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Flashcards in Age Considerations Deck (96):
1

Patients are considered pediatric up to what age?

12 weeks

2

After what are are organ systems nearly developed?

12 weeks

3

Neonates are dependent on what for cardiac output?
This is due to a minimal ability to increase what?

- Heart rate
- Contractility

4

Which nervous system is immature in a young animal?

Sympathetic

5

Which fluid volume is increased in young animals?

ECF

6

Do young animals have slower or higher metabolic rate?

Higher

7

What might persist in young animals, especially foals?

Fetal circulation with a R to L shunt.

8

Do young animals have a high or low resting respiratory rate/minute ventilation?
What is this due to?

- High
- Increased oxygen demand

9

What is different about pulmonary reserve in young animals?

Have minimal pulmonary reserve.

10

T/F: Young animals have a greater work of breathing.

True

11

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.

12

Blood loss can lead to what in young animals?

Significant decrease in oxygen delivery to tissues.

13

What type of drugs will have a greater activity in young animals?
Why?

- Highly protein-bound drugs
- Due to hypoalbuminemia

14

What type of enzymes can young animals be deficient in?
What effect does this have?

- Hepatic microsomal enzymes
- Prolonged drug effects

15

Is GFR increased or decreased in young animals?
What effect does this have?

- Decreased GFR
- Prolonged effect of drugs excreted in urine

16

Are kidneys more or less efficient in young animals?
What is a result of this?

- Kidneys less efficient
- Less tolerant of fluid overload

17

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

18

Are young animals susceptible to hyperthermia or hypothermia?

Hypothermia

19

T/F: Young animals have low metabolism and significant hepatic glycogen.

False - Young animals have HIGH metabolism and MINIMAL hepatic glycogen.

20

Are young animals susceptible to hypoglycemia?

Yes

21

Do young animals have lower or higher permeability of the BBB?
What is seen with this?

- Higher
- More profound drug effects

22

What is important for any age patient?

Appropriate analgesia

23

Pain experienced as a neonate may cause what?

Altered pain processing/perception for life.

24

Are nursing animals fasted?

No

25

How long are young animals fasted?

3-4 hours

26

What might be difficult or impossible to place in an emergency?

IV catheter

27

Anything given IV may also be given by what other route?

IO - Intraosseus

28

What are 2 types of sedatives that are not recommended with young animals?

- Phenothiazines
- Alpha-2 agonists

29

What category of sedative provides good sedation in foals?
Is this the same for adult horses?

- Benzodiazepines
- No

30

Which benzodiazepine is preferred in foals?

Midazolam

31

In young animals, benzodiazepines generally maintain what?

Respiratory and CV function

32

What category of drug is a good choice for young animals for analgesia and some sedation due to their minimal CV/respiratory effects?

Opioids

33

Which opioid has a long DOA and is poorly reversible?

Buprenorphine

34

Why are anticholinergics often given with the premed in young animals?

Dependent on heart rate for cardiac output.

35

Can anticholinergics be given intra-op with young animals?

Yes

36

What should be aggressively treated if seen in young animals?

Bradycardia

37

With local anesthetics in young animals, should the low end or high end of the dose range be used?

Low end

38

How are esters metabolized?

Plasma esterases

39

How are amides metabolized?

Hepatic metabolism

40

Are NSAIDs recommended in young animals?
Why?

- No
- Due to immature hepatic and renal function.

41

What are 2 induction agents that can be used in young animals due to having rapid onset and recovery?

- Propofol
- Alfaxalone

42

What are 2 side effects seen with propofol?

- Hypotension
- Respiratory depression

43

What is a side effect seen with alfaxalone?

Respiratory depression

44

Can etomidate be used for induction with young animals?

Yes

45

Which induction agent has comparatively longer induction and recovery periods?

Ketamine

46

What is an alternative induction method for foals?

May be induced with iso/sevo via a nasotracheal tube.

47

What are 2 conditions to watch out for during the maintenance of anesthesia in young animals?

- Hypotension
- Hypoventilation

48

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

49

Consider supplementing what in the fluids given to a young animals under anesthesia?

Dextrose

50

What are 2 considerations for supportive care for young animals under anesthesia?

- Active warming
- Careful fluid administration

51

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.

52

Animals that are older than 75% of their expected life spans are considered what?

Geriatric

53

Dogs are considered geriatric in what age range?
Cats?
Horses?

- Dogs: 7-10
- Cats: 10-12
- Horses: 18-20

54

What are geriatric animals dependent on for cardiac output?

Atrial kick and normal sinus rhythm

55

What is important for CV function in geriatric patients?

Adequate preload

56

Neonatal refers to dogs/cats less than what age?
Foals/calves less than what age?

- Less than 6 weeks
- Less than 2 weeks

57

Why do geriatric animals have a limited ability to increase heart rate?

Beta receptors are LESS responsive

58

What do geriatric animals rely on to increase cardiac output?

Increased stroke volume

59

What are 3 cardiovascular functions that are usually decreased with geriatric patients?

- Arterial compliance
- Myocardial compliance
- Maximum heart rate and cardiac output

60

T/F: Geriatric animals may have valvular incompetence.

True

61

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.

62

What are 4 aspects of the respiratory system that are decreased in geriatric patients?

- Gas exchange
- Vital capacity
- Thoracic compliance
- Lung elasticity

63

Is there an increase or decrease in PaO2 in geriatric animals?

Decrease in PaO2

64

What respiratory function is increased with geriatric animals?

Increased work of breathing

65

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

66

Is kidney mass increased or decreased in geriatric animals?
Functional nephrons?

- Decreased kidney mass
- Decreased functional nephrons

67

What are 3 kidney functions that are decreased in geriatric animals?

- GFR
- Ability to concentrate urine
- Ability to correct volume or electrolyte derangements

68

Is MAC increased or decreased in geriatric animals?

Decreased

69

T/F: Muscle mass in increased and fat is decreased in geriatric animals.

False - Muscle mass in DECREASED and fat is INCREASED.

70

The decreased plasma volume in geriatric animals lead to what?

Increased plasma drug concentration.

71

Due to their decreased metabolic rate, geriatric animals are less able to maintain what?

Their body temperature

72

If there is an arrhythmia auscultated in a geriatric animal, what should be run?

ECG

73

If there is a murmur auscultated in a geriatric animal, what should be considered?

Echocardiogram

74

The function of what 2 organs CBC/Chem/UA of a geriatric animal?

- Liver
- Kidneys

75

What 2 categories of sedatives can be used in healthy older patients with conservative dosing?

- Phenothiazines
- Alpha-2 agonists

76

Which type of sedative often provides better sedation in geriatric animals compared to younger adults?

Benzodiazepines

77

Which type of sedative generally maintains respiratory and CV function better: phenothiazines, alpha-2 agonists or benzodiazepines?

Benzodiazepines

78

What might be needed for diagnostics or IVC placement in a geriatric cat?

Heavy IM sedation

79

What are 3 conditions that many geriatric cats have?

- Heart murmurs
- Hyperthyroidism
- Renal disease

80

What is probably the most appropriate sedative for geriatric cats?

Alfaxalone

81

What are 2 sedatives to avoid if possible due to having significant CV side effects?

- Dexdomitor
- Ketamine

82

What are 2 reasons opioids are a good choice for analgesia and sedation in geriatric patients?

- Minimal CV/resp effects
- Reversible

83

Which opioid has a long duration of action and is poorly reversible?

Buprenorphine

84

Are anticholinergics recommended for routine pre-medication in geriatric animals?

No

85

What are 3 reasons anticholinergics may be used in geriatric patients?

- Brachycephalics
- Procedures causing vagal stimulation (ophtho, GI)
- Bradycardia

86

What are 2 affects local anesthetics have in geriatric patients?

- Good analgesia
- Decreases MAC

87

The dose for what type of local anesthetic needs to be adjusted if hepatic dysfunction is present?

Amides

88

Can NSAIDs be used in healthy geriatric patients?

Yes

89

What is required for the use of NSAIDs in geriatric animals?

Normal liver and kidney function

90

What should be checked before administering NSAIDs to a geriatric patient?
Why?

- Urine specific gravity
- Ensure concentration ability

91

What are 2 good choices for induction of geriatric animals?

- Propofol
- Alfaxalone

92

Can etomidate be used for induction of geriatric animaos?

Yes

93

What induction agent should be avoided in cats with chronic renal failure or with confirmed/suspected heart disease?

Ketamine

94

What 2 maintenance inhalants are used for geriatric patients?
What are 2 possible side effects?

- Sevoflurane and isoflurane
- Hypotension and hypoventilation

95

If renal disease is present, what should MAP be kept above in geriatric patients?

Above 70 mmHg

96

Careful attention should be paid to what 2 things in geriatric patients?

- Body temperature
- Fluid balance