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What are the 5 different phases of anesthesia?
- patient assessment
- premedication
- induction
- maintenance
- recovery
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What do we need to do for patient assessment?
- get a history
- physical exam
- signalment
- lab evaluation
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What do we look for in a history?
- previous anesthesia episodes
- medical problems that could affect anesthesia
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What is the purpose of the physical exam?
assess current condition of patient
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Why do we need a signalment?
- different breeds may have different issues with anesthesia
- age
- size
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What kinds of lab tests can we run for before anesthesia?
- CBC
- chem (pap or full panel)
- clotting times (PT, PTT, ACT, BMBT)
- UA (especially specific gravity)
- EKG
- imaging
- 4DX
- combo test
- fecal
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What is the purpose of premeds?
- helps decrease induction and maintenance meds
- reduces pain (takes more meds to chase pain than to prevent it)
- anxiety relief for patient, owner, and staff
- reduces side effects of other drugs
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What are the three types of premeds?
- analgesics
- sedatives
- anticholinergics
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What are the three types of analgesics?
- opioids
- NSAIDS
- alpha 2 agonists
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What are the different types of opioids?
- morphine
- oxymorphine
- hydromophine
- fentanyl
- buprenophine
- butorphanol
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Which opioids are mu agonists?
- morphine
- oxymorphine
- hydormorphine
- fentanyl
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Which opioids are partial mu agonists?
buprenorphine
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Which opioids are kappa agonist/mu antagonists?
butorphanol
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What is the onset time of buprenophine?
- IV: 5 - 10 minutes
- SQ and IM: 45 - 60 minutes
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What is the indication for opioids?
analgesia first and then sedative
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What is the duration of morphine, oxy, and hydro?
4 - 6 hours
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What is the duration of the fentanyl patch?
3 days
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What is the duration of buprenophine?
6 - 12 hours
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What is the duration of burtorphanol?
1 - 2 hours
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What are the main side effects of opioids?
- bradycardia
- respiratory depression
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What is the duration for carprofen (Rimadyl, Novox)?
12 - 24 hours
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What is the duration for meloxicam, deracoxiv, firocoxib, ketoprofen, etodolac, robenacoxib?
24 hours
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What are the different types of NSAIDS?
- carprofen
- meloxicam
- deracoxiv
- firocoxib
- ketoprofen
- etodolac
- robenacoxib
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What is the side effects of NSAIDS during anesthesia?
- renal perfusion - need to maintain using fluids
- monitor blood pressure for hypotension
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What are the alpha 2 agonists?
- xylazine
- dexmedetomidine (dexdomitor)
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What are the side effects of alpha 2 agonists?
bradycardia
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What are the main types of sedatives?
- phenothiazine tranquilizer
- benzodiazepine
- alpha 2 agonist opioid
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What is the phenothiazine tranquilizer we use?
acepromazine
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What are the benzodiazepines that we use?
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What are the alpha 2 agonists we can use for sedatives?
- xylazine
- dexmedetomidine (dexdomitor)
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What are the side effects of phenothiazine tranquilizers (acepromazine)?
hypotension and hypothermia due to vasodilation
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What side effect are we concerned with when using diazepam?
hypotension
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What are the different types of anticholinergics?
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What do anticholinergics do?
- decrease secretions
- increase heart rate
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Which anticholinergic has a quicker onset time?
atropine
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Which anticholinergic has a longer duration?
- glycopyrrolate (1.5 - 2 hours)
- atropine only lasts for 1 hour
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What is the side effect of anticholinergics?
tachyarrhythmias
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What are the different induction agents?
- propofol
- inhalants
- dissociatives
- barbiturates
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What are the different inhalants?
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What are the different dissociatives?
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What is tiletamine?
Telazol
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What are the different barbiturates?
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What is the duration of propofol?
very short - 5 minutes
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What are the side effects of propofol?
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What do we have to do when administering propofol?
carefully titrate
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What is the onset time for inhalants as an induction agent?
onset depends on the premeds and size of patient
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What can the patient go through when masking them down with inhalants?
can go through the excitement phase
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What are the side effects of using inhalants as an induction agent?
- cardiovascular depression
- respiratory depression
- unable to secure an airway right away
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Do we titrate inhalants when we are using them as an induction agent?
yes
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What do we usually combine ketamine with when using it as an induction agent?
benzodiazepine (diazepam)
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Which dissociative is safer, ketamine/diazepam or Telazol?
ketamine/diazepam
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Do dissociatives have a lot of side effects? What are the side effects?
- no
- increased heart rate, increased cardiac output
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Do we have to titrate dissociatives when using them as an induction agent?
no
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What are the side effects of barbiturates?
- major apnea (lasting 20 minutes)
- cardiovascular depression
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Do we need to titrate barbiturates?
yes, carefully
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What do we use for maintenance?
inhalants or CRIs
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What does CRI stand for?
constant rate infusion
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Why do we usually use inhalants as maintenance?
- east to titrate
- fast recovery
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What can we use as CRIs?
- dissociatives (ketamine)
- propofol
- fentanyl
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What do we combine with ketamine for maintenance?
- MLK - morphine, lidocaine, ketamine
- put in an IV bag to have it constantly flowing in
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What can dissociatives cause?
stormy recovery
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What is pulse dosing?
give them more when they start to wake up (we do this if we were using propofol)
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What is the primary goal for recovery?
have a smooth recovery
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What is the secondary goal for recovery?
avoid a prolonged recovery
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What are the reversable drugs for the alpha 2 agonists?
- dexmedetomidine: atipamazole
- xylazine: yohimbine
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What is the reversing agent for opioids?
naloxone
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What is the reversing agent for benzodiazepines?
flumazenil
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What is tramadol?
synthetic opioid like drug
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What is the duration of tramadol?
8 - 12 hours
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What are considered controlled drugs?
- opioids
- dissociatives
- benzodiazepines
- barbiturates
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What are the 4 analgesics that we can use other than for premeds?
- opioids
- NSAIDS
- alpha 2 agonists
- dissociatives
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