General Anes. 2

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General Anes. 2
2012-02-08 00:02:00
Clinical Practice

Clinical Practice
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  1. What are the four IV induction techniques called?
    • To effect
    • Crash
    • Slow
    • Drip
  2. What does "to effect" mean?
    Give half calculated dose quickly, wait 15 - 30 sec, give small increments until get sufficient results
  3. How would we use the technique "to effect" on?
    Fairly calm patients
  4. What are the advantages to using the "to effect" technique?
    uses minimum dose
  5. What is another word for "using minimum dose"?
  6. What is "crash induction"?
    Give entire calculated dose over 10 - 15 seconds
  7. What patients would we use crash induction on?
    • if you think the patient will vomit (unfasted patients)
    • if a patient has breathing problems (brachycephalics)
    • any patient where you need to establish an airway quickly
  8. What are the advantages to using the crash induction method?
    rapid induction...gets them down quickly if we need to establish an airway quickly
  9. What does slow induction mean?
    Give calculated dose over 1 - 2 minutes
  10. What kind of patients would we use slow induction on?
    patients who have been given propofol because it produces minimal excitement.
  11. What is an IV drip induction?
    Give induction agent in IV fluids to effect...administer slowly
  12. What kind of patients would we use IV drip inductions on?
    debilitated patients
  13. What are the 2 mask inductions?
    • slow
    • fast
  14. Describe slow mask induction.
    • start on 100% oxygen, then start adding anesthetic gas very gradually
    • allows time for patient to get accustomed to the smell
  15. Describe fast mask induction.
    start on high oxygen flow and highest setting of anethetic gas
  16. Why should anesthetic monitoring begin before induction?
    so you know what the patient's normals are
  17. How often should vital signs be monitored during anesthesia?
    every 3-5 minutes for routine, continuously for risky patients
  18. What effect do most anesthetic agents have on the cardiac and respiratory systems?
    depression of both rate and function (lowers cardiac output and respiratory tidal volume)
  19. Besides rate, what other heart monitoring is necessary?
  20. What could be causing an arrhythmia?
    low O2, high CO2...drugs (xylazine, halothane), impending cardiac arrest
  21. How is the heart monitored?
    manually by feeling the chest or the pulse, via stethoscope or esophageal stehtoscope, electronically by pulse oximeter or electrocardiogram
  22. Does feeling or hearing the heart beat indicate adequate cardiac function?
  23. How do you assess cardiac function?
    • pulse quality
    • capillary refill time
    • blood pressure
  24. What is the goal for IV induction?
    safety of the patient
  25. What is IV induction appropriate for?
    • endotracheal intubation
    • short procedures
  26. What drugs are commonly used for IV induction?
    • thiopental
    • propofol
    • ketamine/ace
    • ketamine/diazepam
    • telazol
    • oxymorphone/ace
  27. Is it best to use an IV catheter for IV inductions?
  28. Why is it best to use a IV catheter for IV inductions?
    • to have venous access in case of emergencies and we have to give another drug
    • prevents perivascular injections
  29. After a patient has been given an IV induction, how can the patient be maintained?
    inhalation or injection
  30. When is best to maintain by injection?
    for short, minor procedures
  31. Why is maintaining anesthesia by injection not as safe?
    • drug builds up in the body
    • more toxic side effects
    • prolonged recovery
  32. What drugs are commonly used for IM induction?
    • ketamine/xylazine
    • ketamine/ace
    • telazol
  33. IM induction dose is _____ IV induction dose.
    2 - 3 times
  34. How is an IM induction given?
    • entire calculated dose is give - no giving to effect
    • make sure you aspirate the syringe
  35. What kind of onset of anesthesia does an IM induction have?
    slow onset
  36. What kind of recovery does IM induction have?
    slow recovery - it takes a long time to metabolize and excrete the IM drug
  37. What drugs are commonly used for inhalation inductions?
    • isoflurane
    • sevoflurane
    • + nitrous oxide
    • all given with oxygen
  38. What are the advantages of doing an inhalation induction?
    • make induction is safer than injectable induction
    • do not have to place a catheter
  39. What are the disadvantages to an inhalation induction?
    • need to restrain the patient during induction
    • leaky - room air pollution with gas
    • cannot "bag" patient
  40. What types of masks are used for inhalation induction?
    • opaque
    • clear
  41. What is the book technique for doing an inhalation induction?
    • give 100% O2 for 2-3 minutes
    • start gas at 0.5%
    • increase by 0.5% every 20 seconds until 3-4%
  42. What is Dr. Malcolms way of doing an inhalation induction?
    put the patient straight on 5% (or 7%) gas
  43. What should you do after you have induced the patient using gas?
    intubate and reduce the gas to 1.5 - 2.5%
  44. What are the advantages of maintaining a patient using a mask?
    less effort - not taking time to intubate (this is not really a good thing)
  45. What are the disadvantages of maintaining a patient using a mask?
    • leaks - gas leaks out - or pollution (dangerous to people)
    • room air leaks in - dilutes the gas - patient gets light
    • can't bag the patient
    • patient can vomit and then aspirate
    • permits rebreathing CO2
    • excess "dead space" for patient to move air through
  46. What are the advantages to using a chamber to induce?
    good for fractious animals, hedgehogs, snakes, wild animals
  47. What are the disadvantages to using a chamber to induce?
    • patient must be small
    • can't monitor as well (only visual)
    • patient may vomit and can aspirate before you can get to them
    • room air pollution with anesthetic gas
    • since this is a slow induction it should be avoided in patients that need a rapid induction and airway control
  48. What types of patients should we avoid using an induction chamber for?
    • brachycephalics
    • respiratory problems
    • unfasted
    • cardiovascular problems
  49. How do you make a home made induction chamber?
    • 10 gallon aquarium
    • unbreakable
    • lid that fastens on
    • inlets for gas and Os
    • scavenger port to prevent CO2 build up
  50. What is the procedure for using an induction chamber?
    • place conscious patient inside chamber
    • run high O2 and gas %
    • observe patient closely for loss of reflexes and other problems
    • as patient goes down enough to handle, get him out and finish induction by face mask