What Category and subcategory is Diazepam?
Pre-Anesthetic, Benzodiazapine (tranquilizer)
How can you Administer Diazepam?
ONLY IV- GIVE SLOW (if given rapid may cause bradycardia and hypertension
What are some Physiological Effects of Diazepam?
Minimal effects on cardio, respitory. Muscle relaxant, anticonvulsant, can stimulate appetite in felines
How is Diazepam metabolised?
with help of its carrier propylenglycol, not water soluable
What is the onset and duration of Diazepam?
immediate, aprox 30minutes
What patients may Diazepam be preferred on?
Seizure patients,
What are the contraindications of Diazepam?
May cause excitement in young & healthy animals, dysphoria in cats
What should you keep in mind when preparing Diazepam for use?
Sensitive to light(its kept in brown bottle) and can absorb into plastic(can't let it sit for long)
What is venous thrombus?
clott
What is the only drug you can mix in a syringe with Diazepam?
Ketamine
Does Diazepam have a reversal?
yes but very expensive, hardly used
?
.
What category and subcategory of drug is Acepromazine?
Pre-Anesthetic, Phenothiazine (sedative)
What is the ceiling effect?
After a certain amount the drug the degree of sedation is plateaued
What are the physiologic effects of Acepromazine?
Pronounced vasodilation and hypotension, minor respiratory changes, antiemetic, antihistamine,
decreases seizure threshold
What is an antiemetic?
Helps with nausea
How can you administer Acepromazine?
IM, SQ, IV, PO
What is the onset and duration Acepromazine?
10m post IM, 20m post SQ, 20m post PO, Duration- 3-6hours
What is the Max amount you can inject of Acepromazine?
3mg
What are contraindicators to Acepromazine?
geriatric, hepatic dysfunction, liver problems, seizure/epileptic patient, generally unhealthy, cardiovascular patient, hypovelemia patients,
What is the category and subcategory of Atropine?
Pre-anesthetic, anticholinergic
What is the mechanism of action for Atropine?
Parasympatholytic- blocks/stops parasympathetic systeme
what are the physiologic effects of Atropine?
Cardio-prevents bracycardia (by blocking stimulation of vagus nerve) transient tachycardia, Bronchodilates, thickens respitory secreations, decreates salivary secretions, decreases GI motility. Eye dilator, dries the eyes (lube those up!)
What are the routes of administration for Atropine?
SQ, IM, (IV AND IT in emergencies)
What is the onset and duration of Atropine?
IM 5 mins, SQ 20m, IV immediate, Duration 1-1.5hrs
What is an advantage of using atropine over glycopyrrolate?
Quicker onset (but shorter duration)
What are contraindicators of Atropine?
interoccular/glacoma patients, Ileus patients or GI cases
Does Atropine have analgesic properties or is it reversible?
nope, and nope
What are our pre-anethetic anticholinergics?
atropine, glycopyrrolate
What are our pre anesthetic Subcategories?
Alpha2Agonist, Phenothiazine, Opioid, anticholonergic and Benzodiazepine.
What are our Alpha2Agonist drugs?
Xylazine, Dexdomitor
What are our Phenothiazine drugs?
Acepromazine
What are our Opiod drugs?
Morphine, Fentanyl, Butorphanol, Buprenorphine, and Hydromorphone
What are our Benzoidazepine drugs?
Diazepam, Midazolam, and Zolazepam
What are our Anesthetic categories?
Barbiturate, Dissociative, Inhalant, and Miscellaneous
What are our barbiturate anesthetic drugs?
Thipental, pentobarbital, and phenobarbital
What are our dissociative anesthetic agents?
Ketamine and Tiletamine
What are our Inhalant drugs?
Isoflurane, Sevoflurane, Nitrous Oxide
What Is our Miscellaneous anesthetic drug?
Propofol
What is an advantage of Glycopyrrolate to Atropine?
Can't cross blood brain barrier or placental barrier
What is the onset and duration of glycopyrrolate?
onset 30-45m, duration 2/more hours
What Category and subcategory is glycopyrrolate?
PreAnesthetic, anticolinergic
How do Agonists and Antagonists interact?
Agonist- causes effect
Antagonist- reverses effect of agonist
What drug do you never use to treat an Alpha2Agonist induced brachycardia?
Anticholinergics
What are some clinical effects of xylazine/dexdomitor?
pale gums, reduced CRT, weak/not able to feel pulse
What are the physiologic effects of xylazine?
periphrial vasoconstriction, hypertension, sensitizes heart to catecolomine, potent depression of respitory rate, GI increased chance of GI upset, muscle relaxtion
What are the routes of administration for xylazine?
IM SQ IV-caution
What is the onset and duration of Xylazine?
10post IM, 3hrs duration (analgesia affect 1hr long)
Does Xylazine have analgesic properties or is it reversable?
some analgesia (not spay worthy) reversable
definition of shock
perfusion failure; impaired delivery of oxygen to the tissues
what is the effect of shock
imbalance between oxygen demand and oxygen delivery
what is the result of shock
ischemia, necrosis, organ failure, and death
what happens in hypovolemic shock
reduction in circulating blood volume which creates decreased perfusion
what happens in distributive shock
abnormal distribution of blood flow
what happens in cardiogenic shock
primary heart disease
what happens in septic shock
infection or infectious disease
what precedes respiratory and cardiovascular collapse
shock
what happens during compensatory shock (what does the animal do)
Moves interstitial fluid into the vascular system to increase blood volume, activates the sympathetic nervous system to release epinephrine and norepinephrine, peripheral vasoconstriction, ADH and aldosterone are released to reabsorb sodium and water.
what happens during decompensatory shock
The body and the treatment fail to restore normal blood flow and oxygen delivery. Signs include grey mucous membranes, bradycardia, loss of vasomotor tone leading to hypotension, and severely altered mentation
what 3 things can help treat shock
oxygen supplementation, preventing circulatory collapse, and avoid hyperventilation
cessation of effective heart contraction
cardiac arrest
cessation of effective respiration
pulmonary arrest
which usually comes first: cardiac arrest or respiratory arrest
respiratory arrest precedes cardiac arrest
what is the key rule for CPCR
the sooner treatment is started, the better the outcome
what does CPCR stand for
Cardiopulmonary Cerebrovascular Resuscitation
what do you do if a patient needs CPCR while under anesthesia
turn the gas off, reverse, and begin
what is the goal for CPCR
perfuse tissues and oxygenate until the animal's physiologic systems kick back in
what usually precedes arrest
shock
what are signs of respiratory arrest
dyspnea, apnea, abnormal CRT/HR/pulses, and cyanosis
what are signs of cardiac arrest
no palpable pulse or heartbeat, no muscle tone, dilated pupils with lack of pupillary light response, cyanotic or pale MM, and a prolonged CRT
what do you do during CPCR for airway
clear blockages and endotracheal intubation
what do you do during CPCR to help with breathing
mouth to snout, ET tube with ambu bag, ET tube connected to oxygen, manually breath for them, or Jen Chung
what is the least effective way to help with breathing during CPCR
mouth to snout
what is the most effective way to help with breathing during CPCR
ET tube connected to oxygen
what is the rate for breathing for the animal during CPCR
give 8 - 12 breaths per min
how much should the chest expand when breathing for an animal during CPCR
around 30%
what is Jen Chung
stick GV 26 with a needle to stimulate respiration
when should you start chest compressions during CPCR
palpate pulse, if nothing, auscultate the heart, if no heartbeat, start compressions
what is the rate of compressions during CPCR
120 compressions a minute, or 2 compressions a second
what position should a cat, small, and medium dog be in during CPCR
right lateral recumbency
where is the heart located
5th intercostal space
how should your hands be to do compressions on cats
fingers on down side, thumb on up side
how should your hands be to do compressions on dogs
heel of hand, lock elbows, bend at waist
cardiac pump theory
recreate systole and diastole by pushing directly on the heart to restore blood movement
how much should the chest circumference decrease when doing compressions
25%-30%
how often should you change people during CPCR and why
every 2 minutes to decrease fatigue and increase effectiveness
how should you position a large dog for CPCR
dorsal recumbency
where should your hands be placed for chest compressions of a large dog
1-2 inches above the xiphoid process
thoracic pump theory
increased intrathoracic pressure during compression results in forward blood flow
when should interposed abdominal compressions be done and why is it done
during the relaxation phase to increase venous return to the heart
what 2 things can you do to evaluate an effective compression
palpable pulse and a doppler placed on the cornea
what can you do if there is no evidence of a pulse
change hand position, rate, intensity, personnel, or check end tidal CO2
what is the order of steps for CPCR
Circulation, Airway, Breathing
what drugs can be given through an ET tube safely
Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine
what do you do for the dose of a drug given through ET tube
double the dose of IV and flush with saline
what is atropine
a parasympatholytic
what is epinephrine
a catecholamine
what is naloxone
an opioid antagonist
what is lidocaine
a local anesthetic
what is dopram
a respiratory stimulant
what is asystole
flat line
pulseless electrical activity
A condition in which the heart's electrical rhythm remains relatively normal, yet the mechanical pumping activity fails to follow the electrical activity causing cardiac arrest
ventricular fibrillation
A condition in which the heart's electrical impulses are disorganized, preventing the heart muscle from contracting normally
what is the surgical fluid rate used at MWVT
5mL/lb/hour
what kind of analgesic do opioids have
somatic and visceral
which opioids have the best analgesia
fentanyl, morphine, hydromorphone
which opioid is best for mild to moderate analgesia
buprenorphine
which opioid is the worst for analgesia
butorphanol
what are the benefits of opioids
analgesia, reversible, mostly safe
what is the category and sub category of ketamine
anesthetic, dissociative
what is crucially important for ketamine
NEVER EVER EVER give ketamine by itself
what are some cardiovascular effects of ketamine
increase in HR, CO, BP, slight vasoconstriction, increase in cerebral bloodflow, increase in intracranial pressure, and increase in intraocular pressure
what are some respiratory effects of ketamine
it depresses the respiratory system and causes apneustic breathing in cats
what type of analgesia does ketamine have
has somatic analgesia, but not visceral
how is ketamine metabolized and excreted in dogs and cats
dogs: metabolized by the liver and excreted by kidneys, cats: excrete unchanged by the kidney, but the liver does not break it down
besides cardio and resp, what other effects does ketamine have on the body
muscle rigidity, tremors, increases the reflexes, and increases salivary secretions
what routes of administration can ketamine be given
IM or IV
what is it called when a patient wakes up "rough
emergence delirium
what is the partial reversal for ketamine
Yohimbine
what 2 drugs make up Telazol
Zolazepam and Tiletamine
why is Telazol contraindicated in dogs
they can have a rough recovery because zolazepam wears off
what is the onset of ketamine
5 minutes
what is the duration of ketamine in dogs and cats
30 minutes for dogs, 1 hour for cats
catelepsy
catatonic muscle rigidity
what are some contraindications of ketamine
kidney failure, blocked cat, seizures, head trauma, glaucoma, and hypertension
what are the 5 reasons that ET tubes are used
to maintain an open airway, decrease anatomical dead space, transport gas to patient, prevent aspiration of foreign material, and monitoring/controlling respiration during anesthesia
what are some things to consider when choosing an ET tube
diameter, length, and stiffness
how do you measure the diameter of the ET tube for your patient
put the beveled end up to their nose and fit it between the 2 external nares
how do you measure the length of an ET tube for your patient
measure from K9 tooth to thoracic inlet
what are the characteristics of a PVC ET tube
they are transparent and stiff
what are the characteristics of a red rubber tube
flexible and it is prone to kinking
what are the characteristics of a silicone ET tube
more expensive, strong and pliable, and they are measured in French
what does a murphy ET tube look like
it has a beveled end, a side hole, and can or cannon have a cuff
what does a cole ET tube look like
it does not have a side hole and the diameter is decrease at the patient end
what are the parts of an ET tube
valve, pilot balloon, cuff, machine attachment, and tube sizing information
how many tubes should you get when preparing to intubate
3 tubes: the size you think you will need, one size bigger, and one size smaller
what equipment should you have ready when you are going to anesthetize
3 different tubes, lubricant, non-stretch gauze, empty syringe, lidocaine gel for cats, maybe a laryngoscope, and the anesthesia machine
what does lidocaine gel do for intubation
desensitizes the vocal folds in cats and prevents laryngospasm
what is the maximum amount of air that should inflate a cuff
5 cc
what are 3 ways you can verify placement for an ET tube
look for condensation in the tube, visualization, and ascultation
what happens if the ET tube is too long
it will advance into one bronchi and therefore only one lung will get oxygen and anesthesia. it will be difficult to keep the patient anesthetized
what are some complications that can happen with ET intubation
trauma, laryngospasm, overinflation of the cuff, and obstructed/occluded tube
how long should the patient be only on oxygen once the procedure is done
5 minutes after gas is turned off
when can you remove the ET tube
once swallowing reflex is back
how should you inspect ET tubes?
inflate the cuff completely, wait 10 minutes, and see if the cuff deflated at all
how do you clean ET tubes
clean with disinfectant inside and out, make sure to inflate the cuff to clean it, and then gas sterilize it
what color is oxygen on an anesthetic machine, and what color is nitrous oxide
green for oxygen, blue for nitrous oxide
what is the PSI for a full tank of oxygen
2,200 pounds per square inch
what are the 2 types of oxygen tanks
E tanks are the smaller ones, and H tanks are the large ones
what is P.I.S.S.
Pin Index Safety System. it is a direct source from an E tank
what is D.I.S.S.
Diameter Index Safety System. it is a central source from an H tank
what is the yoke
the piece that holds the E tank on
what does a pressure regulator do
reduces pressure from tank to a constant pressure of 50 PSI entering the machine
what is the pressure gauge
it shows the amount of oxygen left in the tank
what are the 2 functions of an oxygen flowmeter
controls the rate at which oxygen is being delivered and it decreases pressure from 50 PSI to 15 PSI
where should you read the ball or bobbin on an oxygen flowmeter
you read a ball at the center and a bobbin at the top
what does the O2 flush valve do
delivers fresh oxygen into system at 35 to 75L/min, it bypasses vaporizer and delivers O2 directly, and it dilutes the anesthetic agent
what is the function of a vaporizer
it takes a liquid and turns it into a breathable gas
what color is isoflurane
blue (in 1 book) purple (in another book)
what color is sevoflurane
yellow
what is a precision vaporizer
a vaporizer that delivers an exact concentration of the anesthetic agent
what is a non-precision vaporizer
a vaporizer that does not have an exact known concentration
what are 4 risks from compressed gas tanks
combustion, a forceful release of gas may tear thskin or injure the eye, if the cylinder is dropped and the valve breaks off, it can cause serious injury, and if it is inadvertently attached to a valve, yoke, or hose, the wrong gas can be given to the pat
what is an oxygen concentrator
a device that extracts oxygen from room air, concentrates it, and pressurizes it for medical use
tanks should always be marked.. what are the 3 things they could be marked as
full, in service, or empty
when should a tank be changed
when the pressure drops below 500 PSI
what does the term "bled out" mean when referring to anesthesia
depressing the oxygen flush valve until the line pressure gauge reads 0 psi
what is a flow meter
a vertical glass cylinder of graduated diameter with a valve attached to the bottom
what are the 2 different flow meters found on anesthesia machines
oxygen and nitrous oxide
what should you NOT do when turning the flow meter off
crank it to the right, you are just supposed to turn it until the ball drops to the bottom
how should you press the oxygen flush valve
shorts bursts to make sure the reservoir bag does not overfill
what should you do when delivering fresh oxygen to a critical patient
turn off the vaporizer, force the gases out of the bag by gently squeezing it, and finally press the oxygen flush valve to refill the bag with fresh oxygen
when should the oxygen flush valve not be used and why
shouldn't be used with a non-rebreathing system because a high flow rate of oxygen can damage the lungs
what does it mean for a vaporizer to be "variable bypass, flow-over
they regulate the anesthetic output by routing a portion of the carrier gas through the vaporization chamber where the liquid anesthetic is located while the remainder of the carrier gas bypasses the vaporization chamber.
what type of anesthetic should use a precision vaporizer
isoflurane, sevoflurane, and desflurane
what is an anesthetic agent that uses a nonprecison vaporizer
methoxyflurane
what are some commonly used "high vapor pressure liquids
isoflurane, sevoflurane, and desflurane
what does the term "high vapor pressure liquids" mean
that the anesthetics readily evaporate and may reach concentrations of 30% or higher if the amount of vapor being delivered is not controlled
what is the maximum concentration for isoflurane
5%
what is the maximum concentration for sevoflurane
8%
what does VOC and VIC refer to
where the vaporizer is in relation to the breathing circuit
how does a vaporizer out of circuit work
oxygen from the flow meters flow into the vaporizer before entering into the breathing circuit, they use precision vaporizers
how does a vaporizer in circuit work
carrier gases enter the breathing circuit directly from the flow meter without first entering the vaporizer, they use nonprecision vaporizers
what factors can affect vaporizer output
temperature, carrier gas flow rate, back pressure, barometric pressure, and respiratory rate and depth
what is respiration minute volume
the total amount of gases a patient inhales or exhales in 1 minutes
what is back pressure
an increase in pressure at the vaporizer outlet port caused by manual ventilation or activation of the oxygen flush valve
what is the induction rate and maintenance rate of isoflurane
induction is 3-5% and the maintenance is 1.5-2.5%
what is the induction rate and maintenance rate of sevoflurane
induction is 4-6% and maintenance is 2.5-4%
what is the induction rate and the maintenance rate of desflurance
induction is 10-15% and the maintenance is 8-12%
what should be done if an anesthetic machine is tipped over or shaken
run oxygen through the machine at the maximum flow rate with the vaporizer dial turned off for 15 minutes
what is the vaporizer inlet port
the point where oxygen and other carrier gases enter the vaporizer from the flow meters
what are the 2 functions of the common gas outlet
it is the point of exit from machine for gas to enter patient breathing circuit and it is the site of attachment for non-rebreathing circuit
trace an oxygen molecule through the breathing circuit starting at the common has outlet
common gas outlet, inhalation valve, inhalation hose, ET tube, patient, ET tube, exhalation hose, exhalation valve, reservoir bag/pop off valve/scavenging, and finally to the CO2 absorbent
what are the 3 spots that exhaled gas can go
reservoir bag, scavenging, or pop off valve
what is the function of the pop off valve
allows for release of excess pressure
what is the hose you should use for patients under 30 lbs
pediatric hose
what should you NEVER do with the pop off valve
leave it closed
what is the function of the CO2 absorbent canister
it removes CO2 before returning to the patient
what does the CO2 canister have in it
soda lime
how do you know it is time to change the CO2 canister
the soda lime changes color
what is the function of a pressure manometer
monitors pressure in the system and does not read any higher than 20
how do you calculate tidal volume for a reservoir bag
animal's weight in pounds x 5mL
how do you determine what size reservoir bag a patient needs
patient weight in lbs x 30 = bag size in mL to L
how often should you breathe for an animal
every 5 minutes
what is a passive scavenging system
uses gravity/pressure of gas in the system. F-Air canisters
what is the active scavenging system
the blue hose, a vacuum system
when should you use a rebreathing system
animal is over 15 pounds
when should you use a non-rebreathing system
animal is under 15 pounds