SA Anesthesia Parts 1-4

Question 1

The 4 goals of small animal anesthesia

Answer 1

Unconsciousness
Loss of movement
Loss of nociception
Maintain hemostasis

Question 2

What three things comprise an animal’s signalment

Answer 2

age, breed, sex

Question 3

What 4 vital signs are assessed during physical examination

Answer 3

temp, pulse, respiratory rate, pain

Question 4

T/F: finding elevated liver enzymes is indicative of impaired hepatic function and could mean prolonged drug metabolism

Answer 4

FALSE

Enzymes indicate DAMAGE NOT FUNCTION!!

Bile acids for liver function

Question 5

What does ASA stand for

Answer 5

America society of anesthesiologists

Question 6

A healthy patient that presents for an elective dental procedure would receive which ASA classification?

Answer 6

ASA I

Question 7

A healthy patient with an injury that requires surgical correction (i.e. TPLO) would receive which ASA classification?

Answer 7

ASA II

Question 8

A patient with CHF that’s being well managed with drugs and needs a surgical procedure would receive which ASA classification?

Answer 8

ASA III

Question 9

A patient who presents with a septic abdomen and will die without rapid surgical intervention would receive which ASA classification?

Answer 9

ASA IV

Question 10

A patient who is going to die no matter what is done would receive which ASA classification?

Answer 10

ASA V

Question 11

3 advantages and 1 disadvantage of making NSAIDs part of the anesthetic plan

Answer 11

A:

1) long-acting
2) central and peripheral effects
3) no cross-reaction with anesthetics

D:
1) inadequate for surgical pain

Question 12

3 advantages of sedative use as a pre-med

Answer 12

1) reduces inhalent/agent requirement
2) facilitates handling pre-operatively
3) may have analgesic properties

Question 13

Name 3 sedatives commonly used as pre-meds and what their classification is

Answer 13

1) Ace–alpha 1 agonist
2) Dexmeditomidine–Alpha 2 agonist
3) Midazolam–Benzodiazepine (GABA agonist)

Question 14

2 advantages of using opiods as premeds

Answer 14

Synergism for sedation

Analgesia

Question 15

Name 4 opiods commonly used as premeds and which receptors they work at

Answer 15

1) Butorphanol–Kappa agonist
2) Hydromorphone–mu agonist
3) Morphine–mu agonist
4) Buprenorphine–partial mu agonist

Question 16

4 reasons why inducing with an inhalant isn’t recommended

Answer 16

1) increased mortality
2) no control of airway
3) CV depression
4) stress

Question 17

Which induction agent is associated with causing transient apnea?

Answer 17

Propofol

Question 18

Repeated exposure of propofol in _____ can lead to _____?

Answer 18

Cats; heinz body anemia

Question 19

When inducing with a dissociative (i.e. Ketamine) which CV effect is commonly seen?

Answer 19

Indirect sympathetic stimulation (leads to hypertension & tachycardia)

Question 20

Concerning injectable induction agents:

1) which has longest duration of action
2) which causes the lease CV depression
3) which is best for puppy vigor following C-section

Answer 20

1) ketamine
2) etomidate
3) Alfaxalone

Question 21

A common side effect seen when inducing with Etomidate?

Answer 21

maintained gag response

Question 22

Neuroleptanesthesia combines which 2 types of drugs?

Give 2 examples

Answer 22

Sedative & opioid

Midazolam w/ Fentanyl
Midazolam w/ Hydromorphone

Question 23

Name 3 ways to induce intra-operative anesthesia

Answer 23

1) local/regional anesthetic
2) premed + intermittent boluses
3) Premed + CRI

Question 24

3 advantages of local/regional anesthetics

Answer 24

1) blocks low on the pain pathway (no risk for central sensitization)
2) Eliminates surgical stimulation
3) Reduces the need for systemic analgesics

Question 25

A common block indicated for a castration?

Answer 25

Testicular Block

Question 26

3 indications for a mandibular nerve block?

Answer 26

1) extractions
2) fracture
3) mandibulectomy (partial or full)

Question 27

A patient presents for an ulnar fracture that involves the elbow. Which regional anesthetic technique would be indicated?

Answer 27

Brachial plexus block

Question 28

3 disadvantages of using epidural anesthesia/analgesia

Answer 28

1) motor blockade (patient will be non-ambulatory)
2) sympathetic blockade (can lead to systemic hypotension…depends on volume given)
3) Failure (most common)

Question 29

Most common site of epidural injection in small animals

Answer 29

Lumbosacral space L7-S1

Question 30

Concerning epidural anesthetics:

1) volume determines?
2) Concentration determines?

Answer 30

1) extent of spread cranially

2) duration of action and effectiveness

Question 31

What property of morphine makes it suitable for use in the epidural space?

Answer 31

NOT lipophilic (won’t go systemically)

Question 32

Which classes of opiods (and 1 other drug) can be used as CRIs

Answer 32

Full mu agonists (morphine, methadone, hydro, fentanyl)

Dexmedetomidine

Question 33

Post-operative inflammatory pain is best managed by?

Answer 33

NSAIDs

Question 34

Name 1 thing that can prevent hypothermia and how?

Answer 34

Low flow anesthesia; allows patient to maintain heat and moisture

Question 35

What 2 factors determine BP

Answer 35

cardiac output

systemic vascular resistance

Question 36

When is it indicated to interfere for low BP (hypotension)

Answer 36

when MAP is <60mmHg

Question 37

Concerning doppler, what does it measure in:

1) dogs
2) cats

Answer 37

1) systolic arterial pressure (SAP)

2) Mean arterial pressure (MAP)

Question 38

Describe the treatment protocol for hypotension

Answer 38

1) start with assessing depth; if too deep, lighten anesthesia
2) administer fluids; start with 2 boluses of crystalloid fluids (@ 10ml/kg); if that doesn’t work, 2 blouses of colloids (@ 5ml/kg)
3) if neither of the above work, use drugs: anticholingerics, inotropes, or pressors

Question 39

When would an inotrope be indicated over an anticholinergic for hypotension

Answer 39

Use inotropes when HR is normal

Question 40

Indication for treating bradycardia?

Answer 40

When it impacts CO (check BP to determine)

Question 41

2 differentials for tachycardia; how would you treat each?

Answer 41

1) Hypotension (compensatory); Tx with fluids

2) Sympathetic stimulation (pain); give analgesics

Question 42

Concerning ventricular arrhythmias:

1) 2 indications for treatment
2) Tx of choice

Answer 42

1) affecting BP or degrading (getting worse)

2) Lidocaine

Question 43

Which 2 factors impact ETCO2 and when would you intervene for hypercapnia?

Answer 43

Amount of CO2 produced & Minute ventilation

If ETCO2 >60

Question 44

2 causes of low ETCO2?

Answer 44

Tachypnea
Decreased CO

*check BP to distinguish

Question 45

For which abnormal capnographic waveform is treatment not needed?

Answer 45

Unstable plateau

Question 46

T/F: Oxygen saturation adequately indicates the level of oxygen delivery to the tissues

Answer 46

FALSE

Question 47

Appropriate rate for chest compression during CPR in large dogs?

Answer 47

100 beats/min

Question 48

When do most peri-anesthetic deaths occur?

Answer 48

during recovery (first 3 hours in)