Flashcards in Age Considerations Deck (96)
Patients are considered pediatric up to what age?
After what are are organ systems nearly developed?
Neonates are dependent on what for cardiac output?
This is due to a minimal ability to increase what?
- Heart rate
Which nervous system is immature in a young animal?
Which fluid volume is increased in young animals?
Do young animals have slower or higher metabolic rate?
What might persist in young animals, especially foals?
Fetal circulation with a R to L shunt.
Do young animals have a high or low resting respiratory rate/minute ventilation?
What is this due to?
- Increased oxygen demand
What is different about pulmonary reserve in young animals?
Have minimal pulmonary reserve.
T/F: Young animals have a greater work of breathing.
T/F: PCV increases by 1/3 in first 28 days in small animals.
False - PCV DECREASES by 1/3 in first 28 days in small animals.
Blood loss can lead to what in young animals?
Significant decrease in oxygen delivery to tissues.
What type of drugs will have a greater activity in young animals?
- Highly protein-bound drugs
- Due to hypoalbuminemia
What type of enzymes can young animals be deficient in?
What effect does this have?
- Hepatic microsomal enzymes
- Prolonged drug effects
Is GFR increased or decreased in young animals?
What effect does this have?
- Decreased GFR
- Prolonged effect of drugs excreted in urine
Are kidneys more or less efficient in young animals?
What is a result of this?
- Kidneys less efficient
- Less tolerant of fluid overload
Do young animals generally have a low or high level of body fat?
What effect does this have?
- Low body fat
- Decreased mass for drug redistribution
Are young animals susceptible to hyperthermia or hypothermia?
T/F: Young animals have low metabolism and significant hepatic glycogen.
False - Young animals have HIGH metabolism and MINIMAL hepatic glycogen.
Are young animals susceptible to hypoglycemia?
Do young animals have lower or higher permeability of the BBB?
What is seen with this?
- More profound drug effects
What is important for any age patient?
Pain experienced as a neonate may cause what?
Altered pain processing/perception for life.
Are nursing animals fasted?
How long are young animals fasted?
What might be difficult or impossible to place in an emergency?
Anything given IV may also be given by what other route?
IO - Intraosseus
What are 2 types of sedatives that are not recommended with young animals?
- Alpha-2 agonists
What category of sedative provides good sedation in foals?
Is this the same for adult horses?
Which benzodiazepine is preferred in foals?
In young animals, benzodiazepines generally maintain what?
Respiratory and CV function
What category of drug is a good choice for young animals for analgesia and some sedation due to their minimal CV/respiratory effects?
Which opioid has a long DOA and is poorly reversible?
Why are anticholinergics often given with the premed in young animals?
Dependent on heart rate for cardiac output.
Can anticholinergics be given intra-op with young animals?
What should be aggressively treated if seen in young animals?
With local anesthetics in young animals, should the low end or high end of the dose range be used?
How are esters metabolized?
How are amides metabolized?
Are NSAIDs recommended in young animals?
- Due to immature hepatic and renal function.
What are 2 induction agents that can be used in young animals due to having rapid onset and recovery?
What are 2 side effects seen with propofol?
- Respiratory depression
What is a side effect seen with alfaxalone?
Can etomidate be used for induction with young animals?
Which induction agent has comparatively longer induction and recovery periods?
What is an alternative induction method for foals?
May be induced with iso/sevo via a nasotracheal tube.
What are 2 conditions to watch out for during the maintenance of anesthesia in young animals?
Do young animals tend to have a lower or higher BP under anesthesia?
What is an average BP in an awake 1 month old puppy?
- Lower BP
- 50 mmHg
Consider supplementing what in the fluids given to a young animals under anesthesia?
What are 2 considerations for supportive care for young animals under anesthesia?
- Active warming
- Careful fluid administration
T/F: Young animals have a lower daily fluid requirement but are more tolerant of fluid overload.
False - Young animals have a HIGHER daily fluid requirement but are LESS tolerant of fluid overload.
Animals that are older than 75% of their expected life spans are considered what?
Dogs are considered geriatric in what age range?
- Dogs: 7-10
- Cats: 10-12
- Horses: 18-20
What are geriatric animals dependent on for cardiac output?
Atrial kick and normal sinus rhythm
What is important for CV function in geriatric patients?
Neonatal refers to dogs/cats less than what age?
Foals/calves less than what age?
- Less than 6 weeks
- Less than 2 weeks
Why do geriatric animals have a limited ability to increase heart rate?
Beta receptors are LESS responsive
What do geriatric animals rely on to increase cardiac output?
Increased stroke volume
What are 3 cardiovascular functions that are usually decreased with geriatric patients?
- Arterial compliance
- Myocardial compliance
- Maximum heart rate and cardiac output
T/F: Geriatric animals may have valvular incompetence.
T/F: With geriatric animals, there is a decrease in function but not efficiency of the respiratory system.
False - There is an overall decrease in function and efficiency in the respiratory system.
What are 4 aspects of the respiratory system that are decreased in geriatric patients?
- Gas exchange
- Vital capacity
- Thoracic compliance
- Lung elasticity
Is there an increase or decrease in PaO2 in geriatric animals?
Decrease in PaO2
What respiratory function is increased with geriatric animals?
Increased work of breathing
Is liver mass increased or decreased with geriatric patients?
What affect does this have on drug clearance?
- Decreased liver mass
- Decreased drug clearance causes prolonged duration of action
Is kidney mass increased or decreased in geriatric animals?
- Decreased kidney mass
- Decreased functional nephrons
What are 3 kidney functions that are decreased in geriatric animals?
- Ability to concentrate urine
- Ability to correct volume or electrolyte derangements
Is MAC increased or decreased in geriatric animals?
T/F: Muscle mass in increased and fat is decreased in geriatric animals.
False - Muscle mass in DECREASED and fat is INCREASED.
The decreased plasma volume in geriatric animals lead to what?
Increased plasma drug concentration.
Due to their decreased metabolic rate, geriatric animals are less able to maintain what?
Their body temperature
If there is an arrhythmia auscultated in a geriatric animal, what should be run?
If there is a murmur auscultated in a geriatric animal, what should be considered?
The function of what 2 organs CBC/Chem/UA of a geriatric animal?
What 2 categories of sedatives can be used in healthy older patients with conservative dosing?
- Alpha-2 agonists
Which type of sedative often provides better sedation in geriatric animals compared to younger adults?
Which type of sedative generally maintains respiratory and CV function better: phenothiazines, alpha-2 agonists or benzodiazepines?
What might be needed for diagnostics or IVC placement in a geriatric cat?
Heavy IM sedation
What are 3 conditions that many geriatric cats have?
- Heart murmurs
- Renal disease
What is probably the most appropriate sedative for geriatric cats?
What are 2 sedatives to avoid if possible due to having significant CV side effects?
What are 2 reasons opioids are a good choice for analgesia and sedation in geriatric patients?
- Minimal CV/resp effects
Which opioid has a long duration of action and is poorly reversible?
Are anticholinergics recommended for routine pre-medication in geriatric animals?
What are 3 reasons anticholinergics may be used in geriatric patients?
- Procedures causing vagal stimulation (ophtho, GI)
What are 2 affects local anesthetics have in geriatric patients?
- Good analgesia
- Decreases MAC
The dose for what type of local anesthetic needs to be adjusted if hepatic dysfunction is present?
Can NSAIDs be used in healthy geriatric patients?
What is required for the use of NSAIDs in geriatric animals?
Normal liver and kidney function
What should be checked before administering NSAIDs to a geriatric patient?
- Urine specific gravity
- Ensure concentration ability
What are 2 good choices for induction of geriatric animals?
Can etomidate be used for induction of geriatric animaos?
What induction agent should be avoided in cats with chronic renal failure or with confirmed/suspected heart disease?
What 2 maintenance inhalants are used for geriatric patients?
What are 2 possible side effects?
- Sevoflurane and isoflurane
- Hypotension and hypoventilation
If renal disease is present, what should MAP be kept above in geriatric patients?
Above 70 mmHg