Surgery & Anesthesia
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| Long term toxicity of inhalant anesthetics is thought to be caused by | release of toxic metabolites during liver metabolism
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| The anesthetic most clearly associated with neurologic and adverse reproductive effects is | Nitrous Oxide
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| Which of the following can be used to effectively monitor waste anesthetic gas levels? | passive dosimeter badge
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| to conduct a low pressure test for an anesthetic machine you must | Close the pop-off valve, turn on the flow meter, and occlude the end of the circuit. (all)
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| How often should a test for low pressure leaks be conducted? | Each day that the machine is used
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| The safest way to transport a large high-pressure tank, such as an oxygen tank, is by | using a handcart
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| A technician may reduce the amount of waste gas by | using cuffed endotracheal tubes, ensuring that the anesthetic machine has been tested for leaks, and using an injectable agent rather than a mask or chamber (all)
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| In what units are waste anesthetic gas levels measured? | Parts per million (ppm)
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| which of the following is a source of waste anesthetic gas? | Exhaled by the patient during recovery
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| which of the following is true regarding short term exposure to waste anesthetic gas? | resolve spontaneously when the area of exposure is left
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| Which is not a potential long term side effect of waste gas exposure? | Thyroid cancer
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| What strategy is most effective at reducing waste gas exposure? | Utilizing a scavenging system
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| which of the following inhalant gases is least likely to cause long term side effects | Isoflurane
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| which of the following hospital areas contain the largest concentration of waste gas? | recovery room, surgical suite, and surgical prep room
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| If the pop-off valve is inadvertently left shut, it will | cause a significant rise of pressure within the circuit
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| A geriatric patient is considered to be one that | has reached 75% of its life expectancy
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| How do you check if an ET tube is blocked? | Bag he patient and see if their chest rises
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| How do you decrease the anesthetic risk for a geriatric pt.? | Decrease the IV fluid rate
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| Which is true regarding anesthetizing pediatric pt. | Tend to develop hypoglycemia, anesthetic drugs should be calculated at lower doses, and dextrose can be added to IV fluids to decrease risk (all)
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| Why should brachycephalics be oxygenated prior to anesthesia | It provides a reserve of pure oxygen for them to draw on during induction
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| Obese pts are at increased risk during ax because | it is difficult for them to fully expand their lungs, difficult to accurately dose anesthetic drugs, and anesthetics poorly distribute (all)
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| Who has the highest risk of vomiting or regurgitating while anesthetized? | Pregnant dams
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| How long after impact are HBCs at risk for fatal cardiac arrhythmias? | 72 hours
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| Which of the following is a sign of fluid overload? | Increased respiratory rate
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| what condition makes pt most susceptible to fluid overload? | Cardiac dz
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| What is an indication for an enterotomy? | intestinal foreign body
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| what fracture fixation technique has the highest risk of infection? | External skeletal fixator
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| Drug induced calm, pt is reluctant to move, aware of but unconcerned with surroundings | tranquilization
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| Balanced anesthesia | administration of multiple drugs at smaller doses than would be necessary if given alone
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| anesthetic agents have | narrow therapeutic indices
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| anesthetic accidents may result in | permanent dz or dysfunction, death, legal action against staff (all)
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| O2 tank half full, pressure gauge will read | 1100 psi
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| O2 tank should be replaced at | 500 psi
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| part of anesthetic machine that controls the amount of O2 going to the pt | flow meter
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| anesthetic machines deliver inhalation and | remove respiratory waste products
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| What part of ax machine enables a quick infusion of O2 into the breathing circuit? | Oxygen flush valve
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| non rebreathing | pt under 2.5 kg
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| 2200 psi indicates the tank is | full
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| flow meters with a ball gauge should be read | from the middle of the ball
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| unidirectional valves on ax machine help | control the direction of movement of gases
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| the pop-off valve helps | prevent gas pressure from building up within the breathing circuit
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| spinal cord neurons become hypersensitive and interpret non-painful stimuli as painful | wind-up
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| pop-off valve should only be closed when | giving the patient a breath
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| continuous suture patterns | are not as secure as interrupted patterns, are quicker to place and use less suture, and if one part of the suture line breaks the entire line fails (all)
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| small animal ax, when the pt is bagged the pressure manometer reading should not exceed | 20 cm H2O
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| granule in the CO2 absorber have been depleted when | granules are brittle, hard, and change color (all)
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| Pt. weighing 26.5 lb uses | rebreathing
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| scavenger system attaches to | the pop-off valve
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| first ground drape is placed | on the side closest to the person draping
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| inadequate tissue perfusion during sx is most likely to damage | kidneys
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| reservoir bag not moving well may indicate | ET tube not in trachea, decreased tidal volume, or there is a leak around the ET tube (all)
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| pt attached to machine, pop-off valve should always be | open
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| important to perform instrument/sponge count at beginning and end of sx | to avoid leaving instruments or sponges inside the body
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| during surgical gowning | the hands must remain inside the gown cuffs until the gloves are on
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| to aid in hemostasis | apply firm pressure to site of hemorrhage, pass the appropriate hemostat, and blot, don't wipe, the blood (all)
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| presoaking instruments | prevents blood and other surgical debris from drying on the instruments
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| eyes in ventral position indicate | stage 3/plane 2 of anesthesia
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| exposed tissues are kept moist by | dripping sterile solution onto them
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| the part of ring handled surgical instruments that lock the jaw closed is | the ratchet
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| gentle tissue handling is important | to avoid causing trauma to healthy tissue, avoid complications such as hemorrhage, dehiscence, etc, and avoid further compromising unhealthy tissue (all)
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| what contributes to hypothermia in a healthy pt | anesthetic induced muscle relaxation, water and alcohol used in surgical prep, and administering room temperature IV fluids (all)
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| hypotension can be caused by | cardiac insufficiency
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| when passing ring handled instruments | the instrument should be gently laid in the surgeon's waiting hand
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| minimum pt database for young healthy cat having elective surgery should include | PCV/TP, BUN, ALT, blood glucose
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| reflex that significantly diminishes or is absent in surgical plane of ax | palpebral
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| monitoring device that measures O2 saturation | pulse oximeter
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| how should you pass a scalpel handle? | handle facing surgeon, blade facing away from you
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| untreated pulse deficits lead to | shock
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| blood pressure cuff should be what percentage of limb width to ensure accuracy? | 40%
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| eye position when too deep under anesthesia | central
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| what breeds need to be watched closely under ax to ensure patent airway | brachiocephalic
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| how to monitor respirations | watch the reservoir bag, watch the tube fogging, chest auscultation (all)
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| unconscious pt responds to sx with movement is in what stage of ax? | stage 3/plane 1
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| instruments on instrument table should be laid out | with the ring handles facing you
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| if the patient is apneic | turn inhalant gas down
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| normal SaO2 for anesthetized pt | >95%
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| tachycardia may indicate | pt is too light
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| ALWAYS an emergency | dyspnea
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| pt is too deep | hypotension
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| towel clamps that penetrate through the drape into the skin | Bakhaus
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| good jaw tone (snapping back) | pt is too light
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| losing consciousness, vocalizing and struggling | stage 2
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| measure the length of the ET tube to | the thoracic inlet
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| ET tube for brachiocephalic pt | select 1-2 sizes smaller than measured
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| ET tube is too far | pt will breath with abdominal press
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| dog with bcs of 8/9 will require more anesthetic per unit body weight | false
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| overinflation of ET tube cuff results in | tracheal necrosis
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| surgical assistant cannot wear | sandals, nail polish, jewelry (all)
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| jerky abdominal respirations, loose jaw tone, bradycardic, prolonged CRT | stage 3/plane 4
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| large O2 tanks should be stored | chained to the wall
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| part of the anesthetic machine that does not need to be checked prior to use | oxygen flush valve
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| pt breathing rapidly under anesthesia | turn up inhalant gas
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| what retractor requires more than one person for proper use? | Senn
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| what is the first thing you should do if the SaO2 reading is low? | check your equipment
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| what should you NOT do if pt is bradycardic? | turn up the inhalant gas
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| conscious, struggling, fearful | stage 1
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| what part of scrubbed in gown are part of the sterile field | front from chest to table
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| how should thumb forceps be held? | like a pencil
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| appropriate breakfast on surgery day? | whole wheat toast with PB
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| nail care practices for surgery day? | clip shorter than fingertips and remove polish
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| surgical mask should cover | nose and mouth
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| if you need to sneeze in surgery while wearing a mask | step back from the table and don't turn your head
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| minimum time for pre-surgical scrubbing? | 5 minutes
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| absence of what equals asepsis? | all pathogenic microorganinsms that cause infection
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| scalpel blade used for declaw? | 12
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| Unscrubbed assistant | should not step between 2 scrubbed people in the surgical field, should not step between pt and equipment table, always face the surgical field (all)
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| when opening a pack and checking it for sterility | check the sterile indicator on the package
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| surgical instrument "box locks" | absorb the greatest stress during use
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| liquid seeping through the sterile drape is | strike-through
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| if mucous membranes are blue, first | check for obstruction of the ET tube
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| scalpel blade used for most dog/cat surgical procedures | 10
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| sleeplike, non-responsive to verbal stimulus, aroused by painful stimulus | stuporus
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| why are needle holders the only surgical instruments that should be used to hold metal? | it is unsafe to use other instruments, it will wear the jaws of other instruments, it will place too much stress on the box lock of other instruments (all)
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| how long should small animals be fasted prior to surgery? | 12 hours
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| atraumatic surgical instruments | cause little damage to tissue
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| very young/small pt should be fasted ____as other animals | not as long
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| healthy 6 month old puppy according to ASA physical status classification system | P1
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| HBC w/internal bleeding (ASA) | P5
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| signalment | age, breed, gender
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| premature suture loss and surgical site opening | dehiscence
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| debridement of infected scratch on dog's hind limb should be done | in the prep room
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| needle holders with built in scissors | Olson-Hegar
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| vessels in the skin | halstead mosquito hemostat
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| what room should the autoclave go in? | Scrub room
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| nonmovable equipment of surgery room | overhead lights
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| moveable equipment of surgery room | suction unit
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| after turning off the anesthetic vaporizer | leave pt on oxygen for 5 minutes
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| pt is most likely to die during | induction and recovery
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| postanesthetic pt is recovered when | physiologic parameters have returned to normal
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| hemostats with serrations extending half way up the tip | Kelly hemostats
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| recover period: thrashing, crying out, paddling limbs | emergence delirium
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| Pt to be given reduced concentrations of anesthetic agents | neonates, sighthounds, pt with liver or kidney dz (all)
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| terminal cleaning | cleaning surgery and prep rooms and equipment at the end of a surgery day
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| never use to clean surgery room | dry dusting
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| scissors to use to cut gastrocnemius muscle | Mayo scissors
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| deactivate the effects of chlorine-based disinfectant | fecal matter
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| significant finding in calm canine pt with regard to anesthetic risk | increased respiratory effort
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| Surgical scissors with long, thin blades used to cut delicate tissue | Metzenbaum scissors
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| hemorrhage from surgical incision | apply direct pressure 5-10 minutes
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| seroma at surgical site due to | overactivity
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| treatment for seroma | warm compresses
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| operating scissors used | to cut inanimate objects
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| treatment for emergence delirium | hold pt, talk quietly to pt, ask vet to administer tranquilizer (all)
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| pt experiencing pain after surgery can be given | both an opioid and an NSAID
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| instrument milk is for | lubrication
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| can only be mixed with ketamine | diazepam
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| system targeted by anesthetic agents | brain
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| most general anesthetics provide analgesia | false
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| why administer pre-meds | sedation, calm excited animals, analgesia, muscle relaxation, make induction and recovery smoother (all)
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| not an appropriate route of preanesthetic agents | PO
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| primary effect of anticholinergics (atropine, glycopyrrolate) | increased heart rate
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| drug that provides analgesia | dexmeditomidine
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| preanesthetic drug, causes hypotension, reduces seizure threshold | Acepromazine
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| safe for high risk, geriatric animals | diazepam
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| antibiotics | should not be needed if sterile and aseptic technique were followed
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| side effect of propofol | apnea
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| induction agents that cause sensitivity to light, sound, and touch | dissociatives
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| best anesthetic gas for mask inductions | sevoflurane
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| stage that smooth induction should bypass | stage 2
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| what can kill a cat during anesthesia | laryngospasm from improper intubation, leaving pop-off valve closed, incorrect calculation of pre-anesthetic drugs (all)
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| ring handled instrument rings should be held with | thumb and ring fingers
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| pulse oximetry allows accurate estimation of | SaO2 or percent saturation of hemoglobin with oxygen
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| bradycardic | turn vaporizer down
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| hypotensive | turn vaporizer down
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| fully dilated pupils, no PLRS | turn vaporizer down
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| tachypnic | turn vaporizer up
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| palpebral reflex | turn vaporizer up
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| amount of oxygen animal is receiving is indicated by | the flow meter
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| device that measures CO2 levels | capnometer
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| surgical plane of anesthesia, pt eyes are | ventral
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| Jaw with no tone "flapping in the breeze" indicates | Pt is too deep
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| Cats and dogs should be fasted how long prior to surgery | 12 hours
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| ASA classification- mildly anemic or moderately dehydrated | P3
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| Most common reason veterinary staff are sued? | lack of communication
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| common adverse affect of induction agents | apnea
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| safe technique to prevent hypothermia in SA surgical pt | circulating hot water blanket
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| two most important practices to prevent surgical infection | aseptic and sterile technique
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| strike through renders drapes | contaminated
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| only scrubbed in, sterile personnel should | reach over the surgical field
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| regarding the surgical field | excessive talking and movement among personnel is unacceptable
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| unscrubbed personnel should never face the surgical field | false
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| surgical assistant is responsible for | monitoring the patient, maintaining sterility, and maintain hemostasis (all)
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| unscrubbed personnel enter or touch the sterile field | it is no longer considered sterile
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| the space above and around an open sterile pack is considered | part of the surgical field
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| scrubs can be worn for surgery more than one day as long as no blood is on them | false
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| fingernail polish protects against microbial growth | false
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| consent forms for surgery/anesthesia are | legally required
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| caps and masks are put on | before scrubbing, gowning, and gloving
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| pt who is underweight will appear ___ dehydrated than they are | more
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| necklaces can be worn when scrubbing in for surgery | false
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| postoperative recovery period begins | on discontinuation of anesthesia
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| what contributes to prolonged recovery from anesthesia? | hypoglycemia, liver dz, kidney dz (all)
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| what can hasten recovery? | physical stimulation, oxygen supplementation, warming measures (all)
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| when moveable equipment is removed from the surgery room | it should be thoroughly cleaned and disinfected before being returned
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| if there are no instructions how do you clean stethoscopes, BP cuffs, and other non-critical items for the surgery room? | clean then disinfect with alcohol
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| how often should surgery room floor be cleaned? | daily
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| difference between antiseptics and disinfectants? | antiseptics used on living tissue, disinfectants use on inanimate objects
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| contact time | time required for disinfectant to be in contact with the microorganism to achieve intended effect
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| correct order to disinfect surgical instruments | clean, sanitize, sterilize
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| neuroleptanalgesic | combination of opioid and tranquilizer
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| opioid reversed with | naloxone
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| to avoid transient apnea with propofol | titrate in several boluses
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| problem associated with recovery from teletamine-zolzepam in dogs | excitement
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| severe bradycardia caused by dexmedetomidine is treated with | atipamezole
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| surgical instruments should only be used for their designated purpose | to avoid damaging them, to protect their useful life, high quality instruments are expensive and should be handled with care (all)
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| part of anesthesia machine that converts liquid anesthetic to gas anesthetic | vaporizer
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| what do you use to place scalpel blade in scalpel handle? | needle holders
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| idiopathic pain is defined as | pain of unknown cause
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| pathologic pain is | pain caused by tissue injury
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| spay has what components of pain? | both somatic and visceral
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| in multimodal analgesic therapy | the dose of each drug is decreased when multiple drugs are used
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| how does treating pain affect wound healing? | treating pain improves wound healing
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| an animal enduring pain is | suffering
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| how do we prevent windup? | adding analgesic to premeds prior to surgery
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| behavioral responses to pain | vary depending on species, breed, age, and temperament, presence or absence of humans, and cats tend to hide, dogs seek owner attention (all)
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| when in perioperative period is analgesia needed? | preanesthetic period, surgical period, postoperative period (all)
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| which analgesics also provide anti-inflammatory action, can cause GI unlers, and can be sent home with owners | NSAIDs
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| which analgesics cannot be used with NSAIDs? | corticosteroids
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| good nursing care includes | keeping cages clean and dry, making sure pt surroundings are quiet, supplying a toy or blanket from home (all)
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| skipping patient prep | may result in life-threatening complications
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| after administering pre-meds by IM injection | place pt in quiet, dark cage where you can constantly observe them
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| most dangerous type of induction | chamber induction
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| what type of induction allows anesthetist to control both increases and decreases in depth? | inhalant induction
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| tracheal rupture caused by | overzealous intubation
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| pt is significantly too deep | turn off vaporizer
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| before repositioning pt | disconnect ET tube from anesthetic machine
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| during recovery from anesthesia | physiologic parameters should be monitored every 5 minutes until they return to normal
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