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Anesthesia > Monitoring during Anesthesia > Flashcards

Monitoring during Anesthesia Flashcards

1
Q

What do you need to know?

A

what is normal

how old is the patient?

species?

what drugs did the patient recieve?

what is the procedure?

what is normal for this specific patient?

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2
Q

what do we monitor?

A

CNS

CVS

respiratory

renal

temperature

other? -case dependent

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3
Q

CNS monitoring

A
  • need to maintain good anesthetic depth
  • check for reflexes:
    • eye (palpebral, corneal, nystagmus, lacrimation)
    • jaw tone
    • anal reflex
    • pedal reflex
  • EEG and other monitoring not used regularly
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4
Q

evaluating plane of anesthesia:

A
  • species and individual variations
  • position of eye
  • movement
  • muscle tone
  • certain reflexes
  • response to surgical stimulation
  • nystagmus (usually in horse)
  • shivering (light)
  • eye reflexes present
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5
Q

light plane of anesthesia

A
  • central eye position
  • cessation of limb movements
  • muscle tone remains
  • response to surgical stimulation (either movement or breathing/hemodynamic response)
  • nystagmus (horse)
  • eye reflexes present
  • shivering
  • moist cornea
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6
Q

medium plane of anesthesia (goal)

A
  • no spontaneous movement
  • no reflex movement
  • no change in hemodynamic or breathing in response to surgical stimulation
  • moderate muscle tone
  • decrease in tidal volume
  • no palpebral reflex
  • no shivering
  • ventromedial rotation of the eye
  • small pupil aperture
  • moist corneas
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7
Q

deep plane of anesthesia

A
  • decrease in tidal volume
  • abdominal breathing may be noted
  • eyes fixed centrally
  • no pedal reflexes
  • no spontaneous or reflex movement
  • bradycardia/hypotension and worsening of hemodynamic function
  • no palpebral and corneal reflex
  • dilated pupil
  • dry cornea (dead…)
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8
Q

CV monitoring

A

maintain perfusion to body organs and maintain a normal rhythm and rate

use clinical skills as well as specific equipment to monitor HR, BP, etc

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9
Q

evaluating mucous membranes

A
  • pale pink/pink: normal
  • white/pale: anemia, vasoconstriction, lack of circulating fluid
  • cyanosis: lung disease, decrease in oxygen flow to the breathing circuit, endobronchial intubation
  • red/bright pink: hypercapnia
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10
Q

evaluating CRT

A
  • the time it takes for blood flow back into the capillary bed after it is manually compressed with a digit of the anesthetist
  • may be deceptive in determining peripheral perfusion: may refill from engorged veins as well as arteries
  • normal < 1-2 seconds
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11
Q

evaluation of pulse

A
  • information about the rate, rhythm and pulse quality
  • subjective
  • SA: lingual, femoral and digital
  • LA: facial, transverse facial, digital arteries
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12
Q

equipment/techniques used to monitor CVS

A
  • esophageal stethoscope
  • ECG
  • BP monitoring
  • pulse ox
  • central venous pressure
  • urine output
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13
Q

esophageal stethoscope

A
  • blind-ended tube that is passed into the esophagus at the level of the heart and is connected to ear pieces to which you can listen to
  • can evaluate rhythm, rate
  • cannot evaluate adequacy of circulation
  • can be annoying to the anesthetist
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14
Q

ECG

A
  • electrical activity of the heart
  • heart rate and rhythm
  • not good for evaluation cardiac function or disease
  • placement of leads
    • LA-lead I
      • RA-right jugular farrow
      • LA- ventral midline under heart apex
      • RL- any site remote from heart
    • LA-lead II
      • RA-right elbow
      • LA-left elbow
      • LL-left stifle or abdomen
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15
Q

common arrhythmias

A

sinus tachycardia

sinus bradycardia

second degree AV block

VPCs

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16
Q

normal HR for different species:

A

dog 70-140

cat 110-140

horse 30-45

cattle 60-80

sheep 70-130

goat 90-160

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17
Q

BP monitoring

A
  • maintain adequate perfusion to the vital organs
  • a mean BP should be maintained above 60 mmHg (70 in horses)
  • two methods:
    • direct
    • indirect
18
Q

direct BP

A
  • provides real time beat by beat pressure monitoring
  • invasive: place an arterial catheter which is connected to tubing then to a pressure transducer
  • aseptic technique when placing arterial lines
  • hematoma formation common
  • arteries used:
    • dogs: femoral, dorsal pedal
    • cats: dorsal pedal, tail
    • horse: facial arteries, transverse facial, great metatarsal
    • cattle: middle coccygeal, median auricular
    • sheep/goat: median auricular artery
19
Q

indirect BP monitoring

A
  • sphymomanometry
  • occlusion of artery by inflatable cuff and return of BF distally to the cuff as the pressure of the cuff is reduced
  • when pressure is reduced, 1st sound heard is systolic P
  • cuff measure at which BF ceases to increase with decreasing cuff P is diastolic P
  • stethoscope, doppler pulse detectors
  • systolic should be > 80 mmHg
20
Q

why is cuff size important when measuring BP?

A

width of cuff should be ~40 % of circumference of limb

bigger width than circumference: underestimate BP

smaller width than circumfrence: overestimate BP

too tight: underestimate

too loose: overestimate

21
Q

oscillometric method

A
  • cuff is inflated to a pressure and pressure is slowly released as the monitor detects the oscillations in the cuff caused by BF under cuff
  • as pressure decreases, there is an increase in BP and oscillations
    • systolic: rapid increase in amplitude of oscillations
    • mean: lowest cuff pressure at which maximum oscillation occurs
    • diastolic: rapid decrease in oscillation after max oscillation
  • MAP > 60 mmHg
22
Q

measuring cardiac output

A
  • invasive method (thermodilution)
  • requires special and expensive equipment
  • not used routinely
  • CO = SV x HR
23
Q

pulse oximetry

A
  • arterial oxygen saturation
  • heart rate monitoring
  • placed on tongue, ears, digits
  • measures light absorption of two different wavelengths at fast intervals during pulsation
  • detects reduced hemoglobin and oxyhemoglobin
  • sensitive to movement, cold, vasoconstriction
  • should be maintained >95%
24
Q

at what percent do you consider the patient to be hypoxemic?

A

<90%

25
Q

central venous pressure

A
  • pressure within the thoracic vena cava
  • balance between venous blood volume and contractility of the heart
  • decreased CVP = hypovolemia
  • increased CVP = fluid overload
  • normal
    • SA: 2-7 cmH2O
    • LA: 15-25 cmH2O
26
Q

urine output

A
  • dependent on CO, blood volume, and renal function
  • not used often in anesthesia
  • need to catheterize in order to quanitify
  • normal 1-2 mL/kg/hr
27
Q

monitoring respiratory system

A
  • maintain oxygenation and remove CO2
  • respiratory rate
  • chest excursions
  • abdominal effort
  • tidal volume can be subjectively evaluated based on movement of rebreathing bag and thoracic excursions
  • monitor MM color
28
Q

normal respiration rates

A

dog 10-30

cat 24-42

horse 8-15

cow 12-35

sheep 15-40

goat 15-25

pig 10-45

29
Q

equipment/techniques for monitoring respiration

A

ventilometer/respirometer

blood gas analysis

capnograph

pulse ox

30
Q

ventilometer/respirometer

A

measures the tidal volume and minute volume of the patient

normal tidal volume 10-15 mg/kg

creates dead space, can accidentally extubate patient

31
Q

blood gas analysis

A

measures levels of oxygen and CO2 in arterial blood

provides acid-base status

can also measure electrolytes/glucose/lactate

32
Q

capnography

A
  • measures the end tidal CO2 and the inspired CO2 tension
  • connected between the patient and the breathing system
  • provides info on: adequacy of ventilation, CVS, patient’s metabolism
  • useful to measure: hypoventilation, hyperventilation, apnea, disconnection, rebreathing, obstruction, embolism
33
Q

phases of capnogram

A

Phase I: inspiratory baseline

Phase II: expiratory upstroke

Phase III: expiratory plateau

Phase IV: inspiratory downstroke

34
Q

Phase I

A
  • inspiratory baseline
  • represents the inspiration of fresh gas with CO2
  • the baseline should stay at the level that corresponds to zero concentration (mmHg) of CO2
  • normal end tidal CO2 = 35-45
35
Q

Phase 2

A
  • expiratory upstroke
  • occurs shortly after the inspiration ends
  • upstroke is caused by the rapid washing out of the fresh gas in the anatomic space and then replacement by CO2-rich alveolar gas
  • should be steep
36
Q

Phase 3

A
  • expiratory plateau
  • represents continuous exhalation
  • line will be perfectly horizontal if ventilation and perfusion were perfectly matched
  • however, ventilation and perfusion are not perfectly matched
  • this results in CO2 slowlly increasing as the gas from the lung areas with lower ratio of ventilation to perfusion reaches the sampling site
37
Q

phase 4

A
  • inspiratory downstroke
  • occurs shortly after expiration ends and represents the rapid washing out of the CO2 by fresh gas as inspiration starts
  • should be steep
38
Q

pulse ox to monitor respiratory system

A

lower oxygen tension means lower arterial oxygen saturation

will also see low saturation with pulmonary embolism

39
Q

body temperature

A
  • hypothermia and hyperthermia should be avoided
  • thermistor/thermocouple inserted into the esophagus (core temp)
  • can use a rectal thermometer
  • maintain >94 deg F
  • rule out malignant hyperthermia in pigs
40
Q

anesthetic complications due to hypothermia:

A

decrease in anesthetic requirements

not responding to anticholinergics

prolonged recovery

cardiopulmonary depression

Anesthesia (14 decks)

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