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93 Cards in this Set
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What are arguably the two most commonly used alpha-2 agents in equine anesthesia?
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Xylazine and detomidine
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What are indications where acepromazine should not be used in the horse?
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Excitable animal
Shock or anemia is present Cachexia Hypotension |
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How should your alpha-2 agonist dose be modified in older horses? In draft horses? In quarter horses?
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Older horses and draft horses are more susceptible (reduce dose);
quarter horses (use normal dose) |
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When should alpha-2 agonists be avoided in horse premeds?
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Shock or anemia
Cachexia Hypotension (pretty much like ace) |
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What are the alpha-2 reversal agents?
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Yohimbine
Tolazoline Atipamezole |
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What is the generic recipe for neuroleptanalgesia in the horse (bonus points if you can name specific drugs)?
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Tranquilizer + Analgesic
(usually xylazine or romifidine + butorphanol) |
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In which of the following animals should preanesthetic fasting NOT be implemented?
a) horse b) cow c) goat d) cat e) 2 wk old puppy f) llama |
not puppy since it is a neonate
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Which of the following is/are unacceptable induction protocol drug combinations in the horse?
a) Thiopental alone b) Ketamine followed by Guaifeniesen c) Thiopental + Guaifeniesen d) Xylazine followed by Ketamine e) Xylazine + Ketamine + Guaifeniesen |
b) Ketamine followed by Guaifeniesen (should be Guaifeniesen FIRST)
e) Xylazine + Ketamine + Guaifeniesen (this is a MAINTENANCE mixture) |
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Which type of laryngoscope blade is commonly used for equine intubation?
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NONE -- blind intubation is usually used!
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A period of tachypnea followed by apnea is known as...
Which species does this generally occur? |
Biot's Breathing occurs in 24-30% of foals
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What is the normal MAP range for a horse?
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75 - 100 mmHg
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What is the normal respiration rate in an anesthetized horse? A foal?
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Horse (4-10)
Foal (6-20) |
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Describe the desired CNS reflexes that are desired in an anesthetized horse?
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Ocular reflex (should MAINTAIN a slow palpebral reflex)
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What points should be protected during horse anesthesia?
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Coronary band
Eye Brachial plexus Nose roll prevents laryngeal hemiplegia |
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What is the most important factor in preventing myopathy in the horse?
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Maintenance of perfusion pressure
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What are common options for cardiovascular support in the horse with low perfusion pressure?
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Dobutamine
Ephedrine Calcium gluconate |
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What can prevent soft palate displacement during equine extubation?
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Get horse to swallow
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What are causes of difficult jugular venipuncture in camelids?
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Thick skin
Close jugular/carotid proximity Jugular valves |
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Regurgitation is common in which of the following animals?
a) Camelids b) Horses c) Oxen d) Sheep and goats e) Pigs |
a) Camelids
b) Oxen d) Sheep/Goats e) Pigs |
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Which of the following is NOT commonly used in camelid sedation protocols?
a) Xylazine b) Medetomidine c) Butorphanol d) Acepromazine e) Nalbuphine |
d) Acepromazine
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Which of the following is NOT an acceptable mode of chemical restraint in the camelid?
a) Xylazine IM followed by Ketamine IM 15-20 min later b) Xylazine + Ketamine given together IM c) Xylazine alone (IM or IV) d) Medetomidine IM e) Romifidine IV |
a) Xylazine IM followed by Ketamine IM 15-20 min later
(Ketamine should be IV) |
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What are the components of "Keatmine Stun"? Which animal(s) is this associated with?
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Ketamine + Xylazine + Burorphanol (pretty much same as BKX but with more xylazine and butorphanol)
Associated w/Camelids |
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What are the relative proportions of BKX?
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10mg butorphanol
100mg xylazine 1000mg ketamine |
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What can often help when catheterizing a camelid?
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Using a needle or scalpel to incise the skin first
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Which animal has the highest rate of syncope during anesthesia?
a) horse b) cow c) llama d) sheep e) fainting goat |
Probably a fainting goat but in reality, LLAMAS have a high degree of syncope
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Which of the following are acceptable induction regimens in camelids?
a) Thiopental alone (IV) b) Thiopental + Guaifensen (IV) c) Ketamine + Guaifensen (IV) d) Propofol (IV) e) Xylazine followed by Ketamine (IV) |
ALL are acceptable!
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What is triple-drip? How do the proportions differ between the camelid, horse, and ruminant?
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Triple drip = Xylazine, Ketamine, Guaifensen
(Use less xylazine in camelids, even less in ruminant) |
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Which method describes intubation of the camelid?
a) Orotracheal b) Blind nasotracheal c) Nasotracheal w/laryngoscope d) a and b only e) all of the above |
e) all of the above
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Which structures must be avoided during nasotracheal intubation of a llama? What are some complications of this?
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Avoid middle meatus, pharyngeal diverticulum (epistaxis is a complication)
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In which animal is atropine a common part of the preanesthetic preparation?
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Camelids
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What are normal heart rates of camelids?
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60-90 bpm (w/atropine)
28-40 bpm (w/xylazine) 100-125 bpm (juvenile w/atropine) |
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What is a good MAP range for camelids? How about respiratory rate?
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75-90 mm Hg
10-25 bpm (adults) 20-30 bpm (juveniles) |
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When should the ET tube be removed from camelids?
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It should remain in-place as long as possible!
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What is the common injection site for epidural anesthesia in camelids? What are common drugs used for epidurals?
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Sacrocaudal joint
Use xylazine or pretty much anything ending in -caine |
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Which pre-anesthetic drug is NEVER used in bulls?
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Acepromazine
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Place the following in order of greatest to least sensitivity to alpha-2 agonists:
Sheep Pig Calf Goat Llama Horse |
Goat (most sensitive)
Calf Sheep Llama Horse Pig (least sensitive) |
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What are two side-effects of using xylazine in ruminants?
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Hypoxemia
Oxytocin-like effects |
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Xylazine + Butorphanol is commonly used as neuroleptanalgesia in which of the following animals?
a) camelids b) pigs c) horses d) ruminants |
ALL OF THE ABOVE
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T or F:
Ruminants should undergo a preanesthetic fasting period of 8-24 hrs to prevent regurgitation. |
False!
Fasting only prevents BLOAT in ruminants |
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T or F:
Orotracheal intubation is blind in cattle but can be done with a laryngoscope in most other ruminants. |
True
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What are normal MAP values for cattle? Sheep/goats?
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Cattle (90-120 mm Hg)
Sheep/Goats (70-90 mm Hg) |
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A palpebral response is NOT desired during anesthesia in which of the following animals?
a) horse b) cow c) camelid d) dog e) cat |
b) cow
d) dog e) cat |
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Which drug is used in swine for sedation that isn't used in any other large animal/ruminant/camelid?
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Azaperone
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Which 3-drug combination (technically a 4-drug combo) is used in chemical restraint of swine?
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TKX (Tiletamine, Zolazepam, Ketamine, Xylazine)
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What additional technique must be used when intubating swine?
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Lidocaine on arytenoids
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Which physical anesthetic monitoring characteristics are the most important in swine anesthesia?
a) palpebral reflex b) Heart rate c) Corneal reflex d) Movement |
HR and movement (response to pain); ocular reflexes are worthless
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Name the condition that causes anesthetic complications in the following animals:
Horses Dobermans Sighthounds Boxers Pigs |
Horses (HYPP)
Dobies (Von Willebrand's Dz) Sighthounds (Thiobarbiturates) Boxers (Cardiac dz; Acepromazine) Pigs (Malignant hyperthermia) |
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What are complications associated with animals at either extreme of body condition scoring?
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low score = cachexic (poor anesthetic candidate)
high score = fat (frequently overdosed) |
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Which of the following has the least impact on changing anesthetic protocols?
a) Body condition score b) Age of patient c) Preanesthetic labwork d) Patient temperament |
c) Preanesthetic labwork (recent paper showed that labwork had little impact on protocol change)
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What is the ASA status of a patient awaiting a TPLO? Of a patient with pulmonic stenosis?
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TPLO = ASA - 1
Stenosis = ASA - 3 |
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What are the 8 main steps to patient anesthesia? (hint - remember what you did for the dog anesthesia lab)
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Physical exam
Calculate doses Premedicate Set-up machine Place catheters Intubate Maintenance Recover |
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What drugs were used for pre-anesthetic in the dog lab? For induction?
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Pre (Ace + Hydromorphone)
Induction (Propofol) |
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What are two main differences between cats and dogs with regard to anesthesia?
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Cats more prone to hypothermia (small size)
Decreased hepatic capability alters pharmacokinetics |
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What is a good premed drug combo for an aggressive dog?
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Dexmedetomadine + Telazol
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What is a possible complication to hydromorphone use in cats?
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Hyperthermia
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What are procedural indications for anticholinergic use in small animals?
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Endoscopy
Opthalmic procedures |
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Describe the premedication used for a geriatric dog with a fractured mandible.
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Benzodiazepine + opioid
(eg: midazolam + hydromorphone); also nerve blocks |
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Describe the premeds used for a juvenile english bulldog in for ovariohysterectomy.
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Butorphanol or low-dose hydromorphone
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Which long-lasting opioid works really well in cats?
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Buprenorphine
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Which anesthetic drug should usually be avoided in geriatric cats?
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Ketamine (renal excretion)
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What are the two major (common) options for IV induction in small animals?
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Propofol
Ket/Val |
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When properly placed and properly sized, where should the ET connection be located in relation to the patient's anatomy?
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At tip of the nose
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How does intubation of cats differ from dogs?
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Need lidocaine for arytenoids in cats
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What are some adjuncts that can be used during IV induction of small animals?
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Diazepam/midazolam
Lidocaine Opioids |
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What is a great physical monitoring parameter for anesthetic depth in small animals?
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Jaw tone
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Which dog breeds generally have poor recoveries? What can be done for this?
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Curly-tailed breeds (give acepromazine)
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What are some advantages to using local anesthesia IN CONCERT with general anesthesia?
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Reduces necessary amt of other meds (general anesthetics, post op pain meds)
Prevents wind-up Minimizes negative effects of other anesthetic drugs (due to decreased amounts) |
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What are the three general sites of action for local anesthetics? Generally speaking of mechanisms here...
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Inhibit transduction (locally)
Inhibit transmission Modulation of spinal pathways |
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Chemically speaking, what are the three parts to a local anesthetic?
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Hydrophilic part
Lipophilic part Intermediate chain |
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What is the general MOA for local anesthetics?
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Binds to receptor site in Na channel, which inactivates the Na channel and prevents depolarization.
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What are cardiovascular signs of local anesthetic toxicity?
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Hypotension, bradycardia, dysarrthymias
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What is a rough estimate for total volume of lidocaine to administer? Bupivicaine?
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<0.5ml/kg for both
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What effect does the addition of bicarbonate to a local anesthetic injection have?
a) Prolong block duration, increase intensity of block b) Hasten block onset, decrease pain of injection c) Local vasoconstrictor d) Part of multimodal analgesia |
b) Hasten block onset, decrease pain of injectio
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What effect does the addition of epinephrine to a local anesthetic injection have?
a) Prolong block duration, increase intensity of block b) Hasten block onset, decrease pain of injection c) Local vasoconstrictor d) Part of multimodal analgesia |
c) Local vasoconstrictor
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Which nerves are affected in a brachial plexus block?
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Musculocutaneous
Median Radial Axillary Ulnar |
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What tool can ensure the precision of local blocks?
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Peripheral nerve stimulator
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Which block is useful in onychectomies? Which nerves are blocked?
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4-point block (distal foot block)
Superficial radial n. Dorsal br. of ulnar n. Median n. Palmar br. of ulnar n. |
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T or F:
Blocking at the mandibular foramen and/or the infraorbital foramen blocks M4 to I1 on the side of administration. |
False! This only describes blocking at the mandibular foramen! At the infraorbital foramen you block PM3 to I1.
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Give some examples of non-drug anti-pain therapies.
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Acupuncture
Ultrasound Heat/cold therapy Massage "Laser" Electromagnetic treatments |
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What are the major classes of therapeutic anti-pain drugs?
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NSAIDs
Opioids Alpha-2 agonists NMDA blockers Local anesthetics |
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What is the difference between anesthesia and analgesia?
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Anesthesia blocks PERCEPTION of painful stimuli
Analgesia increases TOLERANCE to pain |
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Which is safer, COX1/COX2 balanced NSAIDs or COX2 selective NSAIDs?
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BALANCED NSAIDs are safer overall (less nephrotoxicity, less hepatotoxicity, and better analgesia overall)
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What are feline concerns when using NSAID therapy?
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Hepatic metabolism is variable
Nephrotoxicity in animals w/kidney dz |
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What are benefeits of neutraceuticals? Disadvantages?
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Benefits (positive effect on cartilage matrix, enhance hyluronic acid, inhibit catabolisis in joints)
Disadvantages (no FDA regulation, commonly below potency levels) |
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What is the range of duration for butorphanol effectiveness in cats?
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15min to 8 hours!!!
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This newer drug has an unknown MOA and is used very early in human pain management and shows promise in veterinary pain management.
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Gabapentin
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This drug (NOT ketamine) is a NMDA antagonist and an antiviral. It also may increase DA release.
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Amantidine
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T or F:
Pain should be considered a vital sign. |
yup
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Choose pathological or physiological pain...
...reaction to injury. |
physiological
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Choose pathological or physiological pain...
...requires a high-threshold input. |
physiological
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Choose pathological or physiological pain...
...altered nerve pathways require a low-threshold input. |
pathological
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Choose pathological or physiological pain...
...no protective function. |
pathological
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What are five factors to evaluate for pain? AAARP
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Attitude
Appetite Activity Responses Physiological parameters |
