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23 spring anesthesia > Test 2: 27 hypotension > Flashcards

Test 2: 27 hypotension Flashcards

1
Q

three things that control stroke volume

A

preload
contractility
afterload

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2
Q

arterial blood pressure= CO x —

A

systemic vascular resistance

need to keep a balance that ensures adequate blood flow

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3
Q

⍺1 and ⍺2 receptors cause

A

vasoconstriction

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4
Q

β2 receptors cause

A

vasodilation

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5
Q

what happens to Symp nervous system tone during anesthesia

A

decreased= vasodilation

anesthetic drugs can also directly cause vasodilation (volatile anesthetics, propofol, acepromazine, lidocaine)

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6
Q

what anesthetics cause an increase in SymNS

A

ketamine and tiletamine

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7
Q

what anesthetic drugs cause vasoconstriction

A

⍺ 2 agonists
* Xylazine
* Romifidine
* Detomidine
* Dexmedetomidine

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8
Q

sepsis and histamine will do what to systemic vascular resistance

A

will decrease SVR by causing vasodilation

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9
Q

what are some things that increase HR during surgery

A

β1 agonists, anticholinergics, fever, MH

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10
Q

what are some things that decrease HR during surgery

A

hypothermia, β blockers, opioids

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11
Q

sympathetic works on — receptors to increase HR

A

β1 ( and β2)

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12
Q

PARA symp slows the HR by

A

M2 cholinergic receptors
vagus nerve

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13
Q

what are some anesthetic drugs that decrease HR

A

– Volatile anesthetics
– Opioids
– Propofol, alfaxalone (cats)

– α2 agonists
– Lidocaine
– Cranial epidural with LAs (block cardiac accelerator n.)

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14
Q

what are some anesthetics that cause increased HR

A

Dissociative anesthetics: ketamine, tiletamine
Alfaxalone (dogs)

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15
Q

what are some things during surgery that can cause an increase in HR

A
  • Pain/ Nociception
  • Light anesthetic plane
  • Reflex response to hypotension
  • Hypercarbia
  • Hypoxemia
  • Hyperthermia
  • Cardiac Pathologies
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16
Q

fluids and vasoconstiction will increase or decrease preload

A

increase

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17
Q

hypovolemia, hemorrhage
↑ intrathoracic pressure (PPV) will do what to preload

A

decrease

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18
Q

β1 agonists will — myocardial contractility

A

increase

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19
Q

ingalant anesthetics and sepsis will — myocardial contractility

A

decrease

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20
Q

hypothermia, β blockers and opioids will do what to HR

21
Q

β1 agonists will do what to HR

22
Q

⍺ antagonists will increase or decrease SVR

23
Q

inhalants, sepsis and endotoxemia will do what to SVR

24
Q

⍺ agonists will do what to SVR

25
why can't you just keep giving fluids to improve BP
at a certain point will no longer increase venous return and will cause damage/edema stay on steep part of curve, not in red area
26
what are some things that effect venous return
venous tone blood volume blood distribution positive pressure ventilation (too high and you can collapse vessels)
27
what are some things that can cause decrease contractility
§ Inhalant anesthetics § Hypoxemia / anoxia § Acidosis / acidemia § Catecholamine depletion § Myocardial ischemia / infarction § Systolic dysfunction/ CHF § Hypocalcemia contraction is impacted by β1 agonists and calcium handling
28
what are some things that increase afterload
**everything that increases SVR** (ketamine and tiletamine that increase SNS, or alpha 2 agonists like xylazine and dex that cause vasoconstriction (initially)) **aortic stenosis** **pulmonic stenosis**
29
1st step if pt is hypotensive during anesthetsia
check depth- turn down iso if possible
30
step 2 is pt is hypotensive
**check HR and fluid status** if low HR < 50-80 (dog), < 100 (cat) give **anticholinergic** **Glycopyrrolate** or **atropine** (faster and shorter acting) **fluid challange** give small bolus to figure out where on curve you are, if BP increases with bolus good, if not can fluid overloaded
31
step 3 if pt is hypotensive
**sympathomimetics** § Naturally-occurring catecholamines § Synthetic catecholamines § Synthetic non-catecholamines **inotrope or vasopressors**
32
β1 receptors work where and how
heart inotropic and chonotropic increase HR and contractility
33
⍺1 and ⍺2 receptors work where and how
vascular smooth muscle (contraction)
34
β2 receptors work where and how
vascular smooth muscle lungs (bronchial) dilation/relaxation
35
36
goal of inotropes and vasopressors during hypotension is to
increase myocardial contractility counteract vasodilation of inhalant anesthesia and sepis counteract bronchospasm treat allergic reactions
37
epi works on what receptors
α1,α2,β1,β2 ## Footnote Naturally-Occurring catecholamine → causes increased contractility, HR and cause vascular and bronchial smooth muscle dilation
38
epinephrine will cause
Naturally-Occurring catecholamine → causes increased contractility, HR and cause vascular and bronchial smooth muscle dilation **low dose epi**- vasodilation ↓BP **high dose epi**- vasoconstriction, inotropy = ↑ pulse pressure works on α1,α2,β1,β2 receptors
39
epi is used clinically for
CPR CRI to increase myocardial contractility treat anaphylaxis
40
negative effects of EPI
increase arrhythmias decrease renal blood flow increase coronary blood flow **vasoconstriction**: to skin, mucosa and hepatorenal circulation **vasodilation**: skeletal muscle
41
norepinephrine works on what receptors
β1 and ⍺ (no β2 effect- no vasodilation)
42
norepinephrine is used for
used in refractory hypotension- septic shock causes intense **vasoconstriction**- increase SBP, MBP and DBP baroceptor mediated bradycardia with minimal change to CO
43
dopamine works on what receptors
**low dose**- D1 **medium dose**- β1 = increase inotropy and chronotropy **high dose**- ⍺ - peripheral vasoconstriction
44
effects of dopamine
Increased CO, HR, BP & SVR (β1= ↑CO, ↑HR. ⍺= ↑BP, ↑SVR) Endogenous NE release→ **can see arrhythmias**
45
dobutamine works on what receptors
β(1+2) agonist * increases contractility * slight peripheral vasodilation (β2) * increase CO by increasing HR * high dose can cause tachycardia or arrhythmia
46
dobutamine causes
* increases contractility * slight peripheral vasodilation (β2) * increase CO by increasing HR * high dose can cause tachycardia or arrhythmia works on β 1+2 receptors
47
vasopressin works on --- receptor
V1R works on vascular smooth muscle **low dose**: vasodilation **high dose**: vasoconstriction
48
how does vasopressin work
works on vascular smooth muscle **low dose**: vasodilation **high dose**: vasoconstriction works on V1R receptor
49
vasopressin can be used when
CPR shock works on vascular smooth muscle **low dose**: vasodilation **high dose**: vasoconstriction

23 spring anesthesia (40 decks)

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