Unit 2 Notes Flashcards
PA Period Definition
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
Procedures to be done during the pre-anesthetic period
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.
Steps to Evaluating anesthetic machine
Hook up breathing system, check O2 level and pressure gauge, check anesthetic gas levels, check O2 absorbing granules, pressure check for leaks
Reasons for placing IV catheters
- 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
Risks involved with placing an IV catheter
Introduction of the air into the bloodstream, developing broken catheter tips, accidental overhydration, catheter induced sepsis, giving drugs to rapidly
Supplies needed for placing an IV catheter
IV catheter, heparinized saline flush, tape, surgical clippers, surgical scrub, T-port
Choosing an IV catheter
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
How to tape a catheter in place
- 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
What size surgical clippers would you use
40 blade
Standard surgical fluid rate
10mls/kg/hr
Hypotensive fluid rate
20mls/kg/hr
*5mls/kg/15min allow for increased monitoring
Crystalloid fluids
Replace fluid portion of blood only. Can cause hemodilution, should not use with hypotensive fluid rate.
Ex: LRS, Normosol, 0.9% NaCL
Colloid fluids
$$$- Replace cells and blood.
Ex: Whole blood, hetastarch, and Oxyglobin.
7 Steps to IV catheter placement
- Get all supplies ready
- clip area with 40 Blade
- scrub area
- place IV catheter
- tape in place
- attached T-port
- flush catheter
Placing the IV catheter
- 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
Most common ET tube
Murphy Eye. Has inflatable cuff on distal end, the eye at the end of the tube allows air to enter if blocked.
Coal ET tube
Two different diameters of tubing within the same two. Original style, not commonly used anymore
Ways of running a successful anesthesia protocol
Know your drugs, have a basic understanding of physiological function, be able to monitor patient successfully, know the equipment you’re using.
Presurgery bloodwork
PCV and TP
chemistry- evaluates liver (ALT/Alk Phos) and kidney (BUN/Creat) function
Protocol if poor liver and kidney function
Use gas anesthetic only
Do not run anesthesia PCV and TP values are less then
PCV- < 20%
TP- < 3.5 g/dl
Class one anesthetic risk
Excellent anesthetic risk. Completely healthy patient, six months to six years of age, elective surgery only
Class two anesthetic risk
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)
Class three anesthetic risk
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)
Class four anesthetic risk
Poor anesthetic risk. Severe systemic disease, constant threat to patients life, showing significant symptoms (Shock, severe dehydration, hypovolemia, diabetic patients, GDV, severe pulmonary disease)
Class five anesthetic risk
Guarded anesthetic risk. Morbid patients, not expected to live 24 hours with or without surgery terminal malignancy (Severe trauma, multi- organ failure, DIC patients)
Breeds that can never be class one
Brachycephalic dogs and sight hounds
Went to add an E to anesthetic risk classifications
Can only be added to classes two through five. GDV and pyometra
Why do we use PA drugs
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
Five classifications of routine PA drugs
- Anticholinergics- glycopyrrolate and atropine.
- Tranquilizers- phenothiazines and benzodiazepines.
- Sedatives (alpha-2)- xylazine and Medetomidine.
- Opioids- morphine and Buprenorphine.
- Neuroleptanalgesia- combo of sedatives or tranquilizer with an opioid
What three main effects do anticholinergics achieve
- *Drying agent, dry secretions
- *Block vagal tone, prevents drop in heart rate
- Reduce gastric and intestinal motility
SLURED ❤ Affects of anticholinergics
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
Unwanted reactions of anticholinergics
May cause initial bradycardia after IV administration, sinus tachycardia which increases O2 supply, first and second degree AV blocks, colic in horses
Indications for use of anticholinergics
Use with bradycardia, use with drugs that cause vagal stimulation, use if procedure will cause vagal stimulation
Atropine length of duration
60-90 min
Atropine can treat what
Bradycardia and AV blocks
Contraindications for atropine
Tachycardic patients and patients with ileus or constipation
Glycopyrrolate length of duration
4-6 hours
Advantage of glycopyrrolate
Prevents bradycardia without causing tachycardia
Atropine sulfate namebrand
Atropine®
Sedatives are also known as what
Alpha-2 agonist
Properties of tranquilizers as PA drugs
Relaxation and calmness, management of patients fear, anxiety and aggression by depressing the CNS.
Tranquilizers do not provide what
Analgesia
General characteristics of tranquilizers
Work on CNS, can cause ataxia, or prolapse of third eyelid
Three groups of tranquilizers
Phenothiazines, benzodiazepines, butyrophenones
Acepromazine name brand and group
Promace®
phenothiazine
Diazepam name brand and group
Valium®
benzodiazepine
Midazolam name brand and group
Versed®
Benzodiazepine
Zolazepam name brand and group
Telazol® (with Tiletamine)
Benzodiazepine
Droperidol Name brand and group
Innovar-Vet® (with Fentanyl)
Butyrophenone
Physical properties of Acepromazine
Water-soluble, mental calming and decreased motor activity. Improves analgesic effects of other agents
Acepromazine duration of action
4-8 hours
Acepromazine route of elimination and administration
Elimination via the liver. Administration by oral, or more commonly parenteral
Main side effects of acepromazine
Tachycardia, hypotension, hypothermia, decrease seizure threshold, Respiratory depression, personality changes
3 Benzodiazepine drugs
Diazepam, Midazolam, Zolazepam
Acepromazine maximum dose
3mg, but will never reach this dose in clinical use.
Benzodiazepines are controlled substances
True
Class IV
Diazepam is not water-soluble and therefore cannot…
Mix with other agents
Absorption IM or SQ is unreliable
Midazolam and Zolazepam are water-soluble and therefore can…
Mix with other agents, but have no analgesic properties
Main affects of benzodiazepine
Minimal CNS depression, skeletal muscle relaxation, anticonvulsant, Minimal hypotension, increased anxiety in cats
Benzodiazepine duration of action
Rapid onset of action, duration of 1-4 hours
PA drug of choice for seizure patients
Benzodiazepines
Diazepam route of administration
Most commonly IV, can also be given rectally at 2x IV dose
Midazolam and Zolazepam routes of administration
IV, IM, or SQ
Sedatives/alpha-2 agonist drugs
Xylazine, Medetomidine, Detomidine, and Dexmedetomidime
Alpha-2 agonist definition
Causes a decrease in the level of the neurotransmitter Nor-epinephrine release, causing sedation and analgesia
Sedatives/alpha-2 agonist cause what the effects
Profound sedation five times more potent then with Acepromazine. Produce calming, sedation, muscle relaxation and analgesia
Negative side effects of sedatives/alpha-2 agonist
Bradycardia and sometimes hypotension
Sedative/alpha-2 agonist routes of administration
IV, SQ, IM, PO- All are water soluble and very reliable
Xylazine brand name
Rompun®
Xylazine advantages
Good muscle relaxation and minimal respiratory depression
Xylazine disadvantages
Peripheral vasoconstriction and vomiting
Medetomidine brand name
Domitor®
Medetomidine advantages
Powerful analgesic, 100x more potent than xylazine and good muscle relaxation
Medetomidine Disadvantages
Profound bradycardia and vomiting
Medetomidine Duration of action
Up to 1.5 hours with minimal respiratory depression
Xylazine reversal agent
Yohimbine
Alpha-2 agonist reversal agent
Tolaxoline
Medetomidine reversal agent
Atipamazole
Not a specific antagonist, but is useful for reversing respiratory depression while keeping the patient sedate
Doxapram
Three types of opioid receptors
Mu- sever pain
Kappa- mod pain
Sigma- chronic pain
Morphine potency and Classification
1x, Pure agonist
Oxymorphone potency and classification
5-10x, Pure agonist
Fentanyl potency and classification
100x, Pure agonist
Butorphanol potency and classification
2-5x, Mixed opioid
Stimulates Sigma/Kappa &
Blocks Mu
Buprenorphine potency and classification
3-5x, Partial Mu agonist
Hydromorphone Potency and classification
7x, Pure agonist
M-99 Potency and classification
1,000x, pure agonist
Most effective medication for the treatment of pain
Opioids
When is an opioid best given and why
During PA period, To provide preemptive analgesia
Opioid duration of action
30min- 12hrs
CNS effects of opioids
Depression or excitement depending on dose, drug, and species
G.I. effects of opioids
Increases peristaltic movement, nausea and vomiting
Benzodiazepine reversal agent
Flumazenil
Morphine advantages
Inexpensive and good sedation/analgesia
Morphine disadvantages
Mania in cats and respiratory depression
Vomiting
Oxymorphone brand name
Numorphan®
Oxymorphone max dose
3mg
Opioids are controlled substances
True
Most- Class II-N
Torb- Class IV
Buprenorphine- class III
Oxymorphone advantages
Less vomiting and cardio depression
Good sedation/analgesia
Oxymorphone disadvantages
Expensive and respiratory depression
Fentanyl injectable brand name
Sublimaze®
Fentanyl patch brand name
Duragesic®
Fentanyl advantages
Mild sedation with very good analgesia and can be reversed
Fentanyl disadvantages
Decrease in tidal volume and short duration < 30min
Opioid that is used in patients with pulmonary edema and heart failure because it will increase the capacity of the great veins
Morphine
Butorphanol brand name
Torbugesic®
Butorphanol advantages
Visceral analgesia (Kappa) Potentiates action of other anesthetic agents
Butorphanol disadvantages
Unreliable sedation when used alone and controlled substance
Buprenorphine brand name
Buprenex®
Buprenorphine Advantages
Long-term analgesia about 10 hours and mild sedation with no excitement (good for cats)
Buprenorphine Disadvantages
Unreliable sedation when used alone and difficult to reverse
M-99 brand name
Etrophine®
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
M-99
Hydromorphone brand name
Dilaudid®
Opioid used in cats and humans only
Hydromorphone
Opioid reversal agent
Naloxone
Naloxone brand name And classification
Narcan®
Pure antagonist
3 main actions of NSAIDs
Anti-inflammatory, antipyretic, and analgesia
NSAID drugs
Phenylbutazone, Carprofen, Deracixib, Tepoxalin
Phenylbutazone brand name and use
Butazolidin®
Equine anti-inflammatory only
Carprofen brand-name and use
Rimadyl®
Joint abnormalities in dogs
General Cox inhibitor
Deracixib Brand-name and use
Deramaxx®
Osteoarthritis pain
Cox-2 inhibitor
Acetaminophen brand-name and use
Tylenol®
effective for both anti-inflammatory and analgesia
never give to animals
Tepoxalin Brand-name and use
Zubrin®
Cox-2 inhibitor
Meloxicam brand-name and use
Metacam®
Cox-2 inhibitor
