Total Intravenous Anesthesia and Analgesia Flashcards
what goals are you trying to acheive with GA (not matter which technique is used) `
unconsciousness
immobility
antinociception
muscle relaxation
T/F Intubation and administration of 100 % O2 is beneficial for every anaesthetized patient regardless of the anesthetic technique and agent of choice!
TRUE!
what are some disadvantages to TIVA
drugs may accumulate
more difficult to monitor and control anesthetic depth
elimination half-life changes with
duration of infusion
ideal agent for TIVA should be..
short acting
stable and short context sensitive half-life
no active metabolites
wide therapeutic window
smooth recovery
TIVA most commonlu consists of
CRI of an anesthetic and an analgesic
common anesthetics used for TIVA
propofol, alfaxalone, ketamine
common analgesics used for TIVA
opioids, lidocaine, ketamine, alpha 2 agonist
common adjuvants (to aid in muscle relaxation) with TIVA
benzodiazepines, guaifenesin
what is the most common TIVA
propfol - fentanyl
start CRI higher and reduce rate later on
Alfaxalone TIVA
doesnt seem to accumulate
may be combined with opioid analgesics
Tx disphoria during recovery with sedatives
T/F etomidate is not a option for TIVA
True
inhibits cortisol secretion
accumulation of propylene glycol
which drug can accumulate after large or repeated doses causing a delayed and rough recovery
ketamine
when is a ketamine based TIVA suitable
Field Procedures
triple drip - horses (GG, xylazine, ketamine)
Analgesics infusions can be used…
as part of TIVA/PIVA to reduce dose of anesthetic and provide antinoceception
can be used alone for analgesia - e.g. post OP or in ICU
Opioid CRIs
mostly small animals
fentanyl, morphine
Lidocaine CRI
relief of abdominal pain in colic horses
adbominal and neuropathic pain in dogs
can lidocaine CRIs be given to cats
no - contraindicated in cats
potential cardiotoxic effects
T/F there is a narrow therapeutic window with Lidocaine
True
ketamine CRI
can be used as analgesic infusion
commonly combined with opioids
MLK infusion
morphine, lidocaine and ketamine
(skip lidocaine in cats)
MLK for horses
lidocaine - ketamine infusion reduce MAC and suitable for colic
opioids dont reduce MAC but do not impair quality of recovery
dexmedetomidine CRI for small animals
sedative, analgesic and antiepileptic
dexmedetomidine CRI in horses
reduces MAC by 20-30%
can be substituted with other alpha 2 agonists
Not suitable for risk patients (colic) - adverse CV effects
