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Questions and Answers
What is the most important step in preoperative evaluation for anesthesia and surgery?
What is the most important step in preoperative evaluation for anesthesia and surgery?
Which of the following is a reason to obtain an accurate weight before anesthesia?
Which of the following is a reason to obtain an accurate weight before anesthesia?
What is the standard practice for food and water restriction before anesthesia?
What is the standard practice for food and water restriction before anesthesia?
Withhold food for 8-12 hours (the night before) and water for 2-4 hours (the morning of) prior to anesthesia.
What is the importance of a preanesthesia checklist?
What is the importance of a preanesthesia checklist?
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Which of the following is NOT a component of a basic anesthesia machine?
Which of the following is NOT a component of a basic anesthesia machine?
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A rebreathing circuit uses a high gas flow rate to eliminate CO2.
A rebreathing circuit uses a high gas flow rate to eliminate CO2.
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What is the main function of a vaporizer?
What is the main function of a vaporizer?
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What is the primary reason for using a scavenging system?
What is the primary reason for using a scavenging system?
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The pop-off valve should be left open during positive pressure ventilation.
The pop-off valve should be left open during positive pressure ventilation.
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What is the purpose of a unidirectional valve in a rebreathing circuit?
What is the purpose of a unidirectional valve in a rebreathing circuit?
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Which of the following is NOT a component of a nonrebreathing circuit?
Which of the following is NOT a component of a nonrebreathing circuit?
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What are the two main types of anesthetic circuits?
What are the two main types of anesthetic circuits?
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What is the primary goal of anesthetic monitoring?
What is the primary goal of anesthetic monitoring?
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Which of the following is NOT a commonly used method for monitoring respiratory function during anesthesia?
Which of the following is NOT a commonly used method for monitoring respiratory function during anesthesia?
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Which of the following can be used to evaluate heart rate during anesthesia?
Which of the following can be used to evaluate heart rate during anesthesia?
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Preanesthetic medication is typically given based on the specific surgical procedure being performed.
Preanesthetic medication is typically given based on the specific surgical procedure being performed.
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Describe the primary goal of anesthetic induction.
Describe the primary goal of anesthetic induction.
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Which of the following is NOT a technique for minimizing waste anesthetic gas exposure?
Which of the following is NOT a technique for minimizing waste anesthetic gas exposure?
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The maintenance phase of anesthesia begins after the induction period is complete.
The maintenance phase of anesthesia begins after the induction period is complete.
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What is the purpose of an anesthetic record?
What is the purpose of an anesthetic record?
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Study Notes
Anesthesia & Surgical Assisting Part 1
- Week 11 of the course
- Focuses on preoperative considerations, patient preparation, and equipment.
Preoperative Considerations
- Preoperative evaluation is critical for minimizing anesthetic risks.
- Key factors considered include patient characteristics, medical history, physical examination, and laboratory tests.
- Patient characteristics: species, breed, age, and gender
- Patient medical history: signalment, vaccine status, medical & surgical history, injuries, diseases, past anesthetic complications, changes in patient condition, purpose of the appointment, fasting recommendations, and concurrent medications.
- Physical exam: general body condition score, evaluation of each body system.
- Laboratory tests: PCV/TS, liver enzymes, bile acids, BUN/Cr, glucose, electrolytes, blood smear, heartworm status, fecal analysis, urinalysis, blood coagulation screen, +/- chest X-rays, +/- electrocardiogram (ECG).
Patient Preparation
- Preparation varies based on the procedure. Standard practice involves withholding food for 8-12 hours and water for 2-4 hours before the procedure.
- Pediatric or smaller patients need shorter fasting periods.
- Chronically compromised patients require stabilization before anesthesia.
- Anemic patients need a blood transfusion.
- Dehydrated patients need intravenous (IV) fluids.
- Patients with low total solids (TS) need plasma.
- Accurate patient weight recording is essential.
- Placement of an intravenous catheter (IVC) is necessary.
Preanesthesia Checklist
- Personnel selection and role identification
- Emergency procedures review
- Patient identification and fasting confirmation
- Patient weight
- Special patient preparation
- Preanesthetic examination
- Drug selection and availability
- Drug administration routes
- Crash cart inventory
- IV fluid selection and temperature maintenance
- Equipment checks for adverse events
- Necessary equipment assembly (e.g., Y-shaped IV catheters, injection caps)
Anesthesia Equipment & Supplies
- All equipment must be prepared and checked for proper function before use.
- Use a preanesthetic checklist for inspection.
- Essential to have sufficient oxygen supply, functional flowmeters, properly functioning unidirectional valves and vaporizer.
- Gas lines correctly connected
- Scavenging systems are operational
- Breathing circuit, tubes, and reservoir bags are attached and checked for leaks
Supplies for IV Fluids
- Placement of an IV catheter is essential for patient safety during anesthesia.
- Provides immediate access for IV medications and fluids.
- Anesthetic procedures often cause hypotension or vasoconstriction, highlighting the need for prompt fluid administration.
- Necessary supplies include appropriately sized catheters, infusion sets, needles, syringes, tape, and injection caps.
Endotracheal Tubes (ETT)
- Ensures a patent airway, facilitating ventilation and efficient anesthetic delivery.
- Tube diameter should fit the trachea for ease.
- Cat size; 3-4.5 mm, dog size: 6–14 mm
- Insertion tip should not extend beyond the thoracic inlet to prevent bronchial intubation and mechanical dead space.
- Inflatable cuffs require leak checks.
Laryngoscope
- Visualizes the glottis (vocal cords and epiglottis) for easier endotracheal tube insertion.
- Handles and detachable blades come in various shapes and sizes.
Endotracheal Intubation
- Procedure of inserting an endotracheal tube (ETT) into the trachea.
- This procedure is carried out with proper visualization from laryngoscopy.
Medical Gas Supply
- Common sizes: E cylinder (4.25 x 26 inches), H cylinder (9.25 x 51 inches)
- Oxygen is green, except in Canada (white).
- Pressure regulators reduce cylinder pressure to working pressure.
Anesthesia Machines, Breathing Circuits
- Machine delivers a mixture of oxygen and anesthetic gases.
- Components include oxygen source, pressure regulator, oxygen pressure valve, flowmeter, vaporizer, breathing circuit, reservoir bag, circuit manometer, positive pressure relief valve, carbon dioxide absorbent, and unidirectional valves.
- Two types of breathing circuits exist (rebreathing and nonrebreathing).
Flowmeter
- Receives medical gases from the pressure regulator
- Measures and delivers a constant gas flow to the vaporizer, common gas outlet, and breathing circuit.
- Further reduces intermediate pressure.
- Transparent flow tube with a floating indicator.
Vaporizer
- Delivers a constant concentration of volatile anesthetic.
- Each vaporizer is color coded and designed to be used with a specific agent.
- It functions independently of the breathing circuit.
- Hazards: Incorrect agent, tipping, overfilling.
Breathing Circuits
- Rebreathing circuit: CO2 is absorbed from the expelled air via a soda lime canister.
- Nonrebreathing circuit: Expelled air is vented from the system, using high gas flow rates.
Reservoir Bag
- Aka rebreathing bag; provides sufficient gas volume for maximal inhalation without creating negative pressure in the circuit.
- Used to give positive pressure ventilation (breaths) or to inflate/support the lungs when needed.
- Various sizes available, Ideal size = 5-6 x patient's normal tidal volume of 10 ml/kg (for smaller animals).
Manometer
- Monitors circuit pressure.
- Excessive pressure can prevent normal respiration and cause decreased venous return and drop in cardiac output.
- Useful during positive pressure ventilation (bagging).
- Should not exceed 2 cm H20 during spontaneous breathing.
Positive Pressure Relief Valve
- Aka pop-off valve.
- Prevents excessive pressure in the rebreathing circuit and allows for the removal of excess waste gases.
- Always kept open except during positive pressure ventilation.
- Connected to the scavenging system.
Carbon Dioxide Absorbent Canister
- Removes CO2 from the exhaled gases before they are returned to the patient.
- Contains calcium hydroxide absorbent granules to remove exhaled CO2.
- Replacement is monthly or every 6-8 hours of use (whichever comes first).
Unidirectional One-Way Valves
- Maintain one-way flow of gases within the breathing circuit.
- Inhalation/inspiratory valves open for fresh gas and anesthetic flow into the patient.
- Exhalation/expiratory valves open during exhalation, passing through CO2 absorbent.
Inspiratory & Expiratory Breathing Tubes
- Corrugated hoses that carry anesthetic gases to and from the patient.
- Connected to unidirectional valves and the Y-piece.
- Size varies with patient weight and species.
- Some systems incorporate F-circuit, where inhalation tube is inside the exhalation tube, warming the inhaled gas.
Nonrebreathing Circuits
- Do not have a carbon dioxide absorber.
- Exhaled gases are immediately vented through another hose.
- Suitable for small animals (< 7kg).
Leak Checks
- Two methods for leak checks described.
- Involved checking for leaks in anesthesia machine, pressure in circuit maintained or not maintained during the procedure.
Preanesthetic Medication
- Usually beneficial for the patient.
- Considered for all patients.
- Medication choice based on patient's status, not the surgical procedure.
Induction
- Primary goal is providing maximum safety for the patient and personnel during short-term general anesthesia.
- Induction agents are frequently used to perform short surgical or diagnostic procedures.
Techniques for Minimizing Exposure to Waste Anesthetic Gases
- Leak checks required for circuit maintenance
- Avoid disconnecting patient from the circuit, allowing time for the dispersal of gases.
- Connect pop-off valve to a scavenging system for safe gas discharge
- Avoid spilling liquid anesthetic
- Maintaining adequate ventilation is crucial
Maintenance of Anesthesia
- Continuing patient monitoring and adjustment of anesthesia as needed.
- Amount of anesthetic required varies depending on the patient's condition.
- Important to monitor various parameters like heart rate, blood pressure, and other vital signs.
Anesthetic Record
- Continuous data recordings are made every 5-10 minutes or when significant changes occur
- Essential for legal documentation and analyzing anesthetic events, drug dosages, and patient values.
Anesthetic Monitoring
- Goal is to maintain adequate oxygen delivery to tissues and maintaining tissue perfusion. It involves observing anesthetic equipment, evaluating the central nervous system (CNS), monitoring pulmonary function, and evaluating cardiovascular function.
Monitoring Respiratory Function
- Equipment involved includes a blood gas machine to measure dissolved gases, a pulse oximeter to detect oxygen saturation, and a capnometer to measure end-tidal carbon dioxide.
Monitoring Cardiovascular Function
- Monitors include an aneroid manometer, fine nylon catheter or needle in artery, three-way tap, drip extension tube, and a 20 mL syringe.
- Evaluation uses methods such as heart rate, heart sounds, pulse quality/rate, mucous membrane color, capillary refill time (CRT), electrocardiography (ECG), and blood pressure monitoring.
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Description
This quiz covers Week 11 of the Anesthesia and Surgical Assisting course, focusing on vital preoperative considerations and patient preparation. The content addresses critical evaluation processes and important factors such as medical history, laboratory tests, and aspects of physical examination necessary for minimizing anesthetic risks.
