Intro to Anesthesia Ch 1 & 2; Thomas F17 – Flashcards
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Explain the Continuum of CNS Depression (chart)
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(chart)
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Sedation vs. Tranquilization
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Sedation = CNS depression Drowsiness Drug-induced Various levels Slightly aware or unaware of surroundings Aroused by noxious stimulation Uses: minor procedures Tranquilization = Calmness Patient is reluctant to move Aware of surroundings but doesn't care
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Hypnosis vs. Narcosis
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Hypnosis = Drug-induced Sleeplike state Impairs patient's ability to respond to stimuli Patient can be aroused with sufficient stimulation Narcosis = Drug-induced sleep Patient is not easily aroused Associated with narcotic drugs
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Define Local Anesthesia
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1- Targets a small, specific area of the body 2- Loss of sensation to a specific area 3- Drug is infiltrated into the desired area
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Define Topical Anesthesia
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1- Applied to body surfaces or a wound 2- Produces a superficial loss of sensation
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Define Regional Anesthesia
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1- Loss of sensation to a limited area of the body For example, Nerve blocks & Epidural anesthesia
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Define Balanced Anesthesia
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1- Using multiple drugs in smaller quantities Maximizes benefits & Minimizes adverse effects Gives anesthetist greater control
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The Credentialed Veterinary Technician's Role as an Anesthetist (4)
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1- Anesthetic machine (a) Preparation (b) Operation (c) Maintenance 2- Administer anesthetic agents 3- Endotracheal intubation 4- Patient monitoring
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Anesthesia Challenges and Risks (5)
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1_ Dose calculation and rate adjustment 2- Vital signs and anesthetic depth 3- Assess multiple pieces of information 4- Patient management 5- Anesthetic accidents
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Anesthetics have a Wide or Narrow therapeutic index?
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NARROW
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Miscalculation during anesthesia can result in...
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serious consequences Most anesthetic agents have a very narrow therapeutic index, so the consequences of a calculation or administration error may be serious. Therefore care and attention to detail are critical when dosages are calculated and rates of administration are adjusted
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What does "Assess Multiple Pieces of Information" during anesthetic monitoring mean?
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The anesthetist must accurately interpret a wide spectrum of visual, tactile, and auditory information from the patient, anesthetic equipment, and monitoring devices. To do this successfully, he or she must be able to rapidly assess multiple pieces of information and distinguish those that require action from those that do not.
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What are "Anesthetic Accidents"?
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Death, stroke (in humans) The outcome can be devastating or lethal Owners may pursue legal action Prevent accidents by using high standards Keep meticulous records
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Role of the Veterinary Anesthetist (6)
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Minimum patient database Proper patient fasting Preinduction patient care All supplies are available All equipment is in working order Preanesthetic medication
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Minimum Patient Database (MPD)... 3 things
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Patient history Physical examination and assessment Preanesthetic diagnostic workup
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Patient Preparation "To Do" List (7 things)-- Chart
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(chart)
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When obtaining patient history, remember to obtain these 5 things for each aspect...
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Information given freely Duration Severity or volume Frequency Appearance or character
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When obtaining the history, determine each of the following: (5)
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The signalment Current and past illnesses Medications currently being administered Allergies or drug reactions The status of preventive care
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Patient History - SIGNALMENT (5)
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Species Breed Age Sex Reproductive status
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Anticholinergics avoided in ...
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ruminants
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Ventilation and physical support for...?
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large animals
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Excess airway secretions occur in ...?
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cats and ruminants
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Exotic animals are handled ...?
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differently; they're weird
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___ and ____ are more sensitive to opioids
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Horses and cats
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____ and ____ are sensitive to acepromazine
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Boxers and giant breeds
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____ are resistant to acepromazine
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Terriers
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_______ are difficult to intubate
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Brachiocephalic dogs
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______ are sensitive to barbiturates
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Sighthounds
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_____ are sensitive to sedatives
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Draft horses
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Don't use thiobarbiturates on _______ (and give examples)
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sight hounds Which are = Greyhounds Irish Wolf hounds Saluki Afghan Borzoi Whippet Basenji Pharaoh hound
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During the Anesthesia Pre anesthetic evaluation, Signalment can alert to possible problems, give 3 examples
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1- Age 2- Sex (Status) 3- Breed Young patients may have Hypothermia or Hypoglycemia. Old patient may have Decrease liver and kidney function. Decreased muscle mass May also affect dose. Sex and reproductive status; are they In heat ? Pregnant?
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Acepromazine is contraindicated in ...?
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stallions
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Xylazine is contraindicated in pregnant ___ and ____.
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cows and ewes
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Re: Patient History—Medications; May influence effect of anesthetic agents, give 5 different ways
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1- Sympathomimetics 2- Tricyclic antidepressants 3- Antibiotics 4- Monoamine oxidase inhibitors 5- Antihistamines Detailed explinations = 1- Epinephrine and cyclohexamines, xylazine, barbiturates, and halothane can cause cardiac arrhythmias. 2- Amitriptyline and clomipramine can cause cardiac arrhythmias. 3- Chloramphenicol can cause decreased biotransformation of barbiturate anesthetics and lead to prolonged recovery. 4- Amitraz and selegeline can increase the effects of morphine and other opioids. They can also lead to additive effects with anticholinergics or CNS depressants. 5- Antihistamines can cause CNS and respiratory depression with opioids.
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What does an average Cat ketamine recovery look like?
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prolonged
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What will Dogs have after acepromazine sedation?
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behavioral change
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Patient History—Record Preventive Care includes... (2+ species specific)
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1- Vaccination—date and type 2- Fecal analysis and parasite control Heartworm status—dogs FLV and FIV testing—cats Tetanus toxoid—horses
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Physical Examination (PE) vs. Physical Assessment (PA)
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PE = Performed by a veterinarian To determine diagnosis and treatment planning PA = Performed by a veterinary technician To provide maximum patient care, respond to patient needs, detect changes in patient condition
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What organ systems are most affected by anesthetic agents?
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Cardiovascular, nervous, and pulmonary systems are most affected by anesthetic agents
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Describe the body condition scales of 1-9 and 1-5 for dogs and cats
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1-9 scale 4-5 in dogs or 5 in cats is the ideal weight 1 is extreme cachexia; 9 is extreme obesity 1-5 scale 3 is the ideal weight for both 1 is extreme cachexia; 5 is extreme obesity
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A B/A/R patient is....
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bright, alert, and responsive—he is noticeably engaged and interested in his environment.
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A Q/A/R patient is...
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quiet, alert, and responsive—he is not really engaged or interested in what is going on around him.
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What does an elevated or decreased body temp indicate?
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Elevated = inflammation Decreased = numerous systemic disorders ----------------------------------------------- A high body temperature most commonly indicates an inflammatory condition, which must be identified and may require pretreatment with antibiotics, antiinflammatories, or other medication. A significantly low body temperature may be associated with one of a number of serious systemic disorders.
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Normal vital signs for a dog
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Body temp 100-102.5 HR 60-180 Heart Rhythm NSR or SA RR 10-30 (panting is normal)
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Normal vital signs in a cat
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Body Temp 100-102.5 HR 120-240 Heart Rhythm NSR only RR 15-30
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Normal vital signs for a horse
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Body Temp 99-100.5 HR 30-45 Heart Rhythm NSR, SA or 1st or 2nd degree AV block RR 8-20
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Normal vital signs for a cow
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Body Temp 100-102.5 HR 60-80 Heart Rhythm NSR or SA RR 8-20
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Acronym for Eyes, ears, nose, oral cavity (throat)
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EENT
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What does PLR stand for?
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Pupillary Light Reflex
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Normal sinus rhythm (NSR) can be expected in healthy....
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Dogs, cats, rodents, ferrets, rabbits, horses, ruminants No rhythm irregularities
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Sinus arrhythmia (SA) can be expected in HEALTHY....
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Dogs, horses, ruminants Heart rate is affected by respiration but they're still healthy Sinus arrhythmia is a rhythm in which the heart rate cyclically increases during inspiration and decreases during expiration. This rhythm may be pronounced in young, healthy dogs and can sound to the inexperienced anesthetist as if there are skipped or premature beats. Abnormal rhythms can be differentiated from sinus arrhythmia by observing the respirations while listening to the heart.
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How to find and listen to a heart murmur
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Listen over each valve; Cranial-most aspect of left axilla—PDA They are Caused by blood flow turbulence and May result in increased patient anesthetic risk Murmurs can be associated with leaking valves, stenotic valves, stenotic vessels, and abnormal communication between heart chambers.
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Pulse palpation points in Dogs and cats....
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femoral artery
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Pulse palpation points in large animals...
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animals—facial artery, ventral tail artery, or auricular artery
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How do you find the femoral artery in a dog or cat?
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In the conscious dog and cat the pulse is most easily palpated at the femoral artery, on the medial side of the rear leg. The patient should be standing quietly, and the femoral artery should be located by cupping the hand around the medial aspect of the thigh with the pad of the first or second finger in the groin just over the femur
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Pale mucous membranes or prolonged capillary refill time are indicative of ...
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decreased perfusion from shock, vasoconstriction, hypotension, or a variety of other issues including anemia.
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Cyanotic mucous membranes indicate what?
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reduced oxygen saturation, which is a medical emergency.
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Dyspnea and cyanosis are both what?
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medical emergencies and should be brought to the veterinarian's attention immediately.
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Avoid _________ dyspneic or cyanotic patients... because why?
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STRESSING; as they are very intolerant of handling and can die during examination.
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RE: Respiratory System Examination Lung Auscultation, what are Discontinuous sounds?
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crackles, rales, or rhonchi
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RE: Respiratory System Examination Lung Auscultation, what are Continuous sounds?
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wheezes
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RE: Respiratory System Examination Lung Auscultation, what may Discontinuous or Continuous be an indication of?
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either pulmonary conditions (including pneumonia, bronchial disease, or asthma) or heart failure
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A distended abdomen may indicate ....?
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fluid accumulation, pregnancy, organ enlargement, or tumor
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RE: Abdominal Palpation and Auscultation, normal is....?
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soft and not painful
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RE: Preanesthetic Diagnostic Workup.... No one standardized diagnostic workup fits every patient to be anesthetized, give 3 examples of types of workups that could occur
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Geriatric patient workup Elective surgery patient workup Sick patient workup Workup based on financial considerations
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What blood test is in-house and an excellent indicator of the likelihood of perioperative bleeding?
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The buccal mucosal bleeding time is a simple in-house screening test that is an excellent indicator of the likelihood of perioperative bleeding
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What things are RED FLAGS and should be pointed out to the attending DVM immediately?
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The following findings should be reported to the attending veterinarian immediately: A PCV ;25% in a dog or ;20% in a cat, horse, or cow A PP ;4.0 in any species Any decrease in the platelet count Any coagulation test result outside the normal range
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Preanesthetic Diagnostic Tests and Procedures... name some (6+)
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Complete blood count (CBC) Urinalysis Blood chemistry Blood coagulation screens Electrocardiogram (ECG) Radiography Other tests as deemed necessary
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Blood test Ideally done day of or day prior for dogs categorized by age 7yrs
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Laboratory evaluation of patient Young dogs7yr: PCV, TPP, GLU, BUN, CREA,, ALT, ALK PHOS, +/- additional chemistries, and electrolytes (Na+, K+, Cl-)
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Patient Status: American Society of Anesthesiologists standards; Class I
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Class I Normal patient with no organic disease
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Patient Status: American Society of Anesthesiologists standards; Class II
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Class II Patient with mild systemic disease
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Patient Status: American Society of Anesthesiologists standards; Class III
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Class III Patient with severe systemic disease limits activity but not incapacitating
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Patient Status: American Society of Anesthesiologists standards; Class IV
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Class IV Patient with incapacitating systemic disease that is a constant threat to li
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Patient Status: American Society of Anesthesiologists standards; Class V
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Class V Moribund patient is not expected to live 24 hours with or without surgery
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How to Designate emergency operation?
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Designate emergency operation by "E" after appropriate classification
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Classification is based on an evaluation of the Minimum Patient Database; explain
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Class P1 = minimal anesthetic risk Class P5 = extreme anesthetic risk Classes P1 and P2 use standard anesthetic protocol Classes P3 to P5 need special protocols and stabilization In general, class PS1 and class PS2 patients can be anesthetized with standard anesthetic protocols. Class PS3 to PS5 patients often require special protocols, and should be stabilized before surgery if possible.
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_________ is a preanesthetic that is also an antiemetic—it will prevent vomiting
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Acetpromazine
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_______ will induce vomiting so the stomach can be emptied.
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Xylazine
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Reasons for placing an IV catheter (5)
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1- Fluid administration 2- Rapid IV access in an emergency 3- Constant rate infusion (CRI) of drugs or anesthetic agents 4- Administration of vesicants 5- Sequential administration of incompatible drugs
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Sizes of IV catheters used in small animals and large animals
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Most commonly used 16-24 gauge, 3/4- to 2-inch catheter (small animals) 12-16 gauge, 5¼-inch catheter (large animals)
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Two main types of IV catheters are in common use for fluid and drug administration in veterinary patients....
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through-the-needle catheters and over-the-needle catheters
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Although commonly used in critical care patients, ___________catheters are not frequently used for anesthesia because they are more complex, expensive, and time-consuming to place, especially if the technician is not experienced with their use.
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through-the-needle catheters
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When placing and maintaining an IV catheter for use during surgery, consider the following... (8)
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1- Choose a catheter of sufficient length to minimize the risk of dislodgement. 2- Choose a catheter of large diameter. 3- Choose a location that will not interfere with the procedure. 4- Use an administration set with an injection port. 5- After positioning the patient, check that fluids are flowing freely. 6- Avoid excessive catheter and patient movement during transfer. 7- Administer IV drugs slowly. 8- Use saline flush following IV injection of a drug.
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Placing an IV Catheter in a Small Animal Patient (name the parts in the chart)
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a, Catheter (20 to 24 gauge, ¾ to 1 ½ inches long for cats; 16 to 22 gauge, 1 to 2 inches long for dogs); b, two approximately 6-inch-long strips of 1-inch porous adhesive tape, one approximately 6-inch-long and one approximately 3-inch-long strip of ½-inch tape; c, clipper with #40 blade; d, 1:1 chlorhexidine surgical scrub/water-soaked cotton balls and alcohol-soaked cotton balls; e, ½-inch plastic strip with antiseptic ointment; f, T-port, cap, or administration set (both the catheter and T-port should be flushed with saline before catheterization).
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Placing an IV Catheter in a Small Animal Patient (1)
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Standard aseptic technique uses three chlorhexidine-soaked alcohol cotton balls followed by three alcohol-soaked cotton balls. Assistant is needed to hold off the vein. Apply tension in a ventral direction to tense the skin. Position the catheter with the needle fully inserted and with the bevel up.
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Placing an IV Catheter in a Small Animal Patient (Cont'd -2)
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Advance the catheter and needle assembly as a unit through the skin and the near wall of the vein. Blood will flashback into the needle hub when the vein is entered. Advance the unit a few more millimeters until the end of the catheter is firmly seated in the vein.
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Placing an IV Catheter in a Small Animal Patient (Cont'd-3)
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Holding the needle stationary, advance the catheter over the end of the needle until it is inserted to the hub. Remove the needle. Have the assistant apply pressure at the insertion site to prevent bleeding.
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Placing an IV Catheter in a Small Animal Patient (Cont'd-4)
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Flush the catheter with several milliliters of normal saline through the injection port.
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Placing an IV Catheter in a Small Animal Patient (Cont'd-5)
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Twist the 3-inch-long strip of ½-inch tape into a "bow-tie" configuration.
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Placing an IV Catheter in a Small Animal Patient (Cont'd-7)
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Chlorhexidine ointment is used on the plastic strip.
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Placing an IV Catheter in a Small Animal Patient (Cont'd-8)
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Tear a ½-inch "V" in a 6-inch length of 1-inch tape about 1 inch from the end. Slip it under the catheter with the torn area directly under the catheter hub.
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Placing an IV Catheter in a Small Animal Patient (Cont'd-9)
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Apply the remainder of this length of tape over the plastic strip to secure.
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Placing an IV Catheter in a Small Animal Patient (Cont'd-10)
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Apply the remaining 6-inch-long strip of 1-inch tape around the administration set line or T-port to create a tension loop.
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Giving an IV Injection Through an IV Administration Set Port -1
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IV fluids should be flowing at the standard infusion rate.
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Giving an IV Injection Through an IV Administration Set Port (Cont'd-2)
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Pinching off the administration set line between the injection port and the fluid bag will prevent backflow of agent into the fluid bag during injection.
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Giving an IV Injection Through an IV Administration Set Port (Cont'd-3)
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Give the medication at an appropriate rate as dictated by the VIC. For most medications, a slow IV bolus is appropriate.
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Giving an IV Injection Through an IV Administration Set Port (Cont'd-4)
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Following injection, the administration set line must be released so that the entire dose of medication is flushed into the patient. As much as 0.5 to 2 mL of agent will remain in the fluid line and catheter until flushed out. When administering an induction agent, administer additional doses to effect by following these same steps. As soon as the patient is at an anesthetic depth adequate to permit intubation, remove the needle and syringe to prevent accidental overdose.
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Composition of Body Fluids
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In adult animals, about 60% of the body weight is water. Of the 60% of the body weight that consists of water, about two thirds (or 40% of the body weight) is intracellular fluid (ICF). Although estimates of extracellular fluid (ECF) vary widely (about 15% to 30% of body weight for small animals), most clinicians use the figure 20% for the purpose of calculating fluid needs. About three fourths of the ECF (15% of the body weight) is interstitial fluid (fluid between the cells), and one fourth (5% of the total body weight) is intravascular fluid (plasma) .
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Plasma is ____ of body weight
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5%
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Blood volume is ______ of body weight—dogs and large animals and _____ of body weight—cats
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8-9% of body weight—dogs and large animals 6-7% of body weight—cats
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Calculating blood volume; Dogs and large animal and cats (2)
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Dogs and large animals = 90 mL/kg lean body weight Cats = 60 mL/kg lean body weight
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Body fluids consist of water and ________.
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solutes
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Body fluid solutes are either atoms or molecules dissolved in body water. The solutes most important in fluid therapy are small-molecular-weight electrically charged particles called _______, large-molecular-weight plasma proteins called _______, and small nonionic particles such as ______ and _________ ________.
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ions, colloids, glucose and small proteins.
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Cations have a ______ charge Anions have a ______ charge
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positive , negative
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Important Electrolytes: Anions (4)
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Chloride (Cl?) Bicarbonate (HCO3?) Phosphates (HPO42? and H2PO4?) Proteins
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Important Electrolytes: Cations
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Sodium (Na+) Potassium (K+) Magnesium (Mg2+) Calcium (Ca2+)
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What are Electrolytes?
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Electrolytes are substances that when dissolved separate into positively charged ions, called cations (so called because they migrate toward the cathode during electrolysis), and negatively charged ions, called anions (so called because they migrate toward the anode).
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Define Homeostasis
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A constant state within the body created and maintained by normal physiologic processes Homeostasis is the state of health.
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Solute concentration (osmolarity) in any fluid compartment must be __________..... WHY?
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300 mOms/L. Because Solutes must provide osmotic pressure to pull water into a compartment. In any given compartment, positively and negatively charged particle numbers must be equal.
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What % of IV fluids will stay in the intravascular and interstitial space? WHY?
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One-third of IV fluids administered will stay in the intravascular space. Two-thirds will diffuse into the interstitial space. Colloids don't pass freely through the vascular endothelium. The presence of colloids in the intravascular space draws water into the space creating osmotic or oncotic pressure.
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What 2 solutes must be monitored closely to make sure normal heart and muscle function continue?
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Some solute concentrations (Ca2+, K+) must be kept within a narrow range to maintain normal heart and muscle function.
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Profound perioperative hemorrhage involves what?
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significant loss of albumin, blood cells, and other constituents of blood in addition to electrolytes and water. Patients with low albumin may require colloids or blood plasma (fluids containing large solutes), which provide oncotically active particles that remain in the vascular space for longer periods and help maintain blood volume and pressure.
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To support patients experiencing severe perioperative hemorrhage, administration of WHAT may be necessary, and why?
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blood products may be necessary to provide RBCs or hemoglobin to support oxygen-carrying capacity, and in some cases clotting factors and platelets to support normal coagulation.
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Perioperative hemorrhage involves what?
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fluid loss from the intravascular space, part of the ECF space.
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Patients with perioperative hemorrhage may also benefit from what?
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Patients with perioperative hemorrhage may also benefit from hypertonic saline or colloid solutions, both of which draw water into the vascular space and raise blood pressure.
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What are the 2 Classifications of IV fluids?
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These fluids are most commonly classified as either crystalloids or colloids based in the molecular weight of the primary solutes they contain All IV fluids are solutions consisting of one or more solutes dissolved in water. Most IV fluids contain one or more electrolytes. Dextrose, a naturally occurring form of glucose, is another ingredient present in some fluids. Some fluids also contain the buffers lactate, gluconate, or acetate, which are converted to HCO3- by the liver and help regulate pH. Others contain colloids (large-molecular-weight solutes). There are many intravenous solutions, each with different solute profiles.
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Replacement fluids have high concentrations of ___ and ____ (as ECF does) and are designed to replace fluid losses.
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Na+ and Cl-
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Maintenance fluids have lower concentrations of Na+ and Cl- but somewhat more ____ and are designed to maintain fluid balance over a longer period.
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K+
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General Facts about Crystalloid Intravenous Fluids (3)
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Water and small-molecular-weight solutes May contain dextrose and/or buffers Often used in anesthetized patients
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Isotonic, polyionic replacement solutions (4)
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Lactated Ringer's solution (LR) Normosol-R (NR) Plasma-Lyte A and R (PA and PR) Isolyte S (IS)
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____ & ________ and cannot be administered with blood products
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LR and PR contain calcium
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Isotonic, polyionic maintenance solutions contain less ___ and _____
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Contain less sodium and chloride
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Isotonic, polyionic maintenance solutions contain more _____
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potassium
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Isotonic, polyionic maintenance solutions contain lower concentrations of _____
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buffer
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Isotonic, polyionic maintenance solutions contain _____
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DEXTROSE
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Isotonic, polyionic maintenance solutions INCLUDE _____ and _______
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Normosol-M in 5% dextrose (NM5) Plasma-Lyte 56 in 5% dextrose (PL5)
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Normal saline (NS) includes.... (3)
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Physiologic saline 0.9% saline sodium chloride 0.9%
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Normal saline (NS) is Sometimes used instead of ...?
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isotonic, polyionic replacement crystalloid solution
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Normal saline (NS) is used to....(3)
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Used to bathe tissues during surgery Used to flush the IV catheter Used to flush body cavities
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_____________ are the first choice for fluid therapy of healthy patients undergoing routine surgery as well as many sick patients, as long as the PCV is over ______ and the plasma protein is over _______
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Isotonic, polyionic replacement crystalloids, 20% , 3.5 gm/dL.
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The hypertonicity results in ....?
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fluid being drawn into the intravascular space to maintain blood pressure
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Concentrated saline solution (3%, 7%, and 23.4% [diluted to less than or equal to 7.5%]) is given with isotonic crystalloids in acute care settings to treat ....?
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patients with hypovolemic, traumatic, or endotoxic shock
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Hypertonic saline rapidly but temporarily draws water ______ the intravascular space and supports blood pressure, but, like other crystalloids, _______________ into the interstitial space and so must be followed with _________ if the patient needs long-term blood volume expansion.
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into, rapidly diffuses, colloids
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Dextrose solutions with or without electrolytes are used to support .....?
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blood glucose in neonatal, hypoglycemic, or debilitated patients and in patients with diabetes mellitus that are receiving insulin, or as a part of therapy for hyperkalemia.
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Dextrose solutions are considered ________ solutions
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hypotonic
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Dextrose solutions come in what %s?
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5% dextrose in water (D5W) or 2.5% dextrose
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Colloids are used to support ...?
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expansion of blood volume and blood pressure.
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Colloid solutions stay in the intravascular space longer because ?
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...of the large solutes that cannot pass through the endothelium. Colloids solutions (also referred to as colloids) contain large-molecular-weight solutes that do not freely diffuse across vascular endothelium and therefore stay in the intravascular space.
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Give an example of a Synthetic colloid solutions
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Hetastarch
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Fluid therapy is an exact or inexact science.
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INEXACT. Although there are generally accepted fluid choices and administration rates for animals that are in shock, ill, experiencing blood loss, or undergoing surgery, each patient must be managed in a unique manner appropriate to its condition. Even though these standard rates are used as a starting point, ultimately the veterinarian will use his or her professional judgment to determine the final rate for each patient.
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Fluid Administration Rate During routine anesthesia and surgery
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10 mL/kg/hr during the first hour 5 mL/kg/hr during remainder of the procedure For both small and large animals, a rate of 10 mL/kg/hr during the first hour followed by 5 mL/kg/hr for the remainder of the procedure is commonly used as the IV administration rate for crystalloids during routine anesthesia and surgery. The authors of the 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats consider that this may be unnecessarily high for many patients, especially cats, which are more susceptible to overhydration. They therefore recommend an initial rate of 5 mL/kg/hr in dogs and 3 mL/kg/hr in cats, followed by a reduced rate if the patient is anesthetized for more than 1 hour.
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Fluid Administration Rate Isotonic Crystalloids; Excessive hemorrhage or hypotension
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40 mL/kg/hr (dogs and large animals) 20 mL/kg/hr (cats) As mentioned in the previous section, isotonic, polyionic replacement crystalloids including LR, PLA, PL148, and NR are the first choice fluid for healthy patients undergoing routine surgery as well as many sick patients as long as the PCV is over 20% and the plasma protein is over 3.5 gm/dL. Consequently these fluids are used in the vast majority of anesthetized patients.
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Fluid Administration Rate Isotonic Crystalloids; Shock
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90 mL/kg/hr as rapidly as possibly (dogs and large animals) 55 mL/kg/hr as rapidly as possible (cats) As mentioned in the previous section, isotonic, polyionic replacement crystalloids including LR, PLA, PL148, and NR are the first choice fluid for healthy patients undergoing routine surgery as well as many sick patients as long as the PCV is over 20% and the plasma protein is over 3.5 gm/dL. Consequently these fluids are used in the vast majority of anesthetized patients.
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Fluid Administration Rate Isotonic Crystalloids; Shock and blood loss (large and small animals)
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7% hypertonic saline 3-4 mL/kg slowly over 5 minutes Followed by isotonic crystalloid solution As mentioned in the previous section, isotonic, polyionic replacement crystalloids including LR, PLA, PL148, and NR are the first choice fluid for healthy patients undergoing routine surgery as well as many sick patients as long as the PCV is over 20% and the plasma protein is over 3.5 gm/dL. Consequently these fluids are used in the vast majority of anesthetized patients.
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Hetastarch can cause ____ and _____ if administered too rapidly
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nausea and vomiting
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Fluid Administration Rate Colloids; Administer as a slow bolus
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Over 15-60 minutes (dogs and large animals) Over 30-60 minutes (cats) Synthetic colloids should be administered to dogs and large animals as a slow bolus of 5 mL/kg over 15 to 60 minutes and to cats as a slow bolus of 2.5 to 3 mL/kg over 30 to 60 minutes with reassessment before giving additional boluses, up to a maximum of 10 to 20 mL/kg/day for dogs and for large animals and 5 to 10 mL/kg/day for cats.
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Adverse Effects of Fluid Administration
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1- Volume overload Pulmonary or cerebral edema Use slower infusion rate 2- Overhydration Ocular and nasal discharge Chemosis (edema and swelling of the conjunctiva), Subcutaneous edema Increased lung sounds Increased respiratory rate and dyspnea Coughing and restlessness if patient is awake Hemodilution (dilution of the RBCs and plasma proteins)
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Who is at greater risk for fluid Volume overload?
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Animals weighing less than 5 kg and those with cardiac or renal disease are at greatest risk.
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Use macrodrip sets (10 or 15 gtt/mL) for infusion rates equal to or greater than _______
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100 mL/hr.
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Use microdrip sets (60 drops/mL) for infusion rates less than ________
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100 mL/hr.
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Preanesthetic/Preoperative Medications (5)
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Antibiotics Preemptive analgesia Antiemetics Anticonvulsants Antiinflammatory drugs
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Anesthetic agent is....?
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any drug used to induce a loss of sensation with or without unconsciousness
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Adjunct is...?
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a drug that is not a true anesthetic, but that is used during anesthesia to produce other desired effects such as sedation, muscle relaxation, analgesia, reversal, neuromuscular blockade, or parasympathetic blockade
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Route of administration for Anesthetic Agents and Adjuncts (4)
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Inhalant Injectable Oral Topical
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Time of administration periods (3)
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Preanesthetic Induction Maintenance
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Agonists does what?
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Bind to and stimulate target tissue Most anesthetic agents and adjuncts are Agonists
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Antagonists do what?
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Bind to target tissue but don't stimulate Reversal agents are Antagonists Antagonists competitively bind to target tissues preventing the corresponding agonist from causing more stimulation. Must use the proper antagonist when "waking" a patient from anesthesia.
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Partial Agonists and Agonist-Antagonists
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Opioids Partial agonists Agonist-antagonists Used to block pure agonists
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