Test 3: 39 TIVA Flashcards

1
Q

what 5 things need to happen for anesthetics to be successful

A

immbolity
unconsciousness
analgesia
muscle relaxation
inhibition of autonomic reflexes

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2
Q

pharmacokinetic vs pharmacodynamic

A

kinetic: what body does to drug (breaksdown in liver)

dynamic: what drug does to body (cause bradycardia)

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3
Q

3 independent pharmacokinetic variables

A

volume of distribution
clearance
target plasma concentrations

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4
Q

how to measure volume of distribution

A

measure tissue distribution of a drug

Vd= (amount of drug administered)/ (amount of drug found in plasma)

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5
Q

how to predict loading dose needed

A

desired plasma concentration x volume of distribution

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6
Q

how to determine maintenance dose

A

clearance= dose/AUC

CRI dose = desired plasma concentration (Cpt) x Cl

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7
Q

what characteristics do you want for TIVA drugs

A
  • Fast onset
  • Short duration
  • High therapeutic index
  • Minimal or no side effects
  • Insensitive context half life (no accumulation)
  • Low cost
  • Long shelf life
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8
Q

what drugs are used for small animal TIVA

A
  • Propofol
  • Alfaxalone
  • Opioid (morphine, fentanyl, remifenntanil)
  • Lidocaine
  • Dexmedetomidine
  • Ketamine
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9
Q

what drugs are used for large animal TIVA

A
  • Ketamine
  • GG, Benzodiazepines
  • Alpha 2 agonists (xylazine, detomidine, dexmedetomidine, romifidine)
  • Lidocaine
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10
Q

what can happen with intermittent multiple boluses for TIVA

A
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11
Q

example of small animal intermittent multiple boluses TIVA

A

Example for short procedure (skin biopsy)
1. Premedication Methadone 0.2 mg/kg IV
2. Propofol bolus until loss of righting reflex IV
3. Evaluate anesthetic depth ( eye position, strength of palpebral reflex, jaw tone) top up if needed 0.5 mg/kg of propofol
4. Provide oxygen (face mask)
5. Have ability to intubate & ventilate if patient stops breathing (too deep)

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12
Q

how to do CRI for TIVA

A

do loading dose to get to theraptutic level quickly, then maintain with CRI

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13
Q

what is a triple drip

A

CRI for large animal

GKX (GG 10%, Xylazine 1mg/ml, ketamine 2 mg/ml) add 1g of ketamine, 500 mg of xylazine to 500 ml of Guaifenesin 5 or 10%

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14
Q

problems with TIVA

A
  • dosage based on models of healthy animals
  • context sensitive 1/2 life- takes longer to recover
  • IV access problematic in very small patients (birds, rodents, etc)
  • Not possible to measure real time plasma drug levels (only predict)
  • Cost of drugs
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15
Q

advantages of tiva

A
  • No pollution
  • No need for anesthesia machine
  • Cardiovascular stability
  • Propofol reduces ICP
  • Suitable for prolonged sedation
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