💧Fluids💧
Intracellularly these solutes are found, extracellularly these solutes are found
intracellular- potassium, magnesium, calcium
extracellular- sodium and chloride
Types of fluids what is the main category below?
-Lactated Ringers, (Hartmann’s Solution), Plasma-Lyte, Normosol
-Dextrose 5% in H2O, Dextrose 5% in Saline 0.18%, Saline 0.45%
-Saline 7.2%, Sodium Bicarbonate 8.4%
Crystalloids: 1) isotonic 2) hypotonic 3) hypertonic
These are all the large factors that affect blood pressure (therefore hypotension) (think of the flow chart)
BP-> SVR (system vascular resistance) and CO
CO-> HR and SV (stroke volume)
Also CaO2
delivery of oxygen=cardiac output x oxygen content
What are ANES anatomic concerns in cats and how are they addressed
Intubation-cats prone to laryngeal spasm. so get right tube, don't overinflate, and lidocaine on laryngeal folds
tracheal rupture-most associated with procedures involving head or neck. clinical signs SQ emphysema and pneumomediastinum on rads. coughing, gagging, dyspnea, anorexia and fever
these are the 3 types of nociceptive neurons, which are more common and where do they synapse, and what part of the pain pathway are they apart, tell me about them
transduction pathway (alphas delta and C are most common and synapse in the dorsal horn of the spinal cord)
alpha delata-medium myelinated, fast/sharp pain, more localized
C fibers-small unmyelinated, slow/dull/aching pain, more diffuse
Alpha beta-large myelinated, pressure touch apart of central sensitization
These four particles are osmotically active, drawing water across a semipermeable membrane in response to them.
bonus what two others things effect plasma osmolality?
What are sodium, potassium, chloride, and glucose. Other two are urea and bicarbonate
What fluid type is used in pts with increased intracranial pressure and causes rapid expansion of the vascular compartment? Problems with it?
Hypertonic crystalloids: Limited use, Cause acidosis, hypernatremia and hyperchloremia, Can cause vasodilation
What are the factors that affect HR and how can they be treated?
SNS-analgesia (reduce opioid, adjunctive analgesic CRI, adjust inhalant)
PNS-anticholinergics
Rhythm-anticholinergics, antiarrhythmics (lidocaine)
These are the ANES alterations in total
These dog breeds have anes concerns based on antomic malformations, and what are the concerns and how do we combat them?
What are the toy, chondrodystrophic, and brachocephalic breeds.
brachycephalic-5 malformation: stenotic nares, elongated soft palate, everted laryngeal saccules, tracheal hypoplasia, redundant pharyngeal tissue. (have smaller ET tube) --> avoid heavy sedation, Gi meds, pre-oxy, recovery extend it out
chondrodystrophic breeds-dachshund, corgi, basset hounds-short curved legs, hard IV catheter, alterative site for catheterization, trachea longer than expected
toy breeds-poodle, yorkie, mini pinschers-high metabolism (hypoglycemia, high HR), prone to hypothermia, tracheal collapse-coughing, goose honk, hacking, wheezing, dyspnea, excerise intolerance
primary hyperalgesia-increased sensitivity to noxious stimulus at the site of tissue injury
secondary hyperalgesia-increased sensitivity to noxious stimulus outside the area of tissue injury
allodynia-normally non-noxious stimulus elicits pain
This is the percent dehydration seen if the animal has severe loss of skin elasticity, very dry oral mm. obvious sunken eyes, obvious signs of hypovolemia, altered mentation, +/- recumbency, anuria.
This is the percent dehydration seen if the animal if the animal has skin tenting, dry oral mm. sunken eyes, tachycardia/weak pulses/cool extremities
What is 10-12%
What is 8-10%
What type of fluid can cause acute kidney injury and coagulopathy? What are its positive effects?
What are the factors that affect SV and how can they be treated?
What are contractility, preload/venous return, afterload/vessel tone
contractility-ionotrophs
preload-Intravenous fluids (crystalloids, colloids, hyperosmotic agents)
afterload-ionotrophs (dopamine, dobutamine, nor, phenylephrine, vasopresin)
if contractility in cardiogenic shock give furosemide, manage arrh. systolic dysfunction-ionotrophos, too much sv nitros
In cats these 4 concomitant conditions are commonly seen
bonus What lab values will be needed with them?
What are renal dx, HCM, diabetes mellitus, and hyperthyroidism
Renal function on all older cats (BUN, creatine, USG, electrolytes [k] )
glucose, ketones for diabetics
thyroid hormone
How does pain affect cognition? how does it affect the cardio resp system?
cognition-anxiety, depression, impaired memory, impaired focus, sleep disruption
cardio resp-SNS upregulated-catecholamine release, increase HR, arrhythmias, vasoconstriction, resp-less effective ventilation-acute fasts breaths
Increased creatine can be seen with this injury because of
What acute kidney injury because of reduced renal blood flow.
If fluids are stopped abruptly in a sick pt that has had prolonged or high rates of fluids what will they have issues with and what should be done instead?
What is they will have issues concentrating their urine due to renal medullary washout from long term IV fluids. Instead, fluid therapy should be tapered.
What are the factors that affect SVR and how can they be treated?
what are circulating mediators and innervation
circulating mediators-vasopressors (dopamine, nor, vasopressin, phenylephrine)
These 5 drugs cause effects in cats with ANES and what are the effects
What is NSAIDS, propofol, anticholinergics, benzodiazepines, and opioids
opioids
benzodiazepines-potential for angry and aggressive behavior. seen in young to middle aged healthy cats.
anticholinergics-don't use atropine as a premed if cat induced with ketamine or telazol=death and increased risk of cardiac infarcts
NSAIDS-renal sensitivity, high or repeated doses can lead to decreased renal function. monitor bun and creatine in chronic therapy. meloxicam and robenacoxib are approved for cats
propofol-repeated use may result in heinz body formation.
What is the difference between peripheral sensitization and central sensitization
Peripheral-tissue injury and inflammation release may substances (inflammatory mediators, cytokines, NT), activate and sensitize nociceptors leading to --> primary hyperalgesia
central-intense and or ongoing nociceptive signals increase neuron excitability in the spinal cord and enhance the projection of pain signal to the brain (in dorsal horn). mechanisms-receptors: sensitized, greater numbers, and more active. Alpha beta involved. leads to--> primary and secondary hyperalgesia and allodynia.
Overall effect no incompartmental fluid shift occur, outcome is hypovolemia
Overall effect: both compartments have increased solute concentration
Overall effect: both compartments have decreased solute concentration
1) isotonic fluid loss, osmolality of ECF not change because fluid and solute losses are equal
2) hypotonic-lose water from ECF so fluid flows into ECF from ICF
3) hypertonic-loss solute from ECF so water moves from ECF into ICF
These are 4 things are signs of volume overload
What are chemosis (third eyelid), omental edema, nasal/endotracheal discharge, and limb edema
What are the factors that affect CaO2 and how can they be treated?
PCV transfusion. hb=PCV/3
These dog breeds have associated anes concerns and what are the concerns, +/-screening and tx
What are the artic, grey hounds and sighthound, doberman, mini schnauzer, boxer, and herding breeds.
doberman-von willebrand dx, screening BMBT, tx: desmopressin, cryoprecipitate, fresh whole blood
mini schnauzer-sick sinus syndrome, Pre op: ECG, NIBP, cardio consult
Boxer-ARVC- preop: ECG and NIBP, cardio work up. Also no Acepromazine
sighthounds: lean body mass, reduced CYP450, prolonged recovery with barbiturates, hyperkalemia with GA.
artic breeds-hyperthermia and rough recovery (give post op sedation)
herding breeds-ABCB1 gene: greatest effects at BBB, drugs ace and butorphanol. collies and aussies most effected
How does untreated pain affect overall pt outcome?
POST op pain-increases perioperative mortality, prolongs hospital stay, delays return to function. chronic pain increases mortality.
endocrine cascade-increased cortisol, insulin resistance, delayed wound healing, fluid retention
hypercoagulable, and see immunosuppression-reduced antibody production in chronic pain, accelerates metastasis.