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Anaesthesiology > TV4002 > Flashcards

TV4002 Flashcards

1
Q

What are the common complications of anaesthesia?

A
  • Machine / circuit leaks
  • Rebreathing
  • Barotrauma
  • Hypo/hyperthermia
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2
Q

What is the cause, consequence, recognition and treatment for a machine leak?

A

Cause: faulty / damaged equipment, human error

Consequence: environmental pollution, ineffective delivery of fresh gas, inability to ventilate the patient adequately

Recognition: reservoir bag doesn’t stay fullm smell inhalant, hear hissing noise, inabiliy to ventilate the matient effectively, patient problems (inadequate depth, rebreathing)

Treatment: Regular maintenance of equipment, pressure checks, tape (temporary)

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3
Q

What is the cause, consequence, recognition and treatment for rebreathing?

A

Cause: increased dead space, CO2 allowed to accumulate

Consequence: hypercapnia, inadequate depth, hyperventilation, acidosis, sympathetic nervous stimulation

Recognition: hyperventilation, brick red mm, mild hypertension, inadequate depth, hypoxia, ETCO2 >55mmHg, inspired CO2 >0mmHg (capnograph will not return to baseline)

Treatment: correct inciting cause, support ventilation IPPV, administer O2

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4
Q

What is the cause, consequence, recognition and treatment for barotrauma?

A

Cause: outflow obstruction (pop-off valve closed, O2 flush, overzealous IPPV, innappropriate inflation of ET tube cuff)

Consequence: gas accumulation, ventilatory impairment, death

Recognition: distended reservoir bag, apnoea, pallor, cyanosis, hypotension, subcutaneous emphysaema

Treatment: relieve outflow obstruction, supplement O2, relieve pneumothorax via thoracocentesis, support circulatory function (IC fluids +/- positive inotropes)

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5
Q

What is the cause, consequence, recognition and treatment for hypothermia?

A

Cause: body temp below 37oC

Consequence: progressive decline in cardiovascular, renal and liver function, impaired coagulation, changes in acid-base

Recognition: rectal or oesophageal temperature probe,

Treatment: prevent heat loss, passive and active thermal support

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6
Q

What is the cause, consequence, regonition and treatment for hyperthermia?

A

Cause: overheating (drug reaction / malignent hyperthermia)

Consequence: increased metabolism, denaturation of proteins

Recognition: rectal or oesophageal temperature probe

Treatment: cool environment, fan, alcohol / water application, cool IV fluids

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7
Q

What are the four components of barotrauma?

A
  1. Barotrauma - high pressure
  2. Volutrauma - overextension of alveolar regions due to high volume
  3. Atelectrauma - continuous alveolar collapse and opening, shear force injury
  4. Biotrauma - mechincal stimulation of alveoli releases inflammatory mediators
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8
Q

What are the causes of and treatments for bradycardia?

A
  • too deep - reduce depth
  • drug effect (alpha 2, opioid, propofol)
  • hypothermia - warm the patient
  • vagal stimulaion (GI tract, etc) - atropine
  • hyperkalaemia
  • hypertension - deepen anaesthesia + analgaesia
  • increased ICP - IPPV, mannitol / furosemide
  • Late stage hypoxamia
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9
Q

What are the causes of and treatments for tachycardia?

A
  • Light anaesthesia - increase depth
  • Strong stimulation (sympathetic reflex)
  • Drugs (atropine, ketamine) - wait to wear off
  • Hypercapnia - IPPV oxygen
  • Hypovolaemia / hypertension - fluid therappy + positive inotrope
  • Hyperthermia - cool the patient
  • Early stage hypoxaemia - IPPV oxygen
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10
Q

What are the causes of and treatments for arrhythmias?

A
  • inadequate anaesthetic depth - deepen
  • arrythmogenic drug (medetomidine)
  • hypercapnia - IPPV
  • hypoxaemia - IPPV
  • hypovolaemia / hypotension - fluid therapy
  • hypothermia - warm patient
  • acid-base / elecrolyte imbalance - correct imbalance
  • myocardial disease / injury
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11
Q

What are the causes and consequences of hypotension?

A

Cause: anaesthesia induced CV depression, excessive anaesthetic depth, hypovolaemia, intraoperative haemorrhage, arrhythmia, organ manipulation, IPPV

Consequence: arrhythmias, acute renal failure, post-anaesthetic myopathy, blindness, gut-barrier failure, sepsis, death

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12
Q

What are the clinical signs of blood loss?

A
  • pale mm
  • prolonged CRT
  • hypotension
  • apparent increase in anaesthetic depth
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13
Q

How can you determine how much blood loss has occurred?

A

Calculate:

  • each gauze swab holds 5-10ml of blood
  • lap sponges hod 50-100ml of blood
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14
Q

What causes a flatline capnograph and how do you treat it?

A
  • Caused by complete airway obstruction
  • Treatment:
    • check that curcuit is still connected
    • extend the head and neck to relieve kinks
    • adjust ET tube cuff
    • suction the ET tube
    • provide supplemental O2
    • extubate and reintubate with new ET tube if needed
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15
Q

What causes rebreathing in each type of system?

A

Both: increase in death space

Non-rebreathing: Inadequate flow rate

Rebreathing: exhausted CO2 adsorbent, malfunctioning one-way valve

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16
Q

What are the five reasons for hypoxaemia?

A
  1. Low inspired O2
  2. Hypoventilation
  3. Diffusion impairment
  4. V/Q mismatch
  5. Shunt
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17
Q

What are the four resona for hypoxia?

(inadequate oxygen reaching the tissues)

A
  1. hypoxaemia
  2. reduced delivery capacity of O2
  3. circulatory problem
  4. cytotoxic / histotoxic (cell utilization of O2 inhibited)
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18
Q

How does small animal anaesthesia differ from the horse?

A
  • ETCO2 can be significantly different from PaCO2 due to large dead space
  • PaO2 may be lower than expected with 100% oxygen due to presence of large shunt
  • Min MAP required >70mmHg to perfuse compartmented and compressed muscles
  • Eye signs are less reliable in horses - muscle tone of the neck may be a good indication
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19
Q

What are anaesthetic risk factors that create a ‘compromised’ patient?

A
  • perioperative health status
  • increasing age
  • weight extremes
  • procedural urgency

The very young, old, sick or injured

20
Q

How does acidosis affect the activity of thiopentone?

A

Acidosis increases unionised thiopentone passing through the cell membrane and reduces the protein bound fraction, thus increasing the active component of thiopentone

21
Q

What diagnostic methods can be used to determine lung injury?

A
  • Radiography
  • Auscultation
  • Thoracocentesis
22
Q

Why is stabilisation of a compromised patient important before anaesthesia?

A
  • cannot tolerate anaesthesia well, very high risk
    • hypovolaemia
    • acid-base imbalances
    • thoracic injuries
    • pain!
  • stabilisation will improve vital organ function
23
Q

What are the key factors for a sucessful outcome of anaesthetic of the compromised patient?

A
  • Prepare and anticipate complications
  • Monitor and support patient through the anaesthetic and post-operative period
  • Early detection of abnormalities
  • Pain free
  • Well managed vital organs
24
Q

What is the definition of paediatric?

A

Less than 12 weeks of age

25
Q

What is the definition of geriatric?

A

Last 20-25% of expected natural lifespan

Animals >7 years old at JCU

26
Q

What are the important physiological characteristics of the paediatric CNS?

A
  • highly permeable BBB
  • immature sympathetic nervous system - reduced ability to increase myocardial contractility and reduced vascular tone
  • immature baroreceptor reflex
  • fully developed pain perception
27
Q

What are the important physiological characteristics of the paediatric cardiovascular system?

A
  • generally lower BP, SV and perivascular resistance
  • minimum cardiac reserve
  • CO can only be increased by rapid HR
  • therefore, unable to compensate for significant fluid loss
28
Q

What are the important physiological characteristics of the paediatric respiratory system?

A
  • high metabolic rate - high oxygen demand - high RR
  • weak chest muscles, higher airway resistance - ventilation is less efficient
  • high risk of hypoxaemia and rebreathing
29
Q

What are the important characteristics of the paediatric hepatic system?

A
  • Immature at birth
  • Minimum glucose storage and regulation
  • Slower metabolism
  • Reduced production of protein
  • Matures 8-12wks
  • Puppies: Elevated ALP and GGT
  • Kittens: Elevated ALT
30
Q

What are the important physiological characteristics of the paediatric renal system?

A
  • immature at birth
  • GFR and tubular excretion increases with age
  • low BUN and creatinine
  • less able to concentrate urine
  • mature 8-12 wks
  • cannot compensate for hypovolaemia / overhydration
31
Q

What are the important characteristics of paediatric body composition?

A
  • 80% water (compared to 60% in adults)
  • small fat store
  • PCV declines from birth (50%) to 29 days old (30%) and then increases up to 6months
  • High distribution of cardiac output to vessel rich tissue (heart and brain)
32
Q

What are the important physiological characteristics of the geriatric CNS?

A
  • decrease in cerebral perfusion, O2 consumption and brain weight
  • decrease in neurotransmitters
  • change in pharmacokinetics
  • reduction in MAC
  • increased sensitivity to drugs
33
Q

What are the important physiological characteristics of the generiatric cardiovascular system?

A
  • decrease in blood volume, blood pressure, cariac output and baroreceptor activity
  • increase in circulation time and vagal tone
  • thickened / calcified vessel walls
  • decreased ability to autoregulate blood flow and less cardiac reserve
34
Q

What are the important physiologic characteristics of the geriatric respiratory system?

A
  • decreased lung capacity, O2 consumption and O2 diffusion capacity
  • rigid thoracic wall with low cmpliance lung and weaker repiratory muscles
  • less efficient ventilation
  • loss of protective airway reflexes
35
Q

What are the important physiological characteristics of the geriatric hepatorenal system?

A
  • reduction in liver mass - reduced function
  • decreased renal and hepatic blood flow - loss of nephrons and impaired distal tubular function
  • reduced ability to cope with hypovolaemia / overhydration
36
Q

At what age does a puppy / kitten attain adult organ function?

A

12 weeks

37
Q

What are the fasting recommendations for paediatric patients?

A

milk - 30 minutes

solids - 2-3 hours

38
Q

What are the fasting recomendations for geriatric patients?

A

Fast overnight but allow free access to water

39
Q

What are the important physiological characteristics of the prenant patient cardiovascular system?

A
  • CO increases 30-40% (due to HR) = to meet O2 demand from placenta and foetus(es)
  • Blood volume increases - RBCs increase - low PCV and TPP
  • Therefore, stress for pregnancy may predispose pre-existing cardiac disease to cardiac failure
  • Maintain CV function!
40
Q

What are the important physiological characteristics of the prenant patient respiratory system?

A
  • O2 requirement increases by 20-25%
  • Increased VM from both VT and RR
  • Reduced lung volume and FRC due to pregnant uterus - predisposed to hypoxaemia and faster change in depth
  • Increased VM - reduced PaCO2
    • Vasoconstriction
    • Left shift oxyhaemoglobin dissociation curve: less effective unloading of oxygen to the foetus
  • Pre-oxygenate!
41
Q

What are the important physiological characteristics of the prenant patient CNS?

A
  • Increased venous volume in epidural space - reduced volume
  • Reduction in MAC up to 40%, increases sensitivity of injectable drugs and local anaesthetics: due to progesterone +/- endogenous opioid
  • Low dose! Dose to effect!
42
Q

What are the important physiological characteristics of the prenant patient GI and hepatorenal systems?

A
  • Reduced GI motility, gastric emptying and lower oesophageal sphincter tone
  • Fasting? 56% of maternal deaths following caesarean section due to pneumonia
  • Increased ALP, AST, ALT and LDH
  • Increased renal blood flow: reduction in BUN and Creatinine
  • Quick induction and secure the airway!
43
Q

What are the important physiological characteristics of the pregnant patient’s placenta?

A
  • Uterine blood flow is not “auto-regulated” = it is dependent on the uterine arterial to venous pressure gradient and uterine vascular resistance
  • Therefore, maternal hypotension, hypovolaemia or fear and/or pain will impair placental perfusion and such it is very important to maintain maternal blood pressure and oxygenation
44
Q

What can you give a neonate at caeserian if opioids were given to the mother as premediation?

A

Drop of naloxone under the tongue

45
Q

WHat can you give to neonates at caeserean if benzodiazapam was given to the mother as part of premed / induction?

A

Flumazenil

46
Q

What is your anaesthetic protocol for caeserean section in small animals?

A
  • General anaesthetic
  • IV injectable induction (propofol/alfaxolone)
  • Maintain on isoflurane/sevoflurane
    • Assisted ventilation or IPPV
    • Light plane of anaesthesia until delivery
    • Close monitoring
47
Q

How can you detect pain in cats and dogs?

A
  • abnormal behaviour
  • physiological change: HR, RR
  • pain scale and scoring systems

Anaesthesiology (2 decks)

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