Patient Evaluation

Question 1

Pre-anesthetic patient evaluation

Answer 1

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

Question 2

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

Answer 2

Estimated ideal weight

Question 3

IV drugs should always be given to….

Answer 3

Effect

Question 4

Anesthetic concerns for overweight/obese animals

Answer 4

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

Question 5

Evaluation of thin/cachectic animals

Answer 5

Evaluate and treat any underlying disease prior to anesthetic induction

Question 6

Concerns of IV anesthetics in underweight animals

Answer 6

Drugs stay in VRG longer (titrate to effect)

Prone to severe hypothermia

Question 7

Concerns with very small animals

Answer 7

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

Question 8

Concerns with giant breeds

Answer 8

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

Question 9

Concerns with neonates

Answer 9

1. Increased sensitivity to drug effects
2. Hypothermia
3. Hypoglycemia

Question 10

Concerns with geriatrics

Answer 10

1. Decreased organ reserves

2. Sub-clinical organ function

Question 11

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

Answer 11

True

Question 12

Concerns with brachiocephalic animals

Answer 12

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

Question 13

Concerns with greyhouds

Answer 13

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

Question 14

Concerns with herding breeds (collies)

Answer 14

MDRI mutation- increased sensitivity to invermectins, acepromazine, butorphenol

Question 15

Breeds with predisposition to Cardiomyopathies

Answer 15

Boxers, doberman pincher, giant breeds, maine coons

Question 16

Cardiac/renal disease medications

Answer 16

Potentiate anesthesia related C/V depression

Angiotensin converting enzyme inhibitors, Beta or Ca channel blockers

Question 17

What drug should you avoid with angiotensin converting enzyme inhibitors?

Answer 17

Acepromazine

Question 18

What drug interacts with SSRIs Tricyclics and MAO inhibitors

Answer 18

Tramadol, some opiods

Question 19

What drug increases metabolism of other similar drugs?

Answer 19

Phenobarbital- increases P450 metabolism

Question 20

Why is it important to review anesthesia records?

Answer 20

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

Question 21

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

Answer 21

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

Question 22

Is the ASA risk assessment scale subjective or objective?

Answer 22

Somewhat subjective but based on set standards

Question 23

ASA category I

Answer 23

Normal healthy patient

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

Question 24

ASA category II

Answer 24

Mild systemic disease but well compensated or uncomplicated injury

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

Question 25

ASA category III

Answer 25

Moderate systemic disease requiring medical management but stable physiologically Likely not be managed with the same protocol or dosages and management

Question 26

ASA category IV

Answer 26

Severe systemic disease that is a constant threat to life Likely not be managed with the same protocol or dosages and management

Question 27

ASA category V

Answer 27

Moribund; not expected to survive with or without surgery

Question 28

ASA category E

Answer 28

Emergency Patients usually otherwise classified as III, IV, or V

Question 29

Is pre-anesthetic bloodwork a good predictor of risk?

Answer 29

No, it rarely alters anesthetic protocols

Question 30

Fasting time

Answer 30

12hr fast, free access to water May be longer for endoscopy or GI surgery

Question 31

What patients should receive supplemental glucose?

Answer 31

Neonates and pediatrics Up to 4-6hr prior

Question 32

Diabetic pre-anesthetic protocols

Answer 32

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

Question 33

Should exotics/pocket pets be fasted?

Answer 33

No

Question 34

Why should patients be fasted?

Answer 34

Reduce risk for vomiting/regurgitation- aspiration pneumonia

Question 35

Does fasting decrease incidence regurgitation or reflux?

Answer 35

NO- just reduces material