Preanesthetic Evaluation/Preparation

Question 1

Four components of Preanesthetic evaluation

Answer 1

1. Signalment
2. Medical History
3. Physical Examination
4. Laboratory Evaluation

Question 2

The minimum patient database consists of the following:

Answer 2

1. Patient history, including the patient signalment
2. Complete physical examination findings
3. Results of a preanesthetic diagnostic workup

Question 3

True/False: An appointment should be scheduled several days before the planned procedure to acquire the minimum patient database, so that unforeseen problems can be discovered and addressed well in advance of surgery.

Answer 3

True

Question 4

What is the purpose of a pre anesthetic evaluation?

Answer 4

To identify factors that might lead to anesthetic complications & to select an appropriate anesthetic protocol

Question 5

Signalment refers to?

Answer 5

1. Species: Difference in response, size & temperament
2. Age: Physiologic differences in pediatric & geriatric patients
3. Breed: Physiologic & anatomic differences

Question 6

Explain the signalment step: Age:

Answer 6

◦ Physiologic differences in pediatric & geriatric patients
◦ Pediatric patients do not have fully functional livers therefore they can have a harder time to filter injectable anesthesia
◦ Pediatric patients have a harder time regulating body temperature
‣ Do not like to put under prior to 2 months old
◦ Geriatric patients have a harder time metabolizing drugs therefore decreased respiratory effort is common
‣ Also common for geriatric patients to have liver disease/issues therefore they have a harder time filtering to drugs

Question 7

Explain the signalment step: Breed

Answer 7

◦ Physiologic & anatomical differences
◦ Brachycephalic Dogs:
‣ Collapsing external nares
‣ Enlarged Tonsils
‣ Elongatated soft palates
‣ Small tracheal diameter
‣ Tracheal tubes need to be inserted immediately & needs to stay in much longer after surgery

Question 8

Explain the signalment step: Species

Answer 8

◦ Differences in response, size, and temperament
◦ Opioids have different side effects on different species: Cats have a higher chance of negative side effects. Dogs do pretty well with most injectable opioids
‣ Fentanyl & Buphamorphine works good for cats
◦ Cows are very sensitive to certain drugs, Xylazine only takes like 1ml to knock them out
‣ Xylazine Is used a lot with Equines
◦ Large animal medicine tend to do more under local anesthesia where the patient is not completely under to prevent injuries that could occur after the patient awakes from general anesthesia
◦ Fractious cats are often premed prior to surgical procedures due to their temperaments IV catheters are near impossible to place without prior sedation

Question 9

Medical history

Answer 9

Status of preventative care
Allergies or drug reactions
Medications currently being administered
Collect information about past or current medical problems
Preexisting disease
General signs of illness: anorexia, vomiting, diarrhea, coughing, sneezing, polyuria, polydipsia, tenesmus, dysuria
Should be addressed prior to anesthesia

Question 10

Laboratory evaluation

Answer 10

• Reveals subclinical abnormalities
• Helps determine whether abnormalities detected on physical exam are significant
  Laboratory tests:
• Complete blood count (CBC)
• Urinalysis
• Blood chemistry
• Blood coagulation screens
• Electrocardiogram (ECG)
• Radiography
• Other tests as deemed necessary

Question 11

Physical status classification is based on

Answer 11

the results of the preanesthetic evaluation
Classification is indicative of patient anesthetic risk

Question 12

Class P1 =

Answer 12

minimal anesthetic risk

Question 13

Class P5 =

Answer 13

extreme anesthetic risk

Question 14

Classes P1 and P2 use

Answer 14

standard anesthetic protocol

Question 15

Classes P3 to P5 need

Answer 15

special protocols and stabilization

Question 16

Prior to beginning the anesthetic procedure owner must sign:

Answer 16

Written estimate
Consent form
Legally necessary
Informs of risks
Owner’s daytime phone number
Permission to perform CPR

Question 17

When a complete patient history is being obtained, the following specific questions should be asked.

Answer 17

What Are the Species, Breed, Age, Sex, and Reproductive Status of the Patient?

Question 18

The species, breed, age, sex, and reproductive status are collectively known as the?

Answer 18

signalment

Question 19

Which species are more sensitive to opioids than dogs and ruminants. Therefore some of these agents must be used with caution, at lower doses, or not at all in these species.

Answer 19

Horses and cats

Question 20

True/False: Each species has unique dosing requirements

Answer 20

True

Question 21

True/False: Horses tend to have rougher recoveries from inhalant anesthetic than other species?

Answer 21

True

Question 22

The use of anticholinergics should be avoided in which species and why?

Answer 22

ruminants, as it can make their saliva thick and ropy, which can lead to airway occlusion. Ruminants may also regurgitate at any point during anesthesia, and the anesthetist should take steps to avoid aspiration.

Question 23

Ruminants are more sensitive to?

Answer 23

xylazine

Question 24

Large animals are prone to?

Answer 24

respiratory depression and dependent lung atelectasis and thus often require ventilatory support.

Question 25

Cats can tolerate administration of what agent when dogs can’t?

Answer 25

dissociative agents alone, whereas dogs may experience seizure-like activity unless the dissociative is combined with another agent.

Question 26

Cats, small dogs, and small animal pediatric patients are prone to?

Answer 26

hypoxemia and hypercarbia caused by increased mechanical dead space.

Question 27

Cats and ruminants are prone to?

Answer 27

airway blockage because of development of excess airway secretions.

Question 28

Ruminants are prone to?

Answer 28

Bloat

Question 29

Patient preparation steps prior to an anesthesic procedure?

Answer 29

Correct or compensate for any disease process🡪 IV fluids, drug administration
W/hold food for 8-12 hrs., water for at least 2 hrs.
Place IV catheter
Used to administer anesthetic induction agent, fluids, emergency drugs, constant rate infusions (CRI’s), vesicants, incompatible drugs