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23 spring anesthesia > Test 2: 16 case 2 > Flashcards

Test 2: 16 case 2 Flashcards

1
Q

what are 4 common injectable anesthetics

A

Phenols (Propofol)
Steroids (Alfaxalone)
Imidazoles (Etomidate)

Cyclohexanones (Ketamine, Tiletamine)-

pheonols, steroids and imidazole: increase time GABA A channel is open= ↑ inhibitory effect

cyclohexanones- ketamine: dissociative- block NMDA(glutamate) receptor→ decrease excitatory activity → intense analgesia, light sleep, amnesia and catalepsy

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2
Q

how do phenols, steroids and imidazole work?

A

increase time GABA A channel is open= ↑ inhibitory effect

synergism with benzodiazepines (that allow GABA to bind easier to GABA A channel

Phenols (Propofol)
Steroids (Alfaxalone)
Imidazoles (Etomidate)

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3
Q

how do dissociative anesthetics work

A

cyclohexanones- ketamine: dissociative

block NMDA(glutamate) receptor→ decrease excitatory activity → intense analgesia, light sleep, amnesia and catalepsy

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4
Q

why do injectable anesthetics wear off so quickly?

A

redistribution into other areas of the body

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5
Q

— can cause transient central excitatory effects during induction

A

propofol/etomidate

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6
Q

— can cause transient central exciatory effect during recovery

A

alfaxalone
ketamine, tiletamine (dissociative anesthetics)

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7
Q

— can cause muscle rigidity and hyperreflexia upon induction

A

dissociative anesthetics
(ketamine, tiletamine)

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8
Q

injectable anesthetics will do what to respiratory system

A

↓ tidal volume
↓ respiratory rate

propofol:
↓ RR, bronchodilation, ↓ swallow reflex,
↓ BP, no effect on HR
Alfaxalone:
↓ RR (less then propofol) ↓ swallow reflex
lesser CV effects then propofol- safe in shocky pts
Etomidate:
no/minimal effect on RR or CV
Ketamine:
apneustic breathing, bronchdilation
CV indirect stimulent: ↑ HR, CO, MAP in healthy but in sick direct inotropic and vasodilatory effect

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9
Q

in general injectable anesthetics will do what to CV system

A

cause hypotension

negative inotropic effect and direct vasodilation

propofol:
↓ RR, bronchodilation, ↓ swallow reflex,
↓ BP, no effect on HR
Alfaxalone:
↓ RR (less then propofol) ↓ swallow reflex
lesser CV effects then propofol- safe in shocky pts
Etomidate:
no/minimal effect on RR or CV
Ketamine:
apneustic breathing, bronchdilation
CV indirect stimulent: ↑ HR, CO, MAP in healthy but in sick direct negative inotropic and vasodilatory effect

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10
Q

what are the advantages of alfaxalone and ketamine in comparision to propofol?

A
  • water soluble, can give IM- easier to give to angry animal
  • less respiratory depressent
  • less CV depressent
  • Ketamine has some antinocicpetive (pain relief) activty
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11
Q

in anemic cats — injectable anesthetic should not be used

A

propofol- cats can not metabolize propofol in their liver, leads to heinz bodies formation

etomidate- should not be used in anemic animals- causes decreased adrenal steroid genesis which can lead to hemolysis

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12
Q

why should etomidate not be used in anemic pts

A

causes decreased adrenal steroid genesis which can lead to hemolysis

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13
Q

what are unique features of etomidate?

A
  • extremely rapid induction < 20 secs
  • decrease in CBF → direct cerebral vasoconstriction
  • none or minimal Resp and CV effects
  • extrahepatic metabolism (plasma ester hydrolysis- can be used in liver failure pts
  • lowest plasma albumin binding (76%)- not effected by low albumin

Bad things

  • inhibit adrenal steroid production (11β hydroxylase)
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14
Q

inhalent drugs with high or low B/G coefficients can change induction faster

A

low

sevoflurane and desflurane can be adjusted faster then isoflurane

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15
Q

risks associated with inhalant anesthetics

A

hypoventilation → resp acidemia
V/Q mixmatch → hypoxemia
Hypotension- tissue hypoperfusion, cardiac arrhythmia, muscle weakness
Vasodilation
inhibit ANS- negative inotropic effect, inhibit autonomic CV reflexes
increases stress hormone release

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16
Q

how to reduce risk factors of inhaled anesthetics

A

balanced anesthesia

use many drugs that work in different ways to reduce overall dose of each med

different agent and technique for each element:

  • hypnosis and amnesia
  • analgesia
  • muscle relaxation
  • absence of somatic or autonomic responses to noxious stimulation
17
Q

low dose — can be given to prevent dysphoria post op

A

acepromazine(D2 antagonism- sedative/tranquilizer) /dexmedetomidine
dysphoria from opioids- use butorphanol (partial μ opioid) to block some opioid receptors

18
Q

what can you use for premed of young healthy dog for TPLO

A

Can use many options:

  • Opioid ± acepromazine (D2 antagonist)
  • Opioid ± dexmedetomidine (⍺2 agonist)
  • Systemic NSAIDs (implication of giving this drug pre-op rather than post-op)
  • Opiods: Oxymorphone, hydromorphone, morphine, methadone
19
Q

goals of premed

A

Sedation/ anxiolysis
Reduce induction/ maintenance agent doses

20
Q

why use TIVA over inhalant

A

Both are valid options, but an inhalant anesthetic-based maintenance is certainly cheaper and more convenient

TIVA- pt are faster to ambulate after surgery, need less anesthetics

21
Q

what drugs/protocols are most appropriate from young healthy dog for TPLO

A
  • Propofol or alfaxalone ± midazolam 0.2 mg/kg to effect, followed by isoflurane/sevoflurane in oxygen ± air
  • Propofol or alfaxalone ± midazolam 0.2 mg/kg to effect, followed by propofol and alfaxalone CRI, respectively
  • Ketamine 4 - 5 mg/kg + midazolam 0.2 mg/kg IV, followed by isoflurane/sevoflurane in oxygen ± air
22
Q

which drugs should you not use for induction for TPLO of young healthy pup

A

Etomidate for induction of anesthesia
Telazol for induction of anesthesia
Volatile anesthetics for induction of anesthesia

23
Q

how to control nociception intraoperatively for TPLO

A
  • Lumbosacral epidural anesthesia/analgesia
    ◦ Morphine 0.1 - 0.3 mg/kg
    ◦ Ropivacaine 0.25 %
  • Femoral & sciatic nerve block with 0.5 % bupi- or ropivacaine
  • Fentanyl, Sufentanil or Alfentanil CRI
24
Q

what drugs for 2yo cat declaw

A
  • Local anesthesia with bupivacaine 0.25 - 0.5 %
  • Systemic buprenorphine or oxymorphone or methadone or other opioid
  • Systemic dexmedetomiding
25
Q

what drugs are not effective for analgesia of 2 yo cat with declaw scheduled.

A

*NSAIDS as sole analgesic intervention
* IV lidocaine or IV ketamine

26
Q

which inhalant anesthetic could be optimal for induction of anesthesia for cat declaw

A

propofol or alfaxalone +/- midazolam
ketamine+ midazolem 0.2 mh/kg IV, followed by isoflurane/seroflurane in O2

27
Q

which inhalant anesthetic is optimal for cat declaw

A

seroflurane

28
Q

why use sevoflurane in cats for declaw

A

sevo is faster in onset of diease
- less irritant for the airways

23 spring anesthesia (40 decks)

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