Anesthesia - New material for FINAL exam

TY Abby

What is the function of the cardiovascular system?

to circulate blood and ensure delivery of oxygen to the body

___________ = cardiac output x oxygen content

Oxygen delivery equation

CO x SVR (systemic vascular resistance) =

MAP/mean arterial pressure equation

What are the 4 mechanisms that can cause hypotension?

*separate answers with a comma

vasodilation, bradycardia, decrease in cardiac preload, decrease in myocardial contractility

decreased systemic vascular resistance

vasodilation

What are causes of vasodilation?

*separate answers with a comma

anesthetic agents like inhalant anesthetics or acepromazine, cardiac drugs, sepsis, anaphylaxis

What are the causes of bradycardia?

excessive anesthetic depth, arrythmias, opioids, alpha-2 adrenergic agonists

causes include:

- hemorrhage

- dehydration

- 3rd spacing

- vascular compression/obstruction

- positive pressure ventilation...which is due to cardiac compression

- vasodilation

decreased preload causes

occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or "third" space which can then cause edema, reduced cardiac output, and hypotension

- i.e. effusions, ascites, GI fluid

3rd spacing

causes include:

-neonate/juveniles/pediatrics - receptors are immature and don't respond to catecholamines

- dilated cardiomyopathy

- isoflurane

- propofol

- hypocalcemia

- acidosis

decreased/poor contractility causes

What are the treatment(s) for Vasodilation (mechanism of hypotension)?

*separate answers with a comma

fluid volume, vasoconstrictors or pressors

What are the treatment(s) for bradycardia (mechanism of hypotension)?

*separate answers with a comma

anticholinergics, antiarrhythmics

What are the treatment(s) for decreased preload (mechanism of hypotension)?

*separate answers with a comma

volume bolus, decrease ventilation, relieve obstruction/compression

What are the treatment(s) for Decreased contractility (mechanism of hypotension)?

*separate answers with a comma

positive inotropes, reduce inspired inhalant levels

Stage of cardiovascular disease where the patient is at risk but has no clinical signs

Stage A

Stage of cardiovascular disease where there is a murmur but no past or present clinical signs of heart enlargement or failure

Stage B1

Stage of cardiovascular disease where there is a murmur and cardiomegaly but they're asymptomatic

Stage B2

Stage of cardiovascular disease where patients have past or present clinical signs of heart failure with structural cardiac disease

Stage C

Stage of cardiovascular disease where patients have end-stage heart failure that are refractory to standard therapies

Stage D

What is the anesthetic management for Cardiovascular disease Stage A and B1?

generally do not require intensive management

What is the anesthetic management for Cardiovascular disease Stage B2?

keep patient heart rates normal, keep patient normothermic, avoid Alpha 2s

What is the anesthetic management for Cardiovascular disease Stage C and D?

rely on balanced anesthesia, avoid Alpha 2s, use opioids/benzodiazepines to reduce amounts of induction & inhalant agents needed

the thickening of the cardiac muscle leading to stiffening and failure of relaxation & adequate filling (think of body builders)

HCM/hypertrophic cardiomyopathy

this is the primary loss of myocardial contractility that can lead to dilation of the ventricles

DCM/Dilated cardiomyopathy

the volume of gas inhaled or exhaled in the lungs per minute ventilation

minute ventilation

Maintain ventilation by maintaining CO2 levels of ________________ and pH value of ________________ since these parameters are directly related

*separate answers with a semicolon

35-45 mmHg; 7.35-7.45

What does adequate oxygenation depend on?

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hemoglobin/Hb, arterial oxygen saturation/SaO2, alveolar partial pressure of oxygen/PaO2

Main 3 causes of Hypoxemia...

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low inspired oxygen fraction- FiO2, Hypoventilation, diffusion impairments

Obstructive respiratory diseases include...

*separate answers with a comma

asthma, laryngeal paralysis, tracheal collapse, brachiocephalic

What is the anesthetic management for Obstructive respiratory diseases?

*separate answers with a comma

minimize excitement & stress, mild sedation may be warranted

What are 6 examples of conditions/diseases that cause decreased lung capacity?

*separate answers with a comma

aspiration pneumonia, muscle rigidity, obesity, intra-abdominal changes like tumors and GDV, spinal injuries, intervertebral disc disease

What is the anesthetic management for Decreased Lung Capacity?

*separate answers with a comma

protect airway & suction mouth as needed, pre-oxygenate, mechanical ventilation, monitor oxygenation

blood flow to the brain

- blood pressure affects it's pressure (i.e. if BP is low, blood flow to the brain may be limited

cerebral perfusion

Neurological disease can include...

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brain injury, trauma, tumors, hydrocephaly

if this is too high, blood flow to the brain may be limited

intracranial pressure

What is the anesthetic management for neurological disease, specifically brain injury, trauma, tumors, and/or hydrocephaly?

*separate answers with a comma

maintain MAP, oxygen & ventilatory support, mannitol, hypertonic saline

The liver provides multiple essential functions. List 4...

*separate answers with a comma

bile formation & excretion, metabolic functions, stabilizes osmotic pressure, helps maintain pH

list 3 complications associated with hepatic disease...

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hepatic encephalopathy, hypokalemia, hypoglycemia

What does the GI tract provide to the body?

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supply of water, electrolytes, and nutrients

What are 5 things that GI disease could cause?

anorexia, dehydration, protein loss, abdominal pain, hypovolemia

correct any imbalances before anesthesia. FOR instance, correct dehydration how long before anesthesia?

24 hours prior

___________ functions in:

- excretion of metabolic waste and toxins

- regulation of blood volume and extracellular fluid

-aids in acid-base regulation

kidney functions

- hormone imbalance imbalance - decreased

- decreased metabolism

- weak muscles

- bradycardia

-hypothermia

hypothyroid

- hormone imbalance - increased

- hypertension

- hyperthermia

- cardiac changes

hyperthyroid

What is done for Newborns with airway problems?

*separate answers with a comma

suction mouth, stimulate breathing, don't sling/swing puppies

What is done for Newborns with cardiovascular problems?

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chest compression about 120 bpm, epinephrine drop under tongue

Humane killing is subdivided into what 3 things?

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euthanasia-individuals, humane slaughter-large numbers, depopulation-large numbers

methods producing humane death as the sole means of euthanasia

acceptable

acceptable methods of euthanasia when certain conditions are met

acceptable with conditions

methods of euthanasia not to be used under any conditions

unacceptable

- pain perception requires functioning cerebral cortex

- anesthetized or properly euthanized animals do not feel pain

- loss of consciousness should precede loss of muscle movement

painless and distress free euthanasia

What are the three basic mechanisms?

*separate answers with a semicolon

direct depression of neurons necessary for life functions; hypoxia meaning CO or CO2 overdose; physical disruption of brain activity

- expensive; personnel exposure

- CO2

inhaled anesthetics

How do we administer an anesthetic overdose?

*separate answers with a comma

inhaled anesthetics, injectable anesthetics

- Pentobarbital

- 1 minute onset, minimal movement if properly restrained

- carcass contamination (risk of carcass being dug up, consumed, causing further issues to animal consuming it)

injectable anesthetics

regardless of euthanasia method, death ________________

must be confirmed

regarding Euthanasia and animal workers,

___________ methods have potential to cause physical injury and death

ALL

- transferal of personal feelings/fear onto the animal (animals catch on to how we're feeling)

- depression, grief, anger, guilt, sleeplessness

- job dissatisfaction may result in absenteeism, belligerence, careless/callous animal handling

"killing-caring paradox"

Ethical dilemma involving life-and-death decisions.

The Trolly Problem

Similar to the Trolley Problem, but instead of pulling a lever, you are asked whether it is morally permissible to push a large person off a bridge to stop a runaway trolley from hitting five people on the track below. The dilemma is whether to take direct action to save five lives at the cost of one.

The Fat Man Problem

– IV injection of DEA II, III pentobarbital cpds

– IC or intra-organ injection only on unconscious or anesthetized animals

Pet euthanasia issues

CO2 is minimally affected by _______________disease.

respiratory

What is Medium or High-expansion Water-based Foam euthanasia used for?

*separate answers with a comma

Zoonosis; spreading infectious disease-Immersion causes airway occlusion and death by suffocation

-Pentobarbital; large volumes (approx 100 mls) needed-gunshot or penetrating captive bolt

Horse euthanasia methods

Head shot, penetrating captive bolt, KCl IV, or MgSO4 IV during general anesthesia to reduce toxicity to scavengers

Zoo and wildlife euthanasia methods

Attempts to remove the fetus from the uterus or to revive a fetus following death of the dam are likely to result in what??

serious welfare complications for the newborn

What is recommended for fetuses that have been removed from the uterus?

IP pentobarbital