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Anesthesia
Up to Intra-op and Post-op Care unit done
| Question | Answer |
|---|---|
| What is the name for local or general loss of bodily sensation, especially of touch. | Anesthesia |
| General Anesthesia is: | anesthesia with loss of consciousness. |
| Local Anesthesia is: | anesthesia to a specific body region without change in consciousness. |
| Define sedation: | decreased consciousness (does not change pain perception). |
| Loss of function/movement of a body part is called: | paralysis |
| A pre-anesthetic exam includes: | Hx: Identify risk factors. PE: Cardiovascular health: heart & lung auscultation, MM. Age: Geriatric & Pediatric Complications. Breed: specific issues (Brachycephalic, Sighthounds, Cavalier King Charles, Maine Coons). Temperament: Aggressive/Fearful. |
| How are ASA Categories helpful? | Allows for a quick assessment of the patient. It also assists technicians and veterinarians in determining additional monitoring or concerns throughout the procedure. |
| What does the ASA stand for in ASA Categories? | American Society of Anesthesiologists |
| ASA Categories Describe the classification I: | Normal healthy patient. Example: young healthy patient admitted for spay/neuter or fracture. |
| ASA Categories Describe the classification II: | Mild systemic disease present. Example: mild compensated mitral insufficiency. |
| ASA Categories Describe the classification III: | Severe systemic disease present. Example: Heart disease with exercise intolerance or mild pulmonary edema. |
| ASA Categories Describe the classification IV: | Patient with severe systemic disease that is a constant threat to life. Example: patient with brain tumor causing increased intracranial pressure. |
| ASA Categories Describe the classification V: | Moribund patient who is not expected to survive without the procedure. Example: massive abdominal hemorrhage with hypovolemic shock. |
| ASA Categories An "E" added to any of the I-V categories denotes? | Emergency case |
| One inhalation and one exhalation are considered: | one breath |
| Respiratory rate is determined by counting only: | inhalations or exhalations |
| Name two ways to observe RR: | observing chest movements or reservoir bag |
| How do you calculate RR: | Breaths counted in 15 seconds X 4 = BPM |
| A dog or cat in the "surgical plane" of anesthesia will have a rate of ___ - ___ bpm. | 8-20 |
| True or false: RR of less than 8 bpm is typically considered excessive anesthetic depth. | True |
| When anesthetic depth becomes dangerously deep, ___ will cease before the ___ ___. | respiration, heart stops |
| Breathing Patterns Inspiratory phase is about ___ as long as expiratory phase. | half. A short pause occurs before the next inspiration. |
| Breathing Patterns If an animal feels pain, respiration rate ___. This can also indicate that they are too ___. | increases, light |
| Breathing Patterns "Dissociative" anesthetic injectable drugs may cause: | irregular breathing patterns called apneustic pattern. |
| Breathing Patterns Gasping or labored breathing usually indicate: | tracheal or ET tube obstruction |
| Breathing Patterns Agonal ("death agony") breathing is: | not true gas exchange breathing. It usually occurs after prolonged apnea. Agonal gasps occur after cardiac arrest. |
| Positive Pressure Ventilation Anesthetized patients breathe ___, and assisted ventilation (bagging) is recommended every ___ - ___ minutes. | shallowly, 5-10 minutes |
| What is atelectasis? *Hint: It is one of the most common breathing (respiratory) complications after surgery. | complete/partial collapse of the lungs or a lobe. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid. |
| Positive Pressure Ventilation Describe the process of "bagging" a patient: | Close the pop-off valve. Inflate bag to 20 cm H20 on the manometer. Open the pop-off valve. |
| Why is assessing profusion so important in our patients? | It is a marker of how well oxygenated blood is moving around the body. |
| Normal HR for a canine? | 80 - 120 bpm |
| Normal HR for a feline? | 100 - 180 bpm |
| Why is it important to assess heart rate and pulse at the same time? | To check for a pulse deficit. (poor perfusion). |
| Pulses can be palpated at ___, ___, ___, and ___ sites. | Lingual, Femoral, Carotid, Pedal |
| MAP (Mean Arterial Pressure) should be: | > 60 mmHg |
| Mucous Membrane (MM) Should be pink. Pale indicates: | blood loss or poor perfusion |
| Mucous Membrane (MM) Should be pink. Blue/Purple indicates: | oxygen shortage in the tissues |
| Mucous Membrane (MM) Should be pink. Red/Injected indicates: | can be a sign of cyanide intoxication (rare, but happen), overheating, stomatitis, or gingivitis. |
| CRT (Capillary Refill Time) is a brief indication of blood pressure/perfusion. Normal should be: | 2 seconds |
| True or false: cats tend to retain laryngeal reflex longer than dogs. Which means cats are also more likely to develop ___ ___ during intubation. | True, laryngeal spasm |
| Muscle Tone The deeper the plane of anesthesia, the more ___ the jaw is when attempting to open the mouth. When jaw tone increases, depth of anesthesia is becoming ___. | relaxed (less resistance). Lighter. |
| Muscle Tone When jaw is not accessible check ___ tone. | anal |
| True or false: the position of the eye in the socket, the size of the pupil, and eye response to light can be used to assess depth of anesthetic. | true |
| In moderate or “surgical” level, eyes will rotate ___ and ___. | ventrally and medially |
| Always apply what to the eyes of anesthetized patients? | eye lubricating ointment |
| At light and deep levels of anesthesia the eyes will be in a ___ position. | central |
| When dissociative drugs are used, the eye position may: | never change |
| Pupillary Light Response As anesthetic depth ___, pupils constrict more ___ in response to light (pupillary light response- PLR). | increases, slowly |
| Pupillary dilation, called ___, is affected by ___ drugs (block impulses through the parasympathetic nerves) in deeper stages of anesthesia. | mydriasis, anticholinergic drugs |
| What is a anticholinergic drug? | They block the neurotransmitter acetylcholine in the central and peripheral nervous system. They are used to treat a wide variety of conditions associated with activation of the parasympathetic nervous system. |
| If a patient arrests and expires, pupils are: | fully dilated |
| Stage 1: Planes 1-3 Not anesthetized Patient usually has sedation or analgesia on board. When a patient is in Plane 1 & 2 they are fully conscious and relaxed. In Plane 3, they are ___ __ ___. | unaware of surroundings |
| Stage II of Anesthesia is referred to as the ___ Phase. Describe some characteristics of this phase. | Excitement. This phase and is the stage of anesthesia we try to avoid. Retching noted. This is the reason for food and water restriction! Thrash/vocalize/irregular breathing. They are unconscious. This stage ends with muscle relaxation. |
| Stage III: Surgical Anesthesia Gag reflex is suppressed and may need assistance breathing. Plane I results in: | loss of pain response |
| Stage III: Surgical Anesthesia Gag reflex is suppressed and may need assistance breathing. Plane II results in: | Surgical Plane for most surgeries. |
| Stage III: Surgical Anesthesia Gag reflex is suppressed and may need assistance breathing. Plane III results in: | Deep Surgical Plane for intense orthopedic and neurologic surgeries. |
| Stage III: Surgical Anesthesia Gag reflex is suppressed and may need assistance breathing. Plane IV results in: | beginnings of respiratory paralysis |
| Stage IV results in: | Respiratory Paralysis. Medullary (brain and spinal cord) paralysis. Vasomotor collapse occurs (nerves and muscles that control blood vessels). Circulatory flow drastically reduced. Blood pressure/pulse feeble. Respiration ceases. Eventually DEATH. |
| Anesthesia logs What should we be monitoring every 5 minutes? | Cardiovascular (Perfusion): HR/Rhythm, pulse rate/quality, MM color, CRT, blood pressure. Respiratory: Rate, Saturation (SpO2), ETCO2. |
| Anesthesia logs What should we be monitoring every 15 minutes? | Body temperature. Fluids given (total volume). |
| Anesthesia Logs Other than cardiovascular and respiratory system evaluation, body temperature, and fluid administration, what other things should we be recording? | Drugs given: premed, induction, intraoperative drugs, anesthetic settings (oxygen and vaporizer), and anesthetic and surgical events. |
| Technician Senses Our sense of sight can watch for changes in: | mucous membrane color, patient movement, respiration. |
| Technician Senses Our sense of sound can listen to: | heart rates and rhythms |
| Technician Senses Our sense of smell can detect the presence of: | anesthetic gas |
| Technician Senses Our sense of tough can feel changes in | pulse rates |
| An esophageal stethoscope is inserted to what point in the patient's body? | 5 rib |
| Direct Blood Pressure Requires an ___ ___ and is indicated for critical patients. What are the advantages over indirect monitoring? | arterial catheter. Real time readings. Can be very hands off and stress free for the patient once placed. |
| Capnometer or Capnograph Measures and evaluates ___ in the patient's breath. | CO2 |
| Capnometer or Capnograph A measure of ___. What is a safe range? | Ventilation. 30-45 mmHg |
| Capnometer or Capnograph Too high indicates: | Hypoventilation. Either the patient is producing too much CO2, or it is not expelling sufficient CO2. |
| Capnometer or Capnograph Too low indicates: | Hyperventilation |
| Why is ventilation so important? | If the animal is not ventilating, not inhaling anesthetic gas, they will wake up during surgery. |
| Hypoventilation leads to blood pH becoming: | acidotic |
| Hyperventilation leads to blood pH becoming: | alkalotic |
| Apnea Monitor True or false: it monitors respiratory rate with an audible "beep" following expiration, and it is set to alarm when a specific amount of time has passed without detecting expiration. | True. The sensing portion is placed between the ET tube and the anesthetic machine's breathing circuit. |
| Apnea Monitor Does it assess the quality of breath on expiration? | No |
| Apnea Monitor It is most useful in ___ ___ and ___. | small animals and birds |
| ECG What is the purpose of the ECG? | It is used to indicate electrical activity of the heart. |
| ECG What is the proper placement of leads in anesthesia: Right front leg = ___. Left front leg = ___. Left rear leg = ___. Right rear leg = ___. | Right front leg (White). Left front leg (Black). Left rear leg (Red). Right rear leg: (Green). |
| ECG In Right Lateral Recumbency remember: | "Smoke over fire" "Snow on grass" |
| ___ ___ is the placement of a tube that extends from the oral cavity into the trachea. | Endotracheal intubation |
| What are four reason to intubate a patient? | To administer inhalation anesthetic drug. To ensure a patent airway in unconscious animals. To administer oxygen. To provide ventilatory assistance. |
| Name 10 supplies need to place an endotracheal tube: | ET tube of anticipated size (+ one size smaller & larger). 6 mL syringe. Sterile lubricant. 3x3 gauze pad. Mouth gag. Gauze to tie ET tube in place (not elastic). Laryngoscope/light source. Topical Anesthetic (cats). Stylet for small ET tubes. |
| What are two reliable methods of judging the diameter needed for an ET tube? | Gently palpate the trachea. Tube should be a bit smaller than the trachea. Measure against the nares. |
| Used caution when placing Endotracheal tubes in ___ and ___ pets. | brachycephalic and obese |
| The distal portion of the tube should not extend past the ___, and the proximal end should not extend past the ___ ___. | shoulder, incisor teeth |
| How can you evaluate how well an endotracheal tube will function? | Inflate the cuff to make sure it can hold pressure. Otherwise, it will leak anesthetic. This puts the technician at risk and the patient will be too light. |
| Describe the process of preparing to place an endotracheal tube. | Select endotracheal tube. Premeasure length and diameter. Check inflation of cuff. Check cleanliness of tube. Lubricate end of tube with small amount of sterile lubricant. Having the patient positioned in sternal recumbency is most common. |
| Describe the process of placing an endotracheal tube. | Place mouth gag. Gently pull patients tongue out with gauze pad. Depress epiglottis w/ the tip of laryngoscope blade or ET tube. Pass ET tube through glottis, into trachea until tip is midway between larynx and thoracic inlet. |
| Once the ET tube is place, what should be done next? | Using your tie gauze, tie it around the endotracheal tube behind the adapter (midway on the gauze), place gauze behind canine teeth and then tie gauze around the patients head behind ears. Inflate cuff. |
| What are some ways to verify the endotracheal tube is place in the trachea not in the esophagus. | Look for condensation in the tube. Auscultate both sides of the chest for breath sounds. Visually confirm. |
| What in an important thing to remember to do when adjusting or moving a patient with an ET tube placed? | Temporarily disconnect the endotracheal tube from the breathing tubes. |
| Name three things to monitor in relation to the ET tube placement during the procedure. | Is the tube obstructed with secretions? Is the pop-off valve open? Is the cuff staying inflated? |
| Extubation ___ must return before this is done. Particularly, the ___ ___. What until there are two complete swallows. Do not pull the ET tube back and forth in the patient's trachea. The cuff must be ___ before extubating. | Reflexes. Swallow reflex. deflated. |
| Brachycephalic animals take a ___ time to extubate. Why is this believed to be true? | long. They are finally breathing with a normal airway. |
| If any material is in the tube when you extubate you must: | place the head lower than the body. Drain the material. May need suction. May need to reintubate. Need to prevent aspiration which could lead to pneumonia. |
| An anesthetic machine does what five things? | Mixes carrier gas with the anesthetic vapor in a controlled manner. Delivers oxygen to the animal. Removes exhaled carbon dioxide. Assists or controls the animals’ ventilation. Provides a mechanism for the scavenging of waste anesthetic gases. |
| Oxygen tanks are color coded ___ in the U.S.? | Green |
| "E" sized cylinders are ___ and ___. | small and portable. 660 - 700 L. They have a pin index safety system. |
| "H" sized cylinders are ___ and ___. | Large and stationary. ~7000L |
| All tanks will read ___ psi when full. | 2200 psi |
| Righty tighty, lefty loosey... when turning a tank valve clockwise (right), the tank is being ___. When turning the tank valve counterclockwise (left) the tank is being ___. | closed. opened. |
| Oxygen tanks should be opened prior to ___ or in case of ___. They should be closed _______. | surgery. emergency. At the end of the day. |
| True or false: fires will be fueled by an open oxygen source. | True |
| The first ___ in the system is near the oxygen source tank. What is its purpose? | pressure-reducing valve. This valve reduces pressure leaving the tank and entering the machine to 40 to 45 psi. |
| When open the flowmeter: | delivers a known amount of gas (oxygen) to the vaporizer and breathing circuit. It also allows for even further reduction of pressure carried to the machine/patient. |
| ___ psi is close to atmospheric pressure and well tolerated by patients. | 15 psi |
| Remember, the oxygen flush valve should never be used on a non=rebreather because: | O2 pressure coming out of the machine is too high and can harm the patient. Note: these systems are already using a high O2 flow. |
| During patient recovery phase, the oxygen flush valve can be used to: | flush the system of residual gases to hasten patient recovery. |
| The primary function of the vaporizer is to: | hold liquid anesthetic and vaporize it into a gas form that can be delivered in a controlled manner. It is the most expensive component of the machine. |
| Where does oxygen enter the vaporizer to carry the gas molecules to the patient? The ___ is where the O2 and gas leave the vaporizer to enter the circuit. | the vaporizer inlet. outlet. |
| True or false: vaporizers are calibrated internally for a specific type of inhalant anesthetic and are not interchangeable. | true |
| The flow of O2 arriving in the vaporizer has been "___." | out-of-circuit |
| What are four things to remember when filling the vaporizer? | Indicator visualization window: when there is ½ to ¼ remaining, add liquid anesthetic. If filling is done during use, close vaporizer before opening the fill knob to prevent anesthetic entering the environment. Don’t tip the machine. |
| A precision vaporizer compensates for: | Temperature: cold room vs. warm. Carrier gas flow rate: typically standardized. Back pressure to prevent release of extra gas with PPV (positive pressure ventilation). |
| The inspirator valve is also called a ___, ___, or ___ valve. It is designed to allow movement of gases in ___ ___ direction. | dome, float, flutter valve. only one. |
| The inspiratory valve has a ___-___ ___ valve on top. Why? | Negative-pressure relief valve. It is a safety valve that allows room air to enter the system if the oxygen runs out or is shut off. |
| What is the manometer? | A pressure gauge measuring pressure within the system. Does not regulate. Indicates pressure within a patient’s lungs measured in centimeters of water (cm H2O). The reading should never exceed 20 cm H2O. |
| True or false: the “pop-off” valve and manometer have a direct relationship. The more the “pop-off” is closed the higher the pressure reading on the manometer. | True |
| Describe the rebreathing bag (reservoir bag): | It is a rubber bag that will deflate as the patient inspires and inflate when the patient expires. The movement is a good visual indication of respiratory rate and quality. Allows manual ventilation (“bagging”) of the patient. |
| Describe the process of manual ventilation "bagging" for a patient. | The “pop-off” is closed and the rebreathing bag is squeezed to a pressure no greater than 20 cm H2O on the manometer. |
| Why is choosing the proper rebreathing bag important? | It stores excess gases and provides back-up quantities to be inspired, choosing the proper size is important. |
| How is the proper reservoir bag chosen? | It is based on 5-6 times the tidal volume. Tidal volume is calculated as 10mL/kg of body weight. Round UP not down. |
| As the patient exhales, waste gases pass to either the: | carbon dioxide absorber or the scavenger. |
| What are two common absorbent materials found in the CO2 absorber? | barium lime (Baralyme) or sodium lime (Sodasorb). |
| How can you tell that the crystal are saturated and need to be changed? | there is a color change from white to blue/violet. Fresh crystals are easily crushed. Depleted crystals are very hard. |
| True or false: hours should be accounted for when determining time to change the absorbent material in the CO2 absorber. | True |
| When refilling the CO2 absorber, remember to leave ___ of air space at the top. | 1/2 inch |
| ___ scavenging systems are attached to the machine producing a vacuum that removes gases out of the building. | active |
| ___ scavenging systems rely on gravity as anesthetic gases are the heaviest of expired gases. | passive |
| In passive scavenger systems, tubing is attached to the ___ valve leading to an activated-charcoal canister, which will be changed after a set amount of hours (or over 50 grams of weight gain.) | pop-off valve |
| Breathing Circuits How do we determine that a Rebreathing system is needed? | Allows for recirculation of some expired gases/lower flow of oxygen. Weights greater than 10 pounds. Uses traditional 2 hose & “Y” piece circuit or single hose F circuit, which allows warming of inspired gases by expired gases (tube within a tube). |
| Breathing Circuits How do we determine that a Non-rebreathing system is needed? | No gases are rebreathed. Used for patients less than 10 lbs or respiratory compromised patients. Requires high flow of O2 which pushes gases to patient. Requires less effort for lungs of the small animal. Disadvantage: greater cost due to high O2 use. |
| Name some ways to minimize waste-gas exposure. | Fill vaporizers at end of workday. Fewer people are present. Avoid spilling liquid anesthetic when pouring. Use low-flow techniques when possible. Leave recovering animals attached to machine as long as possible. Exhaled gases will be scavenged. |
| Oxygen Flow Rates Adequate oxygen to the patient is crucial. Using excessive amounts is ___. | wasteful |
| Oxygen Flow Rates “Rebreathers” use ___ flow for induction and recovery, and less volume flow for maintenance. | high |
| Oxygen Flow Rates “Non-rebreathers” use a ___ O2 flow consistently throughout a procedure. What is one advantage of non-rebreathers. | high. It has low resistance for breathing for smaller patients. |
| What are four indications for IV Catheter placement? | Access to vein for: emergency care/Rx delivery, fluid support, blood pressure monitoring, blood sampling. |
| Catheter Maintenance If IV fluids are being given, check rate of fluid delivery every ___ ___. | 1 hr |
| Catheter Maintenance If IV fluids are being given, visually inspect the paw and proximal leg for swelling or extravasation. Re-wrap any wet or dirty bandage material every ___ ___. | 1 hr |
| Catheter Maintenance If IV fluids are being given, remove all wrap down to white tape and inspect for infection, thrombosis or phlebitis every ___ ___. | 24 hours |
| Catheter Maintenance If IV fluids are being given, check body temperature q ___ ___, if elevated contact the DVM, and prepare to culture catheter and replace with new one. | 6 hrs |
| Catheter Maintenance If IV fluids are being given, a new catheter should be put into place every ___ ___, unless otherwise directed by the DVM. | 3 days |
| IV Catheter induced pathology What will you see, feel, or observe, if phlebitis is present (4)? | Redness, Swelling, Tenderness, Increased skin temp. |
| IV Catheter induced pathology What will you see, feel, or observe, if infection is present (5)? | Redness, swelling, tenderness, increased skin temp, fever or purulent discharge at site. |
| IV Catheter induced pathology What will you see, feel, or observe, if thrombosis is present (2)? | Veins stand up on their own and cord-like feel to veins |
| IV Catheter Maintenance If IV fluids are not given, flush catheter with hep-saline flush q ___ ___. Inspect paw for toe swelling or self trauma. | 6 hours |
| IV Catheter Maintenance If IV fluids are not given, check body temperature q ___ ___, if elevated contact DVM, and prepare to culture the catheter and replace with a new one. | 6 hours |
| IV Catheter Maintenance If IV fluids are not given, remove all wrap down to white tape and inspect for infection, thrombosis, or phlebitis every ___ ___. | 24 hours |
| IV Catheter Maintenance If IV fluids are not given, a new catheter should be placed q ___ ___, unless otherwise directed by the DVM. | 3 days |
| IV Catheter Placement Describe items you will need to perform this procedure: | Syringe(s), 3-6 mL, heparinized saline, sterile needle, 20-22 gauge, 1 inch, clippers & #40 blade, 70% alcohol, Betadine or Chlorhexidine scrub, correct size IV catheter, T-set adapter or injection cap, porous white tape, bandaging material (2 layers). |
| What are some potential adverse effects of IV catheters? | Hematoma at the IV catheter site, phlebitis/thrombophlebitis, infection at the IV catheter site, severance of a portion of the IV catheter into the vein, fever due to infection of catheter. |
| Prepare the catheter Open using ___ technique. | aseptic |
| Prepare the catheter Remove the catheter and injection plug at the end of the catheter. Break the seal on the ___ by sliding them apart and return them to original position. | stylet |
| Prepare the catheter Flush catheter with heparinized saline solution ___ and ___ placement. | before and after |
| If the catheter is to be left in place for several days, ___ ___ maximum, a small amount of ___ or ___ ___ on a gauze should be placed over the catheter puncture site before bandaging the catheter in place. | 3 days. antiseptic or antibiotic ointment |
| The catheter placement site should be ___ shaved and the skin ___ ___ ___ ___. The same technique for preoperative skin preparation. | widely, scrubbed with antiseptic solution |
| When inserting an IV catheter, the holder stands on what side of the dog? | the side of the dog opposite to the leg being catheterized. |
| When placing a catheter, what is one reason that the catheter should be placed as distal in the vein as possible? | If the catheter is too proximal, its tip will lay at the elbow. In that case, as the animal withdraws its leg, flow through the catheter may cease. |
| Describe one method to keep the end of the catheter sterile when stopping fluid. | A needle w/ a plastic cover attached to an injection cap can be taped to the IV pole or fluid bag. If fluids are temporarily stopped, the injection cap is placed on the end of the catheter & the capped needle on the end of the IV administration set. |
| All IV catheters provide direct access to a patient's vascular system, therefore all catheters should be placed using: | aseptic technique |
| What is the most common source of contamination for IV catheters in veterinary clinics? | hands of personnel. Wash your hands. |
| Why are cephalic veins the first choice for catheter placement? | Due to superiority for ease of placement and maintenance as well as decrease the likelihood of urine and fecal contamination. |
| Why is the medial branch of the cephalic vein less ideal. | It is often easier to see, but it is a smaller vein. Due to the angle, it is difficult to tape the catheter in alignment with the vein. Mega-paw (peripheral edema) can occur due to tape placed over the carpus. The catheter can kink. |
| How can the saphenous vein be used for IV catheter placement? What is a complication of that site placement? | Both medial and lateral veins can be used. Medial saphenous can work great in cats but the lateral is often too small. Monitoring for fecal or urine contamination is extra important. |
| Clipper burn when clipping for IV catheter placement can be a serious problem. What can you do to reduce the possibility? | Keep the clipper blade as flat to the skin as possible. Make sure the blades are sharpened regularly and sanitize and oil between uses. |
| What can you do to reduce the possibility of bacteria or other contaminants getting into your scrub or alcohol solution for IV catheter placement. | It is best to wet your gauze with scrub or alcohol just prior to using it on your patient. |
| Describe some benefits of Chlorhexidine Scrub: | both bactericidal and bacteriostatic. Minimally affected by the presence of organic debris on the skin or any surface. It is not deactivated by alcohol application. |
| What caution should you be aware of when using Chlorhexidine? | It is irritating or can damage mucous membranes. It can potentially cause mucosal irritation in cats if they groom a prepped area. |
| What word means relief of pain and restoration of mobility and function? | Rehabilitation |
| Physical Therapies Name four to eight strengthening exercises: | weaving/step over obstacles, dancing, simple sit to stand, wheelbarrowing, hill slope incline walking, weight lifting, treating/baiting, weight shifting |
| Physical Therapies When leash walking what can you do to improve therapeutic benefit? | change speed and surface textures. Begin with slow weaving for balance, coordination, weight shifting, and spinal flexion, and increase speed and difficulty. |
| Dancing is good exercise for limb ___ and directional ___. | strengthening. mobility |
| What is a therapeutic technique exercise that support a joint while moving it to the extent of its limitation? | Passive range of motion (PROM) |
| Describe how to perform a PROM exercise and point out one caution. | Limb is supported while gently flexing and extending one joint at a time. Should be performed slowly with muscles relaxed. It should never hurt the animal. |
| What are four benefits of PROM exercises? | Prevents contracture, improve blood and lymph flow, maintain normal range of joint movement, stimulate sensory awareness. |
| What is contracture? | a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints |
| Heat Therapy (thermotherapy) Describe five ways to accomplish superficial heat therapy. | hot packs/wraps, baths/spas, heat pads, infrared lamps (not recommended for animals), warm hair dryers. |
| Heat Therapy (thermotherapy) Which is more beneficial: dry heat or damp, moist heat? | Damp, moist heat |
| Heat Therapy (thermotherapy) What is one general caution to keep in mind when using this type of therapy? | Heat is carried away by circulation, so it will effect other organs. Care must be taken using any form of heat. |
| Heat Therapy (thermotherapy) Hot packs should be applied for: | 15-30 minutes |
| Heat Therapy (thermotherapy) Why should commercial heat packs be avoided in veterinary therapies? | Due to potential toxic substances (should it leak or the animal bites it). |
| Heat Therapy (thermotherapy) Should hot packs be applied directly to the skin? Temperatures should not exceed: | No. Wrap hot pack in a towel to avoid a contact burn. 90 degrees F |
| Heat Therapy (thermotherapy) Spas or whirlpools can cover large surfaces, so the water temperature should not exceed: | 90 degrees F |
| Heat Therapy (thermotherapy) What are four to six benefits of heat? | Reduces pain/blood pressure, muscle spasms/aids relaxation. Increases circulation/metabolism and nerve conduction. Accelerates tissue healing. Improves tissue elasticity. |
| Heat Therapy (thermotherapy) What are five precautions to keep in mind when using this type of therapy? | Use extreme care using electric heat pads. Don't overheat animals immersed in heated water. Use caution when working w/ sedated animals, when using large hot packs w/ small bodies. Never allow patient to lie on top of a hot pack. |
| Cold Therapy (cryotherapy) Cold penetrates ___ and last ___ than heat. | deeper. longer. |
| Cold Therapy (cryotherapy) When is this type of therapy most effective? | When it is used immediately after trauma during acute phase of inflammation. |
| Cold Therapy (cryotherapy) What does this type of therapy provide? | analgesia, reduction of inflammation, controls bleeding, reduces muscle spasm |
| Application of Cold Therapy (cryotherapy) What are two effective ways to apply this type of therapy? Avoid what kind? | Freezer bag w/ crushed ice in a thin damp cloth. Bag of frozen peas. Avoid gel packs. |
| Application of Cold Therapy (cryotherapy) Treat for __ - __ minutes every __ - __ hours. For severe cases treatments should be applied every __ hours. | 10-15 minutes, 3-4 hours, 2 hours |
| Application of Cold Therapy (cryotherapy) When treating small area, ___ ___ is appropriate. What items can be used for this therapy? Describe how this therapy is applied. | ice massage. ice cubes or frozen water in paper cups (removed from cups for application). Ice is rubbed over the affected area for 5-10 minutes (parallel to muscle fibers). It provides massage and cooling. |
| Application of Cold Therapy (cryotherapy) What are some benefits of this therapy? | Reduces pain, blood flow, hemorrhage, inflammation, edema, muscle tone, spasms, metabolism, histamine release, ability to perform rapid movements. Increases connective tissue stiffness. |
| Application of Cold Therapy (cryotherapy) What are some contraindications for this type of therapy? | Advanced cardiovascular disease, local areas of impaired circulation, generalized/localized vascular compromise, acute febrile illness, hx of frostbite, impaired thermoregulation, cold sensitive patient ones that experience swelling from cold (histamine) |
| Application of Cold Therapy (cryotherapy) Cold therapy should not be applied to: | open or infected wounds, acute skin conditions (eczema, dermatitis), malignant tissue, or scar tissue. |
| Precautions of Cold Therapy (cryotherapy) Never apply ice ___ to skin. Name one exception. | directly. Ice massage. |
| Precautions of Cold Therapy (cryotherapy) Always cover ice packs with a ___ ___. | damp towel |
| Precautions of Cold Therapy (cryotherapy) Why should care be taken when applying this type of therapy near superficial nerves? | May cause cold-induced nerve palsy |
| Precautions of Cold Therapy (cryotherapy) Care should be taken when applying to areas of ___ sensation. | poor |
| Cold Therapy is used in acute stages of ___. Post surgery it is usually applied for __ to __ days, but can be prescribed for longer if necessary. | inflammation. 2-3 days. |
| Hot Therapy is ___ used in the first few days post surgery. This type of therapy usually starts once ___ has stopped forming. This is normally __ to __ days post injury. | NEVER. edema. 3-5 days. |
| ___ is a systematic and scientific manipulation of the soft tissue for the purpose of obtaining or maintaining health. | Massage. There are over 70 types of massage philosophies. |
| While massaging the patient, breath ___, ___ and regularly; relaxing both you and the patient and creating your own rhythm. | deeply, slowly |
| True or false: If you are hyper and irritable and try to massage the patient, they will pick up on that and it can make them irritable and not want to be around you. | True. Slow down and relax for yourself. Listen to the patient. |
| When massaging an animal, they start to resist, growl, hiss, or worse you should ___ ___. Most pets usually love massage. | stop immediately |
| Times Massage Should be Avoided in Animals Name three reasons to wait on massage therapy. | If the animal has just eaten: within 2 hours. If the animals has an infection, fever, or serious disease. They may not appreciate this therapy until they are better. |
| Contraindications of Massage: Endangerment Sites Avoid massaging the ___ and ___ of a pregnant animal. It may unintentionally cause premature labor. | back and belly. |
| Contraindications of Massage: Endangerment Sites Do not massage a patient that has just been ___ intensely, or have ___ disease. | exercising. heart. |
| Contraindications of Massage: Endangerment Sites Avoid ___ or ___ wounds, ___ areas, or following a recent ___. | infected or open, hemorrhage, high fever. |
| When massaging an animal, what five sites should you avoid? | throat, eyeballs, brachial plexus, deep abdominal areas, over kidneys |
| What are Shiatsu, Trigger-point (myotherapy), Swedish, Sports, and TTEAM or TTouch of Tellington Touch | Types of massage. |
| TTouch (Tellington TTouch) is method based on ___ movements of the fingers and hands all over the animals body. | circular. It was originally developed for horses, but is now being used in cats and dogs. |
| One benefit of TTouch/Tellington TTouch is: | Helps establish a deeper rapport between humans and animals through increased understanding and more effective communication. |
| TTouch/Tellington TTouch has been effectively used to help in cases of (9): | Excessive Barking/Chewing, leash pulling, jumping up, aggressive behavior, extreme fear/shyness, resistance to grooming, excitability/nervousness, car sickness, problems associated with aging. |
| Massage Techniques ___ is a gliding stroke that follows the contours of the body and is the most common stroke used in animals. | Effleurage (eflo͞oˈˌräZH) |
| Massage Techniques ___ is the manipulation of tissue to increase circulation. | Friction |
| Massage Techniques ___ is a gliding movement, deep or superficial. | Stroking |
| Massage Techniques ___ is a pressure technique such as kneading or skin rolling. | Petrissage (petriˈsäZH) |
| Massage Techniques ___ or ___ refer to techniques in which the cupped hands strike the body. | Tapotenment or percussion (tapping. hacking, pincer like movements as well). Should not be used over fresh bruises, strains, or sprains. |
| How is a therapy ball used in veterinary rehabilitation? | The ball is moved back and forth and side-to-side to balance out the limb that was operated on, to promote weight bearing and to stretch that limb. |
| Simple stand to sit exercises strengthen ___ ___. | hind limbs |
| Harness walking up and down 3" high half steps strengthens ___ limbs, and promotes ___ and ___ joint extension. | pelvic. hip and stifle joint. Outdoor slight incline hill climbing has similar benefit. |
| Leash walking with chest harness increases control of ___ and ___ distribution. | posture. weight. |
| Walking across oblique ___ (long and thin) rails promotes ___ ___ flexion, even ___ distribution, and stimulates ___ limb proprioception (limb postural reflexes). | "Cavaletti" stifle joint. weight. hind. |
| What is proprioception? | perception or awareness of the position and movement of the body. "exercises to improve balance and proprioception." |
| Define oblique: | neither parallel nor at a right angle to a specified or implied line; slanting. |
| Serpentine Curb refers to a rehabilitation technique in which the animal climbs up and down a curb to promote ___ shifting and mildly increase the propulsive role of ___ limbs. | weight. pelvic. |
| Land treadmills are used to increase ___ and ___ and to reeducate front-to-back balance and normal foot placement. | strength and endurance |
| Underwater Treadmills are used to increase stifle and hip ___. | extension. Inclined upwards by 8 degrees. |
| Water-walkers make it possible for an animal to exercise ___, ___, ___, and ___ of limbs following injuries and/or surgery. The buoyancy of the water removes much of the pressure from the painful limbs. | muscles, tendons, ligaments, joints |
| What are some advantages of water-walkers? | faster recovery time after surgery, exercise therapy to build muscle strength, treatment of temporary, paralysis, improving performance in sport dogs, wellness and fat-burning, compensation for lack of exercise, water massage above or below water, |
| Neuromuscular electrical stimulation (NMES) What does this therapy entail? | The application of electrical current to elicit a muscular contraction. |
| Neuromuscular electrical stimulation (NMES) It is a rehabilitation technique used for muscular ___ and reversal of muscle ___. | strengthening. atrophy. |
| Neuromuscular electrical stimulation (NMES) What are some contraindications for this type of therapy? | over heart, animals that experience seizures, decreased pain sensation, over infected site, over carotid sinus, when active motion is contraindicated. |
| Acupressure points on the body are generally small depressions between ___ or between ____ and ___. | muscles. muscles and bones. |
| Apply ___ ___ pressure with a fingertip to a particular acupressure point. | steady. rotating. |
| Acupressure If you want to relax the point, gently massage ___ over the point. If you want to stimulate it and give it more energy, rub ___. | counterclockwise. clockwise. |
| In acupuncture therapy, the needles are left in place for __ to ___ minutes. They should be occassionally manually stimulated. How many treatments should be given over a period of two to four weeks. | 4 - 6 treatments over a 2 - 4 week period. |
| True or false: it is sometimes advantageous to increase the effect of acupuncture by electro-stimulation or by injecting specific solutions into the sites. | True |
| In what eight circumstances can acupuncture be beneficial in cats and dogs? | Back & neck pain. Lameness due to muscle/ligament strain. Arthritis/Joint degeneration. Nerve damage w/ pain. Limb paresis, paralysis, muscle atrophy. Some allergic skin conditions. Constipation/urinary incontinence. Epilepsy. Female infertility. |
| What are some major indications for acupuncture in horses? | Strained muscles/ligaments. Back pain. Neck pain/stiffness. Nerve paralysis (muscle wasting), "summer itch," early stages of chronic obstructive pulmonary disease (COPD). |
| Chiropractic application utilizes a ___ amplitude, ___ velocity thrust to areas of the spinal subluxations in order to facilitate proper function of the ___ ___ resulting in enhanced performance and quality of life. | small, high, nervous system. |
| Therapeutic Ultrasound Uses ___ __ and ___ to treat tissue. | sound waves. heat. |
| Therapeutic Ultrasound What are some tissue types that benefit from this therapy? | tendons, ligaments, muscles |
| Therapeutic Ultrasound Increases ___ extensibility, ___ flow, range of ___, and ___ activity. | collagen, blood, motion, enzyme |
| Therapeutic Ultrasound Accelerates ___ healing. Additionally, it can stimulate healing and help to rehabilitate ___ tissue and ___. | wound. scar. adhesion. It aids in the restoration of the natural elasticity of these tissue. |
| Therapeutic Ultrasound Decreases ___ and ___ spasms. | pain. muscle. |
| Therapeutic Ultrasound True or false: short treatments are generally advised, because too much vibration will damage tissues. | true |
| Therapeutic Ultrasound If a muscle is in severe spasm, ultrasound treatment may be ___ and it may be better to await muscle relaxation before trying again. | painful |
| Therapeutic Ultrasound Why should bony areas be avoided during treatment? | The shock wave may bruise and eventually cause bone damage. It may even cause loss of mineralization around healed fracture sites. |
| What are some things you can do to enhance Therapeutic Ultrasound? | Give stretching exercises, ensure high dietary Vitamin C and Vitamin E. |
| Cold Laser Therapy Class __ lasers (also called cold lasers) are a therapy that is ___ in use to decrease ___ and ___. | 4. increasing. pain. inflammation. |
| Anesthesia Unit: Definitions Relaxed state but with full pain sensation. Animals in this state can respond quickly to pain or noxious stimuli. | Sedation (tranquilization) |
| Anesthesia Unit: Definitions "Without pain sensation" | Anesthesia |
| Anesthesia Unit: Definitions Reversible loss of pain sensation without loss of consciousness. | Local anesthesia |
| Anesthesia Unit: Definitions Reversible loss of pain sensation with loss of consciousness. | General anesthesia |
| Anesthesia Unit: Definitions Decreased perception of pain without loss of other sensations (touch, motor, temperature). | Analgesia |
| Goals of Anesthesia What desired effects are we trying to achieve? | Analgesia. Unconsciousness. Muscle relaxation. |
| Goals of Anesthesia What negative effects are we trying to avoid? | Respiratory depression. Cardiovascular depression. Decreased homeostasis: thermoregulation, renal function, airway protection. |
| Importance of Perfusion The longer and more severe we impair perfusion, the ___ the damage. | worse |
| Reflexes to Monitor During Anesthesia Varies between species. Dogs may have no reflex at adequate surgical depth although complete loss in horses indicates moderately deep anesthesia. | Palpebral reflex |
| Reflexes to Monitor During Anesthesia Does not disappear until deep anesthesia. Should always be present. | Corneal reflex |
| Reflexes to Monitor During Anesthesia Usually indication of excitement and light anesthesia. Dissociative anesthetics (Ketamine) can cause it at moderate anesthetic depth. | Nystagmus |
| Reflexes to Monitor During Anesthesia In horses, central stimulation induced by severe hypoxia or hypercapnia can cause this phenomenon. It should not be confused with light plane of anesthesia as these animals are dying. | Nystagmus |
| Reflexes to Monitor During Anesthesia The most desirable eye position in most species with the exception of horses. In horses it is: | medioventral eye ball position. central |
| Reflexes to Monitor During Anesthesia Most desired jaw tone is ___ to ___. | moderate to loose. |
| Two Reliable things to Monitor in Anesthesia True or false: Gross purposeful movements. Reflex movement in response to stimulation. | True |
| Most Reliable Anesthesia Monitoring Immediate hemodynamic response to stimulation looks like; a sudden marked increase in ___ ___ or ___ ___. | heart rate or blood pressure |
| Most Reliable Anesthesia Monitoring Immediate respiratory response to stimulation; sudden marked increase in ___ ___ or ___ of ___. | respiratory rate or depth of breathing |
| Most Reliable Anesthesia Monitoring Response to stimulation prior to actual incision such as: ___, ___, ___, and ___. | clipping, surgical preparation, drape, clamps. |
| True or false: the basic goal of anesthesia is to maintain the patient as close as possible to physiological normality. | True |
| What are the benefits of the approach of balancing positive effects with negative effects in anesthesia use? | Lower risk of patient mortality and morbidity. Better immune system function. Faster recoveries (freeing up technician's time). Faster wound healing. |
| True or false: the negative effects of almost all anesthetic agents are dose-dependent (they increase as more drug is administered). Is true, what are two potential ways to manage these negative effects? | Use less anesthetic agent. Use an agent with less profound negative effects.` |
| What does "dosing to effect" mean? | Giving only as much anesthetic agent as is required to achieve positive effects: muscles relaxed, analgesia, unconsciousness. |
| What stage and plane of anesthesia is generally ideal for surgery? Describe four anesthesia monitoring methods that the technician can use. | Stage 1, Planes 2 (medium). Pupils are dilated. Absence of pain. Lack of palpebral reflex (medial best)(lateral lost first). Corneal reflexes present. |
| What is the problem faced by all anesthetists if anesthesia is "too light?" What about "too deep?" | Too light: sudden violent movement from patient. Too deep: dangerous, respiratory and cardiac function cease. |
| What are seven of the most reliable signs of anesthetic depth? | Hx of vaporizer setting, muscle tone (jaw tone), pupillary light reflex, palpebral reflex, corneal reflex, moist cornea (lacrimination or tears), position of the eyeball. |
| Why do we use pre-anesthetics? | Support patient homeostasis. Decrease patient anxiety, amount of anesthetic needed, and for analgesic effect. |
| What are anticholinergics? | They are drugs that block the action of acetylcholine. Acetylcholine is a neurotransmitter, or a chemical messenger. It transfers signals between certain cells to affect how your body functions. |
| What does acetycholine do? | The chief neurotransmitter of the parasympathetic nervous system, the part of the autonomic nervous system (a branch of the peripheral nervous system) that contracts smooth muscles, dilates blood vessels, increases bodily secretions, slows heart rate. |
| What are some anticholinergic drugs used for pre-anesthetic purposes? | Atropine and glycopyrrolate |
| What are actions of Atropine and glycopyrrolate? | Prevent bradycardia, excessive salivation and airway secretions. |
| What are some potential side effects of Atropine and glycopyrrolate? | Increased oxygen consumption by the heart. Thick airway secretions. GI ileus: (especially in horses) reduction or complete lack of peristalsis. |
| Name four sedatives used in veterinary medicine: | Phenothiazines. Benzodiazepines. Alpha2 agonists. Opiates. |
| Name one example of a phenothiazine. Two actions of this drug? Does it provide analgesia? | Acepromazine. Tranquilizer, antiemetic. No analgesic benefit. |
| What are possible side-effects of the Phenothiazine Acepromazine? (6) | Increased risk of seizure. Hypotension/hypothermia. Prominent nictitans. Penile prolapse. Prolonged sedation (6-8 hrs). Idiosyncratic aggression. |
| What are contra-indications for Acepromazine (a Phenothiazine)? (7) | Epilepsy. Liver disease. Heart disease. Geriatric or Pediatric patient. Dehydration/hypotension/shock. Breeding stallions. Eye exams. |
| What is an antiemetic? | A drug to reduce nausea and vomiting. Commonly used to treat motion sickness and side effects of opioid analgesics, general anesthetics, and chemotherapy directed against cancer. |
| What does Idiosyncratic mean? | peculiar or individual. An abnormal physical reaction by an individual to a food or drug. |
| Name two examples of Benzodiazepines. Three actions of these drugs? Does it provide analgesia? | diazepam (Valium), midazolam (Versed). Tranquilizer, muscle relaxant. Anti-seizure by enhancing GABA effects in the brain. No analgesic benefit. |
| What are some advantages of using Benzodiazepines (diazepam: Valium, midazolam: Versed)(4)? | Reversal agent available: flumazenil. Minimal depression of respiratory or cardiovascular systems. Short-acting (20 minutes). May be combined with ketamine or tiletamine. |
| What are some possible side effects of using Benzodiazepines (diazepam: Valium, midazolam: Versed)(4)? | Appetite stimulant. Liver failure if given orally to cats. Hypotension if IV injection is too rapid. Diazepam is painful if given IM (Midazolam is not, but $$$). |
| Name two Alpha2 Agonists. Describe two actions. | Xylazine (Rompun), Medetomidine (Domitor). Sedative that decreases norepinephrine release (inhibiting sympathetic nervous system). Analgesia (shorter than sedation). |
| What are four possible side effects and one caution to keep in mind in regard to Alpha2 Agonists. | Profound bradycardia; AV heart block. Vomiting (especially in cats). Risk of bloat in deep-chested dogs. Cattle are very sensitive to these drugs. Caution: use is ideally limited to healthy, young dogs and horses that are closely monitored. |
| Are there any reversal agents for Alpha Agonists? | Yes, Yohimbine and atipamezole, but they may not last as long as alpha2 agonist. |
| Name three Opioids used in veterinary medicine. Describe the actions of these drugs (2). | butorphanal, morphine, oxymorphone. Sedation and analgesia by binding to opiate receptors of the CNS. |
| What are four possible side effects of Opioid use (butorphanal, morphine, or oxymorphone)? | Respiratory depression. Excitement if given rapidly IV. Excitement if used alone in cats and horses. Impaired thermoregulation. |
| Is there a reversal agent available for Opioid drugs (butorphanal, morphine, oxymorphone)? | Yes, naloxone. |
| What are Induction Agents? | Drugs used to facilitate smooth and rapid transition from consciousness to unconsciousness. Sometimes used alone for short anesthetic procedures. |
| Injectable vs "Mask Down" Induction Describe five attributes of Injectable Induction. | Rapid anesthetic induction. Minimal excitement phase/stress. Rapid control of airway. Minimal risk of self trauma. Minimal risk of personnel injury. |
| Injectable vs "Mask Down" Induction Describe four attributes of Mask or Box induction. | Prolonged excitement phase. Risk of trauma to patient and personnel. Increased anesthetic exposure for personnel. No control of patient airway. (high risk of brachycephalic and other airway disease). |
| Name four induction agents used in veterinary medicine: | Propofol. Barbiturates. Dissociative agents. Guaifenesin. |
| Induction agent: Propofol True or false: it is a phenolic compound unrelated to any other general anesthetic. | True |
| What is a phenolic? | A substantive (noun) that may apply to : Phenol (or carbolic acid), a colorless crystalline solid & aromatic compound. Phenols, a class of chemical compounds that include phenol. Found in wine and paper (type of cardboard used for printed circuit boards). |
| Induction agent: Propofol It is not ___ soluble, and is prepared as a ___ ___ emulsion containing soybean oil, egg lecithin, and glycerol. | water. milky white. |
| Induction agent: Propofol True or false: it contains no preservatives and the emulsion supports bacterial growth and endotoxin production. Once exposed to air the contents in the vial must be used within 8 hrs or discarded thereafter. | True |
| Induction agent: Propofol It is ___ scheduled under the Controlled Substances Act (CSA), which means it is not a controlled substance, a major advantage over other scheduled agents. | not. But it does have addictive properties. |
| Induction agent: Propofol It is for ___ use only. | intravenous (non-irritant, but too rapidly metabolized for other routes). |
| Induction agent: Propofol It is ___ respiratory depressive. | very. Worse than thiopental. |
| Induction agent: Propofol Muscle relaxation is usually ___. | fair |
| Induction agent: Propofol Quality of anesthesia (smoothness) is ___ ___. | usually good |
| Induction agent: Propofol Quality of recovery is usually ___. | excellent (very complete) |
| Name three Barbiturate drugs available in veterinary medicine. Do we know the mechanism of action? Which one lasts "ultra short" "short" "long"? | thiopental (ultra short), pentobarbital (short), phenobarbital (long). Mechanism of action is unknown. |
| What are the advantages of using Barbiturates (thiopental, pentobarbital, phenobarbital) (4)? | Ultra short acting 4 induction of anesthesia. They are the least expensive of injectable anesthetics. Need no specialized equipment 4 administration. These drugs have a rapid onset of action, provide predictable response, and rapid recovery (single dose) |
| Precautions of Barbiturates (thiopental, pentobarbital, phenobarbital) use: drug must be given ___ because it is highly alkaline (pH=11); perivascular injection will cause tissue ___. The drug must not be used when ___ access not possible. | intravenously. necrosis. venous (or questionable) |
| Precautions of Barbiturates (thiopental, pentobarbital, phenobarbital) use: there is a ___ margin of safety between an effective dose and a lethal dose - especially in debilitated patients. | small |
| Precautions of Barbiturates (thiopental, pentobarbital, phenobarbital) use: ___ and profound ___ depression following IV bolus injections often occur. | Apnea. respiratory. |
| True or false: all barbiturates are controlled substances. | True |
| Name two Dissociative Agents available in veterinary medicine. What there mechanism of action? | ketamine, tiletamine. N-methyl-D-aspartate (NMDA) antagonist. |
| Dissociative Agents: ketamine, tiletamine Eyes remain ___ ___ with ___ at times, and therefore protective eye ___ is indicated to protect the eye from ___ during anesthesia. | wide open. nystagmus. lubricant. damage. |
| Dissociative Agents: ketamine, tiletamine Emergence hallucination and delirium can be prevented with concurrent use of ___/___. | sedatives/tranquilizers |
| Dissociative Agents: ketamine, tiletamine ___ muscle rigidity is counteracted by use of ___ possessing good muscle relaxant effect. (e.g. benzodiazepines) | Increased. sedative. |
| Dissociative Agents: ketamine, tiletamine Both ___ and ___ is observed. ___ is due to its effect on thermoregulatory centers, and ___ on the increased muscle activity or hyperactive behavioral change. | hypothermia and hyperthermia. hypothermia. hyperthermia. |
| Guaifenesin ___ central-action muscle relaxant that potentiates anesthetic agents, commonly used in large animals. | Intravenous |
| Guaifenesin Also used as an ___ in small animals and humans. | expectorant |
| Guaifenesin Should be given through ___ ___ because of risk of perivascular tissue ___. | IV catheter. necrosis. |
| Inhaled Anesthetic Properties ___ ___ determines maximum concentration achievable in oxygen. | Vapor pressure |
| Inhaled Anesthetic Properties ___ determines how rapidly it will enter and leave the blood. | Solubility |
| Inhaled Anesthetic Properties Minimum Alveolar Concentration (MAC) is the amount of anesthetic that will cause surgical anesthesia in __% of patients. It determines ___ ___ and varies with species. | 50%. vaporizer settings. |
| Inhaled Anesthetic Properties: MAC 1.5 - 2.0 x MAC maintain anesthesia in ___%. | 100% |
| Inhaled Anesthetic Properties: MAC 2.0 - 3.0 x MAC ___ dose. | induction |
| An Ideal Inhaled Anesthetic will be ___-explosive, ___-flammable, ___-toxic, ___ with CO2 absorbent, potent, pleasant to inhale, ___ metabolism, low blood gas ___, ___ analgesia, ___ shelf life, minimal organ ___, and inexpensive. | non, non, non, safe, minimal, solubility, good, good, depression |
| Nitrous Oxide Presented in ___ cylinders filled with liquid N2O. | blue |
| Nitrous Oxide MAC above 100%, so ___ be used on its own. | cannot |
| Nitrous Oxide Much more wide spread use in ___ medicine than in ___ medicine. | human, veterinary |
| Nitrous Oxide Ensure at least __% oxygen is given. | 30%. 70% maximum nitrous oxide concentration. |
| Nitrous Oxide In ___ circuits accumulation of N2O and of nitrogen increases the danger of ___. Use of ___ systems recommended if nitrous oxide is used. | rebreathing. hypoxia. nonrebreathing. |
| Nitrous Oxide 100% ___ should be given at the end of the procedure for approximately __-__ minutes to prevent diffusion hypoxia. | oxygen (O2), 5-10 minutes. |
| Nitrous Oxide It should not be used in ___ or ___ unless blood gas oxygen analysis is available. | ruminants or horses |
| Nitrous Oxide True or false: probably not very practical for private veterinary practice setting as the disadvantages outshadow the real use advantages. | True |
| Isoflurane It is very ___ in blood and a lot less soluble than halothane in ___. What does this mean for our patients? | insoluble. fat. Induction and recovery are faster. |
| Isoflurane Analgesia is ___ and muscle relaxation is ___. | poor. moderate. |
| Isoflurane True or false: dose dependent depression of respiratory and cardiovascular system is seen. | True |
| Isoflurane ___ metabolism is very low, decreasing the risk of ___. | Liver. hepatitis. |
| Sevoflurane It has a ___ blood/gas solubility even ___ than isoflurane. What does this mean for our patients? | low. lower. Induction and recovery is quick. |
| Sevoflurane True or false: in a horse, this quick recovery may cause emergency excitement, so a low dose of sedative (usually zylazine) is given to slow the recovery and avoid the adverse reaction at the time of recovery. | True |
| Sevoflurane True or False: Cardio respiratory effects were similar to those induced by other agents. | True |
| Sevoflurane Just as isoflurane, when the ___ expires (soon), the ___ is expected to drop substantially. | patent. price. |
| ___ is defined as the absence of pain sensation. | Analgesia |
| ___ is the physical or emotional display of physical or mental strain. | Distress |
| Increased sensitivity to non-noxious stimuli is: | Hyperesthesia |
| A ___ is a receptor that translates tissue damage to pain perception. ___: cuts, stretch, crush, puncture. ___: heat and cold. ___: irritant, infection, inflammation. | nociceptor. Mechanical. Temperature. Chemical. |
| Nociception Basic structure of ___ pathway is a 3-neuron chain: Peripheral fiber, spinal tract, brain. | afferent |
| ___ is the translation of noxious stimuli into electrical activity at peripheral nociceptor. | Transduction |
| ___ is the movement of nerve impulse through nervous system. | Transmission |
| ___ is a change of pain perception by the efferent analgesic system. | Modulation |
| What are some consequences of pain? (7) | Decreased quality of life, increased risk of infection, delayed wound healing, reduced food & water intake, decreased sleep (quantity & quality), behavior changes. Mobility changes. |
| What are some things we can use to help us recognize and assess pain? (8) | Increased blood pressure, increased heart rate, increased respiratory rate, stress leukogram (CBC), vocalization, hiding, posture changes, pain numerical rating scale. |
| Numerical Rating Scale (NRS) True or false: should be different for each species and each veterinary clinic should have a standardized Pain Scale System for every veterinary member. | True |
| ___ analgesia are techniques used before the patient is exposed to noxious stimuli. Minimizes duration and intensity of animal discomfort. Minimizes the amount of drug needed to control pain; decreases anesthesia drugs. | Preemptive analgesia |
| What are we trying to prevent when you use preemptive analgesia techniques? | Wind up. Repeated pain impulses to the brain leads to increased sensitivity to pain if it occurs over hours. Therefore, if pain stimulation is occurring during surgery, there will be a higher sensitivity to pain when the animal regains consciousness. |
| The basis of giving analgesia prior to surgery is: | Prevention of Wind up |
| What is multimodal analgesia? | Simultaneous use of two or more analgesic drug classes or techniques: NSAID and Opiate, Local anesthetic and Systemic anesthetic, others. |
| Why is multimodal analgesia so effective? | It interrupts transduction of pain at different sites along the pain pathway. |
| True or False: Mode of delivery of drug can make a major difference in effectiveness of therapy. | True |
| Mode of delivery can make a major difference in ___ of onset of action. | time |
| What are five methods of administering systemic analgesia to our patients? | PO, SQ, IV, Constant Rate Infusion, Transdermal. |
| Describe the process of applying transdermal patches to a patient. (7) | Shave patient without causing abrasion. Clean skin with water ONLY. When dry apply patch to skin and hold with warm hand for 60 seconds. Apply bandage to maintain skin contact. Label: date, time, dose, initials. Never cut patch. 8-24 hr ramp up time. |
| Constant Rate Infusion (CRI) CRI is an IV technique which can be used with many different types of drugs. Name five: | Electrolytes, anti-nausea, anti-arrhythmia, insulin, analgesia. |
| Constant Rate Infusion (CRI) the dosage is given as a fixed amount per ___ | time |
| Constant Rate Infusion (CRI) The dosage is delivered directly in the __ ___, if the fluids are given at a fixed rate. Or the dosage can be delivered in a ___ at a rate independent of fluid support. | IV fluids, Buretrol |
| Constant Rate Infusion (CRI) What is a Buretrol? | a type of infusion device that holds limited quantities of IV fluids or medications often designed to prevent free flow of fluids or air once the infusion is done. |
| Local or Regional Analgesia can be administered by many routes. Name six: | subcutaneous (infiltrative), topical (EMLA & ELA-Max cream), epidural, nerve blocks, intra-articular, pleural. |
| Describe the process of administering a Infiltrative Block: | Shave and surgically prep region. 22 g needle inserted and anesthetic injected at multiple SQ sites to cover "inverted pyramid" Lidocaine or Bupivacaine. |
| Describe the process of completing intra-articular analgesia: | Shave and surgically scrub skin over joint. Sterile needle is guided into the joint. Lidocaine, Bupivacaine. Morphine. |
| How do you perform an epidural? | The L7 region is shaved and surgical prep is performed. Spinal needle is inserted into the epidural space. Anesthetic agent is injected into the CSF. Aseptic technique is mandatory. Significant skill is required for this procedure in small animals. |
| True or false: epidurals are commonly done for large animal surgeries. | True |
| What is the mechanism of action of NSAIDs? | Block prostaglandin sythesis: this decreases inflammatory mediator, and decreases nociceptor sensitivity. |
| COX-__ prostaglandins are protective to homeostasis of ___, ___, ___, and ___. | 1. kidneys, gastric mucosa, platelet function, macrophage function |
| COX-__ prostaglandins are inflammatory mediators. They cause swelling, pain, and chemotaxis. | 2 |
| What is Chemotaxis? | the movement of an organism in response to a chemical stimulus. Somatic cells, bacteria, and other single-cell or multicellular organisms direct their movements according to certain chemicals in their environment. |
| COX-1 and COX-2: Non-specific Name five: | Aspirin, Tepoxalin (Zubrin), Phenylbutazone, Flunixin (Banamine), Bismush subsalicylate: Pepto-bismal, Kaopectate. |
| COX-1 and COX-2: COX2 Inhibitor Name five: | Carprofen (Rimadyl), Etodolac (Etogesic), Deracoxib (Deramaxx), Meloxicam (Metacam), and Firocoxib (Previcox). |
| NSAID: Side Effects/Contra-Indications Name three: | GI ulcers: especially with corticosteroid use. Renal damage: especially with hypotension, renal insufficiency, and in cats. Liver damage: special risk for Rimadyl in Labrador Retrievers. |
| Monitoring NSAID Use How can it be done. How often? | Blood chemistries should be evaluated prior to initiation. Then done again 2 weeks after treatment began. It should be repeated periodically q 3-6 months. |
| NSAID Use Taper use to lowest effective dose. True or false: daily or EOD much more effective than PRN. | True |
| NSAID Use Drug should be stopped immediately if these adverse effects are seen (3): | decreased appetite. vomiting, melena. Pet should be reevaluated. |
| NSAID Use What is melena? | dark sticky feces containing partly digested blood. |
| Opioids: Mechanism of Action Block synaptic receptors: | OP1, OP2, OP3. Inhibits excitatory neurotransmitters. |
| Opioids: Mechanism of Action True or false: different opioids have different receptor affinity and so the effect of each one is not identical. | True |
| Opioids: Mechanism of Action True or false: different opioids have different receptor binding strength and so the effect of each one is not identical. | True |
| What are some side effects/contra-indications of opioid use? (5) | Respiratory depression. Heart rate depression. Vomiting. Hyperthermia (cats). Dysphoria (hallucinations) (cats) |
| Opioid Synergy Enhanced effectiveness may occur when an opioid is combined with: (4) | NSAID, Alpha-2 agonist, Phenothiazine, Local anesthetic. |
| Opioid Reversal How does this work? | opioid antagonists compete with the opioid for receptor binding sites. |
| Name one opioid reversal drug. What is it capable of. Not? | Naloxone. binds to the u and K receptors but has no activity of its own. It can reverse sedation, respiratory depression, narcosis and analgesia. It can not reverse vomiting of apomorphine. |
| What are two local anesthetic agents available in veterinary medicine. | Lidocaine and Bupivacaine. |
| Local Anesthetic Agents Onset of Lidocaine and Bupivacaine? | rapid onset (5-10 minutes) |
| Local Anesthetic Agents Duration of Lidocaine and Bupivacaine? | short duration (45 - 90 minutes) |
| Local Anesthetic Agents Block ___ channels of the neuron. | sodium channels |
| Local Anesthetic Agents At high doses can effect ___ ___. | cardiac rhythms |
| Local Anesthetic Agents Certain drugs in this group (Cetacaine) should not be used in cats. Why? | It causes hemoglobin damage |
| Four Phases of an Anesthetic Event What are they? | Pre-anesthesia, induction, maintenance, recovery |
| Four Phases of an Anesthetic Event What two parts make up the pre-anesthesia phase? | Patient evaluation (P.E., blood work, etc), Preparation for procedure. |
| Four Phases of an Anesthetic Event What goes on in the induction phase? | Transferring patient from conscious to anesthetized state. |
| Four Phases of an Anesthetic Event What three steps make up the maintenance phase? | Keep patient anesthetized. Monitoring/recording and support of homeostasis. Recognizing trends of vital signs is the most important way to prevent anesthetic emergency! |
| Four Phases of an Anesthetic Event What happens in recovery phase? | Patient regains consciousness. This is the most common time for anesthetic -related death (64%), so monitor your patients carefully and often. |
| Four Phases of an Anesthetic Event The period from cessation of anesthesia to normalization of vital signs and consciousness. | Recovery period |
| Safe Extubation This takes 10 steps. Describe step 1: | Discontinue anesthesia, but maintain O2 for at least 5 minutes. Disconnect patient from anesthetic circuit to flush system free of anesthetic agent. |
| Safe Extubation This takes 10 steps. Describe step 2: | Untie endotracheal tube (but keep the cuff inflated). |
| Safe Extubation This takes 10 steps. Describe step 3: | Remove patient restraints, rotate into lateral recumbency. Disconnect circuit to avoid rotating endotracheal tube in patient's throat to avoid pulling on, or twisting, the delicate tissues of the larynx and trachea. |
| Safe Extubation This takes 10 steps. Describe step 4: | Record post-op vital signs (temperature, heart rate, respiration rate every 5 minutes until the patient is sternal. |
| Safe Extubation This takes 10 steps. Describe step 5: | Disconnect unneeded monitoring equipment as the patient becomes progressively more awake. |
| Safe Extubation This takes 10 steps. Describe step 6: | Discontinue oxygen, begin gentle patient stimulation (rubbing, moving, etc). |
| Safe Extubation This takes 10 steps. Describe step 7: | Once patient swallows spontaneously 2-3x, deflate the cuff and gently remove the endotracheal tube. |
| Safe Extubation Exception to step 7? | If the patient is brachycephalic, wait until the patient begins lifting their head before deflating the cuff and extubating. |
| Safe Extubation This takes 10 steps. Describe step 8: | Once ET tube removed, check it for blood, fluid, food. If any abnormalities, hang patient head off table to drain airway. Suction mouth. Evaluate need to replace ET tube (breathing effort/pulse oximetry). Notify DVM of possible aspiration event. |
| Safe Extubation This takes 10 steps. Describe step 9: | Place patient in recovery cage. The floor is not a safe place to recover cats and small dogs. Injury from other animals or people. A table or counter is not a safe place to recover anyone (fall risk), unless a tech has a hand on the patient at all times. |
| Safe Extubation This takes 10 steps. Describe step 10: | Continue monitoring and recording vital signs until the patient has regained consciousness and has normal vital signs. Remember: this is still the phase in which 64% of anesthetic deaths occur. |
| Anesthetic Related Emergencies: Be Prepared! A crash cart/box is a must in any surgery suite and recovery area. What are five things that should be in the crash cart/box? | Suction available. Emergency drugs: Atropine, Epinephrine, Reversal Agents, Hypertonic saline, Syringes & Needles. Laryngoscope, Endotracheal tubes. Ambu bag. |
| Anesthetic Related Emergencies: Be Prepared! ___ is the inhalation of gastrointestinal contents. What two things can be done to prevent this from occurring? | Aspiration. Complete fast of patient (NPO) for 12 hours prior to anesthesia. Do not let the stomach become distended with air. |
| Anesthetic Related Emergencies: Be Prepared! What is one way to prevent the stomach from becoming distended with air? | Leave the endotracheal tube, of appropriate size, cuff inflated until the patient is swallowing spontaneously. |
| Endotracheal Tube Removal Tips 1 of 3 If there has been fluid drainage from esophagus (e.g. stomach contents) or accumulation of fluid in oral cavity (e.g. dental procedures), the endotracheal tube can be gently removed with the cuff ___. | inflated |
| Endotracheal Tube Removal Tips 2 of 3 Why would a technician leave the cuff inflated on an ET tube in a situation in which fluid has accumulated in the oral cavity from the stomach or procedure (dental)? | The cuff helps pull any additional fluid out of the trachea with it. This is particularly helpful if the oral cavity has already been suctioned or swabbed clean of fluid or debris. |
| Endotracheal Tube Removal Tips 3 of 3 Never leave loose ___ ___ in the oral cavity! | loose gauze swab |
| Anesthetic Related Emergencies Describe the six possible steps to aspiration treatment. | Gravity drain airways. (over table/out of kennel). Suction & swab mouth gently. DVM may instruct reintubation & suction of trachea. Oxygen. Prophylactic antibiotics. Prophylactic esophageal treatment: Carafate-erosions. Metoclopromide-nausea/acid reflux. |
| Anesthetic Related Emergencies What are four key things to keep in mind when monitoring a patient post-aspiration event? | Auscultation (moist lung sounds or rales). Pulse oximetry. Arterial blood gas. Radiographs (6 hours after event). |
| Anesthesia Related Complications What are three possible issues? | Hypothermia. Emergence Delirium. Prolonged Recovery. |
| Name 5-7 causes of anesthesia related hypothermia. | Loss of thermoregulation due to anesthetic agents (loss of shivering, central action: brain not controlling body temperature), cold oxygen, hypotension, IV fluids, shave of sx site, open abdomen, abdominal lavage. |
| What are five consequences of hypothermia? | Prolonged recovery, increased infection rate, delayed wound healing, coagulation disorders, patient discomfort. |
| Name 6 - 8 possible preventative measures or treatment options for hypothermia. | Minimize wetting of patient. Water blanket or Bair hugger (not electric pads). Hot water bottles or bean bags. Hot towels from dryer. IV line warmer. Ventilation warmer. Warm lavage fluid. Socks, blankets, bubble wrap, or jacket. |
| The post-anesthesia excitement phase ___ includes exaggerated, uncontrolled movements, vocalizing, hyper-response to noise or light, and risk of self-trauma. | Delirium |
| Delirium What are three possible treatment options? | Hold or "papoose" animal until event passes. Medication: reversal agents, sedatives (valium), increased analgesics. Protect from self-trauma: helmets, padded recovery area. |
| What are some possible causes of prolonged recovery in our patients? (5) | Excessive anesthesia. Hypotension. Hypoglycemia. Hypothermia. Patient disease: Brain disease, liver disease, renal disease. |
| Prolonged Recovery What are some possible treatment options? (6) | Physical stimulation. Ventilation. Fluid support. Reversal agents. Warming measures. IV dextrose (diluted) if hypoglycemic. |
| Complications Related to Surgery Name five: | Hemorrhage. Hematoma. Seroma. Dehiscence. Self-trauma. |
| Complications Related to Surgery: Hemorrhage Incision should be routinely inspected for evidence of bleeding. If hemorrhage seen direct pressure for ___ minutes or ___ should be applied. Clean after bleeding stopped (blood is a culture medium). | 5 minutes. bandage. |
| Complications Related to Surgery: Hemorrhage What are five ways to determine if a hemorrhage is significant? | PCV after 4-6. May not drop right away. Vitals: HR, RR, pulse quality. Ultrasound. Abdominocentesis. Assess clotting status. |
| Complications Related to Surgery: Hematoma Blood collecting under the skin. What are four risks? | Discomfort. Infection. Delayed healing. Unhappy client. |
| Complications Related to Surgery: Hematoma Describe three treatment options. | Warm compresses TID. Prevent self-trauma. Occasionally drained. |
| Complications Related to Surgery: Seroma Collection of ___ in a pocket under the skin. Usually associated with excess dead space or __-__ (___). | serum. self-trauma (scratching). |
| Complications Related to Surgery: Seroma True of false: in the case of seromas, drainage usually is not helpful and will return. What is one possible treatment option. | True. Warm compresses TID will help resolve. |
| ___ are placed to prevent fluid from collecting in wounds that are surgically closed. | Drains |
| What are the two basic types of drains? | Passive drain (Penrose). Active drain. |
| What is a Penrose Drain? | A gravity dependent drain in which fluid leaves the wound through an exit hole. Sutured in place. Inexpensive. |
| How are Penrose Drains usually cared for? | 2-3x day: Warm compresses. Cleaning of sites. Prevent animal from chewing. Remove after 3-5 days. |
| What are three possible advantages to an Active Drain. One disadvantage? Name one of these types of drains. | Efficient. Not gravity dependent. Less change of infection. More difficult to maintain. Jackson-Pratt drain. |
| What is Dehiscence? | Necrosis of the tissue around a suture site. |
| What are three possible causes of dehiscence? | Due to: infection, excess tension on sutures, an allergic reaction to suture material. |
| Bandage Care Bandages, splints, and casts must be kept ___ and ___ at all times. | clean. dry. |
| Bandage Care Wet bandages can lead to skin ___, ___, or even ___. | skin infections. necrosis. sepsis. |
| Bandage Care Bandages must be allowed to "___." Plastic covers for only a few minutes at a time. | breath. We do not want to encourage the growth of infectious anaerobic bacteria. |
| Bandage Care Bandages should be evaluated ___. | QID. Four times a day. |
| Self-trauma Must be prevented. What are the top two first steps when this occurs? | #1 Assess comfort level of patient: proper application of bandages, analgesia. #2 Utilize Deterrents: Elizabethan and buster collars, t-shirts, sprays/creams such as bitter apple. |
| Discharge Appointment Should be in a __ room. Not the lobby or parking lot. Should the patient be in the room during instruction? Give owner ___ and ___ (so they can make notes). Carefully point out important points on handout. | quiet. No. Inform client that they will be brought out after instructions. Handout and pen. |
| Discharge Instructions Do give demonstrations on live animal or show videos for: (3) | Medication administration. Wound care/Drain care. Use of Elizabethan collars. |
| Discharge Instructions True or false: always make the recheck appointment with client before they leave whenever possible. | True |
| Discharge Instructions True or false: custom fit written instructions for specific pet (including pet name and recheck appointment). | True |
| General Post-anesthesia Instructions Be sure to remind the client to: | confine to safe area where pet can't fall downstairs, slip on floors, or become cold. Limit bathroom breaks to leash walks only for first 7 days. First meal should be 1/2 normal amount. |
| General Post-anesthesia Instructions Incisions should be checked ___ a day for ___, ___, ___, or ___. | 3x a day. Swelling. Discharge. Bleeding. Missing Sutures. |
| Elizabethan Collars True or false: Emphasize constant use and remind them to monitor the patient carefully to make sure they can eat, drink, sleep in it. | True |
| Follow-up Monitoring Remind client that they can return for additional demonstrations at no charge. (make an appointment). When should we be giving them a call after a sx procedure (anesthesia)? | 1-2 days to check in. Shows the team cares for them and their pet. Catches problems early. Support the owner in their nursing role. |
| General Post-op Instructions What five side-effects should we remind the client to give us a call for? | vomiting/diarrhea. anorexia. whining/signs of discomfort. Lethargy. Shivering. |
| General Post-op Instructions True or false: if your clinic does not keep 24 hour business hours, a contact number for a 24 hour clinic should be given to the client in case of emergency. | True |
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