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RUSVM Anesthesiology > Patient Monitoring During Anesthesia > Flashcards

Patient Monitoring During Anesthesia Flashcards

1
Q

what is the motto of anesthesia

A

Vigilance!!

expresses the need for quick recognition of a problem

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2
Q

why monitor?

A

provide better patient care (early Dx and Tx)

prevent mortality and morbidity

protect the anesthetist (records!)

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3
Q

how often should you monitor?

A

ideally a responsible person is always available

monitor and record the results every 5 minutes

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4
Q

what 4 main things should be monitored

A

circulation

oxygenation

ventilation

temperature

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5
Q

common methods for monitoring circulation

A

mucous membrane color, CRT

palpation of pulse

ascultation of heart beat

ECG

blood pressure - recommended for all patients

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6
Q

when palpating the pulse, assess:

A

rate, rhythm and quality

subjective measure of adequacy of CO

NOT a surrogate for BP

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7
Q

T/F pulses at different sites may feel different

A

True

varible soft tissue coverage

variable distance from the heart

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8
Q

which artery is affected earlier by hypotension and low CO?

A

Distal artery/dorsal metatarsal

if it feels strong than it likely indicates good CO

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9
Q

common pulse palpation sites in small animals

A

labial

digital

dorsal pedal

metatarasal

femoral

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10
Q

pulse palpation sites in large animal

A

auricular

transverse facial

facial

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11
Q

ausculation of the heart assess:

A

heart sounds, rate and rhythm

respiratory sounds and rate

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12
Q

T/F the ECG does not indicate that the heart is contracting

A

True!

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13
Q

clinical uses of ECGs

A

determine heart rate and rhythm

aid in Dx and Tx of electrolyte disturbances (Hyperkalemia)

Dx chamber enlargement

may provide clues about myocardial oxygenationa dn perfusion abnormalities and location of certain cardiac disease

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14
Q

Mammalian type A conduction system

A

small animals

purkinjie fibers excite the endocardium only

base to apex current flow

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15
Q

Mammalian type B conduction system

A

horses, ruminants, pigs

purkinje fibers penetrate the myocardium

apex to base current flow

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16
Q

which lead is preferred in small animals

A

lead II

yeilds tallest R-wave

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17
Q

which lead is perferred in large animals

A

lead I

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18
Q

T/F you may need to be creative with ECG lead placement

A

True

surgical prepartation may prevent standard electrode placement

ECG traces that look normal will suffice for anesthesia

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19
Q

T/F ECG gel or saline can be used for elextrode contact but not alcohol

A

True

alcohol may ignite if patient had to be defibrillated, poor conductor of electricity

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20
Q

what is the most clinically relevant information gained from the ECG

A

heart rate

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21
Q

T/F normal HR and strong pulse indicates adequate cardiac output even if not sinus rhythm

A

True

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22
Q

what is the best way to dertermine HR

A

count yourself while looking at watch

asculate, palpate pulse, listen to doppler

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23
Q
A
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24
Q

what can effect HR/PR given by the ECG and pulse oximeter

A

bad signal quality

double counting

uneven HR (signal is averaged over time)

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25
Q

what are common arrhythmias under anesthesia

A

sinus bradycardia and tachycardia

AV blocks (1st and 2nd degree)

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26
Q

what can prevent/ reduce runs of V-tach while under anesthesia

A

phenoxybenzamine pretreatment

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27
Q

what happens to blood pressure when HR is high

A

plummets

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28
Q

when should you treat ventricular arrythmias under anesthesia

A

if there is severe underlying heart disease

risk of sudden death

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29
Q

when might you consider treating ventricular arrhythmias

A

severe systemic disease

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30
Q

if a patient has ventricular arrhythmia with moderate systemic disease or trauma should you treat the arrhythmia

A

only if it affects hemodynamics

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31
Q

what is the first line of Tx for ventricular arrhythmias

A

Lidocaine IV

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32
Q

what does blood pressure monitoring depend on

A

where and how it is measured

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33
Q

how does the BP signal change as move from central to periphery

A

systolic becomes higher

diastolic becomes lower

mean remains similar

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34
Q

systolic pressure on the BP waveform

A

highest point of BP curve

represents afterload for the left ventricle

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35
Q
A
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36
Q

mean pressure on the BP waveform

A

aver BP over a full cycle

determinant of tissue perfusion

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37
Q

diastolic pressure on BP waveform

A

lowest point of the BP curve

determinant of mycoardial perfusion

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38
Q

mean and systolic that indicate hypotension in small animals

A

Mean: <60

Systolic: <80

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39
Q

mean and systolic that indicate hypotension in large animals

A

Mean: <70

Systolic: <90

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40
Q

how should you treat hypotension under anesthesia

A

decrease anesthetic administration

give fluid bolus

give drugs (inotropes or vasocontrictors)

41
Q

what other things does a BP measurement yeild

A

heart rate

BP changes with respiration: indicate hypovolemia

waveform: info about inotropy, CO and effect of arrhythmias

42
Q

how can BP be calculated

A

BP= (HR x SV) x SVR

SV: depends on the preload and contractility; preload depends on circulating volume

CO=HR x SV

43
Q

what are the 4 crucial elements of CV function

A

HR (and rhythm)

contractility

Circulating volume

Vasconstriction

**these elements must be normal, not maximal**

44
Q

what is the gold standard for measung BP

A

Invasive (direct): continuously via arterial catheter

45
Q

what are the most common types of non-invasive (indirect) BP measurement

A

oscillometric and doppler

intermittently use a pressure cuff

46
Q

how do you measure IBP

A

insert catheter into an artery

connect to saline filled rigid tubing

connect transducer to a monitor

ensure that blood does not clot in the catheter (flush it)

47
Q

IBP shoudl be used in horses if they are anesthetized for longer than:

A

45 min

48
Q

which arteries can be used for IBP in a dog

A

dorsal pedal, metatarsal

49
Q

which arteries can be used for IBP in a cat

A

dorsal pedal, coccygeal

50
Q

which arteries can be used for IBP in a horse

A

facia, transverse facial, digital

51
Q

which arteries can be used for IBP in a cattle

A

auricular

52
Q

which arteries can be used for IBP in sheep and goats

A

median

53
Q

where should the BP transducer be positioned

A

point of the shoulder in dorsal recumbency

point od sternum in lateral recumbency

54
Q

what is oscillometric NIBP

A

arterial blood flowing under an inflated cuff generates pressure flucuations in the cuff that is detected by the monitor

55
Q

what is doppler NIBP

A

an inflated cuff is placed over an artery

blood flow is detected distally from the cuff using a Doppler flow probe

after complete occulsion of lfow, cuff pressure is slowly decreased

pressure where blood flow reappears is systolic BP

56
Q

how wide should the BP cuff be

A

40% of the circumference of the limb

57
Q

cuff placement in small animals

A

distal radius

distal tibia

metatarsus

58
Q

cuff placement in large animals

A

metacarpus, tail

59
Q

what is an advantage of oscillometry

A

provides systemolic, mean and diastolic BP

60
Q

what is the main disadvantge to oscillometry

A

if patient arrest in between readings you may not know

61
Q

if you can only afford a single anesthesia monitor you should choose:

A

a doppler

62
Q

how is oxygenation measured

A

by pulse oximeter or blood gas

63
Q

what is hypoxemia

A

reduction of oxygenation of arterial blood

(reduction of PaO2, SaO2 or Hb content)

64
Q

a patient is considered hypoxemic when

A

PaO2 < 60 mmHg

SaO2 < 90%

65
Q

PaO2 and SaO2 should always be interpreted in light of:

A

inspired O2 fraction (FiO2)

66
Q

a healthy air breathing animal should have a SaO2 of

A

>95%

67
Q

what should SaO2 be if the animal is breathing pure O2

A

>98%

68
Q

what can affect the results of a pulse oximeter

A

hypoperfusion

pigmentation

movement

abnormal Hb - CO poisoning, methemoglobinemia

69
Q

when is it important to use a pulse oximeter

A

patient is breathing room air

there is V/Q mismatch

there is respiratory disease

70
Q

what is ventilation defined by

A

PaCO2

process involved in the movement of air (gas) in and out of the alveoli

71
Q

what is the normal range for PaCO2

A

35-45 mmHg

72
Q

PaCO2 values >45 can be caused by

A

hypercapnia or hypoventilation

73
Q

PaCO2 values <35 can be caused by

A

hypocapnea or hyperventilation

74
Q

T/F tachypnea does not equal hyperventilation

A

True

there is no reliable correlation between respiratory pattern and PaCO2

75
Q

a capnometer measures

A

only ET CO2

76
Q

what does a capnograph measure

A

ET CO2 vs time on a graph

continuous

77
Q

T/F a capnogram can be an indirect assessment of CO

A

True

especially during CPR - adequate CO is necessary for the transport of CO2 from the tissues to the alveoli

78
Q

what factors influence ET CO2 values

A

CO2 production

circulation

alveolar ventilation

measurement error

79
Q

what is phase I indicative of

A

baseline (inspiration)

80
Q

What is phase II indicative of

A

Expiratory upstroke

81
Q

what is phase III indicative of

A

alveolar plateau

82
Q

what is phase IV indicative of

A

inspiration begins

83
Q

what measurement is indicated by the red arrow (D)

A

ET CO2

84
Q

what pattern is seen here

A

hyperventilation

85
Q

what pattern is seen here

A

hypoventilation

86
Q

what pattern is seen here

A

CO2 rebreathing

87
Q

what pattern is seen here

A

spontaneous breathing during mechanical ventilation

88
Q

what pattern is seen here

A

progressive airway obstruction

89
Q

what pattern is seen here

A

cardiogenic oscillations

90
Q

what pattern is seen here

A

cardiac arrest

91
Q

what can be seen with hypothermia (<96º)

A

decrease in the MAC of the anesthetics (less ISO needed)

CV system may be depressed (bradycardia)

recovery may be prolonged

92
Q

T/F hyperthermia is less common but more serrous than hypothermia

A

True

>102ºF, may damage the CNS

93
Q

how can core body temp be measured

A

esophageal temperature probe entered into mid thorax

94
Q

peripheral body temperature is

A

colder than core temp

pharyngeal, nasal, rectal

95
Q

Tx for hyperthermia

A

find the cause

COOL!! - switch off heatng devices/blankets, decrease room temp, ice packs, ice cold infusions etc

96
Q

T/F anesthetic depth should be determined without reguard to body temp

A

True

it would be misconduct to increase vaporizer dial setting as a “treatment” for hyperthermia

97
Q

what is included in the anesthesia record

A

drug administration (dose, time, route)

monitored variables (HR, RR,) - min every 5 min

98
Q

T/F it is ideal to have personnel that are fully and continuously dedicated for anesthesia care

A

True

99
Q

normal limits under GA

A

check out this super amazing chart!!

RUSVM Anesthesiology (39 decks)

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