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Anesthesia > Small Animal Emergencies > Flashcards

Small Animal Emergencies Flashcards

1
Q

What are the 5 major anesthetic concerns in patients with hemoabdomen?

A
  1. hypovolemia and hypotension due to hemorrhage
  2. anemia = poor oxygen delivery
  3. tachycardia and tachyarrhythmias
  4. pain
  5. regurgitation and aspiration
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2
Q

What are the 4 major concerns in patients with GDV?

A
  1. decreased ventilation - gas distending abdomen
  2. decreased CV function - obstructed venous return
  3. metabolic alkalosis or acidosis
  4. cardiac arrhythmias
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3
Q

What ASA status would a patient undergoing hemoabdomen be? What blood work should be done?

A

ASA 3-4 E

  • CBC/chem
  • repeat PCV and TS immediately before induction
  • blood type and cross match
  • coagulation profile
  • lactate
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4
Q

What imaging is important for hemoabdomen cases?

A

abdominal U/S and thoracic rads

  • site of hemorrhage
  • metastatic disease
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5
Q

Why is lactate an important component of pre-anesthesia blood work in emergency cases?

A
  • INCREASED = worsening perfusion
  • DECREASED = improving function
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6
Q

Why are ECGs and BP measurements important monitoring for patients with hemoandomen?

A

ventricular arrhythmias are very common

gives an idea if the impact of blood loss is being managed

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7
Q

How should catheters be placed in patients with hemoabdomen? What else is done at induction?

A

two catheters placed - one for induction agents and the other available for additional CRIs and transfusions

  • ECG, BP, pulse ox placed
  • preoxygenation with facemask
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8
Q

What drugs are avoided in premedications in patients with hemoabdomen? What is used?

A
  • Acepromazine = vasodilation
  • Dexmedetomidine

neruoleptic anesthesia/analgesia
- pure mu opioid (Fentanyl, Methadone) + BZD (Midazolam) IV

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9
Q

What induction agents are commonly used in patients with hemoabdomen? CRIs?

A

ketamine +/- propofol or alfaxalone —> slow and careful, likely to need less than in a healthy patient

REDUCE/ELIMINATE inhalant usage
- fentanyl, hydromorphone, morphine
- ketamine
- lidocaine: anti-septic and analgesic

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10
Q

What should be prepared before anesthesia in patients with hemoabdomen? What is done if an arrhythmia is noticed prior? What should be done before using inotropes and vasopressors?

A

pre-calculate dopamine and/or norepinephrine CRI

bolus lidocaine, start CRI

restore blood volume

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11
Q

What are the 4 expected complications seen in hemoabdomen cases under anesthesia? How are they treated?

A
  1. hypotension - crystalloid, hypertonic saline, blood products, inotropes, minimization of inhalants
  2. hypoventilation - ventilator, assist to 45-55 mmHg with some permissive hypercapnia (CO2 = resp stimulant)
  3. hypothermia - aggressively prevent and warm patient
  4. tachyarrhthymia - lidocaine
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12
Q

What analgesia is commonly provided during hemoabdomen correction?

A
  • CRIs
  • line block infiltration with local
  • TAP block
  • Nocita at closure

continue/wean off post-op with regular pain scoring

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13
Q

When are Acepromazine and Dexmedetomidine able to be used in hemoabdomen patients? What is indicated for ongoing arrhythmias?

A

at low doses for agitation or euphoria

lidocaine and continousu ECG monitoring

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14
Q

What are 4 important aspects to GDV pre-anesthesia workup?

A
  1. electrolyte and blood gas analysis
  2. CBC/chem, at minimum PCV, TS, glucose, BUN
  3. lactate (trend)
  4. ECG and BP monitoring pre-anesthesia and during induction
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15
Q

How is the placement of IV catheters different in patients with GDV?

A

use forelimbs —> compromised perfusion in back legs due to enlarged stomach

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16
Q

What should be done before beginning induction in patients with GDV?

A
  • decompress stomach with a trochar or stomach tube
  • preoxygenate with face mask
  • correct electrolyte and acid-base abnormalities
17
Q

What is commonly part of premedications in patients with GDV?

A
  • Fentanyl CRI (decreases inhalant need)
  • Midazolam
  • Lidocaine bolus (to be maintained with CRI)

AVOID ACE AND DEX

18
Q

How induction agents are recommended in patients with GDV? How can regurgitation be avoided?

A

propofol or alfaxalone carefully titrated

keep patient sternal with head up until the ET tube and stomach tube are placed

19
Q

What monitoring is especially important post-anesthesia in patients that just had GDV?

A

monitor for ongoing arrhythmias —> lidocaine!

(also want to recheck electrolytes, lactate, and other biochem parameters as indicated by patient status)

20
Q

What are the 4 most common anesthetic concerns in patients with septic abdomens?

A
  1. decreased ventilation
  2. peripheral vasodilation
  3. metabolic acidosis and electrolyte imbalances
  4. cardiac arrhythmias
21
Q

What work up is recommended in patients with septic abdomen?

A
  • CBC/chen
  • lactate
  • coagulation status
  • blood glucose trends
  • blood pressure
  • ECG
22
Q

What additional catheter can be placed in patients with sepsis if time allows?

A

multi-lumen central (jugular) catheter —> quick reaction in patients that are prone to quick decompensation

23
Q

What is important to anesthesia planning in patients with sepsis?

A
  • correct electrolyte and acid-base abnormalities
  • lidocaine CRI for arrhythmias and anti-septic action
  • vasopressor (NE) for hypotension
24
Q

How are CRIs used in septic patients?

A

multiple with a PIVA protocol to minimize inhalants

  • fentanyl
  • lidocaine
  • ketamine
25
Q

What cardiovascular support CRIs should be ready for use in patients with sepsis?

A
  • norepinephrine**
  • dopamine
26
Q

What are the 2 phases of sepsis?

A
  1. vasodilation
  2. hypotension, hypoglycemia
27
Q

What are the 3 specific anesthetic concerns in dystocia cases?

A
  1. decreased ventilation due to oxygen delivery to fetus
  2. fetal perfusion will be reduced by the anesthetic-induced hypotension
  3. higher potential for regurgitation or aspiration since patients are not typically fasted
28
Q

What are the 2 major parts of a dystocia pre-anesthetic workup?

A
  1. abdominal U/S or thoracic radiograph to confirm number of puppies or kittens
  2. basic labs - tend to be healthy, young animals
29
Q

What is the goal of anesthesia planning in dystocia cases?

A

selective analgesia, muscle relaxation, and sedation/narcosis that doesn’t endanger the mother or fetus

30
Q

What are 5 important physiologic parameters that are unique in pregnant mothers?

A
  1. increased HR, CO, blood volume, and plasma volume with decreased PCV/TS
  2. increased minute volume and oxygen consumption
  3. decreased functional residual capacity
  4. increased gastric emptying time and decreased pH and motility = increased chances of regurgitation
  5. increased RBF
31
Q

What are 3 causes of fetal depression?

A
  1. prolonged labor
  2. decreased placental perfusion
  3. fetal hypoxemia, acidosis, and stress
32
Q

What anesthetics should be avoided in dystocia cases? What is commonly found in the mothers?

A

those that cause cardiac depression —> already have increased cardiac work with a decreased reserve due to increased CO and decreased SVF for fetus

hypoxemia and hypercapnia —> abdominal contents are pressinge on diaphragm = decreased FRC and atelectasis

33
Q

What gastroprectants are recommended in patients undergoing dystocia? How else is this treated?

A

increased gastric acidity —> Metoclopramide, Famotidine +/- Maropitant

protect the airway —> pre-oxygenate, sternal, proper ET tube placement

34
Q

What neonate resuscitation supplies should be prepared in dystocia cases?

A
  • suction bulb
  • warming device/incubator
  • suture material and hemostats for umbilical cord
  • sublingual Naloxone to reverse opioids used on mother
  • Atropine for slow fetal HR
  • intubation materials
35
Q

What drugs are avoided in the fetus in dystocia cases? What is used?

A

Acepromazine, Dexmedetomidine, Midazolam, Ketamine

  • short-acting and reversible opioids
  • alfaxalone or propofol
  • epidural at L-S space
    (decreased necessary inhalants until feti are out)
36
Q

Why is uteroplacental circulation maintenance especially important?

A
  • maintained fetal and maternal homeostasis
  • keeps uterine bloodflow proportional to systemic BP
37
Q

What post-anesthesia monitoring is used for mothers that underwent dystocia? What is especially important for the neonates?

A
  • NSAIDs
  • small dose of Ace for sedation
  • additional opioids
  • Nocita incisionally or Bupivacaine at closure

nursing ASAP - consider sublingual dextrose if it becomes prolonged

Anesthesia (40 decks)

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