Physiologic Considerations I
Age is not a disease but... _ _ are more likely.
Chronic conditions
You should rely on _ _ for cardiac output.
Stroke volume
An animal that is more active prior to surgery is more likely to have an improved...
recovery
Although a geriatric patient may seem quiet and compliant, the patient's _ should still be considered.
anxiety/stress
T/F: Post-op ventilation is easier for geriatrics if you let them do it on their own.
False. More work due to loss of muscle strength.
Name 1 physiologic consideration of the hepatic system.
Hepatic: decreased mass, decreased clearance of drugs, lower albumin (reduced protein binding).
Name 1 physiologic consideration of the renal system.
Renal: loss of nephrons, decreased GFR and excretory capacity, difficulty eliminating excess fluid and/or sodium.
What is the appropriate fasting time for an adult small animal?
6-8 hrs
When selecting an anesthesia plan for any patient, you should always ask yourself...
What are your goals?
T/F: You should never reduce MAC for a geriatric patient as they need more anesthetic.
False. Always reduce MAC.
What are physiologic considerations of the pulmonary system of a geriatric patient? Name 2.
Decreased total lung capacity
Loss of lung elasticity
Muscle mass loss
Increased work of breathing/less efficient gas exchange
What are physiologic considerations of the CV system of a geriatric patient? Name 3.
Fibrosis
Calcification
Myocardial fiber atrophy
Loss of vasculature elasticity
Decreased SNS response to stress
Decreased contractility
T/F: Do not weigh your geriatric patient the morning of surgery as this will put unnecessary stress on their joints.
False. Always get an accurate weight to recognize and address muscle loss.
Because geriatric patients have decreased hepatic mass, some combinations of drugs may have a...
increased clinical effect and prolonged half life
Keep interventions readily available...
Just do it.
What are physiologic considerations of the neuromuscular system of a geriatric patient? Name 2.
Decreased MAC
Loss of muscle mass (susceptible to hypothermia)
Position and handling
Neuronal degeneration
Slower return of cognitive function
What are the 3 goals of anesthetic management in mitral valve disease patients? 3 words.
Bonus: Which drugs contradict the goals of anesthetic management of mitral valve disease patients?
Faster (normal to high HR)
Fuller (fluid balance, do not overload)
Vasodilated (balanced afterload)
Bonus: A-2 agonists
T/F: It is best practice to get a BP reading while the patient is awake.
True. Baseline.
What are the 3 key parts of an anesthesia plan that will work for almost any patient (if there are no contraindications present)?
opioid, locoregional, NSAID
Provide cushioning and good positioning for comfort....
Just do it.
In dogs with mitral valve disease, (leakage/stenosis/regurgitation) causes (hypotrophy/hypertrophy). This leads to volume _ of the (right/left) atrium and ventricle.
regurgitation, hypertrophy
left
All in reference to mitral valve disease. Name drugs that can...
1. Reduce volume overload.
2. Reduce afterload.
3. Maintain contractility/positive inotropy
Bonus: Which drug should be discontinued 24hr before anesthesia and why?
1. furosemide/spironolactone
2. ACE inhibitors, pimobendan
3. pimobendan
Bonus: enalapril, can cause significant refractory hypotension
What tests should be run on geriatric patients prior to anesthesia? There are 3 main tests, there are 4 additional tests to consider.
Main: CBC, chemistry, urinalysis
Other: T4, NTproBNP, fructosamine, ACTH stim/LDDS
What are 2 things you should do to your patient while they are waiting to be anesthetized?
preoxygenate, preheat!