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Surgery > Pre-operative & Intra-operative Patient Care > Flashcards

Pre-operative & Intra-operative Patient Care Flashcards

1
Q

What is the purpose of MONITORING?

A

To warn anesthetist of changes in depth or patient status to facilitate an early response

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2
Q

At what point do irreversible CNS and cellular changes occur?

A

3-5 minutes after cessation of blood flow

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3
Q

When should monitoring begin? When should it end?

A

Begins pre-operative –> Recovery

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4
Q

An individualized anestesia plan provides a basis for what 3 things?

A
  1. Drug selection
  2. Monitoring
  3. Anticipated complications and plan of action to address them
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5
Q

What are signs of too light of anesthetic depth?

A

Arousal
Awareness
Movement
Pain

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6
Q

What are signs/consequences of too heavy of anesthetic depth?

A

Decreased cardiovascular function
Decreased respiratory function
Slow recovery

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7
Q

What 3 things together maintain tissue/organ perfusion with oxygenated blood?

A
  1. Oxygenation
  2. Ventilation
  3. Circulation
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8
Q

What 5 things are involved in monitoring a patient?

A
  1. Anesthetic depth
  2. Oxygenation
  3. Ventilation
  4. Circulation
  5. Body temperature
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9
Q

What do you call the inhalant anesthetic concentration in the lungs required to prevent purposeful movement in 50% of animals in response to a noxious stimulus?

A

Minimum alveolar concentration

MAC

(Concentration being exhaled and what is in the brain)

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10
Q

What is the MAC for isoflurane for a dog?

A

1.28%

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11
Q

What is the MAC for isoflurane for a cat?

A

1.63%

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12
Q

What is the MAC for isoflurane for a horse?

A

1.4%

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13
Q

What does DO2 stand for?

A

Delivery of oxygen to tissues

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14
Q

What is DO2 equal to?

A

CO x CaO2

CO = cardiac output
CO = HR x SV
CaO2 = oxygen content of blood
CaO2 = HbO2 + PaO2
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15
Q

When is the best time to check capillary refill time?

A

Pre-operatively

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16
Q

What are the 2 methods of checking blood pressure?

A

Indirect

Direct

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17
Q

What are the indirect methods of blood pressure?

A

Doppler:
Pulse & systolic blood pressure
Place probe over peripheral artery (limb or tail)

Oscillometric:
Systolic, diastolic, & mean arterial blood pressures at a set time interval
Blood pressure cuff on peripheral limb or tail

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18
Q

What do the direct methods of checking blood pressure measure?

A
  1. Systolic blood pressure
  2. Diastolic blood pressure
  3. Mean blood pressure
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19
Q

What is the equation for minute ventilation?

A

Frequency (f) x tidal volume (Vt)

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20
Q

What is the most useful measurement for detection of apnea or hypoventilation?

A

End tidal carbon dioxide

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21
Q

What does PaCO2 stand for?

A

Partial pressure of carbon dioxide in the blood

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22
Q

What is a normal PaCO2?

A

35-45 mmHg

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23
Q

An increase in PaCO2 = hypoventilation

Does this cause acidosis or alkalosis?

A

Acidosis

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24
Q

A decrease in PaCo2 = alkalosis

Does this cause hyperventilation or hypoventilation?

A

Hyperventilation

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25
Q

What factors might cause the gums to appear DARK pink?

A
  1. Vasodilation
  2. Drugs
  3. Increase in CO2
  4. Endotoxemia
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26
Q

What does SpO2 measure?

What is normal SpO2?

A

SpO2 is an indirect measure of PaO2

95-99%

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27
Q

What are the probe sites for SpO2?

A 
Tongue
Prepuce
Ear
Lip
Interdigital space
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28
Q

True or false:

SpO2 is accurate at all times.

A

False

SpO2 is limited in its abilities as it is not helpful in estimating PaO2 in patients breathing 100% oxygen

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29
Q

What are the 5 consequences of hypothermia in patients?

A
  1. Decreased MAC
  2. Increased risk of surgical infection
  3. Impaired wound healing
  4. Impaired platelet function
  5. Decreased coagulation
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30
Q

Why do we give IV fluids during anesthesia?

A
  1. Maintain intra-vascular volume
  2. Compensate for vasodilation effects of drugs
  3. Maintain acid/base balance
  4. Maintain electrolyte balance
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31
Q

Shock dose of IV fluids is 1 blood volume - what is that in the dog, cat, and horse?

A 
Dog = 9%
Cat = 7%
Horse = 10%
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32
Q

What percentage of a shock dose should be used for hypovolemia?

A

1/4 - 1/2 the dose

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33
Q

Which crystalloid should be given to a hyperkalemic patient?

A

0.9% Sodium chloride

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34
Q

Which crystalloid should be used for “liver patients”?

A

Plasmalyte A

35
Q

Which type of fluids stay in the vascular space for a short time?

Which stay for a long time?

A

Short time = crystalloids

Long time = colloids

36
Q

Which type of fluid might you use for a patient with low albumin levels?

A

Colloids

37
Q

Which type of fluid contains large molecular weight molecules?

A

Colloids

38
Q

What 2 effects does hypertonic saline have on biological systems?

How does it produce these 2 individual effects?

A
  1. Increased blood volume
    Draws water from interstitial space
  2. Increased blood pressure
    Venoconstrictor
39
Q

What components make up whole blood?

A
  1. RBC
  2. Protein
  3. Platelets
  4. Clotting factors
40
Q

What components make up packed RBC?

A
  1. RBC

2. PCV 80-90%

41
Q

What components make up fresh frozen plasma?

A
  1. Albumin
  2. Plasma proteins
  3. Clotting factors
42
Q

Which type of blood product might you give to a hypoalbuminemic patient?

A

Fresh frozen plasma

43
Q

Which blood product allows for the most oxygen carrying capacity?

A

Packed RBC

44
Q

Which blood product allows for correction of oncotic pressure?

A

Fresh frozen plasma

45
Q

Which blood product should be used for patients with prolonged clotting times?

A

Fresh frozen plasma

46
Q

What is the term used for an aversive sensation and feeling associated with actual or potential tissue damage>

A

Pain

47
Q

What are the 5 parts of pain?

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Projection
  5. Perception
48
Q

Where does transduction occur?

A

At tissue level

49
Q

Explain transduction…

A

Specialized nerve endings (nociceptors) transform mechanical, thermal, chemical stimuli into action potentials

50
Q

Explain transmission…

A

Action potential is trasmitted via sensory nerves to dorsal root ganglion -> via dorsal root nerves to grey matter or spinal cord

51
Q

Which part of pain do local anesthetics and nerve blocks act against?

A

Transmission

52
Q

Which part of the pain tract amplifies OR suppresses impulses?

A

Modulation

53
Q

Which type of medications work against modulation?

A

Opioids
Alpha-2 agonists
NMDA antagonists
NSAIDS

54
Q

Which part of the pain tract is associated with “wind up”?

A

Modulation

55
Q

Where does modulation work?

A

Synapse with neurons in the dorsal horn of spinal cord grey matter

56
Q

Which part of the pain tract is associated with nociceptive information being conveyed to the brain by nerve tracts?

A

Projection

57
Q

Which part of the pain tract do general anesthetics work against?

A

Perception

58
Q

What other drug work at the level of perception?

A

Opioids
Alpha-2 agonists
Sedatives

59
Q

Which part of the pain path is associated with integration, processing, and recognition of sensory info occurring in multiple areas of the brain?

A

Perception

60
Q

When it comes to age, which patients are at an increased anesthetic risk?

A

Geriatric patients - decreased organ reserve

Pediatric patients - increased risk of hypoglycemia, hypothermia, decreased drug metabolism

61
Q

What should your pre-anesthesia physical exam focus on?

A

Cardiovascular
Respiratory
CNS

62
Q

What lab tests should be run on a normal, healthy animal less than 5 years of age?

A

Packed cell volume (PCV)
Total protein (TP)
Azostrip
Blood glucose (BG)

63
Q

What lab tests should be run on an animal above 5-7 years of age?

A

CBC
Chem
UA

64
Q

What tests should be ran for neoplasia?

A

Thoracic radiographs

CT

65
Q

What tests should be run for heart disease/murmur?

A

Thoracic radiographs

ECG

66
Q

What tests should be run for trauma?

A

Thoracic radiographs

Abdominal radiographs

67
Q

What is the risk for a dog or cat in Classes I or II?

A

0.12%

68
Q

What is the risk for a dog or cat in Classes III-V?

A

4.8%

69
Q

What is the risk for a horse undergoing non-emergency surgery?

A

1%

70
Q

What is the risk for a horse undergoing emergency surgery?

A

2-10%

71
Q

In what 3 situations would you proceed immediately to anesthesia and surgery?

A
  1. Excellent prognosis
  2. Continual blood loss
  3. Acute abdomen (colon torsion, colic, GDV)
72
Q

Which drug has a tendency to cause hypotension?

A

Acepromazine

73
Q

Which drugs have a tendency to cause excitation?

A

Benzodiazepines

74
Q

What is the anesthetic protocol for a cat?

A

Dexmedetomidine + an opioid

Opioids:
Butophanol
Buprenorphine
Methadone
Hydromorphone

+/- ketamine for aggressive patients

75
Q

What is the anesthetic premed protocol for a horse?

A

Sedative + an opioid

76
Q

What are the alpha-2 agonists for horses?

A

Xylazine
Detomidine
Romidfidine

77
Q

What are the NSAIDs for horses?

A

Phenylbutazone

Flunixin

78
Q

What are the premed options for cattle?

A

May or may not need premed

Xylazine
Butorphanol

79
Q

What is the anesthetic premed plan for goats and sheep?

A

Butorphanol +/- benzodiazepine +/- xylazine

80
Q

What problems can Xylazine cause in sheep?

A

Hypoxemia

81
Q

What drugs might you use for anesthetic induction in a dog?

A

Propofol
Ketamine/benzodiazepine
Alfaxalone

82
Q

What drugs might you use for anesthetic induction in goats and sheep?

A

Ketamine w/ benzodiazepine

83
Q

What might you use for anesthetic induction in cattle?

A

Triple drip: GG + xylazine + ketamine

84
Q

What are the anesthetic related complications?

A 
Hypotension
Cardiac arrhythmia
Cardiac arrest
Respiratory insufficiency
Hypothermia/hyperthermia
Myopathy/neuropahty (equine, cattle)

Surgery (15 decks)

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