Term
| State of general anesthesia is: (5 things) |
|
Definition
Unconsciousness
Muscle relaxation
Amnesia
Analgesia
Absence of reflex response |
|
|
Term
| The anesthetic period consists of: |
|
Definition
Pre-anesthetic evaluation and stabilization
Premedication
Induction
Maintenence
Recovery
Pain management (all through all stages and after) |
|
|
Term
|
Definition
Calm patient
Smooth induction, maintenance, recovery
Reduce doses need subsequently
Analgesia, muscle relaxation
Decrease airway secretions, saliva
Obtund autonomic reflexes |
|
|
Term
| What are the 5 P's of anesthesia: |
|
Definition
| Previous planning prevents poor performance! |
|
|
Term
| Three most common anesthetic mishaps: |
|
Definition
1. Mechanical malfunction
2. Accidental disconnection of equipment
3. Human error (equip, drug calculation) |
|
|
Term
| 5 ways to avoid poor anesthetic outcome: |
|
Definition
1. adequate preoperative evaluation
2. good preopertative stabilization
3. Anticipation of intraoperative complications, how to handle
4. good preoperative equipment check to reduce malfunction
5. diligent monitoring |
|
|
Term
| AT A MINIMUM, what information do we need for laboratory database? |
|
Definition
| PVC, total solids, blood glucose |
|
|
Term
|
Definition
| Normal healthy patient, no discernible disease |
|
|
Term
|
Definition
| Patient with mild systemic disease, elective |
|
|
Term
|
Definition
| Patient with severe systemic disease |
|
|
Term
|
Definition
| Patient with severe, life-threatening disease |
|
|
Term
|
Definition
| Moribund patient not expected to survive |
|
|
Term
|
Definition
| Emergency (you add this to the end of numerical class) |
|
|
Term
| Goal of pre-anesthetic stabilization |
|
Definition
| have the patient's condition as stable as possible without worsening the prognosis by delaying surgery |
|
|
Term
| Why withhold food and water: |
|
Definition
1. minimize regurg and aspiration
2. minimizes bloat and ability to ventilate
3. Minimize risk of stomach rupture |
|
|
Term
| Withhold food from dogs and cats for: |
|
Definition
| 6-12 hours (if <8 weeks or <2kgs, 1-2 hrs) |
|
|
Term
| Withhold food from small rodents and rabbits: |
|
Definition
|
|
Term
| Withhold food from birds: |
|
Definition
|
|
Term
| Withhold food from swine: |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Food: 12-18 h
Water: 8-12 h |
|
|
Term
|
Definition
Food: 18-48 h
Water: 12-18 h |
|
|
Term
|
Definition
| drug that has high potential for abuse and no accepted medical use |
|
|
Term
|
Definition
| permits usage ONLY with a medical prescription (most opioids other than heroin) |
|
|
Term
| Schedule III drug examples |
|
Definition
| agonist/antagonists and partial agonists |
|
|
Term
| Endogenous and exogenous opioids work at (same/different) receptors. |
|
Definition
|
|
Term
|
Definition
| respiratory depression and ileus/constipation |
|
|
Term
| Receptors involved in opioid analgesia: |
|
Definition
Mu1 in the brain
kappa in the spinal cord
ORL-L in brain |
|
|
Term
|
Definition
|
|
Term
| ________induce a maximal response when they bind to a receptor. |
|
Definition
|
|
Term
| ________ cannot produce a maximal response and therefore have a lower curve. They are safer. |
|
Definition
|
|
Term
| ___________ shift the dose response curve to the right with respect to a full Mu agonist. |
|
Definition
|
|
Term
| The ceiling effect of partial agonists refers to both the analgesia and the negative effects (T/F) |
|
Definition
|
|
Term
| Where are most opiates metabolized? |
|
Definition
| liver but also extra hepatic sites |
|
|
Term
| Oral opiate bioavailability: |
|
Definition
|
|
Term
| Opiate metabolism and excretion: |
|
Definition
|
|
Term
| Morphine, meperidine, oxymorphone, hydromorphone, fentanyl, alfentanil, sufentanil are _________ and should be used for _____________________________ pain. |
|
Definition
| pure mu agonists, moderate to severe pain |
|
|
Term
| Etorphine, carfentanil used for _____________ |
|
Definition
| chemical immobilization of wild animals |
|
|
Term
| Buprenorphine is a ________________ and butorphanol is a ______________ used for __________pain |
|
Definition
| partial agonist a mu receptors; mild mu agonist or mu antagonist and kappa agonist; mild to moderate pain |
|
|
Term
| Pure Mu agonists can cause these mood alterations: |
|
Definition
| euphora, dysphoria and sedation (if combined with sedatives) |
|
|
Term
| _______ system is main regulator of emotion. |
|
Definition
|
|
Term
| Opioids tend to decrease ___________in cats and dogs |
|
Definition
| spontaneous motor activity |
|
|
Term
| This species shows increased locomotor activity and agitation with high doses of opioids: |
|
Definition
|
|
Term
| Respiratory effects of opioids: |
|
Definition
antitussive
decreased responsiveness of resp center to CO2
decrease resp rate and tidal volume |
|
|
Term
|
Definition
bradycardia
mild hypotension
very little decrease in myocardial contractility |
|
|
Term
|
Definition
reduce propulsive activity of gut
smooth muscle and sphincter tone increased
decreased peristalsis
vomition
ileus |
|
|
Term
| Exogenous opioids are _______ rapidly broken down than endogenous opioids. |
|
Definition
|
|
Term
|
Definition
| need for higher doses to achieve the same effect |
|
|
Term
| Morphine induces vomiting when given ___operatively but not not _____operatively or when animals are suffering. |
|
Definition
|
|
Term
| When given opioids IV, there is a release of ____ |
|
Definition
|
|
Term
| the analgesic effects of this drug result from metabolism to morphine |
|
Definition
|
|
Term
| this partial agonist and agonist/antagonist has poor analgesic effects but great anti-tussive activity |
|
Definition
|
|
Term
| this is a partial mu agonist that has a longer duration of action than most opioids: |
|
Definition
|
|
Term
| Mu-receptor agonist that causes histamine release and hypotension when given IV; has a epidural formulation called Duramorph |
|
Definition
|
|
Term
| Mu-receptor agonist that is 5x more potent than morphine and has no histamine release |
|
Definition
|
|
Term
| Mu agonist that is 50-100X more potent than morphine and is a very potent respiratory depressant; has a transdermal patch formulation and a topical patchless formulation called Recuvyra |
|
Definition
|
|
Term
| Non-opiate analgesic; + enantiomer is more potent mu agonist, but - enantiomer acts on alpha-2 receptors to reduce reuptake of norepe and serotonin/increases their release; analgesic mechanism is adrenergic and serotonergic paths |
|
Definition
|
|
Term
| Partial agonists and full agonoists have the same affinity for a receptor (T) |
|
Definition
|
|
Term
| Three opiate antagonists: |
|
Definition
naloxone
naltrexone
nalmefene |
|
|
Term
|
Definition
sedation/tranquilization
muscle relaxation
analgesia
decrease subsequent drug dose
amnesia |
|
|
Term
| What is an example of an anticholinergic pre-medication drug? |
|
Definition
|
|
Term
| What anticholinergic drug crosses the BBB, has an intense effect on HR and GI, shorter duration of action, and is administered IM, IV, IT, SQ: |
|
Definition
|
|
Term
| This anticholinergic pre-med drug is polar, and thus does not cross the BBB, has less intense systemic effects, and is administered IM, IV, SQ: |
|
Definition
|
|
Term
| What are some GI effects of anticholinergics? |
|
Definition
reduced salivary secretion
reduced motility
increased pyloric sphincter tone |
|
|
Term
| What are some effects of anticholinergics on the respiratory system? |
|
Definition
bronchodilation
decreased bronchial secretion |
|
|
Term
| Name a phenothiazine premedication drug that is a dopamine receptor antagonist: |
|
Definition
|
|
Term
| Acepromazine has strong analgesic effects (T/F) |
|
Definition
|
|
Term
| Which tranquilzer/sedative premedication has no reversal? |
|
Definition
|
|
Term
| Are alpha-2 adrenoceptor agonists reversible? |
|
Definition
|
|
Term
| Where do the sedative and analgesic effects of alpha-2 adrenoceptors work? |
|
Definition
| supraspinal and dorsal horn |
|
|
Term
| Whicg group of pre-medications demonstrate bi-phasic blood pressure changes? |
|
Definition
| Alpha-2 adrenoceptor antagonists |
|
|
Term
| Describe the biphasic BP changes in alpha-2's? |
|
Definition
Initial vasoconstriction and reflex bradycardia
Later vasodilation and low contractility/cardiac output |
|
|
Term
| What class of drug is xylazine? |
|
Definition
| Alpha-2 adrnoceptor agonist |
|
|
Term
| Tolazoline and yohimbine reverse what drug? |
|
Definition
|
|
Term
| What alpha-2 does antisedan (atipamezole) reverse? |
|
Definition
|
|
Term
| At which receptor do benzodiazepines work? |
|
Definition
| GABA (primary inhibitory neurotransmitter in CNS) |
|
|
Term
| Describe the clinical effects of benzos. |
|
Definition
sedation/anxiolysis
muscle relaxation
anticonvulsant
retrograde amnesia
minimal CV & resp effects |
|
|
Term
| What drugs does flumazanil reverse? |
|
Definition
| benzos (zolazepam, midazolam, diazepam) |
|
|
Term
| What is the most widely used benzo? |
|
Definition
|
|
Term
| What are 7 qualities of Diazepam? |
|
Definition
1. very irritating
2. absorption is poor/unpredictable
3. water insoluble
4. light sensitive, binds to plastic
5. highly protein bound
6. rapidly distributed in body
7. co-induction with ketamine or propofol |
|
|
Term
| Properties of midazolam (4) |
|
Definition
1. sedative and muscle relax effect
2. water soluble and lipid soluble in body
3. light sensitive
4. relatively shorter duration of action |
|
|
Term
| Which benzo is only found in Telazol? |
|
Definition
| Zolazepam (with tiletamine) and has a longer duration of action |
|
|
Term
| Physiochemical and pharmacokinetic ideals of an injectable: (4) |
|
Definition
1. water soluble
2. long shelf life
3. Stable when exposed to light
4. ssmall volume needed for induction |
|
|
Term
| Pharmacodynamic ideals of injectable anesthetic: (8) |
|
Definition
1. minimal individial variation
2. safe therapeutic ratio
3. rapid onset
4. short duration of action
5. inactivated to non-toxic metabolite
6. smooth recovery
7. no anaphylaxis
8. no histamine release |
|
|
Term
|
Definition
| total IV anesthetic (no inhalational) |
|
|
Term
|
Definition
|
|
Term
| Name two dissociative anesthetics: |
|
Definition
|
|
Term
| Dissociative mechanism of action: |
|
Definition
| inhibit uptake of catecholamines into post-ganglionic nerve endings & prevent extra-neuronal uptake of catcholamines (results in increased sympathetic tone) |
|
|
Term
| Dissociates cortico-thalamic processing: |
|
Definition
|
|
Term
| This dissociative has an extreme safety margin and is highly compatible with other anesthetic agents |
|
Definition
|
|
Term
This dissoc results in
-increased HR
-increased systemic and pulmonary BP
-increased peripheral vascular resistance
-increased cardiac output
-increased myocardial O2 consumption |
|
Definition
|
|
Term
| Which drug do we not give alone? |
|
Definition
|
|
Term
| Ketamine recovery is by_________ and metabolized by_______ |
|
Definition
|
|
Term
| Eyes remain open with dilated pupils on this dissociative |
|
Definition
|
|
Term
| MAJOR GOALS OF COMBINING OTHER DRUGS WITH KETAMINE: (4) |
|
Definition
1. improve analgesia
2. improve muscle relaxation
3. prolong anesthesia period and immobilization
4. decrease amt. of ketamine needed |
|
|
Term
| which ketamine combo is most used in large animal med? what is used in small animal? |
|
Definition
| xylazine-ketamine; benzodiazepine-ketamine |
|
|
Term
| Which benzo is used with ketamine most often in small animal med? |
|
Definition
|
|
Term
| You want to avoid this combo in head or eye traumas due to increased cranial and ocular pressures |
|
Definition
| ketamine/benzo (versed or valium) |
|
|
Term
| Which injectable dissociative/benzo mixture drug is used in fractious animals for its rapid and reliable restraint- it is not as good an outpatient drug but maintains is great safety margin-? |
|
Definition
| Telazol- (tiletamine and zolazepam) |
|
|
Term
| Is Telazol appropriate as the sole anesthetic agent for a procedure? |
|
Definition
|
|
Term
| What is the best choice of injectable drug for frightened or aggressive dogs- causes respiratory depression? |
|
Definition
|
|
Term
| This drug has a very smooth pleasant induction and recovery, rapid, but respiratory depression is the major side-effect? |
|
Definition
|
|
Term
| The elimination rate exceeds the hepatic perfusion of this drug. |
|
Definition
|
|
Term
| The "intralipid" vehicle of this drug can support bacterial growth and can cause histamine reslease |
|
Definition
|
|
Term
| This injectable drug type has a cumulative effect, though this drug of MJ's choice has NO cumulative effect/ |
|
Definition
| dissociative anesthetics; propofol |
|
|
Term
| It is important to limit uses of propofol in cats: |
|
Definition
|
|
Term
| Which injectable drug is our heart friendly drug (maintains cardiac output, blocks adreno-cortical stess response, rapid recovery, good relaxation, poor analgesia) |
|
Definition
|
|
Term
| rapidly acting steroidal anesthetic on GABA receptors: |
|
Definition
|
|
Term
| Thiopental belongs to this group of injectables: |
|
Definition
|
|
Term
| This group of drugs causes CNS depression, no analgesia, and RAS depression and is currently unavailable on the market: |
|
Definition
|
|
Term
| These are physiologic effects of barbiturates: |
|
Definition
1. mild transient increase in HR
2. arrythmias (PVC)
3. decreased contractility
4. decreased arterial BP
5. POTENT RESP DEPRESSION |
|
|
Term
| What are volatile anesthetic agents? |
|
Definition
| Liquids that are vaporized and delivered as a vapor in a carrier gas (usually O2) |
|
|
Term
| Though we do not totally know how inhalant anesthetics work, what ions are involved in the mx of action? |
|
Definition
|
|
Term
| Which receptor is most likely most involved in volatile anesthetic mech of action? |
|
Definition
|
|
Term
| Which 2 volatiles are most commonly used in vet med? |
|
Definition
| Isoflurane and sevoflurane |
|
|
Term
| What are the MAC values for Iso and Sevo? |
|
Definition
| 1.5 for iso and 2 for sevo (in humans) |
|
|
Term
| How does Iso's pungent smell inhibit delivery of anesthetic? |
|
Definition
| When masking a pt down, they often hold their breath due to pungent smell, and therefore do not receive any anesthetic |
|
|
Term
|
Definition
| the % of alveolar space that must be occupied by inhalant to induce immobilization and no response to a surgical stimulus in 50% of patients |
|
|
Term
| The MAC value of a drug closely correlates with______ |
|
Definition
| lipid solubility ( the lower the MAC, the more potent and lipid soluble) |
|
|
Term
| Why are concurrent sedatives and analgesics used to reduce the MAC? |
|
Definition
| Because volatile inhalants are the most potent and profound CV and respiratory depressant drugs |
|
|
Term
| List factors that can decrease the MAC: 8 |
|
Definition
hypothyroidism
geriatric state
neonatal state
PaCO2 > 95 mmHg
PaO2 < 50 mmHg
metabolic acidosis
hypothermia
hemorrhage |
|
|
Term
| At 1.2 MAC, what % of pts will not respond to stimulus? |
|
Definition
|
|
Term
| At 2 MAC, what percent of pts will not respond to stimulus? |
|
Definition
|
|
Term
| What is the aim of MAC/volatile anesthetics? |
|
Definition
| To keep pt in surgical plane while at lowest possible % of anesthetic volatile |
|
|
Term
| The three major risk factors associated with mortalitly intra-op: |
|
Definition
1. intraop hypotension
2. longer duration on deep anesthesia
3. concurrent d'se |
|
|
Term
| Of these three PD effects of volatiles, which is desired? CNS effects, CV effects, Resp effects |
|
Definition
|
|
Term
| Name CNS effects of volatile agents: |
|
Definition
loss of consciousness
analgesia
amnesia
muscle relaxation
decreased cerebral metabolic rate
cerebral vasodilation |
|
|
Term
| In which class of drugs is there minimal direct myocardial depression, hypotension due to vasodilation, minimal arrythmic effects, and maintained baroreceptor reflex? |
|
Definition
|
|
Term
| Which group of drugs can cause infertility and birth defects, bone marrow suppression.... |
|
Definition
| volatile anesthetic inahlants |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Stage three of anesthesia: |
|
Definition
| General anesthesia with three planes |
|
|
Term
Plane I
Plane II
Plane III
of anesthesia |
|
Definition
I: light
II: medium
III: deep |
|
|
Term
|
Definition
|
|
Term
| What is the surgical plane of anesthesia? |
|
Definition
|
|
Term
| What method of anesthesia takes the patient directly to stage III? |
|
Definition
|
|
Term
| What 4 things does monitoring general anesthesia include? |
|
Definition
1. determining stage
2. monitoring muscle tone
3. reflex activity
4. eye signs |
|
|
Term
| What skeletal muscle tone do we most often monitor during anesthesia? |
|
Definition
Jaw
anal sphincter
limb muscle |
|
|
Term
| What 5 reflexes do we monitor in an anesthetized patient? |
|
Definition
Swallowing reflex (absent in plane I)
Palpebral reflex (weak or absent in plane II)
Corneal reflex (always present or pt very deep/dead)
Limb withdrawal
Anal reflex |
|
|
Term
| Central eye + palpebral reflex intact + constricted pupil = |
|
Definition
|
|
Term
| Ventromedial rotation of eye + wak or absent palpebral reflex = |
|
Definition
|
|
Term
| Central eye position + absence of palpebral reflex + dilated pupil = |
|
Definition
|
|
Term
| pupils are constricted if pt is too _____ but dilated if the patient is too _____ |
|
Definition
|
|
Term
| When predicting complications, what is H^3? |
|
Definition
Hyptension
Hypothermia
Hypoventilation |
|
|
Term
|
Definition
| 10 ml/kg/hr for surgical anes. then decreased to 5 ml/kg/hr after 1-2 hrs |
|
|
Term
| What is the equation for a fluid rate infusion? |
|
Definition
| FRI = [BW (kg) x infusion rate (ml/kg/hr) x infusion set calibration (drops/ml)/ 60 (min in an hour) |
|
|
Term
| In what cases would you not want to give fluids? |
|
Definition
pulmonary contusions
cardiac disease
anuric renal fail
low plamsa oncotic pressure |
|
|
Term
| At what SAP can you not detect peripheral pulse anymore? |
|
Definition
|
|
Term
| What are the MAP and SAP standards for adequate tissue perfusion? |
|
Definition
|
|
Term
| Doppler cuff width should must be ____-____% |
|
Definition
| 40-60 circumference leg or tail |
|
|
Term
| What is the gold standard of BP monitoring? |
|
Definition
|
|
Term
| How can yo recognize hypotension? |
|
Definition
low MAP, SAP
prolonged CRT
pale mm
weak pulses
elevated T wave |
|
|
Term
| You can use fluids, sympathomimetics (^stroke volume, venous constriction), and cholinergics (^HR) to manage BP. What three things do we want to achieve in this? |
|
Definition
increase HR
increase contractility
increase venous return |
|
|
Term
|
Definition
| The pressure in the right atrium- used in critical cases |
|
|
Term
Negative CVP?
Elevated CVP? |
|
Definition
-hypovolemia
-overadminsitration of fluid |
|
|
Term
| What is adequate cardiac output dependent on? |
|
Definition
|
|
Term
| What % of blood loss can healthy animals tolerate? |
|
Definition
|
|
Term
| Old, debilitated, anemic may need transfusion after % of blood volume loss? |
|
Definition
|
|
Term
NORMAL BLOOD VOLUMES
Dog
Cat
Sheep
Horse |
|
Definition
-80-90 ml/kg
-50-60 ml/kg
-60-70 ml/kg
-90-100 ml/kg |
|
|
Term
|
Definition
|
|
Term
| Gold standard for measuring blood oxygenation? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Minimum urine production under general anesthesia: |
|
Definition
|
|
Term
| What is the PSI of a full O2 tank? |
|
Definition
|
|
Term
| Full E tank has _____PSI and _____Liters at ____degrees Celsius |
|
Definition
|
|
Term
| What are two safety features built into anesthetic machines to prevent hooking up wrong gases? |
|
Definition
Pin index safety system
Diameter index safety system |
|
|
Term
| Final stage of pressure reduction is at the flow meter. What is the last reduced pressure? |
|
Definition
|
|
