Term
State of general anesthesia is: (5 things) |
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Definition
Unconsciousness Muscle relaxation Amnesia Analgesia Absence of reflex response |
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Term
The anesthetic period consists of: |
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Definition
Pre-anesthetic evaluation and stabilization Premedication Induction Maintenence Recovery Pain management (all through all stages and after) |
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Term
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Definition
Calm patient Smooth induction, maintenance, recovery Reduce doses need subsequently Analgesia, muscle relaxation Decrease airway secretions, saliva Obtund autonomic reflexes |
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Term
What are the 5 P's of anesthesia: |
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Definition
Previous planning prevents poor performance! |
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Term
Three most common anesthetic mishaps: |
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Definition
1. Mechanical malfunction 2. Accidental disconnection of equipment 3. Human error (equip, drug calculation) |
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Term
5 ways to avoid poor anesthetic outcome: |
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Definition
1. adequate preoperative evaluation 2. good preopertative stabilization 3. Anticipation of intraoperative complications, how to handle 4. good preoperative equipment check to reduce malfunction 5. diligent monitoring |
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Term
AT A MINIMUM, what information do we need for laboratory database? |
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Definition
PVC, total solids, blood glucose |
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Term
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Definition
Normal healthy patient, no discernible disease |
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Term
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Definition
Patient with mild systemic disease, elective |
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Term
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Definition
Patient with severe systemic disease |
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Term
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Definition
Patient with severe, life-threatening disease |
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Term
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Definition
Moribund patient not expected to survive |
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Term
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Definition
Emergency (you add this to the end of numerical class) |
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Term
Goal of pre-anesthetic stabilization |
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Definition
have the patient's condition as stable as possible without worsening the prognosis by delaying surgery |
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Term
Why withhold food and water: |
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Definition
1. minimize regurg and aspiration 2. minimizes bloat and ability to ventilate 3. Minimize risk of stomach rupture |
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Term
Withhold food from dogs and cats for: |
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Definition
6-12 hours (if <8 weeks or <2kgs, 1-2 hrs) |
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Term
Withhold food from small rodents and rabbits: |
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Definition
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Term
Withhold food from birds: |
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Definition
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Term
Withhold food from swine: |
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Definition
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Term
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Definition
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Term
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Definition
Food: 12-18 h Water: 8-12 h |
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Term
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Definition
Food: 18-48 h Water: 12-18 h |
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Term
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Definition
drug that has high potential for abuse and no accepted medical use |
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Term
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Definition
permits usage ONLY with a medical prescription (most opioids other than heroin) |
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Term
Schedule III drug examples |
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Definition
agonist/antagonists and partial agonists |
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Term
Endogenous and exogenous opioids work at (same/different) receptors. |
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Definition
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Term
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Definition
respiratory depression and ileus/constipation |
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Term
Receptors involved in opioid analgesia: |
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Definition
Mu1 in the brain kappa in the spinal cord ORL-L in brain |
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Term
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Definition
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Term
________induce a maximal response when they bind to a receptor. |
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Definition
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Term
________ cannot produce a maximal response and therefore have a lower curve. They are safer. |
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Definition
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Term
___________ shift the dose response curve to the right with respect to a full Mu agonist. |
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Definition
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Term
The ceiling effect of partial agonists refers to both the analgesia and the negative effects (T/F) |
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Definition
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Term
Where are most opiates metabolized? |
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Definition
liver but also extra hepatic sites |
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Term
Oral opiate bioavailability: |
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Definition
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Term
Opiate metabolism and excretion: |
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Definition
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Term
Morphine, meperidine, oxymorphone, hydromorphone, fentanyl, alfentanil, sufentanil are _________ and should be used for _____________________________ pain. |
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Definition
pure mu agonists, moderate to severe pain |
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Term
Etorphine, carfentanil used for _____________ |
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Definition
chemical immobilization of wild animals |
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Term
Buprenorphine is a ________________ and butorphanol is a ______________ used for __________pain |
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Definition
partial agonist a mu receptors; mild mu agonist or mu antagonist and kappa agonist; mild to moderate pain |
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Term
Pure Mu agonists can cause these mood alterations: |
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Definition
euphora, dysphoria and sedation (if combined with sedatives) |
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Term
_______ system is main regulator of emotion. |
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Definition
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Term
Opioids tend to decrease ___________in cats and dogs |
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Definition
spontaneous motor activity |
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Term
This species shows increased locomotor activity and agitation with high doses of opioids: |
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Definition
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Term
Respiratory effects of opioids: |
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Definition
antitussive decreased responsiveness of resp center to CO2 decrease resp rate and tidal volume |
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Term
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Definition
bradycardia mild hypotension very little decrease in myocardial contractility |
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Term
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Definition
reduce propulsive activity of gut smooth muscle and sphincter tone increased decreased peristalsis vomition ileus |
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Term
Exogenous opioids are _______ rapidly broken down than endogenous opioids. |
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Definition
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Term
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Definition
need for higher doses to achieve the same effect |
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Term
Morphine induces vomiting when given ___operatively but not not _____operatively or when animals are suffering. |
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Definition
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Term
When given opioids IV, there is a release of ____ |
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Definition
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Term
the analgesic effects of this drug result from metabolism to morphine |
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Definition
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Term
this partial agonist and agonist/antagonist has poor analgesic effects but great anti-tussive activity |
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Definition
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Term
this is a partial mu agonist that has a longer duration of action than most opioids: |
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Definition
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Term
Mu-receptor agonist that causes histamine release and hypotension when given IV; has a epidural formulation called Duramorph |
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Definition
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Term
Mu-receptor agonist that is 5x more potent than morphine and has no histamine release |
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Definition
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Term
Mu agonist that is 50-100X more potent than morphine and is a very potent respiratory depressant; has a transdermal patch formulation and a topical patchless formulation called Recuvyra |
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Definition
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Term
Non-opiate analgesic; + enantiomer is more potent mu agonist, but - enantiomer acts on alpha-2 receptors to reduce reuptake of norepe and serotonin/increases their release; analgesic mechanism is adrenergic and serotonergic paths |
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Definition
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Term
Partial agonists and full agonoists have the same affinity for a receptor (T) |
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Definition
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Term
Three opiate antagonists: |
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Definition
naloxone naltrexone nalmefene |
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Term
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Definition
sedation/tranquilization muscle relaxation analgesia decrease subsequent drug dose amnesia |
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Term
What is an example of an anticholinergic pre-medication drug? |
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Definition
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Term
What anticholinergic drug crosses the BBB, has an intense effect on HR and GI, shorter duration of action, and is administered IM, IV, IT, SQ: |
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Definition
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Term
This anticholinergic pre-med drug is polar, and thus does not cross the BBB, has less intense systemic effects, and is administered IM, IV, SQ: |
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Definition
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Term
What are some GI effects of anticholinergics? |
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Definition
reduced salivary secretion reduced motility increased pyloric sphincter tone |
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Term
What are some effects of anticholinergics on the respiratory system? |
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Definition
bronchodilation decreased bronchial secretion |
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Term
Name a phenothiazine premedication drug that is a dopamine receptor antagonist: |
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Definition
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Term
Acepromazine has strong analgesic effects (T/F) |
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Definition
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Term
Which tranquilzer/sedative premedication has no reversal? |
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Definition
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Term
Are alpha-2 adrenoceptor agonists reversible? |
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Definition
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Term
Where do the sedative and analgesic effects of alpha-2 adrenoceptors work? |
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Definition
supraspinal and dorsal horn |
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Term
Whicg group of pre-medications demonstrate bi-phasic blood pressure changes? |
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Definition
Alpha-2 adrenoceptor antagonists |
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Term
Describe the biphasic BP changes in alpha-2's? |
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Definition
Initial vasoconstriction and reflex bradycardia
Later vasodilation and low contractility/cardiac output |
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Term
What class of drug is xylazine? |
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Definition
Alpha-2 adrnoceptor agonist |
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Term
Tolazoline and yohimbine reverse what drug? |
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Definition
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Term
What alpha-2 does antisedan (atipamezole) reverse? |
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Definition
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Term
At which receptor do benzodiazepines work? |
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Definition
GABA (primary inhibitory neurotransmitter in CNS) |
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Term
Describe the clinical effects of benzos. |
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Definition
sedation/anxiolysis muscle relaxation anticonvulsant retrograde amnesia minimal CV & resp effects |
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Term
What drugs does flumazanil reverse? |
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Definition
benzos (zolazepam, midazolam, diazepam) |
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Term
What is the most widely used benzo? |
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Definition
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Term
What are 7 qualities of Diazepam? |
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Definition
1. very irritating 2. absorption is poor/unpredictable 3. water insoluble 4. light sensitive, binds to plastic 5. highly protein bound 6. rapidly distributed in body 7. co-induction with ketamine or propofol |
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Term
Properties of midazolam (4) |
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Definition
1. sedative and muscle relax effect 2. water soluble and lipid soluble in body 3. light sensitive 4. relatively shorter duration of action |
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Term
Which benzo is only found in Telazol? |
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Definition
Zolazepam (with tiletamine) and has a longer duration of action |
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Term
Physiochemical and pharmacokinetic ideals of an injectable: (4) |
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Definition
1. water soluble 2. long shelf life 3. Stable when exposed to light 4. ssmall volume needed for induction |
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Term
Pharmacodynamic ideals of injectable anesthetic: (8) |
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Definition
1. minimal individial variation 2. safe therapeutic ratio 3. rapid onset 4. short duration of action 5. inactivated to non-toxic metabolite 6. smooth recovery 7. no anaphylaxis 8. no histamine release |
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Term
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Definition
total IV anesthetic (no inhalational) |
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Term
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Definition
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Term
Name two dissociative anesthetics: |
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Definition
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Term
Dissociative mechanism of action: |
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Definition
inhibit uptake of catecholamines into post-ganglionic nerve endings & prevent extra-neuronal uptake of catcholamines (results in increased sympathetic tone) |
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Term
Dissociates cortico-thalamic processing: |
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Definition
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Term
This dissociative has an extreme safety margin and is highly compatible with other anesthetic agents |
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Definition
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Term
This dissoc results in -increased HR -increased systemic and pulmonary BP -increased peripheral vascular resistance -increased cardiac output -increased myocardial O2 consumption |
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Definition
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Term
Which drug do we not give alone? |
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Definition
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Term
Ketamine recovery is by_________ and metabolized by_______ |
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Definition
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Term
Eyes remain open with dilated pupils on this dissociative |
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Definition
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Term
MAJOR GOALS OF COMBINING OTHER DRUGS WITH KETAMINE: (4) |
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Definition
1. improve analgesia 2. improve muscle relaxation 3. prolong anesthesia period and immobilization 4. decrease amt. of ketamine needed |
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Term
which ketamine combo is most used in large animal med? what is used in small animal? |
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Definition
xylazine-ketamine; benzodiazepine-ketamine |
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Term
Which benzo is used with ketamine most often in small animal med? |
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Definition
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Term
You want to avoid this combo in head or eye traumas due to increased cranial and ocular pressures |
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Definition
ketamine/benzo (versed or valium) |
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Term
Which injectable dissociative/benzo mixture drug is used in fractious animals for its rapid and reliable restraint- it is not as good an outpatient drug but maintains is great safety margin-? |
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Definition
Telazol- (tiletamine and zolazepam) |
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Term
Is Telazol appropriate as the sole anesthetic agent for a procedure? |
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Definition
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Term
What is the best choice of injectable drug for frightened or aggressive dogs- causes respiratory depression? |
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Definition
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Term
This drug has a very smooth pleasant induction and recovery, rapid, but respiratory depression is the major side-effect? |
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Definition
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Term
The elimination rate exceeds the hepatic perfusion of this drug. |
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Definition
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Term
The "intralipid" vehicle of this drug can support bacterial growth and can cause histamine reslease |
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Definition
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Term
This injectable drug type has a cumulative effect, though this drug of MJ's choice has NO cumulative effect/ |
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Definition
dissociative anesthetics; propofol |
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Term
It is important to limit uses of propofol in cats: |
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Definition
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Term
Which injectable drug is our heart friendly drug (maintains cardiac output, blocks adreno-cortical stess response, rapid recovery, good relaxation, poor analgesia) |
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Definition
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Term
rapidly acting steroidal anesthetic on GABA receptors: |
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Definition
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|
Term
Thiopental belongs to this group of injectables: |
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Definition
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Term
This group of drugs causes CNS depression, no analgesia, and RAS depression and is currently unavailable on the market: |
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Definition
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Term
These are physiologic effects of barbiturates: |
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Definition
1. mild transient increase in HR 2. arrythmias (PVC) 3. decreased contractility 4. decreased arterial BP 5. POTENT RESP DEPRESSION |
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Term
What are volatile anesthetic agents? |
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Definition
Liquids that are vaporized and delivered as a vapor in a carrier gas (usually O2) |
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|
Term
Though we do not totally know how inhalant anesthetics work, what ions are involved in the mx of action? |
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Definition
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|
Term
Which receptor is most likely most involved in volatile anesthetic mech of action? |
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Definition
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|
Term
Which 2 volatiles are most commonly used in vet med? |
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Definition
Isoflurane and sevoflurane |
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Term
What are the MAC values for Iso and Sevo? |
|
Definition
1.5 for iso and 2 for sevo (in humans) |
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Term
How does Iso's pungent smell inhibit delivery of anesthetic? |
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Definition
When masking a pt down, they often hold their breath due to pungent smell, and therefore do not receive any anesthetic |
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Term
|
Definition
the % of alveolar space that must be occupied by inhalant to induce immobilization and no response to a surgical stimulus in 50% of patients |
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Term
The MAC value of a drug closely correlates with______ |
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Definition
lipid solubility ( the lower the MAC, the more potent and lipid soluble) |
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Term
Why are concurrent sedatives and analgesics used to reduce the MAC? |
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Definition
Because volatile inhalants are the most potent and profound CV and respiratory depressant drugs |
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Term
List factors that can decrease the MAC: 8 |
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Definition
hypothyroidism geriatric state neonatal state PaCO2 > 95 mmHg PaO2 < 50 mmHg metabolic acidosis hypothermia hemorrhage |
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Term
At 1.2 MAC, what % of pts will not respond to stimulus? |
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Definition
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|
Term
At 2 MAC, what percent of pts will not respond to stimulus? |
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Definition
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|
Term
What is the aim of MAC/volatile anesthetics? |
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Definition
To keep pt in surgical plane while at lowest possible % of anesthetic volatile |
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Term
The three major risk factors associated with mortalitly intra-op: |
|
Definition
1. intraop hypotension 2. longer duration on deep anesthesia 3. concurrent d'se |
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|
Term
Of these three PD effects of volatiles, which is desired? CNS effects, CV effects, Resp effects |
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Definition
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|
Term
Name CNS effects of volatile agents: |
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Definition
loss of consciousness analgesia amnesia muscle relaxation decreased cerebral metabolic rate cerebral vasodilation |
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Term
In which class of drugs is there minimal direct myocardial depression, hypotension due to vasodilation, minimal arrythmic effects, and maintained baroreceptor reflex? |
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Definition
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|
Term
Which group of drugs can cause infertility and birth defects, bone marrow suppression.... |
|
Definition
volatile anesthetic inahlants |
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Term
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Definition
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Term
|
Definition
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Term
Stage three of anesthesia: |
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Definition
General anesthesia with three planes |
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Term
Plane I Plane II Plane III of anesthesia |
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Definition
I: light II: medium III: deep |
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Term
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Definition
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|
Term
What is the surgical plane of anesthesia? |
|
Definition
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|
Term
What method of anesthesia takes the patient directly to stage III? |
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Definition
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|
Term
What 4 things does monitoring general anesthesia include? |
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Definition
1. determining stage 2. monitoring muscle tone 3. reflex activity 4. eye signs |
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Term
What skeletal muscle tone do we most often monitor during anesthesia? |
|
Definition
Jaw anal sphincter limb muscle |
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Term
What 5 reflexes do we monitor in an anesthetized patient? |
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Definition
Swallowing reflex (absent in plane I) Palpebral reflex (weak or absent in plane II) Corneal reflex (always present or pt very deep/dead) Limb withdrawal Anal reflex |
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Term
Central eye + palpebral reflex intact + constricted pupil = |
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Definition
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|
Term
Ventromedial rotation of eye + wak or absent palpebral reflex = |
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Definition
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|
Term
Central eye position + absence of palpebral reflex + dilated pupil = |
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Definition
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|
Term
pupils are constricted if pt is too _____ but dilated if the patient is too _____ |
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Definition
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Term
When predicting complications, what is H^3? |
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Definition
Hyptension Hypothermia Hypoventilation |
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Term
|
Definition
10 ml/kg/hr for surgical anes. then decreased to 5 ml/kg/hr after 1-2 hrs |
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|
Term
What is the equation for a fluid rate infusion? |
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Definition
FRI = [BW (kg) x infusion rate (ml/kg/hr) x infusion set calibration (drops/ml)/ 60 (min in an hour) |
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|
Term
In what cases would you not want to give fluids? |
|
Definition
pulmonary contusions cardiac disease anuric renal fail low plamsa oncotic pressure |
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Term
At what SAP can you not detect peripheral pulse anymore? |
|
Definition
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|
Term
What are the MAP and SAP standards for adequate tissue perfusion? |
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Definition
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|
Term
Doppler cuff width should must be ____-____% |
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Definition
40-60 circumference leg or tail |
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Term
What is the gold standard of BP monitoring? |
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Definition
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|
Term
How can yo recognize hypotension? |
|
Definition
low MAP, SAP prolonged CRT pale mm weak pulses elevated T wave |
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|
Term
You can use fluids, sympathomimetics (^stroke volume, venous constriction), and cholinergics (^HR) to manage BP. What three things do we want to achieve in this? |
|
Definition
increase HR increase contractility increase venous return |
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|
Term
|
Definition
The pressure in the right atrium- used in critical cases |
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|
Term
Negative CVP? Elevated CVP? |
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Definition
-hypovolemia -overadminsitration of fluid |
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|
Term
What is adequate cardiac output dependent on? |
|
Definition
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|
Term
What % of blood loss can healthy animals tolerate? |
|
Definition
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|
Term
Old, debilitated, anemic may need transfusion after % of blood volume loss? |
|
Definition
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|
Term
NORMAL BLOOD VOLUMES Dog Cat Sheep Horse |
|
Definition
-80-90 ml/kg -50-60 ml/kg -60-70 ml/kg -90-100 ml/kg |
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Term
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Definition
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|
Term
Gold standard for measuring blood oxygenation? |
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Definition
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|
Term
|
Definition
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|
Term
Minimum urine production under general anesthesia: |
|
Definition
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|
Term
What is the PSI of a full O2 tank? |
|
Definition
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|
Term
Full E tank has _____PSI and _____Liters at ____degrees Celsius |
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Definition
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|
Term
What are two safety features built into anesthetic machines to prevent hooking up wrong gases? |
|
Definition
Pin index safety system Diameter index safety system |
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|
Term
Final stage of pressure reduction is at the flow meter. What is the last reduced pressure? |
|
Definition
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