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lbethune
on FreezingBlue Flashcards.
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injectable
- minimal equiptment, less costly
- poor control once given, metabolized in liver and excreted in kidneys, oxygenation minimized
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inhalant
- depth change easy/safe, metabolized by lungs, can administer large volumes of O2, mechanical ventilation possible
- high equiptment costs, slow induction, gas anesthetic waste/pollution
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fill the lungs (alveoli) with gas ASAP
inhalants goal
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safe and rapid
ideal inhalant agent
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halogenated compounds
liquid at room temperature
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isoflurane
Aerrane, most commonly used from the mid 80's
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sevoflurane
SevoFlo, mid 90's
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mechanism of action
inhibition of nerve function and disabling effect of nerve cells
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general anesthesia, muscle relaxation, poor analgesia, slows respiration and slows heart function
physiological effects of gases
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gas in brain, blood, and alveoli
anesthetic depth is dependant on the partial pressure of...
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vapor pressure
measures the tendency of a molecule to escape from the liquid to the vapor/gas phase
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the speed of evaporation
the vapor pressure determines...
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volatile (ie. vaporizes easily)
High VP
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minimally volatile
low VP
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solubility coefficient
measurement of distribution of an inhalant agent between blood and gas phases of the body
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speed of induction and recovery
solubility coefficient indicates...
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slow induction and recovery because it will hang out in the blood or tissues
high solubility
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fast induction and recovery
low solubility
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minimum alveolar concentration (MAC)
lowest concentration that produces no response in 50% of the patients exposed to a painful stimulus
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reflects the potency of the agent
the importance of MAC...
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1.5 x MAC *nothing else on board*
surgical anesthesia formula
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halothane (red)
- High VP
- Moderate Solubility Coefficient
- 0.87% MAC
- 1% Surgical Anesthesia Maintenance
- 80% Alveolar Metabolism
- 20% Liver Metabolism
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isoflurane (purple)
- High VP
- Low Solubilty Coefficient
- 1.2% MAC
- 2% Surgical Anesthesia Maintenance
- 99% Alveolar Metabolism
- <1% Liver Metabolism
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sevoflurane (yellow)
- High VP
- Low Solubility Coefficient
- 2.1-2.3% MAC
- 3% Surgical Anesthesia Maintenance
- 97% Alveolar Metabolism
- 3% Liver Metabolism
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ether
1842, flammable, explosive
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nitrous oxide
not a potent agent, 100% in humans, 200% MAC in dogs and 250 in cats
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desflurane
chemically similar to iso, twice as fast as iso, single breath induction agent in humans
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mask technique
- deliver 100% O2 for 3 min
- gradually increase to 5% iso
- either maintain on mask or intubate
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prevents cardiac arythmias
allows for patient adjustment to the smell of iso
struggling may occur after 2-3 min
purpose of gradual increase with mask technique
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analgesia
unpleasant sensory or emotional experience associated with actual or potential tissue damage, relief of pai without loss of consciousness
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mild, moderate and severe
3 classifications of pain intensity
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acute
abrupt onset, relatively short, usually treatable (type of pain)
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chronic
slow onset, long duration, potentially manageable (type of pain)
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increased heart rate, blood pressure, respirations and dilated pupils
physiological signs of pain
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endorphins
chemicals in the brain that are released in response to pain to provide analgesia
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preemptive analgesia
analgesia provided before its needed
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operative analgesia
analgesia provided throughout surgery
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postoperative analgesia
analgesia provided after surgery for pain relief
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opioids/alpha-2 agonists, NLA
pain relief that targets the brain and spinal cord
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NSAIDS
pain relief that targets tissues and brain, inhibits chemical release fom neurons
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local anesthesia
pain relief that targets regional areas
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ketamine
pain relief that is somatic, dissociative
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neuroleptanalgesia
opioid and tranquilizer combination
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balanced analgesia
mutiple agents that will reduce the quantity of each agent, min toxicity and reduces pain via diff mechanisms
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cat declaw, spay and dental with extractions
- Metacam-preanesthetic NSAID
- dexdomitor/ketamine/buprenorphine-induction and postop analgesia
- bupivicaine-local ring and op and postop analgesia
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dog spay or neuter
- Rimadyl-analgesia
- dexdomitor/Atropine/buprenorphine
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orthopedic surgery
- fentanyl patch-analgesia
- dexdomitor/Atropine/buprenorphine
- morphine/ketamine/lidocaine
- Rimadyl
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local anesthesia
use of a chemical agent on sensory and motor neurons to produce a temporary loss of pain sensation and movement
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local anesthetics
target organs are the PNS and Spinal Cord, they interrupt nerve pathways by loss of electrical impulses on neurons
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infiltration
injectable application of agent into tissues by a major nerve
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regional anesthesia
injectable application of agent near spinal cord or major nerve plexus
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injection into nerve-paralysis
tissue irritation-stings
paresthesia-abnormal sensation of tingling
allergic reactions
systemic toxicity
inadvertent spinal injections
local anesthetic risks
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mechanical ventilation
physical movement of air and or anesthetic gases in and out of lungs
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inhalation
active phase of mechanical ventilation
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exhalation
passive phase of mechanical ventilation
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tidal volume
amount of air that passes in and out of lungs in one breath
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assisted ventilation
anesthetist ensures that an increased volume of air is delivered to the patient, although patient initiates each inspiration
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controlled ventilation
externally initiated by anesthetist, patient does not make spontaneous repirations
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positive pressure ventilation (PPV)
ensures patient receives adequate O2 and is able to exhale adequate amounts of O2
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hypercarbia
rise in PaCO2 causes blood pH to fall which leads to resp. acidosis
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atelectasis
partial collapse of sections of the lung due to alveoli not expanding as fully as normal due to reduced tidal volume
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periodic bagging
l breath every 3-5 minutes
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continuous bagging
8-12+ breaths every minute
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pressure manometer
do not exceed 15-20 cm H2O
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neuromuscular blocks
controlled muscle paralysis (blocks impulses of motor neurons)
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geriatric patients
these patients are at greater than 75% of their life expectancy
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pediatric patients
patients that are less than three months old, increased risk of hypothermia
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bracycephalics
anatomical conformation impedes air exchange (elongated soft palate and small diameter ET)
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be a team player
be prepared
be active
be responsive
technicians role in emergencies
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tachypnea (hyperventilation)
higher than normal resp rate
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bradypnea (hypoventilation)
lower than normale resp. rate
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respiratory arrest
perm. brain damage occurs within 4 minutes if O2 isnt delivered to it...turn off agent gas and bag every 5 minutes
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Cardiopulmonary Cerebral Resuscitation
CPCR
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R lateral recumbancy
hands at mid chest level (where flexed elbow meets chest)
1-2 compressions/sec
CPCR steps
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atropine, Respiran, Epinephrine
drugs to be given during cardiac arrest
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