1. Why is postoperative care as one facet of adequate veterinary care so important?
2. Who has the final authority for the provision of adequate veterinary care, including presurgical and postsurgical care?
a) the IACUC
b) the Institutional Official
c) the facility manager
d) the attending veterinarian
3. Can responsibilities for postoperative care be delegated to somebody else than a veterinarian?
4. Name basic conditions of recovery areas after surgery!
5. All of the following are adequate recovery areas, except:
a) separate anesthesia recovery area close to the surgery suite
b) rooms, runs, or cages where the animal will remain for the rest of the study that are easily accessible, clean, warm, comfortable etc.
c) in the original home cages without any changes to the preoperative status
d) in the original home cage with precautions for adequate surveillance, warmth, and safety
e) intensive care units.
6. The proper recovery environment should minimize animal anxiety, fear, and social stresses and optimize comfort and well-being. Name at least five factors that fulfill these objectives!
7. Table I at page 381 lists equipment, supplies, and drugs that may be required in postoperative care of ICU settings. What does analeptic mean? Name 3 analeptic drugs!
8. Why are general nursing care protocols desirable?
9. SOP’s define how to perform a particular activity. What influences the degree of detail in a SOP?
10. Ideally, trained veterinary personnel should be responsible for postoperative monitoring and for supportive and intensive care. However, research personnel may also perform such activities. Who is responsible for the training of scientists, animals technicians, and other personnel involved in the above mentioned activities?
a) according to the AWA and 9CFR
b) according to the Guide
c) according to the PHS Policy on Humane Care and Use of Lab Animals
d) according to the Guide for the Care and Use of Agricultural Animals in Agricultural Research and Teaching
11. Personnel training can be achieved via a number of approaches, except:
a) formal classes
b) on the job training as an adequate member of the surgical/anesthesia team
c) individual or small group practical training sessions under close supervision.
12. Records of postoperative and intensive care unit care should be maintained as part of the animal’s medical record. Name three reasons why this is important!
13. True/False: A general guideline for recordkeeping is that the type of record used should be appropriate for the species and procedure of concern and fulfill current regulatory requirements.
14. Name important information that should be included in those records!
15. True/False: The style of the records of a particular research project is of paramount importance.
16. Who is responsible for the development of guidelines for postoperative care?
a) the attending veterinarian
b) the IACUC
c) the institution
17. What are the three overlapping phases of the postoperative period?
18. What are special considerations during recovery from anesthesia
a) in general important for all species
b) rabbits, dogs, cats, and small pigs
19. What are useful observations during the long-term postoperative period?
20. The monitoring and assessment of animal pain and the need for analgesic treatment is best accomplished by observation of the animal. What other additional parameters can help?
21. Name nonspecific signs of pain, distress, and discomfort!
22. List physiological indicators of pain or distress!
23. What abnormalities regarding pattern and sounds can be observed/auscultated in animals experiencing respiratory difficulties?
24. Define hyperpnea, polypnea, tachypnea, and dyspnea!
25. Define hypercapnia (also hypercarbia called)! What can cause hypercapnia?
26. What are reasons for hypocapnia and what effect has a PaC02 < 20 mmHg?
27. What does a venous PCO2 reflect?
28. What are normal ranges of PaO2 and PvO2?
29. Explain the term venous admixture and list the four causes of it!
30. Which three distinctly different aspects of cardiovascular function should be evaluated in order to obtain an overall assessment of CV effectiveness?
31. Name the electrical abnormalities commonly encountered and there causes!
32. How can the mechanical activity of the heart in a simple way be evaluated?
33. What factors can induce decreased peripheral perfusion?
34. In what way is central venous pressure (CVP) helpful to monitor during anesthesia?
35. What are the determinants of arterial blood pressure?
36. What causes hypotension?
37. Renal function is important to monitor during anesthesia. Urine output can be a valuable tool in assessing the adequacy of hydration, circulation volume, and visceral perfusion! What are reasons for oliguria or anuria?
38. Intermittent or indwelling urinary catheters may be indicated for quantified urine collection for renal function tests or pharmacokinetic studies. Those catheters predispose to what conditions and how is it best avoided?
39. The mental status, activity, and behavior of the patient should be monitored as a general index of animal welfare. What do the following symptoms/conditions suggest:
a) light-reactive, mydriatic pupils
b) light-reactive, miotic or unequal pupils with physiological nystagmus
c) bilaterally unresponsive miotic or mydriatic pupils and the absence of physiological nystagmus +/- irregular breating pattern
d) agonal gasps and apnea
e) multiple cranial nerve dysfunction
f) decerebrate rigidity?
40. What should be done when cerebral edema is suspected?
41. Some animals, especially nonhuman primates, rabbits, and rodents, will remove conventional skin sutures, causing incisional trauma, dehiscence and associated complications. What can be done to prevent injury or self-trauma?
42. Certain research procedures will necessitate the implant of devices such as catheters, recording leads, telemetry devices, flow probes, cephalic recording devices, and orthopedic implants. In addition to the specific care of the implanted device, often described as a part of the model, periodic monitoring of the animal should be performed. List parameters that should frequently be monitored!
43. Identification and treatment of postoperative infections are important parts of patient monitoring and care. What are factors that increase the risk of infection and should receive special consideration in research protocols?
44. Name the cardinal signs of infection/inflammation!
45. Localized wound infections may manifest as paraincisional cellulites or abscessation. Besides antibiotics, what treatment should be instituted?
46. Consideration has to be given to species intolerances of particular antibiotic regimens. All of the following examples are true, except:
a) Guinea pigs and hamsters are among the most sensitive to antibiotic-induced gastrointestinal disturbances,
b) Certain antibiotics may be associated with enteric disturbances and death in rabbits but oral administration of ampicillin, low doses of lincomycin and the administration of erythromycin are well tolerated in rabbits,
c) Penicillin, lincomycin, and erythromycin have reportedly caused gastrointestinal problems in guinea pigs and hamsters
d) Antibiotics such as fluoroquinolones, trimethoprim/sulfonamides, chloramphenicol, and gentamycin are effective and well tolerated in guinea pigs.
47. Why is adequate nutrition of the intensive care or postoperative veterinary patient an important component of supportive care?
48. A number of equations are available to determine the energy needs of animals under differing conditions of activity, development, and disease. To calculate the total energy requirements a disease factor may be assigned for certain illnesses. True/False: The highest disease factor is used for burn or head trauma patients.
49. Significant deviations from average energy requirements are reported for a number of species. Some adult desert rodents, desert carnivores, and fossorial rodents have lower metabolic rates than those predicted for placental mammals as a group. True/False: Marsupial metallic rates are approximately 30% higher than those of the placental mammals.
50. Methods of nutritional support can be enteral and parenteral. Name some examples for both ways of nutritional support!
51. The placement of an indwelling vascular catheter may be required for the short-term administration of intravenous fluids and medications in the perioperative period. Name the most common sites for placement of peripheral venous catheters in the dog, cat, goat, sheep, calf, rabbit, ferret, monkey, pig!
52. List other routes of administration of fluids and medication in small species where the intravenous route is usually not feasible!
53. What is the device of choice for long-term administration of drugs/fluid or blood collections?
54. Naturally occurring fluid loss can be divided into four broad categories: (1) whole blood loss, (2) predominantly extracellular fluid losses that have electrolyte compositions similar to that of the extracellular fluid compartment (ECF), (3) ECF fluid losses that are high in protein, and (4) pure waterlosses such as evaporation from the respiratory and skin surfaces. Name examples for (2) and (3)!
55. List some clinical signs of a vascular volume deficit!
56. The clinical sign of an interstitial fluid deficit is an increased tendency for the skin to retain its position after it has been lifted into a fold. An interstitial fluid deficit is expected in all categories of fluid loss except ………
57. If a patient is judged to be vascular volume depleted, blood volume restoration therapy should be instituted. List the three different groups of solutions used for blood volume restoration!
58. The volume restoration achieved by crystalloid fluids may be fleeting. How many percent of the crystalloid solutions remain in the vascular fluid compartment 30 min following their administration?
59. When is the administration of hypertonic saline indicated?
60. What are the criteria for colloid administration instead of crystalloids?
61. What should be considered for blood transfusions?
62. All of the following may be sings of a immunologic transfusion reaction, except:
a) restlessness or acute collapse
d) dyspnea, wheezing
e) urticaria, fever
f) hemoglobinemia or hemoglobinuria.
63. What should be considered when developing a fluid plan once the life-threatening hypovolemia and electrolyte imbalances have been corrected?
64. How can deficits be determined?
Chapter 17: Current Research in Anesthesia and Trends in Clinical Applications
1. GABA stands for _____. It is an (excitatory or inhibitory?) neurotransmitter.
2. __ is the ion whose movement across the neuronal cell membrane is most affected by GABA.
3. Benzodiazepines (increase or decrease?) the potency of GABA.
4. Among the intravenous anesthetic agents, which of these enhance GABAA receptor function, as reflected by increased Cl - flux?
e) all of the above
5. Glutamate is an (excitatory or inhibitory?) neurotransmitter.
6. True or False. The effects of _2 adrenergic agonists are known to be mediated through a pertussis toxin-sensitive G protein.
7. True or False. _2 agonists have little to no analgesic properties when administered epidurally.
8. _2 adrenergic receptors are found in all the following tissues EXCEPT:
f. skeletal muscle
9. The functions of voltage-gated K+ channels in the brain include:
a. termination of the action potential
b. regulating neurotransmitter release
c. repolarizing the neuron
d. setting the resting potential.
e. all of the above
10. True or False. In the anesthetic Telazol, both tiletamine and zolazepam are excreted by the kidneys.
11. Flumazenil is a centrally acting antagonist of:
12. Sevoflurane and desflurane are (more or less?) soluble than isoflurane or halothane.
13. Sevoflurane and desflurane are (more or less?) potent than isoflurane or halothane.
14. True or False. Soda lime (Baralyme) will degrade sevoflurane and produce a toxic olefin breakdown product.
15. True or False. In computer-controlled drug delivery, intravenous pumps can be programmed to infuse a drug according to pharmacokinetic data obtained from multicompartmental models, in order to rapidly achieve and maintain a steady state plasma concentration.
16. The space between the spinal cord dura and the vertebral canal is the ____ space.
17. Spinal, or intrathecal, anesthesia involves injecting local anesthetic in the ___ space.
18. Compared to systemic administration, the epidural route requires (lower or higher) doses of opioids and _2-adrenergic agonists to achieve a similar effect.
19. True or False. Local anesthetics such as lidocaine and bupivicaine do not affect motor nerve function.
20. Local anesthetics cause (vasodilation or vasoconstriction) in the
21. Clonidine is in what class of drugs?
c. _2-adrenergic agonist
22. True or False. Substance P (SP) is an important
neurotransmitter in the nociceptive pathway.
23. True or False. Neuraxial administration (epidural or
intrathecal) of opioids results in elimination of pain, with no side
Anesthesia and Analgesia in Laboratory Animals: Chapter 1: Pharmacology of Injectable Anesthetics
1. a 24. d,
2. b 25. c
3. b 26. d
4. a 27. d
5. True 28 a
6. True 29. c
7. c 30. b
8. a 31. a
9. c 32. False
10 .a 33. a
11 .c 34. False
12. c 35. b
13. c 36. d
14. b 37 d
15. c 38. d
16. True 39. a
17. True 40. d
18. a 41. a
19. d 42. c
20. True 43. c
21. True 44. b
22. b 45. b
Chapter 2 - Pharmacology of Inhalation Anesthetics
1. (b): the rapidity with which the animal can be induced and recovered: page 30, right column
2. (d): the brain blood flow and blood solubility of the agent will determine the rate of equilibration: page 30, right column
3. (c): is directly related to the maximum concentration of volatile anesthetic than can be achieved in the inhaled volume: page 31, left column
4. (d): correspondingly greater time will be required to bring brain tissue into equilibrium and anesthesia: page 32, left column
5. True: the smaller the animal, all other things (temperature, healthy lung etc) being equal, will equilibrate more rapidly than the latter animals; page 32, left column.
6. (a): uptake of anesthetic gas by the material of the anesthetic circuit: page 33, right column
7. False. The smaller the animal, the rapid is equilibration. Page 33, left column.
8. (d). the concentration of volatile anesthetic in the alveolar air that will produce analgesia in 50% of the patients or in the same patient, 50% of the time. Page 33, right column
**** Be careful of this area. The lead off sentence says MAC produced immobility in 50% of the test subjects. Three sentences further, MAC is defined as the alveolar concentration that produces analgesia to a noxious stimulus in 50% of the patients.
9. (a) this anesthetic has the same potency in these species. Page 34
10. (c) reduction = 1.5 degrees x 5% = 7.5% ([0.075 x 0.87] – 0.87 = 0.80%
(a) age, catecholamine releasers, other volatile anesthetics, and sedatives. Page 34 –35
(b) the liver and kidney are targeted by halogen radicals. Page 35, right side
(d) gamma aminobutyric acid (GAMA). Page 35 (right side)/36 (left sdie)
(b) surgical anesthesia can not be effected without hypoxemia. Page 36, right side
False. Nitrous oxide is not soluble in blood or tissue fluids and equilibrium is achieve exceedingly rapidly. Page 36, right side
(c) the toxicity of the metabolic products even at low doses over long periods of time. Page 37, left and right side
(d) provides for both rapid induction and recovery from surgery. Page 37, right side
(a) isoflurane has less myocardial depressant activity than does halothane. Page 38, left side
(d) the gas mixture that is expelled at the end of expriation. Page 39, left side
(a) for sampling of several agents being used simultaneously. Page 39, right side
Anesthesia and Analgesia in Laboratory Animals
1 (d) cyclooxygenase
4 (a) PGE2
5 (b) cyclooxygenase
6 (d) mucin
7 (e) TXA2
8 (c ) kidney
9 (d) decreased hepatic metabolism; relatively alkaline urine
10 (b) serum albumin: distribution; metabolism and elimination
11 ( c ) phenylepherine
12 (b) the locus coeruleus
13 (e) mu
14 (a) delta
15 F. Opioids are most effective for dull pain
17 ( c ) ruminants
18 (e) oxicam
19 (b) the spinal cord
20 (b) ~80 times
21 (d) naloxone
Chapter 4 - Paralytic Agents.
True. Page page 64
True. See page 59.
True. See page 58
False. Succinylcholine is a depolarizing antagonist but is NON-COMPETITIVE. See page 59
True. See page 69, Response of Different Muscle Groups to Stimulus.
False. The ED95 is used for comparative purposes. See page 68, Clinical Features of Neuromuscular Blockade.
True. See page 63
d. malignant hyperthermia…Remember dantrolene is supposed to be a specific antidote for this acute condition, though not mentioned in this chapter.
a. reflex tachycardia. See page 63-64
d. aminoglycoside antibiotics. See page 64-65
d. calves and badgers. Table IV, page 69.
b. jaw tone. Theoretically, the skeletal muscles have been paralyzed though these facial muscles are more resistant to blockade.
Chapter 5: Monitoring Anesthesia
1. (b) central nervous system, cardiovascular and respiratory systems
3. (d) measuring central venous pressure
4. (b) decelerating; is; does
5. (a) administering an beta adrenergic agent
7. (e) administration of ketamine (Sympathomimetic agent)
9. (d) 60 mm Hg (torr)
10. (b) 69 mm Hg (torr)
11. central venous pressure
12. (c) Tidal volume
13. False. A direct relationship usually applies: The smaller the animal, the higher the metabolic rate and the rapid is the breathing.
14. (a) increased partial pressure of carbon dioxide is the primary stimulus; oxygen decrease (hypoxemia) becomes a secondary stimulus)
15. (c) capnography
16. (b) the saturate of blood hemoglobin with oxygen
17. (e) percent
18. (a) the hypothalamus
19. (a) placing the animal on an electric blanket
Chapter 6: Monitoring of Analgesia.
1. Nociception is the physiological response associated with noxious stimulation of pain receptors (nociceptors) and the processing of the information via specialized central nervous system pathways.
2. False: Pain is composed of both physical and psychological components
3. False: Chronic pain is defined as pain that persists beyond the normal time of healing and has also been defined as pain that exists beyond 6 months
4. False, the liver and kidneys do not evoke visceral pain
d. phantom pain
a. opioid agonists
b. local anesthetics
11. False – the pain tolerance threshold is highly variable between subjects and also varies in the same subject at different testing points.
a. skin – rubbing, licking, biting
b. thorax – reluctance to move, spreading of the front legs, shallow respirations
c. abdomen – arched back, hunched posture, guarding, anorexia
d. mouth/teeth – anorexia, excess salivation, rubbing, scratching, pawing
14. body weight, appearance, clinical signs, unprovoked behavior and response to stimulation
15. partially closed eyelids, porphoryin staining around eyes and nose, increased aggression, increased vocalization when handled, licking/biting/scratching, guarding, reduced exploratory behavior, rough hair coat
16. ocular discharge, protruding nictitans, photophobia, diarrhea, constipation, dull attitude, bruxism (tooth grinding), excessive grooming
17. decreased alertness, stiff posture, panting, biting/licking/scratching, increased aggression, increased vocalization
18. foot-stamping, lying with legs extended, swaying stance, decreased food intake, bruxism, guarding, depression, restlessness
19. Heart rate, blood pressure, respiratory rate
20. epinephrine, norepinephrine, cortisol, glucose, glucagon
21. phosphorous, magnesium, testosterone, insulin
22. False – the corneal and palpebral reflexes are unreliable indicators of anesthetic depth in rodents
23. False – the pinnae reflex is more reliable than the pedal reflex in guinea pigs and rabbits.
24. respiratory rate, rhythm and depth, heart rate and rhythm, and blood pressure
26. Simple reflex tests involve spinal reflexes only and do not evaluate higher CNS functions involved in pain perception
27. 1) The endpoint is not as well defined as simple reflex tests 2) the animal may “learn” the correct response after several trials and may react prior to perceiving pain and 3) performance can be affected by conditioning
28. 1) learned escape/avoidance paradigms 2) conflict (approach/avoidance) paradigms and 3) discrimination paradigms
29. Formalin test, Carrageenan test, Freund’s complete adjuvant induced polyarthritis, abdominal writhing test, partial and/or complete peripheral denervation
30. Formalin model: Formalin is injected subcutaneously into the hindfoot resulting in prolonged pain. The responses occur in two stages. The first stage occurs immediately after injection but is of a short duration and is the result of direct activation of nociceptors. In mice or rats, this stage involves holding up the foot and shaking it or biting and licking it. The second stage begins 10 – 20 minutes after the injection and is of a prolonged duration. This stage is related to the pain of inflammation. The Carrageenan test involves injecting carageenan (a mucopolysaccharide extracted from Irish sea moss) subcutaneously into the plantar surface of the foot of a rat. The injection produces an inflammatory response characterized by local hyperthermia and edema. The degree of inflammation is measured by paw volume (edema) and temperature (hyperthermia).
31. Autotomy (self-mutilation), guarding, licking or biting a paw, excessive grooming, vocalization and abnormal ambulation.
BB Anesthesia Chapter 7: Anesthesia Equipment: Types and Use
2). False. There are tube exchangers that are design to allow delivery of gases.
3). D). Less Pressure, high volume cuffs reduce the chance of necrosis.
4). False. E tanks are designed for the mall machines.
7). Diameter Index Safety System
8). False. Designed for more precise control at low flow rates. Low flow on Lt/ High on Rt.
9). CO2 and Nitrous Oxide. Weight of tank is used to determine gas remaining.
10). False. The oxygen flush valve works independently from the flowmeter.
12). False. APL valve has a male fitting that measures 19mm. The breathing circuit is 22 mm. This is to prevent misconnections.
14). D Desflurane has a higher vapor pressure.
15). Linearity is the relationship between the indicated output on the vaporizer and actual output at any given fresh gas flow rate. This is impacted by physical factors such as temperature, pressure, fresh gas flow rate and carrier gas composition.
16) False. Precision-out-of- circuit vaporizers are.
18). The total volume occupied by gas that is not losing oxygen or gaining carbon dioxide.
20). Mapleson D Circuit known as a Bain circuit
21). Piston-Type Ventilator/Barotrauma
23) False. It is under these operating conditions that oxygen levels are difficult to judge.
24) False. Oxygen cannot be measured by infrared means.
Chapter 8, Design of Surgical Suites and Post-surgical Care Units
Surgical suite, postoperative care area, radiographic facilities, pharmacy, diagnostic lab, locker rooms.
Associated with the conduct of surgical procedures, instrument/material prep area, animal prep area, surgeon prep, and operating suite.
A suite can be a number of rooms in a central surgical facility and a room is the actual single room where a surgery is conducted.
Requires aseptic technique, dedicated facilities, provision of post-surgical care for all nonrodent species undergoing major operative procedures.
Major nonrodent survival surgery must be done in facilities for surgical support including animal preparation, surgeon preparation, operating rooms, and postsurgical care. Aseptic technique and sterile instruments may be needed for rodents.
Federal, state, and local building codes including fire, plumbing, electrical, seismic, energy, conservation, handicapped access, health/safety, and environment.
The investigators needs must be met.
The location of the person who is ultimately responsible for the facility should be determining factor of the location of the facility.
Yes, as long as proper separation occurs, and animal prep areas may need to be used for minor procedures, or animals may have to be brought to other surgery areas with different equipment,… proper sanitation and precautions should be taken if animals need to be transported through a human patient/surgery area.
FALSE, survival rodent surgery can be performed in areas that are not dedicated, but are properly managed during the procedure.
PERIMETER, they usually sit and are at a dissecting scope, many surgeons may perform procedures at once.
Special restraint devices, hydraulic lifts, tables, large recovery areas, padded stalls and holding pens. Often large numbers of staff are needed, so suites must be large enough to accommodate the staff needed.
Only the instruments/surfaces that may come into direct contact with the animals. There is a misconception that everything in a surgical suite must be sterile, this is impossible and impractical.
Staff that are not wearing sterile material may come into contact, gloves can tear, surgical gowns can leak and the patient can release GI or bladder contents. Most of these cannot be avoided, but they must be recognized and properly managed.
Operating suite should be separated from the areas that house animals, the surgeon’s scrubbing area and the instrument preparation.
Clean, prepare and sterilize instruments and equipment. It needs cabinets, shelving, and countertops.
Ethylene oxide and steam sterilization. Ethylene oxide is toxic and needs expensive equipment to prevent worker exposure. Autoclaves should be located near in house steam to save money and utilities, so facilities should be designed with this in mind.
Administering preanesthetics, anesthetics, clipping of hair and cleaning of the operative sites.
1st - Initial clothing change from street clothes to scrub suit, 2nd-surgeon prepares in the scrub area donning hat, shoe covers, face mask, eye protection (if necessary) and proceeds to scrub, 3rd – surgeon dons sterilized gloves and gown in the surgical suite.
Ground fault circuitry should be installed for extra precaution.
Excessive bracing in the ceiling due to the weight of the equipment.
An alarm, intercom, or telephone system to contact personnel ion the even of an emergency.
It is a physical environment to support the needs and monitor vital signs of an animal recovering from anesthetics and surgery. It may contain several different types of animal patients which may require mechanisms for separation of species.
Monitoring equipment (ECG, pulse ox), hot blankets, portable caging, proper illumination, gas outlets (oxygen), drains, an examination table, controlled substance lock box.
Human hospitals have documented the spread of disease because of simple housekeeping practices.
Fireproof plasterboard sealed and finished with a water-resistant coating.
No, because explosive anesthetics are not commonly used any more.
Temperatures should be controllable by separate OR users, but the 65-82 deg F are usually recommended.
10 to 20 air changes per hour, but usually 12-15 air changes per hour of fresh air.
120-volt ground faulted receptacles, 6-8 feet intervals at a height of 60 inches from the floor with moisture resistant covers. 220/240V on a separate circuit may be necessary for surgical lasers, portable radiograph machines, etc.
Covered fluorescent fixtures, 100-125 ft candles at 5 foot off the floor, can be fixed, track, and portable.
Portable tanks, fixed manifold tanks stations, and centralized liquefied gas stations. Centralized liquid gas is the most reliable.
No, it hinders the movement of equipment and is an area where bacteria, debris and noxious fumes may accumulate.
42 x 84 inches, for large animal species 6 feet wide total.
Chapter 9: Anesthesia and Analgesia in Rodents