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Previous name of Guaifenesin
GGE (glycerol guaiacolate ether)
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Uses of Guaifenesin
- Skeletal muscle relaxation
- Facilitate intubation
- Ease induction and recovery
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T/F Guaifenesin can cause perivascular tissue irritation
TRUE
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What does the common induction combination known as "triple drip" consist of?
- Guaifenesin
- Ketamine
- Xylazine
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Why is it important to premedicate when using Guaifenesin?
It does not have analgesic or anesthetic properties
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Diethyl ether
- no longer used
- tracheal and bronchial mucosal irritation
- prolonged induction and recovery
- post op nausea and vomiting
- flammable, explosive
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Isoflurane and sevoflurane are _______ compounds
halogenated
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Mixture of iso/sevo and O2 is delivered to the patient via _____ or _______.
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The diffusion rate of halogenated anesthetics is dependent on ________ (alveoli/capillary) and _____________.
- concentration gradient
- lipid solubility
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Distrubution of inhalant anesthetic to tissues is dependent on ______ ________.
blood supply
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Depth of anesthesia is dependent on ________ _______ of anesthetic in the brain
partial pressure
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Effects of halogenated inhalants:
CNS
Cardiovascular
Respiratory
- dose dependent, reversible depression, hypothermia
- depressant
- dose dependent ventilation depression
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Adverse effects of halogenated inhalants:
CNS
Cardiovascular
Respiratory
- Increased intracranial pressure with head tramua/tumors
- Decrease BP and renal blood flow
- hyppoventilation, CO2 retention, respiratory acidosis
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Tendency of an inhalation anesthetic to vaporize to its gaseous state.
Vapor pressure
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T/F: temp can have and effect on the vapor pressure of inhalant anesthetics.
TRUE
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Isoflurane, sevoflurane, desflurane, and halothane are examples of volatile agents and have _____ vapor pressure.
high
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Which inhalation anesthetic is an example of a nonvolatile agent?
Methoxyfllurane
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Measure of the solubility of an inhalation anesthetic in blood as compared to air
Blood:Gas partition coefficent
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agent is more soluble in alveolar gas than in blood at equilibrium.
Low blood:gas partition coefficent
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MAC
- minimum alveolar concentration
- measure of the potency of a drug
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Iso is approved for use in what species?
dogs and horses
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Iso induces ______ to ______ muscle relaxation and provides _______ or _____ analgesia after anesthesia.
- adequate to good
- little or no
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what inhalation agent has the lowest blood:gas partition coefficent, producing the fastest induction and recovery.
Desflurane
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Doxapram is an _______ agent. May be used in neonates after a c-section as a drop on the tounge.
analeptic, stimulates respiration
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T/F: Doxapram lowers the seizure threshold
TRUE
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What are some monitoring parameters or vital signs to regulate anesthetic depth?
- HR
- Heart rhythm
- Respiratory rate and depth
- MM color
- CRT
- Pulse strength
- BP
- temp
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Ideally, the patient should be at a depth that provides:
- immobility
- lack of awareness of pain
- unconsciousness
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avoid the "4 H's"
- hypoventilation
- hypoxemia
- hypotension
- hypothermia
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Swallowing reflex:
light
medium (surgical)
- present in light anesthesia
- lost in surgical anesthesia
- returns just before regaining consciousness
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Palpebral reflex:
light
surgical
- present
- often lost in surgical anesthesia
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Pedal reflex:
light
surgical
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Corneal reflex is most useful in large animal,
light
medium
deep
present in light to medium, absent in deep or excessive anesthesia
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PLR:
light
surgical
deep
present in light and medium, absent in deep
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Other indicators of anesthetic depth
- spontaneous movement
- muscle tone
- eye position
- pupil size
- nystagmus
- salivary and lacrimal secretions
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Describe stage I of anesthesia:
- voluntary movement, begins to lose consciousness
- increased HR and respiration
- ends with recumbancy
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Describe stage II
- excitement stage
- irregular breathing
- vocalization, struggling,paddling
- increased HR and respiration
- pupils dialated
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Stage III plane I
- "light surgical anesthesia"
- not suitable for surgery
- eyes rotated ventrally
- ET tube may be passed
- pupils partially constricted
- decreased PLR
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Stage III plane 2
- "medium" surgical anesthesia
- optimum depth for sx
- regular and shallow respiration with decreased rate
- BP and HR mildly decreased
- relaxed muscle tone
- pedal and swallowing reflexes absent
- ventromedial eye rotation
- PLR sluggish
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Stage III plane 3
- "deep" surgical anesthesia
- excessive
- low HR and respiration
- reduced pulse strength
- increased CRT
- poor to absent PLR
- central eyeballs
- moderately dialated pupils
- reflexes absent
- very relaxed muscle tone
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Stage III plane 4
- "early anesthetic OD"
- too deep
- abdominal breathing
- fully dialated pupils
- marked depression of cardiovascular system
- pale MM's
- flaccid muscle tone
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Stage IV
- cessation of respiration
- circulatory collapse
- death
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Objectives of surgical anesthesia
- doesn't move
- isn't aware
- doesn't feel pain
- no memory of procedure
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HR rhythm, pulse strength, CRT, mm color and BP are indicators of __________
Circulation
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MM color, CRT, hemoglobin saturation, inspired CO2, arterial blood oxygen are indicators of _____________
oxygenation
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Respiration, depth, breath sounds, and expired CO2 levels, and arterial CO2 are indicators of ________
ventilation
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Systolic pressure is produced by what?
contraction of the left ventricle
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Diastolic pressure is produced by what?
pressure that remains in the arteries when the heart is in the resting phase between contractions
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Normal BP in dog or cat
- Systolic: up to 140-160 mmHg
- Diastolic: < 90 mmHg
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MAP (mean arterial pressure) < ____ indicates decreased organ perfusion.
60
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What peripheral arteries can be palpated to estimate pulse strength?
- lingual
- dorsal
- pedal
- femoral
- carotid
- facial
- aural
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MM color is a rough assessment of:
- oxygenation
- tissue perfusion
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blood gas analyzers can measure:
partial pressure
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pulse oximeters measure
oxygen saturation
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SpO2
>95
<90-95
<90
<85
- normal
- hypoxemic
- therapy required
- emergency
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In reflective probes, the sensor and light source are located where?
next to each other
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Ventilation
movement of gas in and out of the alveoli
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Respiration
oxygen is supplied to and used by the tissues and CO2 is eliminated from the tissues
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Tidal volume
amount of inhaled air during a breath
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Hypoventilation is shallow breathing and can lead to _________, can be reversed by _________ ________
- atelectasis
- gentle bagging
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Hyperventilation is ________ _______ _______ and can be caused by _________ or ________ ________.
- increased tidal volume
- hypercapnea or surgical stimulation
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Apneustic
pause between inspiration and expiration
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The two types of capnographs include:
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What could be the reason for an elevated baseline reading on a capnogram?
patient is rebreathing CO2 or the sensor is contaminated.
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List methods of avoiding hypothermia in an anesthetized patient.
- avoid cold prep, sx rooms
- barrier between patient and table top
- warm fluids
- warm water blanket
- warm air blanket
- warmed fluids for abdominal cavity flush
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Vet tech's role in controlling pain consists of:
- pain physiology
- pain associated behaviors
- assessment tools
- analgesic drug pharmacology
- communication with VIC
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Nociception
detection by the nervous system for potential or actual tissue injury, protects the animal from painful or noxious stimuli
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physiologic pain
- ouch pain
- little/no injury
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pathologic pain
- follows tissue injury
- acute/chronic
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Pathologic pain classification is based on the mechanisms, can also be based on _______,_______
- inflammatory- post trauma/sx
- neuropathic
- cancer
- idiopathic
- origin and severity of pain
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Steps in the pain pathway
- transduction
- transmission
- modulation
- perception
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Transduction
- transformation of stimuli into sensory electrical signals. stimuli may be thermal, chemical or mechanical
- action potentials by A delta and C fibers
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Transmission
sensory impulses conducted to spinal cord
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Modulation
impulses are either amplified or supressed
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Perception
impulses are transmitted to the brain
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consequences of untreated pain
- peripheral tissue tramua
- production of mediators from damaged cells
- attracts inflammatory cells
- lowers pain threshold of peripheral pain receptors
- windup
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Physiologic changes caused by pain
- ACTH release
- elevated cortisol, norepi, eip
- decreased insulin, continued wasting
- cardiac arrythmias
- vasoconstriction
- increased myocardial work
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"the five freedoms"
- free from:
- hunger and thirst
- discomfort
- disease
- injury
- pain
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anthropomorphosis
projecting human emotions onto animals
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Physical evidence of pain can include:
- changes in gait or level of activity
- reluctance to lie down or constantly shifing position
- vocalization
- changes in facial expressions, appearence and attitude
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Pain assessment tools
- verbal rating
- simple descriptive
- numeric
- visual analouge
- comrehensive
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