Anes- small animal anesthesia 2

untimely's version from 2015-05-12 03:26

Cats are dumb

Question Answer
what is the unique look cats get with opioids?their eyes DILATE instead of get pinpoint
what is a peculiarity of cat metabolism? what does this mean for them as a unique thing?they have a deficiency in glucoronidation---> phenolic compounds are metabolized slowly, resulting in oxidative insult (eg acetylsalicylic acids, paracetamol, propofol, morphine) (so basically either dont use in cats or use lower dosages.)
how should you handle dosing a cat with propofol?no glucoronidation--> slower metabolism--> just titrate to effect, and do not use repeatedly over several days or it will build up and cause problems
why is ET intubation difficult in cats?laryngospasm (with cat neuter, prolly don't need to intubate)
what drug do we like to give/use with feral cats?ketamine
is ketamine + midazolam a good idea?no analgesia and will probaly not sedate unless young or old or sick. problem is when they recover they freak out...its not the ketamine, the ketamine wears off first, then paradoxical reaction of midazolam in cat.
what premed combos might you wanna do in a feral cat? (2)ketamine+dexmedetomidine, ketamine+ace
#1 thing you wanna do first if you get a blcoked at?rehydrate
what are secondary problems with blocked cats that you should expect?electrolyte imbalances-->HYPERKALEMIA(BRADYCARDIA). azotemia(can make them sensitive to drugs). metabolic ACIDOSIS. dehydration. post-obstructive diuresis (once stones are flushed back into bladder and urethra free--- they pee a ton and then are more dehydrated)
how does HYPERK affect the ECG??BRADYCARDIA, Tented T (tall T) and disappearing P (also prolonged P-R interval, inc QRS duraiton)
If you can't measure the level of K in a blocked cat, what HR is an alarm bell?120 or under
*****dont induce anesthesia is K is ____ (level) >6mmol/L ( >9-10 can see ventricular fibrilation too)
(said in class) why can you still give LRS to a blocked/hyperkalemic cat (even though there is K in it?)some K, but lower than what's in plasma so your're still diluting and has lactate, which is metabolized to bicarb to help tx acidemia
why do you want to give glucose to a hyper K cat?insulin causes K to shift from extracellular to intracellular, thus dec serum levels of K
who do you wanna give Calcium-glukonate to, and why?blocked cats-- provides myocardium stabalization (doesn't help with K though- only an ER tx)
if you must sedate a cat which is blocked, what do you prolly wanna use?opioid + benzo
what can you use to induce a blocked cat? maintain?INDUCE: ketamine-midazolam, or mediazolam-etomidate. MAINTAIN: inhalant anaesthetic, fentanyl CRI (if need to sx remove stones)
what is contraindicated drug in blocked cats?Alpha-2s bc diuretic effect (dont wanna inc volume of bladder) and also severe CV impact
which sedative has a diuretic effect?Alpha-2s
what do you think about cats and benzos?that cat better be sick or really young or old. they can flip out from benzos. (they can stim appetite though!)
which do you usually combine with ketamine for cats?midazolam
when are alpha 2s (medetomidine/dexmedetomidine) usually indicated in cats?combo with ketamine and an opioid for minor procedures, and for IM induction of anesthesia in feral cats, for sedation only in combo with butorphenol
antagonist for alpha-2s?Atipamezol (alpha atip)
when is xylazine usually used in cats?strong emetic effect...not really good for sedative. just for making them puke
what do you think about buprenorphine in cats?awesome for cats- good analgesia, and sublingual route is useful
what do you think about methadone in cats? morphine?meth= only for SEVERE pain. Morph=not opioid of choice-- lots of dysphoria and excitement
what do you think about thiopental in cats?not drug of choice- resp depression, accumulation, arrythmias, small therapeutic window
what do you think about cats and propofol?heinz body anemia
etomidate in cats?only if theyre really sick
what is a popular reason Ketamine is desired in cats? combine with what?IM injection. always combine with sedative/mm relaxant, liek (dex)medetomidine, midazolam (not diazepam if im!!!), or acepromazine
advantages of ketamine + ace?good mm relax, smooth recovery
disadvantages of ketamine + ace?no visceral analgesia, hypothermia, hyperexcitability, mm rigidity
advantages of ketamine + alpha 2s?potent analgesia, good mm relax, can antognize a-2s
disadvantages of ketamine + alpha 2?PRONOUNCED CV effects
advantages of ketamine + midazolam?minimal CV impact, good mm relax
disadvantages of ketamine + midazolam?no visceral analgesia, ET intubation not always possible, top-up with propofol possible

Babies (neonate/pediatrics)

Question Answer
neonate is till what age? pediatric?Neonate: till 4 weeks. Peds: 12 weeks
NEONATE--> CO is dependent on what?HR dependent (so don't dec HR too much with drugs!)
which dominates in the neonate: symp or parasymp?PARASYMP (so bradycardic affect of some drugs might induce SEVERE hypotension) (really? you think a neonate is gonna fight or flight? no.)
what is a neonate's PCV like?LOWER, so less able to tolerate blood loss
what is FRC, what is it like in neonates, what does this mean for you as a vet?functional reserve capacity (the amount of air left in lungs after exhale) and it is LOW in neonates (also low in fatties and preggos). It means they don't really have an O2 reserve so they con't tolerate 2-3min of not breathing if inducing anesthesia, so PREOXYGENATE THEM
why do you wanna pre-oxygenate neonates?they have low FRC (functional reserve capacity)
neonates--> their lung/chest wall compliance is low, which means there are major risks ofairway closure and hypoventilation
what is the O2 demand of a neonate like?2-3xs higher (high metabolic rate)
what is the RR of a neonate like?higher
the neonate's high RR, high O2 demand, low FRC(functional reserve capacity) and low lung/chest wall compliance all lead to what risk factors?hypoxemia and re-breathing (cant breathe against resistance)
what is temp regulation like in the neonate? why? what can you do?low SC fat reserves, high surface area:body area ratio, poor thermoregulatory ability, and less ability to shiver means---> MAJOR RISK OF DEVELOPING HYPOTHERMIA DURING ANESTHESIA~! so use warming devices and do everything you can to minimize duration of sx and anesthesia
what should you keep in mind if giving fluids to a neonate?DEC GFR ability during first 6-8wk--> so don't overload with fluids!
what unique attributes of the neonate must you keep in mind when giving drugs?immature hepatic metabolism of neonate up to 12wk, and Hypoalbumenaemia (so greater free/active portion of drug), and inc permeability of BBB----> MORE SENSITIVE TO DRUGS
how do you approach fasting with neonates/pediatrics? (keep age in mind)<6 weeks NO FASTING. >6wk only 2-3 hrs
blood work--> glucose--> how does this usually run in neonates?with glucose they often run low, so do LRS infusion combined with glucose to make sure dont get hypoglycemia.
if there is an abdominal emergency what must you closely monitor?electrolytes
which premeds should be AVOIDED in babies?NO A-2s and NO ACE (contraindicated! due to CV effects of dex (need HR maintained, dont wanna induce bracycardia) and ace is just too long acting-- need them up as soon as possible so they can eat/drink soon.)
which premeds are preferred in babies?benzos (good for v young patients)
should you use opioids in babies?risk of resp depression and bradycardia, but SHOULD be used for PAINFUL conditions
which anesthetic gas is preferred in mask induction of babies?SEVO (less irritating to airways)
what is a pro and con of IV induction?IV placement often challenging but very rapid (good for abd sx or dyspnea)
most common IV anesthetic induction combo for babies?propofol or ketamine/midazolam
advantage and disadvantage of ketamine in a baby?always combine with sedative! good: lack of CV depression. Bad: extensive hepatic metabolism and salivation
what drugs should you AVOID in animals <8-10wk?barbitruates
is alfaxalone good in babies?works well
should you intubate a baby? (pro vs con)PRO: recc due to narrow upper airways and big tongue CON: delicate tissue, laryngeal edema, spasm easily produced. DONT CUFF
which breathing system?non-rebreathing
If you need to move an intubated baby, ALWAYSDISCONNECT THEM FIRST. (you can tear their trachea)
when (age) should you use NSAIDS?ONLY ABOVE 12 WK
how should you do opioids, which opioid is preferred?reduced dosage, inc intervals. buprenorphine, butorphanol>pure mu agonists
what kinda LA might you wanna do?EMLA (calc max dose very careful with babies)
*lidocaine dose?2mg/kg
how much glucose do you want to provide in fluids?2.5% glucose in LRS*
with babies, restore what asap?RESTORE NORMAL FEEDING/BH ASAP
which premed combo is usually desired for babies?IF NECESSARY, midazolam+butorphenol (both can be antagonized)

old farts (geriatric)

Question Answer
how do you define geriatric?reached 75-80% of breed-specific expected lifespan (dogs >8y, great danes >6y, toy >12y, cats >12y)
how does age affect the CV system?reduced cardiac reserve capacity, cardiac dz common, likelihood of arrhythmia inc, circ time inc
clinical implications of CV changes in old animals?avoid extreme HR changes, avoid sudden changes in ABP, avoid inc vascular resistance, avoid arrythmogenic drugs
how is the resp system affected clinically?dec fxn reserve, lower PaO2
clinical implications of