Anesthesia3- SA Dz and Anesthesia

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  1. What are the general goals with cardiovascular dz?
    • maintain cardiac output
    • maintain tissue perfusion
  2. How does low HR and high HR affect CO?
    • Low HR: decreases CO directly
    • High HR: can also decrease CO b/c of decreased diastolic filling time, absence of atrial kick
  3. How do low and high preload affect CO, and what causes each?
    • Low preload: decreases CO; dehydration, shock, hemorrhage
    • High preload: decreases CO; ventricular overdistension, systolic dysfunction
  4. How do low and high afterload affect CO, and what causes each?
    • Low afterload: increases CO; acepromazine, inhalants, propofol, alfaxalone [vasodilators]
    • High afterload: decreases CO; alpha-2 agonists [increased SVR]
  5. How do increased and decreased inotropy affect CO, and what causes each?
    • Increased inotropy: increases CO; catecholamines, dobutamine, ketamine
    • Decreased inotropy: decreases CO; cardiomyopathy, CHF, pericardial effusion, general anesthesia
  6. What are anesthetic considerations for animals with volume overload (MV regurg, etc)? (4)
    • promote forward flow of bloe
    • avoid fluid overloading, which might reduce preload
    • maintain HR (decreases time for regurgitant flow)
    • decrease afterload (avoid alpha-2's, avoid stress)
  7. What is the anesthetic plan for an animal at risk of volume overload?
    • Pre-med: low dose acepromazine (vasodilator- decrease afterload) or benzodiazepine (minimal cardiac effects)
    • Analgesia: opioids (minimal cardiac effects, may decrease HR, which can be treated with atropine)
    • Induction: alfaxalone or propofol to effect (vasodilators); etomidate if CHF (no CVS effects)
    • Lower fluids
    • Inhalants at lowest possible concentration
  8. What are special considerations for DCM?
    • [decreased systolic function] be ready to treat tachyarrhythmias- lidocaine, procainamide
    • positive inotropes- dobutamine, dopamine
  9. Causes of volume overload.
    • MV regurg/ insufficiency
    • DCM
    • CHF
  10. Causes of pressure overload.
    • subaortic stenosis
    • pulmonic stenosis
  11. What are anesthetic considerations and plan for animals with pressure overload (SAS, PS)?
    • [poor ventricular compliance] maintain adequate preload while avoiding overload
    • treat intra-op hypotension aggressively with volume (opposite of volume overload)
    • avoid drastic increases in HR- premeds and opioids
  12. What are causes of diastolic dysfunction?
    • hypertrophic cardiomyopathy/ obstructive CM
    • small end diastolic volumes
    • stiff ventricle
  13. What are anesthetic considerations for animals with HCM/ diastolic dysfunction?
    • optimize diastolic filling
    • maintain lower heart rates (more time for filling)
    • avoid drugs that increase contractility (gets rid of more EDV, which is bad in this case)- ketamine, inotropes
    • don't decrease afterload (may worsen situation)
  14. What is the anesthetic plan for an animal with HCM?
    • avoid ketamine
    • low dose alpha-2 may be helpful (increases afterload--> some volume stays behind--> reduce outflow tract obstruction)
    • maintain vascular tone for BP support- dopamine, phenylephrine [I thought we didn't want to increase inotropy???]
  15. What is the treatment for Vtach?
    IV lidocaine or procainamide
  16. What are reasons to treat VCPs under anesthesia? (4)
    • Vtach or runs
    • multiform (coming from different foci)
    • R on T phenomenon (R wave on top of previus T wave- Vtach)
    • hemodynamic compromise (high HR, no atrial kick, poor perfusion)
  17. What is the treatment for a fib?
    • diltiazem
    • electrocardioversion
  18. What is the treatment for supraventricular tachycardia?
    • diltiazem
    • esmolol
  19. How do you treat bradycardia?
    • correct any underlying cause (ex. electrolytes)
    • parasympatholytic (atropine, glycopyrrolate)
    • complete AV block may require pacemaker
  20. What are anesthetic considerations for animals with upper respiratory disease?
    • pre-oxygenate by mask (but don't stress them out! maybe premed first)
    • adequate sedation- decrease stress, watch for worsening obstruction, avoid drugs that cause vomiting (alpha-2's, opioids)
    • IV access as soon as possible
    • rapid induction and intubation- airway airway airway
    • use smaller tubes for brachys (brachy dz- small trachea)
    • monitor SpO2 and EtCO2
    • recovery in sternal recumbency, extubate as late as possible
  21. If there is airway swelling/ obstruction after recovery (ex. brachycephalic dog), what do you do? (3)
    • re-induce
    • re-intubate
    • corticosteroids for acute airway tissue swelling
  22. What are the components of brachycephalic disease? (4)
    • elongated soft palate
    • stenotic nares
    • everted laryngeal saccules
    • hypoplastic trachea
  23. How is lower airway disease managed with anesthesia?
    • similar to upper airway disease
    • in cases of poor gas exchange after intubation and 100% FiO2, positive pressure ventilation +/- PEEP

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Mawad
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326169
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Anesthesia3- SA Dz and Anesthesia
Updated:
2016-11-30 04:11:49
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