ECP 4

Question 1

What are the 6 main special physiological considerations for equine anaesthesia

Answer 1

1) large muscle mass
2) myopathy on recovery
3) Hyperkalemic periodic paralysis
4) Respiratory concerns
5) additional respiratory concerns
6) effect of GI tract in dorsal recumbency

Question 2

In terms of large muscle mass for horses how does this affect equine anaesthesia and the two main forms of issues

Answer 2

- Risk for neuropathy
○ Must provide adequate padding
○ Special attention to surface nerves (i.e. Facial)
1) Facial nerve paralysis 
2) radial nerve paralysis

Question 3

Facial nerve paralysis in equine anaesthesia what due to, how to avoid and does it resolve

Answer 3

○ Often due to pressure on nerve from halter in lateral recumbency
§ Remove halter for procedure
§ Avoid halters with metal buckles on dependent side during recovery
□ Place a towel or pad between the buckle and the face if unavoidable
○ Can resolve spontaneously over a few days but not always
§ Affect ability to eat and drink

Question 4

Radial nerve paralysis in equine anaesthesia what due to, how to avoid and does it resolve

Answer 4

○ Can be caused by prolonged lateral recumbency
§ Pull dependent limb forward -> unstacks the shoulders so brings body weight of the radial nerve
May resolve spontaneously over several days

Question 5

Myopathy on recovery in equine anaesthesia why occurs, how to prevent and the worse result

Answer 5

• Due to poor perfusion intraoperatively
  ○ Blood flow to both dependent & “up” limbs decreased @ 1.5 x MAC Isoflurane (AJVR 1987)
  § Other drugs can affect this too!
  ○ Maintain MAP = 70 mmHg (80 mmHg for heavily muscled breeds) - need to perfuse the butt of the horse
• Can develop rhabdomyolysis (muscle death)
  ○ Supportive care + treatment for potential myoglobinuric renal failure - can be death sentence or reduced function

Question 6

Hyperkalemic Periodic Paralysis for equine anaesthesia what is it, caused by, how to prevent

Answer 6

○ genetic disorder of Quarter Horses
- Stress of sedation & anaesthesia can cause attack
- Quarter Horses: test for presence of gene in America and possibly do in Australia
○ Pre-treat both hetero- & homozygotes w/ acetazolamide (promote insulin production drive Na back into cells) prior to anaesthesia
- Careful intraoperative monitoring for signs of high K+ - for all standard breeds that haven’t tested
○ BRADYCARDIA first clinical sign

Question 7

What is an important respiratory concern with equine anaesthesia, why does this occur

Answer 7

• At risk of development of hypoxemia & hypercapnia w/out ventilatory support
  General anaesthesia leads to V/Q mismatch in the horse!! (↑ shunt fraction)
  Due to:
• Horses preferentially perfuse dorsocaudal lung fields
• Positioning changes ventilatory patterns
  ○ Lateral recumbency causes atelectasis of dependent lungs = decreased ventilation

Question 8

What are the 2 other important respiratory concerns of equine anaesthesia why occur and how to prevent

Answer 8

1) Hypoventilation
§ Positional, weight of chest wall, muscle weakness from drugs, GI tract impeding diaphragmatic movement (fall onto diaphragm)
§ Assisted ventilation should be provided for procedures longer than 45-60 mins
2) Obligate nasal breathers
§ Nasal edema can occur (esp. in dorsal)
□ Consider nasotracheal tube &/or phenylephrine for recovery
§ Confirm nasal air flow after extubation

Question 9

Effect of GI tract in dorsal recumbency in equine anaesthesia what occurs and what can lead to

Answer 9

○ Stomach/intestines rarely fully emptied
○ Weight of on abdominal vena cava ↓ venous return & cardiac output
§ May see tachycardia to compensate
○ Will push on diaphragm → ↓ diaphragmatic excursion → Hypoventilation

Question 10

What are the 3 main special pharmacologic considerations with equine anaesthesia

Answer 10

1. Anticholinergics:
   Decrease GI motility = Ileus = Risk of Colic
2. Opioids:
   ○ Can cause excitement when given alone - not given alone
   ○ All opioids decrease equine GI motility!! - not first line of defence for pain
   § Butorphanol “theoretically” less so than pure mu’s - only lasts for an hour -> redosing issue
3. Alpha-2 Agonists: - use in sick horses
   ○ Provide visceral analgesia - significant pain relief
   § Better than opioids or NSAIDs
   ○ Xylazine = significant contributor to colic therapy
   ○ Other systemic effects (↓CO, etc.) as in other species

Question 11

What are the 2 main venous access in an adult horse, what needle and what used for

Answer 11

1) Jugular vein 
○ 18-20 gauge needle for injections - can tell the difference between carotid (high blood flow) and jugular (trickle) 
○ Most common vein accessed in horse
○ Carotid artery just dorsal to vein!
2) Cephalic Vein
○ Good for short term catheters
○ Some horses do not tolerate
○ Impractical for injections or blood draws
3) Others
○ Femoral, Lateral Thoracic

Question 12

What are the 4 main important equine patient preparation for anaesthesia

Answer 12

1. Physical Exam
   - Include respiratory & cardiac auscultation
   - TPR, MM colour & CRT
2. Bloodwork
   - PCV, TS (+/- Creatinine) every time
   - Others as needed dictated by patient/procedure
3. Clean/Pick feet + wrap
   - Remove shoes if possible
4. Wash out mouth!

Question 13

What are 2 main equipment needed for equine anaesthesia

Answer 13

1) Mouth gag
○ Typically PCV or metal dental gag - to stop the horse from chewing the tube (high jaw tone) 
2) Choosing an Endotracheal Tube
○ 26-30 mm ID
○ 20 mL cuff syringe
Test cuff!

Question 14

What is the goal of equine premedication, what combination of medications generally used

Answer 14

• Goal is moderate sedation
  ○ Usually an alpha-2 agonist +/- opioid
  ○ +/- acepromazine - not enough for pre-medication by itself BUT study suggest that will reduce risk of dying
  § Needs 30mins to work -> not used in emergency situation
  § Stallion -> risk of priapism -> consider positives and negatives

Question 15

What are the 4 main clinical signs of sedation in the horse

Answer 15

○ Dropped head
○ Droopy lower lip
○ Relaxed ears
○ Relaxed posture

Question 16

Equine anaesthesia induction what is the goal, most common combination of medication, what is important to consider and the 2 types

Answer 16

• Goal is controlled “fall” to recumbency
  ○ Diazepam/Ketamine (most common), Thiopental, Guaifenesin/Ketamine, Xylazine/Ketamine, Zolitel
• Safety of personnel is priority!
  Make sure everyone in area knows that horse has drugs “on board”
  1) Field induction
  2) Stall induction

Question 17

Stall induction for equine anaesthesia what are the 2 main types

Answer 17

1) Assisted induction
○ Horse against wall with personnel holding to wall - eases them down
- Safer to use “swing gate” to hold horse against wall if possible
2) Pneumatic Lift Table
○ Horse must be sedated prior to “strapping” to table

Question 18

Intubation of horses what are the 2 types how to intubate and when don’t you need to

Answer 18

1) Endotracheal intubation is “blind”
○ Place mouth gag between incisors
○ Slide tube through gag and slowly advance into trachea (feel like butter, oesophagus more tissue)
○ Confirm tracheal placement
§ EtCO2 ** - see carbon dioxide movement
§ “Feeling” air
§ Palpating neck
2) Nasotracheal intubation sometimes performed
○ Typically 20-22 mm ID
○ Technically more difficult
- Field Anaesthesia – horse may not be intubated

Question 19

Equine Anaesthesia maintenance what used for different length procedures

Answer 19

1) Balanced crystalloids @ 10 mL/kg/hr
2) TIVA Triple Drip - = 45 mins to 1 hr as need ventilation support for larger procedure
3) Maintain on inhalants - > 1 hr
○ Iso MAC – 1.3-1.4%
○ Sevo MAC – 2.3-2.8%

Question 20

Blood pressure monitoring during equine anaesthesia what are the 2 types and goal in terms of level

Answer 20

• Goal of MAP >/= 70 mmHg
  ○ 80 mmHg in heavily muscled breeds/drafts
  1) Can use non-invasive
  ○ Doppler
  ○ Oscillometric
  2) Invasive (arterial) is gold standard - common for surgery
  ○ Facial, Mandibular, Transverse Facial, Lateral Metatarsal aa.

Question 21

What are some options for intraoperative analgesia for equine anaesthesia

Answer 21

○ Intermittent opioid boluses
○ Local and regional anaesthetics
○ Intra-articular morphine
○ CRI’s
	§ Lidocaine
	§ Alpha-2 agonists
	§ Butorphanol?
	§ Ketamine

Question 22

Recovery from equine anaesthesia what are important considerations

Answer 22

• Place in lateral recumbency in quiet, dim stall
• Provide supplemental oxygen
• Extubate when breathing spontaneously and well
  ○ No need to wait for swallowing - no risk of regurgitation
• Can be very eventful/rough
  ○ Consider assisted recovery
  • Hand - not recommended for adults
  • Rope - assistance
  • Sling - to help protect limbs
  • Pool
• Consider light sedation while inhalant wears off

Question 23

Foal anaesthesia what to do with mare

Answer 23

○ Let her accompany the foal for as long as possible
○ She may need sedation
○ Let her see the foal as soon as possible afterwards - make sure can stand properly

Question 24

Foal anaesthesia what are 4 main considerations in terms of physiological differences

Answer 24

1) Immature Liver
○ May not maintain normoglycemia
○ Altered/slow drug metabolism
2) Immature thermogenesis
○ May need external heating support
3) More compliant chest and high RR
4) Immature SNS

Question 25

Foal anaesthesia premedication examples

Answer 25

- Benzodiazepine (sedative in foals) + Butorphanol – great sedation/premedication for very young &/or sick foal - Alpha 2 Agonist for older/robust foals

Question 26

Foal anaesthesia induction protocols

Answer 26

- Facemask or NT tube Inhalant in oxygen ○ But CEPEF showed that injectable reduced mortality - Propofol or Alfaxan (+/- muscle relaxant) - Ket/Val (ketamine/diazepam) - in older animals - KetoFol! -> ketamine and Propofol Typical endotracheal tube sizes 8-16 mm ID - special foal ones

Question 27

Foal anaesthesia what maintain on, monitoring and recovery

Answer 27

Maintain on Inhalants or TIVA Monitoring important as with adults - Direct ABP may be technically more difficult - May need external heat support - Should check perioperative blood glucose Recovery usually assisted by hand (1-2 people depending on size/age)

Question 28

Heat requirements for reptiles what are the two main types and the important instruments for this

Answer 28

Poikilothermic - PBT: preferred body temperature varies for every body function - POTZ: preferred optimal temperature zone varies between taxa/species ○ Tank need to provide this!!!! - Heat source preferences vary between taxa Thermostats vs thermometers

Question 29

What are the 3 different light requirements for reptiles and what reptiles need what

Answer 29

○ UVA,B and C - A = activity, B = bone, C = cancer ○ UVA debate ○ UVB essential for chelonians, lizards other than geckos, crocodiles § Most snakes don't need it

Question 30

Ultraviolet light for reptiles what are important considerations

Answer 30

- 30cm or less from basking area -> larger animal needs longer length globe - Change globe every 6 months - Full spectrum is visible UVA spectrum only - Fluorescent, mercury vapor, compact UVB - Blocked by glass and plastic

Question 31

Humidity for reptiles what does it affect how to get high and low humidity and how do some reptiles access water

Answer 31

- Enclosure humidity affects hydration, hygiene, health of sin, lungs and gut and behaviours ○ Low humidity: small water bowl at cool end, rare bathing and misting, dry substrates, excellent drainage ○ High humidity: large shallow water source near heat, foliage, frequent misting, bathing allowed § Good ventilation essential for both - Some reptiles drink from containers, other from foliage or misting - Too much access to water can be as unhealthy as too little from some taxa

Question 32

Space requirements for reptiles what are 3 important considerations

Answer 32

1) Enough space to stretch out, climb or swim and to behave normally ○ Spread out from one corner to the other diagonally 2) Enable retreat from companions ○ Give multiple hides, basking spots etc. 3) Designed to provide an appropriate temperature mosaic

Question 33

What are some important considerations with substrates and furnishings

Answer 33

Substrates - Consider hygiene, thermal properties, absorbency, abrasiveness - Turf, newspaper, commercial litters, stones, slate tiles (can hold heat), bark, sand Furnishings - Logs, rocks, tiles, plants, artificial works - Hides, burrows, screening

Question 34

What are 4 important things that cause stress in reptiles in terms of the envionment

Answer 34

- Handling reptiles usually takes them out of their POTZ - Socialising with mammalian carnivores is usually stressful - Being under constant surveillance by us or other pets is very stressful - Vibrations through their tanks also cause stress

Question 35

What are general diets for snakes, chelonians, lizards and crocodiles and what is important to consider with diets

Answer 35

- Snakes: whole prey, never live prey - Chelonians: tortoises are terrestrial and herbivores, turtles are aquatic, fresh water turtles eat invertebrates with varying proportions of plants - Lizards: very wide range of dietary niche - Crocodiles: carnivores The quality of the diet is only as good as the quality of raising of the prey items

Question 36

what are important aspects of hygiene in an aquatic tank and vivarium

Answer 36

``` Aquatic - Water quality monitoring ○ Nitrogen cycle, water hardness, Ph - Filtration ○ In tank vs external, under gravel - Partial water changes Vivarium - Daily spot cleaning, 3-6 monthly scrub F10 - Mite prevention and treatment ```

Question 37

What are the 3 important tank set up considerations when asking a client

Answer 37

- Poikilotherms with individual POTZs ○ Heat source management, basking opportunities, insulation, ventilation - Light (visible and UVB) ○ UVB globe type, position, age of globe ○ Day length - Humidity Water source, misting, furnishings, ventilation

Question 38

Rabbit physiological characteristics what makes them different

Answer 38

- Small lung volume - Obligate nasal breathers - Narrow gape in a crowded mouth - Cannot regurgitate and must eat very often ○ Caecal fermenters -> gut status - DON'T FAST RABBITS - Prey animal mask their fear and pain

Question 39

Rabbit patient examination what are 5 important parts

Answer 39

- Patency of nasal passages - Hydration - Gut fill and faecal consistency - IV catheterisation marginal ear vein - DO NOT FAST patient at all

Question 40

Rabbit anaesthesia what is involved withe premedication, induction and maintenance

Answer 40

Premedication ○ Opioid and sedation ○ Oxygenation before give drugs - IMPORTANT ○ Quiet, calm, be gentle but restrain well, turn light of to work Induction ○ IV or IM Maintenance ○ Gaseous per tube (intubate) or mask (harder to ventilate, but positive pressure ventilation on the nose) ○ Circuit for patients less than 10Kg/5Kg

Question 41

What are the 7 steps in incubating a rabbit

Answer 41

1. Sternal recumbency, neck extended, head parallel to bench 2. Otoscope with largest possible cone 3. Hold tongue gently, pass scope in to view pharynx 4. Use tube to dislodge epiglottis from soft palate 5. Spray larynx once with local anaesthetic 6. Insert tube down through cone 7. Check (condensations not tube, air flow from tube, capnography)

Question 42

Rabbit anaesthesia monitoring what is important

Answer 42

- Use your eyes, hands and stethoscope - Pulse oximetry ○ Ear - Oscillometric blood pressure cuffs - Temperature - Reversal and supportive medications ○ Glucopyrrolate/atropine for HR and BP ○ Ephedrine/dopamine for BP

Question 43

Rabbit anaglesia and post op care what is important

Answer 43

``` - Additional analgesia for surgery ○ Local anaesthesia § Lignocaine <4mg/kg § Bupivicaine <2mg/kg - Post op ○ Meloxicam 0.5-1mg/kg s/c then orally q24hr ○ Buprenorphine orally q6-8hrly ○ heat ○ Feeding, feeding, feeding ```

Question 44

Guinea pigs design features and how works with pre-anaesthetic examination and preparation

Answer 44

``` Design features and patient preparation - Nasal breathers, palatal ostium - Can't regurgitate but have cheek pouches ○ High risk for aspiration - High risk gut stasis as per rabbits - Very thick skin compared to rabbits Pre anaesthetic examination - GIT and respiratory focus Patient preparation - Flush cheek pouches ```

Question 45

Guinea pigs anaesthesia and post op care compared to rabbits

Answer 45

- Sedation, analgesia and induction ○ Induction very similar to rabbits but higher dose rates ○ Intubation only possible with rigid scope so mostly use mask Post op care - Analgesia - Assisted feeding - Heat

Question 46

Ferrets what are important physiological characteristics for anaesthesia

Answer 46

- Fast inside and out - 4-6 hours before surgery - Carnivores, strong smell so don't house them with the rabbit, rodents and birds - Strong jaw tone that is slow to decrease under GA - Wide gape good for intubation - Rapid gut transit time so short fasting - They can regurgitate

Question 47

Ferrets what is important with pre-anaesthetic examination and patient preparation

Answer 47

Pre-anaesthetic examination as per cats and dogs - Be alert for endocrine disease signs ○ Symmetrical alopecia ○ Pale mucosae ○ Enlarged vulva Patient preparation - Fast adults for no more than 4 hours and pre-weaned kits for 1 hour only - Measure haematocrit and blood glucose - Post op feed as soon as awake and mobile

Question 48

Ferrets anaesthesia what involved with premedication, induction, maintenance, monitoring, analgesia and post-op care

Answer 48

Premedication– Acepromazine (long acting), butorphanol, Medetomidine with butorphanol Induction – Alfaxan IV Maintenance – Isoflurane per mask Monitoring – as other species Analgesia – Meloxicam/carprofen/buprenorphine Post-op care – as other species

Question 49

Parrot special features important for anaesthesia

Answer 49

- Fleshy tongue obscures glottis - Small trachea (complete rings) and bifurcation at syrinx - Extremely efficient and rapid gas exchange - Air sacs (compress easily so don't squeeze) - Lose heat easily Cages birds often very unfit with poor diet

Question 50

What are important parts of the pre-anaesthetic examination and patient preparation for parrots

Answer 50

- Observe without handling first - Handling precautions - Measurements ○ Haematocrit, blood protein, weigh, HR (over 6 seconds) - Crop palpation (should be empty) Budgie -> fast for 1 hour Patient preparation - Fast large parrots 2-4 hours - Fast small parrots 1 hour - Draw up all medications

Question 51

Anaesthesia for parrots - premed, anaglesia, induction and maintenance

Answer 51

``` Premedication ○ Premed § Midazolam IM - anxiolytic ○ Analgesia § Butorphanol CONTINUE Induction and maintenance ○ Isofluorane per bespoke mask ○ Intubation ○ Ayre's T-piece or Bain's coaxial circuits ○ IPPV often needed as hypercapnea and breath holding common § 30-40 breaths per minute § Ventilator peak inspiratory pressure <5cm H20 ```

Question 52

Parrot anaesthetics support and post-op care

Answer 52

``` - Patient care ○ Heat ○ Fluids (always warmed) - Post op care ○ Extubate at last possible moment, check for clear airway ○ Oxygen flow-by until fully conscious ○ Feed as soon as co-ordinated again ○ Pain relief ```

Question 53

Reptile general features that are important for anaesthetics

Answer 53

- Thermoregulation ○ Temp affects metabolism of drugs ○ Preferred body temperature is species specific - Anatomical and physiological features ○ Heart - physiological division of blood flow in ventricle § Can divert away from lungs if not breathing ○ Lungs - sac like and extend further caudal than in mammals ○ Kidneys - renal portal system

Question 54

Reptile what is involved with pre-anaesthetic examination and patient preparation

Answer 54

``` General pre-anaesthetic examination - Weigh - Assess muscle condition - Measure respiratory rate and note effort or noise - Measure heart rate (doppler probe) Patient preparation - Fast for 24-72 hours ○ Snake at least 72 hours - Warm to preferred body temp ```

Question 55

Reptiles what use for anaglesia

Answer 55

- Not easy to determine how effective the pain relief is - Morphine/Methadone commonly used Use local blocks during anaesthesia whenever possible - butorphanol - anaglesia in reptiles

Question 56

Reptiles what use in for premed, induction and maintenance

Answer 56

Premedication ○ Opioids alone - morphine ○ Or add ketamine +/- alpha 2 Induction ○ Injectable agents IV (into caudal vein) § Propofol/Alfaxan ○ Isoflurane via ET tube and IPPV (inter positive pressure ventilation Maintenance ○ IPPV manually 2-4 breaths per minute or with ventilator (pressure <10cmH20) ○ Non-rebreathing circuits

Question 57

What are important aspects of monitoring, support and recovery for reptile anaesthesia

Answer 57

- Doppler over heart, capnography, (assess changes rather than absolute values) - Cloacal or oesphageal temperature - Heat pads/lamps/warm fluid bags - Fluid support - Recovery on room air IPPV at continue

Question 58

Australian mammal anesthesia handling, premed, anaglesia, induction and maintenance examples

Answer 58

- Handle possums inside pillow slip or towel - Hold koala firmly against pillow or towel roll - IM sedation with diazepam - Buprenorphine IM - pain relief - Alfaxan IM - Pre oxygenate if available - Isofluorane per mask or alfaxan IV via cephalic

Question 59

What is the normal respiratory rate and heart rate for horses as well as temperature

Answer 59

normal resting respiratory rate is 8-16 breaths per minute Normal resting heart rate of a horse is 28-40 beats/min Normal resting adult range is 37 - 38.4 degree Celsius

Question 60

What are 4 important questions to ask in terms of ECG

Answer 60

1. HR and rhythm? ○ Tachycardia, bradycardia 2. Are the QRS complexes normal ? ○ If normal - good ventricular rhythm 3. Is there a P wave in front of every QRS complex ? ○ If ventricular issues ○ Activity of the sinus nerve 4. Is there a QRS complex after every P wave ? ○ Do I have a AV block - if P waves not always related to QRS complex

Question 61

What are the 3 main waves of the ECG trace and what do they represent

Answer 61

1. P wave depolarisation of atria 2. QRS complex ventricular depolarisation - Q and S are negative as vectors facing towards atrium 3. T wave ventricular repolarisation

Question 62

Endotracheal tube cuff inflation what does it provide, what can overinflation cause and how to check for leaks

Answer 62

- Allows sealing of the airway to prevent aspiration and to provide positive-pressure ventilation without air leaking - Over inflation of the cuff can cause necrosis and stenosis of the tracheal mucosa. Turn off O2 and pop off valve, and listen for a leak at the same time than someone else is giving a breath to your patient. - If a leak is present, inject air into the cuff while listening and until the leak has disappeared.

Question 63

How to use a laryngoscope

Answer 63

- Don't put your hand in the mouth, use laryngoscope to guide tongue to the side for assistant to grab - Place laryngoscope rostral to the epiglottis and move tube into the lumen of the glottis - Check that there is humid air moving in and out of the tube

Question 64

What are 4 indications for mechanical ventilation and what are 2 risks associated

Answer 64

- General anaesthesia -> don't have to do for all animals - Oxygenation failure: Low PaO2 even with O2 therapy - Ventilation failure: High CO2 - Post cardio-pulmonary resuscitation Risk: - Oxygen toxicity (decreases pulmonary function, pulmonary oedema, species-specific) ○ More common in humans than animals - only really occurs after 24 hours of 100% oxygen - Barotrauma, cardiovascular depression, infection

Question 65

What is the anaesthesia machine made up of (2 parts) and what occurs

Answer 65

Anaesthesia machine + re-breathing system - O2 flow meter -> vaporizer -> breathing system Re-breathing system - Blue -> rich in O2 - Red -> rich in CO2 back into rebreathing bag ○ Into soda lime removing CO2 and move back into the patient Ventilator is generally placed where the rebreathing bag is on the system

Question 66

What are the 2 main modes of mechanical ventilation and what control respiratory rate etc.

Answer 66

1) CMV: controlled mandatory ventilation ○ No consideration of patient breathing effort -> you dictate the respiratory rate ○ Control volume or pressure, and respiratory rate 2) PEEP: Positive end expiratory pressure ○ Patient mechanically ventilated § Everything controlled with the ventilator

Question 67

What are the parameters that influence oxygen delivery and cardiac output

Answer 67

1) Oxygen delivery -> DO2 = CaO2 X CO Ca O2 = arterial oxygen content = amount of haemoglobin and saturation of haemoglobin 2) CO = cardiac output = SV x HR SV -> high preload, high contractility and low afterload

Question 68

How to monitor HR and arterial blood pressure

Answer 68

1) HR from ECG, Pulse oximeter, stethoscope 2) BP - two ways 1. Non-invasive blood pressure: for routine cases is related to heart rate § Such as a cuff § IF choose a curve that is too small -> artificially reading of too high and vice versa □ However can 2. Invasive blood pressure: higher risk cases § Catheter inside the artery - more accurate reading

Question 69

What are the 4 important aspects of respiratory function that you need to monitor

Answer 69

- Respiratory rate, rhythm and effort, - Haemoglobin oxygen saturation - EtCO2 - Arterial blood gases

Question 70

What are the 2 types of pulse oximeters and how works

Answer 70

1) PO (transmission) - most common Monitor detects pulse after light moves through the tissue - Difference absorbance of wavelengths -> difference between haemoglobin with and without oxygen to give saturation readings 2) RPO (reflectance) - not as common - instead of through tissue reflects on the tissue - Used on the tongue, lips, vulva

Question 71

Pulse oximeter what level is considered hypoxaemic and what is the issue with this measurement

Answer 71

Hypoxaemia -> when PO2 is less than 60mmHg -> 60 related to about 89% oxygen saturation Problem - % saturation of oxygen doesn't change that much between PO2 of 600-60 mmHg so may tell you are in an issue NOW which could be given too late ○ Horses mainly -> don't go into recovery until PO2 120mmHg (cannot tell with pulse oximetry)

Question 72

What are 5 important causes of hypoxaemia

Answer 72

1. Reduce partial pressure of oxygen in the inspired air 2. Alveolar hypoventilation 3. Ventilation perfusion mismatch 4. Shunt (intracardiac or intrapulmonary) 5. Impaired alveolar-capillary diffusion

Question 73

Capnography what does it monitor, how presented, what is the important value and why important to measure

Answer 73

- Monitoring of the alveolar partial pressure of carbon dioxide Usually presented as a graph of expiratory CO2 over time End tidal value -> is the most important value Why CO2 is transported as bicarbonate -> increase CO2 -> increase bicarbonate -> decrease pH of your blood ○ Outside regular range of pH will lead to denaturing of proteins -> cannot function properly

Question 74

Define TIVA, PIVA and balance anaesthesia

Answer 74

- TIVA = Total Intravenous Anaesthesia – only IV agents used to provide balanced anaesthesia - PIVA = Partial Intravenous Anaesthesia – inhalant and IV agents used concurrently to provide balanced anaesthesia - Balance Anaesthesia = Judicious use of hypnotic and analgesic agents to minimise side-effects of each while providing anaesthesia and analgesia

Question 75

What are the cardiovascular and central nervous system hazards for inhalants

Answer 75

Cardiovascular ○ cardiovascular depression (enflurane>halothane>isoflurane) § All gas have these effects ○ cardiovascular stimulation (desflurane) § If increase too fast - sympathetic storm -> tachycardic and hypertensive Central nervous system ○ cerebral vasodilation -> increase intracranial pressure - DON'T USE ○ epileptic activity (enflurane)

Question 76

What are the respiratory and toxicity hazards of inhalants

Answer 76

Respiratory ○ irritancy (des>iso>halothane) § Don't mask a patient down with desflurane ○ block hypoxic pulmonary vasoconstriction § Shunt the blood from collapsed alveoli to alveoli that are active § Increase risk of hypoxaemia if patient is on the side and the alveoli on that side are collapsed but blood still going there as this reflex is blocked Toxicity ○ nephrotoxicity (methoxyflurane, sevo?) - hepatotoxicity (all) ○ malignant hyperthermia ○ operating room pollution

Question 77

Hazards of nitrous oxide what are the 3 main ones

Answer 77

1) diffusion into gas-filled areas ○ gastrointestinal tract - horses and cattle have high levels of gas in their stomach - pneumothorax / trauma cases 2) air embolism 3) bone marrow toxicity, nervous system, cardiovascular, hepatic, and reproductive effects in humans IF CHRONICALLY EXPOSED

Question 78

In terms of the environment which is more friendly Hydrochloroflurocarbons or nitrous oxide

Answer 78

Hydrochlorofluorocarbons - considered ozone friendly as lifetime of only 5-6 years Nitrous oxide - very stable in atmosphere (150yrs), destroys ozone

Question 79

What are 6 main advantages of using intravenous anaesthesia and 1 limitation

Answer 79

- better for environemnt - rapid, smooth induction - seamless transition from induction to maintenance - easy to deepen anaesthesia - more rapid than changing ventilation settings - rapid, predictable recovery of better quality - less likely to have issues - safe for patients with MH, asthma and other allergic conditions Dis - expensive (alfaxalone > propofol)

Question 80

List the 4 delievery systems for intravenous anaesthesia

Answer 80

1) intermittent bolus 2) constant rate infusion (CRI) 3) Variable rate infusion 4) target controlled infusion - best practice

Question 81

Intermittent bolus as delievery system for intravenous anaesthetics what okay for, advantages and disadvantages

Answer 81

○ Okay for short cases (<5-10mins) § Give bolus, when lighter give another bolus, etc. - cannot do this forever ADV - Simple - no speciial equipment needed DIS ○ Poor quality (peaks and troughs) anaesthetics level at the brain goes up and down ○ Large total drug dose than continuous infusion - MORE side effects ○ Slow recovery

Question 82

What are the important characteristics of constant rate infusion, variable rate infusion and target controlled infusion

Answer 82

Constant rate infusion (CRI) ○ Smoother anaesthesia ○ Deeper with time - overtime will accumulate slightly ○ Risk of awareness (longer time for induction) or side effects (rate) - better if give bolus than CRI Variable rate infusion - most common ○ Smoother - Lower total drug dose ○ Faster recovery ○ Frequent adjustment needed Target Controlled Infusion - best practice ○ A computer ○ A set of PK (pharmacokinetics) parameters specific for a given agent and a given population - Gives you the concentration that you want for the whole time § Propofol want 3,000 concentration

Question 83

Co-infusion what are the 3 options to use with porpofol or alfaxalone and why choose

Answer 83

OPIOIDS - with similar profile (easily titratable, rapid recover) 1. traditional opioids - morphine and pethidine - ODN'T USE 2. fentanyl - use for shorter surgeries - 20-30min 3. remifentanil - what we want to use especially in long surgeries, rapid recovery

Question 84

What is the difference between an antibiotic and antimicrobial

Answer 84

antibiotic - small molecular substance produced by microorganism that kills other microorgansisms antimicrobial - any substance, natural synthetic that kills microorganisms All antibiotics are antimicrobials, but not all antimicrobials are antibiotics.

Question 85

What are 6 important factors in choosing an antibiotic

Answer 85

1. Legally prescribing and dispensing 2. An appropriate active ingredient 3. That gets to the site of infection 4. At levels above the MIC 5. For an appropriate period 6. Taking into account: - prudent use of antibiotics - Cost - Compliance - Drug interactions

Question 86

Gram positive bacteria what are the two types and microorganisms within

Answer 86

1) Cocci ○ Only 2 groups –Staphylococcus and Streptococcus ○ Differentiate with catalase test 2) Rods ○ Bacillus, Clostridia, Corynebacterium, Listeria, Nocardia, Actinomyces,

Question 87

What are the 4 groups of gram megative bacteria and examples or bacteria within

Answer 87

1. Oxidase –ve ○ Enterobacteria – E. coli, Salmonella, Klebsiella, Yersinia, Proteus - gastrointestinal 2. Oxidase +ve -> turn purple with oxidase test ○ Rods -Pseudomonas, Pastuerella, Hemophilus, Taylorella, Brucella, Bordetella, Actinobacillus ○ Spiral ones –Campylobacter, Lepto, Spirochetes 3. Gram negatives that behave like gram positives - use gram positive antibiotics on them ○ Moraxella and Fusobacterium (penicillin) 4. Acid Fast ○ Some class acid fast with the gram negatives ○ Mycobacteria (Norcardia)

Question 88

What are the 8 common classes of antibiotics in vet medicine and which do what bacteria

Answer 88

1. Penicillins 2. Cephalosporins 3. Macrolides 1-3 gram positive 4. Aminoglycosides - NARROW GRAM NEGATIVE 5. Tetracyclines 6. Sulfonamides 7. Fluoroquinolones 8. Metronidazole 5-8 - broad spectrum

Question 89

Which 2 antibiotics only really used in small animals and large animals

Answer 89

``` Small animal 1. fluroquinolones 2. metronidazole Large animal 1. macrolides 2. aminoglycosides ```

Question 90

Pencillins what are the 4 different types and there spectrum/beta lactamse resistance

Answer 90

1) Pencillin G - Gram positive but beta-lactamase sensitive 2) Amoxycillin - gram positive and negative but beta-lactamase sensitive 3) Cloxacillin - gram positive and beta-lactamase resistant 4) Clavulanic acid -> BOTH gram positive and negative AND breaks down beta-lactamase so resistant - WHY PRESENT

Question 91

Cephalosporins what are the 4 classifications, what changes and main disease/animals use for

Answer 91

- Classified into “generations”, with increasing spectrum of activity 1) Cephalexin (1st Generation) ○ common in SA practice - the only common cephalosporin in dog/cats § especially skin, urine, osteomyelitis ○ resistant to β-lactamase from staphs (not enterobactria) 2) Cefurioxime (2nd Generation) ○ Mastitis in cattle 3) Ceftiofur (third generation) - Respiratory disease in cattle, horses ○ Expensive 4) Cefovecin (third generation) - Convenia ○ Very long acting -> but resistance issue In general, the use of 3rd generations is avoided in animals for resistance reasons.

Question 92

Aminoglycosides what end in, 4 examples, spectrum of activity, side effects and important info

Answer 92

- The opposite of the macrolides, but still end in –mycin - Neomycin, Streptomycin, Gentamycin, Tulathromycin –large animals mostly - Gram –ve and Staphylococcus (not streps) - only narrow gram negative - Nephrotoxicity, and residues in kidneys - not used in small and not really in large animals - Streptomycin and Gentamycin BANNED in food producing animals - Must not use gentamycin unless specifically indicated

Question 93

Tetreacyclines how common, spectrum of activity, what are the 2 main drugs and what used in

Answer 93

Highest use antibiotic in vet medicine. Broad spectrum, safe and cheap Doxycycline - small animals Oxytetracyclin - large animals (cattle)

Question 94

Sulfonamides spectrum of activity, what mostly used for, examples and where good penetration

Answer 94

- Broad spectrum, usually combined with trimethoprim - Mostly used for diarrhoea in large animals - Excellent against staphs; some resistance in streps - mastitis decisions EG - Sulfadimidine, sulfatroxazole, sulfadiazine, sulfamerazine, sulfadoxazoleetc… - No particular differences between them except for coccidia (sulfadimidine is best) - Good penetration into gut, milk, lungs, urine

Question 95

Fluoroquinolones give example, spectrum of activity, when should you use and when can't you

Answer 95

- Enrofloxacin (Baytril) and others - They treat everything in all species … - Should avoid their use because of the potential for resistance in human disease - BANNED IN FOOD PRODUCING ANIMALS

Question 96

Metronidazole what used for

Answer 96

- Anaerobic infections | - Particularly mouths, osteomyelitis, peritonitis

Question 97

what are you allowed to dispense in terms of antibitoics and what do you need before this for small animal and large animal clients

Answer 97

- APVMA registers all products - Vets can supply human and veterinary antibiotics If not registered by APVMA, or in a way different to label = “off label” - Vet takes responsibility for off-label use - MUST NOT USE ANTIBIOTICS AGAINST A LABEL RESTRAINT - In small animals ○ Need consent from client ○ Need to be able to justify the use (egto the vet board) - Also, In food producing animals ○ Single animal treatment only - Need appropriate withholding period

Question 98

What are the 11 important things needed on label for medication

Answer 98

1. The words ‘KEEP OUT OF REACH OF CHILDREN’ in red on a white background 2. The words ‘FOR ANIMAL TREATMENT ONLY’ 3. if the substance is intended for external use only, the word ‘POISON’ or the words ‘FOR EXTERNAL USE ONLY’ in red on a white background; 4. business name, address and telephone number of the veterinary practitioner 5. the identity of the animal(s) to be treated; e.g. tag number, species, breed, age, sex 6. the name of the animal’s owner or person in charge 7. the date the product was used or sold 8. the trade name 9. the quantity in the container 10. adequate directions for treating the animal with the product including the method of administration, dose rate, dose frequency and number of days of treatment 11. the withholding period or the statement ‘Nil withholding period required’ when treating food producing animals.

Question 99

In terms of antibimicrobial resistance what are the 3 levels of use and examples within

Answer 99

1) High - essential for humans infections EG - 3rd gen cephalosporins and fluroquinolones 2) Medium - other alternatives but less available EG - cloxacillin, clavulox, 1st gen cephalsporins 3) Low - reasonable alternatives EG - penicillins, tetracycline, neomycin, erythromycin

Question 100

What are 4 important AVA guidelines for obligations of the prescribing veterinarian

Answer 100

- Report all suspected adverse drug experiences - Review patient or farm records to ensure compliance with prescribing label instructions. - Evaluate the response to previous treatment before again prescribing antimicrobials. - Maintain a high level of awareness of the problem of antimicrobial resistance in humans and prudent use of antimicrobials in animals and communicate this to clients.