Anesthetic Agents & Tech 1

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Anesthetic Agents & Tech 1
2012-02-02 18:57:12
Clinical Practice

Clinical Practice
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  1. Which type of anesthesia is safer - injectable or inhalation?
  2. Over which type of anesthesia does the anesthetist have the most control - injectable or inhalation?
  3. What do we mean by "have more control over anesthesia"?
    the anesthetist is able to make the patient go either deeper or lighter and to keep the patient under anesthesia for the correct amount of time - not coming up too soon, not staying down too long
  4. Which type of anesthesia requires the most training for the anesthetist - injectable or inhalation?
  5. When using an injectable anesthetic drug only (with no reverser available), can the anesthetist make the patient deeper? Explain.
    yes - can inject some more drug
  6. When using an injectable anesthetic drug only (with no reverser available), can the anesthetist make the patient lighter? Explain.
    no - has to wait for the patient to recover
  7. When using an inhalation anesthetic drug only, can the anesthetist make the patient deeper? Explain.
    yes - can turn up the vaporizer
  8. When using an inhalation anesthetic drug only, can the anesthetist make the patient lighter? Explain.
    yes - can turn down the vaporizer
  9. How are inhalation anesthetic drugs mainly eliminated by the body?
    exhaled by the lungs
  10. How are injectable anesthetic drugs mainly eliminated by the body?
    metabolized by liver to a more hydrophilic form; excreted by kidneys; redistribution
  11. What is "redistribution" of injectable anesthetic drugs?
    Blood levels of the drug are relatively high after IV or IM injection. The drug rapidly reaches high levels in the brain, with its excellent blood supply. In the meantime, the drug is starting to accumulate in fat (poor blood supply) and other tissues - this causes the blood level of the drug to come down - so the brain level of the drug comes down, and the patient starts to recover.
  12. When a patient has recovered from injectable anesthesia with a drug that is redistributed, does this mean that all of the drug is out of the patient's body at recovery? Explain.
    no - there is just not enough drug in the brain to anesthetize the patient. There is still low levels of drug present in brain, fat and other tissues, which will gradually get into the blood, go to the liver to be metabolized, and to the kidney to be excreted.
  13. Why is delivery of 100% oxygen to the anesthetized patient desirable?
    They are breathing more slowly and shallowly than usual, and 100% O2 helps to compensate for this. Makes sure they get enough O2.
  14. Is 100% oxygen routinely delivered to patients receiving inhalation anethesia? Why?
    Yes - need oxygen to deliver the inhalation anesthetic drug vapor
  15. Is it possible to deliver 100% oxygen to a patient receiving injectable anesthesia? Is this routinly done? Explain.
    Yes, it is possible. Use a mask or place a trach tube to deliver the oxygen. Is usually not routinly done for the short minor procedures that injectable anesthetic drugs are used for. If it is a long major procedure, the patient should be on inhalation anesthesia.
  16. How much oxygen is in room air? How much oxygen is in exhaled air?
    20% in room air, 16% in exhaled air.
  17. What are 3 reasons to intubate an anesthetic patient?
    Deliver inhalation anesthetic, control ventilation, available for emergency purposes.
  18. What does "to control ventilation" mean?
    The anesthetist is getting air or oxygen plus anesthetic gases into and out of the patient's lungs.
  19. List 3 disadvantages of inhalation compared to injectable anesthesia.
    Need an expensive inhalation anesthesia machine, usually costs more, and can cause room air pollution.
  20. What is room air pollution?
    When inhalation anesthetic drugs (vapors, gases) escape into the room air where we, people, veterinary staff, can breathe it. This can cause health problems in people.
  21. List 4 main classes of injectable anesthetic drugs.
    • cyclohexamines
    • propofol
    • neuroleptanalgesia
    • barbiturates
  22. List 6 main types of inhalation anesthetic drugs.
    • ether
    • nitrous oxide
    • methoxyflurane
    • halothane
    • isoflurane
    • sevoflurane
  23. Of the 6 main types of inhalation anesthetic drugs, which 2 are most routinly used in veterinary medicine today?
    • isoflurane
    • sevoflurane
  24. List 3 drugs that are classified as cyclohexamines
    • ketamine
    • tiletamine
    • phencyclidine
  25. Are the cyclohexamines controlled drugs?
  26. How do cyclohexamines work?
    Disrupt brain pathways by selective stimulation, or excitation, of the CNS
  27. What is the type of anesthesia called?
    dissociative anesthesia
  28. Is dissociative anesthesia considered to be "typical" or "atypical" anesthesia? Why?
    Dissociative anesthesia is atypical anesthesia, since it is due to CNS excitation
  29. What is "typical" anesthesia?
    Anesthesia due to CNS depression, such as the anesthesia caused by propofol, barbiturates, and inhalation anesthetic agents
  30. What is another term for "dissociative anesthesia"?
  31. What are the 5 main clinical features of catalepsy?
    Patient appears awake but unaware, exaggerated reflexes, skeletal muscle rigidity, some analgesia, amnesia
  32. What posture do we associate with cyclohexamine anesthesia?
    stiff, stretched out forelimbs, extended neck.
  33. Is the analgesia associated with cyclohexamine anesthesia good enough for procedure like stitching skin lacerations and lancing abscesses?
  34. Is the analgesia associated with cyclohexamine anesthesia good enough for procedures like abdominal and orthopedic surgery?
  35. Do cyclohexamines have reversal agents?
  36. Are cyclohexamines most commonly used alone or in combination with tranquilizers?
    mostly used in combination with tranquilizers
  37. What purposes are cyclohexamines generally used for?
    short procedures such as cat neuters, anesthetic induction (not maintenance), restraint for exams and minor procedures
  38. What effect so cyclohexamines usually have on the heart?
    increase heart rate and blood pressure
  39. If we were concerned about increasing the heart rate too much with use of cyclohexamines, would it be best for us to use atropine or glycopyrrolate as a preanesthetic?
  40. Should cyclohexamines be sued in patients with heart problems?
  41. Describe the "apneustic" pattern of breathing.
    patient inhales, pauses, then exhales
  42. Can cyclohexamines cause apneustic breathing?
  43. Are cyclohexamines painful when given IM injection?
  44. Do cyclohexamines cause increased salivation?
  45. What can we do about the increased salivation caused by cyclohexamines?
    give atropine
  46. Are cyclohexamines emetic?
  47. Do patiens under cyclohexamines anesthesia have rotated eys in surgical anesthesia?
    no - eye straight forward
  48. Should cyclohexamines by used in patients with ocular injuries?
    no - cause increased intraocular pressure - eye may rupture
  49. Should cyclohexamines be used in patients with cerebral trauma? Explain.
    no - cause increased CNS pressure - may cause brain damage.
  50. Should cyclohexamines be used in patients prone to seizures? Why not?
    no - may cause seizures
  51. Can patients recovering from cyclohexamine anesthesia have a stormy recovery?
  52. List 3 clinical signs that may be seen during recovery from cyclohexamine anesthesia.
    • hallucinations
    • spastic incoordination
    • hyperexcitability
  53. What can we do to help a patient recovering from cyclohexamine anesthesia?
    Keep him in a quiet, dark area, avoid noise and bright lights. Make sure he does not get into such a contorted position that he is unable to breathe properly. Make sure he cannot fall of anything.
  54. When should we leave food and water in the cage with the patient recovering from cyclohexamine anesthesia?
    When he is fully normal.
  55. What type of patient should cyclohexamines be reserved for use in - young and healthy, or sick and debilitated?
    young and healthy
  56. List 3 drugs that are classified as cyclohexamines
    • ketamine
    • tiletamine
    • phencyclidine
  57. Is ketamine usually used by itself, or in combination with other drugs?
    in combination
  58. Can ketamine be used IM, IV, or both?
  59. Is there any difference between the IM dose and the IV dose of ketamine for particular patient? Explain.
    Yes - IM dose is 3 to 4 times as much as the IV dose.
  60. If you give an IM dose of ketamine to a cat IV, what will probably happen to the cat?
    will probably kill the cat
  61. If you cannot get your hands on a fractious cat, is it possible to squirt some ketamine (with ace) into his mouth to subdue him?
  62. If you have given a cat a dose of ketamine but he startss to wake up before the procedure is over, is it a good idea to prolong the anesthetic episode by giving him more ketamine?
    no - mask him with isoflurane or sevoflurane
  63. What drugs are commonly used with ketamine for anesthetic purposes?
    • anticholinergics - atropine or glycopyrrolate
    • tranquilizers - diazepam, xylazine, acepromazine
  64. Why are anticholinergics given with ketamine?
    to reduce the excess salivation caused by ketamine
  65. Are anticholinergics given with ketamine specifically for the purpose of preventing bradycardia?
    no - bradycardia is usually not a problem with ketamine
  66. Which combination is safer - ketamine/diazepam or ketamine/xylazine?
  67. In the past, ketamine was not a controlled drug. Why is it controlled now?
    due to the potential for abuse of ketamine by low-quality people.
  68. What is Telazol? What 2 drugs are combined to make Telazol?
    Telazol is a commercial combination of tiletamine and zolazepam.
  69. What othe commonly used cyclohexamine drug is tiletamine related to?
  70. What other commonly used benzodiazepine drug is zolazepam related to?
  71. What are the advantages of zolazepam in this combination?
    reduces risk for seizures, improved muscle relaxation
  72. Does Telazol need to be reconstitiuted? What does this mean?
    yes - liquid must be mixed with the dry component before use.
  73. When you reconstitute a drug, what important thing must you record on the vial and why?
    the date the vial was reconstituted, so you can be sure not to use the drug past its stability date.
  74. What was the first cyclohexamine developed? Do we use it in veterinary medicine?
    phencyclidine. no. criminal drug.