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Doctor of Veterinary Medicine (Work in progress) > Veterinary Medicine - Anesthesiology > Flashcards

Veterinary Medicine - Anesthesiology Flashcards

1
Q

Capnography - Rebreathing CO2 - Possible Causes

A

Tachypnea, Low oxygen flow relative to respiratory rate, Soda lime exhaustion, Stuck one-way valve, Patient too small for rebreathing circuit, Increased resistance in circuit

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2
Q

Capnography - Rebreathing CO2 - Management

A

Increase flow rate until inspiratory CO2 goes down to zero, Check inspiratory valves, Check soda lime color, Check source of resistance, Ventilate

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3
Q

Capnography - High ETCO2 - Possible Causes

A

Deep-plane anesthesia, Lung disease, Atelectasis, Obesity, Body position, Induction apnea

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4
Q

Capnography - High ETCO2 - Management

A

Decrease anesthesia gas, Mechanical ventilation

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5
Q

Capnography - Tachypnea - Possible Causes

A

Low plane anesthesia, Pain, Hyperthermia

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6
Q

Capnography - Tachypnea - Management

A

Increase anesthesia, Analgesia, Cooling, Ventilate

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7
Q

Capnography - Leak in the circuit - How does it look?

A

Slowly tapering of ETCO2 after normal initial expiration and plateau

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8
Q

Capnography - Leak in the System - Management

A

Inflate ET cuff, Replace circuit

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9
Q

Capnography - “Shark Fins” - Possible Causes (2)

A

Partial obstruction of the circuit, Bronchoconstriction

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10
Q

Capnography - “Shark Fins” - Management

A

Clear obstruction, Administer Bronchodilators

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11
Q

Capnography - “Additional Peaks” - Cause

A

Flow rate is lower than required - Patient is breathing in his own

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12
Q

Capnography - “Additional Peaks” - Management

A

Increase ventilation, Administer OpiatesKetamine to cause respiratory depression + increase ventilation

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13
Q

You’re experiencing Capnography abnormalities - Describe the management algorithm

A

1) Check Patient (Pulse / Breathing / Reflexes) 2) Check O2 Flow + Ventilate 3) Check Soda Lime Valves Circuit 4) Check Capnograph

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14
Q

Oscillometric Pressure Devices - Best placed on which artery?

A

Coccygeal A.

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15
Q

Doppler Pressure Devices - Best placed on which artery?

A

Metatarsal A.

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16
Q

Doppler Pressure Devices - Measures…?

A

Systolic Arterial Pressure (SAP)

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17
Q

Oscillometric Pressure Devices - Measures…?

A

Mean Arterial Pressure (Measured directly). *SAP (Calculated). *DAP (Calculated)

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18
Q

Oscillometric Pressure Devices - Originally created for human patients with human sized arteries - Therefore the use of them is less recommended in which animals?

A

Cats, Small breed dogs

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19
Q

Invasive blood pressure measurement - Contraindications

A

Thrombocytopenia, Thrombocytopathy, Decrease in clotting factors

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20
Q

Invasive blood pressure measurement - Indications

A

Sepsis, GDV, Suspected Expected reperfusion injury , Active Expected hemorrhage , Cardiac failure, Shock of any kind, Unstable BP of any kind

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21
Q

a2 Agonists - What are our 2 reversal drugs and when to use them?

A

1) Vasoconstriction (Peripheral effect) -> Reflex bradycardia. 2) Vasodilatation (Central Effect) + Bradycardia

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22
Q

Hypertension - Causes

A

Situational (e.g. Stress, Excitement). Secondary: -Renal disease (e.g. AKI, CKD). -Endocrinopathies (e.g. Cushing’s disease, Hyperaldosteronism, Diabetes Mellitus, Hyperthyroidism, Hyperestrogenism). -Pheochromocytoma. -2nd to high Intracranial pressure

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23
Q

Screening for Hypertension - What is the best organ to assess?

A

Retina

24
Q

Anesthesia in Brachycephalic Syndrome - Sedation / Analgesia / Pre Induction / Induction / Post-anesthesia important notes

A

Sedation - Midazolam (Preferably no hard sedatives). Analgesia - Light opiates (due to GI signs). Pre Induction - O2 for a few minutes. Induction - Propofol. Post Op: Late extubation | O2 for a couple of hours Cooling Steroids if airway inflammation is present

25
Q

Anesthesia in (Chronic) Renal Disease - What is the most contraindicated induction/anesthesia drug? Why?

A

Ketamine. It’s metabolite (Nore-ketamine) can’t be excreted through the kidneys - thus making the effect longer

26
Q

Anesthesia in (Chronic) Renal Disease - Sedation / Induction

A

Sedation - Midazolam Induction - Propofol / Alfaxolone

27
Q

Anesthesia in (Chronic) Renal Disease - Why is hypotension dangerous when anesthetizing kidney-disease patients? How to treat if it does happen?

A

The kidneys already aren’t fuctioning properly and GFR is lowered, and in addition to that - Perfusion is furthered lowered - Worsening GFR. Treat aggressively with everything you have! Don’t let the kidneys suffer any more! Options: 1) Ephedrine (alpha & Beta Agonist) 2) Dobutamine 3) Norepinephrine / Dopamine

28
Q

Anesthesia in liver failure - Sedation / Analgesia / Pre Induction / Induction / Anesthetic Drug

A

Sedation - Midazolam (or any other reversible sedative). Analgesia - Opioids. Pre induction - Correct hypoalbuminemia, hypoglycemia. Induction - Propofol. Anesthesia - Any gas anesthesia

29
Q

Anesthesia in Neonates - Cardiac output is mostly determined by?

A

Heart Rate

30
Q

Anesthesia in Neonates - Anesthesia-wise, Neonates should be treated like they have — & — failure

A

Liver and kidney failure

31
Q

Anesthesia in Neonates - Contraindicative sedatives

A

Acepromazine (Causes Hypotension), Medetomidine (Causes Bradycardia)

32
Q

Anesthesia in Neonates - Induction drug that is contraindicated and why

A

Ketamine. Same as with liver failure - Can’t excrete the metabolite

33
Q

Anesthesia in Neonates - Sedation / Analgesia / Pre Induction / Induction / Anesthetic Drug

A

Sedation - Midazolam. Analgesia - Opioids. Induction - Propofol / Alfaxolone. Anesthesia - Any gas anesthesia

34
Q

Anesthesia in liver failure - Sedation is preferred with Diazepam / Midazolam

A

Midazolam

35
Q

C-Section and Anesthesia - A lot of drugs are contraindicated because most drugs will also affect the puppies. What is the recommended protocol for performing a C-Section?

A

Analgesia - Opioids ONLY AFTER PUPPIES ARE OUT! Induction - Alfaxolone > Propofol. Maintenance gas - Desflurane . No Sedation / Analgesia if puppies are still inside!

36
Q

Anesthesia and Heart Failure - Contraindicated drugs

A

Acepromazine (Hypotension / Can’t be reversed). Medetomidine (Hypotension / Bradycardia). Atropine (Not recommended)

37
Q

Anesthesia and Heart Failure - Sedation / Analgesia / Induction / Anesthetic Drug

A

Sedation - Midazolam. Analgesia - Opioids. Induction - Alfaxolone >> Propofol. Anesthesia - Any gas Anesthesia

38
Q

What NSAIDs can be used in Cats with a low risk for causing AKI?

A

Robenacoxib

39
Q

What NSAID is recommended to be administered only once in Cats?

A

Meloxicam

40
Q

What NSAID can be given to puppies 6 weeks or older (As opposed to other NSAIDs that are only from 6 months <)

A

Carprofen

41
Q

NSAID Administration - Contraindications

A

Renal Failure, Liver Failure, Heart Failure, Dehydration / Hypotension / Shock / Hemorrhage , GI Disease, Concurrent GC administration, Very young puppies, Coagulopathies, Spinal injuries

42
Q

Anesthesia - What are important monitoring needed during the anesthesia?

A

BP (Ocillometry / Doppler), Pulse Oximetry, etCO2, ECG, Temp, Plane of anesthesia (e.g. Palpebral / Location of pupil)

43
Q

What is the “R on T” Phenomenon on EKG?

A

Fusion of the two due to VPCs. Can indicate incoming Ventricular Tachycardia / Fibrillation

44
Q

Why are multi-focal (Heterogenous morphology) VPCs are more dangerous and require treatment as opposed to a single-origin VPCs (Single morphology)? What is the treatment?

A

Indicates incoming Ventricular Tachycardia / Fibrillation. Lidocaine

45
Q

How and when do you treat a patient who starts having AV-Block under anesthesia?

A

1st Degree - not uncommon under anesthesia. Not necessarily requires treatment. 2nd Degree - treat with Atropine / Glycopyrrolate. 3rd Degree - requires a pacemaker!

46
Q

Why does anti-cholinergic drug (i.e. Atropine) can sometimes cause (instead of curing) AV-Blocks and worsening of bradycardia?

A

Usually happens with under-dosing of Atropine. It binds to the pre-synaptic receptor causing a negative feedback loop on the inhibition -> Increasing the release of ACh

47
Q

What are 2 common Vasopressors used in an emergency setting / anesthesia complications?

A

Dopamine, Norepinephrine

48
Q

What are the 2 best pre-vet visit anxiolytic drugs for dogs and cats?

A

Gabapentin - Cats, Trazodone - Dogs

49
Q

In-hospital sedation in cats - What would you choose for light / moderate / strong sedation?

A

-Butorphanol -Acepromazine -Dexmedetomidine. + Alfaxolone (Recommended), +/-Midazolam

50
Q

What sedative is contraindicated in animals with heart problems?

A

Medetomidine

51
Q

Anesthesia in cardiovascular patients - What are our choices in terms of induction drugs?

A

1) Alfaxolone 2) Propofol 3) Etomidate

52
Q

Anesthesia in Cardiovascular Patients - What Drug is Absolutely Contraindicated in Cats with HCM

A

Ketamine

53
Q

What drug family is highly associated with high risk of causing reflux during anesthesia? of the family - which is the Least risky option?

A

Opiates . Demerol (Safest)

54
Q

What are the Risk Factors for Reflux during Anesthesia?

A

Orthopedic surgery, Recumbency: Dorsal, Bigger Breeds >> Smaller Breeds, Long anesthesia, Drugs: Opioids , Older Dogs, Pregnancy: 2nd/3rd Trimester

55
Q

Reflux due to anesthesia - prevention

A

8-12 hours fasting prior to surgery, Metoclopramide CRI, Omeprazole

56
Q

Reflux due to Anesthesia - If Happened Already - What to do?

A

Warm water lavage until content clears +/- Bicarbonate

57
Q

What is the Ultimate Risk of Reflux During Anesthesia?

A

esophagitis —-> STRICTURE

Doctor of Veterinary Medicine (Work in progress) (17 decks)

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