Anesthesia midterm 3

kelseyfmeyer's version from 2015-09-27 20:58

LAs ctd

Question Answer
intrathecal anesthesia refers to where? and aka? what should you know about this?spinal or SUBARACHNOID--> can be intentional or not, usually happens at L4-5-6 in dogs, and the drugs mix with the CSF which means they can get to the brain (prolly not good)
what kinda shaving/septic margins do you want for epidural? what should you know about the septic technique?big BIG margins bc needs to be VERY clean. DONT USE ALCOHOL (or at least dont lather it on) because alcohol is NEUROTOXIC and you can push it into the spinal canal
what are three different ways you can verify correct placement of the needle?gold standard: fluoroscopy contrast rx (xray that moves), or feel a loss of resistance, or a HANGING DROP (distinct pop/plop sensation)
things that can go wrong from injecting LA too fast? things you can try to do to see if you're doing it slow enough?recc you have ECG and BP monitoring in place while performing epi, due to LA side effects. if you inject too fast, will spread too far cranial. might cause "patchy" anesthetic because you injected too fast and it all went into fat depots instead of reaching nerves
no matter the drug used for epidural, what should you know about the formulation?PRESERVATIVE FREE
what are some drugs used for epidural?(PRESERVATIVE FREE) lidocaine, ropivicaine/bupivicaine, morphine, alpha 2 adrenoreceptor agonists, ketamine
***which wears out first... sensory or motor block?motor block wears off first (makes sense, thats the deepest level of block so they'll come out of itfastes but sensory is a ton of diff nerves)
compare the dose, onset, and duration for morphine vs bupivicaine for an epiduralMORPHINE- takes long, lasts long, need like nothing (DOSE: 0.1mg/kg, onset 30-90min, LASTS 16-24) Bupivicaine- even though slow other ways, MUCH faster than morphine (0.5-1mg/kg, ONSET: 3-4min, LASTS: 4-6hr)
for all drugs without preservatives used for epidural, what do you want to dilute them to, and whats the max administered amount?NEW VIALS! dilute to 0.2ml/kg, NO MORE THAN 6ml for a dog
indications for eda (epidural)perineal sx, tail amputation, hind limb sx, thoracic sx (MORPHINE ONLY), lower abdominal sx
CONTRAINDICATIONS FOR EDA (epidural)skin infxn and injection site, blood clotting probs, septicemia, fractured pelvis or spine (those supposted to be landmarks), pre-existing hypotension (no LA for this- LA would make more hypotensive), meningitis, CNS disorders, OBESITY (cant palpate landmarks), discospondylitis (lumbosacral space not accessable anymore)
how much of reg dose if performing spinal anesthesia?1/3 dose
what's different about epidurals in cats?spinal cord further caudal, 50% of time its spinal epi. also duration of effect usually shorter
brachial plexus blocks which spinal nerves? which area on body is blocked?--> good for what probs?C6-T1. distal from elbow. (good for radio-ulnar fractures)--> blocks radial, ulnar, musculocutaneous, median, axillary.
2 techniques for brachial plexus block?(1) BLIND- needle medial to tip of shoulder. advance toward costochondral junction. inject as needle is withdrawn (2) nerve locator- instrument that senses elec impulse of nerves is used to find the nerves
Drugs for brachial nerve block? (what are the doses for each technique?)LIDOCAINE and/or BUPIVIVAINE (elbie's arm needs work). (1) BLIND- 1ml/kg max 15ml. (2) nerve locator- 0.25ml/kg (blind needs more bc not sure how effective placement)


Question Answer
nociception =/=pain (sensory and emotional experience and inability to communicate doesnt mean no pain)
whats transduction?detection of innocuous(not harmful) and noxious info.
which fibers arent myelinated? thinly myelinated? what should you know about the effect of myelination?B and C arent myelinated. A-delta are thinly myelinated. **THIS MAKES THEM SLOWER
which is the "first pain" fibers?A-delta (A delta carwash should be your FIRST choice)
which is the "second pain" (burning, slow pain) fibers?C-fibers ( C is's the roundabout pain)
activation of what two nerv fibers is necessary for perception of acute pain?A-delta (delta is the A choice for fast cars- first pain fibers) and C (roundabout pain- slow burning)
what are the silent/sleeping nociceptors, and why are the called this?the A-delta and C fibers (once responsible for acute pain)-- they are sleeping bc NOT activated by tissue damaging events- activated by inflammation (particularly sensitive to mechanical stim) (ADC, SLEEEEPY)
path of pain with fancy wordsstimulus--> transduction(end of fiber) --> transmission (to spinal nerve) --> modulation (SC modifies signal) --> projection (up spinal cord)--> perception(brain)
explain low intensity stimulus vs high intensity stimulus (which fibers)low intensity stim: (A-beta fibers) transmit innocuous sensation.(A-B is so lazy it just transmits that sthing happened, not pain...lazy bc just said first two letters of alphabet and was done with it) HIGH intensity stimulus: (A-delta and C fibers) PAIN!
allodynia is what, and is caused by what fibers?NONPAINFUL stim feels like pain--- so is A-Beta fibers. makes sense because they are the AB-lazy ones who usually do innocuous stim , but theyre overstim so are like "uhh what do? PAIN"
hyperalgesia is what and caused by what fibers?sensitized nerves cause more pain that what was actually reasonable. So caused by nerves which are already doing pain- A-delta and C fibers
what is primary hyperalgesia?aka peripheral sensitization. inflammatory/sensitizing soup, results as hyperalgesia at site of injury
what is central sensitization?results in primary and secondary hyperalgesia (2*=pain sensitivity that occurs in surrounding undamaged tissues) and allodynia, responsible for pain memory
what is wind up?temporal summation of sensory inputs in the spinal cord. (perceived increase in pain intensity over time when a given non painful stimulus is delivered repeatedly above a critical rate. It is caused by repeated stimulation of group C peripheral nerve fibers, leading to progressively increasing electrical response in the corresponding spinal cord (posterior horn) neurons) SHE SAYS: causes inc sympathetic innervation/excitation or DORSAL ROOT GANGLION (sensory one). Also disinhibition of inhibitory inputs. leads to abnormal patterns of spinal cord inernuronal communication
peripheral sensitization activates what fibers?silent nociceptors (A-d and C)
substances which work on pain signal inhibiton in the braininhalents, sedatives, injectable anesthetics, NSAIDs, opioids
substances which work on pain signal inhibiton in the SCinhalents/injectable anesthetics, opidoids, a-2 agonists, ketamine
substances which work on pain signal inhibiton in the transmission of painLAs
substances which work on pain signal inhibiton in the TRANSDUCTION of painopioids, LAs, alpha-2 agonists, NSAIDS
UMPS- uni of melbourne pain scale- explainobjective physiological data- HR, RR, pupil ize, rectal temp. Also b/h responses- activity, reponse to palpatino, posture, mental status, vocalization. assign #s to each factor and end score will be between 0-27
most vigorously validated scale for assessing acute post operative pain in dogs? explainGCPS: glascow composite measure pain scale. b/h categories (posture, comfort, vocalization, attention to wound, demeanor and response to humans, mobility, respponse to touch),
pray posture specific to what sp?dogs
low carriage of tail specific to what sp?dogs
hunched posture with lowered back spp?cat
eyelids half closed means what in who?pain in cats
not grooming could mean pain incats
pain scale at least hourly post op for how long?4-6hr
preemptive analgesia why?prevent wind-up/hypersensitivity
three pillars of traditional analgesia?opioids, NSAIDs, LAs
what's cool about location and amount of opioid receptors?they can occur anywhere theyre needed ((grow more too)
opioid noteable for CRI?fentanyl
how can you make fentanyl absorption of patch faster?warm that area of skin. onset ~12hr. duration 72hr
fentanyl transdermal- onset? duration?2-4hrs onset, pain relif for 4 days
COX 1 vs COX 21- housekeeping (hoursekeeping is most important) COX 2- response to tissue damage
traditional NSAidS vs COXIBStraditional: inhibit cox1(housekeeping) and cox 2. more adverse affects. bc both inhibited. two types- non-speific((aspirin) and preferential(meloxicam). COXIBS: onLY COX 2 :)
NSAID pregnancy effects?premature closure of ductus arteriosis
contraindications for NSAIDS?impaired renal/hepatic fxn, dehydration/hypovolemia, coagulopathies, other nsaids or corticosteroids already being recievved, GI ulcers/lesions/diarrhea, preg/lactating animalss
which LA is burney and what can you do to help?bupivi- use in intraabdominal, add sodium bicarb to lessen sting
NEUROPATHIC PAIN DRUGSTrauma-doll, neuropathic pain? LI down, G(r)ABA NSAiD (neuropathic pain is tramadol, Lidocaine, GABApentin, NSAIDS)
MLK is bad for cats...why?MLK= corneal ulcers. MLK is morphine, lidocaine, ketamine
BLK HORSESbutorphanol, lidocaine, ketamine (And the BLK horses name is dEX/met)
lidocain CRI used for?analgesia for neuropathic pain, reduce hyperalgesia, dec mac, widely used in dogs horses cats
ketamine reduces sensitization where?dorsal horn
ketamine reduces requirement for what anesthetic gas?iso
how much ketamine for pain tx?microdoses-- WAY LESS than induction
which alpa-2 agonsits in sm ani? lg?SMALL=dex and me. LG= xyla, det, romifidine, me
which drugs provide analgesia?ketamine(NMDA ANTAGONISTS) and the alpa2agonists (also N2O goes, from inhlanets), GABApentin
some stuff about tramadolopioid like, synthetic analogue of codeine, weak mu receptor agnist, plus inhibit uptake of serotoniin and noradrenaline. low potential for abuse, PO route (tablets), dogs+cats+horses
which causes diuresis?alpha 2 agonsits
MLK vs FLKFLK expensive but useful if need to do neuro tests
CV depressant in catslidocaine (I dont LI DO, cats have no heart)
prevents wind up and central sensitizationketamine
MLK--> in 1000ml LRS, add how much of each, and infusion rate inraoperative and post20morphine (two is addicted to morphine), 300 lidocaine (no addetives...three like to feel numb), 60mg ketamine (six will get you high with fear). INTRA=10ml/kg/hr. POST=2-5ml/kg/hr

Recent badges