Anesthetic Problems 4

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Anesthetic Problems 4
2012-04-10 20:56:01
Clinical Practice

Clinical Practice
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  1. When is a patient considered to be a geriatric patient?
    when they have reached 75% of their life expectancy
  2. Which organs have reduced function in geriatric patients?
    • heart
    • lung
    • liver
    • kidney
  3. What kind of response to geriatric patients have to stress?
    poor response
  4. What are some degenerative disorders do geriatric patients have?
    • heart failure
    • chronic renal disease
    • DM
    • cancer
  5. What precautions do we need to take for geriatric patients?
    • thorough preanesthetic history, PE, and lab work up
    • blood profile
    • EKG
    • chest radiographs
  6. What kind of drug doses do we use for geriatric patients?
    lower doses
  7. Do drugs take more time to take effect in geriatric patients?
  8. What kind of drugs should we avoid with geriatric patients?
    drugs requiring liver metabolism and renal excretion
  9. What do we give IV fluids to geriatric patients?
    prevent low BP
  10. What kind of IV fluid drip should we use for geriatric patients and why?
    slow drip - avoid overhydration
  11. What kind of recovery do geriatric patients have?
  12. What are geriatric patients prone to?
  13. What patients are considered neonatals?
    under 3 months old
  14. Why should we avoid prolonged fasting with neonatals?
    hypoglycemia and dehydration
  15. How do we prevent hypoglycemia during anesthesia for neonatals?
    give 5% dextrose IV
  16. What might we need to do to drugs to get the accurate dosing with neonates?
    dilute the drug
  17. Should we avoid injectable anesthetics in neonatal patients? Why or why not?
    • yes
    • less plasma protein binding
    • less efficient liver metabolism and renal excretion
  18. Why is inhalation anesthesia preferred with neonatal patients?
    lung excretion and rapid recovery
  19. Why are brachycephalic dogs a challenging patient for anesthesia?
    their airway tends to get obstructed
  20. Should we always intubate brachycephalic dogs? Why or why not?
    • yes
    • hard to maintain open airway when anesthetized without intubation
  21. What kind of parasympathetic tone do brachycephalic dogs have?
    high parasympathetic tone
  22. Because brachycephalic dogs have high parasympathetic tone, what are they prone to and how do we prevent this?
    • prone to bradycardia
    • give atropine
  23. How long should we preoxygenate brachycephalic dogs?
    5 mintues before induction
  24. What kind of induction should brachycephalics have and how do we accomplish this?
    • rapid induction with IV
    • intubate rapidly, may take smaller trach tube than expected, use laryngoscope
  25. Why do we need to watch brachycephalics very closely through recovery?
    airway obstructions can occur even after they are standing and walking around
  26. We might have to give brachycephalics what in order for them to be able to tolerate the tach tube for a longer period of time?
    opioid analgesics
  27. Sighthounds are sensitive to what?
    certain drugs, especially barbiturates
  28. What are sighthounds sensitive to certain drugs?
    • lack of body fat for redistribution
    • may have inefficient liver metabolism (has not been fully determined)
  29. Which barbiturate can we give to sighthounds?
  30. Why do obese patients uptake drugs slower?
    because fat has poor blood supply
  31. How should we dose our obese patients?
    dose according to ideal weight, not true weight
  32. Why do obese patients have respiratory difficulties? How do we help with this?
    • more effort to breathe due to weight of fat over chest and abdomen
    • preoxygenate
  33. What kind of induction should obese patients have?
  34. What kind of respirations do obese patients have under anesthesia? How do we compensate for this?
    • rapid shallow respirations
    • may need to bag him every 5 seconds to get downt o proper anesthetic depth and a more normal respiratory rate
  35. How should C-section mother's be positioned during surgery? Which position is better?
    • dorsal recumbency
    • lateral recumbency (better)
  36. Why is dorsal recumbency not the best position for a c-section mama?
    • pressure on caudal vena cava
    • less blood return to the heart
    • lower CO and BP
  37. What two body parts does c-section mama's put pressure on?
    • pressure on diaphragm: unable to breathe well
    • pressure on stomach: prone to regurgitation and aspiration
  38. What are c-section mother's at risk for? How do we prevent these things?
    • hemorrhage and shock
    • give IV fluids
  39. What kind of drugs should we avoid with c-section mothers?
  40. Will drugs given to a mother affect the babies as well?
  41. Can we give reversing agents to mothers?
  42. What are the different types of chest trauma that can affect anesthesia?
    • pneumothorax
    • hemothorax
    • pulmonary bruising
    • diaphragmatic hernia
  43. Cardiac arrhythmias are common for up to _____ after chest trauma.
    72 hours
  44. What are trauma patients at risk for?
    • cardiac arrhythmias
    • shock
    • hemorrhage
    • other internal injuries
  45. Why should we wait a day or so before doing surgery to trauma patients?
    • stabilize and evaluate patient thoroughly
    • PE, x-rays, EKG, etc
  46. What can cause cardiovascular disease?
    • anemia
    • shock
    • CHF
    • cardiomyopathy
    • heartworm disease
  47. What do cardiovascular disease patients tend to develop?
    • arrhythmias
    • tachycardia
    • pulmonary complications of heart disease (pulmonary edema)
  48. How long should we preoxygenate cardiovascular disease patients before induction?
    5 minutes
  49. What drugs should we avoid with a patient with cardiovascular disease?
    avoid drugs that depress heart function (halothane, xylazine)
  50. Which drugs are preferred for patients with cardiovascular disease?
    • isoflurane
    • opioids
    • diazepam
  51. Why do we need to watch for overhydration with cardiovascular disease patients?
    lungs are already compromised
  52. Which patients are the most challenging for anesthesia?
    respiratory disease patients
  53. What are some different cardiac diseases?
    • pulmonary edema
    • pleural effusion
    • diaphragmatic hernia
    • pneumothorax
    • pulmonary contusions
    • pneumonia
  54. What are some signs of respiratory disease?
    • coughing
    • dyspnea
    • cyanosis
    • respiratory arrest
  55. Respiratory disease patients don't tolerate _____ well.
  56. What kind of extra work ups do we need to do for respiratory diseased patients?
    • thoracic radiographs
    • thoracocentesis
  57. What should we avoid with respiratory disease patients?
  58. How long should we preoxygenate respiratory disease patients?
    5 - 10 minutes
  59. What position should we avoid with respiratory patients and why?
    • avoid head down position
    • compresses lungs, can cause diaphragmatic hernia - more viscera can slide into the chest
  60. What kind of induction should respiratory disease patients have?
  61. Hepatic disease patients have less ability to do what?
    metabolize drugs for excretion
  62. Because patients with hepatic disease have less ability to synthesize blood proteins, what does that mean?
    • could become hypoproteinemic
    • avoid barbiturates
  63. Because patients with hepatic disease have less ability to synthesize blood clotting factors, what does this mean?
    • bleeding disorders
    • hemorrhage during surgery
  64. What does a debilitated patient with hepatic disease look like?
    • ADR
    • thin
    • icteric
    • anemic
    • dehydrated
  65. Which drugs should be avoided with patients who have hepatic disease?
    • barbiturates, sylazine, acepromazine
    • anything that is metabolized by the liver
  66. Which drugs should we use with patients who have hepatic disease?
  67. What does a patient with renal disease look like?
    • dehydrated
    • anemic
    • debilitated
    • acidotic
    • electrolyte abnormalities (hyperkalemia)
  68. Why should we avoid stressing out a patient with a urinary blockage?
    causes release of epinephrine which can cause a cardiac arrhythmia
  69. Which drug is preferred for a patient with a urinary blockage?