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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

A

decrease

21
Q

β1 agonists will do what to HR

A

increase

22
Q

⍺ antagonists will increase or decrease SVR

A

decrease

23
Q

inhalants, sepsis and endotoxemia will do what to SVR

A

decrease

24
Q

⍺ agonists will do what to SVR

A

increase

25
Q

why can’t you just keep giving fluids to improve BP

A

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
Q

what are some things that effect venous return

A

venous tone
blood volume
blood distribution
positive pressure ventilation (too high and you can collapse vessels)

27
Q

what are some things that can cause decrease contractility

A

§ 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
Q

what are some things that increase afterload

A

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
Q

1st step if pt is hypotensive during anesthetsia

A

check depth- turn down iso if possible

30
Q

step 2 is pt is hypotensive

A

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
Q

step 3 if pt is hypotensive

A

sympathomimetics

§ Naturally-occurring catecholamines
§ Synthetic catecholamines
§ Synthetic non-catecholamines

inotrope or vasopressors

32
Q

β1 receptors work where and how

A

heart inotropic and chonotropic

increase HR and contractility

33
Q

⍺1 and ⍺2 receptors work where and how

A

vascular smooth muscle (contraction)

34
Q

β2 receptors work where and how

A

vascular smooth muscle
lungs (bronchial)

dilation/relaxation

35
Q
A
36
Q

goal of inotropes and vasopressors during hypotension is to

A

increase myocardial contractility

counteract vasodilation of inhalant anesthesia and sepis

counteract bronchospasm

treat allergic reactions

37
Q

epi works on what receptors

A

α1,α2,β1,β2

Naturally-Occurring catecholamine → causes increased contractility, HR and cause vascular and bronchial smooth muscle dilation

38
Q

epinephrine will cause

A

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
Q

epi is used clinically for

A

CPR
CRI to increase myocardial contractility
treat anaphylaxis

40
Q

negative effects of EPI

A

increase arrhythmias
decrease renal blood flow
increase coronary blood flow
vasoconstriction: to skin, mucosa and hepatorenal circulation
vasodilation: skeletal muscle

41
Q

norepinephrine works on what receptors

A

β1 and ⍺

(no β2 effect- no vasodilation)

42
Q

norepinephrine is used for

A

used in refractory hypotension- septic shock

causes intense vasoconstriction- increase SBP, MBP and DBP

baroceptor mediated bradycardia with minimal change to CO

43
Q

dopamine works on what receptors

A

low dose- D1
medium dose- β1 = increase inotropy and chronotropy
high dose- ⍺ - peripheral vasoconstriction

44
Q

effects of dopamine

A

Increased CO, HR, BP & SVR
(β1= ↑CO, ↑HR. ⍺= ↑BP, ↑SVR)

Endogenous NE release→ can see arrhythmias

45
Q

dobutamine works on what receptors

A

β(1+2) agonist

  • increases contractility
  • slight peripheral vasodilation (β2)
  • increase CO by increasing HR
  • high dose can cause tachycardia or arrhythmia
46
Q

dobutamine causes

A
  • 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
Q

vasopressin works on — receptor

A

V1R

works on vascular smooth muscle
low dose: vasodilation
high dose: vasoconstriction

48
Q

how does vasopressin work

A

works on vascular smooth muscle
low dose: vasodilation
high dose: vasoconstriction

works on V1R receptor

49
Q

vasopressin can be used when

A

CPR
shock

works on vascular smooth muscle
low dose: vasodilation
high dose: vasoconstriction

23 spring anesthesia (40 decks)

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