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Jr. Sx - Anesthesia MUST KNOW 1

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drraythe's version from 2017-09-13 16:24

Equipment & 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), & occlude PTx end of breathing system w/ your thumb/hand. Then start to fill bag w/ O2 (can use the flowmeter or the O2 flush button). When the pressure gauge says 30, turn off the O2 (but keep occluding w/ your thumb) & watch the pressure gauge & 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 1ST & 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. 1st, you want to determine if it is a significant leak. While still occluding, turn on your O2 & 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 & 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, & greater than you use rebreathing.
Fresh gas flow → REBREATHING → what is high flow (induction) & 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, & 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 PTx leak test?Hit APL button (popoff button), put ear by face of PTx to listen, & 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 & squeeze bag & listen again. When you hear no hiss, release pop-off valve & you're done!
What is the order you put the monitoring equipment on in?CAPNOGRAPH, SP02, BP (oscillometric & doppler), ECG, Then thermometer (Can Super Balls Eat Time?)
Don't extubate until how many swallows?2 (At 1 swallow you can deflate cuff tho)
You can place the PTx 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 PTx
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.) & 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 & 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 oscillometric pressure cuff go?On the leg w/o 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 & pre-scrotal blocks?Testicle = Lidocaine, skin = Bupivacaine. Prof will show us
Some things you need to do to monitor PTx 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 & CRT should be <2
Peripheral pulses should be used to monitor HR (use eso. stethoscope, dorsal pedal, femoral, carpal, & lingual arteries)
Induction tray (list provided, however, read over the stuff you will need)Tape
Chlorohex & alcohol scrubs
Injnxn port
3 saline flush
2 catheters (20 for reg, 22 for very small)
Eso. Stethoscope
Laryngoscope
Eye lube
3 ET tubes
KY lube
Cuff syringe
Tie
There is an ET tube chart on the wall to determine ET size for your dog (still pick 3). What are the 2 exceptions w/ 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 PTx 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, rhythm, 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 PTx. Keep PTx attached to breathing system & increase O2 flow for approx. 5 minutes after Isoflurane has been switched off
How does FGF compare w/ rebreathing & 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 minute volume
If you are on low flow for a rebreathing system, & 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 & reduces loss of heat & moisture
How does resistance vary btwn rebreathing & 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 ANx?90mmHg
Minimum DAP for ANx?40mmHg
Minimum MAP for ANx?60mmHg
What is the normal ETCO2???35-45mmHg
What is ETCO2 the ultimate monitor? (What does it tell you?)Indicates blood flowing to lung & PTx 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 & pulse rate)
What does ECG tell you?Only tells you electrical Fxn, not mechanical, nor CO
What might cz a lower reading on the SPo2?Hypothermic/hypotension → poor perfusion → low reading
When should you def be concerned about # on SPo2?<90 very bad, means hypoxemia bc O2 disassociation curve drops steeply
What 2 parameters change w/ hypoventilation?Capnograph reads over 45mmHg & 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 ANx, positioning
What is hyperventilation?When the CO2 elim is > bodies production of it
Normal BP in anesthetized dogs & cats?120/80
What is hypotension?SAP<90, MAP<60
Normal CRT value & what does it tell us?<2sec & pink, tells us about CV Fxn & tissue perfusion
Pale pink MM means?Not enough perfusion/vasoconstriction/ dec of CV Fxn possibly
Bright pink MM color means?Excessive profusion/ vasodilation
Normal body temp anesthetized of dogs/cats?100.5-102.5.
If hypotension w/ 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 & BP down?Hypovolemia bc vasodilation w/ reflex tachycardia
If HR down & BP up?Hypertension bc vasoconstriction w/ reflex bradycardia
NORMAL HEART RATE IN adults anesthetized dogs & cats?DOG: 70-120 (up to 160 is normal)
CAT: 120-140
Bradycardia & tachycardia in adult anesthetized dogs & cats?DOGS: brady is <60 & tachy is >160
CATS: brady is <100 & tachy is 240
Normal sinus beat & rhythm
What is sinus arrhythmia? How does it affect the PTx?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 & RR is dec
How to Tx hypothermia?Active warming if <97°, monitor until 100.4°. Can cover them, use bearhugger, IV line warmer, dec prep time, dec high gas flow, use low flow
How does most heat loss happen?Radiation & convection
Advantages of MILD hypothermia?Dec metabolic rate & dec O2 consumption
Dec ICP & 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 Infnxn
Where do you wanna take a pulse in an anesthetized dog?Dorsal pedal
Femoral
lingual
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 anesthetized dogs/cats?HYPOventilation
HYPOtension
HYPOthermia
BRADYcardia
Why do you keep the PTx connected to the breathing system & O2 in the end of ANx after inhalational agent turned off?O2 on to help recover faster w/ fresh air pushing away anesthetic gas out of lungs & 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 & the end of ANx?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
memorize

Drugs

Question Answer
FORMULA TO CALC DRUGS IS...(WEIGHT x DOSE / CONC)
FORMULA TO CALC FLUIDS IS...Weight x Sx fluid rate x drop set = drops/hr (then divide by 60 for drops/min, & divide by 60 again for drops/sec)
What numbers scored on the Glasgow 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 & how do you do it?Injnxn IM into the epaxial mm... Make sure to palpate spine & then move about 2 fingers out DONT FORGET TO ASPIRATE BEFORE INJECTING
If thrombocytopenia, avoid which premed & why?Acepromazine, bc inhibits platelet aggregation
If PCV < 25%, which premed do you avoid & why? What else should you do?Avoid Acepromazine & decrease dosage of premedication...dec BP & ALSO czs erythrocytes to be sequestered in the spleen, lowering PCV even more.
Premedication + preemptive analgesia for dog castration is what 2 drugs? How is it admin?Acepromazine + Morphine injected IM
Induction drug for dog castration?Propofol
What drug is used intratesticular & what is used prescrotal?Bupivacaine prescrotal
Lidocaine intra-testicular
What are the 2 options for your post-op analgesia? Route?Carprofen SQ, or Meloxicam SQ
If the dog is HW pos, what should you know about premeds?Don't use α2s, use Ace only
Which 1 should you not give w/ low PCV?Ace
Which 1 should you not give is low platelets?Ace (or NSAID's like Carprofen & Meloxicam)
The D2/A1 blocker?Ace
Which premed dec BP & which inc?ACE DEC, & DEX INC
Bradyarrhythmia?Dex - 1st & 2nd degree AV blocks (bc α 2 agonists inc BP → reflex bradycardia → can become brady arrhythmia)
Premed that provides analgesia?Dexmedetomidine
Which premed is antiemetic, which is emetic?Ace is Anti-emetic
Dex is emetic
Which drug can cz them to pee more, & why?Dexmedetomidine, bc α2 agonists inhibit ADH
Which premed czs resp depression, which doesnt?Ace = minimal resp effects
Dex = resp depression at high doses
1st & 2nd degree AV blocks?Dex
Which drugs are known for their nasty heart problems?α2 agonists
Which drug dec CO?Dex (αs)
Startle response?Dex (αs)
Hyperglycemia?αs (so, Dex)
Atipamezole is what?Antagonist for α agonists (Dex)
Hypothermia in dogsMorphine
Drug to give if HR & BP are both going down?Atropine
Resp depression & risk of apnea?Propofol (Alfaxalone can do this if given too fast also)
The give slow drugsPropofol & Alfaxalone
CV & resp effects of Propofol?Initial apnea & resp depression, decreased CO (so titrate slowly & to effect IV)
How does iso affect resp & CV?Resp depression & dose dependent CV depression
Like Lidocaine intratesticularly & Bupivacaine pre-scrotally?Lidocaine has a short half-life & the balls are coming out soon anyway, so it doesnt matter. Bupivacaine lasts longer & the skin will be staying, so it needs the block longer. (Also Bupivacaine effective as a "splash it on" method)
CV & resp of ace?HR stays the same or slight inc, BP gets low (vasodilation). Minimal resp effects
α (Dexmedetomidine) CV & resp effects?Minimal resp effects, vasoconstriction & reflex bradycardia (bradyarrythmia-1+2 AV blocks)
CV & resp effects of opioids?Min CV depression, resp is dose dependent depression. If IV Morphine → histamine release → hypotension & reflex tachycardia
CV & resp effects of Propofol?Initial apnea
Hypotension
Dec CO
memorize