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Anesthesiology

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What does epinephrine do?
the adrenergic sympathetic) effects increases the heart rate
Use of succinylcholine in combo w/general anesthetics is advantageous to surgeons during certain prodecures, but it gives the anesthetist 1 less measure with which to monitor anesthetic depth. What is of no use in monitoring patients given succinylcholin
Jaw muscle tone;
Succinylcholine is a muscle paralyzing agent that may be used to achieve pronounced muscle relaxation for certain procedures, but cannot be used as an indicator of anesthetic depth
During CPCR, 2% lidocaine is used to treat ventricular arrhythmias. A complication that may occur after IV infusion of lidocaine is:
bradycardia;
A slowness of the heartbeat
Depressant preanesthetic medication may have what effect on patient recovery?
Prolong the recovery time
In dogs, normal doses of narcotics generally produce all of the following except:
Respiratory depression, decreased heart rate, analgesia, excitement
Excitement is rare
Response to a painful stimulus in a surgical patient if the anesthetic depth is inadequate may be indicated by all of the following except:
Increased HR and BP, decreased lacrimation and salivation, increased RR, sweating on foot pads
Decreased lacrimation and salivation;
A light plane of anesthesia may be indicated by increased lacrimation and salivation
SX eval. of a dog HBC revealed a PCV of 18% and plasma protien below 2.5 g/dl. All are true except:
he is predisposed to pulmonary edema, fluid admin. rates should be watched closely, he should receive plasma or whole blood before sx, he should not
the patient should not receive fluid before surgery is incorrect
According to the National Institute for Occupational Safety & Health, the max. recommended level of exposure of people to volatile anesthetic agents in the environment is:
2 ppm
Narcotics are used in anesthetic protocols primarily as:
analgesics
A cardiac rhythm disturbance detected detected shortly after induction of anesthesia may be the result of any of the following except:
the induction agent, difficulty intubating, hypoxemia, breathing O2 enriched air
Breathing O2 enriched air will not affect the cardiac rhythm
The causes of true hyperventilation and tachypnea during anesthesia may include all of the following except:
progression from light to moderate anesthesia, response to metabolic acidosis, response to a mild sx stimulus, presence of pulmonary edema
Progression from light to moderate anesthesia is incorrect. The opposite (moderate to light anesthesia) holds true.
An abnormally elevated central veous pressure developing during anesthesia and srgery may indicate:
IV fluid overload
If a dog is too deeply anesthetuced, all of the following may be seen except:
tachycardia, bradycardia, pale MM, increased jaw tone
increased jaw tone would not be seen
Malignant hyperthermia is a potentially fatal syndrome to the anesthetized patient. Which species is most prone to this cx?
Cattle, pig, dog, goat
pig;
although it may occasionally be seen in dogs anesthetized wth ketamine or halothane, pigs are more susceptible
When comparing inhalation anesthetics, you should us the minimum alveolar concentration (MAC) as a guide in assessing what?
Potency of the agent;
MAC is the concentration in percent at 1 atmosphere that prevents gross purposeful skeletal muscle mvment in response to a noxious stimulus in 50% of petients.
In rabbits, IV anesthetics should be injected into which vein?
Auricular
Capillary refill time is noticeably prolonged (>2 sec) when the blood pressure drops below what value?
70-80mm Hg
Epidural techniques are used in many species, but the primary disadvantage in animals is?
high cost, difficulty of administration, poor analgesia, movement of the patient
movement of the patient;
although they provide analgesia, patient movement is still of concern & prevents their use in most sx procedures
Thiobarbiturates should not be administered by what route? WHY?
SQ;
it causes severe tissue irritation and necrosis.
It is advisable to turn the anesthetized patient from side to side during recovery. Should you turn dorsally or sternally? Wha?
sternally;
to lessen the chance of gastric torsion, especially in deep chested dogs
If the unidirectional valves are missing from the anesthetic machine, is it ok to use it? why or why not
not ok except with the nonrebreathing circuit;
the absence of unidirectional valves allows rebreathing of CO2. Because the attachment of a nonrebreathing device to the fresh gas port bypasses the circuit, it is ok.
Which may potentiate the anesthetic effects of barbiturates when administered during the perioperative period?
(IV fluids w/o dextrose, O2, epi, IV phenylbutazone)
IV phenylbutazone;
it is a heavily protien-bound drug, as are barbiturates.
What 2 drugs does the combo drug Telazol contain
Zolazepam and tiletamine
What drug is an antagonist of xylazine?
Yohimbine
During the maintenance period of anesthesia, RRs fewer than how many breaths/min may indicate excessive anesthetic depth?
8
What is the estimated blood volume in dogs?
80 ml/kg
In which species is morphine most likely to cause an adverse central nervous system reaction?
Cats
What is the most common arrhythmia associated with use of thiobarbiturates in dogs during induction of anesthesia?
Bigeminy;
def: in association with pairs
Whole blood should be administered in which of the following presurgical situations?
PCV 30%, PCV 14%, Von Willebrand's +, Chronic anemia w/ PCV 25%
PCV 14%
Which agent is associated with long induction and recovery times?
Nitrous oxide, Iso, Halothane, Methoxyflurane
Methoxyflurane;
it is highly sobule in tissue and 50% of the drug must be metabolized for complete elimination from the body. This equates to longer recovery.
Some anesthetists routinely bag their patient under inhalation anesthesia once every 5 min. to help prevent?
atelectasis
def:the absence of gas from all of a part of the lungs, due to failure of expansion of gas from the alveoli
A dog anesthetized with halothane in 99% O2 develops ventricular tachycardia. What is the drug of choice for therapy?
Lidocaine
Which of the following is not an effect associated with atropine administration?
Tachycardia, Excessive salivation, mydriasis, decreased gastrointestinal motility
excessive salivation is wrong;
atropine decreases salivation
def. mydriasis: prolonged abnormal dilation of the pupil)
For each milliliter of blood loss during surgery, the crystalloid fluid replacement volume should be:
3mL
Which agent produces the least amount fo toxic metabolic byproduct?
Methoxyflurane, halothane, enflurane, Isoflurane
Iso
When monitoring the MM color of an anesthetized patient with pigmented gingivae, you should look at what alternative sites? (4)
tongue,
buccal mucous membranes,
conjunctivae of lower eyelid,
lining of prepuce/vagina
Which drug is not classified as a barbiturate? What is it?
Thiamylal, Thiopental, Pentobarbital, Propofol
Propofol;
it is an alkylphenol, nonbarbiturate, highly lipid-soluable HYPNOTIC AGENT
The approx. volume of O2 in an E cylinder is:
700L
What is the most accurate way to evaluate the effectiveness of respiration?
Measure the arteriole blood O2 and carbon dioxide partial pressures
(SPO2 and PCO2)
The minimum fresh gas flow in a semi-closed system is correctly determined by the:
patient's metabolic rate;
metabolic rate determines the min. O2 requirement
What is the pressure of gas entering the flow meter of teh anesthetic machine?
50-60 psi
Use of an indwelling catheter in an artery to monitor blood pressure is termed:
Direct monitoring;
Use of an external devices when monitoring blood pressure is termed:
indirect monitoring
Dehydration greater than 10% is considered:
a seriously morbid state
Pentobarbital anesthesia is to be avoided in patients with
hepatic disease
The responsibilities of the anesthetist during a surgical procedure include continuous monitoring of the patient's vital signs and recording observations how often?
5 min. intervals
Which agnet is least likely to produce cardiac arrhythmias?
Methoxyflurane, Halothane, Enflurane, Isoflurane
Iso
Once extubated, what position should the body and neck of the patient be?
Sternal recumbency with the neck extended;
maintains patent airway
A 10% solution of thiamylal sodium for anesthetic induction contains:
100 mg/mL;
Percent solutions= move decimal 1 place to left
Diazepam is considered to be a good choice in patients when which body system is compromised?
Hepatic, renal, cardiovascular, all body systems
Cardiovascular;
In hepatic or renal patients, recovery may be prolonged as a result of the metabolic requirements.
A dog received the correct dose of xylazine IM. 2nd-degree heart block and bradycardia developed. Based on the most common cause of this adverse rxn, what would be the best therapy? why?
Glycopyrrolate;
the anticholinergic effects of glyco block the vagal-induced bradycardia and 2nd-degree heart block commonly associated with xylazine.
A half-full tank of nitrous oxide gas has a pressure of?

A full tank of nitrous oxide gas has a pressure of?
750psi

750psi
In the US, xylazine is not approved for use in what species?
Dogs, cats, horses, cattle
cattle
What doest the use of nitrous oxide in anesthesia do?
decreases the amount of inhalation anesthetic required (because it adds to the effect of the other inhalation anesthetics)
Propofol is what kind of drug? with what potential?
a nonbarbiturate IV anesthetic with hypotensive potential
What drug should be avoided in the stallion because it may cause petmanent prolapse of the penis?
Acepromazine
During CPCR, adequate cardiac massage is present when:
a peripheral pulse is present
Cardiac arrhythmias that occur during anesthesia are commonly associated with all of the following except:
normocapnia, excessive halothane concentration, hypoxemia, myocardial ischemia
Normocapnia: normal CO2 levels do not induce arrhythmias.
(def. ischemia: decrease in the blood supply caused by constriction or obstruction of a vessel)
For which patient would ET intubation not be routinely used to prevent possible aspiration of regurgitated material? WHY?
dog in for routine OVH after fasting 12 hrs., cat with fractured femur, cow with displaced abomasum, horse gelding in for arthr
Horse; the equine esophagus consists of entirely smooth muscle; therefore, the horse is not capable of regurgitation, except in severe cases of bloat in which case it is a reflux problem, not true regurgitation
In a Siamese cat, when should the ET tube be removed? Why?
As soon as s/he begins to swallow and cough;
because it is nonbrachycephalic, so it must be done before s/he has had a chance to puncture the tube
Diazepam is used to produce:
muscle relaxation
Which inhalation anesthetic is least likely to cause cardiac arrhythmias in dogs? Why x2?
Isoflurane, Halothane, enflurane, Methoxyflurane
Iso;
it maintains better cardiac output and produces less sensitivity of the myocardium to catecholamines
Which stment about use of IV anesthesia in lg. animals is least accurate?
1.used for casts, castration & hernias 2.works well if need complete immobilization 3.shouldn't be used if procedure is >45-50 min. 4.need preanesthetic for sedation
It works well on procedures requiring complete immobilization of patient is incorrect
What volume of thiamylal sodium should be administered IV to a 500kg horse for induction of anesthesia? The dosage is 8mg/kg, and you are using a 10% solution.
40mg

(wt)(rate)/conc
(500kg)(8mg/kg)/100mg/mL
The volume of blood administered to a patient is determined by all of the following except:
PCV of donor, PCV of recipient, desired PCV, age of recipient
Age of recipient is incorrect
Dobutamine is used in emergency anesthetic and clinical situations to:
Increase cardiac output
Using ketamine as an anesthetic agent diminishes the value of which measure in assessing anesthetic depth? Explain.
Eye position; it does not cause eye rotation, even at moderate depths of anesthesia
Which drug is the most potent sedative?
Xylazine, Detomidine, Acepromazine, Diazepam
Detomidine
Following discontinuation of the anesthetic gas, periodic bagging of the patient with pure O2 is advisable because:
it helps reinflate collapsed alveoli
Immediately after tracheal intubation in a 3kg cat you notice extreme respiratory distress. The most likely cause?
Bronchial intubation
Hypothermia has become significant in a 4kg anesthetized cat. The best way to restore body heat:
warm water blanket, submerge patient in warm H2O, with a heat lamp, warm the air in the breathing circuit by some method
warm the air in the breathing circuit by some method
Vaporizers may be classified according to all of the following except:
method of regulating output, method of faporization, location in the anesthetic circuit, type of breathing circuit with which they can be used
the type of breahting circuit with which they can be used;
all vaporizers can be used with any breathing circuit
At normal doses, what effect does atropine have on the heart rate?
Prevents a decrease (bradycardia)
Describe the eye position, pupil size, and responsiveness to light in stage III, plane 3 of anesthesia
eye is usually central to slightly rotated, pupils moderately dilated and respond to light slowly or not at all
Describe the eye position and pupil size in stage III, plane 2 of anesthesia
eyes are usually rotated ventrally, pupils slightly dilated
Describe the eye position, pupil size, and responsiveness to light in stage II of anesthesia
eyes are usually central, pupils may be dilated and responsive to light
Describe the eye position, pupil size, and responsiveness to light in stage IV of anesthesia
eyes are central with widely dilated pupils that are unresponsive to light
the rebreathing bag on an anesthetic machine should be approximately what size in relation to tidal volume
6 times the patient's tidal volume
In dogs recovering from anesthesia, the ET tube should be removed when?
the swallong reflex returns
Acepromazine should be avoided in what kind of patients?
patients with a history of seizures
Precision vapors, such as those for iso, work correctly when placed where on the system?
out of the circle
Which of the following is not a good reason to use a preanesthetic?
calms the patient, minimize the dose of induction agent needed, smooths induction and recovery, increases vagal activity
increases vagal activity is incorrect;
premedication agents are used to minimize undesirable autonomic effects
Which drug is a dissociative anesthetic?
Thiamylal sodium, Ketamine, Xylazine, Acepromazine
Ketamine
All of the following cross the placental barrier in significant amounts except:
Acepromazine, Diazepam, Iso, Neuromuscular blocking agents
Neuromuscular blocking agents; escentially all anesthetics except neuromuscular-blocking agents cross the placental barrier
In which of the following animals is a laryngoscope generally required for intubation:
siamese, boxer, pot-bellied pig, steer
Pig (sheep, goats, llamas, and rabbits also) because of their oral and pharyngeal anatomy
what is the most common complication with ET intubation?
placement of thube in the esophagus;
then overinflated cuff injury to the trachea
Which statement about the pressure manometer in the anesthetic circuit is least accurate?
1)it's calibrated in cm of H2O or mm or Hg 2)it's helpful when ventilating patients 3)it's related to the pressure in the patient's airway 4)it measures O2 par
4)it measures O2 partial pressure is least accurate
Mean arteriole blood pressure of the halothan anesthetized horse can be used for what?
as an indication of anesthetic depth
The advantage of xylazine over acepromazine is that it:
produces a short period of anealgesia;
Acepromazine has no analgesic effect
You should be aware of effects of anesthetic agents on patients.When used as preanesthetics, atropine & ace can cause all of the following except:
prolapse of nictating membrane, respiratory depression, reduced salivation & tear production,
Respiratory depression;
phenothiazine drugs, such as ace, do not cause respiratory depression & are considered to have a wide margin of safety
Patients that have H2O withheld for long periods before sx and general anesthesia may be prone to what 2 things?
dehydration and hypotension
What is the volume of O2 in an H cylinder?
7,000L
Doxapram may produce all of the following except:
CNS excitement, decreased venous return, respiratory alkalosis, hypoventilation
hypoventilation;
doxapram is used to stimulate respirations in newborns or after anesthesia
Halothane concentrations of 1-2% may produce any of the following except: hypotension, hypoventilation, hypothermia, increased cardiac output
increased cardiac output;
inhalation anesthetics are expected to decrease cardiac output at working concentrations
It is cause for concern if an anesthetized cat's heart rate falls below ___ beats/min
100 bpm
During CPCR in a medium-sized dog, you should maintain a ventilation rate of how many breaths/min?
12
Tachycardia in an anesthetized patient may be an indication of any of the following except:
Hypotension, Pain, light plane of anesthesia, xylazine overdose
xylazine overdose;
would cause bradycardia rahter than tachycardia
A 20kg dog is resuscitated after cardiac arrest. The HR is now 160bmp with sinus rhythm, poor pulse quality, and pale MM. The most appropriate drug to administer is:
(Epi, doxapram, atropine, dobutamine)
Dobutamine
The dose of ace is 0.1mg/kg, and the maximum dose is 4mg. How many mg would you administer to a 60kg dog?
4mg is the max dose
The O2 flow rate necessary to prevent rebreathing with an Ayre's TSS piece is:
>1.5 times the minute ventilation;
flows <1.5x the minute ventilation allows rebreathing of CO2
Butorphanol is best described as:
an antiimflamatory, an analgesic, ananesthetic, a diuretic
an analgesic
Guaifenesin is most often used in horses and cattle to provide:
muscle relaxation
In patients is it recommended to wait a longer period before extubation because of the liklihood of moniting or airway obstruction
brachycephalic
Routine use of atropine in horses should be avoided because it:
May cause colic;
The anticholinergic effects of atropine on the intestinal tract of horses includes: ileus, intestinal distention and colic.
An isoflurane anesthetized cat suddenly begins breathing 30 times a minute during a surgical procedure. You first response should be:
Evaluate vital organ function and ET tube placement and make necessary adjustments
Which statement concerning soda lime is least accurate?
1)it removes CO2 from the breathing circuit 2)its capacity should be 1-2x the tidal vol. 3)it can be nonfunctional & maintain its original color 4)it shoudl be changed once a month
4)it should be changed once a month;
normally soda lime should be changed on the basis of hours of use, depending on the size of the cannister
Describe anatomically where the ideal placement of the ET tube should be inserted.
its tip is midway between the thoracic inlet and the larynx
A 10yr old K9 has been anesthetized for removal of a skin tumor & is now maintained on 2% iso. The anesthetist observes that its respirations are 8/min & shallow, HR=80bpm, pupils are central, jaw tone is slack & all reflexes are absent. What
Stage III, plane 3
While monitoring a horse receiving O2 at the rate of 8 L/min, halothane 1.5%, & fluids at 20mL/kg/hr, you note that the BP suddenly falls to 60mmHg & the peripheral pulse becomes weak. What is your 1st response?
Lower the halothane concentration and increase fluid delivery rate
Which animal is most likely to experience laryngospasm?
cat
(sheep are also susceptibele)
When inflating a cuff on an ET tube, you sould use a larger tube if cuff inflation requires infection of how much air?
5mL
In the anesthetized surgical patient, pale MM indicate all of the following except:
inadequate O2 levels, cyanosis, excessive blood loss, decreased tissue perfusion
cyanosis
Glycopyrrolate is an anticholinergic what main advantages over atropine?
atopine crosses the placental barrier, glyco does not
Corticosteroids are used during CPCR for all of the following except to:
induce vasodilation, aid in regulating fluid and electrolyte homeostasis, stimulate respiration, stabilize the cellular membrane
corticosteriods do not stimulate respiration
When an ET tube is being inserted in a horse, the animal should be placed in what position:
In lateral recumbency with its head, neck and back extended
A 1:10,000 dilution of epinephrine contains how much epi per milliliter?
0.1mg

1/10,000 = 0.0001 x 100
= 0.01% x 10
= 0.1 mg/mL
why is the combination of xylazine and butorphanol is used?
to provide greater analgesia and muscle relaxation than either drug can alone
hypoventilation that occurs in the anesthetized patient is characterized by:
(compare O2 and Co2 levels)
decreased O2 levels and increased CO2 levels
When monitoring the vital signs of an anesthetized patient, you must observe and record all of the following except:
MM color and CRT, HR and RR and depth, reflexes, pulse quality and strength
reflexes;
the term vital sign refers to measures that indicate the response of the animal's homeostatic mechanism to anesthesia
What is the preferred method for treating a cat with laryngospasms?
Place a drop if a topical anesthetic in the laryngeal area, wait a few minutes, then intubate
While monitoring a horse during inhalation anesthesia, you note that the HR suddenly increases to 80bpm. What would your most approperiate response be?
evaluate the eripheral pulse, MM, and other vital organ function before responding
Mask inductions are:
1)best used in dogs and cats with airway obstruction 2)best used in aggressive dogs and cats 3)absolutely the best way to induce all dogs and cats 4)more approperiately used in calm dogs and cats
4)used in calm dogs and cats;
mask inductions in aggressive patients can be so stressful that they offset the benefit of avoiding premedication and induction agents
Detomidine is approved for use in what species?
horses
If the rectum of a patient is covered by a surgical drape of is otherwise inaccessible to the aneshtetist, a rough estimate of body temp can be obtained by:
touching the patient's feet or ears
What color are nitrous oxide cylinders painted?
Blue
After correctly placing, lubricating, and inflating the cuff of the ET tube, you note a sudden decrease in HR. What is the most likely cause?
cuff may be overinflated, producing vagal-induced bradycardia
Which drug is a narcotic antagonist?
Naloxone, Atropine, Pancuronium, Droperidol
Naloxone
What is the best method for determining theproper inflation of an ET tube cuff?
inject air while applying pressure from the reservoir bag until no air escapes around the tube
Whaen planning to use low flows of O2 in a circle system, remeber to:
deliver high flows until the circuit O2 concentration is near 100%
Which statement concerning the Ohio #8 vaporizer is least accurate?
its placed in the circle, its a nonprecision vaporizer, its not temp compensated, its a bubble-through vaporizer
Its a bubble0through vaporizer
Apneustic breathing patterns are frequently seen in cats with the use of what drug?
Ketamine,
characterized by an inspiration hold and rapid expiration
activated charcoal devices aborsb all inhalation agents except:
Nitrous oxide
Hoe many mg/mL does a 2% lidocaine solution contain?
20mg/mL
2% x 10 = 20mg/mL
The minimum acceptable heart rate (beats/min) for the anesthetized canine patient is?
70bpm
What do pulse oximetry monitoring devices determine?
oxygen saturation of hemoglobin in arterial blood
The advantages of a nonrebreathing system, as compared with a circle breathing system, include all of the following except:
reduced resistance to breathing, greater potential for hypothermia caused by high flows needed, reduced mechanical dead space
greater potential for hypothermia caused by high flows needed
What does the O2 flush valve do?
Allows O2 to flow into the breathing system without going through the vaporizer
When inflating lungs with the thoracic cavity open to the atmosphere, be sure that the pressure reached on the manometer is:
20 cm H2O;
adequate inflation of the normal lung requires approx. 20 cm H2O
A 10kg dog w/a ventricular arrhythmia is treated w/an IV lidocaine drip at 50 micrograms/kg/min. How many drops per minute from a minidrip infusion set (60 drops/mL) are necessary if the concentration of lidociane is 1mg/mL?
30
50mcg = 0.5mg
(10kg)(.05mg/kg/min)=.5mg/min
(.5mg/min)/(1mg/mL)=.5mL/min
(.5mL/min)(60drips/mL)=30
Which drug is most likely to cause hypotension in normal doses?
Diazepam, Butorphanol, Acepromazine, Flunixin meglumine
Acepromazine;
it is an alpha blocker with significant potential to produce hypotension even though it is rarely a problem in healthy patients
Sodium bicarbonate is used to:
combat acidosis
The Ohio #8 vaporizer is correctly used to deliver:
Iso, Enflurane, Halothane, Methoxyflurne
Methoxyflurane
There have been reports of increased health concerns among people exposed chronically to trace levels of anesthetic gas. All of the following cx have been attributed to such exposure except:
abortion & congenital abnormalities, hepatic/renal dz,
insomnia
xylazine is best described as what kind of drug?
A potent analgesic sedative
Caudal epidural administration of lidocaine in the dog is:
an excellent caudal analgesic for surgical prodecures involving the rear limbs and anal area
Adequate O2 may be evauluated subjectively during anesthesia by the:
MM color and CRT
What stage of anesthesia may be characterized by vocalization, struggling, and holding breath?
Stege II
AKA the "excitment stage"
What inhalation anesthetic is biotransformed to the greatest extent in the animals body?
Methoxyflurane
In a cat that is too deeply anesthetized, all of the following may be present except:
pale MM, tachycardia, bradycardia, voluntary movement
voluntary movement
Indications of poor cardiac function include all of the following except:
Cyanosis in patients w/PCV of 45%, poor perfusion, cardiac arrhythmias, normal pulse
normal pulse
A disadvantage of breathing 50% nirtous oxide is that it:
decreases the arterial PaCO2;
partial pressure of O2 in arterial blood should be aprox. 5x the % inspired O2. Breathing 100% O2 would then yield a PaO2 of 500mmHg. O2 50% + N2O 50% would yield a PaO2 of 250mmHg. In some patients this may not be desirable.
If 180mL of 5% solution of guaifenesin is administed to a 150kg foal, how many mg/kg would be administered?
60mg/kg
180mL of 5% sln means times
(5%)(10mg/mL)=50mg/mL
(180mL)(50mg/mL)=9000mg
(9000mg)(150kg)=60mg/kg
All anesthetic machines should have
an anesthetic waste gas scavenging system

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