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A&S - Week 2
Anaesthetic Drugs, Schedule 3 & Surgical Drains
| Question | Answer |
|---|---|
| How Do We Achieve Effective Anaesthesia? | -Use a combination of drugs = reduces the dose required of each individual drug, therefore likelihood of side effects is reduced -Synergistic effect (1 + 1 > 2) -Anaesthetic protocol |
| What Are The Three Stages Of Anaesthetic Protocol? | -Pre-medication (pre-med) -Induction -Maintenance |
| What Are The Main Aims Of Pre-Medication? | -Calm patient -Reduce total dose of anaesthetic drugs needed (less induction agent) -Relieve pain -Allow smooth recovery -Reduce autonomic side effects -Reduce other side effects |
| What Drugs Are Used In Pre-Medication? | -Phenothiazines -Opioids -Benzodiazepines -α-2 agonists -Anti-muscarinics (anti-cholinergics) -NSAIDs -Ketamine |
| What Are The Properties Of Phenothiazines And Name An Example Medication | -Acepromazine -Used in combination with an opioid -Sedative in high doses, tranquilliser in low doses -Anti-emetic -Removes inhibition (can make fear-aggression worse) -Reduces total anaesthetic dose by 1/3rd -No reversal agent |
| What Are The Properties Of Opioids And Name An Example Medication | -Morphine -Enhances effect of sedative -Binds to specific receptors in CNS to block pain signals -Full agonists (enhances sedative, full response at receptor), and partial agonists (lower analgesia) -Reversal agents available |
| What Are The Properties Of Benzodiazepines And Name An Example Medication | -Diazepam and midazolam -Calms patient/anxiolytic -Minimal cardiovascular effect -Can be unpredictable in healthy patients |
| What Are The Properties Of Alpha 2 Agonists And Name An Example Medication | -Domitor -Profound sedation, reduces total anaesthetic dose -Muscle relaxation and some visceral analgesia -Can cause effect on cardiovascular system, vomiting, kidney diuresis, hyperglycaemia and abortion -Reversal agents available |
| What Are The Properties Of Anti-Muscarinics And Name An Example Medication | -Atropine, glycopyrrolate -Found in crash kits, as prevents bradycardia -Not generally used -Blocks parasympathetic system -Reduces respiratory secretions -Reduces salivation -May case tachycardia, pupil dilation, causes dry mouth |
| What Are The Properties Of NSAIDs And Name An Example Medication | -Meloxicam -Analgesic -Often part of pre-med -Can reduce renal blood flow (acute renal failure) |
| What Is The Standard Dose Calculation For Volume Given If The Is Dose Given In ml/kg | volume to be given (ml) = dose (ml/kg) x weight (kg) |
| What Is The Standard Dose Calculation For Volume Given If The Is Dose Given In mg/kg | volume to be given (ml) = dose (mg/kg) x weight (kg) / strength of solution (mg/ml) |
| What Are The Signs Of Stage 1 Anaesthetic Depth? | -Voluntary excitement -Lasts until unconsciousness is present -Patient may resist induction and show fear and apprehension, then disorientation -Heart rate increased due to sympathetic stimulation |
| What Are The Signs Of Stage 2 Anaesthetic Depth? | -Involuntary excitement -From unconsciousness until rhythmic breathing is present -All cranial nerve reflexes present, hyperactive -Heart rate increased -Struggling movements and howling may be seen without awareness |
| What Are The Signs Of Stage 3 Plane 1 Anaesthetic Depth? | -Reflexes less prominent -Regular deep respiratory movements -Heart rate slightly reduced and regular -Eye central but beginning to rotate ventrally -Muscle tone (e.g. jaw) still present and responsive |
| What Are The Signs Of Stage 3 Plane 2 Anaesthetic Depth? | -Palpebral, pedal reflexes absent -Slightly reduced respiratory movements, will still increase with painful stimuli -Heart rate slightly reduced and regular -Eye rotated ventrally, pupil may be constricted -Muscles relaxed |
| What Are The Signs Of Stage 3 Plane 3 Anaesthetic Depth? | -All reflexes absent but corneal -Shallow respiration and rate decreased -Reduced heart rate and blood pressure -No muscle tone |
| What Are The Signs Of Stage 4 Anaesthetic Depth? | -Reduced respiration rate, irregular/jerky progressing to agonal -Heart rate low, pulses weak and slow -Reflexes absent -Eye central, pupil fixed and dilated -Muscle tone flacid -Cardiac arrest imminent |
| What Are The Properties Of An Ideal Induction Agent? | -Takes the patient as smoothly and rapidly as possible from a conscious state to being anaesthetised -Is short acting-but allows enough time for an inhalation agent to become effective -Has minimal effects on the cardiovascular and respiratory systems |
| What Drugs Are Used In Induction? | -Propofol -Alfaxalone -Ketamine (as part of a combination) |
| What Are The Properties Of Propofol? | -Hindered phenol -Given after pre-med, slowly (over 30-40 secs) -Duration is 5 mins -Top up doses can be given but may prolong recovery -Usually, patient is intubated, and inhalational agents are used for maintenance -Supplied in emulsion |
| What Are The Advantages Of Inducing With Propofol? | -Non-irritant on injection -IV slow -Top ups can be given -Smooth rapid induction and recovery, metabolised in liver -Can be used for c-sections but wait for mother to metabolise drug (15 mins) before removing pups |
| What Are The Disadvantages Of Inducing With Propofol? | -Pain on injection -Some cardiovascular and respiratory depression -Post injection apnoea (breath holding) if injected too quickly -No analgesic properties |
| What Are The Properties Of Alfaxalone? | -Steroid analgesia -Used for dogs and cats -Given slow IV over 60 secs -Lasts 5-10 mins -Can use on own, better after pre-med -Can be used to maintain anaesthesia but recovery prolonged |
| What Are The Advantages Of Inducing With Alfaxalone? | -Less cardiopulmonary suppression than propofol, rapidly metabolised in liver -High safety margin -No pain on injection, can be used for c-section |
| What Are The Disadvantages Of Inducing With Alfaxalone? | -Post injection apnoea if too quick -Been licensed for 10 years but used less than propofol -Longer recovery if given top up -No analgesia -Twitching on recovery |
| What Are The Properties Of Ketamine? | -Dissociative anaesthetic -Needs to be used in combination with other drugs (double/triple combination (cats/dogs), benzodiazepine (cats)) -Excreted unchanged in urine of cats (hepatic metabolism in dogs) |
| What Are The Advantages Of Inducing With Ketamine? | -Good somatic analgesia, can be given IM or IV in combination with a benzodiazepine, relatively safe in sick animals -Respiratory function not compromised -Rapid onset, especially when used IV, also absorbed over mucous membranes |
| What Are The Disadvantages Of Inducing With Ketamine? | -Pain on IM injection -Reclassified as schedule 2 controlled drug -No muscle relaxation -Eyes remain open – must lubricate corneas -Cannot be used on its own without risk of extreme excitement or seizures |
| What Are The Properties/Considerations Of Using Inhalational Drugs? | -Must be taken from the alveolus into the bloodstream and then circulated to the brain -Require the use of an anaesthetic breathing system -Can be used for induction but more commonly used for maintenance |
| What Is Minimum alveolar concentration (MAC)? | The minimum concentration of anaesthetic agent in the alveoli required to keep 50% of patients asleep |
| What Are The Pros And Cons Of Using Isoflurane As An Inhalational Drug? | -Good muscle relaxation -Some analgesia -Irritant to respiratory tract -Animals don’t like the smell (consider when using as induction agent) -Not licensed in small mammals |
| What Are The Pros And Cons Of Using Sevoflurane As An Inhalational Drug? | -More rapid induction/recovery than isoflurane -No smell and non-irritant to respiratory tract -Higher vaporiser setting = higher cost -Reacts with soda-lime in rebreathing circuits -Depth of anaesthetic can change quickly = care when monitoring |
| What Are The Pros And Cons Of Using Nitrous Oxide As An Inhalational Drug? | -Weak anaesthetic, so cannot be used alone, given with O2 and isoflurane or sevoflurane -Given at 50% -Very good analgesia -Minimal cardiopulmonary depression 0Will diffuse into gas filled structures (GDV, pneumothorax) -Environmental impact |
| What Is The Second Gas Effect When Using Nitrous Oxide As An Inhalational Drug? | Nitrous oxide will increase the rate of uptake of other inhalational agents into the blood stream, therefore an appropriate level of anaesthesia will be reached more quickly. |
| Why Does Diffusion Hypoxia Occur With Using Nitrous Oxide As An Inhalational Drug? | Due to a rapid movement of gas (when recovering animal and nitrous switched off, must maintain on O2 for 10-15 minutes, if not oxygen can reach dangerously low levels in alveoli as nitrous diffuses out of the blood stream). |
| What Is The Function Of Scavenging Systems In Anaesthetics And Name Some Scavenging Methods ? | -Prevents contamination of the theatre environment with volatile agent -Active scavenging -Passive scavenging -Fluosorbers |
| What Are The Main Points Of The Veterinary Surgeons Act 1966? | -Acts of veterinary surgery may only be carried out by a registered and qualified veterinary surgeon |
| What Does The Term Veterinary surgery Include Under The Veterinary Surgeons Act? | -The diagnosis of diseases in, and injuries to animals including diagnostic tests performed -The giving of advice based upon such diagnosis -The medical or surgical treatment of animals -The performance of surgical operations on animals |
| What Is Schedule 3 Of The Veterinary Surgeons Act? | -Provides exemptions to some restrictions in veterinary surgeons act -Originally included RVNs and lay persons, now includes SVNs (amended 2002) |
| When May Medical Treatment Or Minor Surgery (Not Involving Entry Into A Body Cavity) Be Delegated To A VN/SVN? | -When the animal is under the care of the vet surgeon -When the vet is the employer/acting on behalf of the employer -When the vet is satisfied that the VN is qualified to carry out the task |
| How Is Schedule 3 Different For SVNs Compared To VNs/RVNs? | -Any treatment or surgery should be supervised by a VS or VN -For surgery, this should be direct, continuous and personal |
| What Examples Of Medical Treatment Are Often Delegated To VNs Under Schedule 3? | -Anaesthesia -Diagnostic tests -Fluid therapy -Cleaning and dressing wounds -Placing catheters -Giving medication |
| Which Vaccines Can A VN Give Under Schedule 3? | 2nd vacs can be done by VN if directed by VS at the time of 1st vac |
| What Constitutes As Minor Surgery Under Schedule 3? | -Does not involve any procedure considered to be life threatening or risky -Does not involve any complex procedure -Is carried out on a patient that is otherwise healthy -Does not involve entry into a body cavity |
| What Are Some Examples Of Minor Surgery Under Schedule 3? | -Suture wounds -Remove skin masses -Biopsies -Abscess lancing -Aural haematoma -Digit and dew claw removal -Amputate ear tips/tail |
| What Aspects Of Dentistry Do Not Fall Under Schedule 3? | Dental Extractions |
| What Are The Aims Of Surgical Drains? | -Eliminate dead space -Help remove fluid accumulation from a wound |
| How Can Fluid Accumulation Be Detrimental To An Animals Health? | -Provides excellent medium for bacteria -Reduces perfusion -Causes discomfort -Prevents tissue apposition |
| What Are Active And Passive Surgical Drains And Provide An Example? | Active Drains = Providing suction, jackson pratt drain Passive Drains = Using gravity, penrose drain |
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aimee_knows_nothing
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