Week 8 notes Flashcards
What does patient pre consist of?
asses, prepare and weight the patient, calculate the volume of each drug, prepare equipment required to administer drugs, prepare fluid administration equipment, and prepare monitoring equipment (including paperwork)
Incomplete patient preparation often result in?
complications ranging from mild to life-threatening.
When choosing an anesthetic protocol what three things do you take into account?
minimum patient database, physical status, and procedure to be performed
Drug choices for anesthetic protocol are influenced by?
training, clinical experience, personal preference, and DVM
What do you do with all injectable drugs before administering?
double-check doses
What do you label syringes containing injectable drugs with?
name of patient, name of drug, and drug concentration
When trying to minimize adverse effects you should administer what dosage of a drug?
minimum dosage of drug to get desired effect.
When inducing what do you do if your patient is in excessive depth of anesthesia?
monitor, support patient until metabolized, or reversal agent
IV induction is only good for how long?
10 minuets or less
When using inhalant anesthetic when are large dial changes warranted and when are subtle dial changes warranted?
Large- when patient is significantly light or deeply anesthetized
Subtle- patients anesthetic depth is slightly too light or deep
What are the sequence of events when inducing a patient?
administer induction agent, check jaw tone, place and secure ET tube, check vital signs, connect patient to anesthetic machine, inflate ET tube, check anesthetic depth, monitor
Patients weighing less than what need a non-breathing circuit?
7 kg
What is the equipment needed for intubation?
ET tubes (the size you think it is and 2 additional one + and one -), IV tubing (gauze, ties), gauze sponge, 12 mL syringe, exam light, stylette, Lidocaine, laryngoscope
How do you determine length of and ET tube?
should extend from the tip of the nose to the thoracic inlet
How do you prepare your ET tube?
make sure it is clean, free of damage, hole, discoloration, make sure the connector is firmly attached, the cuff inflates and hold pressure, lube (water soluble)
Readiness for ET tubing is characterized by what?
unconsciousness, lack of voluntary movement, absent pedal reflex, sufficient muscle relaxation for mouth to be held open, and no swallowing when tongue is grasped.
How do you check for correct ET tube placement?
Re-visualize the larynx, watch the reservoir bag, feel for air movement, watch for fogging, check unidirectional valves, vocalization?, cough upon intubation, capnography
Why should care be taken when intubating a cat?
irritation of the larynx can cause laryngospasms which can occlude the airway if severe
What are some complications that can occur with intubation?
cuff not inflated/underinflated or over inflated, tube diameter too small or large, Tube too long or short, overzealous intubation, tube kinked or obstructed, tube not cleaned or disinfected
What factors effect recovery?
the longer the patient is under, condition of the patient, type of anesthetic and route, temperature, and breed
What are the signs of recovery?
animals progress back through anesthetic planes and stages, vital signs and reflexes change in predictable ways, animals may shiver, and voluntary movement
A recovering patient should be turned every _____ and why?
10-15 minuets, to prevent pooling of blood in the dependent lung and tissues. (hypostatic congestion)
Large animals require ______ doses of medication on a ____ per _____ basis
lower; mg/kg
What drugs are commonly given with sedation and standing chemical restraint in horses?
acepromazine, xylazine, and detomidine
What injectable agents are used in field anesthesia with horses?
xylazine/ketamine mix, diazepam, guaifenesin, and butorphanol
What are the indicators of anesthetic depth on a horse?
eyes, reflexes, HR, pulse quality, RR
What needs to happen with positioning and protective padding with horses?
must be lifted after induction on to padded table, placed in dorsal recumbency need padding on both sides to prevent rolling, padding must not prevent breathing, in lateral recumbency will need padding between down and up legs to keep upper legs parallel to floor
what is the maintenance fluid rate for an average size horse?
5L/hour
crystalloids are given to horses at a rate of?
10 mL/kg/hr
Cattle are typically in what position for surgery?
standing
what are some issues for cattle with anesthesia?
regurgitation, bloat, and saliva production
How much saliva do cattle produce?
50L every 24 hours
what is the most common drug used in cattle?
xylazine
What are common induction agents for cattle?
Ketamine and telazol
What is a “triple drip”?
CRI of guaifenesin, ketamine, and xylazine
What technique is used to intubate horses and cattle?
bind technique or palpation
what is the routine maintenance fluid rate for cattle?
5-10 mL/kg/hour
What is the fluid volume for rabbits, guinea pigs, rats, mice, gerbils, and hamsters?
100 mL every 24 hours
Most small mammals are induced by what route?
IP
What are some potential issues with IP induction?
safety margins of agent, ability to titrate, variable response to agents, high dose rates compared to IV, prolonged recovery, hypothermia
What are some reasons for emergencies with anesthesia?
humane error, equipment failure, anesthetic agents,
What are some patient factors with emergencies?
geriatric patients, pediatric patients, brachycephalic dogs, sight hounds, obese animals, C-sections, trauma patients, diseases
What are the anesthetic issues with geriatric patients?
reduced organ function, poor response to stress, degenerative disorders, increased risk of hypothermia, and over-hydration
How do you decrease the risks in geriatrics?
reduce anesthetic dosage by 30-50%, allow longer time for response to drugs, administer fluids at a reduced rate, keep warm, select agents with minimal cardio effects, pre-oxygenate
What are the anesthetic issues with pediatrics?
increased risk of hypothermia and over-hydration, inefficient excretion of drugs, difficult intubation, and difficult IV catheterization
How do you decrease the risks with pediatrics?
keep warm, avoid prolonged fasting, administer 5% dextrose in LRS, accurate weight, dilute injectables, reduce anesthetic dose
What are the anesthetic issues with brachycephalic dogs?
tendency toward airway obstruction, and high vagal tone
how do you decrease the risks with brachycephalics?
utilize anticholinergics, pre-oxygenate, induce rapidly, delay extubation, observe closely when recovering
What are the anesthetic issues with obese animals
accurate dosing difficult, poor distribution of drugs, potential respiratory difficulties
How do you decrease the risks with obese animals?
dose according to ideal weight, pre-oxygenate, induce rapidly, assist ventilation as necessary, delay extubation, observe in recovery
what are the anesthetic issues with C-sections (Dam)?
increased work load to heart, potential respiratory compromise, increase to vomit or regurgitate, increased risk of hemorrhage
Anesthetic issues with C-sections (offspring)?
agents crossing the placenta, reduced respiratory function, and cardio function
how do you decrease the risks with C-sections (Dam)?
administer IV fluids, clip before induction, pre-oxygenate, use lowest effective dose, avoid ketamine/diazepam and pentobarbital
how do you decrease the risks with C-sections (offspring)?
use reversal agents, doxapram, administer O2 via face mask, administer atropine for bradycardia
Anesthetic issues with trauma patients and how to decrease them?
issues- respiratory distress, shock, hemorrhage, internal injuries, cardiac arrhythmias up to 72 hours post-incident
decrease- stabilize patients before anesthesia, thoracic radiographs, ECG, thorough PE
What are some emergency situations?
pale MM, hypotension, hypoventilation, cyanosis, dyspnea, tachypnea, cardiac or respiratory arrest.
For dogs respiration what requires treatment and what is critical? (number)
treatment- <4
For dogs HR what requires treatment and what is critical?
treatment- 140
critical- 175
For cats respiration what requires treatment and what is critical? (number)
treatment- <6
For cats HR what requires treatment and what is critical?
treatment- 200
critical- 225
What is ABCDEF?
airway, breathing, circulation, drugs, ECG, fluids
CPR in large dogs how?
place animal in lateral recumbency, place firm object under chest just behind elbow, compress chest against object with heel of one hand where chest is widest, let chest wall bounce back rapidly.
CPR medium dog?
place on hand under chest and other hand at 5th intercostal space (just over the heart), compress chest between hands
CPR small dog or cat?
with animal in lateral recumbency, compression applied using thumb to compress chest against fingers of the same hand.
What are the rate of compressions for CPR?
1-2/second
depending on size of animal
large dogs- 80 times/ minuet
small dog or cat up to 120 times/ minuet
How far should the chest be compressed in CPR?
1/3rd the diameter of the chest wall
If you have 2 people for CPR when should you bag? if solo?
every 3-5 seconds; 10 compressions with 2 breaths
What is the emergency drug doses for epinephrine and atropine?
epinephrine- 1:1000 = 0.1 mg/kg
Atropine- 0.5 mg/mL = 0.025 mg/kg
What are the short term effects of waste gases?
fatigue, headache, drowsiness, nausea, depression, irritability
Long term waste gas exposure has been linked to ?
reproductive disorders, liver damage, kidney damage, bone marrow abnormalities, and nervous system dysfunction
Which inhalant is less toxic iso or sevo? and how much of each is retained?
Iso- 0.2%
Sevo- 3%
What is an active scavenging system?
system that uses suction created by a fan or vacuum pump to dispose of waste gases
what is a passive scavenging system?
system that discharges waste gas to the outdoors through a hole in the wall or canister (f/air or charcoal canister)
What is the reversal agent for etorphine?
Diprenorphine, naloxone, naltrexon
