Test Review:

Anesthesia
Jenifer Sweet, B.A., S.R.S., L.A.T.
MPI Research
in coordination with
The Academy of Surgical Research
Testing Committee
 Overview
General Anesthesia Equipment
 Definition Review
 Stages of Anesthesia
 Considerations
Pharmacokinetics
 Method of action
 Modifying factors
Types of Anesthesia
 Pre-anesthetic Agents and Adjuncts
 Injectable Anesthetic Agents and
Adjuncts
 Inhalation Anesthesia
 Local and Regional Anesthesia

 Physical Methods of Anesthesia

General Anesthesia
What is general anesthesia?
Doses based on “average”
animal
Biological variations
Metabolic rate
% fat
General health
Sex
Genetics
Time of day
Species
Individualized sensitivity
The perfect anesthetic agent
does not exist
Stages of Anesthesia
4 Stages of Anesthesia
Stage I: “The stage of Stage II: “The stage of delirium
voluntary movement” or involuntary movement”
 Initial administration of anesthetic  CNS depression
to the loss of consciousness  Loss of voluntary control
 Tachycardia and hypertension  Exaggerated reflexes
 Irregular / increased respiration  Struggling, breath holding,
tachypnea, hyperventilation
 Breath holding
 Cardiac arrhythmias may occur
 Pupils dilate
 Eyelash and palpebral reflexes
 Struggling as animal becomes present
ataxic  Vocalization
 Some analgesic effects  Salivation
 Laryngeal spasm
Stages of Anesthesia
Stage III: “Stage of Surgical Anesthesia”
 Pulse rate returns to normal
Plane II:
 Muscles relax
Surgical Anesthesia
 Swallowing and vomiting reflexes lost
Bradycardia
 3-4 planes
Hypotension
 Plane I:
Capillary refill slows
Eyeball movement ceases
Palpebral reflex diminishes
Normal BP with strong pulse and disappears
Decrease of respiratory rate and depth Eyeball rotates ventrally
Pupils less dilated Abdominal muscle tone lost
Eyeball may rotate Minimal jaw tone
Palpebral reflex present Pedal reflex absent
Slight reaction to surgical manipulation Dysrhythmia possibility low
Loses jaw tone
Stages of Anesthesia
Stage III (cont): “Stage of Surgical Anesthesia”
 Plane III:  Plane IV:
 Deep surgical anesthesia  Deep/ Overdose
 Intercostal and abdominal muscle tone minimum  Dysrhythmia probability
 Weak corneal reflexes  Respirations slow and irregular
 Diaphragmatic breathing  Lowered HR

 Profound muscle relaxation  Cyanosis

 Widely dilated pupil and
 Centered and dilated pupils
unresponsive to light
 Bradycardia intensifies  Flaccid muscle tone
 Hypotension increases  Jaw tone lost
 Respiratory rate and depth decrease  Sphincter control lost
Pharmacokinetics
 Action of anesthetic on CNS
 Partial pressure gradients
 Inhalants vs. Injectables
 Distribution and clearance
 Modifying factors
 Concentration
 Plasma pH
 Protein binding
 Hydration
 Multiple drugs present
Effects of Disease
Cardiovascular dysfunction Neurologic disease
 Most anesthetics cause CV  Loss of ICF and CBF regulation
depression  Watch for respiratory depression
 Animals prone to fluid overload &
 Nitrous oxide contraindicated
arrhythmias
Renal disease
Pulmonary dysfunction
 Stress and anesthetic agents
 Most anesthetics cause
decrease rate of filtration
pulmonary depression
 Reduction in elimination = increase
 Balancing between lowering
in acidity and plasma
doses and preventing anxiety concentrations
 Intubation and ventilation are key
 Lingering effects
 Nitrous oxide contraindicated
 K+ increases in serum
Effects of Disease
 Hepatic disease
 Acepromazine, thiobarbiturates and α-2-adrenergic agents
contraindicated
 Propofol, ketamine and inhalation the safest
 Lowered elimination rate and coagulation
 Gastrointestinal disease
 Damaged GI can release toxins
 Decrease in cardiac function and ventilation
 Endocrine disorders
 Select anesthesia for easiest reversibility
Pre-anesthetic Agents and Adjuncts
 Anticholinergics
 Tranquilizers
 Opioids
 Alpha2adrenergic agonists
 Alpha2adrenergic antagonists
 Tranquilizer-opioid combinations
 Paralytic agents
Anticholinergics
Block acetylcholine receptors
Reduce secretions
Prevent vagal inhibition and GI stimulation
Reduce vagus nerve response (vomiting and laryngospasm)
Promote bronchodilation
Dilate the pupil
Treatment of choice for opioid, xylazine and vagal reflex activity induced
bradycardia
Anticholinergics
Atropine Sulfate Glycopyrrolate
 Contraindicated with tachycardia,
 Reduces diffusion over blood brain
constipation and obstruction
or placental membranes
 May cause thick mucus secretions
in cats  Lasts longer than atropine
 Atropine esterase occurs in cats,  Prevents ketamine/xylazine
rats, and rabbits
associated bradycardia in rabbits
 Minimally effective in sheep and
goats  Longer onset of action in ruminants
 Increased incidence of bloat
 Prolongs thiopental anesthesia
 Overdose: dry mucous
membranes, thirst, dilated pupils
and tachycardia (dogs most
susceptible)
 Can be treated with physostigmine
IV over several minutes
Tranquilizers
NO ANALGESIC EFFECTS
Relieve anxiety
Decrease anesthetic dosages
Reduce histamine release and vomiting
Make anesthetic recovery smoother
Promote skeletal muscle relaxation and vasodilatation
May lead to hypotension and excessive heat loss
May raise seizure thresholds/ act as anticonvulsants
Tranquilizers
Acepromazine Maleate Diazepam
 Phenothiazine  Benzodiazepine
 May reduce or prevent malignant  Prevents seizures
hypothermia in swine  Rapidly passes blood-brain and
Droperidol placental barriers
 Butyrophenone  Should be injected slowly to
prevent venous thrombosis and
 Alpha-adrenergic antagonist
should not be injected IA
 May prevent epinephrine induced
 IM injection not recommended-
dysrhythmias
painful
 Decreases barbiturate doses
 Primarily used as a component of
InnovarVt in a mixture with fentanyl
Tranquilizers
Midazolam Flumazenil
 Benzodiazepine  Reverses CNS action of
 Shorter duration of action and benzodiazepine without anxiety,
tachycardia, or hypertension
clearance than diazepam
 Rapid action (24 minutes)
 May cause behavioral changes in
dogs and cats  Replaced aminophylline and
 Suitable for IM injection physostigmine

 Can be mixed with other

preanesthetic agents
Opioids
Depress CNS
Lower the amount of anesthetic agents
needed
Do not cause unconsciousness at
therapeutic levels
Addictive
Most are controlled substances
Best for continuous dull pain
Opioids
Morphine sulfate Methadone hydrochloride
 Stimulates vomiting (Methadone, Dolophine)
 Decreases BMR and body temp  Synthetic opioid unrelated to
morphine
 Variable effects
 2-6 hours of analgesia
 Poor effects on neuropathic pain
 Decreases barbiturate dose by
Meperidine hydrochloride 50%
(Demerol, Pethidine) Oxymorphone hydrochloride
 Analgesic effect 1/10 of morphine (Numorphan)
 Rapidly excreted  Semi synthetic
 Does not cause vomiting  10 times more potent than
 Slow administration recommended morphine
 Provided effective epidural
analgesia
Opioids
Fentanyl citrate Sufentanil
 250 times more potent than  5 to 10 times as potent as fentanyl
morphine  Provided unpredictable anesthesia
 Rapid onset of action in dogs
 Short duration; peak at 30 minutes  Provides neuroleptanalgesia when
 Depressed respiration combined with tranquilizers and
glycopyrrolate
 Exaggerated response to loud
noise Alfentanil
 Little cardiac output or BP effects  1/5th to 1/10th as potent as fentanyl

Carfentanil citrate  80-1000 times more potent than

morphine SC
 10,000 times more potent than
 More rapid onset than fentanyl or
morphine
sufentanyl
 Used primarily for capture of wild
 Used primarily for the capture of
animals
wild animals
Opioids
Buprenorphine (Buprenex) Pentazocine lactate (Talwin)
 25 to 30 times as potent as  1/3rd as effective as morphine
morphine  Minimal CV effects
 Max analgesic effect less than
morphine
 Slow onset of action (20-30
minutes)
 Excreted in feces
Alpha 2 Adrenergic Agonists
Produce sedation, muscle relaxation and analgesia
Not potent respiratory depressant
Non-addictive
Anticonvulsants
Wide range of drug interactions
Barbiturate, inhalant and dissociative anesthetic doses should be lowered
used in combination with alpha 2 adrenergic agonists
Alpha 2 Adrenergic Agonists
Xylazine hydrochloride (Rompun) Detomidine
 Most common sedative/analgesic in  Sedative with analgesic properties
horses and cattle  Cardiac, respiratory and antidiuretic
 Short term surgical anesthetic when effects
combined with ketamine  Primarily used in horses
 Effects within 10-15 minutes IM or 3-5  Dexmedetomidine (Precedex)
minutes IV  More potent than medetomidine
 IV bolus causes bradycardia,  Sedative, analgesic, sympatholytic and
hypotension followed by decreased CO anxiolytic effects
and BP
 Sedation without respiratory depression
 Poor efficacy in swine
 Shortens time to extubation
 Wide margin of safety  Reduces anesthetic dosages
 May cause emesis in cats and dogs Clonidine
 Reduces insulin secretion, effecting Alpha-methyldopa
blood glucose levels
Medetomidine
 More potent than xylazine
 BP and RR decreases dose dependent
Alpha 2 Adrenergic Antagonists
 Used as reversal agents for injectable anesthetics
Yohimbine
Reverses xylazine
Also reverses ketamine and pentobarbital combinations when combined with
4-aminopyridine.
Tolazoline
Reverses xylazine and some anesthetic drug combinations with xylazine
Atipamezole
Selectivity ration 200 to 300 times higher than yohimbine
Rapid IV doses may cause death or severe hypotension and tachycardia
Tranquilizer-Opioid Combinations
 Provide neuroleptanalgesia
 Intense analgesic action with short duration

Fentanyl citrate Droperidol (Innovarvet)

Wide margin of safety with easy recovery
Partially reversed with opioid antagonists
Paralytics
 Provide superior muscle relaxation as an adjunct to general anesthesia
 DO NOT PROVIDE ANALGESIA OR UNCONSCIOUSNESS
 Prohibited as a sole anesthetic by the Guide
 Mechanical ventilation required
 More difficult anesthesia management
Paralytics
 Succinylcholine  Vecuronium
 Depolarizing neuromuscular paralytic  More potent and shorter acting than
pancuronium
 Marked twitching for 30 minutes before
muscle relaxation  rapid recovery
 Muscle pain and stiffness associated  no effect on HR
 Rise in intraocular pressure  Widely used
 Cats, swine and ponies resistant  do not use with renal or hepatic failure
 May not be reversible  Pipecuronium
 Pancuronium  Long acting- twice duration of
pancuronium
 Lasts 20 to 30 minutes
 2 to 4 times as potent as pancuronium
 Causes increased HR
 Rapid onset
 Metabolized in liver, excreted via
kidneys  Retained in kidneys for days
 no effect on HR
Paralytics (continued)
 Rocuronium  Atracurium
 20% as potent as vecuronium  Unstable- refrigerate
 Rapid recovery  Intermediate muscle relaxant
 Curare (dTubocurarine)  Widely used
 Long acting  Doxacurium
 Increases HR  Long acting
 Metocurine  No autonomic side effects
 Safer than curare  Mivacurium
 Gallamine  Lasts slightly longer than
succinylcholine and ½ the duration of
 Long acting vecuronium
 Produces tachycardia  No autonomic side effects
 The only non-depolarizing agent to
cross the placenta
Paralytic Reversal Agents
 Anticholinerases
 Bradycardia, arrhythmias, secretions
 CNS stimulation
 Edrophonium, neostigmine, pyridostigmine
 4 Aminopyridine and Guanidine
 Calcium
 Only partially effective
Injectable Anesthetic Agents and Adjuncts
 Enter blood stream for transport to target tissues
 Require redistribution
 Generally detoxified in liver and excreted via kidneys
 Metabolism based on first order kinetics
 Constant fraction metabolized in a given period
 Less control of elimination process
 Barbiturates
Barbiturates
Divided into Ultra short, Short, Intermediate and Long acting
Depress CNS neurons
May lead to respiratory depression, central and peripheral CV
depression, decreased BP and BMR, reduced stroke volume and
increased HR
Hypnotic sedatives
Cross cell walls and placental membrane
Glucose effect in some animals
Should not be administered to animals less than 3 months old
IV administration preferred
Barbiturate slough may occur
Oxybarbiturates
Thiobarbiturates
Oxybarbiturates
Phenobarbital Sodium Methohexital Sodium (Brevital)
 Long acting  Ultra short acting (redistribution)
 Effective anticonvulsant  Respiratory failure with overdose
 Excreted slowly and cumulative  Good for induction
Pentobarbital Sodium
 Short acting
 Initial spike in HR followed by a
decrease in HR and BP
 Prolonged use leads to decreased
systolic BP, stroke volume, pulse
pressure, CO, pH, and BT (shock-like)
 Crosses placenta
 Tranquilizers advised for smooth
recovery
Thiobarbiturates
Thiopental sodium Thiamylal sodium
 Ultra short acting  Ultra short acting
 Most secreted in urine within 4  IV bolus lasts approx. 15 minutes
days  Less cumulative than thiopental
 Initial respiratory depression  Less CV effects than thiopental
 Increase in HR, BP and vascular
resistance
Non-Barbiturate Anesthetics
Althesin Chloralose
 Don’t use with barbiturates  Minimal CV depression
 Good muscle relaxation  Less depression of neuronal
 May cause allergic reaction function
 Long duration, acute procedures
Chloral Hydrate, U.S.P.
 Oral admin may cause vomiting
Urethane, N.F.
 Carcinogenic
 Depresses cerebrum
 Good hypnotic/poor anesthetic Magnesium sulfate
 Amount needed for anesthesia  Globally depresses CNS
close to lethal dose  Means of euthanasia after
unconsciousness
Non-Barbiturate Anesthetics
Metomidate (Hypnodil) Propofol
 Hypnotic w/ relaxant properties  Supports microbial growth
 Sleep without anesthesia  Rapid uptake into CNS
Etomidate  Quick and smooth recovery
 No depression of CV or respiratory  Minimal analgesic effects
centers Propanidid
 Does not trigger MH in swine
 Extremely short duration of action
 Anticonvulsant properties
 Difficult to administer fast enough
 Venous pain during injection
 Severe respiratory depression and
hypotension in dogs
Tricaine Methanesulfonate (MS222)
 Anesthesia of fish and amphibians
Dissociative Anesthetics
 Interrupts transmission from the unconscious to the conscious brain
 Characterized by a cataleptic state in which eyes remain open and
nystagmus present
Ketamine Telazol
 Least potent  Tiletamine hydrochloride and
 Rapid onset of action Zolazepam
 Wide safety margin
 Rapid redistribution
 Tissue irritation due to low pH (3.5)  Rapid and smooth
induction/recovery
 Analgesic effects greater for
 Good muscle relaxant
somatic pain than visceral pain
 Transient decrease in respiratory  Lingering analgesic effects
rate  May cause increased HR and
 Hallucinatory behavior respirations
 Decrease in MAP
Inhalation Anesthesia
 Administration and elimination through lungs
 Dependent upon:
 Vapor pressure
 Boyle’s law
 Dalton’s law
 Temperature
 Charles’ law
 Solubility
 Partition coefficients
 Pharmacokinetics
 Biotransformation
 MAC
 Much more control
Inhalation Anesthetics

Historical Inhalant Agents

 Chloroform
 Cyclopropane
 Diethyl ether
 Fluroxene
 Trichlorethylene
Inhalation Anesthetics
Nitrous oxide Ether
 Rapid onset  Explosive
 Minimal cardiovascular, liver and  Highly irritating
kidney effects
Methoxyflurane
 May cause pneumothorax, blood
embolus, increase in middle ear  Low volatility
pressure  High solubility
 Must be combined with another  Extensively metabolized
agent
 Respiratory depressant
 Beware of diffusion hypoxia
Isoflurane
Halothane
 Potent and low solubility
 Potent and rapid onset
 Rapid induction and recovery
 High volatility
 “Safer” than halothane
 Respiratory depression
 Coronary vasodilator
 Mixed with thymol for stability
Inhalation Anesthetics
Desflurane
 Very rapid induction and recovery
 Lower solubility than isoflurane
 Respiratory irritant
 Requires heated vaporizer
Sevoflurane
 Very rapid induction and recovery
 Lower solubility than isoflurane,
halothane or methoxyflurane
Local and Regional Anesthesia
 Administration  Examples
 Topical  Lidocaine

  Proparacaine
Solution in gel or aerosol
 Benzocaine
 Injectable local
 Tetracaine
 Ring block
 Butacaine
 Brachial plexus block
 Epidural
 IV regional block
 Intercostal nerve
blocks
• Affects 2 adjacent
intercostal spaces
 Muscle nerve blocks
• For extensive surgical
manipulation
• Interpleural admin
Physical Methods of Anesthesia
 Hypothermia
 Some vital organs can survive for longer
periods at low temps with reduced blood
supply
 Risks profound CNS and vital organ
depression
 <28°C may cause VF
 Prolonged clotting time
 3 methods of hypothermia
 Surface
 Body cavity
 extracorporeal
 Electronarcosis
 Delivered via electrodes applied to head
 Convulsions during induction
 Difficult to monitor and questionably
humane
 Acupuncture
 Useful for chronic pain
Equipment
 Anesthesia machine
 Components
 Vaporizer in circuit or out of circuit?
 Rebreathing, non-rebreathing, semi-closed
circuits
 CO2 absorber/ Scavenging
 Medical gas cylinders
 Color codes
 Airway maintenance
 Endotracheal tubes
 Laryngoscope blades
Review:
What do you need to know?

 Know your drugs- what group they belong to and what

they do
 Know the stages of anesthesia
 Have a basic understanding of the pharmacokinetics
behind anesthesia
 Know your patient and how biological variations can
effect anesthesia
 Be familiar with anesthetic equipment
 Areas not covered in depth: fasting, thermoregulation,
fluids and acid/base balance
Good Luck!