Anesthesia Quiz 3

What is the purpose of monitoring patients under anesthesia?

To warn the anesthetist of changes in anesthetic depth and petient condition in enough time to permit intervention

Monitoring is necessary for what two reasons?

• to keep patients safe

• to regulate anesthetic depth

Failure to monitor and maintain vital signs within acceptable limits may lead to devastating consequences such as what?

permanent brain damage or even death

____ - this type of monitoring consists of a physical assessment such as putting your hands on the patient or listening to heart sounds.

subjective

____ - this type of monitoring consists of connecting machines that calculate a number for the result, such as ECG or blood pressure

Objective

• Listeing to the heart sounds

• palpating pulse quality

• temperature

• assessing reflexes

• assessing respiratory character

• assessing MM and CRT

• assessing muscle tone

Are these all subjective or objective monitoring techniques?

subjective

• ECG

• blood pressure

• capnography

• pulse oximeter

Are these all subjective or objective monitoring techniques?

objective

What are some vital signs we monitor during surgery?

• heart rate/rhythm

• respiratory rate/depth

• MM/CRT

• pulse strength

• blood pressure

• temperature

What are some reflexes we monitor during surgery?

• palpebral

• corneal

• pedal

• swallowing

• larygneal

• pupillary light reflex

T or F: Both reflexes and other indicators are useful for determining anesthetic depth but are not useful for assessing cardiopulmonary function or homeostasis.

True

Swallowing and pedal reflexes are expected to be present when the patient’s anesthesia level is too ____

light

Muscle tone, HR, and RR are expected to be high during ____ anesthesia.

light

If the patient’s eyes are centrally positioned, what does this tell us?

that they are either under light anesthesia or deep anesthesia

If the patient’s eyes are rotated into the ventromedial position, what does this tell us?

They are in the correct surgical depth of anesthesia

General anesthesia is divided into how many stages?

4

Loss of consciousness marks the border between stages ___

I and II

Loss of spontaneous muscle movement marks the border between stages ____

II and III

Loss of reflexes, widely dilated and unresponsive pupils, flaccid muscle tone, and cardiopulmonary collaspe marks stage ____

IV

Which stage is known as the stage of voluntary movement? In this stage, the patient begins to lose consciousness, and is usually characterized by fear, excitement, disorientation, and struggling.

Stage I

Which stage is known as the stage of involuntary movement? This stage is characterized by involuntary reactions in the form of vocalizing, struggling, or paddling.

Stage II

Which stage is known as the excitement stage?

stage II

____ this stage is characterized by the HR/RR elevating, pupils are dilated, muscle tone is marked, and reflexes are present and may appear exaggerated.

Stage II

When does stage II anesthesia end?

It ends when the animal shows signs of muscle relaxation, slower RR, and decreased flex activity.

Stage III anesthesia is divided into how many planes?

4

This stage is known as the period of surgical anesthesia. The patient is unconscious and progresses gradually from light to deep anesthesia.

Stage III

____ - in this plane of stage III anesthesia you are able to intubate the patient. Their eyeballs start central, but will gradually start to rotate ventrally.

Plane 1 of Stage III

T or F: Patients are able to tolerate surgical procedures under plane 1 of stage III.

False

_____ - this plane of anesthesia stage III is the optimum depth for surgical/invasive procedures. Surgical stimulation may evoke a mildly increased HR or RR, but the patient will remain unconscious and immobile

Plane 2 of Stage III

____ - during this plane of anesthesia stage III, significant depressin of circulation and respiration may be observed. Abdominal breathing may be observed.

Plane 3 of stage III

____ - this plane of anesthesia stage III is known as early anesthetic overdose. The patient is too deeply anesthetized and is in danger of respiratory and cardiac arrest.

Plane 4 of stage III

This stage is known as the period of anesthesia overdose. There is a cease of respiration, and the cardiovascular system is markedly depressed with a dramatic drop in HR and BP, accompanied by pale MM and prolonged CRT. Followed by circulatory collapse and death.

Stages IV

____ - a device used o display the electric impulses generated by the cardiac conduction system that iniate each heart beat.

ECG

In small animals, where should the white electrode be placed?

right axillary

In small animals, where should the black electrode be placed?

left axillary

In small animals, where should the red electrode be placed?

left inguinal

In large animals, where should the white electrode be placed?

right jugular furrow

In large animals, where should the black electrode be placed?

left jugular furrow

In large animals, where should the red electrode be placed?

apex of the heart

____ - the force exerted by flowing blood on arterial walls. Used during anesthesia to evaluate tissue perfusion.

blood pressure

Blood pressure is determined by complex interactions among what?

• heart rate

• stroke volume

• vascular resistance

• arterial compliance

____ - the volume of blood ejected by the heart on each beat/contraction

stroke volume

____ - the diameter of the vessels

vascular resistance

____ - is also known as the elasticity of blood vessels

arterials compliance

____ blood pressure is produced by the contraction of the left ventricle as it propelss blood throug the systemic arteries

Systolic Blood pressure

____ blood pressure is the pressure that remains in the arteries when the heart is in the resting phase between contractions

Diastolic blood pressure

_____ - the average pressure throughout the cardiac cycle

Mean Arterial Pressure (MAP)

What is the most important value from the anesthetist’s standpoint because it best indicates BP of the internal organs?

Mean Arterial Pressure (MAP)

What is the normal systolic arterial BP for dogs and cats?

110-160

What is the normal mean arterial BP for dogs and cats?

60-90

What is the noraml diastolic arterial BP in dogs and cats?

50-70

What is the normal systolic arterial BP in horses and cattle?

>80

What is the normal mean arterial BP in horses and cattle?

60-90

What is the normal diastolic arterial BP for horses and cattle?

>50

T or F: Hypertension is common during anesthesia?

False, hypotension is common

Does blood pressure usually increase or decreased under anesthesia?

decrease

If MAP falls below ___mmHg in small animals, blood flow to internal organs is reduced and tissue becomes hypoxic.

60

If MAP falls below ___ in horses, there is deceases blood flow to the muscles

70

The oscillometic and doppler methods are both ___ methods used to collect blood pressue

noninvasive

Monitoring blood pressure through the arterial line is known as a ____ method

invasive

____ - estimates the saturation of hemoglobin (So2), expressed by a % of the total binding sites.

pulse oximetry

What is the normal pulse oximetry?

95-100%

A pulse oximetry of 90-94% must be investigated because it indicates the patient is what?

hypoxemic

A pulse oximetry less than 90% indicates need for what?

therapy

A pulse oximetry saturation less then 85% for longer than 30 seconds is considered what?

a medical emergency

Slide 16 Monitoring ppt