Test 2 Notes: Janet Flashcards
Why is species important when administering different medications & dosages?
Cats can be sensitive to medicines that are normally fine for dogs
Smaller animals need different dosages than larger animals
2 Breed complications during anesthesia
Brachycepahlics tend to get airway obstructions during recovery due to:
Small tracheas
Narrow nares
Parasympathetic tone
Sight hounds are sensitive to barbituates during recovery due to their lack of fat
(barbituates need fat to metabolize)
How should obese patients be dosed?
by their ideal weight -most drugs are dosed according to brain size, not weight
How should emaciated patients be dosed?
by their true weight -these patients are prone to hypothermia and hypoglycemia so a quick recovery is ideal, may need to add dextrose to fluids to prevent hypoglycemia
Geriatric patients are prone to ____
Early, sub-clinical renal failure & hypothermia
always use IV fluids!
Why is it important to have IV fluids running on a patient?
Functional nephrons need good renal perfusion (Blood pressure and volume)
IV fluids keep the nephrons functional and prevent renal failure in the long run
Both geriatric and young animals ideally need what kind of drugs during anesthesia?
Short acting
Reversible
If a female is in heat during a spay what could happen?
Hemorrhage risk is increased due to increased blood flow and bigger arteries around uterus
Why would pregnant spays be an increased risk?
The patient will be dehydrated due to the removal of the fetuses and all of the enzymes and fluids she was providing for them. Give bolus of fluids
Aggressive patients are at a higher risk due to ____
Lack of ability to get PA information
Increased stress
Why is knowing how long the surgery will be important?
So you know when to turn down the anesthetic %
Liver and Kidney problems could be and issue with anesthesia due to ____
Decreased metabolism- would have trouble excreting the drug
Vomiting/Diarrhea
loss of electrolytes
Dehydration
Acid/base imbalance
What type of drug do you avoid if you have a patient with a history of seizures? and why?
Epileptogenic Drugs
They have a lower seizure threshold
What two specific drugs should be avoided for epileptic dogs?
Ketamine & Acepromazine (Use Valium instead)
Hyperthyroidism in cats causes ____ during anesthesia
Increased heart rate
Why is it important to know if the patient is currently on any other drugs?
Not all drugs work well together and may produce adverse side effects
Anesthesia history would be beneficial to have because ____
You can see if the patient had any previous complications or allergies
How long should you withhold food & water before PA drugs are given?
8-12 hours for food, water is okay up until PA drugs are given
Why is food withheld before a anesthesia procedure?
Most anesthetic drugs will cause vomiting which could lead to aspiration
Normal patient temp.
101.5 +/- 1degreeF
Respiratory rate
15-30rpm in dogs
20-30rpm in cats
Fever may indicate ___ which may worsen following anesthesia due to ____
an infection
stress and immunosuppression
Hypothermia ____ the effects of anesthesia, so ___
Potentiates
Less drugs are needed
Hypothermia complications
Longer recovery
Delay in wound healing
Longer clotting times
Normal heart rate in dogs and cats and what spot is used to get this?
60-160 (up to 180 in toy breeds and 220 in puppies)
110-220 in cats
Femoral ARTERY
Cachexia means ____
emaciated
S&S or S&R stand for
Strong and Synchronous
Strong and Regular
What is evaluated when palpating a pulse?
rate and character
A weak or absent pulse may indicate ____
hypotension
A bounding pulse may indicate ____
Hypertension
What could auscultating the heart help you find?
The rate and rhythm Could hear respiratory sinus arrhythmia (normal in dogs) Cardiac murmurs (fast-slow-fast-slow: matches respirations)
2 Main reasons for increased CRT and pale MM color
Peripheral Vasoconstriction
Decreased Tissue Perfusion
Examples of Peripheral Vasoconstriction causes
Hypothermia
Pain
Alpha-2 agonists (sedatives)
Causes of Cyanosis and why this is a result
Hypoxia
Because there is an increase in the amount of unsaturated hemoglobin
Things to look at when evaluating the pulmonary system
Respiratory rate, depth and effort
MM color
Auscultation of breath sounds
What is important to know when evaluating neuro system?
History of seizures–avoid epileptogenic agents–use Valium= tranquilizer + anticonvulsant
Pupillary light reflex–both eyes should constrict
Hepatic function is important during anesthesia for ____
LIVER:
Metabolism and elimination of drugs
May effect other body systems
Renal function is important during anesthesia for ____
KIDNEYS: Elimination Water distribution Electrolytes Blood pressure RBC production
Sign of abnormal renal function
PU/PD
Things to evaluate when checking GI system
Do they have any:
V/D– dehydration & electrolyte imbalances
Parasites– anemia, diarrhea
GDV– impairs ventilation, decreased cardiac output, hypovolemic shock, ^^^RISK!
Ascites– fluid in abdomen, could indicate liver dz. or heart failure
What are the bare minimum lab tests that should be run? What tube should be used?
PCV & TP
RTT
What does the PCV evaluate for?
Anemia
Oxygen carrying capacity
Hydration status
If your patient is dehydrated the PCV will have a ____ & if they are over-hydrated the PCV will have a
Relative increase
Relative decrease
TP evaluates for ____
Hydration status
Blood loss
Liver function
Increased TP would indicate
dehydration
Decreased TP could indicate ____
Over-hydration
Liver disease
Malnutrition
When there is blood loss and acute hemorrhage what will drop first?
TP, PCV will be normal ~12 hours post blood loss
CBC consists of what tests, and what will they evaluate?
RBC/Hct/Hgb= oxygen carrying capacity WBC= leukocytosis (infection/stress) leukopenia (immunosuppression/viral infection) Eos= parasites/allergies Plt= coagulation
The PA panel usually includes what 4 things?
- Glucose
- BUN/Creat
- ALT/alk phos
- TP
Glucose
pancreatic function test (DM)
could be stress induced
How to differ between DM and stress induced glucose in urine
Urine test to check for ^ GLU
BUN/creatinine
Kidney function (glomerular filtration of kidney)
When will glomerular filtration of the kidney be increased?
(Azotemia) When the animal is: Dehydrated In shock Hypotension or Impaired renal function
ALT/alk phos
Liver Function
ALT= hepatocyte damage or destruction
Alk phos= hepatobiliary obstruction or bone growth/injury
What is the liver specific enzyme in dogs and cats?
ALT
Normal electrolyte balance is important for _____
Normal physiologic function
Blood gas tests are more important in what species?
Equine anesthesia
Urinalysis consists of ____
USG– renal tubular function
Dipsticks– pH, blood, bilirubin, GLU
Sediment– crystals (ethylene glycol/ammonium biurate)
What are 2 additional tests that may be run
ECG – known heart dz.
Rads – fractures, thorax, abdomen
4 reasons why placing a patient on a IVC is beneficial
- easier to admin. IV induction agents (titrate)
- can use CRI of anesthetics/analgesics
- important if emergency drugs are needed
- IV fluids
2 Reasons IV fluids are highly recommended
To maintain blood volume and support blood pressure
When would you DEFINITELY want IV fluids hooked up?
If the sx will result in significant blood loss
Patient is dehydrated
Long anesthesia
Animal is at risk for hypotension or shock
Class I anesthetic risk
Excellent anesthetic risk
Normal healthy patient getting a elective procedure only (OHE, Declaw, Neuter)
Class II anesthetic risk
Good anesthetic risk Patient with slight to mild systemic disease Well controlled disease of ONE body system Neonatal or Geriatric Mild to Mod obese ACL repair Brachycephalic Sighthound Well-regulated diabetic
Class III anesthetic risk
Fair anesthetic risk Moderate systemic disease Mild clinical signs Controlled dz of 1 or more body systems Low to moderate fever Moderately dehydrated Anorexia/Cachexia Heart or renal disease Complicated fracture
Class IV anesthetic risk
Poor anesthetic risk Severe systemic disease that is a threat to life At least 1 poorly controlled severe disease High fever Azotemia Severe dehydration Morbidly obese Severe anemia Emaciated DKA, GDV *Sx must be preformed to save life*
Class V anesthetic risk
Guarded anesthetic risk Moribund (close to death) Patient not expected to survive 24 hours with or without surgery Sx preformed in desperation Not expected to survive
What are some myths of pain in animals?
Animals don’t perceive pain like people- they tolerate it better than humans
Owners won’t pay for analgesics
Better to keep animals in pain so they won’t ruin the sx. site
Biology/physiology of pain
Increased anxiety and stress
Alters metabolism
Affects endocrine system
Decreased immune function
Signs that animal is in pain
Vocalization Facial expressions Body posture- hunched over/abnormal Activity- restless/not moving Attitude- aggression/depressed Guarding/Licking/Chewing Decreased appetite Not sleeping Panting/Salivation
What are the first 4 vital signs?
- Temp
- Pulse
- Resp.
- Pain assessment
What is the wind-up effect?
Hyper-excitability of central neurons due to constant bombardment of pain signals – will wake up with overwhelming pain sensation, harder to control.
Why should pre-emptive analgesics be used?
Decreases the wind-up effect
Decreases the amount of GA needed
What 2 things does the wind-up effect lead to?
Allodynia
Hyperalgesia
Allodynia
Pain caused by a stimulus that normally does not result in pain
ex: petting
Hyperalgesia
increased response to a painful stimulus
Over-exaggerated
Opioids
Agonists
Best choice
What do opioids act on?
receptors in the brain and spinal cord
may also provide some sedation
OTM
Oral trans-mucosal
Butorphanol- cheek pouch in cats
Routes of administration for Opioids
PO IM & SQ Transdermal (patch) Intraarticular Epidural
Epidural duration of action
Most commonly morphine
Provides 6-24 hours of analgesia to caudal thorax, abdomen, hind limbs, pelvis, and tail