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Anesthesia > Patient Monitoring During Anesthesia > Flashcards

Patient Monitoring During Anesthesia Flashcards

1
Q

What are the 4 things we monitor

A

Circulation Oxygenation Ventilation Temperature

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2
Q

Systolic - diastolic pressures = ____

A

Pulse pressure **Not a surrogate for blood pressure

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3
Q

Pulse at different sites may feel different therefore you should examine the ____ at the same site

A

Examine the trend at the same site

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4
Q

Use a _____ artery such as the ____ metatarsal

A

Use a distal artery such as the dorsal metatarsal

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5
Q

Common pulse palpation sites in small animal

A

Labial, digital, femoral, dorsal pedal, metatarsal

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6
Q

Pulse palpation sites in large animals

A

Auricular, transverse facial, facial

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7
Q

Where is the esophageal stethoscope inserted

A

Exactly midline, dorsal to the ET tube, right along palatine raphe

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8
Q

The ECG does NOT indicate that ______

A

ECG does not indicate that the heart is contracting

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9
Q

What can the ECG tell you

A

HR and rhythm Electrolyte imbalances Chamber enlargement May provide clues about myocardial oxygenation and perfusion

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10
Q

P Wave is

A

Atrial depolarization

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11
Q

QRS Complex is

A

Ventricular depolarization

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12
Q

T wave is

A

Ventricular repolarization

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13
Q

Mammalian A Type: Purkinje fibers ____ the _____ only and excitation spreads via muscle fibers

A

Purkinje fibers excite the endocardium only

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14
Q

Mammalian A Type: Generates ____ to ____ current flow

A

Base to apex flow (Positive R Wave)

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15
Q

Who have mammalian A type

A

Humans, small animals

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16
Q

Mammalian B Type: Purkinje fibers _____ the ____ and most of it is excited simultaneously

A

Purkinje fibers penetrate the myocardium and most of the myocardium is excited simultaneously

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17
Q

Mammalian B Type: Generates ____ to ____ current flow

A

Apex to base flow (Negative R Wave)

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18
Q

Who have mammalian B type

A

Horses, ruminants, pigs

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19
Q

White lead goes on the

A

Right arm

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20
Q

Black lead goes on the

A

Left arm

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21
Q

Red lead goes on the

A

Left leg

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22
Q

In healthy small animals lead ___ is yielding the tallest R wave and therefore preferred

A

Lead 2 (white to red)

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23
Q

Lead 1 goes from ___ to ____

A

Lead 1 from white (right arm) to black (left arm)

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24
Q

Lead 2 goes from ____ to _____

A

Lead 2 goes from White (right arm) to Red (left leg)

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25
Q

Lead 3 goes from ____ to _____

A

Lead 3 goes from Black (left arm) to Red (left leg)

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26
Q

Where is the white lead place on the horse

A

Right jugular furrow or withers

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27
Q

Where is the black lead placed on a horse

A

Cardiac apex region

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28
Q

Where is the red lead place on a horse

A

Anywhere else

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29
Q

Which lead is preferred for horses

A

Lead 1 - White to Black (whithers/jugular to cardiac apex)

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30
Q

On the horse lead 1 has a ___ R wave

A

Negative

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31
Q

What two substances can you use for electrode contact

A

ECG gel or saline

***NOT ALCOHOL

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32
Q

What are the two common arrhythmias seen under anesthesia

A

Sinus bradycardia/tachycardia

AV blocks (1st and 2nd)

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33
Q

What is this, what caused it and how can it be prevented

A

V Tach in a dog with pheochromocytoma

Prevented with phenoxybenzamine pretreatment

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34
Q

What does V Tach do to blood pressure

A

Blood pressure plummets when HR is high

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35
Q

What is the goal when treating ventricular arrhythmias

A

Improve hemodynamics and prevent sudden death

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36
Q

What is the first line of treatment for ventricular arrythmias

A

Lidocaine IV

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37
Q

Treatment of arrythmias should be done when there is

A

underlying heart disease – there is risk of sudden death

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38
Q

You should consider treating Ventricular arrythmias when

A

There is severe systemic disease

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39
Q

With moderate systemic disease or trauma, ventricular arrythmias should only be treated when

A

hemodynamics are affected

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40
Q

BP going from Central to Peripheral the systolic becomes

A

Higher

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41
Q

BP going from Central to Peripheral the diastolic becomes

A

Lower

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42
Q

BP going from Central to Peripheral the Mean

A

Remains similar

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43
Q

Highes point on the BP curve, represents afterload for the left ventricle

A

Systolic Pressure

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44
Q

Average BP over a full cycle, determinant of tissure perfusion

A

Mean pressure

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45
Q

Lowest point of the BP curve, determinant of myocardial perfusion

A

Diastolic pressure

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46
Q

Values of hypotension in small animals (mean and systolic)

A

Mean < 60

Systolic < 80

47
Q

Values of hypotension for large animals (Mean and Systolic)

A

Mean < 70

Systolic < 90

48
Q

During hypotension which organs may become under perfused

A

Brain, kidney, muscles

49
Q

What are the three steps to treating hypotension

A

Decrease anesthetic

Give fluid bolus

Give drugs (inotropes or vasoconstrictors)

50
Q

Inotropes used to treat hypotension

A

Dobutamine, dopamine, ephedrine

51
Q

Vasocontrictors used to treat hypotension

A

Phenylephrine, norepinephrine, vasopressin

52
Q

BP changes with respiration indicates _____

A

Hypovolemia

53
Q

What does the pressure waveform provide information on

A

Inotropy, CO and the effect of arrythmias

54
Q

BP measurement also yields HR which is a determinant of ____ and ______ which provides information about the function of the vegetative nervous system and pain

A

Determinant of CO and myocardial work load, indicating function of vegetative nervous system and pain

55
Q

What is the mathematical model for BP

A

BP = (HR x SV) x SVR

SV: Stroke Volume

SVR: Systemic Vascular Resistance (vasoconstriction)

CO: Cardiac Output

56
Q

Stroke Volume (SV): depends on preload and _____

A

Contractility

57
Q

Preload depends on ______

A

Circulating volume

58
Q

What are the two ways of measuring blood pressure, which one is more accurate and considered the “gold standard”

A

Invasive (direct) - via arterial catheter – Gold Standard

Non-invasive (indirect) - via pressure cuff

59
Q

Which form of BP measurement should be used on horses if anesthetized longer than 45 min

A

Invasive (direct)

60
Q

What arteries in the dog can be used to measure BP

A

Dorsal pedal, metatarsal

61
Q

What arteries in the cat can be used to measure BP

A

Dorsal pedal, coccygeal

62
Q

What arteries in the horse can be used to measure BP

A

Facial, Transverse Facial

63
Q

What arteries in cattle can be used to measure BP

A

Auricular

64
Q

What arteries in sheep/goat can be used to measure BP

A

Median

65
Q

Where should the BP transducer be placed?

At the level of _______

_______ in dorsal recumbency

_______ in lateral recumbency

A

Transducer should be positioned at the base of the heart

Point of shoulder in dorsal recumbency

Point of sternum in lateral recumbency

66
Q

What is an Oscillometer

A

Arterial blood flowing under an inflated cuff generates pressure fluctuations in cuff that is detected by the monitor

67
Q

What is Doppler

A

Inflated cuff is placed over an artery, blood flow is detected distally from the cuff using a doppler flow probe. After complete occlusion of flow cuff pressure is gradually decreased, pressure where blood flow appears is systolic BP

68
Q

The cuffs width should be about ____ of the circumference of the limb and be placed at _______________

A

40%, placed at the level of the base of the heart

69
Q

Where can the cuff be placed on small animals

A

Distal radius, distal tibia, metatarsus

70
Q

Where can the cuff be placed on large animals

A

metacarpus, tail

71
Q

What readings does oscillometry provide

A

Systolic, Mean, Diastolic

72
Q

What are disadvantages of oscillometry

A

May be inaccurate

If patient arrested between readings you may not know

73
Q

How does the doppler flow probe work

A

Probe transmits U/S signal that is refelcted back from moving red cells

Transmitted and refelcted wavelength shifts depending on blood flow

74
Q

Changes in the strength of the doppler signal indicates changes in _____ and _____

A

Changes in blood flow velocity and volume

75
Q

Where should the doppler sensor be placed on a small ruminant

A

Median artery

76
Q

Where should the doppler sensor be placed on small animals

A

Digital artery

77
Q

What are the advantages of doppler

A

Can measure on small animals

Less sensitive to artifacts from movement/arrhythmias/vasoconstriction

Excellent pulse monitor

78
Q

Disadvantages of doppler

A

Doesn’t matter MAP

Noisy

Can be difficult to place

Labor intensive

79
Q

Hypoxemia is defined as PaO2 _____ or SaO2 _____

A

PaO2 < 60 mmHg

SaO2 < 90%

80
Q

Healthy breathing animals should have SaO2 of _____

If breathing pure O2 ______

Adequate value for healthy animals ____

A

Normal > 95 %

Pure O2 > 98%

Adequate > 90%

81
Q

Pulse oximetry results are affected by

A

Hypoperfusion (vasoconstriction)

Pigmentation

Movement (shaking)

Abnormal Hb species – CO poisoning (reads higher) Methemoglobinemia (reads around 85%)

82
Q

When is using a pulse oximeter important

A

Patient is breathing room air

There is V/Q mismatch (horses)

There is respiratory disease

83
Q

Ventilation is defined as _____ and the normal value should be _____

A

Defined as PaCO2 with a normal value of 35-45 mmHg

84
Q

Regarding ventilation along with a normal PaCO2 they should also have normal

A

Tidal volume, RR, rhythm and effort

85
Q

What are the PaCO2 values for:

hypercapnia/hypoventilation

Normocapnia/normoventilation

Hypocapnia/hyperventilation

A

hypercapnia/hypoventilation > 45

Normocapnia/normoventilation 35-45

Hypocapnia/hyperventilation < 35

86
Q

T/F: Tachypnea = hyperventilation

A

FALSE — Tachypnea DOESN’T equal hyperventilation

**There is no reliable correlation between respiratory pattern and PaCO2

87
Q

What is capnometry

A

Measurement of CO2 partial pressure in the airways – resipiratory monitor

88
Q

What does a capnometer measure

A

Only measures the ET CO2

89
Q

What does the capnograph do

A

Continuously displays ET CO2 vs. time on a graph

90
Q

What does a capnogram indirectly assess

A

Indirect assessment of cardiac output especially during CPR

91
Q

What factors influence ET CO2 values

A

CO2 production

Circulation

Alveolar ventilation

Measurement error

92
Q

What does each phase on the graph represent and what is the arrow pointing to

A

Phase I - Baseline (respiration)

Phase II - Expiratory upstroke

Phase III - Alveolar plateau

Phase IV - Inspiration begins

Arrow - ET CO2

93
Q

What is does this graph represent

A

Hyperventilation

94
Q

What does this graph represent

A

Hypoventilation

95
Q

What does this graph represent

A

CO2 Re-breathing

96
Q

What does this graph represent

A

Spontaneous breathing during mechanical ventilation

97
Q

What does this graph represent

A

Progressive airway obstruction

98
Q

What does this graph represent

A

Cardiogenic Oscillations

99
Q

What does this graph represent

A

Cardiac arrest

100
Q

At what temperature is it considered hypothermia

A

< 96 F

101
Q

What are the complications associated with hypothermia

A

Decreases the MAC of anesthetics

CV system may be depressed (bradycardia)

102
Q

At what temperature is it considered hyperthermia

A

> 102 F

103
Q

What are the consequenses associated with hyperthermia

A

Increases MAC

May damage CNS

104
Q

What should you not do to treat hyperthermia

A

Increase vaporizer dial setting

105
Q

What should be determined without regard to body temperature during hyperthermia

A

Anesthetic depth

106
Q

What is the normal limit for temp under anesthesia

A

98 - 102.5 F

107
Q

What is the normal HR range of dogs under anesthesia

A

50 - 160 bpm

108
Q

What is the normal HR range of cats under anesthesia

A

100 - 200 bpm

109
Q

What is the normal HR range of horses under anesthesia

A

28 - 50 bpm

** Foal up to 80 bpm

110
Q

What is the normal HR range of ruminants under anesthesia

A

48 - 90 bpm - cow

60 - 150 bpm - sheep/goat

111
Q

What are the values of MAP and SAP with hypotension for dogs under anesthesia

A

MAP < 60

SAP < 80

112
Q

What are the values of MAP with hypotension for horses under anesthesia

A

MAP > 70

113
Q

What is the normal value for SpO2 under anesthesia

A

95 - 100%

114
Q

What is the normal value for ETCO2 under anesthesia

A

35 - 45 mmHg

Anesthesia (7 decks)

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