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Anesthesiology Exam I
Lectures 1-10, labs 1-3
167
Veterinary Medicine
Graduate
10/20/2014

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Term
State of general anesthesia is: (5 things)
Definition
Unconsciousness
Muscle relaxation
Amnesia
Analgesia
Absence of reflex response
Term
The anesthetic period consists of:
Definition
Pre-anesthetic evaluation and stabilization
Premedication
Induction
Maintenence
Recovery
Pain management (all through all stages and after)
Term
Goals of pre-medication:
Definition
Calm patient
Smooth induction, maintenance, recovery
Reduce doses need subsequently
Analgesia, muscle relaxation
Decrease airway secretions, saliva
Obtund autonomic reflexes
Term
What are the 5 P's of anesthesia:
Definition
Previous planning prevents poor performance!
Term
Three most common anesthetic mishaps:
Definition
1. Mechanical malfunction
2. Accidental disconnection of equipment
3. Human error (equip, drug calculation)
Term
5 ways to avoid poor anesthetic outcome:
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
Term
AT A MINIMUM, what information do we need for laboratory database?
Definition
PVC, total solids, blood glucose
Term
ASA Classification I
Definition
Normal healthy patient, no discernible disease
Term
ASA Classification II
Definition
Patient with mild systemic disease, elective
Term
ASA Classification III
Definition
Patient with severe systemic disease
Term
ASA Classification IV
Definition
Patient with severe, life-threatening disease
Term
ASA Classification V
Definition
Moribund patient not expected to survive
Term
ASA Classification E
Definition
Emergency (you add this to the end of numerical class)
Term
Goal of pre-anesthetic stabilization
Definition
have the patient's condition as stable as possible without worsening the prognosis by delaying surgery
Term
Why withhold food and water:
Definition
1. minimize regurg and aspiration
2. minimizes bloat and ability to ventilate
3. Minimize risk of stomach rupture
Term
Withhold food from dogs and cats for:
Definition
6-12 hours (if <8 weeks or <2kgs, 1-2 hrs)
Term
Withhold food from small rodents and rabbits:
Definition
not fasted
Term
Withhold food from birds:
Definition
not fasted
Term
Withhold food from swine:
Definition
12-24 hours
Term
Fast horses for:
Definition
8-12 hours
Term
Fast ruminants:
Definition
Food: 12-18 h
Water: 8-12 h
Term
Fast adult cattle:
Definition
Food: 18-48 h
Water: 12-18 h
Term
Schedule I Drug:
Definition
drug that has high potential for abuse and no accepted medical use
Term
Schedule II drugs:
Definition
permits usage ONLY with a medical prescription (most opioids other than heroin)
Term
Schedule III drug examples
Definition
agonist/antagonists and partial agonists
Term
Endogenous and exogenous opioids work at (same/different) receptors.
Definition
Same
Term
Mu2 receptors:
Definition
respiratory depression and ileus/constipation
Term
Receptors involved in opioid analgesia:
Definition
Mu1 in the brain
kappa in the spinal cord
ORL-L in brain
Term
Delta receptors:
Definition
+/- analgesia
euphoria
Term
________induce a maximal response when they bind to a receptor.
Definition
Agonists
Term
________ cannot produce a maximal response and therefore have a lower curve. They are safer.
Definition
Partial agonists
Term
___________ shift the dose response curve to the right with respect to a full Mu agonist.
Definition
Agonist/antagonist
Term
The ceiling effect of partial agonists refers to both the analgesia and the negative effects (T/F)
Definition
True
Term
Where are most opiates metabolized?
Definition
liver but also extra hepatic sites
Term
Oral opiate bioavailability:
Definition
generally poor
Term
Opiate metabolism and excretion:
Definition
hepatic, renal
Term
Morphine, meperidine, oxymorphone, hydromorphone, fentanyl, alfentanil, sufentanil are _________ and should be used for _____________________________ pain.
Definition
pure mu agonists, moderate to severe pain
Term
Etorphine, carfentanil used for _____________
Definition
chemical immobilization of wild animals
Term
Buprenorphine is a ________________ and butorphanol is a ______________ used for __________pain
Definition
partial agonist a mu receptors; mild mu agonist or mu antagonist and kappa agonist; mild to moderate pain
Term
Pure Mu agonists can cause these mood alterations:
Definition
euphora, dysphoria and sedation (if combined with sedatives)
Term
_______ system is main regulator of emotion.
Definition
Limbic
Term
Opioids tend to decrease ___________in cats and dogs
Definition
spontaneous motor activity
Term
This species shows increased locomotor activity and agitation with high doses of opioids:
Definition
horses
Term
Respiratory effects of opioids:
Definition
antitussive
decreased responsiveness of resp center to CO2
decrease resp rate and tidal volume
Term
CV effects of opioids:
Definition
bradycardia
mild hypotension
very little decrease in myocardial contractility
Term
GIT effects of opioids:
Definition
reduce propulsive activity of gut
smooth muscle and sphincter tone increased
decreased peristalsis
vomition
ileus
Term
Exogenous opioids are _______ rapidly broken down than endogenous opioids.
Definition
less
Term
Tolerance:
Definition
need for higher doses to achieve the same effect
Term
Morphine induces vomiting when given ___operatively but not not _____operatively or when animals are suffering.
Definition
Pre; post
Term
When given opioids IV, there is a release of ____
Definition
histamine
Term
the analgesic effects of this drug result from metabolism to morphine
Definition
codeine
Term
this partial agonist and agonist/antagonist has poor analgesic effects but great anti-tussive activity
Definition
butorphanol
Term
this is a partial mu agonist that has a longer duration of action than most opioids:
Definition
buprenorphine
Term
Mu-receptor agonist that causes histamine release and hypotension when given IV; has a epidural formulation called Duramorph
Definition
Morphine
Term
Mu-receptor agonist that is 5x more potent than morphine and has no histamine release
Definition
hydromorphone (dilaudid)
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
Definition
fentanyl
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
Definition
tramadol
Term
Partial agonists and full agonoists have the same affinity for a receptor (T)
Definition
T
Term
Three opiate antagonists:
Definition
naloxone
naltrexone
nalmefene
Term
Why premedicate? (5)
Definition
sedation/tranquilization
muscle relaxation
analgesia
decrease subsequent drug dose
amnesia
Term
What is an example of an anticholinergic pre-medication drug?
Definition
atropine, glycopyrrolate
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:
Definition
atropine
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:
Definition
glycopyrrolate
Term
What are some GI effects of anticholinergics?
Definition
reduced salivary secretion
reduced motility
increased pyloric sphincter tone
Term
What are some effects of anticholinergics on the respiratory system?
Definition
bronchodilation
decreased bronchial secretion
Term
Name a phenothiazine premedication drug that is a dopamine receptor antagonist:
Definition
acepromazine
Term
Acepromazine has strong analgesic effects (T/F)
Definition
F
Term
Which tranquilzer/sedative premedication has no reversal?
Definition
Acepromazine
Term
Are alpha-2 adrenoceptor agonists reversible?
Definition
Yes
Term
Where do the sedative and analgesic effects of alpha-2 adrenoceptors work?
Definition
supraspinal and dorsal horn
Term
Whicg group of pre-medications demonstrate bi-phasic blood pressure changes?
Definition
Alpha-2 adrenoceptor antagonists
Term
Describe the biphasic BP changes in alpha-2's?
Definition
Initial vasoconstriction and reflex bradycardia

Later vasodilation and low contractility/cardiac output
Term
What class of drug is xylazine?
Definition
Alpha-2 adrnoceptor agonist
Term
Tolazoline and yohimbine reverse what drug?
Definition
xylazine
Term
What alpha-2 does antisedan (atipamezole) reverse?
Definition
dexmedetomidine
Term
At which receptor do benzodiazepines work?
Definition
GABA (primary inhibitory neurotransmitter in CNS)
Term
Describe the clinical effects of benzos.
Definition
sedation/anxiolysis
muscle relaxation
anticonvulsant
retrograde amnesia
minimal CV & resp effects
Term
What drugs does flumazanil reverse?
Definition
benzos (zolazepam, midazolam, diazepam)
Term
What is the most widely used benzo?
Definition
Diazepam (VALIUM)
Term
What are 7 qualities of Diazepam?
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
Term
Properties of midazolam (4)
Definition
1. sedative and muscle relax effect
2. water soluble and lipid soluble in body
3. light sensitive
4. relatively shorter duration of action
Term
Which benzo is only found in Telazol?
Definition
Zolazepam (with tiletamine) and has a longer duration of action
Term
Physiochemical and pharmacokinetic ideals of an injectable: (4)
Definition
1. water soluble
2. long shelf life
3. Stable when exposed to light
4. ssmall volume needed for induction
Term
Pharmacodynamic ideals of injectable anesthetic: (8)
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
Term
TIVA
Definition
total IV anesthetic (no inhalational)
Term
PIVA
Definition
partial IV anesthetic
Term
Name two dissociative anesthetics:
Definition
ketamine
tiletamine
Term
Dissociative mechanism of action:
Definition
inhibit uptake of catecholamines into post-ganglionic nerve endings & prevent extra-neuronal uptake of catcholamines (results in increased sympathetic tone)
Term
Dissociates cortico-thalamic processing:
Definition
dissociative anesthetics
Term
This dissociative has an extreme safety margin and is highly compatible with other anesthetic agents
Definition
ketamine
Term
This dissoc results in
-increased HR
-increased systemic and pulmonary BP
-increased peripheral vascular resistance
-increased cardiac output
-increased myocardial O2 consumption
Definition
ketamine
Term
Which drug do we not give alone?
Definition
Ketamine
Term
Ketamine recovery is by_________ and metabolized by_______
Definition
redistribution; liver
Term
Eyes remain open with dilated pupils on this dissociative
Definition
ketmaine
Term
MAJOR GOALS OF COMBINING OTHER DRUGS WITH KETAMINE: (4)
Definition
1. improve analgesia
2. improve muscle relaxation
3. prolong anesthesia period and immobilization
4. decrease amt. of ketamine needed
Term
which ketamine combo is most used in large animal med? what is used in small animal?
Definition
xylazine-ketamine; benzodiazepine-ketamine
Term
Which benzo is used with ketamine most often in small animal med?
Definition
Midazolam
Term
You want to avoid this combo in head or eye traumas due to increased cranial and ocular pressures
Definition
ketamine/benzo (versed or valium)
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-?
Definition
Telazol- (tiletamine and zolazepam)
Term
Is Telazol appropriate as the sole anesthetic agent for a procedure?
Definition
No
Term
What is the best choice of injectable drug for frightened or aggressive dogs- causes respiratory depression?
Definition
Telazol
Term
This drug has a very smooth pleasant induction and recovery, rapid, but respiratory depression is the major side-effect?
Definition
Propofol
Term
The elimination rate exceeds the hepatic perfusion of this drug.
Definition
Propofol
Term
The "intralipid" vehicle of this drug can support bacterial growth and can cause histamine reslease
Definition
propofol
Term
This injectable drug type has a cumulative effect, though this drug of MJ's choice has NO cumulative effect/
Definition
dissociative anesthetics; propofol
Term
It is important to limit uses of propofol in cats:
Definition
TRUE
Term
Which injectable drug is our heart friendly drug (maintains cardiac output, blocks adreno-cortical stess response, rapid recovery, good relaxation, poor analgesia)
Definition
etomidate
Term
rapidly acting steroidal anesthetic on GABA receptors:
Definition
Alfaxalone
Term
Thiopental belongs to this group of injectables:
Definition
Barbituates
Term
This group of drugs causes CNS depression, no analgesia, and RAS depression and is currently unavailable on the market:
Definition
barbiturates
Term
These are physiologic effects of barbiturates:
Definition
1. mild transient increase in HR
2. arrythmias (PVC)
3. decreased contractility
4. decreased arterial BP
5. POTENT RESP DEPRESSION
Term
What are volatile anesthetic agents?
Definition
Liquids that are vaporized and delivered as a vapor in a carrier gas (usually O2)
Term
Though we do not totally know how inhalant anesthetics work, what ions are involved in the mx of action?
Definition
Na, K, Ca, Cl
Term
Which receptor is most likely most involved in volatile anesthetic mech of action?
Definition
GABA
Term
Which 2 volatiles are most commonly used in vet med?
Definition
Isoflurane and sevoflurane
Term
What are the MAC values for Iso and Sevo?
Definition
1.5 for iso and 2 for sevo (in humans)
Term
How does Iso's pungent smell inhibit delivery of anesthetic?
Definition
When masking a pt down, they often hold their breath due to pungent smell, and therefore do not receive any anesthetic
Term
Define MAC:
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
Term
The MAC value of a drug closely correlates with______
Definition
lipid solubility ( the lower the MAC, the more potent and lipid soluble)
Term
Why are concurrent sedatives and analgesics used to reduce the MAC?
Definition
Because volatile inhalants are the most potent and profound CV and respiratory depressant drugs
Term
List factors that can decrease the MAC: 8
Definition
hypothyroidism
geriatric state
neonatal state
PaCO2 > 95 mmHg
PaO2 < 50 mmHg
metabolic acidosis
hypothermia
hemorrhage
Term
At 1.2 MAC, what % of pts will not respond to stimulus?
Definition
95%
Term
At 2 MAC, what percent of pts will not respond to stimulus?
Definition
98%
Term
What is the aim of MAC/volatile anesthetics?
Definition
To keep pt in surgical plane while at lowest possible % of anesthetic volatile
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
Term
Of these three PD effects of volatiles, which is desired? CNS effects, CV effects, Resp effects
Definition
CNS effects
Term
Name CNS effects of volatile agents:
Definition
loss of consciousness
analgesia
amnesia
muscle relaxation
decreased cerebral metabolic rate
cerebral vasodilation
Term
In which class of drugs is there minimal direct myocardial depression, hypotension due to vasodilation, minimal arrythmic effects, and maintained baroreceptor reflex?
Definition
volatile anesthetics
Term
Which group of drugs can cause infertility and birth defects, bone marrow suppression....
Definition
volatile anesthetic inahlants
Term
Stage I of Anesthesia:
Definition
voluntary excitement
Term
Stage II of anesthesia:
Definition
involuntary excitement
Term
Stage three of anesthesia:
Definition
General anesthesia with three planes
Term
Plane I
Plane II
Plane III
of anesthesia
Definition
I: light
II: medium
III: deep
Term
Stage IV of anesthesia:
Definition
overdose
Term
What is the surgical plane of anesthesia?
Definition
Stage III, Plane II
Term
What method of anesthesia takes the patient directly to stage III?
Definition
injectable
Term
What 4 things does monitoring general anesthesia include?
Definition
1. determining stage
2. monitoring muscle tone
3. reflex activity
4. eye signs
Term
What skeletal muscle tone do we most often monitor during anesthesia?
Definition
Jaw
anal sphincter
limb muscle
Term
What 5 reflexes do we monitor in an anesthetized patient?
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
Term
Central eye + palpebral reflex intact + constricted pupil =
Definition
light anesthesia
Term
Ventromedial rotation of eye + wak or absent palpebral reflex =
Definition
surgical plane
Term
Central eye position + absence of palpebral reflex + dilated pupil =
Definition
deep anesthesia
Term
pupils are constricted if pt is too _____ but dilated if the patient is too _____
Definition
light; deep
Term
When predicting complications, what is H^3?
Definition
Hyptension
Hypothermia
Hypoventilation
Term
IV fluid rate should be:
Definition
10 ml/kg/hr for surgical anes. then decreased to 5 ml/kg/hr after 1-2 hrs
Term
What is the equation for a fluid rate infusion?
Definition
FRI = [BW (kg) x infusion rate (ml/kg/hr) x infusion set calibration (drops/ml)/ 60 (min in an hour)
Term
In what cases would you not want to give fluids?
Definition
pulmonary contusions
cardiac disease
anuric renal fail
low plamsa oncotic pressure
Term
At what SAP can you not detect peripheral pulse anymore?
Definition
<50 mmHg
Term
What are the MAP and SAP standards for adequate tissue perfusion?
Definition
SAP >90mmHg
MAP >70 mmHg
Term
Doppler cuff width should must be ____-____%
Definition
40-60 circumference leg or tail
Term
What is the gold standard of BP monitoring?
Definition
Direct (intra-arterial)
Term
How can yo recognize hypotension?
Definition
low MAP, SAP
prolonged CRT
pale mm
weak pulses
elevated T wave
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
Term
What does CVP measure?
Definition
The pressure in the right atrium- used in critical cases
Term
Negative CVP?
Elevated CVP?
Definition
-hypovolemia
-overadminsitration of fluid
Term
What is adequate cardiac output dependent on?
Definition
adequate blood volume
Term
What % of blood loss can healthy animals tolerate?
Definition
20
Term
Old, debilitated, anemic may need transfusion after % of blood volume loss?
Definition
10
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
Term
Normal O2 saturation?
Definition
96-100%
Term
Gold standard for measuring blood oxygenation?
Definition
Blood gas analysis
Term
What should ETCO2 be?
Definition
35-45 mmHg
Term
Minimum urine production under general anesthesia:
Definition
.5-1 ml/kg/hr
Term
What is the PSI of a full O2 tank?
Definition
2200 pSI
Term
Full E tank has _____PSI and _____Liters at ____degrees Celsius
Definition
2200; 680; 20
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
Term
Final stage of pressure reduction is at the flow meter. What is the last reduced pressure?
Definition
15-20 psi
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