Week One: Anesthesia Quiz

[DCLissa17]

Week One participants: Anna Kim, Linda Ness, and Melissa Hoemann

Here is the quiz on Anesthesia that was given out at the Tuesday study
group and served as our talking points for the evening!

ACCES Study Group - Week One : Anesthesia
Anesthesia Quiz & Answer Key

1. Which of the following anesthetic agents is contraindicated as an
induction agent in a patient with clinical signs of increased
intracranial pressure?
A. Pentothal
B. Propofol
C. Etomidate
D. Ketamine

Correct answer: D. Ketamine; Ketamine induces significant increase in
cerebral blood flow, intracranial pressure, and CSF pressure as a
result of cerebral vasodilation and elevated systemic blood pressure.
Pentothal and Etomidate both decrease cerebral metabolic rate of
oxygen consumption and intracranial pressure and may have brain
protective properties. Propofol also decreases intracranial pressure
following administration.

2. Your enterotomy surgical patient is intubated on Isofluorane
running at 3% and you note that they are experiencing hypotension with
a mean blood pressure of 50. What is the best course of action?
A. Give a 20ml/kg IV fluid bolus
B. Check anesthetic depth, turn down iso
C. Turn off iso entirely
D. Start a Dopamine CRI

Correct answer: B. Check anesthetic depth, turn down iso. First you
want to take several blood pressure readings over a couple of minutes
to establish that the hypotension is true. If so, alert your
veterinarian. Then check your patient's other monitoring parameters
and anesthetic depth. A surgical patient with proper pre-and intra-op
analgesia should not need to be maintained at 3% for sufficient
anesthetic depth. If possible, turn down the iso and monitor response.
If patient becomes too light at 2.5 or 2%, check with the veterinarian
on if you need additional analgesia. If the patient does not become
too light but hypotension does not improve, a crystalloid and/or
colloid bolus may be needed. If not response to fluid boluses and
decreased anesthetics is seen and hypotension is significant, a
vasopressor CRI may be initiated at that time.

3. Etomidate is particularly well suited for induction of dogs with
which of the following problems?
A. Severe cardiac disease
B. Renal failure
C. Orthopedic disease
D. Pediatric (younger than 4 weeks)

Correct answer: A. Severe cardiac disease; Etomidate has a short
duration of effect, can be given as multiple boluses or infusion,
thereby forgoing the need for inhalant anesthetics altogether if
necessary. It has minimal effects on cardiovascular function including
heart rate, rhythm, cardiac output, and blood pressure. It also
provides better cerebral perfusion than other induction agents.

4. A cat presents with a history of chronic renal failure that is
currently well-managed with diet and is non-symptomatic. He was seen
chewing on a hairband and radiographs reveal a gastric foreign body.
This patient, under the ASA classification system, would be
designated:
A. Class II "good"
B. Class III "fair"
C. Class IV "poor"
D. Class V "guarded"

Correct answer: B. Class III "fair" This class is designated for
patients experiencing moderate systemic disease, including low-
moderate grade fever, moderate dehydration/hypovolemia, anorexia,
anemia, well-managed chronic heart disease or chronic renal failure,
complex orthopedic fractures, or mild-moderate chest trauma. A patient
in this category will likely require some measure of specific
preanesthetic testing and stabilization prior to anesthesia but has a
good prognosis providing appropriate anesthetic care is taken.

5. Common side effects of dexmedetomidine administration do not
include:
A. 2nd degree heart block and other arrhythmias
B. Bradycardia
C. Diarrhea
D. Transient hyperglycemia

Correct answer: C. Diarrhea, Dexmedetomine may cause hypotension,
bradycardia, reduced cardiac output, 2nd degre heart block,
sensitization of the heart to epinephrine leading to more common
cardiac arrhythmias, possible respiratory depression, cyanosis due to
reduced local blood flow, and inhibition of secretion of insulin by
the pancreas leading to a transient hyperglycemia and therfore osmotic
diuresis.

6. The most accurate method of evaluating blood pressure is:
A. Direct blood pressure
B. How strong the pulse quality is when palpated
C. Doppler blood pressure
D. The pet's MM color and CRT

Correct answer: A. Direct blood pressure. Direct or invasive blood
pressure monitoring is the Gold Standard, though is is not often
performed as it is time-consuming, invasive, and generally impractical
as placement of an arterial catheteter is needed. Indirect blood
pressure monitoring, such as via a Doppler or an oscillometric blood
pressure machine is the most common method used with a high level of
accuracy. A patient's MM/CRT do not give you an accurate sense of
blood pressure as they can be altered/delayed for a number of reasons,
including anemia, hypovolemia, decreased cardiac output, shock, etc.
The strength of a pulse upon palpation is only indicative of the
difference between the systolic and diastolic pressures.

7. What drug is commonly given along with Ketamine to acheive a more
smooth induction?
A. Propofol
B. Acepromazine
C. Diazepam
D. Dexdomitor

Correct answer: C. Diazepam; Ketamine is nearly always given along
with Diazepam. Ketamine when given as a singular induction agent has
several undesirable effects, including marked sensitivity to sensory
stimuli, increased muscle tone towards the point of rigidity, and
spontaneous random movements despite deep anesthetic depth, and rough
anesthetic recovery. Concurrent administration of Diazepam with
Ketamine helps provide muscle relaxation, eases intubation, produces a
more sleep-like anesthetic state, and results in a smoother induction/
recovery.

8. Signs that your patient is too deeply anesthetized do NOT include:

A. Present palpebral reflex
B. Dilated, straight ahead pupils
C. Shallow respirations
D. Bradycardia

Correct answer: A. Present palpebral reflex. Palprebral reflexes are
diminished to lost at Plane 2 of Stage 3 anesthesia, a medium
anesthetic depth or the normal surgical plane. A patient with a
present palpebral reflex would be in either Plane 1 or 2, thereby
indicating a light-medium plane of anesthesia. Signs of a patient who
is too deep and therefore in Plane 3-4 of Stage 3 would include:
decreased respiration rate of <10bpm, shallow respirations, abdominal
exertion "push" with respiration, significant bradycardia of <60-70 in
a dog and <100 in a cat, weak pulses, hypotension with systolic <80,
increased CRT, pale or cyantic MM, cardiac arrhythmias, hypothermia,
all reflexes completely absent, flaccid muscle tone, and/or fixed &
dilated pupils with no pupillary light response. If a patient is
suspected to be too deeply anesthetized the anesthetic agents should
immediately be decreased/turned off depending upon the surgical state
and severity/compromise to the patient and the veterinarian alerted.