VNSE - revision session Flashcards
to cover the info on the power point
what is an endogenous infection ?
when micro organisms responsible for infection originate from the same individual
what is an exogenous infection?
when microorganisms responsible for the infection originate from another sauce. eg. staff or the environment
what is the definition of contamination?
the accidental induction of a microorganism to the body tissues.
what is the definition of colonisation ?
a state where microorganisms are present but there is no evidence of disease.
what is the most common organisms found in wound infections ?
endogenous staphylococci and streptococci
how could you prevent an endogenous infection and how would you nurse a patient with that infection?
washing hands wearing gloves who hand wash designated areas for urination barrier nursing
what are the ways that animals could excrete infection ?
ocular discharge nasal discharge saliva vomit milk genital discharge faeces urine blood fluid from skin lesions
what is horizonal transmission ?
either the direct or indirect transmission of infection between individual animals of the same generation.
when might horizontal transmission occur ?
during the incubation period of an infection when the animal doesn’t exhibit any clinical signs.
when the animal is unwell
or if the animal has recovered but is still a carrier.
what is direct transmission of an infection ?
the spread of infection directly from one animal to another eg. grooming, sleeping in close contact, mating, fighting, inhalation.
what is indirect transmission of an infection?
refers to infection being transferred via an intermediary .
what is vertical transmission of infection?
vertical transmission is where disease is spread from her dam to her offspring. it may occur before or during birth. or via milk.
what are some sources of transmission?
the patient the surgical team the operating theatre the equipment fomites
factors that increase the risk of surgical cite infections?
clipping prepping length of general anaesthetic time of procedure surgical tissue handling number of people present length of stay
why shouldn’t you rely on antibiotics ?
high costs, ineffectiveness of antibiotics, outbreaks of drug resistant nosocomial infections
what are the 5 most common nosocomial infections ?
surgical site infections
intravenous cannula associated infections
catheter associated urinary tract infections
Diarrhoea
Pneumonia
what does sterilisation mean ?
sterilisation is the removal of all viable forms of microbial life, including bacterial spores to achieve acceptable sterility assurance level.
what does disinfection mean ?
disinfection is a process designed to remove microbes that may result in an infection.
what are the aims of preoperative skin antisepsis?
to reduce bacterial numbers to a level that can be controlled by the patients local defences.
to remove particularly virulent harmful microbes that may cause infection even if present in small numbers
what is anaesthesia?
a reversible immobile state, that makes the patient unaware of noxious/ harmful stimuli and induces amnesia.
what are the 3 components of anaesthesia needed to create balanced anaesthesia?
unconsciousness
muscle relaxation
pain relief
what is a pre mendicant?
a drug given prior to the use of another drug, this can be to counteract side effects.
give an example of a pre mendicant?
a sedative drug given prior to an anaesthetic induction agent as part of a planned anaesthetic protocol.
eg. Phenothiazines
Benzodiazepines
what are some analgesics that could be used in pre-mendicants?
opioids
Non steroidal anti inflammatory drugs
local anaesthetics
why are pre mendicants used ? - To calm and control the patient
- easier handling
- quiet induction
- muscle relaxation
- results in reduced levels of catecholamines, eg Adrenaline which will reduce chances of arrhythmias
why are pre mendicants used ? - To relive pain
An animal in pain is not settled, they tend to be restless.
Analgesics eg. opioids are given to exert a pre-emptive effect, during surgery and for immediate recovery.
why are pre mendicants used to reduce the amount of anaesthetic agent required for induction and maintenance of anaesthesia?
because it reduces unwanted side effects. anaesthetic agents have unwanted side effects, a pre anaesthetic medication can reduce such effects.
what happens if you induce a patient with ketamine?
they will have muscle ridgity, this effect can be reduced or abolished with the use of an agent with muscle relaxing properties eg, benzodiazepine or alpha 2 agonist.
what are some other reasons for the use of premediates?
It decreases airway secretions
reduces autonomic reflex responses
decreases gastric fluid volume and prevents regurgitation
If a patient is extremely sick then pre meds are very important as it means that less induction agent will be needed.
What are the drug groups of sedative pre mendicants?
Phenothiazines
Alpha 2 agonists
Benzodiazepines
give an example of a sedative pre mendicant in the group Phenothiazines?
Acepromazine 2mg/ml injectable solution
What is Acepromazine (a Phenothiazine ) most commonly used for?
Most commonly used as a Sedative Tranquilising properties Anti-emetic - anti sickness Spasmolytic Anti-histamine Alpha-1 adrenergic blockade
what are the uses of the sedative premediates in the phenothiazines group? (Acepromazine)
tranquilisation with moderate sedation
maximal sedative action at low doses
what happens if you combine acepromazine (a phenothiazine) with Buprenorphine (an opioid)
neuroleptanlagesia can be created when a phenothiazine is combined with an opioid eg. buprenorphine and acepromazine
give an example of how neuroleptanlagesia can be created
buprenorphine and acepromazine, combining phenothiazine with an opioid.
what animals respond well to Phenothiazines such as Acepromazine?
nervous animals respond well however aggressive animals do NOT respond well at all.
limitations of Phenothiazines? which is a type of pre med sedative.
Bradycardia - slow heard rate Cardiac depression hypotension do not use in hypovolaemic animals contributes to hypothermia
pre meds are split into 2 groups. sedatives and analgesics. what are the different types of sedatives?
phenothiazines
alpha 2 agonists
Benzodiazepines
pre meds are split into 2 groups. sedatives and analgesics. what are the different types of analgesics?
opioids
Non steroidal anti inflammatory drugs
local anaesthetics
what are alpha 2 adrenoceptor agonists?
a type of sedative pre mendicant , 2 types agonist and antagonists that has a receptor site in the pre synaptic membrane.
what are some examples of alpha 2 adrenoceptor agonists? - pre med - sedative
medetomidine
dexmedetomidine
uses of alpha 2 adrenoceptor agonists - pre med - sedative such as medetomidine dexmedetomidine
dose dependant sedation and analgesia anxiolytic provides muscle relaxation used as chemical restraint will reduce anaesthetic induction by 20-80%
side effects of alpha 2 agonists such as medetomidine or dexmedetomidine
bradycardia hyper then hypotension minimal reduction in respiration can increase dilute urine grey mms
when should an alpha 2 adrenoceptor agonists NOT BE USED? such as medetomidine or dexmedetomidine
Congestive heart failure respiratory disease intracranial pressure gastrointestinal tract obstruction diabetes anaemia urinary obstruction late pregnancy
give an example of a alpha 2 adrenoreceptor antagonist ? its a sedative pre med
atipamezole
Zoetis
what does alpha 2 adrenoreceptor antagonist such as Zoetis or atipamezole do?
its a reversal agent and stops the effect of medetomidine and dexmedetomidine
what is a Benzodiazepine ?
it is a sedative pre mendicant.
Give an example of a pre med, sedative , Benzodiazepine drug?
Diazepam and Midazolam
uses of Benzodiazepine drugs such as Diazepam or Midazolam?
Calming Anxiolytic Minor Tranquilizer Sick, depressed, depilated animal can use them . its an anticonvulsant muscle relaxant
limitations and side effects of using the sedative pre meds in the Benzodiazepine group such as Diazepam, Midazolam.
not reliable sedation
minimal in healthy animals
doesn’t reduce the induction agent a lot
avoid in hepatic patients
what are opioids?
they are pre meds in the Analgesic category . they are potent analgesics , that stimulate the receptors in the central nervous system.
Give examples off partial agonist Opioid ?
Buprenorphine
give an example of a full agonist Opioid ?
Methadone
What does an agonist mean?
drug occupies receptors and activates them
what does antagonist mean ?
occupies receptors . doesn’t activate. blocks receptor from agonist.
limitations of Opioids?
respiratory depression
sedation or excitement
nausea
defecation
what group is the opioid methadone in and what schedule is it? who can prescribe it ?
Methadone is a full agonist , that is POM V and a schedule 2 drug.
what are the limitations of Methadone?
cumulative effects
duration of action can be greater than 4 hrs
pain score every hr
What group is Buprenorphine ? and what’s is schedule and who can prescribe it?
Buprenorphine is a POM-V schedule 3 drug . its a partial mu receptor agonist/antagonist.
what can Buprenorphine be used for ?
Analgesia for mild to moderate pain ,
its a neuroleptanlagesia when combined with acepromazine.
Limitations of Buprenorphine opioid ?
unsuccessful for severe pain
avoid liver cases
will cross placenta
what group, schedule or prescription is the opioid Butorphanol in?
group partial opioid agonist, POM V schedule 4
what are the uses of the Opioid Butorphanol ?
sedative
antitussive
mild analgesia
antiemetic
NOT USED FOR BAD PAIN, UNPREDICABLE BAD FOR PATIENTS WITH LIVER, PANCREATIC,RENAL,HYPOTHYROIDISM,ADDISONS. can be used in pre med with acepromazine
how do general anaesthetics, Opioids and Alpha 2 adrenoreceptor agonists work?
they cause analgesia through their effects on the brain
what properties do non steroidal anti inflammatory drugs have?
anti-inflammatory and analgesic properties- mainly periphery
what do non steroidal anti inflammatory drugs do?
inhibits an enzyme called cyclo-oxygenase and prevent formation of prostaglandins
a common pre med combination for dogs?
Acepromazine, Buprenorphine and Medetomidine.
a common pre med combination for cats ?
friendly cat - Acepromazine , buprenorphine
morphine
what support should be given once pre meds are given?
brachycephalic dogs should be watched they need warming oxygen therapy Pheromones IVFT- fluid therapy iv
key drug groups in triad of anaesthesia
pre medicants
inhalational anaesthetics
injectable anaesthetic drugs
neuromuscular blocking agents
what are the two types of inhalation anaesthetics
gaseous anaesthetics
volatile anaesthetics
what is a gaseous anaesthetic?
nitrous oxide
what are the volatile anaesthetics and which ones are most commonly used?
common -Isoflurane
sevoflurane
halothane
desflurane
how do inhaled anaesthetics work
inhaled into lung, cross alveolar membrane, dissolve into blood, blood go to brain
inhalation soluble anaesthetics have a …
slow induction
slow recovery
and are very soluble volatile anaesthetic agents
inhalation insoluble anaesthetics …
have a rapid induction and recovery and are insoluble
which inhalation drug takes a long time to recover from?
Halothane
which inhalation drug takes a short time to recover from?
Desflurane
what is minimum alveolar concentration?
The minimum concentration of anaesthetic needed for the procedure. is a measure of how potent the anaesthetic agent is
what are the types injectable anaesthetic drugs ?
Barbiturates
steroids
dissociative drugs
Phenols
give an example of a injectable anaesthetic drug in the Barbiturates category ?
Thiopentone- horses ONLY
Give an example of a injectable anaesthetic in the Steroid category?
Alphaxalone
Give an example of an injectable anaesthetic drug that is a dissociative anaesthetic drug?
Ketamine
Give an example of an injectable anaesthetic drug in the Phenols category?
Propofol
what are 3 injectable anaesthetics?
Alfaxalone
Ketamine
Propofol
what is the group and use of Alfaxalone? (an injectable anaesthetic )
Neuroactive steroid
anaesthesia in dogs, cats and rabbits
- has a rapid onset
some comments specific to small animals regarding the use of Alfaxalone as a anaesthetic-(an injectable anaesthetic )
excellent muscle relaxation
stress free recovery if given pre med
no tissue retraction
no pain on injection
what group is ketamine in, and whets it schedule and who can prescribe it?
(an injectable anaesthetic )
cyclohexanone derivative, POM V Schedule 2 controlled drugs
what are the uses of Ketamine? (an injectable anaesthetic )
chemical restraint
dissociative anaesthesia for cats and small mammals
Analgesia infusion in dogs
inhibits NEUROMUSCULAR BLOCKING AGENTS blockade
in cats how long does it take for the onset of ketamine when its used as a sedative ? (an injectable anaesthetic )
5mins
in cats how long does it take for the onset of ketamine when its used as an anaesthetic and a muscle relaxant?
(an injectable anaesthetic )
3mins lasting for 25-45 mins
limitations and side effects of using ketamine
(an injectable anaesthetic )
cranial nerve preservation
can cause seizures as it stimulated central nervous system
if used without alpha 2 agonist they cause body regiity and stiffness
tachycardia
salvation
painful injection
what group anaesthetic is Propofol and who can prescribe it?
(an injectable anaesthetic )
phenol
POM V
What is the anaesthetic Propofol used for?
(an injectable anaesthetic )
intravenous induction agent for anaesthesia and to control benzodiazepine resistant seizures
what are the limitations and side effects of using the anaesthetic Propofol?
(an injectable anaesthetic )
twitching and tremors during anaesthesia and recovery
Rapid injection causes apnoea, cyanosis and severe hypotension
Vomiting and excitement on recovery.
Care exercised in hypovolaemic, cardio-pulmonary, hepatic and renal cases.
comments specific to small animals regarding using Propofol?
Comments specific to small animal patients:
Rapid recovery
Non irritant to tissues
Pain response on intravenous injection
what are the general effects of anaesthetic drugs on major organ systems?
Exact mechanism unknown, but causes reversible depression of CNS
Unconsciousness
Reduced sensitivity to concentration of carbon dioxide in the blood and reduced respiratory
Reduces cardiac output
reduced oxygenation of tissues
reduced blood flow to major organs
Peripheral vasodilation or vasoconstriction
What are Neuromuscular blocking agents NMBA
Also known as muscle relaxants
Paralyse all skeletal muscles by working at the neuromuscular junction
Must be used in combination with adequate general anaesthesia
Must be able to provide IPPV
Why are Neuromuscular blocking agents used?
Relax skeletal muscles for easier surgical access
To gain control of respiration during thoracic surgery
To assist ophthalmic procedures
