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Anesthesiology > Patient Evaluation > Flashcards

Patient Evaluation Flashcards

1
Q

Pre-anesthetic patient evaluation

A
  1. Signalment/general appearance
  2. History
  3. Physical exam and accurate weight
  4. Risk assessment
  5. Pre-anesthetic workup (blood work, radiology, etc)
  6. Preparation
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2
Q

What weight should you use for obese patients to calculate drug dosages?

A

Estimated ideal weight

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3
Q

IV drugs should always be given to….

A

Effect

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4
Q

Anesthetic concerns for overweight/obese animals

A
  1. Increased CO
  2. Decreased lung and chest wall compliance
  3. Decreased functional residual capacity- respiratory depression, mechanical ventilation often necessary
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5
Q

Evaluation of thin/cachectic animals

A

Evaluate and treat any underlying disease prior to anesthetic induction

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6
Q

Concerns of IV anesthetics in underweight animals

A

Drugs stay in VRG longer (titrate to effect)

Prone to severe hypothermia

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7
Q

Concerns with very small animals

A
  1. Severe hypothermia
  2. Must get accurate weight to avoid overdose of drugs and fluids
  3. Difficult to access under drapes
  4. Prone to hypoglycemia
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8
Q

Concerns with giant breeds

A
  1. Profound response to sedatives (lower MBR)
  2. Smaller body surface area to body weight ratio (BSA dosages should be reduced)
  3. Senescence occurs earlier and have lower life expectancy
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9
Q

Concerns with neonates

A
  1. Increased sensitivity to drug effects
  2. Hypothermia
  3. Hypoglycemia
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10
Q

Concerns with geriatrics

A
  1. Decreased organ reserves

2. Sub-clinical organ function

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11
Q

T/F: Hyper or aggressive animals typically take higher dosages of drugs to achieve the same effect.

A

True

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12
Q

Concerns with brachiocephalic animals

A
  1. Elongated soft palate
  2. Everted saccules
  3. Obstructed nares
  4. High vagal tone- predisposes to bradycardia
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13
Q

Concerns with greyhouds

A
  1. Susceptible to stress hyperthermia
  2. Low body fat
  3. Avoid thiobarbituates (decreased ability to metabolize)
  4. Sensitive to propofol
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14
Q

Concerns with herding breeds (collies)

A

MDRI mutation- increased sensitivity to invermectins, acepromazine, butorphenol

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15
Q

Breeds with predisposition to Cardiomyopathies

A

Boxers, doberman pincher, giant breeds, maine coons

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16
Q

Cardiac/renal disease medications

A

Potentiate anesthesia related C/V depression

Angiotensin converting enzyme inhibitors, Beta or Ca channel blockers

17
Q

What drug should you avoid with angiotensin converting enzyme inhibitors?

A

Acepromazine

18
Q

What drug interacts with SSRIs Tricyclics and MAO inhibitors

A

Tramadol, some opiods

19
Q

What drug increases metabolism of other similar drugs?

A

Phenobarbital- increases P450 metabolism

20
Q

Why is it important to review anesthesia records?

A

To find any previous potentially drug related problems and avoid those drugs or try to alleviate

21
Q

Should a physical exam always be performed the day of the anesthetic procedure?

A

Yes- helps determine ASA physical status and if any changes have occurred

22
Q

Is the ASA risk assessment scale subjective or objective?

A

Somewhat subjective but based on set standards

23
Q

ASA category I

A

Normal healthy patient

Likely will not require any invasive monitoring, extra IV catheters, different/special drug protocols/contradindications

24
Q

ASA category II

A

Mild systemic disease but well compensated or uncomplicated injury

Likely will not require any invasive monitoring, extra IV catheters, different/special drug protocols/contradindications

25
Q

ASA category III

A

Moderate systemic disease requiring medical management but stable physiologically

Likely not be managed with the same protocol or dosages and management

26
Q

ASA category IV

A

Severe systemic disease that is a constant threat to life

Likely not be managed with the same protocol or dosages and management

27
Q

ASA category V

A

Moribund; not expected to survive with or without surgery

28
Q

ASA category E

A

Emergency

Patients usually otherwise classified as III, IV, or V

29
Q

Is pre-anesthetic bloodwork a good predictor of risk?

A

No, it rarely alters anesthetic protocols

30
Q

Fasting time

A

12hr fast, free access to water

May be longer for endoscopy or GI surgery

31
Q

What patients should receive supplemental glucose?

A

Neonates and pediatrics Up to 4-6hr prior

32
Q

Diabetic pre-anesthetic protocols

A

Adjustment of insulin dose (usually half) and early morning procedures

33
Q

Should exotics/pocket pets be fasted?

A

No

34
Q

Why should patients be fasted?

A

Reduce risk for vomiting/regurgitation- aspiration pneumonia

35
Q

Does fasting decrease incidence regurgitation or reflux?

A

NO- just reduces material

Anesthesiology (27 decks)

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