Anesthesiology Quiz 1 Part 1

kelseyfmeyer's version from 2015-09-08 16:55

Intro + Planning

Question Answer
definition of Sedation/tranquilization? What are the two primary intentions of this?CNS depression in which the patient is awake but calm. The two primary intentions are: (1) First, sedation is recommended to allow patients the ability to tolerate unpleasant diagnostic or surgical procedures and to relieve anxiety and discomfort. (2) for uncooperative pts, it can help expedite and simplify special procedures that require little or no movement.
Define General anesthesiadrug induced and reversible state of: loss of consciousness, loss of sensation (analgesia), mm relaxation (immobility), and hyporeflexia
what does a "classic anesthetic drug" do?leads to unconsciousness, analgesia, immobility, and reduced reflexes
what is "balanced anesthesia"?surgical anesthesia produced by two or more drugs or anesthetic techniques.
define hypnosisartificially induced sleep, from which the pt can be aroused by sufficient stimulation (this is not the case with general anesthesia)
what is Neuroleptanalgesia?hypnosis + analgesia produced by the combination of a neuroleptic drug (eg: acepromazine), and an analgesic drug
what are the 6 main types of premedications used?Phenothiazines (acepromazine), Alpha-2 adrenoceptor agonists (xylazine, detomidine), Benzodiazepines, opioids, anticholinergics (atropine), dissociatives (ketamine)
when do most deaths from anesthesia occur?POST OPERATIVELY! Because they are put in a cage while recovering and are not checked on
what is anamnesis?the pre-anaesthetic assesment. It includes the history, PE, blood/other tests, concurrent drugs, previous anesthetic records, etc.
why are some reasons PU/PD might need further investigationmight indicate renal dz, diabetes, or pyometra
If a dog has a harsh cough, often at night, what might it indicate?cardiac problems
concurrent medications with potential drug interactions--> Corticosteroids. What problems might this type of drug cause?chronic tx will depress adrenal fxn. might compromise renal fxn and predispose to GI ulceration in combination with NSAIDs
concurrent medications with potential drug interactions--> NSAIDs. What problems might this type of drug cause?highly protein bound--> consideration of altering PK of other protein bound anesthetics (NOT ACTUALLY A CLINICAL PROB THO)
concurrent medications with potential drug interactions--> Abx. What problems might this type of drug cause?aminoglycosides potentiate NMB (neuromuscular blockade), renal tox
concurrent medications with potential drug interactions--> cardiac glycosides. What problems might this type of drug cause?dysrrythmias and reduced Cardiac Output
concurrent medications with potential drug interactions--> anticonvulsants. What problems might this type of drug cause?may reduce induction dose of anesthetic
concurrent medications with potential drug interactions--> antidepressants. What problems might this type of drug cause?may interfere with neuroactive drugs
4 reasons youd see a pale mucous membrane?hypotension, hypothermia, hypertension due to vasoconstriction (a-2 agonists), anemia
what does a brick red mucous membrane with a CRT of >2sec indicate?vasodilation, hypercarbia (elevated CO2), endotoxemia
which hemoparasites are we especially looking for in Grenada? which lab parameters might give us indications of a problem with this?ehrlichia, heartworm, anaplasma (look at PCV, TP, and platelet count)
** ASA status 1- what does this mean?EXCELLENT- normal healthy patient.
** ASA status 2- what does this mean?GOOD- MILD SYSTEMC DZ. slight to moderate dz (uncomplicated fracture, compensated cardiac disease, slight dehydration)
** ASA status 3- what does this mean?FAIR- SEVERE SYSTEMIC DZ. moderate to major dz, not incapacitating. (chronic heart dz, chronic anemia, trauma)
** ASA status 4- what does this mean?POOR- SEVERE SYSTEMIC DZ WHICH IS A CONSTANT THREAT TO LIFE (like GDV). severe, life-theratening, systemic dz (toxemia, uremia, heart failure, severe anemia, severe hypovolemia)
** ASA status 5- what does this mean?CRITICAL- morbitund or dying
what are 4 good reasons youd want pre-anesthetic fasting?(1) less likely regurgitation/aspiration (2) reduced pressure on the diaphragm (3) reduced intrabdominal pressure--> venous return less impaired--> CO better maintained!! (4) reduced risk of tympany
what is the minimum time of preanesthetic fasting for dogs/cats/horses when gastic emptying is normal?4-6 hrs
what benefit might starvation/fasting have on ruminants in particular in regards to a specific type of dz they get?bloating and tympanies are reduced!
what are the recommended fasting times for a...monogastric? equine? cattle? camelid?MONO: 8-10hrs, EQUI: 6-12hrs, CAMELID: 12-18hr, CATTLE: 12-24hrs **additional water deprivation for 8-12hr.
if there is an emergency and you cannot fast, what can you do to prevent regurg/aspiration?rapid ET intubation with a SEALED TUBE!
what is the major caveat to fasting before a procedure?neonats, very young animals and small rodents should NOT be starved (or for only very short periods)
according to the chart on slide 27 of lecture 2, which animal has the highest anesthetic risk?horses (of courses)
when do most deaths occur due to anesthesia?WITHIN THE FIRST 48 HRS POST-OP!!!
what are two things that can decrease the anesthetic risks in horses?premed with acepromazine, and TIVA (total intravenous anesthesia)
what are some things which will increase the anesthetic risks in horses?the type of sx (ie: orthopedics), duration of anesthesia, time of anesthesia (night and weekend), no premed, gaseous induction and maintainance
what can decrease anesthetic risks in cats?using a pulse oximeter
what are some things which will inc the anesthetic risk in cats?ASA 3-5, major procedure, weight <2kg or >6kg, age >12y, ET intubation (laryngeal spasms with fragile tissue), IV fluids (overinfusion specifically)
what are some things which will inc the anestheric risk in dogs?ASA 3-5, major vs mino procedure, urgent vs scheduled, increasing duration of procedure, weight <5kg, age greater than or equal to 12yr, injectable or inhalant alone (as opposed to balanced anesthesia)
what are the benefits to placing an IV catheter in the patient? (5)stress free anesthesia induction, no risk of perivascular injection, admin of IV fluids, rapid access in case of complications, avoidance of intra-arterial injection
Yellow catheter is what size?24G- tiniest
blue catheter is what size?22G- small
pink catheter is what size?20 G- medium. MOST COMMONLY USED IN SM ANI she said
green catheter is what size?18g- biggest

Premedication: Intro, Phenothiazines, and Butyrophenones

Question Answer
what does the peri-anesthetic process include?preparation, premed, anesthesia induction, maintainance, recovery, and immediate post-operative period
route and timing of premed--> (in general) IM/SC- how long does it take for induction? Who do you use this in?15-45min before induction. Use in small animals.
route and timing of premed--> (in general) IV- how long does it take for induction? Who do you use this in?(1) 5-10 min for induction in horses or ruminants (2) rapid sequence induction in small animals
route and timing of premed--> (in general) PO- how long does it take for induction? Who do you use this in?60min before induction (rare, species limitations)
which drug is in the "phenothiazines" category?ACEPROMAZINE (also chlorpromazine, Propionylpromazine, and promazine, but we don't seem to care about these too much...)
What is the mechanism of action for acepromazine? (what effect does the MOA result in?)***2 MOAs!***(what an ace!) (1) Blocks(antagonist) D2 receptors (antipsychotic and sedative effect) (2) Blocks(antagonist) Alpha-1 adrenoreceptors (vasodilation, hypotension) (***do not confuse the A-1 antagonism here for the A-2 AGONIST of xylazine etc)
what are the routes of admin by which you can give acepromazine?(1) INJECTABLE (2) ORAL
what is the IV onset of acepromazine? How about IM/SC?(1) IV- up to 20 minutes for onset of action. (2) IM/SC- up to 45 minutes
who can you give acepromazine orally to, and in what forms?tablets for dogs, pastes for horses
how long does the peak affect of acepromazine last? how long is the duration?peak effect up to 40 min, but there is a LONG DURATION of 4-6 hours (why you can take them on planes)
how is acepromazine metabolized?hepatic metabolism, slow hepatic clearance
central effects--> what is sedation like? how does it affect your anesthetic dose when used as a premed? how does it affect motor activity? How does it affect the GI? what interesting tidbit is there about ace and CNS?ace provides variable sedation, allows you to dec your anesthetic does, decreases motor activity, and can work as an ANTIEMETIC! (keep pets from getting airsick--> think about how Dopamine plays a role in emesis, and we are antagonizing D2 receptors) Ace can reduce the seizure threshold and is contraindicated (seizure on a plane would be scary)
central effects--> does acepromazine provide analgesia?NO!!! however, it can potentiate analgesics
CV effects--> how does acepromazine affect blood vessels? (explain this)... heart rate?causes VASODILATION because of ace's alpha-1 blocking. However, this causes hypotension so dont use in shock or dehydration pts! However, the heart rate stays the same or only increases slightly (you might have hypotension but heart doesnt seem to compensate, which is why it might be worrisome on planes)
CV effects--> how does acepromazine affect the PCV (and why)?it leads to a DECREASE in the PCV because it causes erythrocytes to be sequestered in the spleen
CV effects--> explain the relation between acepromazine and arrhythmias?acepromazine can stabilize the heart against catecholamine-induced arrythmias (b/c alpha-1 blocker)
CV effects--> explain the "epinepherine reversal" side effect of acepromazineif you administer acepromazine, and then you administer epinephrine, you will see paradoxical vasodilation and hypotension (usually epi would have the opposite). (this is because if A-1s are blocked by phenothiazines, epi cannot be effective on those receptors (where it would cause vasoconstriction), and so it moves to the B-2 receptors where it causes MORE vasodilation--> double vasodilation)
CV effects--> species to be cautious about with acepromazine?occasional bradycardia/collapse in boxers (peggy thought she was an ace until her heart slowed down too much)
explain why you might want to give a blanket to a dog on acepromazineace can cause Poikilothermia, which is a loss of normal thermoregulation. So putting them in a place too cold or too hot can be a problem. (why they cuddle on the stay warm)
how does acepromazine affect respiration?minimal affects on respiration (peg can breathe easy, even if it makes her pass out)
thing you should note about horses and acepromazine?can cause PRIAPISM in horses (penis wont go back into sheath) which is a big problem if it is a breeding stallion
can acepromazine cause allergies?actually, it works as a antihistaminic (peggy is an ace at carrying the benadryl to me)
what is the risk of clotting with use of acepromazine?HA--- it actually INHIBITS platelet aggregation (which is great since when the blood slows down from the vasodilation you arent going to throw a clot)
which sedative can you use if you want them to be sedated, but if you rouse them they can walk to the induction table with you?acepromazine
in which animals can you use acepromazine as a premedication?small animals and horses (ace wrap on horse...obv in sm ani)
can you combine acepromazine with opioids?YES! First off, it doesnt provide analgesia, and second off, it can help potentiate them so you can use less. yay!
when is a specific situation where acepromazine being used to sedate a horse is ESPECIALLY useful?sedation where ataxia should be avoided (such as during transport)
how would you administer acepromazine if you wanted long-term sedation effects?PO
WHAT ARE THE CONTRAINDICATIONS OF ACEPROMAZINE? (6)Boxers (relative, can cause bradycardia and collapse (most likely due to vasovagal syncope) ), breeding stallions (due to priapism), and animals with hypotension, shock (due to a-1 block causing vasodilation), anemia and bleeding disorders (dec PCV due to splenic segregation)
which drugs are in the Butyrophenones category?Droperidol(Innovar-Vet), Azaperone(Stresnil, Suicalm). These drugs act really similarly to the phenothiazines so she considers them together with ace. (piggie names Az's but)
what is the clinical use of AZAPERONE? (2) (what group does it belong to again?)(1) mainly used in combination with ketamine for anesthesia (2) **sedation of PIGS with IM admin (AZAz the PIG-ZAZ) (belongs to the Butyrophenones group)

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