8. Monitoring Anesthesia Flashcards Preview

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Flashcards in 8. Monitoring Anesthesia Deck (33):
1

The big 5s

ECG, pulsox, capnograph, BP, temperature

2

main causes of complications of anesthetic death

respiratory and CV
50% in post-op period

3

which palpebral do you loose first?

lateral

4

Guedel's classification

clinical assessment of CNS, eyes mostly, old school

5

BIS bispectral index

0-100 100 = awake
indicates level of consciousness
results controversial in dogs, used in humans

6

why monitor BP?

indicates tissue perfusion

7

hypotension

MAP <65mmHg
range of pressure where range of perfusion to organ is preserved, below 65 autoregulation is not preserved and adequate perfusion will not happen

8

measuring BP

Indirect v. Direct
*pulse does not indicate BP its just difference between systolic and diastolic

9

Oscillometic method

indirect, cuff inflates above systolic and deflates in stepwise fashion, when the P = systolic the vessell starts vibrating, when vibrating the most thats the MAP.

10

cuff width

40-60% circumference of extremity, between ELBOW AND CARPUS is best!

11

inaccurate BP because?

wrong size cuff!! (too big cuff -> lower BP, vice versa) And put cuff at level of the heart

12

Doppler method

emits US, signal becomes sound indicating blood flow. First audible sound = systolic AP.
- does NOT give diastolic or mean!!!!!!!
***sortof inaccurate, portela doesn't like it.

13

Direct monitoring

gold standard. ***continuous monitoring****

14

which artery for direct BP?

dorsopedal artery (dorsal metatarsal) most often
(lingual, radial/carpal, coccygeal, femoral, auricular)
*Flush regularly to avoid clotting

15

inaccuracies of direct bp monitoring?

1. overdamping - air bubble, systolic lower than real
2. underdamping - systolic higher than real number

16

Fluid responsiveness

increase in volume causes inc. left ventricle, inc. preload, inc. stroke volume.
- doesn't work if in FLUID OVERLOAD

17

Pulse pressure variation must be ____ for patient to be responsive to fluids

above 15%

18

what measures Tidal volume

wright respirometer

19

What is capnography

indirectly measures ventilation, espimates PaCO2
- differences between PaCO2 and end tidal CO2 due to dead space ventilation
- can indicate, problem in circuit, obstruction, cardiogenic shock

20

What happens when hypoventilating?

- if hypoventilating, theyre moving mostly deadspace, end tidal CO2 would be low
- if ET CO2 is low, give a big breath and see if it goes up (if it doesn't they may be hyperventilating)

21

two types of capnography monitoring

1. side stream:
- monitor is away from patient, sampling continuously, delayed response every time it aspirates
- in small animals doesn't work
- sample is contaminated in nonrebreathing system
2. main stream:
- monitor in connector, in real time, more accurate, big awkward thing connected to tube

22

low ET CO2 indicates?
high ET CO2 indicates?

hyperventilation/deadspace
hypoventilation

23

Ventilating Deadspace indicates what on capnography??

Low end tidal CO2
** Know this, he kept saying it**
Check by giving big breath!!

24

Cardiac oscillations

normal, heart pushing on lung parynchyma

25

/| alpha angle increased?

obstruction! kink in ET, bronchoconstriction

26

|\ shark fin? (swimming towards you)

Leak, or washing out with high flow O2

27

inspiration doesn't go down to 0 on capnograph?
(increased baseline)

rebreathing CO2
exhausted exorbant, or unidirectional valves not working.

28

gradual decrease in ET CO2

sudden bp drop, or CO drop, cardiac arrest, PTE

29

Sudden disappearance of capnograph waveform?

apnea, disconnection

30

90 Hb saturation indicates ____ PaO2

60 mmHg

31

uses absorbance of infared light for O2 saturation?
- affected by?

pulsox
- ambient light, motion, skin pigment

32

vasoconstriction during anesthesia affects temperature mostly during the _______. Loose heat via skin

first hour.
Preheat if you predict your animal will get hypothermic
(skinny, small dogs)

33

hypothermia causes

marked CNS depression, little or no anesthetic req, unresponsive bradycardia