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Manual of Equine Anesthesia and Analgesia
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Страница 1
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Страница 7
Страница 8
Страница 9
Страница 10
Страница 11
1 Preoperative Evaluation and Patient Preparation The Risk of Equine Anesthesia
I Risk of equine anesthesia
II Classification of physical status (see
Box 1.1
)
Box 1.1
ASA Classification System
III Risk factors A Age and physical status
B Type of surgery and recovery
C Time of day
D Body position
E Drug choice
F Duration and management of anesthesia
Suggested Reading
Patient Preparation
I Preparation of the horse A Evaluation
B Laboratory tests
C Physical examination
D History
E Fasting
F Medications
G Jugular catheter
H Flushing the oral cavity
I Removal of shoes
Suggested Reading
2 Serum Chemistry and Hematology
I Complete blood count (CBC) A Erythrocytes
B Leukocytes
Neutrophils
Eosinophils
Lymphocytes
Monocytes and Basophils
C Platelets
Thrombocytosis
(platelet count >400 000/μl)
Thrombocytopenia
(platelet count <75 000/μl)
II Blood chemistry interpretation
A Creatine kinase (
CK
)
B Aspartate aminotransferase (AST)
C Gamma glutamyl transferase (GGT)
Urinary GGT
D
Alkaline phosphatase
(
ALP
)
E Sorbitol (Iditol) dehydrogenase (SDH)
F
Total bilirubin
(
TBIL
)
G
Serum bile acids
(
SBA
)
H
Blood urea nitrogen
(
BUN
) and
creatinine
(
Cr
)
Pre‐renal azotemia
Renal azotemia
Post‐renal azotemia
III Plasma proteins
A Albumin
Hypoalbuminemia can result from:
B Globulins
Hyperglobulinemia
Hypoglobulinemia
C Fibrinogen
IV Lactate
Suggested Reading
Страница 66
3
The Cardiovascular System: Physiology of the Cardiovascular System
I Anatomy A Chambers
Atria
Ventricles
Atrio‐ventricular valves
Semilunar valves
B Structural or “skeletal” components of the heart
C Neural input to the heart
II Cardiac contractions A Initiation
B Components of the specialized electrical conducting system
III Unique features of the equine heart
IV Circulatory systems
A Components of the systemic circulation
B Components of the pulmonary circulation
C Blood
V Cardiovascular physiology
A Events occurring during late diastole
B Events occurring during systole
C Events occurring at the end of the ejection period (late systole/early diastole)
D Events occurring during early diastole
VI Cardiovascular function and clinical applications
A Cardiac output
Factors affecting cardiac output:
B Heart rate
Factors influencing HR:
C Stroke volume (SV)
Preload
Afterload
Contractility (inotropy)
Relaxation (lusitropy)
D Blood Pressure (see
Table 3.2
)
E Physics of flow
Ohm's law
Poiseuille's law (Hagan‐Poiseuille)
Laplace's law
Starling's law (Frank‐Starling mechanism,
see
Table 3.1
)
F Tissue oxygen delivery
Box 3.1
Effects of Decreases in [Hb] and SaO
2
on CaO
2
VII Anesthesia A Effects of anesthetic drugs (see
Table 3.3
)
B Effects of cardiovascular disease
VIII Cardiovascular disease in horses presented for anesthesia A Diseases of the conducting system
Atrial fibrillation
B Congenital disease
C Primary myocardial disease
D Secondary cardiovascular compromise
IX Anesthetic plan for horses with cardiovascular disease A Patient preparation
B Sedation and induction
C Maintenance
D Recovery
Evaluation of the Cardiovascular System
I Cardiovascular evaluation A Body condition
B Edema
C Mucous membranes
Color:
Moistness:
Exposure:
Capillary refill time
(
CRT
)
:
D Peripheral arteries (pulses)
Sites for palpation:
Assessment of the pulse:
E Peripheral veins
Jugular vein waveforms
Occluding the jugular vein
F Heart
Cardiac silhouette
Heart rate
Heart rhythm
Auscultation
Left side heart sounds
:
Right side heart sounds
:
Normal heart sounds
(see
Figure 3.1
)
ECG
(see Section III below)
II Heart murmurs
A Location
B Timing in cardiac cycle
C Intensity
Sounds
D Physiologic (non‐pathologic) murmurs
E Pathologic murmurs
III Electrocardiogram The elements of the ECG (see
Figure 3.3
)
B Evaluation of the ECG
Is each QRS complex preceded by a P wave?
Is each P wave followed by a QRS complex?
IV Arrhythmias
A Bradycardia
B Tachycardia
C Second‐degree AV blockade (see
Figure 3.4
)
D Atrial fibrillation (see
Figure 3.5
)
Treatment of atrial fibrillation
E Atrial flutter
F
Premature atrial contractions
(
PACs
)
Treatment
G
Premature ventricular complexes
(
PVCs
)
(see
Figures 3.6
and
3.7
)
Treatment of single PVCs
Treatment of multiple PVCs
H
Ventricular tachycardia
(
VT
)
(see
Figure 3.8
)
Treatment
Suggested Reading
4 The Respiratory System: Anatomy of the Equine Respiratory System
I Organization of respiratory system
A Conducting components
B Gas exchange components
II Tubular organs
A Tunica mucosa
B Tunica submucosa
C Tunica muscularis
D Tunica adventitia
III Nasal cavity
IV Paranasal sinuses
V Pharynx
Guttural pouch
VI Larynx (see
Figure 4.1
)
A Cartilages
B Innervation of the larynx
VII Trachea
VIII Lungs and pulmonary circulation
A Blood supply
B Nerve supply
IX Bronchi and bronchioles
X Respiratory epithelium
XI Alveolar region
A Alveoli
B Type I pneumocytes
C Type II pneumocytes
XII Blood–air barrier
XIII Muscles of respiration
Suggested Reading
Physiology of the Respiratory System
I Alveolar ventilation (V
A
)
A Mechanics of ventilation
B Work of breathing
C Lung and airway resistance
II Lung volumes (see Figure
4.2
) A Minute ventilation (V
E
)
B Tidal volume (V
T
)
C Dead space
D Measurement of dead space – Bohr equation
Factors that increase dead space include
E
Functional residual capacity
(
FRC
)
III Pulmonary compliance
A Distribution of alveolar ventilation
B Factors decreasing pulmonary compliance
IV Alveolar perfusion A Lung blood flow
B Distribution of blood flow in lung
C Hypoxic pulmonary vasoconstriction
D Ventilation/perfusion (V/Q) ratio (see
Figure 4.4
)
V Alveolar gas exchange A Composition of gases
B Movement of gases
C Factors influencing diffusion
D Carbon dioxide
E Oxygen
F Alveolar‐arterial oxygen gradient [P(A-a)O
2
]
G Arterial/alveolar ratio
H Oxygen carriage
I Oxygen binding to Hb
J Shunting and oxygenation
VI Effects of sedation and anesthesia on respiratory function A Sedation
B General anesthesia
C Mechanisms for decreased oxygenation
Suggested Reading
Evaluation of the Respiratory System
A Patient history
B Physical examination
Auscultation
Airway Management
I Larynx A Function
B Innervation
C Recurrent laryngeal nerve neuropathy
D Iatrogenic laryngeal neuropathy
E
Hyperkalemic periodic paralysis
(
HYPP
)
II Assessment of airway A History
B Physical examination
C Situations in which difficulty is to be expected
III Airway equipment
A Mouth gag
B Laryngoscope
C Endotracheal tubes
D Inflatable cuffs
IV Complications of airway intubation A Tissue damage
B Edema
C Over inflation of the cuff
D Lubrication
V Intubation of trachea A Difficulty
B Position
C Technique
D Confirmation of tracheal tube placement
E Intubation of the difficult airway
VI Extubation of the trachea
VII Airway obstruction
A Signs of airway obstruction include:
B Laryngospasm
C Obstruction of the upper airway
At induction
Management
Intraoperative obstruction
At extubation
Management
D Obstruction of the nasal passages due to edema
E Obstruction of the nasal passages due to nasal bleeding
Suggested Reading
Tracheostomy
I Terminology
Temporary tracheostomy
Permanent tracheostomy
(see
Figure 4.11
)
II Indications
III Surgical anatomy
IV Tracheostomy tubes (see
Figure 4.12
)
V Technique
VI Post‐operative care
VII Complications
Suggested Reading
5 The Renal System
I Role of the kidney
II Normal anatomy and physiology
A The nephron
The glomerulus
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
(
DCT
)
Collecting duct
Equine urine
B Renal blood flow and GFR
Renal blood flow
(
RBF
)
Renal plasma flow
(
RPF
)
Filtration fraction
(
FF
)
Glomerular filtration rate
(
GFR
)
Autoregulation
Tubuloglomerular feedback
(
TGF
)
C Urine formation
D Urine volume in the horse
Comments
:
III
Renin‐Angiotensin‐Aldosterone‐System
(
RAAS
)
(see
Figure 5.2
)
Renin
Angiotensin I to Angiotensin II
Effects of Angiotensin II
Angiotensin III and IV
Aldosterone
Angiotensin‐converting enzyme (ACE) inhibitors
(e.g.
enalapril)
IV Effects of anesthetics on renal function
A Changes in RBF with anesthetics
B Inhalational anesthetics
Methoxyflurane
Sevoflurane
Compound A
C
α
2
adrenergic agonists
D Other injectable sedatives and anesthetics
Phenothiazines
Benzodiazepines
Opioids
NMDA antagonists
Propofol
E Intermittent positive pressure ventilation
F Stress
V Diuretics
A Osmotic diuretics (e.g.
mannitol
)
B Carbonic anhydrase inhibitors (e.g.
acetazolamide
)
Use in potential HYPP episodes
: (see HYPP
Chapter 38
)
C Loop diuretics (e.g. furosemide)
D Thiazide diuretics (e.g. hydrochlorothiazide)
E Potassium sparing diuretics
Aldosterone inhibitors
(e.g.
spironolactone)
Sodium channel blockers
(e.g.
amiloride)
VI Nonsteroidal anti‐inflammatory drugs
Suggested Reading
6 Neurophysiology and Neuroanesthesia
I Neurophysiology Membrane potentials
B Synaptic transmission
C Brain metabolism
D Cerebral blood flow
E
Cerebral perfusion pressure
(
CPP
)
F
Cerebrospinal fluid
(
CSF
)
II Central nervous system pathophysiology A Seizures
B Intracranial pressure (ICP) increase
III Neuroanesthesia
A Cerebral metabolic rate
B Cerebral blood flow and perfusion pressure
Anesthetic drugs
Increased PaCO
2
Positive pressure ventilation of lungs
Venous return
Head position
C Autoregulation
IV Neuroanesthesia for specific procedures
A CSF withdrawal
B Increased intracranial pressure
Includes head trauma, abscess, and tumor removal
.
Preparation
Sedation, premedication, and induction
Induction of anesthesia in foals
Sedation of adult horses
Maintenance of anesthesia
C Cerebral edema
Drug‐induced decompression
Ventilation
D Seizures
Anesthesia of horses prone to seizures
Suggested Reading
7 The Autonomic Nervous System
I General organization of the ANS (functional anatomy)
A Central autonomic nervous system
B Peripheral autonomic nervous system
C Afferent input
D Efferent output
II Physiology of the autonomic nervous system A Neurotransmitters
B Synthesis, duration of action, and degradation of ACh
C Synthesis, duration of action, and removal of NE
D Receptors on the effector organs
Cholinergic
receptors are subdivided into
muscarinic
and
nicotinic
.
Adrenergic receptors
are subdivided into
alpha
(α
1
and α
2
),
beta
(β
1
and β
2
), and
dopaminergic
(DA).
Dopaminergic receptors
III Function of the adrenal medulla A SNS innervation of the adrenals
B Effect of NE release from adrenals
C Effect of EPI release from adrenals
IV Autonomic effects on the cardiovascular system A The heart
B Systemic blood vessels
C Effects of SNS and PNS stimulation on arterial pressure
D Cardiovascular autonomic reflexes
V Autonomic effects on the pulmonary system
VI Pharmacology of the ANS A Drugs that act on adrenergic effector organs (sympathomimetic drugs)
B Drugs that cause release of NE from nerve endings
C Drugs that have a PNS potentiating effect (anticholinesterase drugs)
D Drugs that block cholinergic activity at effector organs (antimuscarinic drugs) (see
Table 7.5
)
VII Clinical use of autonomic drugs
A Hypotension (see
Chapter 38
)
B Cardiac arrest
C Bradycardia
D Circulatory shock
E Bronchodilation
F Priapism (see
Chapter 38
)
G Reversal of neuromuscular block (see
Chapter 15
)
H Spasmolytic effect
Suggested Reading
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