New Final Exam Material Flashcards
Aggressive fluid replacement, regular insulin therapy, dextrose and K supplementation are required before emergency anesthesia for which condition?
Diabetic ketoacidosis
When should surgery be scheduled for a diabetic patient?
First thing in the morning
How much insulin should be given on surgery morning?
1/2 the normal dose
What is your main concern before induction in terms of glucose?
Hypoglycemia- this is because you have fasted the patient and also given some insulin, so they may have a shortage of glucose in circulation
This class of drugs can cause hyperglycemia via inhibition of insulin release or stimulation of glucagon release.
Alpha-2 agonists: SHOULD NOT BE GIVEN TO DIABETIC PATIENT
How often should you check BG during surgery with a diabetic patient?
q. 30-60 minutes
What is your goal BG level during anesthesia for a diabetic patient?
150-250 mg/dl
T/F: In a patient with an insulinoma, you should give frequent glucose supplementation.
FALSE- your patient is used to low BG, don’t overdo it.
What is the main concern we worry about with an insulinoma patient?
Hypoglycemia
What are the two types of diabetes insipidus and what is the difference?
Central DI and Nephrogenic DI
Central: ADH deficiency
Nephrogenic: Kidney doesn’t respond to ADH
What is our main concern with DI?
Sodium content
Why is it important that you never restrict water from a DI patient?
They will become hypernatremic
What is an underlying disease that is often seen with hyperthyroid patients?
Renal disease is often unmasked when hyperthyroid patients are treated
What is the best drug that can be used to treat symptoms of a thyroid storm?
B-blocker- thyroid storm initiates catecholamine release
What are some drugs that should be avoided in hyperthyroid patients?
Ketamine, routine anticholinergics, ACP, and alpha-2 agonists
What medications should be used to manage HR in hyperthyroid patients?
Opioids and benzodiazepines
What is the primary concern for Addison’s pre-op?
Blood glucose and electrolytes
What drug should you avoid with Addison’s patients?
Etomidate- causes adrenocortical suppression
What is an important consideration post-op for Addison patients?
Restart chronic PO steroids ASAP
What are the common clinical issues for hyperadrenocorticism?
Hypertension, hypercoagulability, hepatomegaly, poor immune function and wound healing
What is a tumor of the adrenal medulla that releases epinephrine and norepinephrine?
Pheochromocytoma
What drug is used to stabilize BP and HR several weeks pre-op for pheocromocytoma removal?
Phenoxybenzamine
What drugs should be avoided in patients with pheochromocytoma due to the tachycardia and vasoconstriciton effects?
Ketamine, Alpha-2 agonists and pre-anesthetic atropine
What is an important side effect to remember once the pheochromocytoma has been removed?
Sudden drop in catecholamines- bradycardia and hypotension
What is the main side effect of anesthesia on the kidneys?
Decrease GFR and RBF w/ dose-dependent fashion
Why should ketamine be avoided in cats with renal failure?
This drug requires renal excretion
Why should NSAIDs be avoided in renal failure patients?
Decrease prostaglandin production- renal ischemia
What should be the maintained MAP for a renal failure patient intra-op?
70-80 mmHg
What conditions need to be stabilized in a cat with urethral obstruction?
Hyperkalemia (Ca gluconate) and hypovolemia (isotonic IV fluids)
What is the cushing reflex?
Severe increase ICP –> poor cerebral perfusion –> SNS response –> hypertension –> reflex bradycardia –> irregular breathing pattern
What are your two treatment choices for decreasing ICP?
Mannitol and hypertonic saline
T/F: Vomiting increases ICP
True- this is why opioids can be a problem with brain injury patients
Which class of drugs are relatively safe for brain injuries (minimal CBF and ICP effects)?
Alpha-2 agonists
Which injectable anesthetics are safe for ICP?
Propofol, etomidate and alfaxalone
Which injectable anesthetic is contraindicated for increased ICP?
Ketamine- increases ICO and CBF
T/F: All volatile anesthetics at >1 MAC increase CBF and ICP via cerebral vasodilation
TRUE
Which anesthetic gas has the largest effect on ICP?
Halothane- don’t use for neuro patients
When is mannitol given if you suspect increased ICP?
BEFORE induction
What are some factors that increase anesthetic risk with liver disease patients?
Low albumin –> ascites
Decreased coag factors –> excessive hemorrhage
Decreased gluconeogenesis –> hypoglycemia
Increased ammonia –> encephalopathy
Which drug class may worsen signs of hepatic encephalopathy?
Benzodiazepines
Which fluids are not recommended for liver diseased patients?
LRS- lactate requires hepatic metabolism
What drugs are contraindicated for liver disease patients?
ACP (inhibits platelet aggregation), alpha-2 agonists, barbiturates (protein bound), halothane (decreases hepatic blood flow), succinylcholine, guaifenesin
What occurs with reperfusion of compromised tissue in the GI tract?
Release of inflammatory mediators –> vasodilation, decreased inotropy, ventricular arrhythmias
What is the most common form of megaesophagus in dogs?
Acquired idiopathic
What is the main concern of megaesophagus?
Regurgitation
Why should you avoid prolonged fasting with megaesophagus patients?
These patients are bound to throw up, so if there is no food in the stomach-the gastric material will be more acidic and damage the esophagus
Which induction agent should be used because of rapid induction?
Propofol
What is the most common cause of hemoabdomen (not trauma related)?
Secondary to hemangiosarcoma
Why should you not resuscitate a patient with a hemoabdomen to normal awake BP?
Can disrupt clots that have formed
What cardiac dysfunction is commonly observed in patients with splenic disease?
Ventricular arrhythmias- LIDOCAINE
What are some biochem abnormalities seen with GI foreign body?
Hypochloremic metabolic alkalosis
What is a common concern with a GDV patient?
Hypotension
Which drug can be used in mesenteric volvulus patients as a free radical scavenger?
Lidocaine
