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stage 1 (Analgesia Stage)
loss of pain without loss of consciousness or sense of touch
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stage 2 (Excitement Stage)
loss of consciousness to onset of regular (or spontaneous) respiration
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Stage 3 (Surgical Anesthesia Stage)
onset of regular respiration to stopping of spontaneous respiration.
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Stage 4
begins with respiratory problems and progresses quickly to circulatory failure
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plane 1
plane-respiration is regular, pupils are constricted, loss of eyelid and pharyngeal reflexes, loss of small muscle tone
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plane 2 (where you wanna be)
plane-respiration is regular but shallower, pupils are mildly dilated, loss of corneal, visceral, laryngeal and cough reflexes, large muscles begin to relax
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plane 3
plane-period in which respiratory intercostal muscle movement slows, pupils are moderately dilated and all muscle tone is lost except diaphragmatic
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plane 4
plane-period in which there is respiratory intercostal muscle paralysis and breathing is diaphragmatic, pupils are fully dilated
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capillary refill time (CRT)
reflection of the blood flow to the tissues
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2 seconds or less
normal CRT under anesthesia
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pink
normal MMB color under anesthesia
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100-102o
desired body temperature under anesthesia
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lingual or femoral arteries
pulse monitoring locations
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60-120 bpm, 60 min in dogs and 100 min in cats
normal heart rate under anesthesia
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60-180 bpm in dogs and 110-120 bpm in cats
normal heart rate in awake patients
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electrocardiography (ECG)
used to monitor the electrical activity in the heart
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> 160-180 bpm in dogs, > 200 bpm in cats
tachycardia heart rate
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< 60-70 bpm in dogs, < 100 bpm in cats
bradycardia heart rates
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heart block
results from inefficient transmission of electrical impulses that cause heart to beat
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premature ventricular contraction (PVC or VPC)
Impluse in the rhythm that arises from an ineffective and uncoordinated contraction of the ventricles
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fibrillation
fibrillation (contraction) of small muscle bundles within the ventricles or atria.
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direct monitoring of blood pressure
measurement of direct venous blood pressure
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indirect blood pressure monitoring
measurement of indirect arterial blood pressure
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central venous pressure monitoring (CVP)
measures blood pressure in a large vein (such as vena cava)
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< 8 cm H2O in dogs and cats
desired CVP under anesthesia
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systolic pressure
produced by ventricle contraction pumping blood through aorta and major arteries, highest pressure point in the system
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diastolic pressure
pressure that remains when the heart is resting between contractions, lowest pressure point in the system
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mean arterial pressure (MAP)
average pressure throughout the cardiac cycle, best indicator of blood organ/tissue perfusion
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doppler monitors
detect ultrasound waves from RBC's passing through vessel and converts them to an audible sound, systolic blood pressure
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> 90 mm Hg
systolic blood pressure rate under anesthesia
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120mm Hg
normal systolic pressure in awake patients
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oscillometric monitors
detect oscillations within the cuff that are caused by the pulsing of the artery beneath the cuff, provide systolic, diastolic and mean arterial pressures
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70-90mm Hg in dogs and cats
desired MAP under anesthesia
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90-100mm Hg in dogs and cats
normal MAP in awake patients
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blood gases
assessment of oxygen and carbon dioxide levels within the body
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PaO2
oxygen dissolved in plasma, oxygen partial pressure in arteries, measured by blood gas analyzers
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SaO2
oxygen combined with hemoglobin in RBC's, % of hemoglobin saturated with O2, measured by pulse oximeter analyzers
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generally elevated (up to 500mm Hg)
PaO2 levels under anesthesia
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90-115 mm Hg
normal PaO2 in awake animals
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95% + (95% is equivalent to PaO2 85-100mm Hg)
desired SaO2 under anesthesia
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30% in HgB, 10% in plasma and the rest reacts with carbonic acid and converts to bicarb and hydrogen ions
carbon dioxide is carried three ways
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PaCO2
partial pressure of CO2 in the arteries
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45-60 mm Hg
PaCO2 under anesthesia
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tidal volume
volume of air breathed in or out during normal respiration
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ETCO2
amount of CO2 at the end of expiration
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capnograph
electronic monitor that measure ETCO2
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32-35 (cats) and 35-46 mm Hg (dogs)
normal ETCO2 in cats and dogs
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recovery
the return of consciousness
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anesthetic machine
allows the administration of precise amounts of anesthetic agent under controlled conditions
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compressed gas supply
components that store and transport carrier agents to the anesthetic machines
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anesthetic machine
components that transport carrier agents and anesthetic agents to the breathing circuit
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breathing system
components that transport carrier agents and anesthetic agents to the patient and carry expired CO2 away from the patient
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E cylinder
30", hours of use approx. 11 hours
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H cylinder
54", hours of use approx. 118 hours
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tank pressure gauge
indicator of pressure of oxygen delivered by the tank, measure in psi
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1800 and 2200
psi in E and H tank
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tank psi x 0.3, change tanks when lower than 500psi
formula for volume of O2 tank pressure
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pressure reducing valve (regulator)
reduces the line pressure from tank to usable pressure of 50 psi
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gas flow meters
indicates amount of carrier gas that is being delivered to a patient, further reduces line pressure to 15 psi
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vaporizers
converts liquid anesthetic agent to a gas that can be inhaled by a patient
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precision vaporizers
agent specific vaporizers, very specific, located outside the circle (VOC)
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non-precision vaporizers
used with low vapor pressure agents, located inside the circle (VIC)
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valves
keep gases moving in one direction
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inhalation flutter valve
one way valve that allows flow of gases TO the patient
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exhalation flutter valve
one way valve that allows flow of gases AWAY from the patient
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hoses
transport gases from the anesthetic machine to the patient
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reservoir bag
reservoir bag for O2 and gas anesthetics that expands and contracts continuously, reflecting the patient's respirations
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bagging
manual delivery of O2
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atelectasis
alveoli in lungs are collapsed and not useful for transport of gases, patient has a reduced tidal volume
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500ml, 1L, 2L, 3L....30ml/lb
bag sizes and formula
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pressure relief valve (pop-off)valve
allows excess gas to exit the breathing circuit
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CO2 absorber canister
absorbs CO2 expired by the patient, contains soda lime crystals, soda-sorb.
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oxygen flush valve
delivers increased amounts of oxygen at a rapid pace
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pressure manometer (pressure gauge)
indicates pressure of gases within the breathing system, 15-20 cm H2O or 11-15 mm Hg
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savenger
allows exhaled waste gases to safely leave the anesthesia machine without going into the room air
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active scavenging system
tubes that leave the building, able to remove all gases from the environment, attached to pop-off valve
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passive scavenging unit
F-Air canister (removes only excess halogenated gases), weight of canister determines remaining absorption capaciity, discard at 50g
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negative pressure relief valve
designed to open and admit room air to the circuit, 21% oxygen room air is better than nothing
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breathing system
reasons by which gases circulate through the anesthetic circuit
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total rebreathing (closed), partial rebreathing (semiclosed), and non-rebreathing (open)
3 types of breathing systems
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total rebreathing (closed)
patient rebreaths almost all of its own exhaled gases plus a certain amount of fresh oxygen and anesthetic. oxygen flow rate is low, pop-off valve is almost closed
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partial rebreathing (semiclosed)
some exhaled gases remain in the circuit and some exit to the scavenger, slightly highed O2 flow rate and the pop-off valve will be open allowing more gases to escape
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non-rebreathing (open)
little or no gases return to the patient, bypasses the inhalation and exhalation valves and also the CO2 canister as the gases are scavenged upon exhalation
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200 ml/kg/min
oxygen flow rate for induction, nonreb. system and recovery
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15 ml/kg/min
oxygen flow rate for closed rebreathing system
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50 ml/kg/min
oxygen flow rate for semiclosed rebreathing system
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check outside circle for leaks
check inside the circle for leaks
close pop-off valve, cover y-piece, depress oxygen flush...does the reservoir bag fill/pressure manometer read 20 cm H2O
check the level of anesthetic agent
check the level of O2
steps to check for leaks
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