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When is a patient considered to be a geriatric patient?
when they have reached 75% of their life expectancy
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Which organs have reduced function in geriatric patients?
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What kind of response to geriatric patients have to stress?
poor response
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What are some degenerative disorders do geriatric patients have?
- heart failure
- chronic renal disease
- DM
- cancer
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What precautions do we need to take for geriatric patients?
- thorough preanesthetic history, PE, and lab work up
- blood profile
- EKG
- chest radiographs
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What kind of drug doses do we use for geriatric patients?
lower doses
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Do drugs take more time to take effect in geriatric patients?
yes
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What kind of drugs should we avoid with geriatric patients?
drugs requiring liver metabolism and renal excretion
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What do we give IV fluids to geriatric patients?
prevent low BP
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What kind of IV fluid drip should we use for geriatric patients and why?
slow drip - avoid overhydration
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What kind of recovery do geriatric patients have?
prolonged
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What are geriatric patients prone to?
hypothermia
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What patients are considered neonatals?
under 3 months old
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Why should we avoid prolonged fasting with neonatals?
hypoglycemia and dehydration
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How do we prevent hypoglycemia during anesthesia for neonatals?
give 5% dextrose IV
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What might we need to do to drugs to get the accurate dosing with neonates?
dilute the drug
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Should we avoid injectable anesthetics in neonatal patients? Why or why not?
- yes
- less plasma protein binding
- less efficient liver metabolism and renal excretion
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Why is inhalation anesthesia preferred with neonatal patients?
lung excretion and rapid recovery
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Why are brachycephalic dogs a challenging patient for anesthesia?
their airway tends to get obstructed
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Should we always intubate brachycephalic dogs? Why or why not?
- yes
- hard to maintain open airway when anesthetized without intubation
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What kind of parasympathetic tone do brachycephalic dogs have?
high parasympathetic tone
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Because brachycephalic dogs have high parasympathetic tone, what are they prone to and how do we prevent this?
- prone to bradycardia
- give atropine
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How long should we preoxygenate brachycephalic dogs?
5 mintues before induction
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What kind of induction should brachycephalics have and how do we accomplish this?
- rapid induction with IV
- intubate rapidly, may take smaller trach tube than expected, use laryngoscope
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Why do we need to watch brachycephalics very closely through recovery?
airway obstructions can occur even after they are standing and walking around
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We might have to give brachycephalics what in order for them to be able to tolerate the tach tube for a longer period of time?
opioid analgesics
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Sighthounds are sensitive to what?
certain drugs, especially barbiturates
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What are sighthounds sensitive to certain drugs?
- lack of body fat for redistribution
- may have inefficient liver metabolism (has not been fully determined)
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Which barbiturate can we give to sighthounds?
methohexital
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Why do obese patients uptake drugs slower?
because fat has poor blood supply
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How should we dose our obese patients?
dose according to ideal weight, not true weight
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Why do obese patients have respiratory difficulties? How do we help with this?
- more effort to breathe due to weight of fat over chest and abdomen
- preoxygenate
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What kind of induction should obese patients have?
rapid
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What kind of respirations do obese patients have under anesthesia? How do we compensate for this?
- rapid shallow respirations
- may need to bag him every 5 seconds to get downt o proper anesthetic depth and a more normal respiratory rate
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How should C-section mother's be positioned during surgery? Which position is better?
- dorsal recumbency
- lateral recumbency (better)
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Why is dorsal recumbency not the best position for a c-section mama?
- pressure on caudal vena cava
- less blood return to the heart
- lower CO and BP
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What two body parts does c-section mama's put pressure on?
- pressure on diaphragm: unable to breathe well
- pressure on stomach: prone to regurgitation and aspiration
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What are c-section mother's at risk for? How do we prevent these things?
- hemorrhage and shock
- give IV fluids
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What kind of drugs should we avoid with c-section mothers?
barbiturates
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Will drugs given to a mother affect the babies as well?
yes
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Can we give reversing agents to mothers?
yes
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What are the different types of chest trauma that can affect anesthesia?
- pneumothorax
- hemothorax
- pulmonary bruising
- diaphragmatic hernia
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Cardiac arrhythmias are common for up to _____ after chest trauma.
72 hours
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What are trauma patients at risk for?
- cardiac arrhythmias
- shock
- hemorrhage
- other internal injuries
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Why should we wait a day or so before doing surgery to trauma patients?
- stabilize and evaluate patient thoroughly
- PE, x-rays, EKG, etc
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What can cause cardiovascular disease?
- anemia
- shock
- CHF
- cardiomyopathy
- heartworm disease
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What do cardiovascular disease patients tend to develop?
- arrhythmias
- tachycardia
- pulmonary complications of heart disease (pulmonary edema)
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How long should we preoxygenate cardiovascular disease patients before induction?
5 minutes
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What drugs should we avoid with a patient with cardiovascular disease?
avoid drugs that depress heart function (halothane, xylazine)
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Which drugs are preferred for patients with cardiovascular disease?
- isoflurane
- opioids
- diazepam
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Why do we need to watch for overhydration with cardiovascular disease patients?
lungs are already compromised
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Which patients are the most challenging for anesthesia?
respiratory disease patients
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What are some different cardiac diseases?
- pulmonary edema
- pleural effusion
- diaphragmatic hernia
- pneumothorax
- pulmonary contusions
- pneumonia
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What are some signs of respiratory disease?
- coughing
- dyspnea
- cyanosis
- respiratory arrest
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Respiratory disease patients don't tolerate _____ well.
restraint
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What kind of extra work ups do we need to do for respiratory diseased patients?
- thoracic radiographs
- thoracocentesis
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What should we avoid with respiratory disease patients?
N2O
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How long should we preoxygenate respiratory disease patients?
5 - 10 minutes
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What position should we avoid with respiratory patients and why?
- avoid head down position
- compresses lungs, can cause diaphragmatic hernia - more viscera can slide into the chest
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What kind of induction should respiratory disease patients have?
rapid
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Hepatic disease patients have less ability to do what?
metabolize drugs for excretion
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Because patients with hepatic disease have less ability to synthesize blood proteins, what does that mean?
- could become hypoproteinemic
- avoid barbiturates
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Because patients with hepatic disease have less ability to synthesize blood clotting factors, what does this mean?
- bleeding disorders
- hemorrhage during surgery
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What does a debilitated patient with hepatic disease look like?
- ADR
- thin
- icteric
- anemic
- dehydrated
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Which drugs should be avoided with patients who have hepatic disease?
- barbiturates, sylazine, acepromazine
- anything that is metabolized by the liver
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Which drugs should we use with patients who have hepatic disease?
isoflurane
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What does a patient with renal disease look like?
- dehydrated
- anemic
- debilitated
- acidotic
- electrolyte abnormalities (hyperkalemia)
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Why should we avoid stressing out a patient with a urinary blockage?
causes release of epinephrine which can cause a cardiac arrhythmia
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Which drug is preferred for a patient with a urinary blockage?
isoflurane
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