Anesthesia Test 3

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Terms in this set (...)

taking an animal from the normal conscious state and rendering unconscious (most vulnerable time of anesthesia)
Induction Period
Induction Period
Most vulnerable time of anesthesia
Injectable and inhalant
2 types of induction agents
extremely slow, titrate to effect
How to give injectable induction
unconsciousness, relaxed jaw tone
two things you look for induction period?
False- Never use inhalation agents on brachycephalic due to redunant sort palate
True/False The best way to induce a Brachycephalic is through inhalation anasthetics?
set high oxygen flow rate (2-5 L 02/min)
Set high vaporizing setting (ISO- 4-5%, Sevo 6-8%)
Ad) Faster induction than nice way
Dis) Vasodilation (hypotension), patient cooperation, waste gas
Blast em technique
Advantages?
Disadvantages?
Set high O2 flow rate (2-5 L O2/min)
100% O2 1min
increase vap 0.5% every min
Ad: Less pt anxiety= less catecholamine production
Dis: Longer induction process, Knowing when to intubate
Nice way tech
Advantages, Disadvantages?
Murphy eye tube*
Cole
2 types of ET tubes
Provide patent airway
Prevent aspiration
Provide efficient delivery
Decrease physiologic dead space
Allow for controlled vent. of pt
Reasons for intubating? (5)
Inflammation/Irritation of mucosa of trachea
Development of mucous plug and obstruction of tube
stimulation of vagas nerve
Risk of bronchii insertion
Can contribute to hypothermia
Disadvantages of ET tube use (5)
*Poor pt positioning
Laryngospasms
Inadequate plane of anesthesia
3 cause for difficult intubation
Period of time following anesthetic induction in which a stable level of anasthesia is achieved.
Maintenance period of anesthesia
Slight increase in heart rate and RR due to surgical stimulation
describe "stable" anesthesia
Stage 1- Voluntary excitement phase
-conscious
- +/- decrease pain sensitivity
-HR/RR normal
-+/- disoriented
Describes?
-conscious
- +/- decrease pain sensitivity
-HR/RR normal
-+/- disoriented
Stage 1- Voluntary excitement phase
Stage II- Involuntary excitement phase
Induction phase is what stage/plane of anesthesia?
Stage III Plane I
Light Anesthetic plane
In what Stage/Plane to we intubate?
Stage III/Plane II
What stage/plane is best for sx?
Stage III/ Plane II
-Slight decrease of HR/RR until surgical stimulation then increases
-most protective reflexes are absent
Describes what stage/plane?
-Slight decrease of HR/RR until surgical stimulation then increases
-most protective reflexes are absent
Stage III/ Plane II
Stage III/Plane III
Deep anesthetic plane
-HR/RR depressed
- no response to sx stimulation
- all reflexes absent (jaw tone slack)
- requires extreme monitoring
Describes what stage/plane?
-HR/RR depressed
- no response to sx stimulation
- all reflexes absent (jaw tone slack)
- requires extreme monitoring
Stage III/Plane III
Deep anesthetic plane
Stage III/Plane IV
Overdose of Anesthetic
-+/- HR decreased or increased
- RR very depressed
-Hypotension
-no reflexes
Describes what stage/plane?
-+/- HR decreased or increased
- RR very depressed
-Hypotension
-no reflexes
Stage III/Plane IV
Overdose of Anesthetic
Stage IV
Coma/Death
Describes what stage/plane?
Coma/Death
Stage IV
Palpebral/"Blink"
*Jaw tone
Pedal Reflex/Toe Pinch
Eye Rotation
Ear Flick Response
Swallowing/Gag reflex
Nystagmus
Reflexes to check if deep enough?
Cats and horses
Ear Flick Response can be used on
medial and ventral (cross eyed)
if central= too light or deep
During surgical plane of anesthesia eye rotate
Individual variation
Ventilating pt. too frequently
improper vaporizer function
tech errors
4 Reasons pt may be getting to deep?
individual variation
inappropriate O2 flow rate (low)
Is there any gas in vaporizer?
Leak in system?
ET tube improperly placed
Over usage of O2 flush valve
7 Reasons pt may be getting to light
Blood pressure
Most overlooked parameter in monitoring anesthesia?
Force of luminal pressure against wall of vessel
Blood pressure definition
100-160 mmHg
Systolic BP normal
60-100 mmHg
Normal Diastolic BP
80-120 mmHg
Normal Mean BP
20 less than minimum of each
S- < 80mmHg
D- < 40 mmHg
M- < 60 mmHg
Hypotensive values for Systolic, Diastolic, Mean BP
C.O
Vascular resistance
Blood volume
3 things that contribute to BP
*OD of anesthetic gases (99% of time)
Hypovolemia
Decrease C.O (Bradycardia, Dysrhythmia, Pt. positioning)
...
-+/- decrease of anesthetic gases
- IV bolus of fluids (add 20ml/kg/hr)
- Positive inotropic drugs (Ephedrine sulfate, CRI of Dopamine)
3 ways to manage hypotension
Cuff (40% circumference of leg, attached to sphygmomanometer, proximal to crystal)
Crystal (placed concave on artery, taped in place)
Placement of Doppler
add 15 mmHg for mean
artificial low systolic
Doppler on cats you need to
-Amount of Hemoglobin saturated with Oxygen (SpO2)
-Pulse Rate
Pulse Oximeter used to read
Non-pigmented skin
-Tongue
-Pinna
-Toe webbing
-Vulva/Prepuce
-Rectal Probe
(light through artery first, keep moist)
Where do you place a pulse oximeter?
-V/Q mismatch (decrease in transmission of gases across alveolar sacs/longer distance (fluids) b/w alveoli and capillaries)
-Disconnect from breathing system
-Blocked airway
-Inadequate O2 flow rate
* Erroneous readings
-Probe placement issues
- Hypovolemia
6 reasons for SpO2 desaturation
D- 60-160 bpm
C- 110-220 bpm
H- 30-40 bpm
Pulse rate normals
Dog, Cat, Horse
Awake= >90%
Anesthetized= >95%
SpO2 Normals
decreased TV of about 25%
tidal volume while on general anesthesia?
Prevent Hypercapnia
Prevent Atelectasis
Two main reasons why we Ventilate?
*Capnograph
*Reservoir Bag
-Other devices (Esophageal stethoscope, Flutter valve)
-Rate/Character
4 ways to monitor RR
RR
ETCO2- End Tidal Co2
InCO2- Inspiratory CO2
3 values from capnograph
35-45 mmHg
Normal ETCO2 rate under anesthesia
Cat/Dog- 8-20 rpm
Horse- 8-12 rpm
Normal RR under anesthesia (Cat, Dog, Horse)
0-5 mmHg
Normal InCO2 under anesthesia
Resp. acidosis
ETCO2 > 45mmHg
Resp. Alkalosis
ETCO2 < 35mmHg
1) close pop-off valve
2) Squeeze 20cm of H20
3) Open pop-off valve
3 steps to ventilating
-Px Atelectasis
-Px Hypercapnia
-counteract hypoventilation
-Increase Tidal Volume
-Px hypoxia
-Some sx require (thoracic, long, GDV, Colic)
6 reasons why we ventilate
-Ventilate at rate of 12-16 rpm
- After appox. 3-5 min. watch pt (notice when breathing stops)
- Decrease ventilation to 8-12 rpm rest of sx
-Recovery= decrease ventilations at rate of 1 res. every 2-3 min.
Process of completely taking over respirations with reservoir bag
-Inspiratory pressure
-Inspiratory time (I:E)
-Tidal Volume
-Resp. Rate
Mechanical Ventilators can control 4 things
Bird Mark 7
Pressure Cycle Ventilator common name
Pressure cycle Ventilator (Bird Mark 7)
Air may leak- never reaches pressure- over inflate chest
Least safe ventilator and why?
Volume Cycle Ventilator/Ohio Metomatic
Most safe Mech. Vent.
Inspiratory pressure
Pressure cycle/Bird Mark 7 ventilator must set...
Tidal Volume
Volume Cycle Ventilator/Ohio Metomatic must set...
Ohio Metomatic
Volume Cycle Ventilator common name
Drager
Time Cycle Ventilator common name
Inspiratory time
Better to control CO2 levels
Time Cycle Ventilator/Drager must set?
advantage?
hypotension
over ventilating may lead to
Heart Rate
Heart Rhythm
2 values ECG gives
Cautery, Movement, Electric Dental Equipment, Drying out of electrodes, 60 cycle interference
5 most common types of artifacts on an ECG
-Electrolyte imbalance (hypokalemia, hypomagnesemia)
-GDV
-Catecholemines (Epinephrine)
-Drugs (Barbiturates)
4 Generalized causes of VPCs
-Find underlying cause
- increase ventilations (more O2 to heart)
- Notify Dr.
-Lidocaine/Procainamide to slow down HR
Tx for if needed
V-Tach
VPC
V-Tach
Lidocaine (CRI)
Procainamide (Pronestyl)
Tx
V-Fib
Defibillation
CPR
Tx
Sinus Tachycardia
Increase O2 flow rate, Increase anesthetic
>160 bpm
Tx
Sinus Bradycardia
+/- decrease anesthesia
Anticholinergics (Atropine)
<40 bpm
True
True/False 1 and 2 degree AV blocks can be normal in equines
1 degree AV block
2 degree AV block
Tx: Atropine
Tx:
3rd degree AV block
Tx: Pacemaker
Tx:
25%
T-waves should be no more than ____% the height of R-wave
Myocardia Hypoxia
Tx: Ventilate
Broadened and Heightened T-wave indicates
Tx:
Electrolyte Imbalance
(beware VPC's are coming)
Common in Blocked Toms
Tx: Dextrose
Spiked T-waves indicate
Common in?
Tx?
lead to?
A genetic disorder will have increased muscle activity leading to hyperthermia (under anesthesia)
Malignant Hyperthermia
-Decreased muscle activity
- Decreased metabolic rate
- introduction of cold gases
- Sx. prep (shave, alcohol)
- Opening of body cavities
Hypothermia causes (in anesthesia) (5)
-Keep something b/w pt and table (blankets, circulating water blanket)
-Warm IV Fluids
-Warmies
-Bear hugger
4 ways to px hypothermia
no physiologic consequences
> or equal to 96 F
90-94 F
at what temp do we have body system depression
82-86 F
at what temp do we have complete body system depression aka coma?