Patient Evaluation and Preparation

Question 1

who should preform the preanesthetic evaluation?

Answer 1

the clinician who refers the patient - comunicate results with anesthetist

Question 2

what should the anesthetist do?

Answer 2

read all patient related documentation

personally examone the patient

request/perfomr additional tests if necessary

make anesthetic plan

Question 3

it is misconduct not to….

Answer 3

examine the patient yourself before anesthesia

ALWAYS: see, touch, and auscultate

Question 4

parts of preanesthetic examination

Answer 4

signalment

history

physical exam

laboratory examinations

advanced diagnostics

Question 5

Species and breed specific conditions: Doberman Pinschers

Answer 5

Von Willebrands Dz

DCM

Question 6

Species and breed specific conditions: Miniature Schnauzers

Answer 6

Sick Sinus Syndrome

Question 7

Species and breed specific conditions: Pugs

Answer 7

Brachycephalic Syndrome

Question 8

Species and breed specific conditions: Quarter Horses

Answer 8

Hyperkalemic Periodic Paralysis (HYPP)

Question 9

Species and breed specific conditions: Rabbits

Answer 9

have atropine estherase

(used Glycopyrrolate instead)

Question 10

the history can provide information about:

Answer 10

previous - trauma, Dz, Sx, anesthetic events/ complications, vax

current (or recent) - symptoms, medications, feeding

Question 11

current medications that can interfere with anesthesia

Answer 11

liver microsomal enzyme activity - inducers (phenobarb, phenytoin); inhibitors (cimetidine)

NSAIDS - nephrotoxicity

ACE inhibitors - hypotension

chemotherapeutics - toxicitiy

Question 12

what should you be checking to assess ventilation

Answer 12

rate, regularity, effort, thoracic auscultation

palpate the larynx and trachea (intubation) - this also helps to estimate ET tube size

Question 13

what do you check to asses oxygenation

Answer 13

mucous membrane color

Question 14

whats the difference between oxygenation and ventillation

Answer 14

ventillation - act of moving air in an out and the removal of CO2

oxygenation - refers to gas exchange, amount of O2 in the arterial blood

Breathing does not mean they are oxygenating!

Question 15

what is CRT an indicator of

Answer 15

peripheral perfusion

Question 16

normal CRT

Answer 16

1-2 sec

Question 17

increased CRT

Answer 17

<1 sec

may indicate hyperdynamic state and vasodilation (also bright red mm)

associated with sepsis, distributed shock, hyperthermia

Question 18

prolonged CRT

Answer 18

may indicate decreased peripheral perfusion

associated with shock and dehydration

Question 19

T/F CRT is important to examine but it is not considered to be a very specific test

Answer 19

True

other influential factors: vasodilation, strength of compression, site tested

Question 20

normal mucous membranes are:

Answer 20

pink and moist (may be pigmented)

Question 21

pale mucous membranes can indicate

Answer 21

anemia, vasoconstriction, hypovolemia

Question 22

brick red mucous membranes can indicate:

Answer 22

hyperdynamic status (e.g. sepsis)

Question 23

petechial bleeding can indicate

Answer 23

thrombocytopenia, thrombocytopathy

Question 24

yellow mucous membranes can indicate

Answer 24

icterus, hyperbilirubinemia

Question 25

clinical signs: \<5 % dehydration

Answer 25

not detectable

Question 26

clinical signs: 5-6 % dehydration

Answer 26

subtle loss of skin elasticity

Question 27

clinical signs: 6-8% dehydration

Answer 27

definite delay in return of skin to normal position slightly prolonged CRT eyes possibly sunken possible dry mucous membranes

Question 28

clinical signs: 10-12 % dehydration

Answer 28

tented skin stands in place definite prolonged CRT eyes sunken in orbits dry mm. possible signs of shock

Question 29

clinical signs: 12-15% dehydration

Answer 29

definite signs of shock - tachycardia, cool extremities, rapid and weak pulses death imminent

Question 30

T/F preanesthetic laboratoary examinations should be less than 1 week old

Answer 30

**True**

Question 31

general recommendations for healthy \<2year old small animals

Answer 31

PCV, TP, glucose, BUN canine: CBC becuase of the platelet related tick born diseases

Question 32

general recommendations for sick and old patients

Answer 32

CBC Chem U/A tests for specific cases: BMT, coag, etc

Question 33

advanced diagnostics

Answer 33

ECG, Radiography, U/S, BP

Question 34

T/F: a physical status classification should be done aafter patient evaluation is complete

Answer 34

**True** proposed by the ASA (American Society of Anesthesiologist)

Question 35

ASA - I

Answer 35

healthy animal, no systemic disease age is not a disease!

Question 36

ASA - II

Answer 36

mild systemic disease (no functional impact) mild anemia or fever, pregnancy, obesity, diabetes mullitus controlled by insulin

Question 37

ASA - III

Answer 37

Moderate or severe systemic disease morbid obesity, heart disease (moderate), some colic horses

Question 38

ASA - IV

Answer 38

severe systemic disease that is a constant threat to life (can die at any moment) emergency colic Sx, GDV, congestive heart failure, sepsis, shock, actively hemorrhaging splenic tumor

Question 39

ASA - V

Answer 39

Moribund patient that is not expected to survive 24 hours with or without surgery (these animals are normally euthanized- more for human med) - end stage of shock, multiple organ/system dysfunction massive trauma

Question 40

emergency patients are give a physical status classification of:

Answer 40

**E**

Question 41

Low risk

Answer 41

ASA - I and II no limitations in organ function

Question 42

moderate risk

Answer 42

ASA - III some limitation in organ function

Question 43

high risk

Answer 43

ASA - IV and V severe limitations in organ function

Question 44

the risk of the procedure depends on:

Answer 44

risk of anesthesia risk of surgery

Question 45

risks of anesthesia include:

Answer 45

physical staus of patient skills of anesthestist anesthestic techniques duration of anesthesia peri-operative care

Question 46

risks of surgery include

Answer 46

type of surgery skills of the surgeon blood loss

Question 47

indications for pre-anesthetic fasting

Answer 47

decreased food and fluid in stomach decreased risk of aspiration distended stomach (rumen) impairs ventilation and gas exchange horses - full stomach may rupture at induction

Question 48

reflux

Answer 48

open lower esophageal sphincter, gastric content enters the esophagus - invisible, silent reflux is very common during anesthesia

Question 49

regurgutation

Answer 49

**passive** discharge of gastric content from the mouth

Question 50

vomitting

Answer 50

**active** process (projectile)

Question 51

T/F feeding small amounts of wet food prior to anestheia could decrease the occurrence of reflux and increase gastric pH

Answer 51

**True**

Question 52

how long should healthy dogs and cats be fasted

Answer 52

8-12 hours except: very young, diabetes mellitus, other severe disease

Question 53

who should not be fasted

Answer 53

rabbits and rats - don't vomit, no need to fast small birds **suckling youngsters!!**

Question 54

T/F pre-anesthetic water deprivation is normally not needed

Answer 54

**True** may be needed in ruminants to decrease ruminal content

Question 55

dont forget to obtain...

Answer 55

**Signed owner consent form!!**