anesthesia exam 4.2

Define sedation

Central depression & drowsiness; general unawareness but may respond to painful stimulus

Define general anesthesia

Drug induced unconsciousness by controlled & reversible CNS depression; unaware of stimuli

T:F - general anesthesia may be safer than heavy sedation

T

IM administration of drugs is typically __x higher than IV administration

2x

Non-pharmacological approach to meet goals for dx or tx procedure

Fear free/ low stress handling

The “Chill protocol” involves

Premed the night before, morning of and 30 min before appt

How to approach stress/anxiety

Multimodally

When dealing with difficult dogs, IM injection of sedative usually required; what should be avoided post administration of drug

Stimulation (until 100% sure they have taken full effect)

Drugs in kitty magic

• ketamine

• Dexmetetomidine

• Butorphanol

Why is Buprenorphine hard to reverse with naloxone

Partial mu agonist

DEA 222 forms are required for what schedule of substance

Schedule 2

Which schedule of controlled substances is dangerous & not acceptable for medical use

Schedule 1

Which schedule of controlled substances includes antitussives & anti diarrheal

Schedule 5

3 mechanisms of euthanasia

1. Direct depression of neurons responsible for life functioning

2. Hypoxia

3. Physical disruption of brain activity

Ideally, method of euthanasia should result in

Rapid LOC followed by cardiac & respiratory arrest then subsequent loss of brain function

AVMA acceptable method of euthanasia

Barbiturates

AVMA conditionally acceptable method of euthanasia

• Inhalant anesthetic overdose (if <7kg)

• CO/CO2

• Argon or nitrogen (chickens & turkeys)

AVMA unacceptable method of euthanasia

• KCl, MgSO4, MgCl2 (unless under GA)

Major ingredient in most euthanasia solutions

Pentobarbital

In what animals can you NOT use pentobarbital on for euthanasia

Food animals

Body disposal must be in accordance with

State & local laws

U.S. fish & wildlife body disposal recommendations to prevent 2ndary poisoning

• incinerate

• Deep burial

• Tag animal & bags with poison tags

Myofascial exam involves

All areas of the body

Goal of myofascial exam

Narrow dx testing, formulate tx plan & determine prognosis

What is the myofascial trigger point

Taut band of skeletal muscle (usually painful & twitches)

Active functional assessment includes

• posture

• Gait/mobility

• Transfers

• Muscle strength

Passive functional assessment includes

• PROM

• end-feel

• Goniometry

• Flexibility

• Myofascial exam

When is cryotherapy used

During acute inflammation

When is thermotherapy used

Chronic pain

Massage techniques

• effleurage (distal—>proximal)

• Petrissage (rolling/kneading)

• Trigger point (compression on spasm)

Laser tx is most effective for

Chronic pain from OA

Extracorporeal shock wave therapy (ESWT) involves

High energy, high amplitude acoustic waves that release energy when encounter change in density (b/w bone & lig.)

In therapeutic u/s ; frequency relates to

Depth of penetration

In therapeutic u/s ; intensity relates to

Degree & rate of production (high intensity = high heat)

Non-thermal therapeutic u/s stimulates

Fibroblasts & protein synthesis

PEMF is FDA approved for tx of what fx type

Nonunion

How much does blood/plasma volume increase in a dam

20%

A PCV of a dam that is WNL actually indicates

Dehydration (relative anemia)

Which breed/litter size is at highest risk for hypocalcemia during pregnancy

Small breed with large litter

How do you measure calcium in the dam

Ionized calcium

Pregnant creatures have increased alveolar ventilation which results in a rapid response to which part of anesthesia

Inhalants (maintenance)

An emergency C-section should be performed if pet has been in active labor with no baby produced for how long long

>1 hour

A planned c-section requires what 2 components

1. Known gestation length

2. Pt is fasted

Resuscitation BP drugs used in pregnant creatures

• ephedrine

• Dobutamine

Which drug used to address hypotension will also decrease uterine blood flow

Dobutamine/dopamine

Which breed most commonly requires c-sections

Brachycephalic

An abdominal u/s of a pregnant pt detects what

Fetal viability

Radiographs of pregnant pts are used to determine

#, size and position of babies

What is the HR range of a healthy fetus in utero

150-200

If fetal HR reads 100-150, is the fetus healthy or distressed

Distressed

Pre-op steps for a c-section

• correct fluid deficits

• Blood type/ cross-match

• Shave + dirty scrub before induction

• Induce in the OR with surgeon ready to go

Timeline goal from induction to having the babies out

5-10 min

Pregnant pts have increased gastric acid & decreased lower esophageal tone which can lead to

Esophageal reflux (pay attention to any Nausea/regurge and treat accordingly)

Why is preoxygenation and readiness to intubate important in pregnant pts

Maternal hypoxemia = fetal hypoxemia & acidosis

How should you preoxygenate a pregnant pt

100% O2 for at least 5 min

In selecting premeds for c-section pt, what is important to consider

Drugs cross the placenta (use short-acting & reversible drugs)

Which pre-med drug classes should be avoided in c-section patients

• benzos (decrease fetal viability bc cannot metabolize)

• Phenothiazines (cause maternal hypotension —> def avoid)

Which induction meds cause significant depression in neonates and should be avoided

Ketamine + Midazolam

Can you mask down a c-section pt

No! ( Airway protection is vital)

During pregnancy, MAC (isoflurane) decreases by

16-40%

How can you use local anesthesia in c-sections

Line block prior to cutting & block each layer as you close

Epidural anesthesia should be decreased by __ %

25% (bc epidural space decreased) (lidocaine > bupivacaine)

Supplies you must have for post-delivery neonates

• suction bulb

• O2 supplementation

• Heat support

• Hemostats & iodine (for cord)

Why are suction bulbs vital in neonate delivery via c-section

Oropharyngeal cavities must be suctioned to avoid upper airway obstruction

What is considered bradycardic in a neonate and indicates need of supplemental O2

<180bpm

Best protocol to use for c-section (associated w lower puppy mortality rate)

Alfax + Propofol + isoflurane

If dam received opioids, what & where can you give babies

Sublingual nalaxone

Acupuncture site that stimulates breaking in neonates

GV-26

What age is considered neonate

<4-6 weeks

What age is considered pediatric

6-12 weeks

In neonates, cardiac output is dependent on

HR

Why are neonates more susceptible to hypoxemia

Have increased tissue oxygen demand (2-3x)

Why should neonates not be fasted or receive high volume fluid boluses

Hypoglycemia!

Which pre-meds should never be used in neonatal anesthesia

Ace & a2-agonists (cause bradycardia)

When giving opioids to neonates, what should you have available

Anticholinergic (glycopyrrolate) & nalaxone

An ECG is a graphical representation of

Cardiac electrical activity

Which membrane channel/pump is most influential in cardiac cells

Na/K ATPase

In the Na/K pump, which ion moves out of the cell

Na

The constant transitory efflux of what ion is responsible for the resting potential of -90mV in heart tissue

K

ECGs measure electrical activity from what electrode

Negative electrode to positive electrode

Delay in AV node conduction to the ventricles allows for what

Ventricles to fill with blood

The P wave on an ECG is what

Atrial depolarization

The QRs Complex on an ECG is what

Ventricular depolarization

The T wave on an ECG is what

Repolarization

Which wave / complex association is important to evaluate in determining arrhythmias

P wave & QRS complex

Which ECG lead placement is most commonly used

Lead II ( neg electrode on R arm, pos electrode on L leg)

steps/questions to ask when reading an ECG that help narrow down potential arrhythmia types

1. Is ECG rhythm associated with a pulse

• is it fast or slow (tachy vs Brady)

• Is it regular or irregular

• Is QRS wide or narrow/normal

• Is there a P for every QRS

• is there a QRS for every P

Sinus rhythm is an example of what type of regularity on an ECG

Regular

Sinus tachycardia (arrhythmia) is what type of regularity in an ECG

Regularly irregular

A-fib is an example what type of regularity when reading and ECG

Irregularly irregular

an arrhythmia w/ a narrow/normal QRS complex is most likely originating from

Supraventricular

Steps in identifying waves on an ECG

1. Identity QRS

2. Identity T wave (repolarization after QRS- required for it to be an actual heart beat)

3. Identify P wave by exclusion

If P waves are consistently identified on an ECG, what is the name of the rhythm

“Sinus ___”

What arrhythmia is this

2nd degree AV block

An arrhythmia that shows a wide QRS complex is most likely originating from

Ventricles

What arrhythmia is this

VPC

2nd degree AV block is associated with ___ so is common to see under anesthesia

Vagal tone

A rhythm shows that there is NOT a QRS for every P wave, what rhythm should you be thinking

2nd degree AV block

A rhythm shows that there is NOT a P wave for every QRS, what rhythm should you be thinking

VPC