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SGTSUP > SGT SUP > Flashcards

SGT SUP Flashcards

1
Q

what class of drugs does atropine belong to?

A

anticholinergics

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2
Q

what is the main use of atropine in vet anesthesia?

A

prevent and treat bradycardia

decrease salivary secretions

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3
Q

what anesthetic emergency would atropine be reached for in?

A

cardiac arrest

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4
Q

what anticholinergic has a similar use to atropine?

A

glycopyrrolate

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5
Q

how does glycopyrrolate differ from atropine?

A

slower onset w/ longer durtion

safer to use in heart patients

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6
Q

when considering your patient’s BP prior to administering an anticholinergic - what values would suggest use of atropine (vs. glyco)?

A

atropine - low HR and BP

glyco - low HR but good BP

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7
Q

why is atropine contraindicated for use in heart patients?

A

can cause cardiac arrhythmia

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8
Q

if you have Dexmedetomidine on board what do you need to do BEFORE giving an anticholinergic (ace or glyco)?

A

administer a half dose of reversal BEFORE giving anticholinergic

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9
Q

what is the main use of acepromazine?

A

as a sedative

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10
Q

t/f - acepromazine has excellent analgesic effects

A

false - acepromazine provides NO analgesia

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11
Q

what class of drug is safe to mix with acepromazine? (think analgesic)

A

opioids

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12
Q

what are some indications for the use of acepromazine?

A

cardiac patients - protect against arrhythmias; decrease cardiac output
mild antiemetic

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13
Q

in what specific case might you see acepromazine administered orally?

A

aggressive animals

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14
Q

is there a reversal agent for acepromazine? if so, what is it?

A

no reversal agent

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15
Q

what are some known disadvantages associated with acepromazine?

A 
peripheral vasodilation 
hypotension 
hypothermia 
increased HR
respiratory depression 
paradoxical excitement (young, healthy animals)
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16
Q

what contraindications are associated with acepromazine?

A

liver patients

penile prolapse in stallions

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17
Q

what altered effect is seen when acepromazine is administered in geriatrics, neonates and debilitated animals?

A

increased potency

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18
Q

what is the main use of benzodiazepines? (diazepam and midazolam)

A

tranquilizers

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19
Q

what indications are associated with the use of benzodiazepines?

A

anti-convulsant
anti-anxiety
calming

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20
Q

what is the ratio of diazepam to ketamine when used together?

A

1:1

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21
Q

t/f - diazepam is absorbed faster and has a shorter half life than midazolam

A

true

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22
Q

do benzodiazepines provide analgesia?

A

no

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23
Q

t/f - will not see paradoxical effect with use of benzodiazepines in young/healthy animals

A

false - it is possible to see paradoxical reaction with use

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24
Q

what emergency would occur if oral diazepam were administered to your feline patient?

A

LIVER FAILURE

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25
Q

what contraindications are associated with the benzodiazepines?

A

liver patients
kidney patients
geriatric
respiratory depression

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26
Q

why are benzodiazepines contraindicated for use in patients with liver disease?

A

they are metabolized slowly

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27
Q

is there a reversal agent for benzodiazepines? if so; what is it?

A

yes - flumazenil

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28
Q

under what class of drugs does dexmedetomidine fall?

A

alpha 2 agonists

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29
Q

what main purpose is dexmedetomidine administered for?

A

sedation
analgesia
muscle relaxation

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30
Q

what routes of administration are safe for use with dexmedetomidine?

A

IM

IV

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31
Q

what clinical indications might call for use of dexmedetomidine?

A

rapid sedation
short-acting analgesia
opioid sparing

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32
Q

t/f - dexmedetomidine CANNOT be reversed once administered

A

false - there is a reversal available

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33
Q

what reversal agent is available for dexmedetomidine?

A

atipamezole (antisedan)

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34
Q

what are some disadvantages that can be seen with use of dex?

A 
bradycardia 
early phase vasoconstriction/hypertension 
late phase vasodilation/hypotension 
vomiting 
**respiratory depression**
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35
Q

what contraindications for use are associated with dex?

A 
liver patients (metabolized)
heart patients 
geriatric 
pediatric 
pregnant 
ill patients
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36
Q

what drugs make up the common solution known as “kitty magic” ?

A

ketamine
hydromorphone
dexmedetomidine

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37
Q

t/f - in comparison to xylazine, dex is less potent but more safe

A

false - dex is more potent and safer than xylazine

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38
Q

t/f - xylazine acts on the same receptors of the body as dexmeditomidine

A

true; both are alpha 2 agonists

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39
Q

t/f - if using xylazine in cattle, the dose will be greater than that used with a small animal

A

false - the dose for cattle is 1/10th of that for a small animal

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40
Q

what contraindications are associated with xylazine?

A

pregnant cows and ewes
liver patients
heart patients

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41
Q

t/f - butorphanol is not an opioid

A

false; it is an opioid

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42
Q

what is a common use for butorphanol in veterinary anesthesia?

A

pre-med and post op analgesic

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43
Q

what unique property does butorphanol possess? (think multi-use)

A

can be used to reverse morphine and fentanyl

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44
Q

t/f - butorphanol is more effective as an analgesic than a sedative

A

FALSE; butorphanol has poor pain control but does cause sedation

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45
Q

what contraindications are associated with butorphanol?

A 
liver disease 
hypothyroid 
renal insufficiency 
addison's 
head trauma 
geriatric/debilitated patients
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46
Q

is buprenorphine administered in severe pain cases for analgesic?

A

no - buprenorphine is good for mild to moderate pain

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47
Q

which is the longest lasting opioid? how long does it act?

A

buprenorphine; 8 hours

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48
Q

what specialized form of buprenorphine is available? what unique quality does it possess?

A

slow-release; lasts up to 3 days

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49
Q

what qualities make hydromorphone superior to morphine?

A

greater analgesic potency
fewer side effects
longer duration of effect
fewer tendencies of vomiting

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50
Q

what is a common side effect that one could expect to see in their feline patient with hydromorphone on board?

A

hyperthermia

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51
Q

when should a cat be given gabapentin (if applicable) before a stressful event?

A

15 hours

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52
Q

what are the two main effects of gabapentin? (that we want to see)

A

decrease in anxiety

analgesic at the nerve level

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53
Q

what drug should ALWAYS be avoided in hypoproteinemic patients and WHY?

A

propofol; it is highly protein bound

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54
Q

what respiratory side effect can you expect to see after intubation with propofol induction?

A

apnea - the patient will hold their breath

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55
Q

if comparing propofol and alfaxalone, which has a longer duration of effect?

A

alfaxalone

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56
Q

what is the purpose of the pressure reducing valve?

A

reduces the pressure from the oxygen tank to a constant usable level of 40-50 psi

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57
Q

is the oxygen released from the tank at a safe pressure level for the patient?

A

NO; needs to be furthered reduced by the flowmeter

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58
Q

what is the purpose of the line pressure gauge? what should it read when you have turned on the oxygen tank?

A

indicates the pressure in the gas line between pressure-reducing valve and flowmeter; should read 40-50psi when tank is open

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59
Q

what is the purpose of the flowmeter? what units are used to express?

A

reduces pressure of gas to 15psi; expressed in L/min (gas flow to patient)

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60
Q

what is the purpose of the oxygen flush valve?

A

delivers a short, large burst of PURE oxygen into the rebreathing circuit or common gas outlet

61
Q

when might you use the oxygen flush valve? is it safe to use when your patient is hooked up to the circuit?

A

refill reservoir bag, dilute gas left in circuit at the end of anesthesia ; NO, never use the oxygen flush while patient is hooked up

62
Q

in a VOC, does oxygen from the flowmeter enter the breathing circuit before or after the vaporizer?

A

oxygen from the flowmeter will enter the breathing circuit AFTER the vaporizer

63
Q

what part of the anesthetic machine is connected to both the vaporizer outlet port and the breathing system?

A

common gas outlet

64
Q

t/f - our smallest patients need to be set up with a rebreathing circuit for anesthesia

A

false - any patient <7kg requires a non-rebreathing circuit

65
Q

what is dead space?

A

gas that is inspired at every breath but does not participate in gas exchange

66
Q

what is animal dead space?

A

anatomical dead space of the animal; space from the mouth (circuit enters) to alveoli (gas exchange)

67
Q

what is mechanical dead space?

A

space from the animal’s mouth to the machine

68
Q

what are some possible causes of circuit resistance?

A

valves
absorbent canister
hose length, diameter

69
Q

what is circuit drag?

A

refers to anything that may cause extubating of the patient

70
Q

what is the purpose of the unidirectional valves?

A

control the direction of gas flow

71
Q

what is the purpose of the pop-off valve?

A

allows excess carrier and anesthetic gases to exit the breathing circuit and enter the scavenging system

72
Q

what are some indications for manual ventilation? (bagging)

A

minimize chance of atelectasis (every 5-10min)
normalize gas exchange
regulate depth of anesthesia

73
Q

what happens with the carbon dioxide canister?

A

soda lime granules react with CO2 to form calcium carbonate

74
Q

what is a physical sign (on your patient) that you may be using depleted soda lime granules?

A

cherry red mucous membranes; isoflurane mixed with depleted granules creates excessive heat and carbon monoxide

75
Q

what is the purpose of the pressure manometer?

A

indicates the pressure of gases within the breathing circuit

76
Q

what level on the pressure manometer should NOT be exceeded when manually ventilating? why?

A

20 cmH2O; to prevent excessive pressure in the lungs

77
Q

what are the three options for scavenging systems?

A

passive
active
activated charcoal canister

78
Q

what kind of scavenging system uses a vacuum pump function?

A

active

79
Q

describe the F circuit

A

rebreathing circuit

coaxial tubing to warm inspired air with expired air

80
Q

describe the coaxial circuit

A

used for specific anesthetic machines
rebreathing circuit
coaxial tubing
has less resistance than the F circuit d/t one less piece of tubing

81
Q

describe the coaxial bain circuit

A

non-rebreathing
coaxial tubing
requires a universal control arm

82
Q

what are the two disadvantages known to be associated with the Ayres T-piece?

A

no pressure manometer (no universal control arm)

need to ensure reservoir bag remains flat (not folded)

83
Q

t/f - endotracheal tube size is not based on lean body weight

A

false - ETT sizing is based off of lean weight

84
Q

how do you calculate the appropriate sized reservoir bag for your patient?

A

tidal volume (10-20ml) x 6

85
Q

what must your flow rate ALWAYS remain above?

A

500ml/min

86
Q

how would you calculate a mask flow rate?

A

tidal volume x 30

87
Q

what are the common induction and maintenance flow rates for a rebreathing system?

A

induction: 50-100ml/kg/min
maintenance: 20-40ml/kg/min

88
Q

what are the common induction and maintenance flow rates for a non-rebreathing system?

A

induction:
maintenance: 200-300ml/kg/min

89
Q

when performing anesthesia, are we looking for a low or high blood-gas partition coefficient? why?

A

low; faster induction/recovery, agent is more soluble in alveolar gas than in blood at equilibrium
high concentrations in pulmonary alveoli lead to steep diffusion gradient between alveoli and tissues

90
Q

what is minimum alveolar concentration? (MAC)

A

concentration of vapour in the lungs that is needed to prevent movement in 50% of subjects (in response to surgical stimuli)

91
Q

how do you measure your patient properly to choose an ETT size?

A

tip of ETT at point of the shoulder with the opposite side coming to the nose of the animal

92
Q

what steps are required for intubation?

A 
preoxygenate for 3-5 minutes 
administer IV induction agent to effect 
position patient in sternal recumbency 
assess depth of anesthesia 
proceed with intubation if deep enough, if not administer more induction agent
93
Q

what may happen in your feline patients during intubation if proper preventative measures are not taken? what measures are these?

A

laryngospasms - avoided by using a local anesthetic spray on the arytenoids prior to intubating

94
Q

how can you confirm the ETT is placed correctly?

A

visualize arytenoid cartilage on either side of tube
look for condensation in tube
watch reservoir bag for movement
palpate the neck
look at the breathing pattern on capnograph

95
Q

how do you inflate the cuff of an ETT? how do you know you have inflated it enough?

A

inflate in 0.5ml increments using a syringe until no leak is heard when reservoir bag is squeezed and pressure in the circuit is 15cm H2O

96
Q

what can pale mucous membranes indicate?

A

blood loss
anemia
poor capillary perfusion

97
Q

what do cyanotic mucous membranes look like? what might they indicate?

A

blue to purple; can indicate:
respiratory arrest
oxygen deprivation
pulmonary disease

98
Q

what is the purpose of the pulse oximeter?

A

measures the saturation of hemoglobin and HR

99
Q

what is a normal pulse ox reading when patient is breathing pure oxygen?

A

> 95%

100
Q

what reading on the pulse oximeter would indicate that your patient is hypoxemic?

A

<90-95%

101
Q

what pulse oximeter reading would indicate a medical emergency?

A

<85%

102
Q

what are the two different types of pulse oximeter probes?

A

transmission

reflective

103
Q

what is the difference between ventilation and respiration?

A

ventilation refers to the movement of gas in and out of alveoli where respiration refers to the process of oxygen being supplied to and used by tissues, and the elimination of CO2 from tissues

104
Q

what is tidal volume?

A

the amount of air that is inhaled in a breath

105
Q

what is hypoventilation?

A

shallow breathing

106
Q

what is hyperventilation?

A

heavy breathing

107
Q

what does respiratory character refer to?

A

the effort required to take a breath

108
Q

what is an apneustic respiratory pattern?

A

prolonged hesitation between inspiration and expiration

109
Q

what is the purpose of the capnograph?

A

measures the level of carbon dioxide in air that is inhaled and exhaled

110
Q

what are the two different types of capnograph monitors?

A

sidestream

mainstream

111
Q

what should the CO2 reading be during inspiration?

A

0 mmHg

112
Q

what should the CO2 reading be during expiration?

A

35-45 mmHg

113
Q

during what point of respiration is the CO2 value most reflective of the arterial values?

A

CO2 value at the end of expiration

114
Q

what capnograph reading would indicate hypocapnia?

A

<35 mmHg

115
Q

what capnograph reading would indicate hypercapnia?

A

> 45 mmHg

116
Q

what must be evaluated to interpret a capnogram?

A

baseline value (should be 0 mmHg)
ETCO2 value
waveform shape
rate of change

117
Q

describe the appearance of a normal waveform on the capnograph?

A

modified rectangle

118
Q

what might rounding at the edges of the waveform on the capnograph indicate?

A

leaking cuff

partially kinked ETT

119
Q

what might be the cause of a rapid loss of waveform on the capnograph?

A

cardiac arrest

120
Q

if you see a rapid decrease in the height of the rectangles in the capnograph waveform, what might be happening to your patient?

A

hypotension

sudden decrease in cardiac output

121
Q

if a gradual increase in the height of the rectangles in the capnograph waveform is noted, what does this mean?

A

hyperthermia

122
Q

how often should your patient’s core body temperature be taken during anesthesia?

A

every 15-30 minutes

123
Q

what factors influence body temperature loss during anesthesia?

A

shaving and skin prep
lack of shivering/decreased muscular activity
decreased metabolic rate
opened body cavity/exposed viscera
hypotension - number one reason for temperature loss
age - pediatric and geriatric most at risk
size - smaller patients lose heat faster
use of a non-rebreathing system

124
Q

what are some influencing factors for hyperthermia during anesthesia?

A

excess internal heat administration
drug induced reactions
patient cannot dissipate heat

125
Q

what is malignant hyperthermia?

A

excess muscle metabolism with use of some anesthetic drugs/muscle relaxants

126
Q

what are the clinical signs of malignant hyperthermia?

A

patient becomes hot and stiff
ears turn red
increased CO2 production
tachyarrhythmias

127
Q

what steps should be taken if your anesthetic patient presents with malignant hyperthermia?

A

immediately stop anesthesia
administer 100% oxygen
use cooling methods
treat with Dantrolene

128
Q

what is assisted ventilation?

A

anesthetist delivers an increased volume of air or oxygen to the patient

129
Q

what is controlled ventilation?

A

anesthetist delivers ALL air required by patient; no spontaneous respiratory effort from patient

130
Q

t/f - anesthetized ventilation is the same as ventilation in awake animals

A

false - reduced amount of air entering and leaving lungs, decreased response from breathing centre d/t use of drugs

131
Q

what are some potential problems associated with ventilation in anesthetized patients?

A

hypercapnia - can lead to respiratory acidosis
hypoxemia - less oxygen entering the lungs
atelectasis - decreased VT so alveoli don’t completely expand which leads to collapse

132
Q

what kind of fluids are contraindicated in liver disease patients?

A

lactated ringers solution (LRS)

133
Q

how do you calculate a fluid deficit?

A

body weight (kg) x % dehydration - will give you volume in L needed to correct the dehydration

134
Q

what is the maintenance fluid rate for cats under anesthesia?

A

3ml/kg/hr

135
Q

what is the maintenance fluid rate for dogs under anesthesia?

A

5ml/kg/hr

136
Q

what fluid rate should be used post-op?

A

2ml/kg/hr

137
Q

what are the vital signs?

A 
heart rate and rhythm 
respiratory rate and depth 
mucous membrane colour 
capillary refill time 
pulse strength 
blood pressure 
body temperature
138
Q

describe the palpebral reflex

A

blink reflex in response to a light touch on the medial or lateral canthus of the eye

139
Q

describe the corneal reflex

A

retraction of the eyeball within its orbit and/or a blink in response to corneal stimulation (a drop of saline on the cornea)

140
Q

describe the pedal reflex

A

check by firmly pinching a digit - observe if animal flexes leg/withdraws paw

141
Q

describe the laryngeal reflex

A

epiglottis and vocal cords close immediately when larynx is touched with an object

142
Q

describe the papillary light reflex (PLR)

A

a light is shone into one eye; both pupils should constrict even when light is only shone in one directly

143
Q

describe the dazzle reflex

A

response to a bright light stimulus on the retinas

144
Q

other than the six reflexes, what are some others ways to assess anesthetic depth in your patient?

A 
spontaneous movement 
muscle tone 
eye position 
pupil size 
nystagmus 
salivary and lacrimal secretions 
heart and respiratory rates 
response to surgical stimulation
145
Q

when placing ECG leads on your patient, should they be in left or right lateral recumbency?

A

left lateral

146
Q

what ECG lead should be hooked up to the left front limb?

A

black

147
Q

what ECG lead should be hooked up to the right front limb?

A

white

148
Q

where is the red ECG lead hooked up to the patient?

A

left hind limb

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