Anesthesia 2, Lecture 1: Review
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Questions and Answers

What is considered tachycardia in dogs?

  • Less than 50 bpm
  • 60-120 bpm
  • 150-190 bpm
  • Greater than 190 bpm (correct)

Which condition is most likely to lead to erratic blood pressure readings?

  • Overly wide cuff
  • Cardiac arrhythmias (correct)
  • Cuff tightened too much
  • Cuff placed over a joint

What is the minimally acceptable mean arterial pressure (MAP) in dogs and cats?

  • 50 mmHg
  • 60 mmHg (correct)
  • 70 mmHg
  • 80 mmHg

Which error would likely cause a falsely high reading in blood pressure measurements?

<p>Cuff overly small or narrow (D)</p> Signup and view all the answers

What does the formula for Mean Arterial Pressure (MAP) include?

<p>Diastolic BP + 1/3 (systolic BP - Diastolic BP) (A)</p> Signup and view all the answers

Which of the following is a common cause of anesthetic-related arrhythmias?

<p>Hypercapnia (D)</p> Signup and view all the answers

What is the normal systolic blood pressure range for dogs and cats?

<p>110-160 mmHg (C)</p> Signup and view all the answers

What can be done if a Doppler cuff is not functioning correctly?

<p>Tape it closed (D)</p> Signup and view all the answers

What does a capillary refill time (CRT) longer than 2 seconds primarily indicate?

<p>Peripheral vasoconstriction or hypovolemia (A)</p> Signup and view all the answers

What is the normal range for SpO2 values?

<p>95-100% (C)</p> Signup and view all the answers

Which condition is characterized by ETC02 levels greater than 45 mmHg?

<p>Hypoventilation (D)</p> Signup and view all the answers

What is a potential effect of hypercapnia during anesthesia?

<p>Increased vascular tone (D)</p> Signup and view all the answers

Which of the following is a sign of septicemia as indicated by SpO2 levels?

<p>SpO2 less than 95% with bright red MM (B)</p> Signup and view all the answers

What should be assessed if low ETC02 is found?

<p>Depth of anesthesia and patient condition (C)</p> Signup and view all the answers

A CRT less than 1 second typically suggests which of the following?

<p>Septicemia and hyperthermia (A)</p> Signup and view all the answers

What factor is critical in interpreting SpO2 readings accurately?

<p>Inspired O2 fraction (FiO2) (D)</p> Signup and view all the answers

What is indicated by a high INC02 level?

<p>Low oxygen flow or respiratory depression (B)</p> Signup and view all the answers

When is a patient considered hypoxic when breathing 100% O2?

<p>SpO2 levels below 98% (B)</p> Signup and view all the answers

What could indicate an exhausted or malfunctioning CO2 absorber during ventilation?

<p>Rebreathing of CO2 (B)</p> Signup and view all the answers

Which factor could lead to insufficient carbon dioxide removal during mechanical ventilation?

<p>Faulty expiratory valve (A)</p> Signup and view all the answers

What is a common sign of esophageal intubation during positive pressure ventilation?

<p>No CO2 sensed or minimal amounts detected (D)</p> Signup and view all the answers

What is an important consideration when using an esophageal stethoscope?

<p>It must be measured to prevent entering the stomach (D)</p> Signup and view all the answers

What is the heart rate range for small dogs considered normal?

<p>120-220 bpm (C)</p> Signup and view all the answers

Why is the esophageal stethoscope considered useful during anesthesia?

<p>It provides heart and lung sounds in noisy environments (D)</p> Signup and view all the answers

What is the primary consequence of inadequate inspiratory flow during mechanical ventilation?

<p>Increased rebreathing of CO2 (D)</p> Signup and view all the answers

What could result from the insertion of the esophageal stethoscope into the stomach?

<p>Opening of the sphincter and potential aspiration (A)</p> Signup and view all the answers

Which condition would not typically lead to obstructed ventilation?

<p>Adequate inspiratory flow (B)</p> Signup and view all the answers

What defines bradycardia in cats during anesthesia monitoring?

<p>Less than 100 bpm (B)</p> Signup and view all the answers

Flashcards

Falsely High Blood Pressure Reading Due to Cuff Size

A systolic blood pressure reading that is too high due to a cuff that is too small or narrow.

Falsely Low Blood Pressure Reading Due to Cuff Size

A systolic blood pressure reading that is too low due to a cuff that is too wide.

Falsely High Blood Pressure Reading Due to Cuff Placement

This occurs when an artery is not fully compressed by the cuff because it was placed over a joint.

Falsely High Blood Pressure Reading Due to Cuff Placement

This happens when the cuff is not placed snugly on the limb and pressure leaks out too quickly, leading to a false high reading.

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Erratic Blood Pressure Reading Due to Arrhythmias

A pressure reading that is erratic due to irregular heart rhythms (arrhythmias).

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Mean Arterial Pressure (MAP)

The average pressure in the arteries throughout the cardiac cycle.

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Hypotension

When a patient's blood pressure is too low, which can lead to insufficient tissue perfusion.

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Tachycardia in Large Dogs

A heart rate greater than 150 beats per minute in large dogs.

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Bradycardia in Large Dogs

A heart rate less than 50 beats per minute in large dogs.

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Capillary Refill Time (CRT)

Indicates how quickly blood flow returns to the tissue after pressure is applied. It provides a visual measure of peripheral circulation. Can be misleading.

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Prolonged CRT

A prolonged CRT of over 2 seconds suggests poor perfusion. This could be caused by dehydration or vasoconstriction.

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Rapid CRT

A CRT of less than 1 second usually indicates good perfusion. It could also indicate septicemia or hyperthermia.

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SpO2

Measures oxygen saturation in the blood. This number should be interpreted with the inspired oxygen fraction (FiO2) in mind.

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Normal SpO2 (Room Air)

A normal SpO2 range when breathing room air is 95-100%.

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Normal SpO2 (100% Oxygen)

A normal SpO2 range when breathing 100% oxygen is 98-100%.

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End-Tidal Carbon Dioxide (ETCO2)

Measures carbon dioxide in the end-tidal breath. Normal range is 35-45 mmHg.

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Hypocapnia

Low ETCO2 levels (less than 35 mmHg) indicate hyperventilation. Causes may be anesthetic depth, low oxygen, rapid decline in ETCO2.

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Hypercapnia

High ETCO2 levels (greater than 45 mmHg) indicate hypoventilation. Often tolerated during anesthesia. Helps with vascular tone and hypothermia.

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Inspired-to-End-Tidal CO2 Gradient (INC02)

Measures the difference between end-tidal and inspired carbon dioxide levels. Normal range is 0-2 mmHg.

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Rebreathing CO2 / Inspired CO2

A condition caused by a malfunctioning or exhausted CO2 absorber, inadequate inspiratory flow, insufficient expiratory time or a faulty expiratory valve. This can lead to an increase in the concentration of CO2 in the inspired gas, resulting in rebreathing of CO2.

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Esophageal Intubation

A situation where the patient is breathing or receiving positive pressure ventilation but no CO2 is detected, or only minimal amounts are present. This is a strong indicator of esophageal intubation, meaning the endotracheal tube is in the esophagus instead of the trachea.

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Esophageal Stethoscope

A special stethoscope designed for use during anesthesia. It is attached to a catheter that is placed down the esophagus, enabling the detection of heart and lung sounds. This is particularly helpful in noisy surgical environments, when monitoring devices fail, or for confirming heart rate accuracy.

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Cat Heart Rate Normals

The normal range for heart rate in cats is 120-220 beats per minute (bpm). Bradycardia is defined as a heart rate below 100 bpm, while Tachycardia is a heart rate over 260 bpm.

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Small Dog Heart Rate Normals

The normal range for heart rate in small dogs is 120-220 beats per minute (bpm). Bradycardia is defined as a heart rate below 60 bpm, while Tachycardia is a heart rate over 260 bpm.

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Obstructed ETT, Airway, or Circuit

A condition where there is an obstruction in the endotracheal tube, airway, or breathing circuit. This can occur due to various factors, including a blocked ETT, airway obstruction, or bronchospasm.

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Inadequate Inspiratory Flow

A condition where the flow of air into the lungs is inadequate. This can be caused by a variety of factors, including a blocked airway, shallow breathing, or a malfunctioning ventilator.

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Insufficient Expiratory Time

This occurs when the patient does not have enough time to exhale before the next breath begins. It can be caused by a rapid breathing rate, a malfunctioning ventilator, or a blockage in the breathing circuit.

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Faulty (sticky) Expiratory Valve

This condition is caused by a sticky or malfunctioning expiratory valve that is not opening properly, restricting the flow of air out of the lungs. This can lead to various complications, including rebreathing of CO2 and difficulty breathing.

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Esophageal Intubation

This is a condition where the esophagus has been accidentally intubated instead of the trachea. This can occur during intubation, and it is a serious complication as it can lead to aspiration of stomach contents.

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Study Notes

Monitoring Review & Normals

  • Circulation Indicators (CRT): Indicates peripheral tissue blood perfusion. Slow CRT may result from factors like epinephrine release, low blood sugar, hypothermia, cardiac failure, excessive anesthetic depth, blood loss, or pain. A CRT longer than 2 seconds suggests decreased perfusion, possibly due to hypovolemia or peripheral vasoconstriction. A CRT less than 1 second often accompanies bright red mucous membranes and indicates septicemia or hyperthermia.

  • SpO2 % Saturation: Should be interpreted based on inspired oxygen fraction (FiO2). Normal SpO2 values are between 95-100%. Breathing room air (FiO2 = 0.21) results in SpO2 greater than 95%. Hypoxia occurs when SpO2 is less than 95%. Breathing 100% oxygen (FiO2 = 1) yields a SpO2 of 100%. Hypoxia occurs when SpO2 is less than 98%.

  • Capnography:

    • ETCO2 (End-tidal CO2): Normal range is 35-45mmHg. Lower values (hypocapnia) are less than 35mmHg, while higher values (hypercapnia) are greater than 45mmHg.
    • INC02 (Inspired CO2): Should be between 0-2 mmHg.
    • Hyperventilation: Occurs when ETCO2 is less than 35mmHg.
    • Hypoventilation: Occurs when ETCO2 is greater than 45mmHg.
    • Low ETCO2: Assess patient's condition, depth of anesthesia, oxygenation, and assess for rapid declines or values below 15 mmHg which may indicate impending cardiopulmonary arrest
    • High ETCO2: Assess possible causes like IPPV (positive pressure ventilation) and monitor patients closely. Hypercapnia (45-55mmHg) may be tolerated during surgery because it has some benefits.

  • Rebreathing/Malfunctioning CO2 Absorber: Exhausted or malfunctioning CO2 absorbers lead to rebreathing of CO2.

Esophageal Intubation

  • Signs of confirmed patient intubation include: breathed or IPPV (positive pressure ventilation) once attached to Assisted Ventilation Devices (ADS). Absence of CO2 or very minimal amounts on the capnograph suggest successful esophageal intubation.

Esophageal Stethoscope

  • Provides sound intensities from the esophagus.
  • To prevent accidental entry into the stomach, measurements should be taken near the 4th-5th ribs.
  • It can assist with HR detection in loud environments and aid in confirming intubation when other devices fail.

Heart Rate Normals

  • Cat: 120-220 bpm. Bradycardia is less than 100 bpm. Tachycardia is greater than 260 bpm.
  • Dog: 60-120 bpm. Bradycardia is less than 50 bpm. Tachycardia is greater than 150 bpm.

Common Technical Errors in Blood Pressure Measurements

  • Cuff Size: Incorrect cuff size can lead to inaccurate readings (falsely low or high readings).
  • Cuff Placement: Cuff placed over a joint, not snugly fitted, or not sufficiently tightened leads to inaccurate high readings.
  • Cuff Integrity: A hole in the cuff or leaks in the cuff integrity can lead to inaccurate or unreliable readings.
  • Cardiac Arrhythmias: Can cause erratic readings.

Blood Pressure Normals

  • Mean Arterial Pressure (MAP): Average pressure throughout the cardiac cycle. Important for tissue perfusion. MAP calculation= Diastolic BP + 1/3 (Systolic BP-Diastolic BP).
  • Dog and Cat Normal Mean: 60-90mmHg
  • Dog and cat Normal Systolic: 110-160mmHg

ECG/Common Causes of Anesthetic - Related Arrhythmias

  • ECG issues: Common factors including inadequate anesthesia or analgesia, bradycardia, tachycardia, hypoxemia, hypercapnia, hypotension, hypothermia, or hyperthermia, and electrolyte abnormalities (such as potassium and magnesium). Oculo-cardiac reflexes are also mentioned as possible causes.
  • Hypotension: Low blood pressure. Must be kept above 60mmHg (minimally acceptable).

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Anesthesia 2 - Lecture 1: Monitoring Review & Normals (PDF)

Description

Test your knowledge on the monitoring parameters of vital signs, including circulation indicators, SpO2 saturation, and capnography. This quiz covers normal ranges, interpretations, and implications of abnormal values. Ideal for students in medical and health-related fields.

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