Pharmacology I: Goals & Pre-Anesthetics

Question 1

Sedation definition

Answer 1

Relaxed state, but with full pain sensation
- Drowsy or “hypnotic” patients
- Sedated Pt can respond quickly to pain or noxious stimuli

Question 2

Tranquilization definition

Answer 2

Relaxed state without altered mentation
- Full pain sensation
- Also called anxiolytic

Question 3

Anesthesia (as a sedative) definition

Answer 3

Without sensation
- Can be general or local

Question 4

Local anesthesia definition

Answer 4

Reversible loss of pain & sensory sensation without loss of consciousness

Question 5

General anesthesia definition

Answer 5

Reversible loss of pain sensation with loss of consciousness

Question 6

Analgesia definition

Answer 6

Decreased perception of pain without loss of other sensations
- Touch, motor, temperature

Question 7

What are three goals of balanced anesthesia?
What are examples of each?

Answer 7

1. Achieve desired effects
   - Analgesia
   - Unconsciousness
   - Muscle relaxation
2. Minimize negative effects
   - Resp depression
   - Cardiovascular depression
   - Decreased homeostasis (temp, renal function, airway protection)
3. Neuroleptanalgesia
   - Part of a balanced anes.
   - Combo of sedative & analgesia meds
   - Synergistic effects

Question 8

Answer 8

Question 9

Perfusion definition

Answer 9

The process of delivering blood to tissue

Question 10

Importance of perfusion
The longer & more severely we impair perfusion…

Answer 10

The worse the damage

Question 11

How do we monitor perfusion? (4)

Answer 11

1. Pulse quality
2. CRT
3. Blood pressure
   - MAP is most useful indicator (>60mmHg)
4. Central Venous Pressure (CVP)

Question 12

T/F: In anesthesia, we want to maintain the patient as close as possible to physiologic normal!

Answer 12

True!

Question 13

Define Anesthetic stages
Stage 1: (3)
Stage 2: (4)

Answer 13

Stage 1:
- Inducement, excitement
- Pupils constricted
- Voluntary struggling
Stage 2:
- Obtunded reflexes
- Pupil diameters start to dilate
- Still excited
- Involuntary struggling

Question 14

Define Anesthetic stage 3
Plane I (6)
Plane II (4)
Planes III & IV (5)

Answer 14

1. Plane I: Light
   - More decreased reflexes:
   - Pupils constricted
   - Brisk palpebral reflex, Corneal reflex
   - Absence of swallow reflex
   - Lacrimation still present
   - No involuntary muscle movement
2. Plane II: Medium
   - Ideal for most invasive procedures
   - Pupils dilated
   - Loss of pain, palpebral reflex
   - Corneal reflexes present
3. Plane III & IV: Deep
   - Respiratory depression
   - Severe muscle relaxation
   - Bradycardia
   - No reflexes
   - Pupils dilated

Question 15

Define Anesthetic stage 4: (2)

Answer 15

1. Respiration ceases
2. Cardiovascular function depressed & death IMMEDIATLEY ensues

Question 16

What are reflexes to monitor for? (5)
Why?

Answer 16

1. Palpebral reflex
   - Dogs may have no reflex at adequate Sx depth
   - Lateral palpebral reflexes are lost before the medial
2. Corneal reflex
   - Should ALWAYS be present!
   - Doesn’t disappear until deep, deep anesthesia
3. Nystagmus
   - Indication of excitement & light anesthesia
4. Ventromedial eyeball position
   - This is the most desirable position in most species (except horses; central position)
5. Jaw tone
   - Moderate to lose is most desirable

Question 17

Dissociative anesthetics (ex ketamine) can cause ___ at moderate anesthetic depths.

Answer 17

Nystagmus

Question 18

If a patients HR &/or RR suddenly jumps up during surgery, the patient is likely ___ ___ even though they didn’t respond to the stimulation of Sx prep.

Answer 18

Too light (anesthesia)

Question 19

Why do we “dose to effect?”

Answer 19

Every patient is unique in its response to anesthetic agents, so we want to use as little as possible without under dosing

Question 20

Three goals of the anesthetic technician is to give…

Answer 20

1. Enough anesthetic to perform procedure
2. As little agent as possible to minimize complication & normalize physiology
3. Constant monitoring & drug adjustment is ideal!!

Question 21

What are reasons to use pre-anesthetic drugs? (4)

Answer 21

1. Support patient homeostasis
2. Decrease patient anxiety
3. Decrease amount of anesthetic needed
4. Analgesic effects

Question 22

Anticholinergic drugs are: Atropine or Glycopyrrolate
Action: (2)
Potential side-effects: (3)

Answer 22

1. Action:
   - Prevents bradycardia –> Increases HR
   - Prevents excessive salivation & excessive airway secretions –> prevents mucous plugs in ET tube/better visualization
2. Side effects:
   - Increased O2 consumption by heart
   - Thick airway secretions
   - GI ileus

Question 23

Ileus is the…

Answer 23

Absence of normal intestinal peristalsis