02: Anesthetist

Why should you never leave an animal alone once you give induction drugs

They rapidly loose the ability to protect the airway

Factors that may impact whether you catheterize before or after you intubate your patient

• How awake the patient is

• Concern about airway

• Temperament

Why is it ESPECIALLY important to lube the eyes for cats with ketamine

Ketamine in cats fixes and dilates the eyes

Signs the indicate you can extubate the patient

• Swallowing

• Lifting head

• Moving mouth

Anesthetic drug protocol for dogs in Jr Sx

TTDex

• Telazol

• Torb (butorphanol)

• Dexmedetomidine

Anesthetic drug protocol for cats in Jr Sx

DKB

• Dexmedetomidine

• Ketamine

• Butorphanol

Why do we not need to aspirate when giving our anesthetic protocol IM (in Jr Sx)

The drug combo can be given IM or IV

Pre-op opioids used for dogs in Jr Sx

• Hydromorphone (<4.5 kg)

• Morphine (>4.5 kg)

Pre-op opioids used for cats in Jr Sx

Buprenorphine

Intra-op meds used for pain management in Jr Sx

Ropivacaine ± fentanyl

Post-op NSAIDs used in Jr Sx

Meloxicam or robenacoxib

Meloxicam v robenacoxib MOA

• Meloxicam: COX-2 preferential

• Robenacoxib: COX-2 selective

Flow of O₂ in the anesthesia machine

O₂ supply → flow meter → vaporizer → common gas outlet → inspiratory valve → patient → expiratory valve → sodalime canister → reservoir bag → APL valve → scavenge system

When should you turn on the O₂ during surgical anesthesia

Before you connect your patient

When should you turn off the O₂ during surgical anesthesia

After you disconnect your patient

O₂ flow rate used to pre-oxygenate the patient in Jr sx

2 L/min

Equation used for Jr sx to determine maintenance oxygen flow rate

Tidal volume x 3

When setting maintenance O₂ rate, what do you need to be especially careful of

That the maintenance rate is not less than the minimum O₂ flow rate for the system

Weight for an adult rebreathing circuit

>15 kg

Weight for a pediatric rebreathing circuit

7.1-14.9 kg

Weight for a non-rebreathing circuit

< 7 kg for Jr sx, < 5 kg for most non-rebreathing models

How much volume should the reservoir bag be able to hold

6x the tidal volume

Minimum O₂ flow rate for the rebreathing circuit

0.5 L/min

Type of circuit that you cannot run a pressure check with

“Out of circuit” non-rebreather circuit

How should you determine what size ET tube you should use

Based on palpation of the patient’s trachea

What happens if you place the ET tube in the esophagus

Take it out and get a new ET tube

How deep should you put the ET tube in

Stop before you get to the thoracic inlet

How do you do a leak check

Give a breath and listen

What is the best anesthetic monitor

You!

Points of a spay that are common pain plateaus

• Pulling the suspensory ligament

• Clamping the uterus

• Closing the body wall

• Closing the skin

Anesthetic reading that should always be 0

FiCO₂

What is happening if FiCO₂ is > 0

The patient is rebreathing

Anesthetic monitoring that should be attached first

Capnometer

Anesthetic monitoring that requires you to change the monitor based on the patient

Non-invasive blood pressure

Starting isoflurane % for adult patients

1%

Starting isoflurane % for pediatric patients

0.5%

Purpose of relief breaths

To fully inflate the lungs and prevent atelectasis

How often do we give relief breaths

Every 5 mins

Amount of pressure used for relief breaths

20 cm H₂O in adults, 10-15 cm H₂O in peds and small patients

How often do we take vitals

Every 5 minutes

How long do we give O₂ to patients once we turn of the isoflurane

5 mins

FATAL FLAW as an anesthetist

Inadequate patient ventilation