Surgery Dr Q: Chapter 12

  1. Humor error is one of the most common reasons for anesthetic emergencies, examples are:
    • Improper calculations
    • Lack of attention to the anesthetic machine
    • Lack of proper patient evaluation
    • Incorrect use of drugs
    • Lack of knowledge of drug pharmacology
  2. Equipment issues:
    • CO2 absorbent exhaustion
    • Empty O2 tanks
    • Misassembly of anesthetic machine 
    • ET tube problems (wrong size, tube blockage, placed too far in)
    • Vaporizer problems (wrong agent for vaporizer, excessive agent, vaporizer dial sticking)
    • Pop off valve cannot be left closed
  3. What happens if the pop off valve is closed and the oxygen flow rate is greater than the patients oxygen requirement?
    Pressure within the circuit and the patients lungs and thoracic cavity will rapidly rise, this prevents exhalation and decreases the venous return to the heart which decreases cardiac output and can lead to death within a short time
  4. ___ ____ are generally safer than use of only one or two drugs
    Multidrug protocols
  5. Anesthetist concerns for C-sections
    • Hypoxemia
    • Hypercarbia
    • Hypotension
    • Bleeding
    • Acid-base imbalance
    • Tissue trauma
    • Drugs passing placenta barrier
    • Arrhythmias
  6. Anesthetist concerns for geriatric patients
    • Reduced organ function
    • Poor response to stress
    • Hypothermia
    • Overhydration
  7. Anesthetist concerns for pediatric patients
    • Hypothermia
    • Overhydration
    • Inefficient excretion of drugs
    • Difficult intubation and IV catheterization
  8. Anesthetist concerns with brachycephalic patients
    • Airway obstruction
    • Abnormal high vagal tone
  9. Anesthetist concerns with sighthounds
    Increase sensitivity to barbiturates
  10. Anesthetist concerns with obese patients
    • Accurate dosing is difficult
    • Poor distribution of anesthetics
    • Respiratory difficulties
  11. Anesthetist concerns with obese patients
    • Accurate dosing is difficult
    • Poor distribution of anesthetics
    • Respiratory difficulties
  12. Anesthetist concerns with trauma patients
    • Respiratory distress
    • Cardiac arrhythmias
    • Shock and hemorrhage
    • Internal injuries often present
  13. Anesthetist concerns with cardiovascular disease
    • Circulation compromised
    • Pulmonary edema common
    • Arrhythmias
    • Tachycardia
  14. Anesthetist concerns with respiratory disease
    • Poor oxygenation of tissues
    • Respiratory arrest
  15. Anesthetist concerns with hepatic disease
    • Delayed metabolism of anesthetic agents
    • Decreased synthesis of blood clotting factors
    • Hypoproteinemic
    • Dehydration
    • May be anemic or icteric
  16. Anesthetist concerns with renal disease
    • Delayed excretion of anesthetic agents
    • Electrolyte imbalance
    • Hyperkalemia
    • Hyperphosphatemia
    • Metabolic acidosis 
    • Dehydration
  17. Anesthetist concerns with urinary obstruction
    • Dehydration
    • Acidosis
    • Uremia
    • Hyperkalemia
    • Bradycardia
  18. Thoracocentesis
    • Chest tap
    • May be required to remove air (pneumothorax), blood or other fluid (pleural effusion) from chest cavity
  19. Most common cardiovascular problem seem by anesthetist
  20. Emergencies during anesthesia
    Too lightly or to deep anesthetized, hypotension, cyanosis, dyspnea, tachypnea, lack of normal heart rate or rhythm, respiratory arrest, and cardiac arrest
  21. Hypotension
    MAP < 60 mm Hg means inadequate tissue perfusion
  22. If hypotension occurs under anesthesia treat by
    • Checking anesthetic depth and lighten
    • Bolus of crystalloids (2-4 X anesthetic rate)
    • Add colloids if needed
    • Give dopamine/dobutamine if all else fails
    • Monitor fluid overload by listening to lungs and looking for pulmonary edema
  23. Treat respiratory trauma by
    • Stabilizing pre op
    • Pleural fluid/air (chest tap)
    • Pulmonary edema (give diuretics)
    • Provide O2
    • Chest radiographs
  24. Ways to provide oxygen to a patient
    • Flow by
    • Mask
    • Nasal tube
    • Oxygen collar
    • Oxygen cage
  25. Cardiac arrhythmias first most commonly occur ___ after chest trauma
    72 hours
  26. Respiratory problems under anesthesia
    • Dyspnea
    • Cyanosis
    • Abnormal CO2
    • Check respiratory character and volume
    • Check anesthetic depth
    • Check ET tube
    • IPPV performed while finding the issue
  27. Cardiovascular disease
    • Mitral valve disease
    • HW disease
    • Anemia
    • Dehydration
    • Shock
    • Cardiomyopathy
  28. ABP
    • CO X SVR
    • (CO=HR X SV)
  29. Treat bradycardia by
    • Decrease anesthesia
    • Anticholinergics (Atropine)
    • Stimulants (Dopamine, Norepinephrine and Epinephrine)
  30. How to treat tachyarrhythmias
    • Dogs= Lidocaine
    • Cats= Diltiazem
  31. If patient wont stay asleep caused by:
    • Vaporizer setting (is gas on)
    • ET tube placement
    • Apnea
    • Poor ventilation
    • Check if anesthetic machine has been assembled and hooked up properly
    • Optimal O2 flow rate
  32. Signs the patient is too deep under anesthesia
    Respirations < 6/min, dyspnea, pale/cyanotic MM, CRT > 2 secs, bradycardia, weak pulse/low BP, arrhythmias, dropping temp, absent reflexes
  33. Problems during recovery of anesthesia
    • Regurgitation/vomiting
    • Post anesthesia excitement/seizures 
    • Dyspnea
    • Prolonged recovery
  34. Absence of palpable pulse at metatarsal artery indicates systolic pressure under ___ and absence of pulse at femoral artery indicates under ___
    • 60 mm Hg
    • 40 mm Hg
  35. You are about to use the anesthetic machine and notice that although the flow meter is working the pressure gauge on the oxygen tank reads close t zero, the best thins to do would be to...
    Check the oxygen tank
  36. While monitoring a patient on an anesthetic machine, you realize that the oxygen tank has become empty, best this to do is..
    Disconnect patient from circuit, put on a new oxygen tank and reconnect
  37. If the pop off valve is left shut it will...
    Cause a significant rise of pressure within the circuit
  38. Geriatric patient is one who has
    Reached 75% of its life expectancy
  39. When performing CPCR the ratio of cardiac compressions to ventilation should be
  40. ET tube may be malfunctioning even if its in the trachea because...
    Compression of the reservoir bag doesnt result in the raising of the chest, animal is dyspneic, cannot be kept at an adequate plane of anesthesia, and reservoir bag is not moving
  41. The pop off valve may be closed or malfunctioning if...
    Reservoir bag is distended with air and patient has difficulty exhaling
  42. Administration of the normal rate of fluids during an anesthetic procedure may result in overhydraion in what types of patients:
    • Cardiac disease 
    • Pediatric patients
  43. Brachycephalic dogs may be at an increased anesthetic risk because
    • Excess tissue around the oropharynx
    • Increased vagal  tone 
    • Small trachea
  44. To decrease the anesthetic risk associated with a brachycephalic dog the anesthetist may elect to
    • Use atropine as part of the anesthetic protocol
    • Preoxygenate the animal before giving anesthetic
    • Use injectable anesthetic to hasten induction rather than masking
    • Ensure intubation is done quickly after induction
  45. Anesthetic agents to avoid cardiovascular disease patients
    Halothane and Xylazine
  46. Animal that has hypoproteinemic requires ___ barbiturate than a normal dog
  47. Tachypnea may result in
    Increased levels of arterial CO2 and to light a plane of anesthesia
  48. Tachyarrhythmias in the cat are best treated with
  49. Too light a plane of anesthesia may be a result of
    Flow rate that is too low, incorrect vaporizer setting, and incorrect placement of the ET tube
Card Set
Surgery Dr Q: Chapter 12
Surgery Dr Q: Chapter 12