A/S - injectables and inhalants
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- Anesthesia - injectables & inhalants
- Anesthesia - injectables & inhalants
- Name two Cyclohexamines and one combo of
- Ketamine, Tiletamine, TKX (Telazol, Ketamine, Xylazine)
- Cyclohexamines can induce ___ in dogs and horses so it is used w/ a tranquilizer
- seizures
- Ketamine, Tiletamine, and TKX are examples of what kind of injectable induction agent?
- Cyclohexamines
- How do Cyclohexamines affect reflexes? muscles?
- reflexes are exaggerated, persistent laryngeal reflexes (cats), sensitive to light, touch, sound, increased muscle tone and rigidity
- Define apneustic respiration - what drugs can cause?
-
breath holding after inspiration, quick expiratory stage
cyclohexamines can cause this - How do cyclohexamines affect the heart? blood pressure? salivation?
- tachycardia, inc blood pressure and salivation
- Will cyclohexamines cause skin necrosis if given IM?
- No, it stings but will not cause necrosis
- Define dissociative analgesia/catalepsy. What drugs cause this?
- A distinctive type of trancelike anesthesia where the animal appears awake but immoble and unaware of its surroundings. Caused by cyclohexamines - Ketamine, Tiletamine
- What are 5 contraindications for cyclohexamines?
- dog/horses w/o tranq, seizure disorder or hx of, renal dz/blockage, hepatic dz in dogs, procedures involving CNS
- What are some unique things about the recovery period when cyclohexamines are used (3)?
- Avoid stimulation (dec light & sound, avoid touching), hallucinatory behavior possible (pawing face), monitor closely to prevent self-injury
- Are cyclohexamines controlled?
- Yes
- Is Ketamine controlled?
- Yes
- Is tiletamine/Telazol controlled?
- Yes
- What is the most commonly used induction agent?
- Ketamine
- How is Ketamine administered to dogs? cats?
- IV only in dogs, in cats IV or IM/orally in fractious animals
- What could happen if a IM does if Ketamine was given IV?
- serious overdose or death
- What is the onset IV, IM, and orally for Ketamine?
- 90 sec IV, 2-4 min IM, 5-10 mins orally
- How long is the recovery period w/ Ketamine?
- 2-6 hours depending on route and patient
- What are three tranquilizers commonly used w/ ketamine?
- Acepromazine, diazapam, xylazine
- An overdose of a cyclohexamine will cause what?
- seizures
- Tiletamine is only sold w/ ___ as ___. What form does it come in?
- w/ zolazepam as Telazol - comes in a powder and must be reconstituted
- Telazol has a long or short shelf life? How long?
- Short - 4 days at room temp, 14 days refrigerated
- Telazol has onset and duration similar to ___
- ketamine
- How are cyclohexamines eliminated?
-
Ketamine - mostly renal in cats/hepatic in dogs
Telazol - hepatic metabolism and renal excretion - What is TKX?
- Telazol/ketamine/xylazine
- In what form is TKX purchased?
- Ea drug separately - the "cocktail" is mixed in-house
- What is the dose and route for TKX?
- 0.015ml/lb IM
- What injectable induction drug is a substituted phenol?
- Propofol
- Propofol is what kind of drug?
- substituted phenol - injectable induction agent
- What route(s) can propofol go?
- IV only
- What form does propofol come in?
- milky oil-in-water emulsion
- Propofol has a very short shelf life once opened - how short and why?
- 6 hour shelf life once opened - product contains soybean oil, egg lecithin, and glycerol which support bacterial growth
- How is the IV of propofol given?
- SLOWLY to prevent apnea - give 1/3 to 1/2 initially and then smaller injections after that until desired plane of anesthesia is reached
- What is the duration of propofol?
- Short - 5-10 mins only
- How is propofol maintained?
- IV drip or injections every 3-5 minutes
- What are 4 uses of barbiturates?
- Induction, maintenance, anticonvulsant, euthanasia
- Barbiturate solutions are sold as a ____ w/ ___ & ___
- Kit with powdered drug and sterile water
- Barbiturates need to be __ after reconstitution and should be discarded if ___ &/or occurs
- need to be refirgerated after reconstition and should be discarded if cloudiness &/or crystallization occurs
- Barbiturates produce dose dependent ___. In what stages does this progress?
- CNS depression - sedation, anesthesia, depression, death
- Do barbiturates provide good analgesia?
- No
- By what route are barbiturates given? How dosed?
- IV only - titrate to effect - 1/2 dose, then 1/2 of remainder and so on
- What meds cause tissue sloughing and necrosis when administered perivascularly?
- Barbiturates - Thiopental and Pentobarbital
- Name two barbiturates
- Thiopental, Pentobarbital
- Thiopental and Pentobarbital are what kind of drugs?
- Barbiturates
- What kind of meds commonly cause post-induction apnea and/or transient arrhythmias?
- Barbiturates - Thiopental and Pentobarbital
- Barbiturates may profoundly ___ respiration
- depress
- What cardio vascular effects do barbiturates have(2)?
- dose dependent decrease in cardiac output and blood pressure, increases sensitivity to epinephrine, thus could cause arrhythmias
- What are some contraindications for barbiturates?
- cardiovasc or resp dz, acidosis, CNS depression, thin/poor nutrition, sighthounds, fearful/agitates animals, geriatrics, neonates, C-sections
- Are barbiturates (Thiopental & Pentobarbital) controlled?
- Yes
- Thiopental has an onset of ___ thus is it considered ___-acting
- 30-60 seconds, ultrashort-acting
- ___ may be used as the sole anesthetic for very brief procedures. What is the duration of this drug?
- Thiopental, 10-20 minutes
- What drug is intermediate acting, has a narrow margin of safety, and is administered via continuous titration ofer 5-10 minutes?
- Pentobarbital
- What drug is an anticonvulsant that may be used if Diazepam is ineffective?
- Pentobarbital
- What drug in a concentrated form is used in some euthanasia solutions?
- Pentobarbital
- Ihalation anesthetics are mixed with ___ for administration
- oxygen
- Inhalation anesthestics are eliminated primarily via the respiratory system - explain the path
- airway to lungs(alveoli) to blood to brain
- The rapid uptake & elimination of inhalation drugs provides ___ depth control and ___ recovery
- excellent depth control and rapid recovery
- Inhalation drugs provide deeper anesthesia and better muscle relaxation w/ less ___ than injectables
- less resp depression
- Define vapor pressure
- the tendency of a molecule to ecape the liquid state and become a vapor or gas
- Agents w/ a high/low vapor pressure require a precision vaporizer
- high
- Define tidal volume
- The amount of gas which moves into and out of the lungs w/ each breath
- ___ x ___ determines the amount of anesthetic agent delivered per minute
- tidal vol x resp rate
- The ___ soluble the gas in blood, the faster the agent leaves the blood to enter the brain or alveoli
- less
- What is second gas effect?
- Adding a second gas takes up space in the alveoli, concentrating the primary agent and speeding up it's entry into the blood.
- What are the two primary factors that affect an inhalation agent's elimination from the body?
- tidal volume and resp rate
- What is MAC?
- Minimum alveolar concentration - the concentration of drug needed to anesthetize 50% of patients to a particular painful stimulus
- ___ x ___ determine maintenance levels of inhalation agents
- 1.5 to 2.0 x MAC
- Name three inahalation agents
- Halothane, Isoflurane, and Sevoflurane
- What inhalation agent provides poor analgesia and sensitizes the heart to arrhythmic effects of epinephrine?
- Halothane
- Halothane produces more/less resp depression than Isoflurane
- less
- At what % Halothane maintained at?
- 1.5%
- At what % is Isoflurane maintained at?
- 1.5-2.0%
- At what % is Sevoflurane maintained at?
- 3.5%
- What inhalation agent provides excellent maintenance of cardiac output but respiratory depression?
- Isoflurane
- What inhalation agent is excellent for birds, geriatrics, and critical care?
- Isoflurane
- What inhalation agent provides fast induction and recovery? What agent is faster and smoother?
- Isoflurane, Sevoflurane
- Nitrous Oxide is not an anesthetic: it is used for ___ and ___
- analgesia and 2nd gas effect
- Nitrous can reduce the vaporizer setting of other agents by __-__%
- 10-20%
- Nitrous is combined w/ O2 at a ratio of _:_
- 2:1
- What color is a Nitrous tank?
- Blue
- What type of inhalation system has no rebreathing, no circuit, no reservoir bag (can't ventilate patient), and no CO2 absorber?
- Open system
- What inhalation system has no rebreathing, no circuit, no CO2 absorber, has a reservoir bag and valve (can vent pt) and is used for pts 15# or smaller?
- Semi-open system - Arye's T-piece, Bain apparatus
- What inhalation system is rebreathing, has a reservoir bag and CO2 absorber, and has a pop-off valve that is adjusted throughout procedure?
- Semi-closed system
- What inhalation system is rebreathing, has a reservoir bag and CO2 absorber, and has a pop-off but it is closed?
- Closed system
- With what kind of inhalation system can the pt not breathe out - pressure builds up in the circuit?
- Closed system