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Vet - Anesthesia > W2 (1) > Flashcards

W2 (1) Flashcards

1
Q

What should be included in the patient assessment

A
  • patient Identification​
  • patient History​
  • Signalment​
  • Physical exam​
  • Diagnostics​
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2
Q

Why is body condition scoring important to Anesthesia?

A

Very thin patients​:

  • Underlying disease​
  • Prone to hypothermia​
  • Drugs may act quicker or stronger on these patients​

Overweight patients​:

  • Underlying disease​
  • Dose to lean body weight​
  • Brain is the same size even if body isn’t​
  • Cardio-pulmonary may be compromised​
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3
Q

Why is TPR important to Anesthesia?

A

Know what “normal values” are for dog, cat, horse, cow​

Hyperthermia/hypothemia​

Tachycardia/bradycardia​

Panting​”

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4
Q

Why is hydration important to Anesthesia?

A
  • In general we want to anesthetize hydrated patients​
  • Exceptions in emergencies​
  • Dehydration will impair tissue perfusion -> Hypotension​
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5
Q

How do you assess hydration?

A

skin turgor, postition of the eye in the orbit, mucous membrane moisture level, heart rate, pulse strength, and level of consciousness

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6
Q

What words are used to describe the level of consciousnes and temperament

A

Consciousness : BAR, QAR, Lethargic, Obtunded, Stuporous, Comatose
Temperament : Anxious, Friendly, calm, Aggressive, Excitable, Scared

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7
Q

What are the different values for Mucous membrane color?

A

Pink​ - normal color
White/pale​ - decreased perfusion from shock, vasoconstriction, hypotension, or a variety of other condictions, anemia
Blue​ - “cyanotic”, reduced oxygen saturation
Yellow​ - Iceteric
Red​

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8
Q

What is a pain score?

A
  • Affects how you interact with animal​

- pain management plan​

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9
Q

What is involved in a preanesthetic Diagnostic workup?

A

Test and Diagnostic Procedures​: PCV/TP or Plasma Protein​, CBC/Profile (Panel)​, Urinalysis​, Serologic or Chemistry Panels​, Coagulation Screen​, ECG/EKG​, Radiographs, Contrast studies​, Ultrasound​

  • All completed tests must be reviewed by the veterinarian, record in the patient’s permanent record before the anesthesia plan/protocol is formed.​
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10
Q

What factors influence the diagnostic tests chosen?

A

Different tests may be ordered based on:​

  • Facility standard policies​
  • Different patient groups​: Pediatric​, Geriatric​, Trauma​, Elective​, Disease states​

Other considerations​: Financing​

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11
Q

Diagnostic : CBC

A

Evaluation of blood cell numbers and morphology ​

  • Packed cell volume (PCV), plasma protein (PP), hemoglobin, ​
  • Total red blood cell (RBC), white blood cell (WBC), platelet, and absolute leukocyte counts.​
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12
Q

Diagnostic : Elevated PCV or RBC

A
  • Dehydration (associated fluid lost leads to decrease in blood volume)​
  • Decreased Blood volume lead to:​ Affecting cardiac output​, Blood pressure​, Tissue perfusion​
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13
Q

Diagnostic : Decreased PVC/RBC

A

Anemia ​

  • Decrease capacity to supply oxygen to the tissues​
  • Anesthesia increase risk​: Tissue hypoxia​
  • PCV less than 25% in dog and 20% in cat, horse, cow should be reported immediately​
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14
Q

Diagnostic : TP

A

(Proteins-albumin, gobulins, and fibrinogen)​

  • Hypoproteinemia​
  • Decreased protein production by the liver​
  • Protein loss in the GI tract, kidneys​
  • Blood loss​
  • Most anesthetics are partially protein bound and the other portion is unbound and free in the blood​ : Patients with low protein, less protein the anesthetic can bound to resulting in increasing drug potency.​
  • Less 4.0 g/dL in any patient should be reported immediately​
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15
Q

Diagnostic : Total WBC and Leukocyte counts

A
  • Measure the total number of leukocytes​
  • Measure the number of each type of leukocyte (neutrophils, lymphocytes, monocytes, eosinophils, basophils)​
  • Changes in counts and morphology may be associated with infection, parasitism, and other diseases​
  • These changes may influence preanesthetic patient management​
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16
Q

Diagnostic : Platelet count

A
  • Evaluate blood coagulation​
  • Patients with thrombocytopenia are at greater risk of intraoperative and postoperative bleeding​
  • May have to stabilize condition before surgery​
  • These changes May influence preanesthetic patient management​
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17
Q

Diagnostic : Blood chemistries (panel/profile)

A
  • Assess organ health and function​
    Kidney – which values Assess Kidney function?​
    Liver – which values Assess Liver function?​
  • Screen For any diseases or conditions that May increase the patient risk under anesthesia​
  • Results of These test will aid to formulate an anesthetic plan​
18
Q

Diagnostic : urinalysis

A
  • Information of urinary and non urinary systems​
  • Kidney function is important in regulating electrolyte and water balance, blood pressure, and elimination of anesthetic agents​
  • Protein in urine or specific gravity is less than​: 1.030 in canine​, 1.035 in feline​
    (Further test needed to assess kidney function​)
  • Macroscopic exam finding (color, clarity odor, biochemical analysis) and Microscopic findings​ : May reveal diabetes, liver or kidney disease, other systemic disorder​
19
Q

Diagnostic : Blood coagulation tests/screens

A
  • Blood coagulation screens evaluate the chemical, and sometimes mechanical, components of blood coagulation.​
  • Various disorders may adversely affect blood coagulation and put surgery patients at high risk for intraoperative and postoperative hemorrhage​
  • A coagulation panel​: prothrombin time (PT)​, activated partial thromboplastin time (APTT)​
  • Should be performed on any patient that may have a preexisting coagulation disorder (end stage liver disease, hereditary disorders – e.g. Von Willebrand’s)​(Doberman, Rottweilers, Scottish terriers​)
  • In house screen tests​ : Buccal mucosal bleed time (see page 26 in the textbook)​
20
Q

Diagnostic : EKG/ECG

A
  • Records the electrical activity of the heart​
  • Assess heat rhythm​

-Recommended in patients with known or suspected:​
Heart disease​ (Patent ductus arteriosus (PDA)​), Chest trauma​, Gastric dilation volvulus (GDV)​, Splenic disease​, Electrolyte disturbances​, Medications that may affect heart rhythm​

  • Because most anesthetic agents alter heart rate, cardiac output, and oxygen consumption to some degree, patients with heart disease are at much greater risk for anesthetic complications.​
21
Q

Diagnostic : Radiography

A

Thoracic and abdominal radiographs (heart disease, traumas, suspected foreign bodies, diaphragmatic hernia, pneumothorax, pleural effusion, etc.)​

22
Q

Diagnostic : Ultrasound

A

Masses, heart blood flow, foreign bodies, bladder stones, etc.​

23
Q

TPR Normal Values (dog, cat, horse, cow

A

Dog -
Cat -
Horse -
Cow -

24
Q

What are the physiological needs of Fluid administration?

A
  • We all need a constant source of oxygen delivered to all body tissues!​ (Necessary to perform basic metabolic functions​)
  • Absence of oxygen will damage any tissue resulting in cell death in the brain and heart muscle​
  • This can happen within minutes​
25
Q

what are the primary functions to take into consideration when administering fluids?

A

Cardio and Respiratory systems is to:​ Supply the oxygen need to the body​, Extracting oxygen from the air and distributing it to every cell in the body​

  • All anesthetic agents affect these systems decreasing oxygen delivery!​
  • These systems need constant attention!​
26
Q

How do anesthetic agents affect cardiopulmonary function?

A

Most decrease heart contractions (force) and cause a slowing of heart rate (bradycardia)​
-Decreased blood flow from the heart​

Most relax the muscle tone of blood vessels​
-Increases vessel dilation (vasodilation)​

​-Decrease cardiac output and vasodilation causes hypotension and decreased perfusion of tissue with blood!​

27
Q

How to prevent hypotension and maintain tissue perfusion

A

Administration of IV fluids to support oxygen delivery**

  • Fluids will increase circulating blood volume​ –> Improving cardiac output​, Supporting blood pressure and tissue perfusion​
28
Q

What are important aspects of the body’s composition to take into consideration when administering fluids

A

60% of adult animal body weight is water!​

- Body composition, age, disease can affect the body percentage weight of water​

29
Q

interstitial fluid

A

Bathes cells and tissues

30
Q

Plasma

A

Liquid portion of blood which consititutes most of the intravascular volume

31
Q

Transcellular fluid

A

Synovial joint fluid, Cerebrospinal fluid, Bile, Lining of the peritoneal cavity, pericardium, and pleural space

32
Q

What is the rule of thumb to simplify the distribution of fluid in the body

A

60: 40:20 rule
- 60% patient weight is water​
- 40% patient weight is intracellular fluid (ICF)​
- 20% patient weight is extracellular fluid (ECF)​

33
Q

Body fluids

A

consist of water and solutes (atoms /molecules dissolved in body water)

34
Q

Electrolytes

A
  • When dissolved change into​ :Cations (positively charged ions)​ + Anions (negatively charged ions)​
  • Sodium Chloride is electrolyte – when dissolved​ Sodium is the cation and Chloride is the anion​
  • provide osmotic pressure​
    Essential for: blood clotting, cardiac function, neuromuscular function​
35
Q

Important Cations/Anions

A

Important cations found in body fluids : Sodium, potassium, magnesium, calcium​
Important anions found in body fluids : Chloride, bicarbonate, phosphates, proteins​

36
Q

Proteins

A

Essential for drug transport, blood pressure regulation (oncotic pressure), and blood clotting​

37
Q

Glucose

A

provides energy to the cells​

38
Q

Homeostasis

A

Constant state with the body​
Maintained by normal physiologic processes​

Dynamic process is constant​:

  • Water and solutes move through cell membranes to maintain balance​
  • Some solutes move though the body along gradients​ (High concentration gradients to low concentration gradients​)
  • Some solutes are confined to or concentrate in a particular space​

This is depend on size and chemistry​

  • Albumin – large size, does not travel freely, tend to stay within the intravascular space​
  • Potassium – active transport through cell membranes is concentrated in the cells​
39
Q

Balance principles (Equilibrium of body fluids)

A

the number of negative and positive charged particles in any fluid compartment Must be equal : Equilibrium​

  • to be healthy and maintain equilibrium the solute concentration or osmolarity Must be maintained in all body fluids​
  • Increased osmolarity Is due to water loss : Dehydration, exercise, heat stroke, vomiting, diarrhea​
  • Congestive heart failure where large quantities of solutes are lost​
40
Q

Osmotic pressure

A

Solutes in each compartment provide osmotic pressure​

  • Pressure that draws water into the compartment in proportion to the number particles present​
  • Example: Vascular space increases or decreases, water will follow, increasing or decreasing blood volume​

Small particle solutes such as ions diffuse freely through vascular endothelium, taking water with them. ​

  • The ions equilibrate relatively quickly between the intravascular and interstitial fluid spaces. ​
  • The interstitial fluid compartment is about three times the size of the intravascular compartment​

Therefore only about one quarter of fluid administered intravenously remains in the vascular space after equilibration.​

Vet - Anesthesia (8 decks)

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