Term
| Know which anesthetic protocols would result in the fastest induction time and the best control over anesthetic depth |
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Definition
| Intravenous induction and maint with an inhalant agent |
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Term
| Know what factors would, and would not, effect the duration of a patient’s anesthetic recovery period. |
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Definition
- length of the anesthetic period
- pt condition
- anes type and route of admin (lengthy more common w/ IM rather than IV given)
- pt temp
- pt breed – certain breeds (ex: greyhounds, salukis, Afghan hounds, whippets and Russian wolfhounds) are slow to recover from certain agents, esp barbiturates |
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Term
| . Know the appropriate vaporizer settings for inducing and maintaining patients on Sevoflurane and Isoflurane. |
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Definition
Mask/chamber induction w/ Iso – 3 – 5 %
Maint Iso 1.5 – 2.5%
Mask/chamber induction w/ Sevo – 4 – 6%
Maint Sevo 2.5 – 4% |
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Term
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Definition
6 – 8 mg/kg IV to effect if not premedicated
2 – 4 mg/kg IV to effect after premed
Give slowly at a rate of ¼ - ½ the calc dose every 30 sec to effect. A more rapid induction rate may be helpful in uncooperative pts but is more likely to induce apnea. If the inj is too slow, excitement may be seen. |
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Term
| IV thiopental sodium +/- lidocaine induction |
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Definition
4 – 8 mg/kg IV to effect after premedication
10 – 15 mg/kg IV if not premedicated (Admin w/o premed is NOT recommended
- via an indwelling catheter to reduce the risk of perivascular inj
- alternatively, a skilled anes may use a needle/syringe with extreme care
- healthy pts – give ½ dose over 10 – 15 sec, then to effect
- if intubation not possible after 45 sec, give 2nd dose of approx 1/4 the calc dose. Continue until desired effect reached
- this allows rapid induction of stage III anes w/ minimal stage II excitement
- old, ill, debilitated pts may need much less, given more cautiously/slowly |
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Term
| IV Ketamine/diazepam Induction |
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Definition
IV Ketamine/diazepam:
Ketamine 5.5 mg/kg IV
Diazepam 0.28mg/kg IV mixed in same syringe
(Equivalent to 1 ml of the mixture/20 lb body wt)
An equiv vol of midazolam can be sub for diazepam.
Butorphanol 0.1 – 0.2 mg/kg or hydromorphone 0.1 mg/kg can be given IV before induction, in a separate syringe, for addtl analgesia.
- Give slowly to effect over 60 – 120 sec
- Slow inj minimizes adverse effects
- May take as long as 2 min to reach peak effect – so overly rapid inj may result in overdose
- If bolus inj technique preferred, 1/3 to ½ the calc dose can be given over 15 – 30 sec, w/ further increments q 30 to 60 sec until desired depth reached |
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Term
| IV diazepam/hydromorphone induction |
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Definition
IV diazepam/hydromorphone (this protocol is intended for older or depressed pts)
Diazepam 0.2 mg/kg (max dose of 5mg) IV alternating w/ hydromorphone 0.1 mg/kg IV. Use separate syringes. Administer boluses of each agent alternately until the pt can be intubated. May need more to allow intubation.
(Midazolam may be sub for diazepam at the same dose; fentanyl at 2 mcg/kg may be sub for hydromorphone) |
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Term
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Definition
IV etomidate
Etomidate 1 – 3 mg/kg IV to effect
- give rapidly to effect after premed w/ a tranquilizer, or concurrently w/ IV diazepam or midazolam (use a separate syringe if diazepam is chosen).
- Some anesthetists recommend administering it via the port of a fluid admin set with the fluids running to reduce adverse effects. |
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Term
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Definition
IV methohexital
Methohexital 5 mg/kg IV to effect after premed
11 mg/kg IV if not premed (admin w/o premed is NOT recommended) |
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Term
IV Induction Protocol for P1/P2 cats
IV “kitty magic” (ketamine/butorphanol/ dexmedetomidine) |
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Definition
IV Induction Protocol for P1/P2 cats
IV “kitty magic” (ketamine/butorphanol/ dexmedetomidine)
Ketamine 1.1 – 2.2 mg/kg
Butorphanol 0.11 – 0.22 mg/kg
Dexmedetomidine 0.005 – 0.011 mg/kg IV mixed in the same syringe
This equates to 0.05 – 0.1 ml of each drug for an avg sized (4.5 kg) cat. |
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Term
| Why must IV induction agents be administered “to effect”? |
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Definition
Because the amt of drug needed to induce or maintain anesthesia cannot be accurately predicted for a given pt, and most anes agents have narrow therapeutic indices.
- initial bolus of ¼ to ½ the calc dose
- immed check HR/RR to be sure pt is stable/breathing (keep in mind that a brief period of apnea is a common adverse effect of some IV anesthetics)
- continue monitoring, give addtl boluses as needed until pt has passed through stage II
- when signs of readiness for intubation are present, intubate and bring pt into sx anesthesia
- during process, must be interplay between drug admin and pt monitoring
- give initial dose, rapidly check vital signs, pedal reflex, palpebral reflex, and jaw tone
- give more if needed, check again, etc
- after the initial dose, subsequent doses should be about 1/5 to 1/10 the calc dose |
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Term
| Know which barbiturates can be used to maintain anesthesia without prolonging recovery |
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Definition
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Term
| What do the unidirectional valves do if the ET tube is placed in the esophagus instead of the trachea? |
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Definition
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Term
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Definition
The pt should be supported as it loses consciousness
If the pt has a dzd lung, it should be placed w/ the dzd lung down
Avoid any more than a 15 degree elevation of the rear |
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Term
| . Be able to define the term Stridor. |
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Definition
| Noisy respirations – upper airway obstruction is often assoc w/ stridor, esp on ispiration |
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Term
| After an anesthetic procedure, when it is best to extubate the patient (dogs)? |
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Definition
- In dogs, return to the swallowing reflex is the most appropriate time because this reflex will help protect the pt from pulmonary aspiration if vomiting occurs during recovery.
- Animals that show voluntary head, limb or chewing movements are close to consciousness and should be extubated even if swallowing has not yet occurred
- Exception is brachycephalic dogs - most prefer to delay extubation until pt can lift head unassisted, as early extubation can lead to resp distress from upper airway obstruction.
- in these pts, prep by having a laryngoscope, ET tube (same size or one six=ze smaller) and approp dose of shortacting IV induction agent such as propofol in case reintubation |
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Term
| After an anesthetic procedure, when it is best to extubate the patient (cats)? |
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Definition
- ET tube may be removed when signs of impending arousal are observed, including swallowing, active palpebral reflex, voluntary limb, head or tail movements
- Delaying extubation not recommended because it may predispose the pt to laryngospasm |
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Term
| What should be done with the cuff after dental cleaning, oral surgery, or any other procedure in which blood or other fluids are present in the oral cavity? |
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Definition
| the cuff should be left partially inflated during removal to sweep out the fluid and prevent it from entering the airways |
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Term
| De able to define and understand the term Hypostatic Congestion. |
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Definition
- pooling of blood in the dependent lung and tissues
- a recovering pt should be turned every 10 to 15 minutes to prevent this |
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Term
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Definition
| extending from side to side at right angle to long axis |
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Term
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Definition
| being on an incline or slanting |
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Term
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Definition
| – curving around a center point or axis |
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Term
| Comminuted reducible fracture |
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Definition
| broken or crushed into numerous fragments but able to be placed or aligned with opposite ends of fracture |
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Term
| Comminuted nonreducible fracture |
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Definition
| – broken or crushed into numerous fragments and unable to be placed or aligned together with opposite ends of fracture |
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Term
| Diaphysis - Anatomy of a long bone (femur): |
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Definition
| long shaft or body of bone |
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Term
| Epiphysis (proximal/distal) - Anatomy of a long bone (femur): |
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Definition
| ends of bone, usually wider than the shaft and either entirely cartilaginous or separated from shaft by cartilaginous disk |
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Term
| Metaphysis - Anatomy of a long bone (femur): |
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Definition
| wider end of shaft of the bone adjacent to diaphysis |
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Term
| Periosteum - Anatomy of a long bone (femur): |
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Definition
| fibrous covering around bone that is not covered by articular cartilage. This layer is important for bone growth, repair, nutrition, and attachment for ligaments and tendons |
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Term
| Articular surface - Anatomy of a long bone (femur): |
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Definition
| smooth layer of hyaline cartilage covering epiphysis where one bone forms a joint with another bone |
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Term
| Medullary cavity - Anatomy of a long bone (femur): |
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Definition
| space in diaphysis containing bone marrow |
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Term
| Endosteum - Anatomy of a long bone (femur): |
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Definition
| – fibrous tissue lining medullary cavity of bone |
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Term
| Physis - Anatomy of a long bone (femur): |
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Definition
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Term
Bone planes (femur
Proximal |
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Definition
| area closest to the body or point of origin |
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Term
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Definition
| farthest from the body or point of origin |
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Term
Bone planes (femur
Midshaft |
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Definition
| center of shaft, or toward median plane |
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Term
Bone planes (femur
Lateral |
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Definition
| – farther from medial plane |
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Term
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Definition
| – toward median plane (inside or middle) |
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Term
| Articular/physeal fractures (Salter-Harris fractures) |
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Definition
- always involve the joint
- frequently seen in young, growing animals
- any fracture involving the physis in early stages of development is detrimental to development and may cause angular limb deformities
- can involve the physis itself or the physis and the bone above and below it |
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Term
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Definition
– types of articular fractures that involve the distal end of the humerus
- fracture lines run ventrodorsally through the humeral condyle and run in transverse or oblique configurations through the medial and lateral epicondyles |
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Term
| What scrubs should be used before ortho sx? |
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Definition
| Broad-spectrum antibacterial, antimicrobial, and antifungal scrub and final prep and adherence to strict sterile technique |
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Term
| Fine-needle aspiration biopsy |
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Definition
- easy to perform, minimal morbidity, usually doesn’t require sedation
- one of the simplist methods for cytologiv eval of a mass
- typically has low diagnostic yield
Technique:
- 22 or 20g needle, 5ml syringe
- apply neg pressure by pulling back on the hub of the syringe
- withdraw the needle and syringe from the mass and remove the needle from the syringe
- fill the syringe w/ air, replace the needle, and gently blow the fluid and cells onto a glass slide
- generally performed several times to obtain representative samples |
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Term
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Definition
- as simple to perform as FNA bx
- esp useful for ulcerated surface tumors and is often performed on freshly cut surfaces
- smears of excised masses can also be easily made b4 samples placed in formalin
Technique
- gently blot surface of mass w/ paper towel to remove excess fluid
- gently touch surface of mass to several areas of a glass slide. Take care not to twist or rub the slide against the mass, because doing so would crush cells and destroy the integrity of the sample |
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Term
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Definition
- equipped w/ either a cutting or a core bx needle and as manual or automatic devices
- take a sm piece of tissue (~ size of pencil lead) for histologic exam
- sedated pts
- u/s guided for internal organs
Technique
- clip and scrubt he area to be sampled
- block overlying skin and muscle with a local
- hold w/ one hand and make a sm stab incision into overlying skin
- insert the end of the needle through the stab incision (the instrument is fired and the inner needle advanced into the mass)
- withdraw the entire instrument from the mass
- gently remove sample from the chamber with a cotton swab or needle |
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Term
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Definition
- generally used only after cytology or needle core bx have failed to provide a dx sample
- a sm wedge of tumor is removed from the mass and submitted for bx |
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Term
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Definition
- involves the complete removal of a mass
- generally only performed on benign skin tumors or when the removal of an organ is indicated |
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Term
| What would be the most appropriate clinical function of the CO2 and diode lasers for biopsies? |
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Definition
- clinical fxn consists of ablation, incision, and excision of soft tissue
- CO2 laser is used predominately to create surgical incisions , to excise after incision, or for ablation of tissue
- Because of the enhanced absorption of hemoglobin, the diode laser may provide more proficient incisions and better hemostasis, esp of larger vessels |
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