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107 Cards in this Set
- Front
- Back
Anesthesia - Intro, depth, and monitoring
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Anesthesia - Intro, depth, and monitoring
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What are the short term effects of exposure to waste anesthetic gases? How do they resolve?
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neurological effects that resolve when no longer exposed to the gases
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What are some long term effects of exposure to waste anesthetic gases?
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reproductive disorders, renal and hepatic damage, bone marrow abnormalities, chronic nervous system disfunction
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How is exposure to waste gases reduced?
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scavenging devices, perform prev maint on equip, alter/improve anesthetic techniques/protocols
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What are two hazards of compresed gas cylinders?
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Fire hazard, hazard of suddenly released pressure.
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Define anesthesia
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loss of feeling or sensation
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Define local anesthesia
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acts where applied, no effect on brain
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Define general anesthesia
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complete unconsciousness
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Define analgesia
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reflief from pain
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Define opioids
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*Synthetic* morphine derivative drugs that produce sedation and pain relief
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Define opiates
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*Natural* morphine derivative drugs that produce sedation and pain relief
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Define narcotic
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opioid or opiate that induces physical dependence and addiction
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Define neuroleptanalgesia
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combination of narcotic w/ a tranquilizer
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Define preanesthesia
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any drug given w/i 1 hour prior to induction
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Define induction
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admin of fast-acting drugs (usually IV) to cause loss of consciousness
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Define maintenance
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admin of drugs to keep pt under anesthesia
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Define surgical anesthesia
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depth of anesthesia under which surgical procedures can be safely and effectively performed (enough muscle relaxation) w/o pain to the pt
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Define tranquilizaton/sedation
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a state of calmness associated w/ some CNS depression
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What are 6 general reasons for using anesthesia?
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Restraint, examination, manipulation, general surgery, seizure control, euthanasia
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What are 5 goals of anesthesia?
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relax skeletal muscles, decrease protective reflexes, induce deep sleep, produce amnesia, and provide analgesia
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When checking to see if anesthesia goals were met one checks for signs of pain - what are 5 of these signs?
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inc heart rate, inc resp rate, gross movement, vocalization, abdominal pressing
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What is balanced anesthesia? How common is this technique?
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The practice of combining a general anesthetic w/ other drugs to minimize the neg effects of the general anesthetic - it is the most common anesthesia technique
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Does balanced anesthesia increase or decrease the amount of gen anesthetic needed?
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decrease
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What are four general considerations re: the pt to receive anesthesia?
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species variations, breed variations, indiv variation, and anesthetic risk
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What is species variation?
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the same anesthetic drug may have different effects in different species
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What is breed variation?
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same drug may have different effect in different breeds
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What dogs are vy sensitive to barbituates?
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sighthounds
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Do smaller breeds need a greater or lesser amt of anesthetic per pound of body wt in comparison to larger breeds? Why?
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greater amount because they have a higher metabolic rate
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Why do you leave brachycephalic breeds inubated as long as possible during recovery?
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They have a long soft palate and are suceptible to laryngospasm
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What can cause individual variation?
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poor condition, age, reproductive status, disposition
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Define "normal" anesthetic classification of risk
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animal is normal, apparently healthy
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Define "moderate" anesthetic classification of risk
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organ abnormality which does not affect overall health
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Define "poor" anesthetic classification of risk
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organ abnormality that does affect overall health - liver/kidney failure, pancreatitis
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Define "grave" anesthetic classification of risk
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organ abnormailty that makes anesthesia life threatening
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What are the two most important vital signs to look at when assessing the pts depth of anesthesia?
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resp rate and heart rate/rhythm/pulse
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As defined by our surg text, what is the normal resp rate for a normal awake dog? Cat?
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dog 10-30 rpm, cat 25-40 rpm
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What is a normal resp rate for an anesthetized dog or cat?
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8-20 rpm
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a resp rate of less than __rpm may indicate that the anesthesia is too deep
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less than 8 rpm
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What is tidal volume? Does anesthesia increase or decrease?
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volume of air inspired w/ ea breath - anesthesia decreases tidal volume
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What is a normal pulse in an awake dog? Cat?
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Dog: 70-140 bpm
Cat: 110-220 bpm |
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A pulse of less than __bpm in a dog may indicate bradycardia or that the pt is too deep. In cat?
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<70 bpm in a dog
<100 bpm in a cat |
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Where are two spots to take a pulse from in an anesthetized pt?
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femoral artery, lingual artery
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What are 5 monitoring methods for pulse/heart rate in an anesthetized patient?
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palpate, esophageal stethoscope, ECG, pulse ox, blood pressure monitor
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Other than HR and RR, what are two other vitals that can be used to assess depth of anesthesia?
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CRT and MM
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What is a normal CRT?
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< 2 seconds
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What are some abnormal MM colors and what are they associated with?
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blue/purple - cyanosis (dec O2)
brick red: endotoxic shock pale white/grey: poor perfusion(shock) |
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What is a palpebral reflex? How is it tested?
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Blinking - tested by touching the corner of the eye
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What is a pinnal reflex? How is it tested?
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ear/pinnae movement - lightly touch hair in ear canal or blow in canal
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What is a pedal reflex? How is it tested?
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movement of foot in response to sensation/pain - pich toes or between toes
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What is a corneal reflex? How is it tested?
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eye - touching cornea w/ sterile object and seeing if the pt blinks and withdraws eye into orbital fossa
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How is jaw tone used to assess anesthetic depth?
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pull down on mandible, want no resistance
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What are two other patient responses that can be used to assess depth of anesthesia?
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eye position, pupillary light response (PLR)
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When is stage one anesthesia seen?
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From start of anesthetic administration to loss of consciousness
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If resp are reg, pupils are resp to light, eyes are central, and all reflexes are present, what stage of anesthesia is pt in?
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Stage 1
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What is stage 2 of anesthesia also called?
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Excitatory stage
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If resp is irreg w/ poss breath holding or hyperventalation, pupils are dilated, eyes are central w/ poss nystagmus, reflexes are present & poss exaggerated, tachycardia, chewing/yawning/vocalization, & vomitting &/or diarrhea are present - what stage?
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Stage 2/excitatory stage
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What is another name for stage 3 plane 1 anesthesia?
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Restraint anesthesia
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At what stage is a pt in if the following are present: regular resp w/ inc rate & depth, resp pupils, eye central moving toward VD, laryngeal reflex gone, losing palpebral, other reflexes present, HR regular & strong
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Stage 3, plane 1
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What is another name for Stage 3, plane 2 anesthesia?
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surgical plane
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What stage? RR reg rhythm & rate, dec tidal vol, pupils slightly dilated, eyes ventral-medial, reflexes - laryngeal, palpebral, & jaw tone gone, pedal diminished or absent, mild dec in blood pressure and HR
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Stage 3, plane 2
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What is another name for stage 3, plane 3?
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Orthopedic plane
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What stage? Resp slow & shallow, pupils moderately dilated, PLR dimished, eyes central or moving central, reflexes all diminished or absent, dec cardiac output, weak pulse, delayed CRT
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Stage 3, plane 3
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What is another name for stage 3, plane 4 anesthesia?
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TOO DEEP!
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What stage? resp - irreg, jerky, shallow, pupils dilated & fixed, eyes central, reflexes absent, pale MM, prolonged CRT, weak pulse, muscles flaccid
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Stage 3, plane 4 - too deep
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What is another name for Stage 4 anesthesia?
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Terminal stage
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What stage? resp arrest, cardiac arrest
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Stage 4
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At what stage may breath holding or hyperventiliation be seen?
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Stage 2/Excitatory stage
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At what stage may nystagmus &/or exaggerated reflexes be seen?
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Stage 2/excitatory stage
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At what stage may chewing, yawning, &/or vocalization be seen?
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Stage 2/Excitatory stage
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At what stage may vomiting or defecation be seen?
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Stage 2/excitatory stage
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At what stage may eyes in a ventral-medial position be seen?
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Stage 3, plane 2/surgical plane
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At what stage is the laryngeal reflex gone, the palpebral diminishing, and other present?
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Stage 3, plane 1/restraint anesthesia
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At what stage are the laryngeal & palpebral reflexes gone, jaw tone gone, and the pedal diminished or absent?
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Stage 3, plane 2/surgical plane
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At what stage is a mild decrease in HR and blood pressure seen?
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Stage 3, plane 2/surgical plane
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At what stage is a decreased tidal volume seen w/ regular resp rhythm & rate?
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Stage 3, plane 2/surgical plane
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At what stage are resp slow & shallow?
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Stage 3, plane 3/orthopedic plne
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At what stage are all reflexes diminished or absent?
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Stage 3, plane 3/orthopedic plane
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At what stage is there dec cardic output, weak pulse and delayed CRT?
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Stage 3,plane 3/orthopedic plane
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At what stage are the pupils moderately dilated and the PLR diminished?
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Stage 3, plane 3/orthopedic plane
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At what stage are resp irregular, jerky, &/or shallow?
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Plane 4 - too deep
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At what stage are the pupils dilated & fixed which indicates brain hypoxia?
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Plane 4 - too deep
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At what stage are all reflexes absent?
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Plane 4 - too deep
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At what stage is there pale mm, prolonged CRT, and a weak pulse?
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Plane 4 - too deep
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At what stage are muscles flaccid?
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Plane 4 - too deep
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What should the tech do if signs of plane 4 present?
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Inform vet and lighten anesthesia by turning vaporizer off or down and ventilating at 8-12 rpm
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When does cardiac arrest occur?
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60-90 seconds after resp arrest
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What does tech do to start emergency procedures?
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turn off vaporizer, flush system 3x w/ pure O2, begin CPR, epinephrine
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What does an analeptic agent do? Example of?
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stimulates CNS and respiration - Doxapram
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What kind of drug is Doxapram?
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analeptic agent
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What is an indication for Doxapram?
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respiratory arrest
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What does a catecholamine drug do? Example of?
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stimulates sympathetic nervous system - epinephrine
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What is an indication for epinephrine?
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cardiac arrest
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What is a counterindication for epinephrine?
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when heart is still beating - can cause tachycardia & fatal arrhythmia
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What are two commom emergency drugs? What are they ea used for?
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Doxapram for rep arrest, epinephrine for cardiac arrest
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What are two manual methods for monitoring the anesthetized patient?
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visual & palpation
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What are 5 mechanical methods for monitoring the anesthetized patient?
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esophageal stethoscpe, ECG, Pulse Ox, Doppler blood pressure monitor, Capnography (CO2 monitor)
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What are some respiratory signs of anesthetic overdose?
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<8 rpm, irregular or exaggerated resps, decreased tidal volume
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What are some cardiac signs of anesthetic overdose?
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bradycardia, prolonged CRT, cyantotic MM, weak pulse
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Hypothermia may be a sign of what?
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anesthetic overdose
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What are some pupilary signs of anesthetic overdose?
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decreased PLR, dilated pupils
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What are some reflex signs of anesthetic overdose?
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greatly diminished or absent
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Recovery from anesthesia requires elimination of the anesthetic drug(s) from the ___
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brain
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What are three ways that gases are eliminated from the brain?
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exhalation, redistribution, and liver metabolism
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The ___ the anesthetic period, the longer the recovery time.
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longer
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What route of anesthetic admin has the greatest recovery time? The shortest?
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IM>IV>Inhalation
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What are some signs of anesthetic recovery?
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resp rate & depth increase, eyes rotate to next shallow stage, reflexes return in reverse order lost, shivering, tongue movement, chewing, movement, lifting of head, attempts to stand
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It is very important to watch for ___ during anesthetic recovery
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seizures
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