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Anesthesia > Respiratory & Cardiac Disease > Flashcards

Respiratory & Cardiac Disease Flashcards

1
Q

What 3 pulmonary mechanics are altered with anesthesia?

A
  1. chest wall tone is lost
  2. functional residual capacity is reduced
  3. atelectasis is common/inevitable
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2
Q

How does anesthesia alter pulmonary function?

A
  • blunts hypoxic pulmonary vasoconstriction, which is in charge of matching V/Q
  • depressed hypothalamic reflexes, resulting in hypoventilation and hypoxemia (if there is no oxygen supplementation)
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3
Q

What is functional residual capacity? What happens when it is reduced?

A

volume of air present at completion of passive expiration = air reserve within the lungs

shunts, low V/Q, atelectasis

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4
Q

What primary and secondary problems are associated with brachycephalics?

A

PRIMARY = stenotic nares, hypoplastic trachea, aberrant nasal turbinates, elongated soft palate

SECONDARY = excessive oropharyngeal soft tissue, everted laryngeal saccules, laryngeal collapse, lower airway dysfunction

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5
Q

How does the anatomy of brachycephalics affect their anesthetic plan?

A

small upper airway results in dramatic resistance to flow

  • hypoxemia, hypercapnia, relative hypertension, and higher vagal tone results with suppressed compensatory mechanisms
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6
Q

What 4 comorbidities are commonly seen in brachycephalic patients?

A
  1. GI disease
  2. obesity = decreased FRC and lung capacity
  3. ocular disease (corneal)
  4. skin disease
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7
Q

What history is important to get from owners of brachycephalics when planning anesthesia?

A
  • snoring when asleep or awake
  • exercise intolerance
  • GI issues: vomiting, regurgitation, licking, swallowing
  • anxiety or stress
  • wotse symptoms
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8
Q

Why can physical examinations be particularly difficult in brachycephalic breeds? What additional diagnostics should be done before anesthesia?

A

upper airway noise makes auscultation difficult —> murmurs can be missed

  • usual BW: PCV/TS, chem
  • thoracic radiographs: regurgitation common in these breeds
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9
Q

Why is it important to lower anxiety in brachycephalics before they’re in the hospital?

A

increased RR and panting makes airway obstruction worse and there is a hihg likelihood of regurgitation and aspiration

  • oral Trazodone and/or Gabapentin at home
  • minimize time in hospital
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10
Q

How can regurgitation be prevented/minimized in brachycephalics?

A
  • Omeprazole at home 2-4 days prior
  • Pantoprazole or Famotidine pre-anesthesia
  • Maropitant and Metoclopramide pre-anesthesia
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11
Q

What ASA status are brachycephalics considered?

A

ASA 2

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12
Q

What are 3 important parts of a pre-medication plan in brachycephalics? What can be used very carefully?

A
  1. oral sedation and GI meds at home
  2. Acepromazine
  3. Butorphanol: anti-emetic effect
  • pure mu agonists: less likely to cause vomiting when administered IV
  • Dexmedetomidine: low dose in fractious dog, MUST monitor respiratory function carefully
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13
Q

Why is pre-oxygenating brachycephalics especially important?

A

if pre-oxygenated, it takes on average 300 seconds to desaturate compared to 70 seconds if not pre-oxygenated

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14
Q

How does the source of oxygen affect PaO2?

A
  • mask = 380 mmHg
  • flowby = 180 mmHg
  • room air = 82 mmHg
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15
Q

How is hypoxemia avoided in brachycephalics?

A
  • pre-oxygenate
  • slow administration of induction drugs (titrate!)
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16
Q

How care brachycephalics properly intubated? How are ET cuffs checked?

A
  • use appropriately sized larygnoscope
  • keep in sternal position with extended neck and raised head
  • proper size - tend to have smaller ET tubes than expected due to their hypoplastic tracheas

careful inflation to hold at 20 cm H2O pressure

17
Q

What anti-inflammatory is preferred for intra-op use in brachycephalics?

A

steroids —> want the option to still use NSAIDs for airway infalmmation

18
Q

What should be done while brachycephalics are recovering?

A
  • ETT and induction drugs available for reintubation
  • clean oropharynx, suction, and monitor for airway edema
  • supplemental oxygen
  • leave ETT in as long as possible
19
Q

How does the cause of cough differ in dogs and cats?

A
  • DOGS: lower airway vs. tracheal vs. cardiac
  • CATS: inflammatory airway disease vs. chronic bronchitis vs. lung/heartworm
20
Q

What is indicative of cats with asthma on physical exam? What needs to be ruled out first?

A

increased bronchovesicular sounds on all fields (sometimes louder on one side) and expiratory wheezing

HW disease, other parasites, infection

21
Q

What are the 2 major anesthetic concerns in asthmatic cats?

A
  1. hypoventilation - worsened by obesity, which is common in these cats
  2. hypoxemia - bronchoconstriction, reduced FRC, atelectasis
22
Q

How are asthmatic cats recovered following anesthesia?

A

on oxygen until extubation and may even need it after

  • monitor until “normal”
23
Q

What 2 things need to be controlled in asthmatic cats before anesthesia?

A
  1. cough and wheezing - steroids, Doxycycline, Fenbendazole, bronchodilators
  2. stress - oral anxiolytics (Gaba at home) night before and morning of
24
Q

What is especially important to monitor in asthmatic cats?

A
  • ETCO2
  • SpO2
25
Q

What is the characteristic capnograph seen with airway obstruction?

A

shark fin sign

  • also seen with mucus plugs in ETT
26
Q

What are the main functions of alpha-1 and beta-1 receptors on the cardiovascular system?

A

ALPHA-1 = vasoconstriction

BETA-1 = increased force and rate of contraction, bronchodilation and skeletal muscle vasodilation

27
Q

Is a heart murmur always associated with heart disease? What helps with anesthesia planning?

A

NO

knowing the cause helps assess risk —> signalment, history, auscultation, pulse quality and rhythm, lung sounds

28
Q

What diagnostic is especially important in patients with heart mumurs? What else is done?

A

echocardiogram - give information on heart function and structure

  • thoracic radiograph - cardiac size and shape, LA size (CHF), pulmonary edema (dog), pleural effusion (cats)
  • ECG
  • blood biomarkers - pro-BNP
29
Q

What are the 3 major causes of heart murmurs in small animals?

A
  1. valvular insufficiency - low CO and HR, congestion
  2. valvular stenosis - ventricular arrhythmias
  3. cardiomyopathy (DCM, HCM) - low CO, arrhythmia
30
Q

What increases regurgitant flow in the heart?

A

vasoconstriction —> avoid alpha-2 agonists in animals with valvular insufficiency

31
Q

What are the 4 major anesthetic concerns in patients with heart mumurs? What are the anesthetic goals?

A
  1. hypotension
  2. bradycardia
  3. arrhythmias
  4. congestion - CHF

reduce stress, support normal CV and respiratory function, manage pain

32
Q

How should established heart medications be giving before an anesthetic event?

A

continue them —> if patient has not taken them or is in risk for CHF, delay anesthesia

33
Q

What needs to be avoided in patients with valvular stenosis? What causes this?

A

tachycardia

  • stress and anxiety
  • oxygenation
34
Q

What needs to be avoided in patients with valvular insufficiency? What causes this?

A

increases in peripheral vascular resistance and bradyacrdia

  • hypotension and hypoxemia
  • CHF
  • alpha-2 agonists
  • stress and anxiety
35
Q

What needs to be maintained in patients with dilated cardiomyopathy? How?

A

myocardial contractility

etomidate use

36
Q

What is hypertrophic cardiomyopathy?

A

asymmetric thickening of the myocardium, causing diastolic dysfunction and LV outflow obstruction

37
Q

What are the 3 hemodynamic goals for patients with hypertrophic cardiomyopathy? What drugs are especially helpful? What should be avoided?

A
  1. maintain preload, afterload, and slower HR
  2. manage arrhythmias
  3. careful with fluid load

antiarrhythmics and alpha agonists for BP support

stress, anxiety, pain = sympathetic stimulation = increased HR

Anesthesia (40 decks)

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