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23 spring anesthesia > Test 2: 17 monitoring > Flashcards

Test 2: 17 monitoring Flashcards

1
Q

5 basic goals of anesthesia

A

Unconsciousness
Amnesia
Immobility
Analgesia
Blunted autonomic responses
* Cardiovascular
* Respiratory
* Endocrine
* Immune

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2
Q

stage 1 of anesthetic depth

A

awake to unconcious

Stage of voluntary movement

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3
Q

stage 2 of anesthetic depth

A

excitatory

stage of delirium or involuntary movement

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4
Q

stage 3 plane 1 of anesthetic depth

A

light anesthesia

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5
Q

stage 3 plane 2 anesthetic depth

A

moderate anesthesia

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6
Q

stage 3 plane 3 anesthetic depth

A

moderate-deep anesthesia

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7
Q

stage 3 plane 4 anesthetic depth

A

deep anesthesia

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8
Q

stage 4 anesthetic depth

A

stage of extreme CNS depression

results in death if not controlled

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9
Q

stage 1 is characterized by

A

voluntary movement:
* Initial administration to loss of consciousness
* Some analgesia (deeper phases)
* Breath-holding in excited, stressed animals
* Tachycardia
* Pupillary dilation
* Salivation
* Urination
* Defecation
*Ataxia
* Recumbency

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10
Q

stage 2 Anesthetic depth characteristics

A

delirium or involuntary movement (excitatory)
* Loss of consciousness to onset of regular breathing pattern
* Loss of voluntary control
* CNS depression -> reflexes more primitive and exaggerated
* External stimuli -> reflex struggling, breath holding, tachypnea, hyperventilation
* Tachycardia, tachyarrhythmias
* Pupil dilation
* Palpebral and eyelash reflexes prominent
* Nystagmus (horses)
* Vocalization
* Salivation (ruminants, cats)
* Vomiting (dogs, cats, goats)
* Laryngospasm (pigs, cats)

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11
Q

stage 3 anesthetic depth characteristics

A

surgical anesthesia

  • Unconsciousness
  • Progressive depression of reflexes
  • Muscle relaxation
  • Ventilation slow and regular
  • Vomiting and swallowing reflexes lost

Classification

  • Planes 1-4
  • Light, medium, deep
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12
Q

stage 4 anesthetic depth characteristics

A

extreme CNS depression → death
* Respirations cease
* Heartbeat slows then stops
* Blood pressure at shock level
* Capillary refill markedly delayed
* Pupils widely dilated
* Death unless immediate resuscitation

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13
Q

eyeball position and rotation during anesthesia for ruminants

A
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14
Q

eyeball position and rotation during anesthesia for cats and dogs

A
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15
Q

eyeball position and rotation during anesthesia for horses

A
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16
Q

what are some things that might prevent change in eyeball position and rotation during anesthesia

A
  • Ketamine → Eye does not typically rotate
  • Neuromuscular blockade
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17
Q

nystagmus during anesthetic depth for horses

A
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18
Q

changes in nystagmus during anesthesia for ruminants and swine

A
19
Q

what are some things that effect nystagmus during anesthesia

A
  • Small animals – nystagmus not normally present under surgical anesthesia
  • Ketamine
  • Neuromuscular blockade
20
Q

how does palpebral reflex change during anesthesia

A
21
Q

how does jaw tone change during anesthesia

A
22
Q

how does sphincter tone change during anesthesia

A
23
Q

Gag and swallow reflexes indicate — level of anesthesia in nearly all species

A

light

24
Q

— reflex lost at deeper planes

A

Cough

25
Q

Response depends on — and —

A

stimulus intensity and anesthetic depth

26
Q

when using ketamine, some laryngeal reflexes may persist but —

A

are not coordinated

need to intubate

27
Q

Focal facial or neck muscle twitching, myoclonus can be seen with what drugs?

A

propofol
etomidate

28
Q

Loss of consciousness occurs before or after loss of spontaneous movement and physiologic response

A

before

pt can start to move when still unconscious

29
Q

— movement reliable sign of light level of anesthesia

A

Spontaneous

30
Q

Any single measure defines —. Assess all available parameters to form —

A

only itself

composite estimate of system

31
Q

what happens to CV system during anesthesia

A
  • Decreased contractility
  • Decreased systemic vascular resistance
  • Reduced blood pressure

Autonomic response to noxious stimulus
* Increased arterial blood pressure
* Increased heart rate

CV system may not be reliable way to assess anesthetic depth based on opposite effects of pain and anesthesia

32
Q

what are some confounding factors to CV system during anesthesia

A

some drugs effect CV system
physiologic status: hypovolemia, temp, hypoventilation
Disease states: hemorrhage, anemia, cardiovascular disease
Co-morbidities
species

33
Q

two important questions about respiratory system during anesthesia

A

how is animal ventilating?

how is animal oxygenating?

34
Q

Autonomic response of respiratory system to noxious stimulus

A
  • Increased respiratory rate
  • Change in respiratory pattern (irratic, panting)
  • Patient-ventilator dyssynchrony (fight ventilation)
35
Q

how to measure inhalant gas delivery

A

End-tidal concentration of volatile anesthetic agent

Minimum Alveolar Concentration (MAC) will be proportional to the amount of drugs getting to the brain

  • Inter- and intra-individual variability
36
Q

what is target controlled infusions

A

way to monitor injectable anesthetics

based off pharmodynamic and pharmokinetic parameters to form model that you can use to adjust rate of infusion

limitations:
* need a bunch of blood samples→ not practical in small animals
* drug interactions
* patient variability- some pts need more drugs then others

37
Q

how does EEG monitoring work

A

computer processes brain activity to give number that correlates to how deep a pt is

EEG changes
* Low amplitude, high-frequency wave pattern during awake state
* High amplitude, low-frequency pattern during anesthesia
-> burst suppression -> electrical silence (deep levels of anesthesia)

38
Q

what are some EEG devices

A

Bispectral Index TM (BISTM)
Cerebral state index (CSI)
NarcotrendTM monitor

39
Q

EEG do not reflect — properties of drugs

A

analgesic

40
Q

response to noxious stimulus at light plane will result in

A
  • Movement!
  • Rapid increase in heart rate and blood pressure
  • Increase in respiratory rate or erratic respiratory pattern → Patient-ventilator dyssynchrony
  • Pupil dilation
  • Increased jaw tone, anal tone

Horses:
* Lacrimation
* CAUTION: May see movement before ANY autonomic changes (BE VIGILANT!)*

41
Q

Response to noxious stimulus at a deep plane

A
  • No movement
  • Minimal-to-absent changes in heart rate
  • Minimal-to-absent changes in respiratory rate
  • Pupil dilation
  • Very relaxed jaw tone, anal tone
42
Q

Monitoring — can be used in conjunction with physical patient assessment.

A

anesthetic drug delivery

43
Q

— is emerging but cannot supplant physical patient assessment and monitoring.

A

Electroencephalography technology (EEG)

44
Q

Assess all available information and clinical picture to judge —

A

anesthetic depth.

23 spring anesthesia (40 decks)

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