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Anesthesia -Scott Newman & Janet King > Unit 2 Notes > Flashcards

Unit 2 Notes Flashcards

0
Q

PA Period Definition

A

The period of time immediately preceding induction (up to 24 hrs prior), in which you prepare yourself and the patient for the anesthetic procedure. Most important. Of anesthesia must look for potential complications

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1
Q

Procedures to be done during the pre-anesthetic period

A

Assess patient, collect patient data, fast patient, give PA drugs, ET tube supplies ready, fill out anesthesia form, draw up induction agents, evaluate all equipment to be used.

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2
Q

Steps to Evaluating anesthetic machine

A

Hook up breathing system, check O2 level and pressure gauge, check anesthetic gas levels, check O2 absorbing granules, pressure check for leaks

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3
Q

Reasons for placing IV catheters

A
  • Should always be placed for any procedure, no matter how small! Allows forward administration of surgical fluids, rapid and easy administration of emergency drugs, administration of anesthetics that are irritating if given perivascular
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4
Q

Risks involved with placing an IV catheter

A

Introduction of the air into the bloodstream, developing broken catheter tips, accidental overhydration, catheter induced sepsis, giving drugs to rapidly

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5
Q

Supplies needed for placing an IV catheter

A

IV catheter, heparinized saline flush, tape, surgical clippers, surgical scrub, T-port

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6
Q

Choosing an IV catheter

A

Cats and small dogs 22 gauge average dog 20 gauge
large dog 18 gauge
giant breeds 18 to 16 gauge
*all breeds 1 inch length

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7
Q

How to tape a catheter in place

A
  1. Half inch tape first with sticky side up under catheter. 2. Then take 1 inch tape with notch, place sticky side down under catheter 3. then take 1 inch tape placed proximal to the Catheter with half on tape half on skin 4. Place last piece of 1 inch tape distal to the catheter to create sterile surface
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8
Q

What size surgical clippers would you use

A

40 blade

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9
Q

Standard surgical fluid rate

A

10mls/kg/hr

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10
Q

Hypotensive fluid rate

A

20mls/kg/hr

*5mls/kg/15min allow for increased monitoring

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11
Q

Crystalloid fluids

A

Replace fluid portion of blood only. Can cause hemodilution, should not use with hypotensive fluid rate.
Ex: LRS, Normosol, 0.9% NaCL

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12
Q

Colloid fluids

A

$$$- Replace cells and blood.

Ex: Whole blood, hetastarch, and Oxyglobin.

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13
Q

7 Steps to IV catheter placement

A
  1. Get all supplies ready
  2. clip area with 40 Blade
  3. scrub area
  4. place IV catheter
  5. tape in place
  6. attached T-port
  7. flush catheter
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14
Q

Placing the IV catheter

A
  1. Take cap off, place in T port tray to keep sterile 2. break seal 3. hold on top of catheter only using thumb and middle finger 4. drop catheter to patients arm, as flat as possible 5. Poke skin should see flash of blood using ring finger to put pressure on back of catheter to flatten out 6. advance into vain 7. flick catheter off of stylet 8. cap Catheter
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15
Q

Most common ET tube

A

Murphy Eye. Has inflatable cuff on distal end, the eye at the end of the tube allows air to enter if blocked.

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16
Q

Coal ET tube

A

Two different diameters of tubing within the same two. Original style, not commonly used anymore

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17
Q

Ways of running a successful anesthesia protocol

A

Know your drugs, have a basic understanding of physiological function, be able to monitor patient successfully, know the equipment you’re using.

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18
Q

Presurgery bloodwork

A

PCV and TP

chemistry- evaluates liver (ALT/Alk Phos) and kidney (BUN/Creat) function

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19
Q

Protocol if poor liver and kidney function

A

Use gas anesthetic only

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20
Q

Do not run anesthesia PCV and TP values are less then

A

PCV- < 20%

TP- < 3.5 g/dl

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21
Q

Class one anesthetic risk

A

Excellent anesthetic risk. Completely healthy patient, six months to six years of age, elective surgery only

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22
Q

Class two anesthetic risk

A

Good anesthetic risk. Brachycephalic breeds and sight hounds, neonates and geriatrics, simple fractures and patients with mild systemic disease (Slight dehydration, murmurs and compensated heart disease)

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23
Q

Class three anesthetic risk

A

Fair anesthetic risk. Moderates a systemic disease, but not showing clinical signs (Pulse deficits moderate anemia, anorexia, chronic heart disease, chronic renal disease, compound fractures and shock, extremely fearful patients)

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24
Q

Class four anesthetic risk

A

Poor anesthetic risk. Severe systemic disease, constant threat to patients life, showing significant symptoms (Shock, severe dehydration, hypovolemia, diabetic patients, GDV, severe pulmonary disease)

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25
Q

Class five anesthetic risk

A

Guarded anesthetic risk. Morbid patients, not expected to live 24 hours with or without surgery terminal malignancy (Severe trauma, multi- organ failure, DIC patients)

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26
Q

Breeds that can never be class one

A

Brachycephalic dogs and sight hounds

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27
Q

Went to add an E to anesthetic risk classifications

A

Can only be added to classes two through five. GDV and pyometra

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28
Q

Why do we use PA drugs

A

Sedate and calm the patient, preemptive analgesia, reduce amount of induction, maintenance and post op drugs, decreased salivary secretions, intestinal movement and prevent bradycardia, provides smooth recovery, Adjunct to local or regional to prevent movement

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29
Q

Five classifications of routine PA drugs

A
  1. Anticholinergics- glycopyrrolate and atropine.
  2. Tranquilizers- phenothiazines and benzodiazepines.
  3. Sedatives (alpha-2)- xylazine and Medetomidine.
  4. Opioids- morphine and Buprenorphine.
  5. Neuroleptanalgesia- combo of sedatives or tranquilizer with an opioid
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30
Q

What three main effects do anticholinergics achieve

A
  1. *Drying agent, dry secretions
  2. *Block vagal tone, prevents drop in heart rate
  3. Reduce gastric and intestinal motility
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31
Q

SLURED ❤ Affects of anticholinergics

A

S- decrease salivation, positive effect
L- decrease Lacrimal secretions, negative affect must do the eyes
U- Decreased contractions of bladder and ureter, not an issue
R- Decreased respiratory secretions, negative affect causing thick mucus
E- Mydriasis, not an issue
D- Decrease G.I. motility, not an issue
❤- Increased heart rate, block vagal response

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32
Q

Unwanted reactions of anticholinergics

A

May cause initial bradycardia after IV administration, sinus tachycardia which increases O2 supply, first and second degree AV blocks, colic in horses

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33
Q

Indications for use of anticholinergics

A

Use with bradycardia, use with drugs that cause vagal stimulation, use if procedure will cause vagal stimulation

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34
Q

Atropine length of duration

A

60-90 min

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35
Q

Atropine can treat what

A

Bradycardia and AV blocks

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36
Q

Contraindications for atropine

A

Tachycardic patients and patients with ileus or constipation

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37
Q

Glycopyrrolate length of duration

A

4-6 hours

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38
Q

Advantage of glycopyrrolate

A

Prevents bradycardia without causing tachycardia

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39
Q

Atropine sulfate namebrand

A

Atropine®

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40
Q

Sedatives are also known as what

A

Alpha-2 agonist

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41
Q

Properties of tranquilizers as PA drugs

A

Relaxation and calmness, management of patients fear, anxiety and aggression by depressing the CNS.

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42
Q

Tranquilizers do not provide what

A

Analgesia

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43
Q

General characteristics of tranquilizers

A

Work on CNS, can cause ataxia, or prolapse of third eyelid

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44
Q

Three groups of tranquilizers

A

Phenothiazines, benzodiazepines, butyrophenones

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45
Q

Acepromazine name brand and group

A

Promace®

phenothiazine

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46
Q

Diazepam name brand and group

A

Valium®

benzodiazepine

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47
Q

Midazolam name brand and group

A

Versed®

Benzodiazepine

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48
Q

Zolazepam name brand and group

A

Telazol® (with Tiletamine)

Benzodiazepine

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49
Q

Droperidol Name brand and group

A

Innovar-Vet® (with Fentanyl)

Butyrophenone

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50
Q

Physical properties of Acepromazine

A

Water-soluble, mental calming and decreased motor activity. Improves analgesic effects of other agents

51
Q

Acepromazine duration of action

A

4-8 hours

52
Q

Acepromazine route of elimination and administration

A

Elimination via the liver. Administration by oral, or more commonly parenteral

53
Q

Main side effects of acepromazine

A

Tachycardia, hypotension, hypothermia, decrease seizure threshold, Respiratory depression, personality changes

54
Q

3 Benzodiazepine drugs

A

Diazepam, Midazolam, Zolazepam

55
Q

Acepromazine maximum dose

A

3mg, but will never reach this dose in clinical use.

57
Q

Benzodiazepines are controlled substances

A

True

Class IV

58
Q

Diazepam is not water-soluble and therefore cannot…

A

Mix with other agents

Absorption IM or SQ is unreliable

59
Q

Midazolam and Zolazepam are water-soluble and therefore can…

A

Mix with other agents, but have no analgesic properties

60
Q

Main affects of benzodiazepine

A

Minimal CNS depression, skeletal muscle relaxation, anticonvulsant, Minimal hypotension, increased anxiety in cats

61
Q

Benzodiazepine duration of action

A

Rapid onset of action, duration of 1-4 hours

62
Q

PA drug of choice for seizure patients

A

Benzodiazepines

63
Q

Diazepam route of administration

A

Most commonly IV, can also be given rectally at 2x IV dose

64
Q

Midazolam and Zolazepam routes of administration

A

IV, IM, or SQ

65
Q

Sedatives/alpha-2 agonist drugs

A

Xylazine, Medetomidine, Detomidine, and Dexmedetomidime

66
Q

Alpha-2 agonist definition

A

Causes a decrease in the level of the neurotransmitter Nor-epinephrine release, causing sedation and analgesia

67
Q

Sedatives/alpha-2 agonist cause what the effects

A

Profound sedation five times more potent then with Acepromazine. Produce calming, sedation, muscle relaxation and analgesia

68
Q

Negative side effects of sedatives/alpha-2 agonist

A

Bradycardia and sometimes hypotension

69
Q

Sedative/alpha-2 agonist routes of administration

A

IV, SQ, IM, PO- All are water soluble and very reliable

70
Q

Xylazine brand name

A

Rompun®

71
Q

Xylazine advantages

A

Good muscle relaxation and minimal respiratory depression

72
Q

Xylazine disadvantages

A

Peripheral vasoconstriction and vomiting

73
Q

Medetomidine brand name

A

Domitor®

74
Q

Medetomidine advantages

A

Powerful analgesic, 100x more potent than xylazine and good muscle relaxation

75
Q

Medetomidine Disadvantages

A

Profound bradycardia and vomiting

76
Q

Medetomidine Duration of action

A

Up to 1.5 hours with minimal respiratory depression

77
Q

Xylazine reversal agent

A

Yohimbine

78
Q

Alpha-2 agonist reversal agent

A

Tolaxoline

79
Q

Medetomidine reversal agent

A

Atipamazole

80
Q

Not a specific antagonist, but is useful for reversing respiratory depression while keeping the patient sedate

A

Doxapram

81
Q

Three types of opioid receptors

A

Mu- sever pain
Kappa- mod pain
Sigma- chronic pain

82
Q

Morphine potency and Classification

A

1x, Pure agonist

83
Q

Oxymorphone potency and classification

A

5-10x, Pure agonist

84
Q

Fentanyl potency and classification

A

100x, Pure agonist

85
Q

Butorphanol potency and classification

A

2-5x, Mixed opioid
Stimulates Sigma/Kappa &
Blocks Mu

86
Q

Buprenorphine potency and classification

A

3-5x, Partial Mu agonist

87
Q

Hydromorphone Potency and classification

A

7x, Pure agonist

88
Q

M-99 Potency and classification

A

1,000x, pure agonist

89
Q

Most effective medication for the treatment of pain

A

Opioids

90
Q

When is an opioid best given and why

A

During PA period, To provide preemptive analgesia

91
Q

Opioid duration of action

A

30min- 12hrs

92
Q

CNS effects of opioids

A

Depression or excitement depending on dose, drug, and species

93
Q

G.I. effects of opioids

A

Increases peristaltic movement, nausea and vomiting

110
Q

Benzodiazepine reversal agent

A

Flumazenil

111
Q

Morphine advantages

A

Inexpensive and good sedation/analgesia

112
Q

Morphine disadvantages

A

Mania in cats and respiratory depression

Vomiting

113
Q

Oxymorphone brand name

A

Numorphan®

114
Q

Oxymorphone max dose

A

3mg

115
Q

Opioids are controlled substances

A

True
Most- Class II-N
Torb- Class IV
Buprenorphine- class III

116
Q

Oxymorphone advantages

A

Less vomiting and cardio depression

Good sedation/analgesia

117
Q

Oxymorphone disadvantages

A

Expensive and respiratory depression

118
Q

Fentanyl injectable brand name

A

Sublimaze®

119
Q

Fentanyl patch brand name

A

Duragesic®

120
Q

Fentanyl advantages

A

Mild sedation with very good analgesia and can be reversed

121
Q

Fentanyl disadvantages

A

Decrease in tidal volume and short duration < 30min

122
Q

Opioid that is used in patients with pulmonary edema and heart failure because it will increase the capacity of the great veins

A

Morphine

123
Q

Butorphanol brand name

A

Torbugesic®

124
Q

Butorphanol advantages

A

Visceral analgesia (Kappa) Potentiates action of other anesthetic agents

125
Q

Butorphanol disadvantages

A

Unreliable sedation when used alone and controlled substance

126
Q

Buprenorphine brand name

A

Buprenex®

127
Q

Buprenorphine Advantages

A

Long-term analgesia about 10 hours and mild sedation with no excitement (good for cats)

128
Q

Buprenorphine Disadvantages

A

Unreliable sedation when used alone and difficult to reverse

129
Q

M-99 brand name

A

Etrophine®

130
Q

When using what drug, must you have Naloxone ready to use In case of contact with the person administering the medication, not so much for the patient

A

M-99

131
Q

Hydromorphone brand name

A

Dilaudid®

132
Q

Opioid used in cats and humans only

A

Hydromorphone

133
Q

Opioid reversal agent

A

Naloxone

134
Q

Naloxone brand name And classification

A

Narcan®

Pure antagonist

135
Q

3 main actions of NSAIDs

A

Anti-inflammatory, antipyretic, and analgesia

136
Q

NSAID drugs

A

Phenylbutazone, Carprofen, Deracixib, Tepoxalin

137
Q

Phenylbutazone brand name and use

A

Butazolidin®

Equine anti-inflammatory only

138
Q

Carprofen brand-name and use

A

Rimadyl®
Joint abnormalities in dogs
General Cox inhibitor

139
Q

Deracixib Brand-name and use

A

Deramaxx®
Osteoarthritis pain
Cox-2 inhibitor

140
Q

Acetaminophen brand-name and use

A

Tylenol®
effective for both anti-inflammatory and analgesia
never give to animals

141
Q

Tepoxalin Brand-name and use

A

Zubrin®

Cox-2 inhibitor

142
Q

Meloxicam brand-name and use

A

Metacam®

Cox-2 inhibitor

Anesthesia -Scott Newman & Janet King (13 decks)

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