Dr. Robert TRUJANOVIC
Languages :
My webcasts
Teaching goals
- Breed-Specific Anatomical and Physiological Differences: Veterinarians must understand and adapt anesthesia protocols to accommodate the unique anatomical and physiological characteristics of different canine breeds to ensure safety and efficacy.
- Importance of Advanced Monitoring and Pre-Anesthetic Considerations: Advanced monitoring and careful pre-anesthetic planning are essential for managing breeds with specific vulnerabilities, like brachycephalic breeds and sighthounds, to prevent complications during anesthesia.
- Role of Genetic Factors in Anesthetic Sensitivity: Genetic predispositions, such as the MDR1 gene mutation in herding breeds, necessitate pre-procedural genetic testing and careful drug selection to avoid adverse reactions to anesthesia
Teaching goals
- Patients with a diaphragmatic hernia must be stabilized before surgery.
- A reverse Trendelenburg position during surgery is beneficial to relieve pressure on the lungs.
- Premedication with an opioid and induction with propofol is a good choice for these patients.
- PIVA or TIVA for maintenance of anesthesia with close monitoring is recommended.
Dr. Robert TRUJANOVIC
Video time : 21 min
+ MCQ
Dipl. ECVAA
Geriatric medicine
Anesthesiology and analgesia
Teaching goals
- Respiratory and Cardiovascular Changes in Geriatric Patients:
Geriatric patients experience decreased lung capacity due to increased functional residual capacity (FRC) and small airway closure. This is coupled with muscle atrophy and reduced reflexes, making intubation necessary. Cardiovascular changes include reduced cardiac reserve due to decreased maximum heart rate and valvular lesions, which reduce cardiac output and increase myocardial workload. - Decreased Renal and Digestive Function:
Renal function diminishes with age, reducing the ability to concentrate urine and making fluid balance critical.Lower esophageal sphincter tone decreases, and gastric pH becomes lower, making older patients more prone to reflux and esophagitis. - Altered Drug Metabolism and Clearance:
Geriatric patients show a reduction in drug clearance and protein binding, leading to potentially higher effective drug concentrations. Special care is needed to avoid drug overdose or prolonged drug effects. - Pre-Anesthetic and Anesthetic Considerations:
Pre-anesthetic preparation should include securing venous access early, minimizing stress, and using analgesia. Induction with propofol and intubation, followed by inhalant or total intravenous anesthesia (TIVA), is recommended. - Post-Anesthetic Care:
Recovery requires close monitoring until airway reflexes return. Supplemental oxygen, analgesia, fluid therapy, and temperature management are essential for a safe recovery.
Teaching goals
- Cardiovascular System: Pediatric patients have lower blood pressure and respond to hypotension primarily with increased heart rate.
- Respiratory System: Higher respiratory rate and easily triggered laryngospasm; they respond to hypoxia in two phases.
- Metabolism and Excretion: Reduced liver function and low glycogen stores lead to longer drug effects and faster hypoglycemia.
- Anesthetic drugs: Anesthetics have stronger and longer effects; inhalation anesthetics like isoflurane are preferred for maintenance.
- Recovery Phase: A calm, warm environment is important; avoid hypothermia and stress; feed quickly to prevent hypoglycemia.
Dr. Robert TRUJANOVIC
Video time : 30 min
+ MCQ
Dipl. ECVAA
Gastroenterology
Anesthesiology and analgesia
Teaching goals
- Gastric dilatation-volvulus (GDV) commonly affects medium- to large-breed dogs and causes acute stomach dilation that compromises blood supply and can lead to tissue necrosis.GDV reduces venous return to the heart by compressing the caudal vena cava, resulting in decreased cardiac output and obstructive shock.Pre-anaesthetic preparation for GDV involves attempting stomach decompression and monitoring key clinical variables like packed cell volume, electrolytes, and lactate levels.Anaesthetic management of GDV patients should avoid drugs with negative cardiovascular effects and include preoxygenation, continuous ECG monitoring, and preparation of lidocaine for ventricular arrhythmias.Post-surgery, GDV patients require vigilant monitoring for cardiovascular issues, appropriate fluid therapy, and effective analgesia to ensure recovery.
Dr. Robert TRUJANOVIC
Video time : 26 min
+ MCQ
Dipl. ECVAA
Ophthalmology
Anesthesiology and analgesia
Teaching goals
- Avoid Increased Intraocular Pressure: It is crucial to prevent increased intraocular pressure in patients with conditions such as corneal ulcers, descemetocele, glaucoma, and cataracts to avoid exacerbating these conditions.
- Maintain Normal Intraocular Pressure: Keeping intraocular pressure normal can be achieved by maintaining normocapnia (normal levels of carbon dioxide in the blood) and avoiding drugs that induce vomiting or retching.
- Minimize Patient Distress: During both the induction and recovery phases of anesthesia, it is important to avoid patient struggling and excessive restraint. This helps in reducing stress and potential trauma to the eye.
- Ensure Appropriate Analgesia: Providing appropriate analgesia helps to ensure a smooth recovery process and minimizes the risk of trauma to the eye.
- Tailor Anesthetic Management: Anesthetic procedures should be largely dictated by the patient’s underlying health conditions. This includes using reinforced endotracheal tubes to prevent tracheal obstruction, especially when the head is positioned “chin on chest,” and employing non-depolarizing neuromuscular blocking agents for cataract surgeries to maintain a centrally positioned pupil. Additionally, mechanical or assisted ventilation is essential when using these agents.
Teaching goals
- Learning about pathysiology of spinal pain and interventional pain therapy options is essential for effectively managing discomfort and improving the quality of life for dogs with discopathies.
These interventions aim to alleviate pain, reduce inflammation, and promote healing while minimizing the risks associated with more invasive surgical procedures.- Understanding the benefits, risks, and appropriate indications for each interventional pain therapy option is crucial for tailoring treatment plans to meet the individual needs of affected dogs.
Teaching goals
- Learning about pathysiology of spinal pain and interventional pain therapy options is essential for effectively managing discomfort and improving the quality of life for dogs with discopathies.
- These interventions aim to alleviate pain, reduce inflammation, and promote healing while minimizing the risks associated with more invasive surgical procedures.
- Understanding the benefits, risks, and appropriate indications for each interventional pain therapy option is crucial for tailoring treatment plans to meet the individual needs of affected dogs.
Dr. Robert TRUJANOVIC
Video time : 24 min
+ MCQ
Dipl. ECVAA
Respiratory
Anesthesiology and analgesia
Teaching goals
- One-lung intubation is a real risk in cats.
- POCUS is a helpful tool in anesthesia.
- Preoxygenation helps to gain more time in critical situations.
Dr. Robert TRUJANOVIC
Video time : 24 min
+ MCQ
Dipl. ECVAA
Respiratory
Anesthesiology and analgesia
Teaching goals
- Hypercapnia associated with respiratory depressant drugs is extremely common in anesthetized patients.
- Treatment of hypercapnia/hypocapnia depends on the underlying cause; however, hypercapniais frequently.
- Oxygenation can be assessed non-invasively (pulse oximetry) or invasively (arterial blood gas), each with their own advantages/disadvantages.
- Mechanisms underlying hypoxemia include: hypoventilation, ventilation-perfusion inequalities, pulmonary or cardiac shunting of blood, impairments to gas diffusion, decreased inspired oxygen levels.
Teaching goals
- Incorporating regional anesthesia into the anesthesia protocol can reduce the surgical stress response in dogs undergoing a TPLO operation.
- Ultrasound-guided blocks are preferable to nerve stimulator or landmark-based blocks.
- Lidocaine is a short-acting local anesthetic.
- Bupivacaine and Ropivacaineis are long-acting local anesthetics.
Dr. Robert TRUJANOVIC
Video time : 27 min
+ MCQ
Dipl. ECVAA
Theriogenology
Anesthesiology and analgesia
Teaching goals
- Infuse the patient as soon as possible.
- Pre-oxygenate the patient before induction.
- Avoid aortocaval compression for as long as possible.
- Use local anesthesia.
Dr. Robert TRUJANOVIC
Video time : 26 min
+ MCQ
Dipl. ECVAA
Nephrology/Urology
Anesthesiology and analgesia
Teaching goals
- Risk vs benefits of performing general anesthesia on patients with AKI need to be assessed (poor prognosis, 50-60%)
- A balanced anaesthetic protocol should be chosen to reduce the required dose of each individual agent and minimize the potential side effects.
- Use loco-regional techniques whenever possible to reduce the amount of anesthetic drugs and anesthetic depth of the patient.
Teaching goals
- The liver is important as it is involved in the production of glucose,albumin,andcoagulation factors.
- The liver metabolizes anesthetic drugs and this can impact anesthetic recovery.
- Glucose is necessary for energy production,brain function and perioepartive stability.
- Anesthetic drugs that are used for patients with liver disease should be short-acting, reversible, or produce minimal cardiovascular and respiratory depression.
Dr. Robert TRUJANOVIC
Video time : 21 min
+ MCQ
Dipl. ECVAA
Respiratory
Anesthesiology and analgesia
Hematology biochemistry
Teaching goals
- Hypoxia is a condition where either all (generalized hypoxia) or a specific part of the body (regional hypoxemia) does not receive or is not able to use adequate oxygen for aerobic metabolism.
- Hypoxemia is a reduction in the concentration of oxygen in arterial blood.
- A PaO2 of <80 mmHg is strictly classed as hypoxaemia, but some classify mild hypoxaemia as PaO2 80–90 mmHg; moderate as 60–80 mmHg; and severe as <60 mmHg.
Dr. Robert TRUJANOVIC
Video time : 18 min
+ MCQ
Dipl. ECVAA
Respiratory
Anesthesiology and analgesia
Hematology biochemistry
Teaching goals
- Arterial blood gas analysis helps determine: blood pH, blood oxygenation, and blood CO2 carriage
- Venous blood gas analysis can also tell about acid-base status.
- Regulation of pH is required because most biochemical (metabolic) reactions can only occur efficiently within a narrow pH range.
Teaching goals
- Epidural administration involves injecting a drug or drug combination into the epidural space—the space between the vertebral canal and dura mater.
- The term epidural anesthesia describes the injection of a local anesthetic into the epidural space, whereas epidural analgesia refers to the epidural administration of analgesics.
- In dogs and cats, epidural procedures are usually performed at the lumbosacral space.
Teaching goals
- Preoperative stabilization of patients with congestive heart failure is mandatory
- Normal to high-lower HRs and normal to high-normal BP are recommended
Teaching goals
- Preoperative stabilization of patients with heart failure is mandatory
- Normal to high-normal HRs and normal to low-normal BP are recommended
Teaching goals
- Preoperative stabilization of patients with heart failure is mandatory
- Normal to high-normal HRs and normal to low-normal BP are recommended
Teaching goals
- Before any thoracic surgery, a detailed examination is necessary to stabilize the patient for surgery.
- Opioids and benzodiazepines are "good" options for premedication.
- Machine ventilation with PEEP is required in every patient where the chest is opened.
- Patients undergoing thoracic surgery must be closely monitored.
Teaching goals
- A central venous catheter (CVC), also known as a central line(c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein.
- CVC is commonly placed in the jugular or femoral vein.
- Most common complications are: pneumothorax, vascular perforation, catheter-related blood stream infections, occlusion, misplacement, venous air embolism, catheter-related thrombosis.
Teaching goals
- Single, uniform, premature ventricular complexes (VPCs) do not usually cause hemodynamic compromise and are at a low risk for electrical instability. As long as the VPCs are infrequent, and the heart rate and blood pressure remain stable, no additional treatment is necessary
- Higher grade arrhythmias such as ventricular tachycardia warrant immediate medical intervention.
- Accelerated idioventricular Rhythm (AIVR) is commonly seen in patients in the 24 hours following a splenectomy or surgery for gastric dilatation and volvulus. Accelerated idioventricular rhythms are identified as abnormal, wide, and bizarre beats that do not come prematurely. It is important to differentiate AIVR from ventricular tachycardia, because AIVR does not typically cause hemodynamic compromise and won’t respond to anti-arrhythmic medications. If AIVR is identified the procedure does not need to be stopped.
Teaching goals
- The ECG is used to diagnose cardiac arrhythmias.
- Sinus rhythm originates in the right atrium.
- First-degree atrioventricular block is a form of atrioventricular block characterized by delayed conduction time between the atrium and ventricle.
- Second-degree AV block is a form of AV block characterized by incomplete AV node block. In second-degree AV blocks, a distinction is made between Mobitz blocks type I and II.
- Third-degree AV block is a form of AV block characterized by a complete failure of the conduction between the atrium and the ventricles of the heart.
Teaching goals
- Hypotension, by definition, occurs when MAP is than 60mmHg
- The treatment of hypotension should depend on the cause of the hypotension.