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Anesthesia > Troubleshooting Small Animal Anesthesia > Flashcards

Troubleshooting Small Animal Anesthesia Flashcards

1
Q

What are the normal systolic and diastolic blood pressures seen in anesthetized patients? What is indicative of hypotension and hypertension?

A
  • SYSTOLIC = 100-130 mmHg
  • DIASTOLIC = 60-100 mmHg
    (mean = 80-120 mmHg)
  • HYPOTENSION = SAP <80 mmHg, MAP <60 mmHg
  • HYPERTENSION = SAP >130 mmHg, MAP >120 mmHg
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2
Q

What is the most common consequence of hypotension? What is over 15 minutes of hypotension associated with?

A

poor perfusion of the brain, heart, kidneys, GIT, and liver

long-term damage to kidneys

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3
Q

What is arterial blood pressure a product of? Why is it so important?

A

CO and systemic vascular resistance

critical determinant of tissue/organ perfusion and oxygen delivery

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4
Q

If a patient is chronically hypertensive, how is hypotension determination changed?

A

> 20-40% reduction from awake baseline

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5
Q

In what ways can the surgeon cause hypotension while performing their surgery?

A
  • hemorrhage
  • vascular compression (vena cava)
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6
Q

What 5 patient factors should be checked when hypotension is present?

A
  1. HR and rhythym, pulse quality, CRT
  2. oxygenation, ventilation, anesthesia machine integrity
  3. anesthetic depth
  4. bradycardia, profound tachycardia
  5. cardiac arrest
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7
Q

What anesthetic machinery should be checked with hypotension? How is it adjusted?

A

oscillometric or Doppler

  • check BP cuff placement, size, and tightness
  • change position of cuff
  • try another machine
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8
Q

What are the 2 most common ways to troubleshoot hypotension?

A
  1. decrease inhalant concentration and increase or add injectable drugs
  2. treat bradycardia
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9
Q

In what 2 ways is bradycardia treated in patients with hypotension?

A
  1. bolus fluids +/- hypertonic saline +/- blood products or colloids depending on comorbidities (DON’T keep bolusing if there is no improvement)
  2. administer inotropes or pressors - dopamine, dobutamine, vasopressin, norepinephrine, epinephrine (emergency)
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10
Q

What are the 2 phases of Dexmedetomidine affects? How does this alter ways of troubleshooting its effects?

A
  1. initial 45 mins - vasoconstriction causes hypertension with reflex bradycardia
  2. after 45 mins - central sympathetic nervous system depression leads to hypotension and continued bradycardia

treating bradycardia (atropine, glycopyrrolate) within phase 1 would cause increased HR in the face of high afterload = increased myocardial work

  • wait until phase 2, where hypotension can be resolved by improving HR
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11
Q

What is the normal arterial CO2 and ETCO2 in normal patients?

A

35-45 mmHg

> 50 mmHg

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12
Q

In what 7 ways should a patient with hypoventilation be checked?

A
  1. HR and rhythm, pulse quality, CRT
  2. anesthetic dept - jaw tone, palpebral reflex, response to surgery)
  3. check oxygen supply, machine, flow meter rate, and machine integrity
  4. check ETT for kinks or obstruction
  5. check ETCO2 and waveform quality
  6. check quality of spontaneous ventilation
  7. ventilate by hand and assess compliance
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13
Q

What 4 actions should be considered in patients experiencing hypoventilation?

A
  1. assisted or mechanical ventilation
  2. decreasing anesthetic depth
  3. reducing respiratory depressant drugs
  4. reversal
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14
Q

What 5 things should be ruled out in patients experiencing hypoventilation?

A
  1. airway obstruction
  2. asthma or chronic airway disease
  3. excessive dead space (pulmonary or equipment)
  4. external compression of chest impending excursion (tight chest wrap)
  5. increased RR = high inspired CO2
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15
Q

What anesthetic depth is associated with hypoventilation?

A

too deep or paralyzed

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16
Q

What is ventilation defined by? Why is ETCO2 commonly lower than arterial CO2?

A

CO2 levels

physiological dead space

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17
Q

What is the primary motivator for breathing? How does anesthetics affect this?

A

arterial CO2

depress ventilatory response to CO2 at sub-anesthetic doses

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18
Q

What 3 things does the measurement of ETCO2 depend on?

A
  1. production of CO2 - metabolism
  2. delivery of CO2 to lungs - CO
  3. removal of CO2 - ventilation
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19
Q

What is indicative of hypoxemia and dangerous hypoxemia?

A

SpO2 < 95%

SpO2 < 90%; PaO2 < 60 mmHg

20
Q

In what 6 ways should a patient be checked for hypoexmia?

A
  1. HR and rhythm, pulse quality, CRT
  2. anesthetic depth - jaw tone, palpebral reflex, response to surgery)
  3. check oxygen supply, machine, flow meter rate, and machine integrity
  4. check ETT for kinks or obstruction
  5. check ETCO2 and waveform quality
  6. ventilate by hand and assess compliance
21
Q

What maneuver can be considered in patients experiencing hypoxemia? What diagnostics can be performed?

A

PEEP

  • thoracic radiographs
  • arterial blood gas
22
Q

What are some rule outs for hypoxemia?

A
  • airway obstruction
  • endobronchial intubation
  • extubation
  • anaphylaxis
  • aspiration
  • asthma
  • diaphragmatic hernia
  • pneumothorax, pulmonary edema
  • congenital heart disease/shunt
  • embolus
  • low cardiac output
  • abnormal hemoglobin
  • heart failure
23
Q

What is a normal PaO2 reading? What are 5 causes of hypoxemia?

A

5x FiO2
- room air is 20% O2 - PaO2 = 100 mmHg
- under anesthesia is 100% O2 - PaO2 = 500 mmHg

  1. low FiO2
  2. hypoventilation
  3. V/Q mismatch
  4. R to L shunt
  5. barrier to diffusion
24
Q

What determines oxygen delivery throughout the body?

A

CO and oxygen content in the blood

25
Q

What is considered bradycardia in large dogs and small dogs/cats? With hypotension?

A

LARGE DOGS - <60 bpm; <50 bpm

SM DOGS/CATS - <90 bpm; <70 bpm

26
Q

What 5 things should be checked on in patients with bradycardia?

A
  1. pulse quality, CRT
  2. ECG
  3. verify oxygenation and ventilation
  4. hemodynamics
  5. temp check for hypothermia
27
Q

What aspect of the anesthesia machine should be altered in patients with bradycardia? What 2 medications can be used?

A

decrease or discontinue inhalant

  1. anticholinergics - glycopyrrolate, atropine
  2. reduce or reverse opioids or alpha-2 agonists
28
Q

What electrolyte abnormality can cause bradycardia?

A

hyperkalemia can lead to cardiac disease/arrest

29
Q

What breeds naturally have high vagal tones that can cause bradycardia? What surgical manipulation can lead to it?

A

brachycephalic dogs

increased ocular pressure and GI manipulation

30
Q

What is considered tachycardic in large dogs and small dogs/cats?

A

LARGE DOG - >140 bpm

SM DOG/CAT - >180 bpm

31
Q

What 5 things should be checked in patients with tachycardia?

A
  1. pulse quality, CRT
  2. ECG
  3. oxygenation and ventilation
  4. BP
  5. surgical manipulation - blood loss, hypovolemia
32
Q

What 2 aspects of surgery are commonly associated with tachycardia?

A
  1. hypotension and hemorrhage
  2. hypoventilation and hypoxemia
33
Q

What anesthetic depth is associated with tachycardia? How can it be treated?

A

too light and painful

increase analgesia and/or inhalant depending on BP

34
Q

What are some causes of tachycardia?

A
  • tachyarrhythmia
  • adrenal tumor
  • hyperthermia
  • anaphylaxis
  • iatrogenic - anticholinergics, inotrope overdose, catecholamine
35
Q

What are common signs seen in patients that will not stay asleep?

A
  • panting
  • moving
  • waking up
  • twitching
  • hypertensive
  • tachycardia
36
Q

What aspects of the patient should be checked if they are not staying asleep?

A
  • HR rhythm, pulse quality, CRT
  • respiratory rate and character
  • anesthetic depth - jaw tone, palpebral, response to surgery
  • confirm intubation
  • inhalant - filled vaporizer, connected
  • oxygenation, ventilation
37
Q

What 4 things are commonly done in patients that won’t stay asleep?

A
  1. increase oxygen flow rate to speed up inhalant delivery
  2. assisting or controlling ventilation
  3. additional analgesia (increase or add CRIs)
  4. reconfirm depth sign
38
Q

What are the 2 most common causes of patients remaining awake?

A
  1. anesthesia machine constant - machine does not buildup adequate inhalant level to maintain anesthesia before patient wakes up following induction
  2. induction drug causes hypoventilation - patients does not take up inhalant, wakes up, give more propofol, continues to not ventilate properly (vicious cycle!)
38
Q

What is considered a prolonged recovery? How can the patient be stimulated?

A

lasting more than 45 mins

  • discontinue all inhalant and injectable anesthetics
  • rubbing
  • tickling ears
  • changing recumbency
39
Q

What monitoring is especially important in patients undergoing a prolonged recovery? What else is checked for?

A
  • hypothermia
  • hypotension
  • hypoxemia
  • hypercarbia

hypoglycemia, anemia, electrolyte or acid-base disorders

40
Q

How are analgesics altered in patients undergoing a prolonged recovery?

A

decrease, discontinue, or reversal

  • typically do not discontinue, or reverse, since pain relief is still needed post-surgery
41
Q

What is reflux/regurgitation? What aspect of the patient should be checked?

A

stomach contents move passively into esophagus +/- pharynx

check ETT cuff/seal - should have no leak when lungs are inflated 20-25 cm H2O

42
Q

What should be done if reflux/regurgitation is observed?

A
  • suction esophagus with red rubber
  • flush water or saline until clear
  • keep cuff inflated and patient sternal until there is strong swallowing and chewing
43
Q

What is avoided when a patient has regurgitated? What medications are commonly recommended?

A

pushing a catheter into the stomach, unless there is significant fluid present

  • local bicarbonate instillation
  • Famotidine
  • Sucralfate
44
Q

What should be monitored post-anesthesia if a patient regurgitates?

A
  • cough
  • increased RR
  • further regurgitation

Anesthesia (40 decks)

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