Surgery Dr Q: Chapter 5 and 6

  1. Monitoring of anesthesia is necessary for 2 reasons
    • Keep patient safe
    • Regulate anesthetic depth
  2. Anesthetic monitoring is based on the principle that...
    In the average patient each monitoring parameter is expected to show a particular response at any given anesthetic depth
  3. Loss of consciousness marks the border between...
    Stage I and II of anesthesia
  4. Loss of spontaneous muscle movement marks the border between...
    Stages II and III of anesthesia
  5. Loss of all reflexes, widely dilated pupils, flaccid muscle tone and cardiopulmonary collapse marks what stage of anesthesia?
    Stage IV
  6. Inadequate stage to perform surgery, swallowing reflex is lost and intubation occurs. Pedal and palpebral present, strong high pulse, normal heart rate, pupils may constrict
    Stage III plane 1
  7. Suitable stage for most surgical procedures, most reflexes subsided, regular respirations (12-16), pupil size moderate
    Stage III plane 2
  8. Stage considered to be excessively deep for most surgical procedures, respirations below 12/min, may need ventilation, HR reduced, and dont respond to surgical stimulation, jaw tone absent
    Stage III plane 3
  9. Stage indicates anesthetic overdose, abdominal breathing
    Stage III plane 4
  10. Pupil size in stage I
  11. Pupil size in stage 2
    Smaller diameter
  12. Pupil size in stage 3
    Smaller diameter than stage 2
  13. Pupil size in stage 3 plane I
  14. Pupil size in stage 3 plane II
    More moderate (back to normal)
  15. Pupil size in stage 3 plane III
    Start to dilate
  16. Pupil size in stage 3 plane IV
    Dilation continues
  17. Pupil size in stage 4
    Totally dilated and fixed
  18. Objectives of surgical anesthesia are that the patient...
    • Doesnt move
    • Not aware
    • Feels no pain
    • Has no memory of procedure
    • No dangerous depression of cardiovascular and respiratory systems
  19. On a ECG a technician must be able to differentiate between..
    • Abnormal and normal rhythms 
    • Dangerous and Non-dangerous rhythms
  20. What is the most important value for the anesthetist
    MAP, best indicator for blood perfusion to internal organs and tissues
  21. What happens when MAP is below the normal 60 mm Hg?
    Blood flow to internal organs is reduced and tissues may become hypoxic
  22. Two basic types of indirect BP monitors
    • Doppler
    • Oscillometric
  23. Pale mucous membranes indicate what?
    • Intraoperative blood loss
    • Anemia
    • Poor capillary perfusion
  24. Cyanosis of mucous membranes indicates
    Low blood oxygen conentration
  25. With a anemic patient what two values dont give an accurate measurement of oxygen availability?
    • PaO2
    • SpO2
  26. With an anemic patient why doesnt PaO2 and SpO2 give a accurate measurement of oxygen availability?
    Carrying capacity of the blood is decreased owing to the decrease in the number of hemoglobin binding sites
  27. What should the oxygen saturation percentage be during oxygen administration?
    Greater than 95%
  28. Pulse oximeter reading of ___ to ___ must be investigated because it indicates that the patient is hypoxemic
  29. Oxygen saturation less than __ indicates need for therapy
  30. Oxygen saturation less than __ for longer than 30 seconds is a medical emergency
  31. What to do in the early stages of atelectasis?
    Bagging or sighing the patient by squeezing the reservoir bag on the anesthetic machine forcing air into the patients breathing passages until the animals chest rises as with a normal breath
  32. Blood CO2 levels are determined by what 3 factors?
    • Rate of production by the cells
    • Rate of transport to the lungs
    • Rate of elimination of the lungs
  33. Effective interpretation of the capnogram requires evaluation of what 4 distinct aspects?
    • Baseline value
    • ETco2 value
    • Waveform shape
    • Rate at which changes occur (suddenly, rapidly, or gradually)
  34. Normal Paco2 value during anesthesia
    45 to 60 mm Hg
  35. Paco2 value greater than 60 mm Hg indicates ____.
  36. During anesthesia body temperature loss is greatest in the first ___?
    20 minutes
  37. Body temperature range of ___ prolong anesthetic recovery and decrease the dose of anesthetic required
    89.6-93.2 F
  38. Temperature below ___ cause dangerous CNS depression and changes in heart function
    89.6 F
  39. Three stages of anesthesia
    • Awake
    • Asleep
    • Dead
  40. Main indicator used to determine when the ET tube should be removed
    Swallowing reflex
  41. The ____ reflex should be absent during surgical anesthesia in small animals maintained with isoflurane and sevoflurane
  42. The ___ reflex is present during light anesthesia and is lost during optimum anesthesia
  43. ___ reflex should be present in light and medium planes of anesthesia and lost when the anesthetic depth is excessive
  44. In small animals the eye is ___ during light anesthesia
  45. In small animals the eye is ___ during medium anesthesia
  46. In small animals the eye is ___ during deep anesthesia
  47. With most injectable and inhalant anesthetics there is generally a progressive depression of ____ and ___ function as the depth of anesthesia increases
    • Cardiovascular
    • Respiratory
  48. Plane of anesthesia most suitable for surgical procedures
    Stage III plane 2
  49. Breath holding, vocalization, involuntary movement of the limbs are most likely indication that the animal is in which stage of anesthesia?
    Stage II
  50. Anatomic dead space is
    Air within the trachea, pharynx, larynx, bronchi and nasal passages
  51. Minimum acceptable heart rate for an anesthetized large breed dog is ___
    60 bpm
  52. If the ECG is normal does that mean the heart must be beating normally?
  53. Respiratory rate of less than ___ breaths/min in an anesthetized dog should be reported to the vet
  54. Patient that has been anesthetized will often have a...
    Mild respiratory acidosis
  55. Should a animal under surgical anesthesia respond to a procedure such as pulling on viscera?
    Yes, heart rate should change
  56. What stage of anesthesia is a patient under if they have a heart rate of 80 bpm, respiratory rate is 8 breaths/min and shallow, jaw tone is relaxed, and all reflexes are absent.
    Stage III plane 3
  57. Pulse oximetry allows accurate estimation of...
    Percent saturation of hemoglobin with oxygen
  58. During anesthesia a mean arterial blood pressure of less than 60 mm Hg indicates?
    Inadequate tissue perfusion
  59. Pule oximeter reading of 89% indicates?
    Need for supportive therapy
  60. An ETco2 level of 65 would be caused by..?
    Decreased tidal volume
  61. Regarding oxygen transport which two values are closely related?
    Pao2 and Spo2, if one goes up so does the other
  62. IV fluids should be warmed to ___ before administration to a patient
    100 F
  63. Animal under stage III plane 2 anesthesia would exhibit which signs
    • Regular respiration
    • Relaxed skeletal muscle tone
  64. What is local anesthesia?
    Use of a chemical agent on a sensory and motor neurons to produce temporary loss of pain, sensation, and movement
  65. Local anesthetics can be used in conjunction with general anesthesia to enhance ___ ____during and after surgery
    Pain control
  66. Do local anesthetics cross the placenta barrier?
  67. Local anesthetics with ___ should not be administered ___.
    • Epinephrine
    • IV
  68. ____ should not be used for IV regional anesthesia as cardiotoxicity is likely after the tourniquet is removed
  69. Types of controlled ventilation
    • Manual (bagging)
    • Mechanical (with a ventilator)
  70. Types of neuromuscular blocking agents
    • Depolarizing
    • Non-depolarizing
  71. Nondepolarizing neuromuscular blocking agents can be reversed by which drugs
    • Neostigmine
    • Edrophonium
  72. Epidural anesthesia is injected where
    Between the last lumbar and first sacrum vertebrae
  73. Adverse effects of local anesthesia
    • Sedation
    • Hyperexcitability
    • Respiratory depression
    • Sympathetic blockade
  74. In healthy awake animal the main stimulus to breathe is a result of..
    Excess CO2 concentration in the blood
  75. In healthy awake animals exhalation lasts at least __ times as long as inhalation
  76. Normal VT in an awake animal is ___ ml/kg
  77. In the anesthetized animal that is breathing room air the anesthetist may expect to see...
    Increase in Paco2 and a decrease in the Pao2
  78. When used in a line block a local anesthetic agent will have a direct effect on the...
    Peripheral nervous system
  79. Local anesthetics block transmission of nerve impulses from...
    Sensory, motor and autonomic neurons
  80. Local anesthetic agents work because they...
    Interfere with the movement of sodium ions
  81. When a local anesthetic is injected around a single major nerve its referred to as...
    Infiltration nerve block
  82. Can epinephrine be mixed with a local anesthetic agent to prolong the effects of the drug?
  83. When performing a epidural in a cat the anesthetist must be aware that the spine may extend as far caudally as...
  84. The max SQ dose of lidocaine for a dog is...
    10 mg/kg
  85. When performing a IV regional anesthesia (Bier block), use lidocaine ___  ___.
    Without epinephrine
  86. Atelectasis means
    Collapse of alveoli
  87. Most common acid-base abnormality in anesthetized patients is?
    Respiratory acidosis
  88. When intermittent mandatory manual ventilation is applied to a patient that is connected to a circle system with a precision vaporizer its customary to...
    Decrease vaporizer setting
  89. What parameter can be used to monitor anesthetic depth in a patient that has been given a neuromuscular blocking agent?
    Heart rate
  90. Will a neuromuscular blocking agent provide analgesia?
  91. When an animal is given a ___ neuromuscular blocking agent an initial surge of muscle activity may be seen before paralysis of the muscle
  92. What muscle is most affected by a neuromuscular blocking agent
    Skeletal muscle
  93. Problems that may result from excessive controlled ventilation may include...
    • Decrease cardiac output
    • State of respiratory alkalosis
    • Ruptured alveoli
  94. Local anesthetics such as lidocaine and proparacaine work well when applied...
    • Topically on mucous membranes
    • Topically on the cornea
    • Through injection
  95. Factors that may interfere with action of local anesthetics agents are...
    • Fat
    • Scar tissue
    • Hemorrhage
  96. Clinical signs of systemic toxicity from local anesthetic agent may include
    • Sedation
    • Convulsions
    • Muscle twitching
    • Respiratory depression
  97. If epidural anesthetic reaches the thoracic and cervical spinal cord the following can occur...
    • Sympathetic blockade
    • Paralysis of intercostal muscles
    • Paralysis of diaphragm
  98. Common causes of hypotension
    • Anesthetic agents
    • Excessive anesthetic depth
    • Blood loss
    • Dehydration
    • Cardiac arrhythmias
    • Preexisting heart disease
    • PPV
    • GI distension
  99. Ways to prevent hypotension
    • Avoid excessive anesthetic depth
    • Provide adequate analgesia
    • Preanesthetic medications to decrease amount of anesthetic required
    • Give drugs that decrease cardiac output
    • Give IV fluids at a continuous rate
  100. Only local anesthetic given IV
  101. Normal tidal volume in awake animal? Reservoir bag needs to be how many times Vt?
    • 10-15
    • 6 times
  102. When intermittent mandatory ventilation is applied to a patient that is connected to a circle system with a precision vaporizer its customary to...
    Decrease vaporizer setting
Card Set
Surgery Dr Q: Chapter 5 and 6
Surgery Dr Q: Chapter 5 and 6