สรุป Anes Practice for vet

  • Published on
    19-Mar-2016

  • View
    228

  • Download
    7

Embed Size (px)

DESCRIPTION

เอกสารนี้เป็นสรุปที่เนื้อหาที่ควรรู้ก่อนฝึกงานทางคลินิก และสรุปเนื้อหาที่ได้จากการฝึกงาน ของคณะสัตวแพทย์ จุฬาฯ จุดประสงค์การทำเพื่อให้น้องๆได้อ่านเพื่อเตรียมพร้อมก่อนการฝึกงานและการสอบ หากเนื้อหาผิดพลาดประการใด ขออภัยมา ณ ที่นี้ด้วย

Transcript

<ul><li><p>1st edition, 2554 </p><p>[ ANES PRACTICE] </p><p>By Vet CU 68 </p><p>,, </p><p>[ </p><p>] </p><p>kkkkk </p></li><li><p> A n e s p r a c t i c e | 1 </p><p>Pain </p><p> Nociception = Nociceptors </p><p> Nociception 4 </p><p> Pain sym HR </p><p> Pain Catecholamines,Endorphines,Cortisol </p><p> Concept : Opioids NSAIDS </p><p> receptors </p><p> Local </p><p>anesthetic </p><p>Anti-</p><p>inflamatory </p><p>drugs </p><p> afferent sensory </p><p>fibers </p><p>Local anesthetic </p><p>(Dorsal </p><p>horn)</p><p>Local </p><p>anesthetic </p><p>Opioids </p><p>2 agonist </p><p>(Cerebral </p><p>cortex)</p><p>Opioids </p><p>2 agonist </p><p>Premedication </p><p> Transquilizers + </p><p>Opioids </p><p>Induction </p><p> injection </p><p>anesthetic </p><p>maintenance </p><p> inhalation </p><p>anesthetic </p></li><li><p> A n e s p r a c t i c e | 2 </p><p>Local </p><p>anesthetics </p><p>Opioids </p><p>Pure mu </p><p>agonist </p><p>Morphine </p><p>(Gold std. </p><p>pure mu </p><p>agonist) </p><p>Fentanyl </p><p>(Potent ) </p><p>Meperidine </p><p>Partial mu </p><p>agonist Buprenorphine </p><p>Mixed </p><p>agonist/antago</p><p>nist </p><p>(K partial agonist, </p><p>mu antagonist) </p><p>Butorphanol </p><p>Pure mu </p><p>antagonist </p><p>Naloxone </p><p>( Butorphanol </p><p>) </p><p>NSAIDS </p><p>2 agonist </p><p>Xylazine </p><p>Detomidine </p><p>Romifidine </p><p>Metomidine </p></li><li><p> A n e s p r a c t i c e | 3 </p><p>1.Local anesthetics </p><p> Na channel n. Action potential </p><p>2. Opioids </p><p> Opioids receptors </p><p>o Mu () analgesia,euphoria(), </p><p>,HR </p><p>o Kappa (K) analgesia,miosis,sedate,dysphoria( </p><p>,,) </p><p>o ( dose) </p><p>o </p><p>o HR(Bradycardia) </p><p>o o Sedate/excite () </p><p>o </p><p>3.NSAIDS </p><p> Peripheral anti-inflammatory </p><p> Local inflammatory mediator </p></li><li><p> A n e s p r a c t i c e | 4 </p><p> Central </p><p> Cox </p><p> Thalamus </p><p> Hypothalamus </p><p> COX1 vs COX2 </p><p> Acute renal </p><p>insufficiency </p><p> Hepatic </p><p>insufficiency </p><p> Dehydrate </p><p> Hypotension(BP) </p><p> CHF </p><p> Ascites </p><p> Coagulopathies </p><p> Gastric ulceration/GI disorder </p><p> Shock </p><p> Trauma </p><p> Corticosteroids </p><p> NSAIDS 2 </p><p> (COX2 induction embryo)</p><p>COX1 </p><p> enz. PGF </p><p> Renal blood flow </p><p> Gastric mucosal blood flow </p><p> Gastric mucosal layer </p><p> HCO-3 </p><p> Platelet </p><p>COX2 </p><p> precursr PGF </p></li><li><p> A n e s p r a c t i c e | 5 </p><p>4.2 agonist </p><p> 2 adrenagic receptor CNS </p><p> Sedate Analgesia ( </p><p>) m. relax Anxiolysis </p><p> Vasoconstrict BP receptor </p><p>HR CO </p><p> dose </p><p>Unconscious </p><p>m. </p><p>relaxant </p><p>painless </p></li><li><p> A n e s p r a c t i c e | 6 </p><p> CVS </p><p> HR Ketamine </p><p>Atropine </p><p> 2 -agonist </p><p> Xylazine </p><p> Medetomidine Opioids </p><p> Morphine </p><p> Meperidine </p><p> Fentanyl </p><p>Contractility Ketamine Halothane Thiopenthal </p><p>Propofol </p><p>Preload Fluids </p><p>Vasoconstrictors </p><p>Acepromazine </p><p> Arhythmia 2 -agonist Xylazine </p><p> Medetomidine Halothane </p><p>Thiopenthal </p><p>Acepromazine </p></li><li><p> A n e s p r a c t i c e | 7 </p><p>Sta</p><p>ge1 </p><p>HR&amp; </p><p>, </p><p>Sta</p><p>ge2 </p><p>reflex </p><p> reflex ,, </p><p>HR&amp; </p><p>(/) </p><p> palpebral reflex </p><p> Nystagmus </p><p> reflex ( ) </p><p>Sta</p><p>ge3 </p><p>Plane1 </p><p> ,HR </p><p> Nystagmus </p><p> palpebral reflex </p><p> Corneal reflex </p><p> Pedal reflex </p><p> reflex </p><p> Laryngospasm </p><p> m. </p><p>Plane2 </p><p> () </p><p> / </p><p> Corneal reflex </p><p>Pedal reflex() </p><p> laryngospsm </p><p> plane </p><p>Plane3 </p><p> m., </p><p> Corneal reflex() </p><p> Pedal reflex </p><p>Plane4 </p><p> resp.+nervous.+cir. </p><p>&amp;mm. </p><p> BP PP </p><p> m. </p><p> reflex </p><p>Sta</p><p>ge4 </p><p>PP. </p><p>BP </p><p>Pale mm. </p><p>m./UB </p><p>Pupilary reflex </p><p> plane </p><p> plane </p></li><li><p> A n e s p r a c t i c e | 8 </p><p> 3 </p><p>1. (Central nervous system) </p><p>2. (Cardiovascular system) </p><p>3. (Respiratory system) </p><p> (seizure) </p><p> / </p><p> (hypoglycemia) </p><p> Severe metabolic disease </p><p> acepromazine, enflurance, ketamine </p><p> : o </p><p>o diazepam 0.2 mg/kg </p><p>o </p><p> Hypothermia </p><p> / </p><p> : o </p><p>o , </p><p>, heat pad </p><p>o </p><p> (Central nervous system) </p><p> (Monitoring and Complication) </p></li><li><p> A n e s p r a c t i c e | 9 </p><p>o </p><p> Hyperthermia </p><p> Ketamine, halothane succinylcholine </p><p> malignant hyperthermia </p><p> : o IV </p><p>o </p><p>o </p><p>o dantrolene sodium malignant hyperthermia </p><p> Recovery excitement </p><p> (disorientation) </p><p> opioids (dysphoria) </p><p> : o </p><p>o opioids morphine </p><p>o dysphoria xylazine, </p><p>acepromazine </p><p> Prolonged recovery </p></li><li><p> A n e s p r a c t i c e | 10 </p><p> (Bradycardia): &lt; 60, &lt; 100, &lt; 60 </p><p> opioids morphine, fentanyl </p><p> alpha-2 adrenergic agonist xylazine </p><p> (hypoxemia) </p><p> Hyperkalemia </p><p> Hyperglycemia </p><p> : </p><p> , vagal reflex, , , , </p><p> Anticholinergic atropine 0.01-0.02 mg/kg glycopyrriate 0.005 mg/kg </p><p> (Tachycardia): &gt; 180, &gt; 240, &gt; 100 </p><p> sympathomimetics adrenaline </p><p> anticholinergic atropine </p><p> Ketamine </p><p> (hyperthermia) </p><p> CO2 (hypercapnia) </p><p> (Cardiovascular system) </p></li><li><p> A n e s p r a c t i c e | 11 </p><p> (hypoxemia) </p><p> (baroreceptor reflex) </p><p> : </p><p> , , </p><p> opioids </p><p> (Hypotension): systolic pressure &lt; 80 mmHg </p><p> Cardiac output systemic vascular resistance vasodilation septicemia, peritonitis mast cell tumor </p><p> vasodilation histamine </p><p> (dehydration) 10% </p><p> CO2 (hypercapnia) </p><p> Anaphylactic/anaphylactoid shock , opioids, , , , </p><p> : </p><p> Acetar, Lactate Ringers solution, NSS </p><p> inotropic agents dopamine, dobutamine, ephedrine dopamine dobutamine 40-200 mg </p><p>5%D5W NSS 250-500 ml 2.5-20 </p><p>g/kg/ </p><p> (Hypertension): systolic pressure &gt; 180 mmHg, </p><p>Mean &gt; 110 mmHg diastolic pressure &gt; 140 mmHg </p></li><li><p> A n e s p r a c t i c e | 12 </p><p> catecholamines : adrenaline </p><p> CO2 (hypercapnia) </p><p> (hypoxemia) </p><p> , hyperthyroidism </p><p> : </p><p> adrenaline </p><p> CO2 , </p><p> Hemorrhage: suction bottle, lap spongs, towel </p><p> : </p><p> 20-30 % (blood volume = </p><p>100 ml/kg, = 60 ml/kg) </p><p> Crystalloid 3 </p><p> colloid </p><p> Tachypnea/ hyperventilation </p><p> CO2 (hypercapnia) </p><p> (hypoxemia) </p><p> (hypotension) </p><p> Airway disease, pulmonary interstitial disease, </p><p> (Respiratory system) </p></li><li><p> A n e s p r a c t i c e | 13 </p><p> : </p><p> ambu bag </p><p> Bradypnea/hypoventilation </p><p> , morphine xylazine </p><p> hyperventilation </p><p> , </p><p> : </p><p> ambu bag </p><p> Apnea </p><p> (hypoxemia) </p><p> (hypotension) </p><p> Pneumothorax, diaphragmatic hernia </p></li><li><p> A n e s p r a c t i c e | 14 </p><p> : </p><p> Airway obstruction: </p><p>paradoxical breathing </p><p> bandage </p><p> : </p><p> tracheostomy </p></li><li><p> A n e s p r a c t i c e | 15 </p><p> Hypovolumic shock </p><p> Hemorrhage </p><p> hypovolumic shock </p><p> 90 ml/kg/hr 45 ml/kg/hr </p><p> 45 ml/kg/hr 22.5 ml/kg/hr </p><p> severe shock colloid hypertonic solutions </p><p> Dehydration </p><p> Deficit loss = body weight x %dehydration x 10 </p><p> Maintenance need = 40-60 ml/kg/day </p><p> Continuing loss = vomiting diarrhea ( ml/day) </p><p>Total fluid/day = deficit loss + maintenance need + continuing </p><p>loss </p></li><li><p> A n e s p r a c t i c e | 16 </p><p> clear airway </p><p> Monitor </p><p>20 % plasma protein plasma protein 3.5 g/100cc </p><p> urinalysis </p><p> isotonic crystalloid solutions </p><p>o 10-20 ml/kg/hr </p><p>o 5-10 ml/kg/hr </p><p> hypertonic saline 4-6 ml/kg &lt; 100 ml/hr </p><p> colloids 10-20 ml/kg/day 5-20 ml/kg/hr </p><p> Hemoglobin &lt; 7 g/dl Hematocrit &lt; 20% </p><p> ( 5-10 ml/kg/hr) </p><p>o : 10-40 ml/kg </p><p>o : 5-20 ml/kg </p></li><li><p> A n e s p r a c t i c e | 17 </p><p> Cardiopulmonary arrest (CPA) (CPA ventilation </p><p>failure circulation failure) </p><p> Hypoxia </p><p> Acid-base, fluid, electrolyte imbalance </p><p> ANS imbalance parasympathetic </p><p> arrhythmias </p><p> Trauma </p><p> Agonal gasping ( ) </p><p> Cyanotic, grey or pale mucous membrane </p><p> (Clinical Sign) </p><p>Cardiopulmonary Cerebral Resuscitation (CPCR) </p></li><li><p> A n e s p r a c t i c e | 18 </p><p> CPCR 3 </p><p> Immediate basic support basic life support </p><p>o A = airway </p><p> Clear airway </p><p> endotracheal tube </p><p> 2 o B = breathing </p><p> 100% O2 (positive pressure ventilation with 100% O2) </p><p> / 1 cm </p><p> ambu bag 5:1 15:2 o C = circulation 2 </p><p> 80-120 / </p><p> 5 10 </p><p> Advance cardiac life support </p><p>o Fluid </p><p> Crystalloid 10-40 ml/kg IV 10-20 ml/kg IV </p><p> Hypertonic saline solution 7.5% saline 6ml/kg 20-25% mannitol 5-10 ml/kg IV </p><p> Colloidal solution 6% dextran 70 6% hetastarch 10 ml/kg </p></li><li><p> A n e s p r a c t i c e | 19 </p><p>o Sympathomimetics </p><p> Epinephrine (adrenaline) 0.01-0.02 mg/kg 0.1-0.2 mg/kg IV cephalic vein jugular vein () </p><p>o Anticholinergic </p><p> Atropine 0.02-0.04 mg/kg IV () o Sodium bicarbonate 0.5 mEq/kg/5 min drip </p><p>fluid 5-10 failure </p><p>o Antiarrhythmics </p><p> Lidocaine 1-3 mg/kg IV ventricular arrhythmia o Inotropes </p><p> dopamine dobutamine 40-200 mg 5%D5W NSS 250-</p><p>500 ml 2.5-20 g/kg/ </p><p>** glucose hypoglycemia </p><p> Recommendation for postresuscitative care </p><p>o O2 </p><p>o </p><p>o perfusion </p><p>o tissue perfusion CRT, </p><p>o reperfusion ( </p><p>O2 CPA 10 ) </p><p> electrolyte, free radical leukocyte </p><p> mannitol free radical </p></li><li><p> A n e s p r a c t i c e | 20 </p><p>1. , </p><p>a. &amp; 6 . </p><p>b. 2 . </p><p>c. </p><p>2. </p><p>a. % dehydrate </p><p>b. HR &amp; Rhthm </p><p>c. Pulse </p><p>d. CRT (&gt;2 sec = dehydrate) </p><p>e. RR &amp; Pattern </p><p>f. mm color </p><p>3. Premedication Induction 15-20 (IM) </p><p>2-3 (IV) </p><p>Atropine </p><p>Dose IV 0.02 mg/kg </p><p> IM/SC 0.04 mg/kg </p><p> 1. HR ( HR Opioids &amp; -2 adenoreceptor </p><p>agonist) </p><p> 2. </p><p> 3.( Ketamine) </p><p> 4., </p><p>Anesthetic practice </p><p>Anticholinergic drug </p></li><li><p> A n e s p r a c t i c e | 21 </p><p> 5. GI movement </p><p> 6. </p><p> 7. Thiobarbiturate </p><p> 8. </p><p> 1. HR </p><p> 2.Sinus tachycardia </p><p> 3. BBB, </p><p> 1.Heart failure </p><p> 2. HR &gt;140 bpm </p><p> &gt;160 bpm </p><p> 3.Premature ventricular contraction/Ventricle </p><p> 4.m. </p><p> 5.Glaucoma </p><p>Glycopylorate </p><p>-Safe Atropine </p><p>- </p><p>Dose IV 0.005 mg/kg </p><p> IM/SC 0.01 mg/kg </p><p> 1. HR Atropine, </p><p> 2. Atropine 5 </p><p> 3. GI movement, </p><p> 4. </p><p> 5. BBB Atropine CNS </p><p> Glycopylorate } </p></li><li><p> A n e s p r a c t i c e | 22 </p><p>Acepromazine </p><p>Dose IV /IM/SC 0.03 0.05 mg/kg ( 0.1 mg/kg) </p><p> 3 mg/ </p><p> 1. </p><p> 2. m., </p><p> 3. dose </p><p> 4. </p><p> 5. </p><p> 1. BP(Hypotension) </p><p> Ephedrine/Methoxamine/Norepinephrine/ </p><p>Phenylephrine Epinephrine </p><p> 2. Shock </p><p> BP </p><p> Anemia </p><p> / </p><p> 3. </p><p> 4. Treshold </p><p> 5. Low dose Morphine </p><p>Dose </p><p> 6. Epidural Spinal anesthesia </p><p> BP </p><p> 7. T </p><p> 8. </p><p> 9.Blood glucose </p><p>Phenothiazine </p></li><li><p> A n e s p r a c t i c e | 23 </p><p> 10.Hct,Blood protein,Platelet </p><p> 11. </p><p> 12. Histamine </p><p> - </p><p> - mast cell tumor </p><p> 13. OP Procaine HCl </p><p>Xylazine </p><p>Dose IV 0.03-0.2 mg/kg </p><p> IM 1-3 mg/kg </p><p>Antidote Yohimbine </p><p> 1., </p><p> 2. </p><p> 3. </p><p> 4. sympathetic </p><p> 5.BP </p><p> 6.RR </p><p> 7. </p><p> 8. </p><p> 1.HRCO (1 2 AV block,severe </p><p>bradycardia,Sinus arrhythmia,Ventricular fibrillation) </p><p> weak,,,</p><p> 2.&amp; </p><p> -2 agonist </p></li><li><p> A n e s p r a c t i c e | 24 </p><p> 3. HR Antagonist(Yohimbine) Atropine </p><p> 4.GI activity </p><p> 5.Hyperglycemia </p><p> 6.Plasma glucose(esp.) </p><p> 7. Ketamine Apnea </p><p> 8. </p><p> 9. T </p><p>Diazepam </p><p>Dose IV 0.2-0.6 mg/kg </p><p>IM 0.4 mg/kg </p><p>Midazolam </p><p>Dose IV 0.1-0.2 mg/kg </p><p> IM 0.2-0.3 mg/kg </p><p> Antidote Flumazenil </p><p> 1. </p><p>2. Opioids&amp;Barbiturate dose </p><p> 3. </p><p> 4. </p><p> 5. esp. </p><p> 6. Catecholamine </p><p>,GDV </p><p> 7.,Safe &amp; </p><p> 1. Ketamine </p><p>Syringe </p><p> 2. IV Venous thrombosis &amp; HR </p><p> 3. </p><p>Benzodiazepines </p></li><li><p> A n e s p r a c t i c e | 25 </p><p>Fentanyl [ ] 50 </p><p>-*first choice * </p><p> - 20 IV </p><p> - potent 50-300 Morphine </p><p> Dose IV 0.04-0.08 mg/kg </p><p> IV 0.02-0.04 mg/kg </p><p> Ortho IV 0.06-0.08 mg/kg </p><p> Soft tiss. IV 0.04 mg/kg </p><p> CRI 2-6 /kg/hr </p><p>Morphine [ ] 10 </p><p> - 4 </p><p> - BUN </p><p>Dose IM/SC 0.2-0.6 mg/kg </p><p> IM/SC 0.3 mg/kg </p><p> Ortho/ IM/SC 0.5-0.6 mg/kg </p><p> IM/SC 0.1-0.2 mg/kg </p><p> *&amp; &gt; 0.2 mg/kg * </p><p> Epidural 0.1 mg/kg </p><p> CRI 0.1-0.3 mg/kg/hr </p><p>Opioids </p></li><li><p> A n e s p r a c t i c e | 26 </p><p>Meperidine(Pethidine) [ ] 50 mg/ml </p><p> - 1 </p><p> - 1 10 Morphine </p><p> - </p><p> - weak </p><p> Dose IV/IM/SC 2-5 mg/kg </p><p> 1. </p><p> 2. </p><p> 1. </p><p> 2.HR </p><p> 3. CSF </p><p>4. GI &amp; </p><p>5. </p><p>6. </p><p> Pentazocine </p><p>- 2 . </p><p>- 1 3 Morphine </p><p> Dose IV/IM/SC 2 mg/ml </p><p>Partial opioids agonist </p></li><li><p> A n e s p r a c t i c e | 27 </p><p>4. Induction </p><p> Propofol [ ] 10 mg/ml </p><p> - &gt; 24 . Endotoxin Bact. Septic shock </p><p> - 1/3 2/3 Coz. Bolusapnea </p><p> - True effect = (Phase 3 plane 2 ) </p><p> -() (5-10 ) </p><p> - </p><p> - </p><p> -&gt; </p><p> Dose Xylazine 1 mg/kg IV 1-2 mg/kg </p><p> Acepromazine 0.025 mg/kg IV 2-3 mg/kg </p><p> Diazepam/Midazolam IV 3-5 mg/kg </p><p> Premed IV 4-6 mg/kg </p><p> 1.BP </p><p> 2. Apnea bolus </p><p> 3.HR </p><p> 4. Bacterimia </p><p> 5. </p><p>Thiopental </p><p> - </p><p>Dose Acepromazine 0.03-0.05 mg/kg IM IV 7-8 mg/kg </p><p> premed IV 8-20 mg/kg </p></li><li><p> A n e s p r a c t i c e | 28 </p><p> 1. 10-20 </p><p> 2. </p><p> 1., ,BP </p><p>2.,GI </p><p>3.Acidosis </p><p>4.Sight hound Thiopental </p><p>5. </p><p>6. </p><p>7. BUN Dose </p><p>8.Blood glucose/Lactic acid/amino acid </p><p>9. Glycogen Dose </p><p>10. </p><p>Ketamine [ ] 50 mg/ml </p><p>Dose Acepromazine 0.2 mg/kg </p><p> Xylazine 0.7-1 mg/kg IM 10 mg/kg </p><p> DiazepamMidazolam 0.2 mg/kg IV 5.5 mg/kg </p><p> 1. </p><p>2. </p><p> 3. HRBPCO( Sym) </p><p> 1./ &amp; ( Benzodiazepine) </p><p>2. resp </p><p>3. Cornea </p><p>4. reflex , </p><p>5. </p></li><li><p> A n e s p r a c t i c e | 29 </p><p>6. </p><p>Tiletamine()/Zolazepam() [ ] 100 50 mg/ml </p><p>Dose IV/IM 2-8 mg/kg </p><p> IV/IM 7 mg/kg </p><p> Propofol 1 mg/kg 5 mg/kg </p><p> 1. </p><p>2. </p><p> 3. HRBPCO( Sym) </p><p> 1. reflex , </p><p>2. Atropine </p><p>3.T </p><p>4. Tiletamine Zolazepam </p><p> Diazepam </p><p>*Ketamine &amp; Zoletil ,, esp. Cornea coz. eye reflex* </p><p>Etomidate [ ] 10 mg/ml </p><p>- Propofol </p><p>- 24 . </p><p>-, </p><p>- </p><p>Dose IV 0.5-2 mg/kg </p><p>Mask induction </p><p> - weak, </p></li><li><p> A n e s p r a c t i c e | 30 </p><p>- 100% O2 3-5 L Halothane Isoflurane 0.5% </p><p>30 3-4% </p><p>5.Maintenance </p><p>- Endotracheal tube trachea size </p><p>- tube coz. </p><p>-Endotracheal tube </p><p> 1. </p><p> 2. </p><p> leak </p><p> Cardiovascular system </p><p> Dexamethasone 0.5 mg/kg , </p><p> shoulder </p><p>-Injectable anesthetics 10-50% Dose Induction </p><p> Propofol 15 , Ketamine 30 </p><p>-Inhalation anesthetics 1-2% Halothane coz. </p><p>(Fibrillation,arrhythmia) 1.5-3% Isoflurane </p><p>- surgeon </p><p>- 3-4% () </p><p>-O2 flowrate O2 4-6 ml/kg/min </p><p>- ambu bag 5 (</p></li><li><p> A n e s p r a c t i c e | 31 </p><p>Non-rebreathing system(Bain) </p><p> &lt; 7 kg, </p><p> O2 flow rate 200 ml/kg/min( 1.5 L) </p><p> O2 flow rate CO2 </p><p>Semiclosed rebreathing system F-circuit &amp; circle </p><p> &gt; 7 kg O2 flow rate 22-44 ml/kg/min ( 1 L) </p><p> 60 ml/kg/min </p><p>-Fluid </p><p> Isotonic crystalloid solution </p><p> Crystalloid 3 ml : 1 ml </p><p>-Rate 10 ml/kg/hr = 3 /kg/ = </p><p> ( 20 /ml) 2 </p><p> rate </p><p>-Shock rate 90 ml/kg/hr </p><p> 44 ml/kg/hr </p><p>- Dehydrate/BP 20-30 ml/kg/hr </p><p>- Protein ,anemia colloid </p><p>- Fluid NSS </p><p>Circle </p><p>F-circuit </p></li><li><p> A n e s p r a c t i c e | 32 </p><p>Monitoring anesthesia </p><p>1./ Palpebral reflex </p><p>2. Pedal reflex </p><p>3.Cornea </p><p>4. </p><p>5.Pink mm. </p><p>6.RR : 8-43 bpm </p><p> : 8-52 bpm </p><p> Critical &lt; 8 bpm </p><p>7.HR : 86-166 bpm </p><p> : 112-198 bpm </p><p> Critical &lt; 60 bpm </p><p>8.Mean BP 80-120 mmHg </p><p> Critical &lt; 60 mmHg </p><p>9.Systolic BP 100-120 mmHg </p><p> Critical &lt; 80 mmHg </p><p>10. coz. T metabolism Overdose </p><p>- BP rate colloid Dopamine D5W </p><p> Adrenaline </p><p>- </p><p> NO2 : O2 5-10 Diffusion hypoxia </p><p> Halothane &amp; Isoflurane : surgeon Skin Gas</p><p> O2 Flush gas 100% O2 4-6 L </p><p> Cuff </p><p>} Ketamine </p><p> RR &gt;8 / </p><p> HR &gt;60 bpm </p><p> MAP &gt;60 mmHg </p><p> SBP &gt;80 mmHg </p></li><li><p> A n e s p r a c t i c e | 33 </p><p>1. 5 7.5 kg Salivary mucocele </p><p> Acepromazine 0.03 mg/kg </p><p> = 0.22 cc </p><p> Morphine 0.5 mgkg </p><p> = 0.36 cc </p><p> Propofol 3 mg/kg </p><p> = 2.19 cc </p><p> ABO Marbocyl </p><p> = 0.7 cc </p><p> Metronidazole </p><p> = 7 cc </p><p>2. 20.55 kg </p><p> Midazolam 0.2 mg/kg </p><p> = 0.82 cc </p><p>Morphine 0.5 mg/kg </p><p> = 1.02 cc </p><p>Propofol 4 mg/kg </p><p> = 8.22 cc </p><p> ABO Cefa </p><p> = 2 cc </p><p>3. 37.8 kg </p><p> Acepromazine 0.03 mg/kg </p><p