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Anesthesiology > Post-Anesthesia Care > Flashcards

Post-Anesthesia Care Flashcards

1
Q

4 signs of airway obstruction after extubation

A
  • increased inspiratory effort
  • stridor
  • thorax doesn’t expand

you cannot feel air passing through the nose

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2
Q

Which patients are more to catastrophic injury during recovery?

A
  • horses
  • large animals
  • wild animals
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3
Q

(hypoxemia/hypoxia) leads to organ damage

A

hypoxia

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4
Q

Dysphoric patients can be treated with ___________ and __________/_______

A
  • opiod antagonists
    • careful, you will reverse analgesia too!
  • sedatives/tranquilizers
    • Acepromazine
    • Dexmedetomidine
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5
Q

Problems with brachycephalics that make them prone to airway issues

A
  • stenotic nostrils
  • elongated soft palate
  • everted saccules and tonsils
  • hypoplastic trachea
  • laryngeal collapse

(plus edema and irritation)

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6
Q

Risk factors for airway obstruction (4)

A
  • obligate nasal breathers
    • horses
    • camelids
    • rabbits
  • brachycephalics
  • pre-existing respiratory conditions
    • tracheal collapse
    • bronchial disease
  • tight bandage around the neck
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7
Q

Predicting airway obstruction prior to extubation (5)

A
  • increased respiratory effort
  • thorax does not expand
  • high PIP alarm on ventilator
  • capnography
  • try to ventilate (feels like trying to ventilate a brick)
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8
Q

causes of hypoxemia (4)

A
  • low FiO2
  • hypoventilation
  • ventilation to perfusion mismatch
  • AV shunt (anatomical)
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9
Q

4 things that can cause prolonged recovery

A
  • residual drug effect
  • acid base/electrolyte abnormalities
  • hypoxemia, hypercapnea
  • hypothermia
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10
Q

Airway obstructions are usually due to _________ or __________

A
  • tube kinking
  • mucus plug obstructing the lumen of the ET tube
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11
Q

3 causes of atelectasis

A
  • absorption (high FiO2)
  • compression
    • mm relaxation
    • external compression
  • decreased surfactant
    • more relevant for long term ventilation
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12
Q

in ______ the alveolus is ventilated but not perfused (caused by _______)

A
  • High V/Q
  • hypotension
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13
Q

_______ and/or ____ are the only way to rule it out hypoxia

A
  • Pulse-oxymetry
  • ABG
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14
Q

3 signs of a painful patient (vs. dysphoric)

A
  • responds to palpation of surgical site
  • seems to be aware
  • responds to administration of an opiod
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15
Q

_____________: profound state of unease or dissatisfaction accompanied by anxiety or agitation

A

dysphoria

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16
Q

__________ during anesthesia can result i a pneumothorax hours after anesthesia is over

A

closed APL (pop-off valve)

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17
Q

What to do when an animal is taking too long to recover

A
  • check the temperature
    • treat hypothermia
  • evaluate the ventilation status
    • capnography (if still intubated)
    • venous or arterial blood gas
  • evaluate oxygenation
    • pulse-ox
    • arterial blood gas
  • evaluate acid base/electrolyte status
  • all normal? can any of the anesthetic drugs be reversed?
18
Q

___________ is the drug given to treat malignant hyperthermia

A

Dantrolene

19
Q

3 causes of myopathy/neuropathy

A
  • malpositioning during anesthesia
  • compression of nerves
  • hypoperfusion of muscles
20
Q
A
21
Q

cyanosis becomes visible when the concentration of deoxyHb rises above ____ g/dL

A

5 g/dL

22
Q

in ______ the alveolus is perfused but not ventilated (commonly caused by _______)

A
  • low V/Q
  • atelectasis
23
Q

Cautions for airway obstruction in alpacas (often silent) (5)

A
  • watch for movements of the thorax
  • use IN phenylephrine prior to recovery
  • nasopharyngeal tubes can be used
  • extubate only when they are reactive and don’t tolerate the tube
  • have drugs for induction and airway equipment available
24
Q

3 signs of dysphoria

A
  • whining
  • screaming
  • uncoordinated movements
25
Q

Aspiration/regurgitation risk factors (7)

A
  • GI surgery (FB, GDV)
  • septic abdomen
  • hx of vomiting
  • megaesophagus
  • laryngeal paralysis
  • airway surgery requiring unprotected airway
  • ruminants
26
Q

3 signs of a dysphoric patient (vs painful)

A
  • does not respond to anything in particular
  • seems to be “out of it”
  • is often caused by opiod administration
27
Q

Can you be hypoxic without being hypoxemic?

A

yes

28
Q

Why does regurgitation/aspiration occur under anesthesia?

A
  • many anesthetic drugs cause nausea, vomiting, and delayed gastric emptying
  • most anesthetic drugs also impair swallowing reflexes
29
Q

Treatment/prevention for aspiration/regurgitation (3)

A
  • administration of gastro protectants/ antiacids
  • suction
  • late extubation of patients at risk
30
Q

About 50% of the anesthesia related mortality happen in the _______ period

A

post anesthetic

31
Q

Risk factors of hypoxemia (9)

A
  • obese patients
  • intra-thoracic surgery
  • abdominal surgeries
  • dorsal recumbency
  • pre-existing respiratory disease
  • long anesthetic procedures
  • patients requiring higher doses of opiods/sedatives
  • painful animals
  • dysphoric animals
32
Q

Why is it easy to become hypoxemic during the recovery period?

A

most of the drugs used during anesthesia or as analgesics/sedatives cause hypoventilation

  • untreated pain may also cause hypoventilation
33
Q

What can we do to promote a smooth recovery in a horse? (5)

A
  • sedation
    • alpha 2 adrenergic agonist
    • acepromazine
  • good analgesia
  • they should lie down for at least 30-40 min after discontinuation of haogenate
  • quiet recovery box
    • limit noises
    • low lighting/cover eyes
  • assist recovery
    • ropes/pool
    • risk for personnel
34
Q

________ is the cause of hypoxia

A

insufficient oxygen delivery

35
Q

_______: deflated alveoli

A

atelectasis

36
Q

__________= Reduction below normal levels of oxygen in blood = low PaO2

A

hypoxemia

37
Q

How to treat hyperthermia (6)

A
  • turn off all heating devices
  • increase fresh gas flow
  • check CO2 adsorbent canister (is it hot)
  • is it a cat or ferret that has been given opiods?
  • initiate cooling process
  • do you suspect malignant hyperplasia?
38
Q

Horses can generate such a substantial negative pressure when trying to breath against an obstructed airway that they can develop ________

A

fulminating pulmonary edema

39
Q

Common post-operative complications

A
  • Respiratory complications
  • poor recovery
  • prolonged recovery
  • hyperthermia
  • CV complications
  • myopathy/neuropathy
  • worsening pre-existing conditions
40
Q

_______: reduction below normal levels of oxygen in the tissues

A

hypoxia

41
Q

T/F

Dysphoria is not a reason to withold the administration of analgesics

A

T

42
Q

Causes of peri-anesthetic hyperthermia (5)

A
  • iatrogenic (heating pads)
  • opiod-related
  • capture related
  • exhausted CO2 adsorbent
  • malignant hyperthermia

Anesthesiology (13 decks)

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