-
What are the four IV induction techniques called?
-
What does "to effect" mean?
Give half calculated dose quickly, wait 15 - 30 sec, give small increments until get sufficient results
-
How would we use the technique "to effect" on?
Fairly calm patients
-
What are the advantages to using the "to effect" technique?
uses minimum dose
-
What is another word for "using minimum dose"?
titration
-
What is "crash induction"?
Give entire calculated dose over 10 - 15 seconds
-
What patients would we use crash induction on?
- if you think the patient will vomit (unfasted patients)
- if a patient has breathing problems (brachycephalics)
- any patient where you need to establish an airway quickly
-
What are the advantages to using the crash induction method?
rapid induction...gets them down quickly if we need to establish an airway quickly
-
What does slow induction mean?
Give calculated dose over 1 - 2 minutes
-
What kind of patients would we use slow induction on?
patients who have been given propofol because it produces minimal excitement.
-
What is an IV drip induction?
Give induction agent in IV fluids to effect...administer slowly
-
What kind of patients would we use IV drip inductions on?
debilitated patients
-
What are the 2 mask inductions?
-
Describe slow mask induction.
- start on 100% oxygen, then start adding anesthetic gas very gradually
- allows time for patient to get accustomed to the smell
-
Describe fast mask induction.
start on high oxygen flow and highest setting of anethetic gas
-
Why should anesthetic monitoring begin before induction?
so you know what the patient's normals are
-
How often should vital signs be monitored during anesthesia?
every 3-5 minutes for routine, continuously for risky patients
-
What effect do most anesthetic agents have on the cardiac and respiratory systems?
depression of both rate and function (lowers cardiac output and respiratory tidal volume)
-
Besides rate, what other heart monitoring is necessary?
rhythm
-
What could be causing an arrhythmia?
low O2, high CO2...drugs (xylazine, halothane), impending cardiac arrest
-
How is the heart monitored?
manually by feeling the chest or the pulse, via stethoscope or esophageal stehtoscope, electronically by pulse oximeter or electrocardiogram
-
Does feeling or hearing the heart beat indicate adequate cardiac function?
NO
-
How do you assess cardiac function?
- pulse quality
- capillary refill time
- blood pressure
-
What is the goal for IV induction?
safety of the patient
-
What is IV induction appropriate for?
- endotracheal intubation
- short procedures
-
What drugs are commonly used for IV induction?
- thiopental
- propofol
- ketamine/ace
- ketamine/diazepam
- telazol
- oxymorphone/ace
-
Is it best to use an IV catheter for IV inductions?
yes
-
Why is it best to use a IV catheter for IV inductions?
- to have venous access in case of emergencies and we have to give another drug
- prevents perivascular injections
-
After a patient has been given an IV induction, how can the patient be maintained?
inhalation or injection
-
When is best to maintain by injection?
for short, minor procedures
-
Why is maintaining anesthesia by injection not as safe?
- drug builds up in the body
- more toxic side effects
- prolonged recovery
-
What drugs are commonly used for IM induction?
- ketamine/xylazine
- ketamine/ace
- telazol
-
IM induction dose is _____ IV induction dose.
2 - 3 times
-
How is an IM induction given?
- entire calculated dose is give - no giving to effect
- make sure you aspirate the syringe
-
What kind of onset of anesthesia does an IM induction have?
slow onset
-
What kind of recovery does IM induction have?
slow recovery - it takes a long time to metabolize and excrete the IM drug
-
What drugs are commonly used for inhalation inductions?
- isoflurane
- sevoflurane
- + nitrous oxide
- all given with oxygen
-
What are the advantages of doing an inhalation induction?
- make induction is safer than injectable induction
- do not have to place a catheter
-
What are the disadvantages to an inhalation induction?
- need to restrain the patient during induction
- leaky - room air pollution with gas
- cannot "bag" patient
-
What types of masks are used for inhalation induction?
-
What is the book technique for doing an inhalation induction?
- give 100% O2 for 2-3 minutes
- start gas at 0.5%
- increase by 0.5% every 20 seconds until 3-4%
-
What is Dr. Malcolms way of doing an inhalation induction?
put the patient straight on 5% (or 7%) gas
-
What should you do after you have induced the patient using gas?
intubate and reduce the gas to 1.5 - 2.5%
-
What are the advantages of maintaining a patient using a mask?
less effort - not taking time to intubate (this is not really a good thing)
-
What are the disadvantages of maintaining a patient using a mask?
- leaks - gas leaks out - or pollution (dangerous to people)
- room air leaks in - dilutes the gas - patient gets light
- can't bag the patient
- patient can vomit and then aspirate
- permits rebreathing CO2
- excess "dead space" for patient to move air through
-
What are the advantages to using a chamber to induce?
good for fractious animals, hedgehogs, snakes, wild animals
-
What are the disadvantages to using a chamber to induce?
- patient must be small
- can't monitor as well (only visual)
- patient may vomit and can aspirate before you can get to them
- room air pollution with anesthetic gas
- since this is a slow induction it should be avoided in patients that need a rapid induction and airway control
-
What types of patients should we avoid using an induction chamber for?
- brachycephalics
- respiratory problems
- unfasted
- cardiovascular problems
-
How do you make a home made induction chamber?
- 10 gallon aquarium
- unbreakable
- lid that fastens on
- inlets for gas and Os
- scavenger port to prevent CO2 build up
-
What is the procedure for using an induction chamber?
- place conscious patient inside chamber
- run high O2 and gas %
- observe patient closely for loss of reflexes and other problems
- as patient goes down enough to handle, get him out and finish induction by face mask
|
|