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Anesthesia -Scott Newman & Janet King > Test 3 Notes: Janet > Flashcards

Test 3 Notes: Janet Flashcards

1
Q

Define induction

A

taking patient from a conscious to an unconscious state

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2
Q

2 Methods of induction

A

Injection

Inhalation

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3
Q

4 Benefits of ET intubation

A

Establish pt. airway
Prevent aspiration
IPPV
Decrease gas exposure to personnel

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4
Q

3 Types of ET tubes

A

Murphy tubes
Cole Tubes
Cuffless ET tubes

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5
Q

Cole Tube

A

Used for small animals & exotics
Skinny end inserted into trachea
Tie behind ears so wider part creates seal
Are easily dislodged

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6
Q

Murphy Tube

A 
Beveled end (easier to insert)
Murphy eye (prevents complete blockage) 
Cuff
Pilot line with balloon 
Radiopaque strip
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7
Q

What are 3 benefits to using a cuffed ET tube

A

Prevents aspiration
Prevents leakage of gas to room
Prevents animal from breathing in room air

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8
Q

Cuffs do NOT ____, they create a ____

A

Hold the ET tube in place, they create a seal

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9
Q

How are ET tubes measured?

A

french scale= external diameter

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10
Q

How do you choose an ET tube size?

A

Use a chart based on weight
Palpate trachea
Measure tube diameter in comparison to nasal opening

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11
Q

How is the length of the ET tube measured?

A

From the tip of the nose to the thoracic inlet

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12
Q

What could happen if the ET tube is too long?

A

Endobronchial intubation

Increased resistance to respiration

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13
Q

How should a patient be restrained for placement of the ET tube?

A

Sternal recumbency
Restrainer holds top jaw
Extend neck and raise head
Intubator will pull tongue down to open mouth

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14
Q

Medical term for vocal folds

A

arytenoid cartilages

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15
Q

How do you restrain a ET tube?

A

Muzzle gauze
Rubberbands/ties
IV tubing

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16
Q

What is the best way to know the ET is in the trachea?

A
  • *To visualize it
  • use fingers to feel for tube between vocal folds
  • feel air with exhalation
  • res. bag movement
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17
Q

How would you know the ET tube is NOT properly placed?

A

You hear vocalization

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18
Q

What are 2 ways to know how much air to use in cuff

A

Back pressure in syringe

Use pressure manometer

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19
Q

What numbers do you look at when using the pressure manometer to inflate the cuff?

A

Hear slight leak at 20cmH2O

No leak at 15cmH2O

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20
Q

What could happen if you over-inflated the cuff?

A

Compression of the tube
Pressure necrosis of trachea
Tracheal rupture/tear

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21
Q

Why are cats more difficult to intubate?

A

Small trachea diameter
Larynx sits deeper in neck (harder to visualize)
Laryngospasms
Vocal folds cover more of the glottis

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22
Q

How would you intubate a cat?

A

Using a stylet or by putting lidocaine on the vocal folds

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23
Q

How much lidocaine would you put on the vocal folds?

A

0.1ml

one drop on each vocal fold

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24
Q

Succinylcholine properties

A

For feline intubation
IV
Lasts 5-10min.
Relaxes jaw tone and prevents spasms

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25
Q

What is the instrument that depresses the base of the tongue and has a light source?

A

Laryngoscope

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26
Q

What are some complications associated with ET intubation?

A 
Pressure necrosis of lining of trachea 
Plugged ET tube (mucus plug)
Kinked tube
Stimulation of vagus nerve 
Trauma 
Animal could chew tube during recovery
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27
Q

How long do you leave the cuff inflated when extubating the patient?

A

Until you see 2 good swallows or you see signs of recovery

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28
Q

What do you do if the animal vomits with an ET tube in?

A

Deflate the cuff 1/2 way and remove (the cuff acts a squeegee)

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29
Q

How are ET tubes cleaned?

A

With dilute antiseptic (like chlorhexadine)
OK to submerge under water
Inflate cuff to remove all mucus
Use brush or pipe cleaner to clean inside
Rinse and hang to dry with cuff inflated

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30
Q

What should you be aware of if lasers are being used during surgery?

A

The laser mixed with the high oxygen could start a fire
Wrap ET tube with duct tape
Use a special laser safe ET tube

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31
Q

What is the Corneal reflex

A

touch cornea with sterile swab, animal should blink and withdraw eye, should be present during surgical plane, more common in equine

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32
Q

What is the Ear flick reflex

A

Gently touch hairs on inside of ear and look for “flick” could be absent or present during surgical plane
More reliable in cats

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33
Q

What is the Palpebral reflex

A

Gently tap medial canthus of the eye and observe blinking reflex
Should be gone during surgical plane

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34
Q

What is Jaw tone

A

Open jaw and observe muscle tone, should have some tone but mostly relaxed
Puppies and kittens have weak jaw tone

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35
Q

Eye position & Pupil size

A

Usually eyes will rotate ventromedial during surgical plane but can also be central
Pupils should be slightly dilated during surgical plane

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36
Q

10 Common vital signs to monitor during anesthesia

A 
Heart rate
Pulse
ECG
Resp. rate
MM color
CRT
Temp 
Blood pressure
O2 saturation
ETCO2
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37
Q

Stage 1

A 
Voluntary excitement phase- induction 
Immediately after admin of injectable or inhalant (usually rougher and longer) 
Animal is conscious, but disoriented 
HR & RR can be normal or increased 
All reflexes present
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38
Q

Stage 2

A

Involuntary excitement phase
Begins with loss of consciousness, all reflexes present, animal is able to chew and swallow
May have rapid movement of limbs, vocalization, struggling etc.
Shorter stage 2 = better!

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39
Q

Stage 3, plane 1

A

Light plane of anesthesia
Can be intubated
Relaxed jaw tone
NOT able to withstand sx.

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40
Q

Stage 3, plane 2

A

Medium plane of anesthesia
Suitable for most surgical procedures
Slight response to surgical stimulation
Patient is unconscious and immobile

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41
Q

What is the normal RR during Stage 3, plane 2?

A

8-30rpm

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42
Q

Stage 3, plane 3

A

Deep plane of anesthesia
Significant depression of circulation and respirations
Excessively deep for most sx procedures
Good plane for very painful surgery
Marked muscle relaxation & slack jaw tone
NO surgical response

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43
Q

Stage 3, plane 4

A

Anesthetic overdose
Patient is too deep
Drop in HR, BP, CRT and pale MM

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44
Q

Stage 4

A

Death
CPCR necessary to save patient
Turn off vaporizer

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45
Q

What are the 6 injectable anesthetic agents?

A 
Barbiturates
Cyclohexamines (dissociatives)
Propofol 
Etomidate
Neuroleptanalgesia
Guaifenesin
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46
Q

What are the 2 main uses for Barbiturates?

A

Anticonvulsants (Pheno)

Euthanasia (Pento)

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47
Q

What is the ultra-short acting barbiturate?

A

Methohexital, thiopental

death row drug

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48
Q

Primary use of Phenobarbital

A

(Barbiturate)

Anticonvulsant

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49
Q

Primary use of Pentobarbital

A

(Barbiturate)
Euthanasia solution
ONLY DOUBLE THE ANESTHESIA DOSE!

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50
Q

Barbiturates properties

A

Controlled
NOT reversible
NO analgesia
IV admin only

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51
Q

4 effects of barbiturates

A

1.CNS depression
anti-convulsants
excitement during induction and recovery (Prolonged stage 2)

2.Potent respiratory depression
apnea with rapid admin or high doses
decreased RR and depth

3.Cardiovascular depression
decreased BP and cardiac output

4.Tissue irritation
IV admin only

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52
Q

What breeds have increased potency with barbiturates?

A

Sighthounds & lean animals

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53
Q

Thiopental properties

A

(Pentothal) -Barbiturate
Ultra-short acting
Used to be used as induction agent
No longer made in the US

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54
Q

Methohexital properties

A

(Brevital) -Barbiturate
Ultra-short acting
Best for use in sighthounds
Death row drug

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55
Q

What are the 2 Cyclohexamines?

A

Ketamine (Ketaset, Ketalar, Vetalar)

Tiletamine (in Telazol)

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56
Q

Cyclohexamine uses and properties

A 
Induction agent 
Controlled
NOT reversible 
Some analgesia 
IV or IM admin.
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57
Q

Cyclohexamine mode of action

A

CNS STIMULATION
Disrupts or scrambles nervous system pathways so they never make it to the brain
“Trance-like” anesthesia- appears awake, but immobile and unaware

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58
Q

CNS effects of Cyclohexamines

A
  • Increased CSF, intracranial pressure, and intraocular pressure
  • Lowers seizure threshold
  • Increased sensitivity to sound
  • Hallucinations
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59
Q

What drug combined with Cyclohexamines can help decrease the rough recovery?

A

Benzodiazepine tranquilizers

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60
Q

Cardiovascular effects of Cyclohexamines

A

Tachycardia
Combine with Glycopyrrolate instead of Atropine
Apneustic respirations

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61
Q

What are apneustic respirations

A

Breath holding, prolonged pause after inspiration

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62
Q

Other effects of Cyclohexamines

A 
Catalepsy (increased muscle tone) 
Spastic reflexes 
Open, dilated eyes 
Nystagmus (mainly cats)
Ptyalism (increased salivation)
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63
Q

What is ptyalism & what can help this?

A

Increased salivation

Anticholingergics can decrease this

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64
Q

How are Cyclohexamines metabolized?

A

Dogs- metabolized by the LIVER, then excreted

Cats- excreted by the KIDNEYS only

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65
Q

Ketamine general properties

A

Most common induction agent
Can be used for short procedures
Can squirt into the mouths of aggressive cats (takes 5-10mins)

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66
Q

Advantages of IV Ketamine

A

Faster onset and recovery
Decreased dose compared to IM
No tissue irritation

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67
Q

Advantages of IM ketamine

A

Can be used in wild/fractious animals

Longer duration of anesthesia

68
Q

Duration of IV & IM Ketamine

A

IV= 3-10min.

IM= Dog: 20-30min, Cat: 30-60min.

69
Q

What is the most common Ketamine combo?

A

Diazepam + Ketamine

commonly mixed with tranquilizer or sedative

70
Q

What are the 3 advantages of Ketamine combos?

A

Increases muscle relaxation
Decreases potential for seizures
Smoother recovery

71
Q

Ketamine-diazepam properties

A

Ket/Val
IV ONLY!
Very common
Can mix in the same syringe

72
Q

Tiletamine properties

A

Newer dissociative, very similar to Ketamine
In Telazol
Can be given IV, IM, or SQ (very useful for aggressive pts.)

73
Q

Tiletamine common combo

A 
Tiletamine & zolazepam 
(benzodiazepine tranquilizer) 
Decreases risk of seizures
Increases muscle relaxation
Smoother recovery
74
Q

Porpofol general properties

A 
(Propo-flo) -No family 
Common IV induction agent 
Oil in water emulsion (shake well)
Milky white but is still given IV 
NOT controlled
NO analgesia
NOT reversible 
More expensive
75
Q

Cardiovascular effects of Propofol

A

Hypotension immediately after injection due to vasodilation

  • usually short duration in healthy patients
  • IV fluids will minimize this
76
Q

Respiratory effects of Propofol

A

Respiratory depression

-transient apnea if given rapidly

77
Q

How should you give Propofol?

A

Slowly over 20-60seconds, titrate to effect
Monitor respirations carefully for a couple min.
Once respirations are good, turn on vaporizer

78
Q

Why should you pre-oxygenate with Propofol?

A

Flow-by or mask patient

To increase the amount of oxygen saturated with hemoglobin

79
Q

Propofol drug properties

A

Very short acting
Rapidly metabolized
Minimal hangover
Wide margin of safety

80
Q

Duration of Propofol

A

Duration= 5-10min.

Complete recovery= 20-30min.

81
Q

Propofol shelf-life

A

Limited, no preservatives
Ingredients support growth of bacteria
Use within 6 hours- Ok to extend to 24 hours

82
Q

PropoFlo28 general info.

A

Newer formulation
Contains benzyl alcohol to minimize bacterial growth
Lasts 28 days

83
Q

Muscle myoclonus with Propofol

A

Seizure like muscle twitch during anesthesia- no treatment required and not common

84
Q

IV injection of ____ prior to Propofol can decrease induction amount by __%

A

Benzodiazepine tranquilizer

33%

85
Q

Etomidate general properties

A 
(Amidate) -No family 
Rapid acting 
Ultra short 
NO analgesia
NOT controlled 
NOT reversible 
Very similar to propofol
86
Q

Effects of Etomidate

A 
Minimal cardio effects 
Mild respiratory depression (transient apnea) 
Wide margin of safety 
Rapid loss of consciousness
Rapid, smooth recovery
87
Q

Adverse effects of Etomidate

A

IV may cause pain/irritation in people
High doses/CRI can cause RBC lysis
Muscle rigidity/myoclonus- Benzos can minimize this

88
Q

Etomidate endocrine effects

A

Suppression of adrenal-cortical axis for 6 hours in dogs and 3 hours in cats
Single induction doses usually not a issue

89
Q

Etomidate should be avoided with what patients?

A

Hypoadrenocorticism patients
(Addison’s Dz.)
vNa
^K

90
Q

Neuroleptanalgesics

A

Combo of opioid and tranquilizer or sedative

Used to achieve increased sedation and analgesia

91
Q

When can Neuroleptanalgesics be used as a induction drug?

A

Only with SICK/debilitated patients

Will NOT produce unconsciousness in a young, healthy patient

92
Q

Guaifenesin general properties

A

(Glycerol guaiacolate- GG or GGE)
Muscle relaxant
Given to large animals to help induce or maintain anesthesia

93
Q

Common Guaifenesin combos

A

Ketamine, Diazepam, Xylazine

Triple drip: GKX

94
Q

How are liquid anesthetics delivered?

A

They are vaporized then delivered by carrier gas (Oxygen)

95
Q

Diffusion of anesthetic gas

A

Gas crosses ALVEOLI then wants to travel to a place with less concentration so it goes to the BLOODSTREAM then the BRAIN becomes saturated due to high blood flow

96
Q

How is the rate of diffusion of anesthetic gas controlled?

A

by a concentration gradient between the alveoli and bloodstream
(Goes from high to low concentration)

97
Q

Concentration of gas in alveoli and blood during induction

A 
Alveoli= increased concentration
Bloodstream= decreased concentration
98
Q

How is depth of anesthesia determined?

A

Concentration of anesthetic in the brain

99
Q

How is anesthesia maintained?

A

By insuring concentration of anesthetic in alveoli, blood, and brain is maintained

100
Q

When recovering, how is the concentration reduced?

A

When the gas in the alveoli is reduced, the higher concentration in the blood will diffuse from blood stream to the alveoli
Then when the concentration of gas in the blood is less than the brain, it will diffuse from the brain, to the blood, to the alveoli

101
Q

How long should animals receive 100% oxygen after the vaporizer is turned off?

A

5 minutes- creates a steep concentration gradient between the blood and alveoli

102
Q

Precision vaporizers deliver inhalants as __ and are VOC. Meaning:

A

a %
VOC= vaporizer out of circuit
(Precision vaporizer)

103
Q

What are the 6 inhalant anesthetics?

A

Iso
Sevo

Nitrous oxide
Methoxyflurane
Halothane
Desflurane

104
Q

Nitrous oxide properties

A

Stil used in human medicine (laughing gas)
Wide margin of safety
NEVER used alone!

105
Q

Nitrous oxide provides ____ & ____

A

Good analgesia & muscle relaxation

106
Q

Color of Nitrous oxide cylinder

107
Q

What 3 things does the patient breathe when using Nitrous oxide?

A

Oxygen
Nitrous
Anesthetic gas

108
Q

Respiratory effects of inhalant anesthetics

A

Decreased RR and Tidal Volume

-can lead to respiratory acidosis and atelectasis

109
Q

Cardiovascular effects of inhalant anesthetics

A

Cardiovascular depression

  • Vasodilation, Bradycardia, Hypotension, Hypothermia…etc.
  • Increases heart’s sensitivity to epinephrine
110
Q

What are the 3 physical properties of inhalant gases?

A

Vapor pressure
Solubility
MAC value

111
Q

What does MAC stand for?

A

Minimum Alveolar Concentration

112
Q

What does vapor pressure measure?

A

the tendency of anesthetic to go from liquid to gas

113
Q

Inhalants with high vapor pressure want to ___. Low vapor pressure gasses want to ___.

A

Be a gas (evaporate readily)

Be a liquid (slow evaporation)

114
Q

High vapor pressure agents must use a ____ vaporizer to carefully control the % being evaporated.

A

Precision (VOC)

115
Q

2 other words for VIC & anesthetic agent used with this.

A

Vaporizer In Circuit
non-prescision
Methoxyflurane

116
Q

What 3 anesthetic agents need a VOC/Precision vaporizer?

A

Isoflurane
Sevoflurane
Halothane

117
Q

What does the Solubility coefficient measure?

A

The solubility of an anesthetic gas in rubber tubing, blood, fat, and other tissues

118
Q

What does Solubility provide info on?

A

SPEED of induction, depth change, and recovery

119
Q

High solubility would mean that it is ____ dissolved in “stuff” and low solubility would mean it ____.

A

Easily

Will not dissolve easily

120
Q

Inhalants with ___ solubility will move rapidly to the brain because they don’t want to ____.

A

Low
stay dissolved in blood, fat, etc.
(faster induction, depth changes, and recovery)

121
Q

Inhalants with ___ solubility are slower, so they will ____.

A

High
be absorbed by tubing, blood, fat, tissues.
(slower induction, depth changes, and recovery)

122
Q

List the 4 inhalant drugs from lowest to highest solubility. (Fastest to slowest)

A

Sevoflurane–fastest: low solubility
Isoflurane
Halothane
Methoxyflurane –slowest: high solubility

123
Q

Inhalants with low solubility are best for what kind of induction?

A

Mask or chamber (faster= better)

124
Q

Low solubility agents allow for ____ stage/plane changes and ____ recovery

A

Quick

Rapid

125
Q

Define Minimum Alveolar Concentration

A

The minimum alveolar concentration (%) of gas that produces no response to surgical stimulation in 50% of patients

126
Q

What is MAC measuring & this gives an indication of the ____

A

The % of gas in alveoli

Potency

127
Q

The ____ the MAC the ____ the gas is.

A

Higher
Less potent
(more needed for sx)

128
Q

The ____ the MAC the ____ the gas is.

A

Lower
More potent
(less needed for sx)

129
Q

MAC x ___= light plane of anesthesia

130
Q

MAC x ___= surgical plane of anesthesia

131
Q

MAC x ___= deep anesthesia

132
Q

List the inhalant agents from lowest to highest MAC

A

Methoxyflurane (most potent)
Halothane
Isoflurane
Sevoflurane (least potent)

133
Q

Halothane vapor pressure & solubility

A

High vapor pressure
Medium solubility
-fairly rapid induction, depth change, and recovery
-popular with equine anesthesia

134
Q

Adverse effects of Halothane

A

Sensitizes heart to epinephrine induced arrhythmias
Increases vagal tone
**Cardio depression
**Respiratory depression- could lead to Atelectesis

135
Q

___% of Halothane is metabolized by the liver and the rest is eliminated through the ____

A

20%

respiratory tract

136
Q

Effects of Halothane

A
  • Fair muscle relaxation
  • Slight analgesia
  • Malignant hyperthermia
137
Q

What is malignant hyperthermia

A

A rare, but often fatal disorder of thermoregulation
Results in increased temp. muscle rigidity, cardiac arrhythmias.
Can happen with any inhalant gas, but more common with Halothane

138
Q

Isoflurane vapor pressure and solubility

A

High vapor pressure
Low solubility
-rapid induction, depth change, and recovery
-great for mask/chamber induction but can be irritating to mm

139
Q

Isoflurane has ___ changes in depth of anesthesia (within ____ after vaporizer is changed)

A

Rapid

1-2 minutes

140
Q

Isoflurane has ___ recovery (within ____ after gas is turned off) But don’t turn off vaporizer until ____.

A

Rapid
1-2 minutes
Close to, or on last stitch

141
Q

Isoflurane has a ____ MAC

142
Q

Common induction % with Isoflurane=

Common maintenance %=

A

2.5%
1.5-2.5%
(Settings vary from patient to patient!)

143
Q

____ has a wider margin of safety than Halothane & has little effect on the heart.

A

Isoflurane

  • *Cardiovascular depression
  • *Respiratory depression
144
Q

How much Isoflurane is metabolized? (%)

A

0.2%

the rest is exhaled

145
Q

Isoflurane has excellent ____ but little to no ____ post-op

A

Excellent muscle relaxation
Little or no analgesia post op
(give pre-emptive & post op analgesics to prevent windup)

146
Q

3 Sevoflurane facts

A

Newest inhalant anesthetic
More expensive than Iso
Less pungent odor and less irritating to MM than Iso

147
Q

Sevoflurane has ____ vapor pressure & ____ solubility

A

High vapor pressure & has the lowest solubility

148
Q

Which gas is the fastest acting?

A

Sevoflurane- lowest solubility

149
Q

When should you turn off your vaporizer when using Sevoflurane?

A

Not until surgery is COMPLETE!

Rapid recovery

150
Q

Which gas has the highest MAC value?

A

Sevoflurane

151
Q

Sevo requires ____ vaporizer settings because it is ____.

A

Higher

the least potent (High MAC)

152
Q

How much (%) Sevo is metabolized?

A

3%

the rest is exhaled

153
Q

Effects of Sevo

A

Greater effect on the heart than Iso, but still considered safe
Moderate muscle relaxation
Little to no analgesia post-op
Smoother recovery- cognitive/motor function
**Cardio depression
**Resp depression

154
Q

Sevo has slightly more ____ than Iso

A

Respiratory depression

Decreased RR & Tidal Vol.

155
Q

Sevo’s manufacturer states that ____ & ____ return simultaneously which results in ____.

A

Cognitive & motor function

Smoother recovery

156
Q

What is the only benefit of induction chambers?

A

Little physical restraint (good for feral patients)

157
Q

What are the 4 disadvantages of induction chambers?

A

Only for small animals
Difficult to monitor patient in chamber (vitals)
No control of airway
Not a good induction method for brachys or animals with resp. or cardio. problems

158
Q

What 2 things do you need when using an induction chamber?

A
  1. Inlet for gas/oxygen
  2. Outlet for scavenge
    (fresh gas in, escaped gas to scavenge)
159
Q

What is the induction chamber procedure?

A
  1. Deliver 100% oxygen for about 5 min.

2. Gradually add inhalant anesthetic by 0.5% increments every 10 seconds

160
Q

The induction chamber procedure uses ____ vaporizer settings for a ____ induction.

A

Higher

Faster

161
Q

How can you tell if a patient is ready to be intubated when using a induction chamber?

A

Observe for loss of righting reflex

Shake the chamber or bang on the glass

162
Q

What are 2 disadvantages of mask induction

A

Some animals resist the mask which leads to stress

Not recommended for brachys or pts. with respiratory problems (no control of airway)

163
Q

When using mask induction and the animal is stressed what could happen?

A

Stress causes release of epinephrine which can predispose patient to cardiac arrhythmias

164
Q

When does the mask induction technique work best?

A

When the patient is calm or sedated

165
Q

Mask induction procedure

A

Hook up rebreathing tubing (can also use NRB)
Hook up tightest fitting mask to Y tubing
Deliver 100% oxygen
Gradually add inhalant increasing by 0.5% increments
When patient appears relaxed, turn off vaporizer, remove mask and intubate

166
Q

Mask induction will need ____ vaporizer settings for a ____ induction

A

Higher

Faster

Anesthesia -Scott Newman & Janet King (13 decks)

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