Anesthesia 3

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Author:
lynnsy
ID:
156452
Filename:
Anesthesia 3
Updated:
2012-05-30 09:40:35
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bel rea anesthesia
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herp
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  1. Wants pts to pass through first 2 stages quickly why?
    less catacalamenes released
  2. Advantages of Injectables
    • simple to give
    • little equipment
    • no explosions or pollution hazard
  3. Disadvantages of Injectables
    • Possible tissue irritation
    • no recall
    • depth not easily altered
    • airway often not provided
  4. IV admin
    • immediate effect
    • easy to titrate to final effect
    • requires more restraint
  5. IM admin
    • Does not require as much restraint
    • Can't titrate to effect
  6. IP admin
    only on pts you cant get veins
  7. Injectable Anesthetics are used for 4 basic reasons
    • *Induction agents (allow intubation/use inhalation)
    • Maintain anesthesia for short procedures
    • to quickly re establish anesthetic plane
    • increased analgesia
  8. Barbiturates (Names)
    • Thiopental - Pentohal (causes splenic engorgement)
    • Methohexitol - Brevital
  9. Barbiturates info
    • Schedule III or II
    • Used for:
    • Induction
    • General anesthesia
    • Sedatives
    • Anti convulsant
    • Euthanasia
  10. 3 Classes of Barbiturates
    • Short acting (Thiopental) (most lipid sol)
    • -Ultra short (Methohexital)
    • Intermediate acting (Pentobarbital)
    • Long acting (Phenobarbital)
  11. Effects of Barbiturates
    • CNS:
    • Excitation during induction / recovery
    • Respiratory:
    • Resp. Depression
    • Hypothermia
    • Cats - get it more
  12. Admin out of vein
    • Stop
    • Keep neg pressure
    • use isotonic saline 2x what you put in
    • tell vet
    • watch for sloughing or irritation
  13. 5 signs after
    • Local swelling
    • Pain
    • necrosis
    • tissue sloughing
    • Scaring
  14. Cyclohexamines/Dissociatives
    • Ketamine - Ketaset, Vatalar, Ketalean
    • Tiletemine & zolazepam - Telazol
    • marked sensitivity to sound and light
    • Disrupt nervous system pathways
    • Poor visceral analgesia, good skin and limbs
    • *Emergence delirium
  15. Ketamine
    • Ketaset, Ketalean, Vetalar
    • Licensed only for cats
    • 2-6hrs
    • *Vocalization, delirium, or seizure activity during recovery
    • *Diazepam with Ketamine, Ket 1st, Val 2nd
  16. Tiletamine
    • Schedule III
    • Zolazepam combo
    • good muscle relax
    • good induction
    • rough recovery in dogs
  17. Propofol
    • DIprivan, Rapinovet, propoflo
    • unrelated to other GA
    • contain soybean oil and egg lecithin
    • *Does not accumulate, can use CRI
    • expensive
    • Will cause dose-dependant Apnea and hypotension
    • smooth brisk recovery
    • Dont use if Bacterimic or Hypotensive
  18. Etomidate
    • Amidate
    • Sedative/hypnotic induction agent
    • *At clinical does it does not depress cardiopulmonary func.
    • *No change in HR, blood pressure, or myocardial activity
    • Used in cadiac cases
    • causes pain, expensive, may causes hemolysis
  19. Neuroleptananlgesia
    • Combo of opioid with tranqs
    • Oxymophone + Acepromazine
    • Oxy + Medetomidine
    • profound sedation
    • induction agent
    • may not get true anesthesia in healthy pts
  20. Guaifenesin
    • Gecolate
    • glycerol guaiacdate ether GGE
    • muscle relaxant
    • does not depress resp center
    • 5% used in prac, >10% hemolysis
    • Triple drip with - Ketamine + Xylazine
  21. Inhalation Anesthetics
    • Methoxyflurane - Metafane, Penthrane
    • Halothane - Fluothane
    • Isoflurane - Herrane, Isoflo, Forane
    • Sevoflurane - Sevoflo, Ultane
    • Desflurane - Suprane
    • Rate of diffusion controlled by concentration gradient and tissue perfusion
  22. 3 Physical and Chem Propertiers
    • 1.Vapor Pressure - amt liquid will evaporate at 20 degrees
    • - high vap pressure evap easy, lethal at 30% o2 delivered to pt, need precision vaps
    • -low do not
    • Halothane 244mmHg
    • Iso 241mmHg
    • Sevo 160mmHg
    • Methoxuflurane 22.5mmHg
  23. 3 Physical and Chem Propertiers
    • 2.Solubility Coefficient- tendency to exist as a gas or dissolve in blood
    • Low = rapid induction, depth change, recovery, remain as gas
    • --Sevo/Iso/Des/Halo
    • High= slow induction,depth change, recovery, dissolve in blood
    • --Methoxu
  24. 3 Physical and Chem Propertiers
    3.Minimum Alveolar Concentration (MAC) - lowest concentration that produces no pain response in 50% pts

    low MAC = more potent = more analgesia produced

    • Methox = excellent
    • Halo = slight
    • Des = slight
    • Iso = slight
    • Sevo = poor
  25. Halothane
    • Fluothane
    • Fairly rapid induction / recovery
    • slight analgesic properties
    • 2.5% then 1.5%
    • precision vap (red)
    • Sensitizes heart to catecholamines ->dysrhythmias
    • maliganant hyperthermia
    • pt with cardiac conditions, dont
  26. Iso / Sevo
    • Iso = Aerrane, Isoflo,Forane
    • Sevo = Iltane, Sevoflo
    • 2.5% then 1.5%
    • 4.5% then 3.5%
    • *Drug of choice for hepatic, renal, cardiac pts
    • *Sevo - cognitive and motor skills return together

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