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Anesthesiology > Monitoring the anesthetized patient (E1) > Flashcards

Monitoring the anesthetized patient (E1) Flashcards

1
Q

What is the best equipment for monitoring the patient?

A

YOU YOU BIG JABRONEE

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2
Q

What do we monitor when anesthetizing a patient?

A 
anesthetic depth 
body temperature 
circulation 
ventilation 
oxygenation (circulation and ventilation combo)
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3
Q

What are the three most important aspects to monitor?

A

Oxygenation
Circulation
Ventilation

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4
Q

What do we look at to monitor anesthetic depth?

A 
Eye position 
Reflexes 
Muscle relaxation 
Movement 
EtCO2
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5
Q

What is the eye position for a properly anesthetized dog, cat, or calf?

A

Rolls ventrally; unmoved means they are too heavy/light

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6
Q

What is the eye position for a properly anesthetized horse?

A

WHO KNOW! Unreliable.

Nystagmus/tearing = too light

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7
Q

What are some reflexes we test?

A

Palpebral
corneal
Withdraw

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8
Q

T/F The corneal reflex should be absent in a properly sedated patient

A

NO! This means they’re dead

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9
Q

How do you test the palpebral reflex for dogs/cats? Horses? What do you see for each?

A

Dogs: tap medial canthus; absent
Horse: brush cilia, slow closure of eye present

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10
Q

What drug can cause the jaw to tighten when administered?

A

Ketamine

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11
Q

What is MAC and why is it important?

A

Minimum alveolar concentration; the concentraiton of inhalant in the lungs needed to prevent movement in 50% of patients

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12
Q

A low MAC means what?

A

The drug is very potent

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13
Q

What is key about MAC x 1.5?

A

95% of patients are anesthetized at this level

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14
Q

What is the MAC of Isoflurane for dogs/cats/horses

A

Dogs: 1.28%
Cats: 1.63%
Horses: 1.3%

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15
Q

What is the MAC of sevoflurane for dogs/cats

A

Dogs: 2.3%

Cats: 2.6%

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16
Q

What can we measure that represents the level of anesthetic in the brain of patients?

A

End tidal concentration

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17
Q

normal respiration is controlled by what?

A

Arterial levels of CO2

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18
Q

EtCO2 is usually how much lower than PaCO2?

A

3-5 mmHg

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19
Q

EtCO2 should be kept below what when anesthetized?

A

60 mmHg; 40 mmHg in normal patients

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20
Q

Delivery of O2 to tissues can be calculated how?

A

CO x Oxygen content of blood (CaO2)

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21
Q

T/F Capillary refill time is key tool to assess anesthetic depth

A

FALSE; would never run this test in an anesthetized patient

22
Q

T/F Pulse pressure is a good indicator for Mean arterial pressure

A

FALSE

Pulse pressure is SAP-DAP
this difference can be affected by drugs ie Ketamine- causes weak pulse but the Mean Pressure is still high

23
Q

What is the gold standard of blood pressure monitoring?

A

Arterial catheter

24
Q

What are the two ways we can indirectly measure blood pressure?

A

Doppler

Oscillometric

25
Q

Carbon dioxide is directly linked to a patient’s:

A

metabolism, perfusion, and ventilation

26
Q

Minute ventilation can be calculated by what? Is it a good indicator of ventilation?

A

Tidal volume X frequency

NO

27
Q

What is the most useful tool to detect apnea and hypoventilation

A

End tidal CO2

28
Q

The measure of pCO2 is called what?

A

Capnography

29
Q

What are the two different ways to measure pCO2? (location of the sensor)

A

Mainstream: measurement device is between ET tube and breathing circuit

Sidestream: sampling device is between ET tube and breathing circuit

30
Q

What is the key consideration when using the sidestream sampler?

A

Low flow rates; could pull all the O2 out of the system

31
Q

What are some causes of high EtCO2?

A

Hypoventilation, fever, increased CO, exhausted soda lime

32
Q

What are some causes of low EtCO2?

A

hypothermia, DEcreased CO, hyperventilation, patient disconnect

33
Q

What is a decrease in PaCO2 classified as? Increase?

A

Respiratory alkalosis

Respiratory acidosis

34
Q

Pulse oximetry is a good way to measure what?

A

Pulsatile arterial blood in tissue bed

35
Q

Where would the ideal SpO2 be for an anesthetized patient? What is a danger level?

A

Ideal is 93-95%

Less than 90% is at risk for hypoxemia

36
Q

How can PaO2 be estimated?

A

SpO2 - 30;

37
Q

T/F PaO2 is most helpful when the patient is breathing room air or transitioning

A

TRUE

we dont use this measurement for patients under general anesthesia

38
Q

T/F Dark pigmented skin can affect a pulse oximeter reading

A

TRUE

39
Q

Cats can experience hyperthermia when given what class of drugs?

A

Opioids

40
Q

Intermittent positive pressure ventilation should be used when:

A

Intra-thoracic surgery
Head trauma/brain tumor
All horses

41
Q

T/F You always wean horses from IPVV?

A

FALSE; never wean them unless brain surgery/ head trauma you would decrease the inhalant

42
Q

What are the two ways to wean a patient from IPVV?

A

Lower respiratory rate to increase PaCO2

Discontinue inhalant to decrease CO2 set point in brain

43
Q

What strategy for weaning would you use for a patient presenting with a head trauma or tumor?

A

ONLY Decrease the inhalant

NEVER lower the resp rate

44
Q

T/F

Anesthetics are dose dependent cardio vascular and respiratory depressants, and as such need to be titrated to the lowest effective concentration

A

TRUE

45
Q

A horse wakes up in the middle of Sx right after you just checked for a palpebral reflex (which was absent) what most likely happened, and what should you have noticed prior to the animal waking up?

A

Horse is on its back isnt it? Swelling of the head during surgery will depress the reflex

you should have noticed nystagmus or tearing which are both indication of a light plane of anesthesia in horses

46
Q

You should begin anesthesia with a _____ flow rate and then switch to ____

A

High flow rate

lower/maintenance rate, remember we titrate back

47
Q

____ is the KEY to patient survival

A

DO2- delivery of Oxygen to tissues

48
Q

What is the threshold for Pulse rate of Dogs/Cats?

A

> 60 in dogs

> 80 in cats

below is considered bradycardia

49
Q

Accuracy of oscillometric machines is dependent on ____; if it is too small the machine will ____ BP; if too big the machine will ___ BP

A

Cuff size

too small -> overestimate

too big -> under estimate

50
Q

T/F

A arterial catheter is placed in all surgeries involving cattle or horses

A

TRUE

51
Q

T/F

The sole benefit of using a pulse oximeter is that it calculates the SpO2 of the blood in the peripheral tissues, which is directly correlated with lung function

A

FALSE

Pulse ox tells you jack shit about lung function, it one of the limiting things about it.

Anesthesiology (13 decks)

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