Veterinary anesthesia – Flashcards
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Anesthetic Protocol
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a series of steps that, when performed properly, maximizes safety and minimizes risk
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Protocol Steps
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1. Weigh the animal 2. Physical Exam 3. Calculate drug dosages and fluid volumes 4. Check volume and findings with veterinarian 5. Set up catheter, IV lines, and anesthetic supplies 6. Give preanesthetic agents 7. Anesthetic Induction and intubation 8. Anesthetic maintenance and monitoring 9. Extubation and recovery
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Three types of preanesthetics
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Anticholinergics Sedatives and Tranquilizers Opioids
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Mode of action of anticholinergics
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blocks ach receptors at the post ganglionic synapse of the parasympathetic nervous system
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Organs effected by anticholinergics
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Heart- heart rate increases GI tract- motility slows Eyes- pupil dilation Secretory Glands- decreases flow (eyes, mouth, etc) Brochi- dilation
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2 Anticholinergics
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Atropine and Glycopyrrolate
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Properties of Atropine
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Crosses placenta natural short duration fast onset
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Properties of Glycopyrrolate
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does not cross placenta synthetic longer duration - slower onset costly
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Purpose of syringe labeling
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identifies syringe filled substance minimizes mistakes in administration means of double checking medications
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What should be included on a label
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patient name/ID drug name drug volume route of administration
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Types of sedatives/tranquilizers
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phenothiazines benzodiazepines thiazine derivatives (alpha 2 agonists)
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example of a phenothiazine
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Acepromazine
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effects of Phenothiazines
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sedation antiemetic antiarrhythmic antihistamine vaso dilation penile prolapse in horses elevated 3rd eyelids
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Acepromazine precautions
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cautious use in boxers potentiates seizure activity
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Example of a benzodiazepine
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Valium (Diazepam)
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effects of benzodiazepines
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anti-anxiety calming skeletal muscle relaxation anticonvulsant activity
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precautions of benzodiazepines
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Liver abnormalities can cause liver necrosis in cats
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Examples of Alpha 2 Agonists
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Xylazine ( reverse w/ Yohimbine) Dexmedetomidine (reverse with Atipamezole)
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Effects of Alpha 2 Agonists
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sedation analgesia muscle relaxation
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Precautions of Alpha 2 Agonists
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cardiovascular and respiratory complications grey gums (worse in dogs) vomiting (worse with cats and xylazine)
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Uses of opioids
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preanesthesia induction recovery
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Benefits of opioids
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sedation analgesia reversability
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Side effects of opioids
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cardiorespiratory depression increased paristalsis sound/light sensitivities dependence
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Examples of Opiods
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Butorphanol Buprenorphine Oxymorphone Fentanyl morphine
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2 types of Preanesthetic cocktails
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BAG or BAA
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BAG
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Butorphanol (opioid) Acepromazine (sedative) Glycopyrrolate (anticholinergic)
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BAA
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Butorphanol (opioid) Acepromazine (sedative) Atropine (anticholinergic)
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Cyclohexamines
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dissociatives/ hallucinogenics
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Physiological effects of cyclohexamines
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catalepsy muscle rigidity exaggerated reflexes poor visceral analgesia (skin and limbs excluded) eyes remain open
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Adverse effects of cyclohexamines
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tachycardia apneustic respiration salivation stings when given IM light and sound responsive
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Examples of cyclohexamines
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Ketamine and Tiletamine
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Define a cyclohexamine cocktail
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a combination of a dissociative agent and a tranquilizer
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Purpose of cyclohexamine cocktails
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muscle relaxation Increase analgesia Smoother recovery
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Examples of cyclohexamine cocktails
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Ketamine and Valium Ketamine and Acepromazine Ketamine and Xylazine
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Ketamine/Valium properties
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Muscle Relaxation Minimal analgesia Minimal cardiac effects
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Ketamine/Acepromazine properties
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Sedation Smooth recovery Minimal cardiac effects poor muscle relaxation
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Ketamine/Xylazine properties
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Muscle relaxation Analgesia Cardiac and respiratory depression
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Use of Ketamine Cocktails
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Induction Intubation Minor procedures
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Function of endotracheal tubes
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provide/remove gasses to/from patient maintain patent airway during anesthesia
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Parts of the endotracheal tubes
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tube cuff adapter signal balloon
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varieties of endotracheal tubes
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size material cuffing
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Advantages of Intubation
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efficient gas delivery minimizes anatomical dead space ventilation minimizes aspiration
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Disadvantages of Intubation
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stimulation of vagus nerve Appropriate size varies (species, breed, mechanical dead space) Iatrogenic trauma Pressure necrosis secretion plugs - mucus mostly with dogs
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intubation process
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select 3 sizes of tubes; check for leaks induce animal in sternal recumbancy intubate (with or without use of laryngascope) connect gas machine when necessary secure et to patient's maxilla with guaze inflate cuff listen for leaks around inflated cuff
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Intubation checks and balances
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animals breath at tubes exit condensation withIN the tube movement of the reservior bag auscultation of lungs patient vocalization eliminated palpation of two tubes (trachea and endotracheal tube)
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Extubation process
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provide 5 minutes of pure oxygen disconnect et from the gas machine untie guaze REMOVE AIR FROM CUFF watch closely for swallowing reflex withdraw the tube deliberately, slowly and smoothly
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Feline et size usual size
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3-5 usually between 3-3.5
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Should the cuff adapter be tied to the et when intubating cats?
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NO
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Where is the guaze tied when intubating cats
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behind the head
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how to deal with a laryngospasm
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wait for patient to inhale and exhale use lidocane 2%(be cautious) use maximum dose of 0.1ml apply one drop on each arytenoids cartilage using a 1cc syringe (no needle) wait 60 seconds for absorption to occur attempt to intubate BE PATIENT!
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12 factors to monitoring the patient
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heart rate mucous membranes blood loss reflexes (toe pinch, ear, swallow, laryngeal, palpebral) respirations CRT eye position muscle tone (jaw, anal) pulse temperature pupil size
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3 emphasized factors of monitoring the patient
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Reflexes(palpebral) Eye position Pupil size
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When should an IV catheter be placed
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ALWAYS
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3 reasons for placing an IV catheter
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Direct vein access during emergencies Peri-operative medications Fluid support
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How long are the fluids usually maintained?
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Until the patient is sterna or sitting up
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How long is the catheter normally maintained?
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until the patient is standing
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"The milk of anesthesia"
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propofol
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How is propofol administered?
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slow IV injection- over 10-15 seconds
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Induction time of propofol
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rapid- within 30 seconds
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recovery of propofol
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smooth, <30 minutes
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Are repeat boluses safe with propofol?
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Yes
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Pros of propofol
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repeat boluses safe safe in sight hounds safe in renal and liver disease minimal cardiovascular depression apnea seldom a problem
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Cons of propofol
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transient excitement stage during induction poor analgesia viable only 6 hours after opening vial Expensive compared to other induction agents crosses placenta
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Maintenance Fluid rate
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2-4 ml/kg/hr
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Surgery fluid rate
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5-10 ml/kg/hr
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Shock fluid rate
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10-20 ml/kg/hr
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Fluid calulation formula
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weight x fluid rate
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Gas anesthesia- gasses are called
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halogens
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Effects of halogen
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Respiration/cardiovascular/CNS dose-dependent depression
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vapor pressure=
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evaporation speed
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solubility coefficient=
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Induction/Recovery speed
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MAC=
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strength of agent
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Surgical ansesthesia: stage III =
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1.5 x MAC
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The safest agent for patient, technician and DVM
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Isoflourane
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Best agent for mask/chamber induction
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Isoflourane
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3 most common gas agents
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Halothane Isoflourane Sevoflourane
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Halothane: vapor pressure
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high
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Halothane: solubility coefficient
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moderate
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Halothane: Minimum Alveolar Concentration
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0.87%
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Halothane: Surgical Maintenance(1.5xMAC)
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1%
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Isoflourane: vapor pressure
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High
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Isoflourane: Solubility coefficient
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Low
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Isoflourane: Minimum Alveolar Concentration
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1.2%
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Isoflourane: Surgical Maintenance(1.5xMAC)
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2%
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Sevoflourane: Vapor pressure
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High
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Sevoflourane: Solubility coefficient
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Low
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Sevoflourane: Minimum alveolar concentration
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2.2%
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Sevoflourane: Surgical Maintenance(1.5xMAC)
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3%
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3 portions of equipment
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Compressed Gas supply Anesthetic Machine Breathing Circuit
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3 parts of the compressed gas supply
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gas cylinders pressure gauges pressure reducing valves
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2 parts of the anesthetic machine
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flowmeter vaporizer
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7 parts of the breathing circuit
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unidirectional valves hoses and reservoir bag pop off valve pressure manometer negative pressure relief valve CO2 absorber, O2 flush valve
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What should the pressure be reported on the pressure manometer of the breathing circuit?
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no higher than 15-20mls
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When should you use an open system
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On small animals and toy breeds
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Induction oxygen flow rate
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200 ml/kg/min
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Maintenance oxygen flow rate in a non rebreathing system
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200 ml/kg/min
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Maintenance oxygen flow rate in a CLOSED rebreathing system
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15 ml/kg/min
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Maintenance oxygen flow rate in a SEMI-CLOSED rebreathing system
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50 ml/kg/min
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Recovery oxygen flow rate
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200 ml/kg/min (flushing with oxygen)
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Formula for Reservoir bag volume
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60 ml/kg
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When determining bag size you should always round up or down?
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Always round up
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What sizes do res. bags come in
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.5L, 1L, 2L, 3L, and 5L
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Steps for setting up the anesthetic system equipment
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connect O2 hose connect tubes and Y-piece secure scavenger connection (weigh it, mark time used) connect reservoir bag inflate/deflate endotracheal tubes to check for leaks
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Anesthetic system checks
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Vaporizer level CO2 canister Ensure that there are NO LEAKS
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How do you ensure that there are no leaks in the anesthetic system?
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close the pop-off valve and cover the end of the y-piece press the O2 flush valve to fill reservoir bag reservoir bag and pressure should be maintained
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What is the minimum flow rate?
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1/2 liter/ minute
