SA Anesthesia Parts 1-4 Flashcards
The 4 goals of small animal anesthesia
Unconsciousness
Loss of movement
Loss of nociception
Maintain hemostasis
What three things comprise an animal’s signalment
age, breed, sex
What 4 vital signs are assessed during physical examination
temp, pulse, respiratory rate, pain
T/F: finding elevated liver enzymes is indicative of impaired hepatic function and could mean prolonged drug metabolism
FALSE
Enzymes indicate DAMAGE NOT FUNCTION!!
Bile acids for liver function
What does ASA stand for
America society of anesthesiologists
A healthy patient that presents for an elective dental procedure would receive which ASA classification?
ASA I
A healthy patient with an injury that requires surgical correction (i.e. TPLO) would receive which ASA classification?
ASA II
A patient with CHF that’s being well managed with drugs and needs a surgical procedure would receive which ASA classification?
ASA III
A patient who presents with a septic abdomen and will die without rapid surgical intervention would receive which ASA classification?
ASA IV
A patient who is going to die no matter what is done would receive which ASA classification?
ASA V
3 advantages and 1 disadvantage of making NSAIDs part of the anesthetic plan
A:
1) long-acting
2) central and peripheral effects
3) no cross-reaction with anesthetics
D:
1) inadequate for surgical pain
3 advantages of sedative use as a pre-med
1) reduces inhalent/agent requirement
2) facilitates handling pre-operatively
3) may have analgesic properties
Name 3 sedatives commonly used as pre-meds and what their classification is
1) Ace–alpha 1 agonist
2) Dexmeditomidine–Alpha 2 agonist
3) Midazolam–Benzodiazepine (GABA agonist)
2 advantages of using opiods as premeds
Synergism for sedation
Analgesia
Name 4 opiods commonly used as premeds and which receptors they work at
1) Butorphanol–Kappa agonist
2) Hydromorphone–mu agonist
3) Morphine–mu agonist
4) Buprenorphine–partial mu agonist
4 reasons why inducing with an inhalant isn’t recommended
1) increased mortality
2) no control of airway
3) CV depression
4) stress
Which induction agent is associated with causing transient apnea?
Propofol
Repeated exposure of propofol in _____ can lead to _____?
Cats; heinz body anemia
When inducing with a dissociative (i.e. Ketamine) which CV effect is commonly seen?
Indirect sympathetic stimulation (leads to hypertension & tachycardia)
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
1) ketamine
2) etomidate
3) Alfaxalone
A common side effect seen when inducing with Etomidate?
maintained gag response
Neuroleptanesthesia combines which 2 types of drugs?
Give 2 examples
Sedative & opioid
Midazolam w/ Fentanyl
Midazolam w/ Hydromorphone
Name 3 ways to induce intra-operative anesthesia
1) local/regional anesthetic
2) premed + intermittent boluses
3) Premed + CRI
3 advantages of local/regional anesthetics
1) blocks low on the pain pathway (no risk for central sensitization)
2) Eliminates surgical stimulation
3) Reduces the need for systemic analgesics
A common block indicated for a castration?
Testicular Block
3 indications for a mandibular nerve block?
1) extractions
2) fracture
3) mandibulectomy (partial or full)
A patient presents for an ulnar fracture that involves the elbow. Which regional anesthetic technique would be indicated?
Brachial plexus block
3 disadvantages of using epidural anesthesia/analgesia
1) motor blockade (patient will be non-ambulatory)
2) sympathetic blockade (can lead to systemic hypotension…depends on volume given)
3) Failure (most common)
Most common site of epidural injection in small animals
Lumbosacral space L7-S1
Concerning epidural anesthetics:
1) volume determines?
2) Concentration determines?
1) extent of spread cranially
2) duration of action and effectiveness
What property of morphine makes it suitable for use in the epidural space?
NOT lipophilic (won’t go systemically)
Which classes of opiods (and 1 other drug) can be used as CRIs
Full mu agonists (morphine, methadone, hydro, fentanyl)
Dexmedetomidine
Post-operative inflammatory pain is best managed by?
NSAIDs
Name 1 thing that can prevent hypothermia and how?
Low flow anesthesia; allows patient to maintain heat and moisture
What 2 factors determine BP
cardiac output
systemic vascular resistance
When is it indicated to interfere for low BP (hypotension)
when MAP is <60mmHg
Concerning doppler, what does it measure in:
1) dogs
2) cats
1) systolic arterial pressure (SAP)
2) Mean arterial pressure (MAP)
Describe the treatment protocol for hypotension
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
When would an inotrope be indicated over an anticholinergic for hypotension
Use inotropes when HR is normal
Indication for treating bradycardia?
When it impacts CO (check BP to determine)
2 differentials for tachycardia; how would you treat each?
1) Hypotension (compensatory); Tx with fluids
2) Sympathetic stimulation (pain); give analgesics
Concerning ventricular arrhythmias:
1) 2 indications for treatment
2) Tx of choice
1) affecting BP or degrading (getting worse)
2) Lidocaine
Which 2 factors impact ETCO2 and when would you intervene for hypercapnia?
Amount of CO2 produced & Minute ventilation
If ETCO2 >60
2 causes of low ETCO2?
Tachypnea
Decreased CO
*check BP to distinguish
For which abnormal capnographic waveform is treatment not needed?
Unstable plateau
T/F: Oxygen saturation adequately indicates the level of oxygen delivery to the tissues
FALSE
Appropriate rate for chest compression during CPR in large dogs?
100 beats/min
When do most peri-anesthetic deaths occur?
during recovery (first 3 hours in)
