml/kg/hr of isotonic crystalloid fluids during anesthesia will increase urine production

A

False, it does not change urine production

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20
Q

What should you do when a patient with previously normal blood volume undergoes cardiac arrest during anesthesia?

A

Administer a vasopressor

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21
Q

When does hypoventilation occur?

A

When PaCO2 > 45 mmHg

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22
Q

When does hypoxemia occur?

A

SpO2 < 85-90%

PaO2 < 60-80 mmHg

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23
Q

When does hypothermia occur?

A

< 32 deg. C

24
Q

When does hypotension occur?

A

MAP < 60 mmHg

25
Q

Does giving O2 to a hypoventilating animal resolve the hypoventilation?

A

No

26
Q

What are clinical signs associated with respiratory difficulty?

A

Apnea or dyspnea
Increased respiratory rate, depth, or effort
Stridor or sonorous breathing
Cyanosis
Wheezes and crackles
Deformities of head, neck, thorax
Abnormal positioning of head, neck, forelimbs

27
Q

What is extra-pulmonary respiratory inadequacy?

A

Conditions that inhibit air movement into and out of the lungs

28
Q

What is pulmonary respiratory inadequacy?

A

Conditions that inhibit gas exchange within the lung

29
Q

What are common causes of extra-pulmonary respiratory inadequacy?

A

Drug-induced hypoventilation
Upper airway obstruction
Pleural cavity disease
Iatrogenic

30
Q

What are common causes of pulmonary respiratory inadequacy?

A

Parenchymal pulmonary disease

Iatrogenic

31
Q

What are causes of isoflurane-induced hypoventilation?

A

Increase PaCO2

Iatrogenic, extrapulmonary

32
Q

What is the treatment for isoflurane-induced hypoventilation?

A

Improve ventilation

33
Q

What are causes of propofol-induced hypoventilation?

A

Increase PaCO2

Iatrogenic, extrapulmonary

34
Q

What is the treatment for propofol-induced hypoventilation?

A

Improve ventilation

35
Q

What is the cause of laryngeal paralysis?

A

Extrapulmonary

36
Q

What is the treatment for laryngeal paralysis?

A

Bypass obstruction to secure open airway, provide O2 as needed

37
Q

What is the cause of pneumonia?

A

Decreased PaO2
LowV/Q ratio
Pulmonary

38
Q

What is the treatment for pneumonia?

A

Increased FIO2

39
Q

Describe physiologic stunts

A

Dynamic
Low V/Q units
Given 100% O2, PaO2 tends to increase

40
Q

Describe anatomic shunts

A

Static
Venous admixture
Given 100% O2, PaO2 tends to stay the same

41
Q

What is accidental hypothermia common with?

A

Vet anesthesia

42
Q

What is accidental hyperthermia due to?

A

Mainly environment

43
Q

How do animals normally stay warm?

A

Hypothalamus (central thermoregulatory center)
Shivering thermogenesis/voluntary muscle movement/cutaneous vasomotion
Oronasal countercurrent air/blood heat exchanger present in many species

44
Q

What is heat loss during anesthesia due to from most common to least?

A

Radiation (40%)
Convection (30%)
Evaporation (20%)
Respiration (10%)

45
Q

How does hypothermia affect CO? Hyperthermia?

A

Decrease

Increase

46
Q

How does hypothermia affect impulse condition? Hyperthermia?

A

Decrease

Increase

47
Q

How does hypothermia affect contractility? Hyperthermia?

A

+/- or decrease

Increase

48
Q

How does hypothermia affect HR? Hyperthermia?

A

Decrease

Increase

49
Q

How does hypothermia affect PVR? Hyperthermia?

A

+/- or increase

Decrease

50
Q

How does hypothermia affect O2 consumption? Hyperthermia?

A

Decrease

Increase

51
Q

How does hypothermia affect renal/hepatic function? Hyperthermia?

A

Decrease

Increase

52
Q

How does hypothermia affect coagulation? Hyperthermia?

A

Decrease

Increase

53
Q

How does hypothermia affect cerebral protection? Hyperthermia?

A

Increase

Decrease

54
Q

What happens to MAC for each degree C under 37C?

A

Decreases 5%

55
Q

Does the anesthetic requirement for febrile patients increase or decrease?

A

Increase

56
Q

How can high IV fluid rate lead to worsened outcomes?

A 
Increase lung water; decrease pulmonary function
Increase body weight
Coagulation defects
Reduced gut motility
Reduced tissue oxygenation
Increased infection rate
Decreased PCV, TP, body temperature
57
Q

How do you treat hypotension?

A

Decrease anesthetic depth
Give IV crystalloid bolus
Give colloid
If patient is normovolemic, use a vasopressor

Anesthesiology (27 decks)

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