Anesthesia CP 1 Exam 3

#1

1. Compressed O2 tank

2. green drop line

3. holds pure oxygen which is carrier gas

4. 2,200 psi

#2

1. Pressure Regulator

2. reduces and controls amount of oxygen leaving tanks

3

1. pressure gauge

2. tells amount of O2 in tank

3. if tank is below 500 psi start watching

4

1. O2 flow meter

2. looks like thermometer

3. controls amount of O2 to patient

4. connected to vaporizer

5. L/min

6. stop turning when ball reaches bottom to turn off (do not tighten)

7. never set O2 meter below 0.5 L/min causes vaporizer to not work properly

5

1. O2 flush

2. bypasses vaporizer

3. allows delivery of pure oxygen to patient

6

1. vaporizer

2. hold liquid GA

3. vaporizes and delivers precise amounts of GA to patient

4. in %

5. isoflurane and sevoflurane most common GA

6A

Common gas inlet

1. port below inhalation valve

2. shared pathway for pure O2 from O2 flush and GA mixture from vaporizer

7

1. unidirectional inhalation flutter valve

2. ensures one way flow of gasses towards patient

8,9, 10

1. Breathing circuit

2. inhalation tube 8

3. y piece 9

4. exhalation tube 10

5. carries gases to and from patient

11

1. unidirectional exhalation flutter valve

2. ensures one way flow of gases away from patient

12

1. scavenger port'

2. exit for waste gases

3. Active- vaccuum system

4. passive- F/AIR container

13

1. Pop off Valve

2. position determines how much of exhaled gases go out to scavenger and CO2 absorber

3. Close- only CO2 absorber

4. do not run anesthesia with closed bc of CO2 toxicity

5. Open- allows access to CO2 absorber and scavenger

14

1. CO2 absorber

2. granules absorbs CO2 from gases exhaled by patient so that GA gases can be recycled

15

1. pressure manometer

2. tells how much pressure in breathing circuit

3. never go above 20 cm of water

16

1. rebreathing/reservoir bag

2. liter bags

3. reserve for gases

4. never be empty or overly full

5. also helps tell excessive pressure in system

Reasons to bag/ventilate

1. prevent atelectasis (collapsing of alveoli) occurs when taking smaller breaths not using them can cause loss

2. remove any buildup of CO2 in lungs

3. rescue breathing for animals in respiratory arrest (close pop off valve, give pure O2)

How to bag

1. bag every 5-15 min

2. do not squeeze too much

3. bag with O2- become lighter

4. bag with GA- go deeper

Circle rebreathing

1. patients over 15 lbs

2. partial rebreathing of exhaled gases

3. pop off open

4. requires all components of machine

5. 30 mL/kg/min O2 flow rate

6. slow change in anesthesia

7. less costly

8. low waste

9. good with heat and moisture conservation

non rebreathing

1. patients under 15 lbs

2. only requires O2, Vaporizer, and scavenger

3. O2 flow rate: 100-300 mL/kg/min

4. fast change in anesthesia

5. costly

6. high waste

7. poor heat and moisture conservation

anesthesia

1. total loss of sensation in a body part or entire body resulting from administration of a drug that supplies the activity of part or all of nervous system

general anesthesia

loss of sensations in the entire body

local anesthetic

loss of sensation in a body part

Anesthesia uses

1. restraint

2. elimination of pain

3. seizure control

4. humane euthanasia

pre-anesthetics

1. pre meds

2. calms patient

induction agents

render unconscious

maintenance agents

maintains unconsciousness

Why do you want to use a combo of anesthetic drugs

to eliminate unwanted side effects

Drug categories

1. anticholinergics

2. tranquilizers

3. sedatives

4. opioids

5. dissociative agents

6. gas anesthetics

pre-anesthetic reasons

1. aid restraint

2. reduce anxiety

3. smooth induction and recovery

4. less need for potentially more harmful drugs

5. counteract undesirable effects of concurrently used drugs

Anticholinergics (6)

1. prevent or reduce brachycardia (they increase HR)

2. prevent excessive salivation and reduce upper airway secretions (drying effect)

3. do not affect level of consciousness

4. do not provide analgesia (pain relief)

5. LA- ruminants- contraindicated (not used) bc of worry of thickening airway secretions and making obstructions

6. Horse- contraindicated bc can mess up GI tract (avoid cholic)

Popular Anticholinergics (2)

1. Atropine- cheaper

2. Glycopyrolate- expensive, longer duration, less risk of cardiac arrhythmia, does not cross placental barrier, and less suppression of GI tract

Tranquilizers (3)

1. aid restraint

2. reduce anxiety

3. reduce struggling (slows motor activity)

popular Tranquilizers (2)

1. Acepromazine (phenothiazine family): does not provide analgesia, contraindicated in patients with liver disease and history of seizures

2. Benzodiazepine family (diazepam, midazolam, zolazepam): not used alone (hyperexcitability), enhances effects of opioids, enhances muscle relaxation, minimal cardiopulmonary effects, anticonvulsants (stops seizures) (good for pediatrics, geriatrics, and cardiac patients

Sedatives (5)

1. drowsiness

2. muscle relaxation

3. analgesia

4. significant cardiac effects

5. decreased thermoregulation

popular sedatives (2)

1. xylazine - LA reversal yohimbine

2. dexdomitor: SA reversal: antisedan (commonly drops HR below minimally acceptable)

minimal acceptable HR

1. dogs: 60 bpm

2. cats: 100 bpm

Opioids (8)

1. powerful analgesics

2. sedation

3. used in pure form

4. can cause excitibility on own

5. bradycardia

6. causes respiratory depression

7. apnea

8. decrease thermoregulation

popular opioids(4)

1. fentanyl

2. hydromorphine

3. oxymorphone

4. reversal: nalaxone

neuroleptanalgesia

state of profound CNS depression due to combo of opioid with tranquilizer or sedative

dissociative agents (6)

1. causes excessive drooling on own

2. muscle rigidity

3. superficial analgesia

4. only used alone to immobilize fractious animals

5. light and noise sensitive

6. avoid with liver and kidney disease

popular dissociative agents (2)

1. ketamine- stimulates multiple areas of brain (do not use with seizures)

2. tiletamine- mixed with zolazepam (also called Telazol)

Induction Agents (7)

1. propafol (only thing given IV that is not clear)’

2. rapid loss of consiousness

3. rapidly metabolized

4. can rapidly wake up

5. given slowly to effect

6. transient cardiopulmonary depression dependent on dose

7. apnea

Gas anesthetics (9)

1. isoflurane and sevoflurane most common

2. maintains unconsciousness

3. can induce using GAs alone (not common bc of excitement stage)

4. eliminated with exhale (not metabolized)

5. any animal with good lungs can use

6. provides analgesia until woken

7. significant drop in HR and RR

8. requires machine

9. Sevoflurane is more potent and works quicker

Stage 1 (5)

1. disoriented

2. normal RR and HR

3. eyeball central

4. light response

5. good muscle tone and reflexes

Stage 2 (5)

1. excitatory stage

2. irregular respiration

3. HR may increase

4. eyeball central (possible nystagmus)

5. possible exaggerated reflexes

normal HR

1. Dog- 60-160 bpm

2. cats- 140-220 bpm

normal RR

dogs- 10-30 brpm

cats- 20-30 brpm

Stage 3 Plane 1 (5)

1. light anesthesia

2. may respond to movement

3. central or rotated eye position

4. light response

5. good muscle tone, swallowing poor or diminished

Stage 3 Plane 2 (8)

1. surgical anesthesia

2. regular RR could be shallow

3. HR greater than 90 bpm

4. moderate depth

5. eyes rotated ventrally

6. sluggish light response

7. relaxed muscle tone

8. some reflexes absent some present (like an ear flick)

Stage 3 Plane 3 (7)

1. shallow RR

2. HR 60-90 bpm

3. deep depth

4. central eyeball may rotate ventrally

5. very sluggish or absent light response

6. greatly reduced muscle tone

7. all reflexes absent

Stage 4(7)

1. jerky RR

2. HR less than 60 bpm

3. overdose

4. central eye position

5. unresponsive to light

6. flaccid muscle tone

7. no reflexes

stage 5

death

normal acceptable RR

dogs and cats 8 brpm

cardiovascular system (6)

1. listen to heart (esophageal stethoscope)

2. HR and rhythm

3. brachycardia common

4. report any arrhythmia

5. sinus arrhythmia normal in dogs (speed up at inhale, slow at exhale)

6. Ways to tell Bp: direct measure, mucus membrane color, capillary Refill Time (2 sec or less), pulse strength

depth

1. shallow/ rapid breaths- too light anesthesia

2. shallow breaths/ decreased RR- too deep, approaching respiratory arrest

3. deep/rapid breathing- too light, response to pain (also propafol)

noise

1. assess any lung sounds

2. common for cats to build up airway secretions (if no condensation in ET tube no airway movement); also turn blue

Body temp

1. normal- 100-102 F

2. take every 15 min

3. report if drop below 97 F

4. usually occurs within 20 minutes (become concerned if 92 F or under)

5. Hyperthermia- rare, cats, any temp over 103 F is concern, address vet on next steps ( mostly due to seizures)

6. Preventative rewarming: (heating blankets, water bottles, warm IV fluids)

CNS: palpebral reflex

1. blink reflex

2. deep- absent

3. present- light anesthesia

4. very sluggish or absent- moderate depth

5. lightly tap corner of eye

CNS: Swallowing reflex

1. present- light anesthesia

2. absent- moderate anesthesia and deep

CNS: pedal reflex

1. pinch toes

2. should flinch or retract

3. absent- moderate depth and deep

4. present- light anesthesia

pupil size

1. constricted- light anesthesia

2. gradually larger- moderate anesthesia

3. widely dilated-deep anesthesia

CNS: ear flick reflex

1. only cats

2. touch outside of ear

3. should flick

4. present'/sluggish- moderate level

5. absent- deep depth

6. over use will lose reflex

CNS: watch tail (cats)

1. no movement- moderate depth

2. slight movement- too light

3. resistance to drop not deep enough

CNS: corneal reflex

1. not routine

2. drop of liquid into eye

3. eye should recoil

4. no recoil- too deep

5. present- light and moderate depth

6. LA

Jaw tone

1. easily open

2. not flaccid

3. resistance- too light

anal tone

1. normally shut

2. relaxes and can open

3. should not be gaping

eye

1. central- too light or deep

2. look down and in- moderate depth

Continuously monitor (8)

1. RR

2. depth

3. HR

4. mucus membranes and CRT

5. jaw tone

6. palpebral reflex

7. eye positoin

8. temp

total rebreathing system

1. 10 mL/kg/min

2. pop off valve closed, all CO2 gets rebreathed