Pre-Operative Drugs

Question 1

what is the definition of general anesthesia

Answer 1

reversible depression of the CNS with drugs that produce unconsciousness

Question 2

what is the ideal anesthetic technique

Answer 2

balanced/multimodal

Question 3

what is the objective of multimodal anesthetic technique

Answer 3

uses less of each drug than if each drug were administered alone, and therefore reduces the likelihood of side effects and increases the likelihood of desired effects

Question 4

what are the 3 goals of pre-medication

Answer 4

1) sedation/anxyolisis
2) muscle relaxation
3) analgesia

Question 5

one goal of premedication is to provide _________ analgesia

Answer 5

preventative

Question 6

T/F premedication makes it easier to monitor and pre-oxygenate patients before induction

Answer 6

T

Question 7

what is the definition of preventative analgesia

Answer 7

block nociceptive input using several analgesic agents, acting on different sites, starting before surgery and continuing for several hours or days following surgery

Question 8

what are 5 advantages of preventative analgesia

Answer 8

1) decreases peripheral inflammation
2) reduces anesthetic needed during surgery
3) reduces pain signalling reaching the CNS during surgery
4) less analgesia needed post-op
5) rapid hospital discharge

Question 9

what anesthetic causes dose dependent hypotension and respiratory depression

Answer 9

propofol and alfaxalone

Question 10

what anesthetic causes dose dependent hypotension and vasodilation

Answer 10

inhalants

Question 11

heavy sedation protocols carry heavier risk of: (3)

Answer 11

• cardiovascular side effects
• respiratory depression
• airway obstruction

Question 12

what is the ideal pre-anesthetic protocol flow (6)

Answer 12

sedation/anxyolisis, analgesia and muscle relaxation -> opioid, anesthetic agent, sedative

Question 13

Opioids:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?

Answer 13

analgesia: +++
anxiolysis: -
sedation: +
reversible: yes (naloxone)
reduces anesthetic requirements: +++

Question 14

Acepromazine:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?

Answer 14

• analgesia: -
• anxiolysis: ++
• sedation: ++
• reversible?: no
• reduces anesthetic requirements?: ++

Question 15

A2 agonists:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?

Answer 15

• analgesia: +
• anxiolysis: -
• sedation: +++
• reversible? yes (yohimbine, atipamezole)
• reduces anesthetic requirements?: +++

Question 16

benzodiazepines:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?

Answer 16

• analgesia: -
• anxiolysis: +
• sedation: +/-
• reversible? yes
• reduces anesthetic requirements? +

Question 17

ketamine:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?

Answer 17

• analgesia: ++
• anxiolysis: -
• sedation: +++
• reversible? no
• reduces anesthetic requirements? +++

Question 18

alfaxalone:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?

Answer 18

• analgesia: -
• anxiolysis: -
• sedation: +++
• reversible? no
• reduces anesthetic requirements? +++

Question 19

what is a neuroleptic combination

Answer 19

combining a sedative and an opioid

Question 20

what is the goal of neuroleptic combination

Answer 20

achieve desired degree of analgesia, sedation, anxiolysis, and immobilization while decreasing doses and therefore side effects

Question 21

for neuroleptic combinations, you want to combine drugs with what action

Answer 21

synergistic action

Question 22

what are 4 general considerations when choosing a protocol

Answer 22

1) ASA status of patient, age and any diseases present
2) degree of sedation needed
3) degree of analgesia needed
4) onset and length of effects needed (dose and route of administration)

Question 23

T/F drugs and doses need to be tailored to the individual patient

Answer 23

T

Question 24

for what type of patients would you use mild sedation and give some examples of mild sedatives

Answer 24

• very friendly, sick, or debilitated patients
• benzodiazepines, low acepromazine, opioids

Question 25

for what type of patients would you use heavy sedation and what are some examples of heavy sedatives

Answer 25

• aggressive or healthy patients
• ketamine, alpha-2 agonists, high doses of acepromazine

Question 26

which opioid would you choose for the following:
- diagnostics (non-invasive)
- minor procedures
- surgery or already painful condition

Answer 26

diagnostics (non-invasive): partial μ agonists/antagonsists, ex. buprenorphine or butorphanol

minor procedures: partial or full μ agonist

surgery or already painful condition: full μ agonist: morphine, fentanyl, hydromorphone

Question 27

T/F you can use an opioid alone

Answer 27

T

Question 28

what are the advantages of using an opioid alone

Answer 28

• less cardiorespiratory depression, more sedation in sick patients

Question 29

when using opioids alone, they cause more sedation in ______ patients but mild sedation in _______ patients

Answer 29

sick; healthy

Question 30

which sedative would you choose for the following:
- mild sedation
- moderate sedation
- profound sedation

Answer 30

• mild sedation: benzodiazepines, opioids, low dose acepromazine
• moderate sedation: acepromazine, low dose α2, alfaxalone
• profound sedation: α2, ketamine

Question 31

T/F you can use a sedative alone

Answer 31

F

Question 32

what are the 4 levels to the sedation score

Answer 32

1) no sedation
2) mild sedation (quiet but still alert and active)
3) moderate sedation (quiet, reluctant to move, slightly ataxic)
4) profound sedation (flat, unable to walk)