Anesthesiology Exam 1

Freedom from or absence of pain

Behavioral change wherein anxiety is relieved and the patient becomes relaxed but is aware of its surroundings

State characterized by central depression accompanied by drowsiness

Drug induced state of deep sleep from which the patient cannot easily be aroused

Artificially induced sleep or trance resembling sleep

Loss of sensation in a circumscribed area of the body

Insensibility in a larger, though limited area of the body

Drug induced unconsciousness that is characterized by controlled but reversible depression of the CNS

State or plane of general anesthesia that provides UNCONSCIOUSNESS, MUSCULAR RELAXATION AND ANALGESIA required for painless Sx

"The Triad"

The use of multiple drugs from different classes to specifically attenuate individual components of the anesthetic state

Dissociation of the thalamocortic and limbic systems characterized by a cataleptoid state in which the eyes remain open and the swallowing reflex remains intact.

Commonly seen with Ketamine

Formulate a Plan
Premedicate
Induction
Maintenance
Monitoring
Supportive Care
Recovery

I - Normal Healthy Patient

II - Patient has mild or local Systemic Dz

III - Patient has severe systemic dz

IV - Patient has severe systemic dz that is a constant threat to life

V - Moribound patients not expected to live 1 day with or without Sx

Hypothermia
~ Most common complication

Hypotension
~ Most anesthetics cause vasodilation
~ Inhalents are very potent vasodilators

Hypoventilation
~ Common secondary to anesthetic and analgesic drugs

Bradycardia
~ Secondary to increased vagal tone from drugs such as Opiods, Alpha-2-agonists, and inhalents

Pain

Reduce anxiety and stress
Provides analgesia
Reverses unwanted side effects
Reduces induction and inhalant requirements

Alpha-2-agonists, Opiods, Benzodiazepines, Phenothiazines, Anticholinergics, Dissociatives

Wait 15-20 minutes for drugs to take effect

Place IV cath

Prepare for induction
~ Prepare induction agent
~ IV flush solution (Hep/saline)
~ Endotrach tubes, Laryngescope, gauze ties, lube
~ IV fluids
~ Pre-Oxygenate patient!! (about 10 min) especially since we are using propofol

Prior to induction
~ Thoracic auscultation and determine HR

Administer Induction Agent
~ In Jx its propofol, SLOWLY

Determine if depth is adequate for intubation

Produce smooth induction with rapid progression through excitement stage (Stages I and II)

Allows for rapid control of airway

Propofol, Thiopental, Ketamine, Etomidate, High dose Opiods, Inhalants

Iso - 1.3
Sevo - 2.3

MAC x 1.5

Iso - 2%
Sevo - 3.45%

Vaporizer Setting

Fresh Gas flow rate
~Set flow meter to 2 L/min

Breaths per minute

Starts as soon as syringe enters cathater

Stage of coluntary movement

Lasting from initial administration of loss of conciousness

Stage of delirium or involuntary movement

Lasting from loss of consciousness to the onset of a regular pattern of breathing

Stage of SURGICAL ANESTHESIA

Further divided into planes 1 to 4

Stage III, plane 2 provides adequate muscle relaxation and analgesia for most surgical procedures

Plane I (light anesthesia)
Plane II (medium anesthesia)
Plane III
Plane IV (deep anesthesia)

Extremely depressed CNS

Respiratory Ceases

Heart beats for only a short time

Cardiovascular collapse and shock

Death occurs quickly unless CPCR is begun

Physical Signs
~ Jaw tone
~ Palpebral reflex
~ Corneal reflex
~ Normals (HR, RR, Systolic mean and diastolic BPs)

Equipment
~ ECG
~ BP
~ SPO2
~ ERCO2

IV Crystaloid Fluids
~ Lac Ringers, Normasol or 0.9% NaCl
~ 10ml/kg/hr then convert to drops/sec
~ Helps w/ vasodilation caused by anesthesia. The fluids will help inc BP

Supplemntal heat

Stage of SURGICAL ANESTHESIA

Further divided into planes 1 to 4

Stage III, plane 2 provides adequate muscle relaxation and analgesia for most surgical procedures

Plane I (light anesthesia)
Plane II (medium anesthesia)
Plane III
Plane IV (deep anesthesia)

Extremely depressed CNS

Respiratory Ceases

Heart beats for only a short time

Cardiovascular collapse and shock

Death occurs quickly unless CPCR is begun

Physical Signs
~ Jaw tone
~ Palpebral reflex
~ Corneal reflex
~ Normals (HR, RR, Systolic mean and diastolic BPs)

Equipment
~ ECG
~ BP
~ SPO2
~ ERCO2

IV Crystaloid Fluids
~ Lac Ringers, Normasol or 0.9% NaCl
~ 10ml/kg/hr then convert to drops/sec
~ Helps w/ vasodilation caused by anesthesia. The fluids will help inc BP

Supplemntal heat

Palpebral: dogs may have no reflex at adequate surgical depth

Corneal: should always be present

Nystagmus: Excitement or light

Lacrimation: parasympathetic stim, light plane

Medioventral eye position: most desirable, central is too deep

Jaw tone: moderate to loose

Most:
Gross purposeful movement
Reflex movement
Immediate hemodynamic response
Immediate resp response

Somewhat:
Hx of vaporizer setting (MAC)
Muscle tone
Pupillary, Palpebral, Corneal reflexes
Moist Cornea
Eye Position

HR
RR
BP

Obliterates the animals response to noxious stimuli without depressing circulatory and respiratory systems