anesthesia note packet two

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lbethune
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66378
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anesthesia note packet two
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2011-03-15 09:39:28
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anesthesia note packet two
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  1. stage 1 (Analgesia Stage)
    loss of pain without loss of consciousness or sense of touch
  2. stage 2 (Excitement Stage)
    loss of consciousness to onset of regular (or spontaneous) respiration
  3. Stage 3 (Surgical Anesthesia Stage)
    onset of regular respiration to stopping of spontaneous respiration.
  4. Stage 4
    begins with respiratory problems and progresses quickly to circulatory failure
  5. plane 1
    plane-respiration is regular, pupils are constricted, loss of eyelid and pharyngeal reflexes, loss of small muscle tone
  6. plane 2 (where you wanna be)
    plane-respiration is regular but shallower, pupils are mildly dilated, loss of corneal, visceral, laryngeal and cough reflexes, large muscles begin to relax
  7. plane 3
    plane-period in which respiratory intercostal muscle movement slows, pupils are moderately dilated and all muscle tone is lost except diaphragmatic
  8. plane 4
    plane-period in which there is respiratory intercostal muscle paralysis and breathing is diaphragmatic, pupils are fully dilated
  9. capillary refill time (CRT)
    reflection of the blood flow to the tissues
  10. 2 seconds or less
    normal CRT under anesthesia
  11. pink
    normal MMB color under anesthesia
  12. cyanosis
    blue coloring
  13. 100-102o
    desired body temperature under anesthesia
  14. lingual or femoral arteries
    pulse monitoring locations
  15. 60-120 bpm, 60 min in dogs and 100 min in cats
    normal heart rate under anesthesia
  16. 60-180 bpm in dogs and 110-120 bpm in cats
    normal heart rate in awake patients
  17. electrocardiography (ECG)
    used to monitor the electrical activity in the heart
  18. > 160-180 bpm in dogs, > 200 bpm in cats
    tachycardia heart rate
  19. < 60-70 bpm in dogs, < 100 bpm in cats
    bradycardia heart rates
  20. heart block
    results from inefficient transmission of electrical impulses that cause heart to beat
  21. premature ventricular contraction (PVC or VPC)
    Impluse in the rhythm that arises from an ineffective and uncoordinated contraction of the ventricles
  22. fibrillation
    fibrillation (contraction) of small muscle bundles within the ventricles or atria.
  23. direct monitoring of blood pressure
    measurement of direct venous blood pressure
  24. indirect blood pressure monitoring
    measurement of indirect arterial blood pressure
  25. central venous pressure monitoring (CVP)
    measures blood pressure in a large vein (such as vena cava)
  26. < 8 cm H2O in dogs and cats
    desired CVP under anesthesia
  27. systolic pressure
    produced by ventricle contraction pumping blood through aorta and major arteries, highest pressure point in the system
  28. diastolic pressure
    pressure that remains when the heart is resting between contractions, lowest pressure point in the system
  29. mean arterial pressure (MAP)
    average pressure throughout the cardiac cycle, best indicator of blood organ/tissue perfusion
  30. doppler monitors
    detect ultrasound waves from RBC's passing through vessel and converts them to an audible sound, systolic blood pressure
  31. > 90 mm Hg
    systolic blood pressure rate under anesthesia
  32. 120mm Hg
    normal systolic pressure in awake patients
  33. oscillometric monitors
    detect oscillations within the cuff that are caused by the pulsing of the artery beneath the cuff, provide systolic, diastolic and mean arterial pressures
  34. 70-90mm Hg in dogs and cats
    desired MAP under anesthesia
  35. 90-100mm Hg in dogs and cats
    normal MAP in awake patients
  36. blood gases
    assessment of oxygen and carbon dioxide levels within the body
  37. PaO2
    oxygen dissolved in plasma, oxygen partial pressure in arteries, measured by blood gas analyzers
  38. SaO2
    oxygen combined with hemoglobin in RBC's, % of hemoglobin saturated with O2, measured by pulse oximeter analyzers
  39. generally elevated (up to 500mm Hg)
    PaO2 levels under anesthesia
  40. 90-115 mm Hg
    normal PaO2 in awake animals
  41. 95% + (95% is equivalent to PaO2 85-100mm Hg)
    desired SaO2 under anesthesia
  42. SaO2 < 90%
    hypoxia
  43. SaO2 < 85%
    cyanosis
  44. 30% in HgB, 10% in plasma and the rest reacts with carbonic acid and converts to bicarb and hydrogen ions
    carbon dioxide is carried three ways
  45. PaCO2
    partial pressure of CO2 in the arteries
  46. 45-60 mm Hg
    PaCO2 under anesthesia
  47. <45 mm Hg
    normal PaCO2
  48. tidal volume
    volume of air breathed in or out during normal respiration
  49. ETCO2
    amount of CO2 at the end of expiration
  50. capnograph
    electronic monitor that measure ETCO2
  51. 32-35 (cats) and 35-46 mm Hg (dogs)
    normal ETCO2 in cats and dogs
  52. recovery
    the return of consciousness
  53. anesthetic machine
    allows the administration of precise amounts of anesthetic agent under controlled conditions
  54. compressed gas supply
    components that store and transport carrier agents to the anesthetic machines
  55. anesthetic machine
    components that transport carrier agents and anesthetic agents to the breathing circuit
  56. breathing system
    components that transport carrier agents and anesthetic agents to the patient and carry expired CO2 away from the patient
  57. E cylinder
    30", hours of use approx. 11 hours
  58. H cylinder
    54", hours of use approx. 118 hours
  59. tank pressure gauge
    indicator of pressure of oxygen delivered by the tank, measure in psi
  60. 1800 and 2200
    psi in E and H tank
  61. tank psi x 0.3, change tanks when lower than 500psi
    formula for volume of O2 tank pressure
  62. pressure reducing valve (regulator)
    reduces the line pressure from tank to usable pressure of 50 psi
  63. gas flow meters
    indicates amount of carrier gas that is being delivered to a patient, further reduces line pressure to 15 psi
  64. vaporizers
    converts liquid anesthetic agent to a gas that can be inhaled by a patient
  65. precision vaporizers
    agent specific vaporizers, very specific, located outside the circle (VOC)
  66. non-precision vaporizers
    used with low vapor pressure agents, located inside the circle (VIC)
  67. valves
    keep gases moving in one direction
  68. inhalation flutter valve
    one way valve that allows flow of gases TO the patient
  69. exhalation flutter valve
    one way valve that allows flow of gases AWAY from the patient
  70. hoses
    transport gases from the anesthetic machine to the patient
  71. reservoir bag
    reservoir bag for O2 and gas anesthetics that expands and contracts continuously, reflecting the patient's respirations
  72. bagging
    manual delivery of O2
  73. atelectasis
    alveoli in lungs are collapsed and not useful for transport of gases, patient has a reduced tidal volume
  74. 500ml, 1L, 2L, 3L....30ml/lb
    bag sizes and formula
  75. pressure relief valve (pop-off)valve
    allows excess gas to exit the breathing circuit
  76. CO2 absorber canister
    absorbs CO2 expired by the patient, contains soda lime crystals, soda-sorb.
  77. oxygen flush valve
    delivers increased amounts of oxygen at a rapid pace
  78. pressure manometer (pressure gauge)
    indicates pressure of gases within the breathing system, 15-20 cm H2O or 11-15 mm Hg
  79. savenger
    allows exhaled waste gases to safely leave the anesthesia machine without going into the room air
  80. active scavenging system
    tubes that leave the building, able to remove all gases from the environment, attached to pop-off valve
  81. passive scavenging unit
    F-Air canister (removes only excess halogenated gases), weight of canister determines remaining absorption capaciity, discard at 50g
  82. negative pressure relief valve
    designed to open and admit room air to the circuit, 21% oxygen room air is better than nothing
  83. breathing system
    reasons by which gases circulate through the anesthetic circuit
  84. total rebreathing (closed), partial rebreathing (semiclosed), and non-rebreathing (open)
    3 types of breathing systems
  85. total rebreathing (closed)
    patient rebreaths almost all of its own exhaled gases plus a certain amount of fresh oxygen and anesthetic. oxygen flow rate is low, pop-off valve is almost closed
  86. partial rebreathing (semiclosed)
    some exhaled gases remain in the circuit and some exit to the scavenger, slightly highed O2 flow rate and the pop-off valve will be open allowing more gases to escape
  87. non-rebreathing (open)
    little or no gases return to the patient, bypasses the inhalation and exhalation valves and also the CO2 canister as the gases are scavenged upon exhalation
  88. 200 ml/kg/min
    oxygen flow rate for induction, nonreb. system and recovery
  89. 15 ml/kg/min
    oxygen flow rate for closed rebreathing system
  90. 50 ml/kg/min
    oxygen flow rate for semiclosed rebreathing system
  91. check outside circle for leaks
    check inside the circle for leaks
    close pop-off valve, cover y-piece, depress oxygen flush...does the reservoir bag fill/pressure manometer read 20 cm H2O
    check the level of anesthetic agent
    check the level of O2
    steps to check for leaks

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