Jr. Sx- Anesthesia Know Hows 1

untimely's version from 2015-10-21 00:31

Equipment and Not Drug knowledge

Question Answer
what should the pressure gauge inside VSL read?50 PSI
APL valve is aka?the pop-off valve!
how do you do a MACHINE leak test?close APL (popoff), and occlude patient end of breathing system with your thumb/hand. Then start to fill bag with O2 (can use the flowmeter or the O2 flush button). When the pressure gauge says 30, turn off the O2 (but keep occluding with your thumb) and watch the pressure gauge and make sure there is no loss of pressure for 10 sec. Then, compress bag until the gauge reads 40, hold for 10 sec. If there is no leak, OPEN APL VALVE FIRST and then release your hand from the breathing system. [see other card for if there is a leak]
IF THERE IS A LEAK DURING YOUR MACHINE LEAK TEST....what do?so you are losing pressure in your system, either when you were holding at 30 or squeezing at 40. First you want to determine if it is a significant leak. While still occluding, turn on your O2 and increase the flow until the flow matches the loss through the leak. Look at how much O2 is flowing- if it is at or higher than 250mL/min (which would be 0.25 L/min on the flowmeter gauge) you need to find the source of the leak. CHECK CHARCOAL CANISTER, INSP AND EXP VALVE DOMES, THE BAG, THE BREATHING SYSTEM. Replace whatever was the problem, then perform test again until results are correct.
what is the cutoff weight for if you need rebreathing or non-rebreathing system?7kg! Less than you need non-rebreathing, and greater than you use rebreathing.
Fresh gas flow---> REBREATHING--> what is high flow (induction) and what is low flow (maintenance)?HIGH FLOW: 40-100mL/Kg/min (ex: my 10kg dog would be 10x100=1000ml/min, which on the flowmeter would be 1L/min). LOW FLOW: about 20ml/kg/min (ex: my 10kg dog would be 10x20= 200ml/min which would read 0.2L/min on the flowmeter)
Fresh gas flow---> NON-REBREATHING--> how do you calc?RR x tidal volume x Kg x system factor (NOTE: the (RR x tidal volume) is aka the minute volume. The average tidal volume for a small animal is 10-15ml/kg. the average system factor is 2 or 3) (Ex: my 5Kg dog needs... 25 RR x 15 tidal vol x 5kg x 3 system factor= 5625ml/min which would read as 5.6L/min on the flowmeter)
what do you wanna turn the iso on to?1.5-2%
what is your drug calc formula?weight x dose / conc
how do you calc fluids? (here just as an extra reminder)weight x sx fluid rate x drop set= drops/hr (then divide by 60 for drops/min, and divide by 60 again for drops/sec) [sx fluid rate is 10ml/kg/hr]
which catheter do you wanna use for your average sized dog?use 20G unless the dog is smaller than 5kg, or is a cat (then use a 22G)
How do you do a PATIENT leak test?Hit APL button (popoff button), put ear by face of pt to listen, and GENTLY squeeze bag (don't exceed 20 on the pressure gauge). If you hear a hiss, open pop-off, then inflate the cuff a little more, then close pop-off and squeeze bag and listen again. When you hear no hiss, release pop-off valve and you're done!
what is the order you put the monitoring equipment on in?CAPNOGRAPH, SP02, BP (oscillometric and doppler), ECG, Then thermometer (Can Super Balls Eat Time?)
don't extubate until how many swallows?2 (At one swallow you can deflate cuff tho)
you can place the pt in the kennel after sx if the temp is what or higher? what if it's not that high?if greater than or equal to 98*, put in kennel. If lower, must warm up pt
cuff width should be?40% circumference of limb
which LNs are we wanting to palpate?mandibular, prescapular, axillary, inguinal popliteal
pulse ox go where?tongue
where do the ECG leads go?White-right (front.) And then snows over the grass, so if there is a green lead, right bottom. Then on the Left, smoke over fire so black on L front and red on L back
where does the doppler probe go?shave a patch of fur on the opposite leg that has the IV(same leg that will have oscillometric cuff on it) on the carpal area abutting the metacarpal pad (big paw pad)
where does the oscilometric pressure cuff go?on the leg without the IV (on forearm)
temp probe is placed where?just stick it in the mouth, try to get into eso. if you can.
how do you do the intratesticular and pre-scrotal blocks?testicle=lidocaine, skin=bupivicaine. Prof will show us
some things you need to do to monitor patient if there are no machines?eye signs (shouldnt have blink reflex, but should have corneal reflex, pupil should be on the small side), jaw tone should be loose, MM should be pink and CRT should be <2, peripheral pulses should be used to monitor HR (use eso. stethoscope, dorsal pedal, femoral, carpal, and lingual arteries)
induction tray (list provided, however, read over the stuff you will need)tape, chlorhex and alcohol scrubs, injection port, saline flush (3), 2 catheters (20 for reg, 22 for very small), eso. stethoscope, laryngoscope, eye lube, 3 ET tubes, KY lube, cuff syringe, and tie
there is a ET tube chart on the wall to determine ET size for your dog (still pick 3). what are the 2 exceptions with their particular needs?Brachycephalic breeds (small ET tube), Dachshunds (large ET tubes)
how do you measure your ET tube correctly?From nose to thoracic inlet (tip of shoulder)
if pt isnt breathing, how often do you manually give breath?3-4 times a min
sx fluid rate is?10ml/kg/hr
what does the doppler tell you?pulse rate, rhythem, SYSTOLIC BP (NOT MAP OR DAP) (in cats measures MAP--> add 15mmHg-->SAP)
when should you discontinue the iso? what do you do after you discontinue the iso?Do not discontinue isoflurane until all the monitoring equipment (except for the SpO2 probe) has been removed from the patient. Keep patient attached to breathing system and increase O2 flow for approx. 5 minutes after isoflurane has been switched off
how does FGF compare with rebreathing and non-rebreathing?rebreathing the FGF can be less than the minute volume. In non-rebreathing, the FGF must be GREATER THAN (or equal to) the the minute volume
if you are on low flow for a rebreathing system, and you need to inc the anesthetic depth, do you inc the FGF or the vaporizer?inc the vaporizer, not the FGF
why do we like low flow? (rebreathing system)reduces anesthetic waste and reduces loss of heat and moisture
how does resistance vary between rebreathing and non-rebreathing?rebreathing-->unidirectional valves-->high resistance. non-rebreathing-->less resistance bc less valves
is rebreathing or non-rebreathing easier to change anesthetic depth?non-rebreathing easier
NORMAL BP??120/80
minimum SAP for anesthesia?90mmHg
minimum DAP for anesthesia?40mmHg
minimum MAP for anesthesia?60mmHg
what is the normal ETCO2???35-45mmHg
what is ETCO2 the ultimate monitor? (what does it tell you?)indicates blood flowing to lung and patient ventilating
understand the capnograph wave
if capnograph doesnt go back down to 0 when inhaling, what does it mean?rebreathing!!! caution!
normal range of SpO2?96-100%
what does the SpO2 actually tell you?only gives info about oxygenation, not CO2 elim/HCT/anemia (O2 saturation and pulse rate)
what does ECG tell you?only tells you electrical function, not mechanical, nor CO
what might cause a lower reading on the SPo2?hypothermic/hypotension--> poor perfucion--> low reading
when should you def be concerned about # on SPo2?<90 very bad, means hypoxemia bc O2 disassociation curve drops steeply
what two parameters change with hypoventilation?capnograph reads over 45mmHg and there is dec RR
what is bradycardia in a dog? (cat?)less than 60bpm dog (less than 100 BPM cat)
hypotension values?SAP is <90, MAP is <60, DAP is <40
reasons there might be hypoventilation?hypothermia, drugs, deep level of anesthesia, positioning
what is hyperventilation?when the CO2 elim is > bodies production of it
normal BP in anesthatized dogs and cats?120/80
what is hypotension?SAP<90, MAP<60
normal CRT value and what does it tell us?<2sec and pink, tells us about CV function and tissue perfusion
pale pink MM means?not enough perfusion/vasoconstriction/ dec of CV function possibly
bright pink MM color means?excessive profusion/ vasodilation
normal body temp anesthatized of dogs/cats?100.5-102.5.
if hypotension with no dec in HR?bolus some fluids (10ml/kg)
drugs you can give for hypotension?dopamine(dog)/dobutamine(horse)
what is considered hypothermia?<99* is hypothermia
what is hyperthermia?>103*
if HR up and BP down?hypovolemia bc vasodilation with reflex tachycardia
if HR down and BP up?hypertension bc vasoconstriction with reflex bradycardia
NORMAL HEART RATE IN adults anesthatized dogs and cats?DOG: 70-120 (up to 160 is normal), CAT: 120-140
Bradycardia and tachycardia in adult anesthatized dogs and cats?DOGS: brady is <60 and tachy is >160. CATS: brady is <100 and tachy is 240
normal sinus beat and rhythem
what is sinus arrythmia? how does it affect the pt?Inspiration increases the heart rate by decreasing vagal tone- physiological abnormality (doesnt affect their health at all)
normal resp rate in adult anesthetized dogs? (cats?)dogs: 18-34. Cats: 16-40
what is hypoventilation?when ETCO2 is greater than 45mmHg and RR is dec
how to tx hypothermia?active warming if <97*, monitor until 100.4*. Can cover them, use bairhugger, IV line warmer, dec prep time, dec high gas flow, use low flow
how does most heat loss happen?radiation and convection
advantages of MILD hypothermia?dec metabolic rate and dec O2 consumption. Dec ICP and dec CPP (cerebral perfusion pressure)
disadvantages of moderate to severe hypothermia?impaired coagulation, prolonged drug action, inc metabolism bc post-op shivering, delayed recovery, inc chance of wound infection
where do you wanna take a pulse in a anesthatized dog?dorsal pedal, femoral, lungual
how do you visually assess breathing? what do these parameters tell us about alveolar ventilation?chest excursions, re-breathing bag, resp rate, tidal volume, breathing pattern, maybe even mm color. CAn't tell us about alveolar ventilation (only ETCO2 can)
4 most common complications in healthy anesthatized dogs/cats?HYPOventilation, HYPOtension, HYPOthermia, BRADYcardia
why do you keep the pt connected to the breathing system and O2 in the end of anesthesia after inhalational agent turned off?O2 on to help recover faster with fresh air pushing away anesthetic gas out of lungs and inc O2 in lungs to dec anesthetic. also keep tube in bc cant yet trust they will vomit/aspirate or stop breathing suddenly.
why do we use high FGF in the beginning and the end of anesthesia?beginning= speed up induction by providing larger volume of anesthetic gas. End= high flow of O2 to flush out their system of the anesthetic gas.
circle system is akarebreathing
what should eyeball position be?ventromedial or central
what is shock dose in a dog? cat?dog is 90 ml/kg. cat is 60ml/kg (bolus at 10-20ml/kg)
bolus of colloids?5ml/kg


Question Answer
FORMULA TO CALC FLUIDS IS...weight x sx fluid rate x drop set= drops/hr (then divide by 60 for drops/min, and divide by 60 again for drops/sec)
what numbers scored on the glascow pain scale require analgesic intervention?greater than or equal to 5/20 OR greater than or equal to 6/24 means you need analgesic intervention
where are we pre-medding and how do you do it?injection IM into the epaxial mm... make sure to palpate spine and then move about 2 fingers out DONT FORGET TO ASPIRATE BEFORE INJECTING
if thrombocytopenia, avoid which premed and why?Acepromazine, because inhibits platelet aggregation
if PCV < 25%, which premed do you avoid and why? what else should you do?avoid acepromazine and decrease dosage of premedication...dec BP and ALSO causes erythrocytes to be sequestered in the spleen, lowering PCV even more.
Premedication+preemptive analgesia for dog castration is what two drugs? how is it admin?Acepromazine+morphine injected IM
induction drug for dog castration?propofol
what drug is used intratesticular and what is used prescrotal?Bupivacaine pre-scrotal, Lidocaine intra-testicular
what are the two options for your post-op analgesia? route?Carprofen SQ, or Meloxicam SQ
if the dog is HW positive, what should you know about premeds?don't use alpha2s, use ace only
which one should you not give with low PCV?ace
which one should you not give is low platelets?ace (or NSAID's like carprofen and meloxicam)
the D2/A1 blcoker?ace
which premed dec BP and which inc?ACE DEC, and DEX INC
bradyarrythmia?dex-- 1st and 2nd degree AV blocks (bc alpha 2 agonists inc BP--> reflex bradycardia--> can become brady arrythmia)
premed that provides analgesia?Dexmedetomidine
which premed is antiemetic, which is emetic?Ace is Anti, and dex is emetic
which drug can cause them to pee more, and why?dexmedetomidine, bc alpha2 agonists inhibit ADH
which premed causes resp depression, which doesnt?ace= minimal resp effects. dex= resp depression at high doses
1st and 2nd degree AV blocks?dex
which drugs are known for their nasty heart problems?A2 agonists
which drug dec CO?dex (A2s)
startle response?dex (A2s)
hyperglycemia? A2s (so, dex)
atipamezole is what?antagonist for A2 agonists (dex)
hypothermia in dogsmorphine
drug to give if HR and BP are both going down?atropine
resp depression AND risk of apnea?propofol (alfaxalone can do this if given too fast also)
the give slow drugspropofol and alfaxalone
CV and resp effects of propofol?initial apnea and resp depression, decreased CO (so titrate slowly and to effect IV)
how does iso affect resp and CV?resp depression and dose dependent CV depression
like lidocaine intratesticularly and bupivicaine pre-scrotally?lidocaine has a short half life and the balls are coming out soon anyway, so it doesnt matter. Bupivicaine lasts longer and the skin will be staying, so it needs the block longer. (also bupivicaine effective as a "splash it on" method)
CV and resp of ace?HR stays the same or slight inc, BP gets low(vasodilation). minimal resp effects.
A2 (dexmedetomidine) CV and resp effects?minimal resp effects, vasoconstriction and reflex bradycardia (bradyarrythmia-1+2 AV blocks)
CV and resp effects of opioids?min CV depression, resp is dose dependent depression. If IV morphine--> histamine release--> hypotension and reflex tachycardia
CV and resp effects of propofol?inital apnea, hypotension and dec CO