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POS > principles of clinical practice: anaesthesia and analgesia > Flashcards

principles of clinical practice: anaesthesia and analgesia Flashcards

1
Q

triple

A

medetomidine hydrochloride, ketamine, and torbugesic

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2
Q

what want from anaesthesia

A
  • unconcioussness
  • analgesia
  • muscle relaxation
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3
Q

analgesia in anaesthesia is necessary to

A
  • inhibit processing of pain in CNS

- antinociception

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4
Q

central eye position in anaesthesia indicates

A

light or deep anaesthesia

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5
Q

eye position in adequate anaesthesia

A

rotated

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6
Q

palpebral reflex and anaesthesia

A

if there is one than anaesthesia is too light

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7
Q

movement is absent in what anaesthesia

A

adequate and deep anaesthesia

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8
Q

the cornea is dry when in anaesthesia

A

in deep anaesthesia

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9
Q

likelyhood that healthy dog dies due to anaesthesia

A

1 in 1849

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10
Q

likelyhood that healthy cat dies due to anaesthesia

A

1 in 895

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11
Q

likelyhood that healthy rabbit dies due to anaesthesia

A

1 in 72

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12
Q

likelyhood that healthy guinea pig dies due to anaesthesia

A

1 in 26

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13
Q

stuff that can happen due to anaesthesia (6)

A
  • muscle nerve damage
  • cerebral hypoxia causing poor recovery
  • peripheral nerve damage
  • spinal cord damage
  • blindness
  • post anaesthetic cognitive dysfunction
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14
Q

low albumin and anaesthetic

A
  • means more free drug so the dose will have a greater effect
  • risk of oedema developing
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15
Q

kidney failure and anaesthetic

A
  • will show as increased creatinine or urea
  • causing acidaemia
  • increased free drug conc
  • also depresses myocardial contractility
  • and shifts HbO2 curve to right so lower affinity to oxygen
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16
Q

3 dangers of waste anaesthetic gas

A
  • cancer
  • miscarriage
  • liver/kidney disease
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17
Q

gas cylinder size usually attached to an anaesthetic machine

A

size E

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18
Q

gas cylinder size normally attached to pipelines

A

size J

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19
Q

oxygen cylinder colour

A

black cylinder with white on top

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20
Q

nitrous oxide cylinder colour

A

blue

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21
Q

air cylinder colour

A

grey cylinder with black/white quarters on top

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22
Q

oxygen is stored at (pressure)

A

13700kPa or 137 bar

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23
Q

nitrous oxide stored how

A

as liquid with gas on top at 4400kPa (4.4 bar)

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24
Q

how tell how much nitrous oxide in cylinder

A
  • weigh it
  • molecular weight 44 so 1 mole is 44 g
  • 1 mole of gas is 22.4 litres
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25
Q

pipeline system for gas end in valves called

A

schrader valves

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26
Q

max O2 concentration you get out of an O2 concentrator

A

95%

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27
Q

how read a flowmeter

A
  • top of bobbin

- middle of ball bearing

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28
Q

low resistance or draw-over vaporises define

A

are in the system and gas that flows through them is generated by the patient

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29
Q

emergency oxygen flush delivers O2 at a flow of

A

30-70 liters per minute

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30
Q

2 rebreathing systems

A
  • circle

- to-and-fro

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31
Q

minute volume define

A

volume of air inspired or expired in a minute

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32
Q

tidal volume define

A

volume of air inspired or expired in one breath

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33
Q

estimate tidal volume to be

A

10-15 ml/kg

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34
Q

magill fresh gas flow

A

equal to minute volume

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35
Q

fresh gas flow for IPPV magill

A

3 x minute volume

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36
Q

magill weight animal

A

over 10kg

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37
Q

lack types 3

A
  • parallel
  • mini
  • co-axial
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38
Q

lack fresh gas flow

A

equal to minute volume

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39
Q

estimate of minute volume

A

200 ml/kg/min

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40
Q

IPPV flow rate lack

A

3 x minute volume

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41
Q

standard lack animal weight

A

over 10kg

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42
Q

mini lack animal weight

A

under 10kg

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43
Q

ayers T-piece flow rate

A

2.5 - 3 x minute volume

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44
Q

ayers T-piece animal weight

A

under 10 kg

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45
Q

bain appearance

A

co-axial T piece with inspiratory tube surrounded by expiratory tube

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46
Q

fresh gas flow rate bain

A

2.5-3 x minute volume

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47
Q

bain animal weight

A

10kg

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48
Q

using a circle fresh gas flow rate

A
  • first 10-15 minutes use a higher fresh gas flow (100ml/kg/min)
  • then reduce to 50ml/kg/min
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49
Q

when change carbon dioxide absorbers

A

when half of it has changed colour

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50
Q

anticholinergics action

A

block acetylcholine receptors of parasympathetic system

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51
Q

3 anticholinergics

A
  • atropine
  • glycopyrollate
  • hyoscine
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52
Q

anticholinergics 5 side effects

A
  • increase heart rate
  • reduce salivation
  • reduce gut motility
  • dilate pupil of eye
  • relax bronchi
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53
Q

3 tranquillisers and sedative agents groups

A
  • phenothiazine
  • 2-adrenoceptor agonists
  • benzodiazepines
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54
Q

define maximal effect

A
  • increaseing dose does not increase action only length
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55
Q

3 phenothiazines

A
  • acepromazine
  • chlorpromazine
  • propionylpromazine
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56
Q

phenothiazines are (tranquiliser or sedative)

A

tranquiliser

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57
Q

phenothiazine action

A
  • dopamine antagonist
  • alpha 1 adrenoceptor antagonist
  • antihistamine
  • anticholinergic effects
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58
Q

acepromazine is a (2)

A
  • antiemetic

- vasodilator

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59
Q

butyrophenones sedative or tranquiliser

A

tranquiliser

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60
Q

butyrophenone action

A
  • alpha 1 adrenoceptor blocker

- dopamine antagonist

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61
Q

example 1 butypophenone

A

azaperone

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62
Q

5 alpha 2 adrenoceptor agonists

A
  • xylazine
  • medetomidine
  • dexmedetomidine
  • detomidine
  • romfidine
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63
Q

alpha 2 adrenoceptor agonist actions

A

centrally to inhibit norepinephrine release

- peripherally in post synaptic receptors

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64
Q

benzodiazepines actions

A

enhance affinity of GABAa receptor to GABA so enhancing inhibitory transmission

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65
Q

profofol metabolism

A

not all by the liver

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66
Q

alfaxalone anaesthesia is a (type)

A

steroid

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67
Q

alfaxalone given

A

i/v or i/m

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68
Q

ketamine is a

A

dissociative anaesthetic

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69
Q

ketamine given

A

i/v or i/m

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70
Q

ketamine pros

A
  • some analgesic properties

- no CVS depression

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71
Q

thiopentone metabolism

A

slowly

it accumulates in body fat

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72
Q

thipentone given

A

i/v

if extravascular then get skin necrosis

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73
Q

etomidate pros

A

good in sick animals as minimal CVS/resp depression

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74
Q

etomidate cons

A

immunosuppresive

75
Q

endotracheal tube and occlusion in lung overcome

A

murpheys eye in end of tube

76
Q

3 methods maintenance with i/v

A
  • intermittent boluses
  • continuous rate infusion (CRI)
  • partial i/v anaesthesia (PIVA) uses some gas as well
77
Q

intermittent bolus mainenance anaesthesia cons

A

swinging plane of anaesthesia

78
Q

solubility inhalational anaesthetics

A

more soluble in blood the less concentrated it is in brain

79
Q

blood:gas partition coefficient define

A
  • number of parts of gas in blood vs alveolus

- if high then means more soluble in blood

80
Q

MAC define

A
  • minimum alveolar concentration of gas required to prevent movment in response to pain in 50% of animals
81
Q

isoflurane dog MAC

A

1.3

82
Q

isoflurane MAC cat

A

1.6

83
Q

isoflurane MAC horse

A

1.3

84
Q

sevoflurane MAC dog

A

2.3

85
Q

sevoflurane MAC cat

A

2.6

86
Q

sevoflurane MAC horse

A

2.3

87
Q

how much sevoflurane is metabolised

A

2%

88
Q

% isoflurane metabolised

A

0.2%

89
Q

sevoflurane metabolism theory

A

free fluoride ions released which are toxic to kidney

90
Q

sevoflurane and older hot soda lime

A

react to make nephrotoxic compound

newer ones dont do this

91
Q

nitrous oxide MAC

A

200%

92
Q

nitrous oxide use

A
  • used for mild analgesic properties
  • speeds up second gas used
  • has to be stopped 10 min before end to help reduce diffusion hypoxia as it reduces lungs O2 partial pressure
93
Q

in horse during anaesthesia what needed for good recovery

A

good muscle perfusion

94
Q

horse systolic blood pressure

A

110

95
Q

horse diastolic blood pressure

A

70

96
Q

horse mean blood pressure

A

90

97
Q

ABP monitoring indirect method how to

A
  • use cuff that has width of 40% of circumference
  • find pulse using doppler thing
  • inflate cuff till doppler stops
  • deflate cuff and when noise starts thats the systolic blood pressure
98
Q

oscillometric method arterial blood pressure monitoring pros

A
  • gives systolic mean and diastolic pressures automatically
99
Q

direct method ABP motioring how to

A
  • put in arterial catheter

- measures everything with electronic transducer

100
Q

pros of direct ABP measurment

A
  • gives continuous blood pressure

- allows blood gas samples to be taken

101
Q

pulse oximetry measures

A
  • haemoglobin O2 saturation

- heart rate

102
Q

pulse oximetry cons

A
  • cant tell partial pressure O2

- misreads carboxyhemoglobin and methemoglobin

103
Q

capnography measures

A

end tidal CO2

104
Q

end tidal CO2 is normally

A

35-45mmHg

105
Q

in hyperventilation and cardiac arrest ETCO2

A

decreases

106
Q

in hypoventialtion ETCO2

A

increases

107
Q

define hypoawemia

A

low O2 in blood

108
Q

hypercapnia define

A

high CO2 in blood

109
Q

3 causes of hypercapnia

A
  • hypoventilation
  • rebreathing exhaled gas
  • increased basal metabolic rate
110
Q

hypercapnia causes 6 things

A
  • tachycardia
  • arrhythmias
  • hypertension
  • increased intracranial pressure
  • CV depression
  • respiratory acidosis
111
Q

intrapleural pressure is always

A

negative

112
Q

IPPV causes intrapleural pressure to

A

go above 0 throughout resp cycle

113
Q

increased intrapleural pressure causes

A
  • decreased venous return and so decreased cardiac output
114
Q

dobutanine effect on heart

A
  • inotrope

- mild chronotroph

115
Q

dobutamine actions

A

beta 1 receptors

116
Q

increased intracranial pressure triggers what reflex

A

cushings reflex

117
Q

rabbits prone to post op

A

post op ileus due to pain/stress

118
Q

rabbit consider for anaesthetic

A

most rabbits have subclinical resp problem. assume that all rabbits have

119
Q

indication of rabbit resp disease

A

nasal discharge

120
Q

4 blood sample taking sites rabbit

A
  • cephalic vein
  • marginal ear vein
  • lateral sephanous vein
  • jugular
121
Q

before inducing rabbit anaesthesia

A
  • apply EMLA cream 1 hour before venepuncture

- place an i/v catheter

122
Q

2 common premeds used on rabbit

A
  • hypnorm

- medetomidine

123
Q

EMLA cream is

A

mix of lidocaine and prilocaine

124
Q

hypnorm is

A

mix of fentanyl and fluanisome

125
Q

hypnorm cons

A
  • resp depression
  • poor muscle relaxant
  • can induce ileus
126
Q

alpha 2 agonist can be reversed with

A

atipamezole

127
Q

intubating rabbit

A

spray larynx with anaesthetic

128
Q

cons rabbit laryngeal mask

A

when cuff blown up can cut of circulation to tongue and make it go blue

129
Q

3 commonly used unlicensed rabbit analgesic

A 
opiods
- bupenorphine
- butorphanol
NSAIDs
- meloxicam
130
Q

rats, mice, gerbil i/v access

A

lateral tail vein

131
Q

guinea pig i/v access

A

medial metatarsal vein

132
Q

healthy horse probability of anaesthetic death

A

1 in 110 horses

133
Q

starvation time for horse pre op

A

8 hourse

134
Q

starvation time pre laproscopy horse

A

48 hours

135
Q

horses need what drug pre op

A

anti-tetnus

136
Q

acepromazine is

A

long acting injectable premed

137
Q

acepromazine actions

A

stabilizes cardiac membrane so reducing chances of adrenaline induced arrhythmia

138
Q

alpha 2 adrenoceptor agonists action

A

sedation

139
Q

analgesia in horse

A
  • opiods

- NSAIDs

140
Q

ketamine in horses usually used with what as induction

A

alpha 2 agonists

141
Q

guaiphensin action

A

muscle relaxant

142
Q

guaiphensin in horse anaesthesia

A
  • given before induction or with induction
143
Q

horse and intubation

A

will always damage the horse trachea

144
Q

isoflurane horse recovery

A

can be too fast need a sedative to improve quality

145
Q

isoflurane halothane compare

A

iso is more respiratory depressant so may need IPPV

146
Q

lateral recumbency horse position anaesthesia

A
  • front bottom leg should be a bit in front
  • back bottom leg should be a bit behind
  • head should be raised slightly
147
Q

hypotension and horse anaesthetic

A

minimum blood pressure usually 30-45 minutes post induction, it improves normally due to an increase in systemic vascular resistance and so causes poor perfusion to extremities

148
Q

tx hypotension (4)

A
  • decreases anesthetic
  • give large volume crystalloids
  • inotropic agents
  • hypercarbia (increase CO2)
149
Q

hypercarbia define

A

increase of CO2 in blood

150
Q

hypercarbia anaesthetic horse

A
  • increases as horse is recumbent

- causes increased cardiac output and blood flow and muscle tremours

151
Q

tx horse hypercarbia

A

IPPV

152
Q

hypoxaemia anaesthetic horse

A

occurs in large horses in dorsal recumbency

153
Q

how to external cardiac massage a horse

A

jump on it landing on its chest with your knees

154
Q

major cause equine death post anaesthesia

A

equine post-anaesthetic myopathy

155
Q

equine post-anaesthetic myopathy due to

A

poor perfusion through weight and hypotension

156
Q

how to position a horse post anaesthetic

A
  • left lateral recumbency if has been in dorsal

- if been in lateral you can leave to reduce chances of hypoxia or swap sides to improve muscle perfusion

157
Q

3 consideration ruminant anaesthesia

A
  • bloat
  • salivation
  • regurgitation
158
Q

bloat and the heart

A

reduces venous return

159
Q

IV sites cows

A
  • tail vein
  • jugular
  • milk vein if desperate
160
Q

sedation in ruminants done with

A

alpha2 agonists

161
Q

alpha 2 agonists and ruminants 4 side effects

A
  • pulmonary oedema
  • reduces eructation and swallowing
  • urine production
  • urethral flow issues
  • uterine contraction
162
Q

3 local anesthetic licensed large animals

A
  • procaine
  • benzocaine
  • tetracaine
163
Q

2 types paravertebral block

A
  • proximal

- distal

164
Q

proximal paravertebral block where

A
  • T13
  • L1
  • L2
165
Q

distal paravertebral block where

A

at lateral processes of

  • L1
  • L2
  • L4
166
Q

caudal epidurals where

A

where dip made when tail lifted up and down

167
Q

what caudal epidural block of

A

rectum and more depending on dose

168
Q

2 induction agents cow

A
  • xylazine

- ketamine

169
Q

best combo anaesthetic for LA

A

ketamine and diazepam

170
Q

when extubate ET tube LA

A

when animal can support its own head

171
Q

halothane and small ruminants

A

can be hepatotoxic

172
Q

camelids develop what with stress

A

third compartment stomach ulcers

173
Q

pigs i/v injections

A

can use ear veins

174
Q

pigs and intubation

A

hard as have small cricothyroid junction and marked laryngeal reflexes

175
Q

how to intubate a pig

A

put in going down, rotate 180 and push round then rotate 180 again

176
Q

define malignant hyperthermia

A

muscles contract producing a lot of heat

177
Q

tx malignant hyperthermia

A

switch to dantrolene though it is expensive

178
Q

prevention malignant hyperthermia

A

can do a test

179
Q

pigs and anaesthetic risk (3)

A
  • malignant hyperthermia
  • hypothermia
  • obstruction
180
Q

1ml of blood weighs

A

1.2 g

181
Q

dog has how much blood

A

80ml/kg

182
Q

how long does mrphine last

A

4 hours

183
Q

an overinflated ET tube can cause

A

tracheal rupture and generalised emphysema

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