Lecture 28 - Small Animal IV

Cardiac

Patients with what conditions, broadly, will have reduced cardiac reserve, be sensitive to fluid overload, and will more commonly have arrhythmias?

ACE Inhibitors

Cardiac patients preparing for anesthesia should avoid the morning dose of what category of drugs, as this can cause dangerous hypotension when coupled with anesthesia?

pro-BNP

What SNAP blood test is done on feline and canine cardiac patients before anesthesia as it is an indicator of stretch and stress on the myocardium?

Troponin

What SNAP blood test is done on canine, equine, and feline cardiac patients before anesthesia as this helps in detection of acute and chronic myocardial damage?

Concentric

Hypertrophic cardiomyopathy causes what type of hypertrophy? This involves diastolic failure, inability of the heart to relax, pressure overload, and pericardial effusion.

Eccentric

Valvular insufficiencies and dilated cardiomyopathy will cause what type of hypertrophy? This will involve volume overload, pump failure, failure of systolic function, inadequate stroke volume and cardiac output, and coronary vascular disease.

Pimobendan

What drug is both a positive inotrope and a vasodilator, and is often given to cardiac patients on the day of anesthesia? It is especially important in patients with mitral regurgitation.

Mitral Regurgitation

What cardiac condition, often caused by myxomatous mitral valve degeneration, will complicate anesthesia? It is present in 30% of small-breed dogs over the age of 10 years, and involves volume overload of the left ventricle and atrium. Heart size correlates with severity of the condition, and contractility will decrease in large breeds and may increase in small breeds. It is treated by reducing the preload and arterial afterload, and maintaining adequate systolic contractility. The aim of anesthesia in these patients is to maintain forward aortic flow while minimizing regurgitant flow and development of pulmonary edema.

Yes

Is it safe to use acepromazine, benzodiazepines, vatinoxan/medetomidine, opioids, etomidate, propofol, alfaxalone, iso/sevoflurane, glycopyrrolate, and dobutamine in mitral regurgitation patients?

No

Is it safe to use alpha-2 agonists, barbiturates, ketamine, and halothane in mitral regurgitation patients? Is it also safe to allow hypoventilation, stress, and anxiety in these patients?

No

In cases of hypotension in mitral regurgitation patients, it is safe to use vasopressors and positive inotropes to correct this. Is it also safe to use a fluid bolus?

Dilated

What type of cardiomyopathy occurs mainly in large breed dogs with decreased systolic function? Left-sided congestive heart failure, arrhythmias, atrial fibrillation, and increased myocardial O2 consumption can all develop. It is uncommon in cats except due to taurine deficiency. It refers to idiopathic primary myocardial failure accompanied by eccentric dilation and volume overload. US, x-rays, and ECG can be used to diagnose it, and the aim of treatment is to reduce preload and afterload, increase contractility, and suppress ventricular arrhythmias. Protocol is similar to mitral regurgitation but there is added risk of systolic dysfunction, arrhythmias, and congestive heart failure.

Yes

Can positive inotropes, antiarrhythmics, anticholinergics, benzodiazepines, opioids, etomidate, alfaxalone, ketamine (low dose), and inhalants/CRIs be used in dilated cardiomyopathy patients?

No

Can acepromazine, propofol, alpha 2 agonists, and barbiturates be used in dilated cardiomyopathy patients?

Hypertrophic

What type of cardiomyopathy involves diastolic dysfunction, increased myocardial oxygen demand, possible mitral regurgitation, and is common in cats and rare in dogs? There is increased risk of thromboembolism in cats with this. It involves concentric hypertrophy of the left ventricle, and is treated by reducing preload, controlling heart rate, and giving antithrombosis agents. The aim of treatment is to treat the underlying disease, maintain heart rate, maintain contractility, avoid inotropic drugs, and slightly increase or maintain stroke volume.

Yes

Can benzodiazepines, opioids, alpha-2 agonists, alfaxalone, etomidate, propofol, and inhalants be used in hypertrophic cardiomyopathy cases?

No

Can ketamine, tiletamine, fluids, hypotension, bradycardia, stress, and excitement be used/allowed in hypertrophic cardiomyopathy cases?

Phenylephrine

What is an example of an alpha 1 agonist drug which can be used to correct hypotension in a hypertrophic cardiomyopathy case?

Pulmonary Hypertension

What condition mainly affects small-toy breeds that are middle-older aged, and can occur as a primary condition, or due to left heart failure, PDA, pulmonary hypoxia, heartworm, or thromboembolism disease? Hypoxemia and hypercapnia may occur, and pain, nociception, hypothermia, and acidosis should all be avoided. The aim in treatment is to maintain or increase preload and contractility, maintain arterial blood pressure, and maintain SVR.

Yes

Can acepromazine, benzodiazepines, opioids, propofol, alfaxalone, and halogenates be used in pulmonary hypertension cases?

No

Can dopamine, ketamine, nitrous oxide, and alpha 2 agonists be used in pulmonary hypertension cases?

Dobutamine

What drug, as well as pimobendan, can be used to treat hypotension in pulmonary hypertension cases?

Sildenafil

What drug can be used 2 hours prior to induction of anesthesia in pulmonary hypertension cases to avoid side effects?

Upper

Is brachycephalic syndrome an example of an upper or lower airway disease?

Lower

Are lung contusions, pulmonary edema, pneumonia, pneumothorax, pleural effusion, and diaphragmatic hernias upper or lower airway diseases?

Brachycephalic

What respiratory syndrome involves short-wide skull, stenotic nares, soft palate hyperplasia, mucosal edema of the larynx, everted laryngeal saccules, laryngeal collapse, and tracheal hypoplasia? Associated problems may include dysphagia, vomiting, regurgitation, restricted airway flow, and impaired heat exchange. Dexamethasone, metoclopramide, and omeprazole can be used prior to anesthesia in these patients. Recovery requires oxygen, late extubation, sternal positioning, pulling the tongue out, glucocorticosteroids, and being ready to re-intubate.

Diaphragmatic

What type of hernia is a respiratory condition and involves presence of abdominal organs in the thoracic cavity? It can be traumatic or congenital, and the liver is the most common organ involved. It can be either an emergency or an incidental finding and may be associated with fractures, lung contusions, and myocardial trauma. Preoxygenation is very important in these cases, as well as use of opioids and alpha 2 agonists, fast intubation sequence, halogenates/propofol TIVA, gentle IPPV, and recovery including oxygen and further observation.

No

Should acepromazine be used in cases of diaphragmatic hernia?

Bronchoscopy

What procedure requires oxygen via an endoscopy port or non-rebreathing system, monitoring of SpO2, recovery with oxygen, and premedication with butorphanol? Induction should be slow and careful, and maintenance with TIVA is commonly done, instead of with inhalants.