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ANESTHESIA > 11 – Alpha2-Agonists Clinical Application > Flashcards

11 – Alpha2-Agonists Clinical Application Flashcards

1
Q

What are the many applications of alpha2 agonists in vet med?

A
  • Pre-medication
  • Sedation for minor procedures
  • Infusion intra- and post- operatively
  • Sedation in recovery period
  • Adjunct for local blocks
  • Epidural administration
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2
Q

Premedication: small animals example

A
  • Dexmedetomidine
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3
Q

Dexmedetomidine: premedication for small animals

A
  • Highly selective for alpha 2 receptor
  • Excellent sedative for healthy exotics
  • Always combine with an opioid for more reliable results
  • Quality of sedation is profound, but can overrride
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4
Q

if IV administration of dexmedetomidine (premed for small animals)

A
  • Decrease dose by half
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5
Q

Dexmedetomidine dose dependent CV and respiratory depression: choose dose based on number of factors:

A
  • Patient temperament
  • Hydration status
  • Anticipated pain levels of procedures
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6
Q

Dexmedetomidine onset of action (IM)

A
  • 15mins
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7
Q

Dexmedetomidine duration of action

A
  • 45mins to 1hr
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8
Q

Dexmedetomidine reversable available

A
  • Atipamezole
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9
Q

Premedication: large animals example

A
  • Xylazine
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10
Q

Xylazine (premedication large animals)

A
  • Horses, ruminants, camelids
  • Excellent sedative for healthy patients
  • Quality of sedation=excellent
  • Reflex bradycardia profound but transient
  • *can be reversed if necessary (RARE)
  • **does for ruminants is lower=more sensitive
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11
Q

Xylazine (premedication large animals): onset of action

A
  • Minutes
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12
Q

Xylazine (premedication large animals): duration of action (IV)

A
  • 30-45 mins
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13
Q

Premedication: horses example

A
  • Detomidine
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14
Q

Detomidine (premedication in horse)

A
  • Good quality sedation: may be slight more ataxic/depressed then with xylazine
  • Onset and duration similar to xylazine
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15
Q

Sedation for minor procedures; small animals example

A
  • Dexmedetomidine
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16
Q

Dexmedetomidine (minor procedures in small animals)

A
  • Profound sedation for minor procedures (quill removal, laceration repair)
    o Even more with IV (place catheter for ‘top ups’ to be easier)
  • Combine with opioid to improve quality of sedation
  • Combined with local block if possible
17
Q

Dexmedetomidine (minor procedures in small animals): reversible

A
  • Get rid of drugs once procedure is complete
18
Q

Sedation for standing procedures: large animals example

A
  • Xylazine
  • Detomidine
19
Q

Xylazine (sedation for standing procedures): horses

A
  • Teeth floats, minor lacerations
  • Feet firmly planted, but can still kick!
  • Often combined with BUTORPHANOL
20
Q

Xylazine (sedation for standing procedures): cows

A
  • Foot trims
  • Combine with BUTORPHANOL
  • Will result in recumbency in 15mins
  • Duration of action: 60mins
  • *reversible with Tolazoline IM (avoid excitement)
21
Q

Detomidine (sedation for standing procedures)

A
  • Often combined with opioid (BUTORPHONAL)
  • Longer standing procedures=make up infusion and administer to effect
    o Laparoscopic ovariectomy
    o Rectovaginal fistula
22
Q

Dexmedetomidine: infusion during surgery

A
  • *anesthetic sparing and analgesia
  • Be aware of bradycardia with bolus
  • More effective when combined with an opioid infusion (Fentanyl/Remifentanil)
  • Not commonly administered to cats as an infusion
  • *very beneficial in horses (less used in dogs and cats)
23
Q

Dexmedetomidine: infusion during post-operative period

A
  • *analgesia and sedation
  • Indications
    o Anxious dogs
    o Fractious dogs
    o Painful dogs (need something more than an opioid)
24
Q

Dexmedetomidine: addition to local anesthetic

A
  • *prolongs duration of block
  • Mix with local anesthetic and administer in same syringe
    o Amount is small
  • Some systemic uptake=may see increased levels of sedation
25
Q

Mechanism of action with dexmedetomidine + local anesthetic

A
  • Vasoconstriction associated with alpha2 agonist DELAYS clearance of local anesthetic from the site
26
Q

Dexmedetomidine in epidurals: small animals

A
  • Not routinely used
  • Direct neurotoxic effects have not been fully tested
27
Q

Dexmedetomidine in epidurals: large animals

A
  • Prolongs duration of blockade
  • Easily accessible for practitioners
  • Does NOT produce motor blockage
  • Often combined with local anesthetics or opioids
  • Produce analgesia
  • Adverse effects (ataxia, recumbency): can be reversed
  • Systemic absorption occurs: CAUTION
28
Q

Xylazine in epidurals: horses

A
  • Provide 2.5 hours of perineal analgesia
  • No hind limb ataxia 1/5th the dose typically given systemically
  • *if combined with lidocaine=do NOT exceed 10mL
    o More volume you put in=further it will spread
29
Q

Detomidine in epidurals: horses

A
  • Potent analgesic AND sedative effects
  • Sedation, ataxia, recumbency, and CV effects can occur
  • Use low doses
  • Analgesia will spread cranially
  • Duration is shorter than xylazine: 2 hours
  • Diuresis occurs
30
Q

Romifidine in epidurals: horses

A
  • Analgesia inconsistent: if works=4hrs of analgesia
  • Spreads cranially similar to detomidine
  • Sedation, bradycardia and decreased RR has been reported
31
Q

Xylazine alone in epidurals: cattle

A
  • Onset of action: 10mins
  • Duration of action: 3-4hours
32
Q

Xylazine combined with lidocaine in epidurals: cattle

A
  • Onset of action: 5mins
  • Duration of action: 6hrs
33
Q

Side effects of xylazine +/- lidocaine in epidurals: cattle

A
  • Mild to moderate sedation
  • Mild ataxia
  • Decreased ruminal motility
  • Bradycardia
34
Q

Romifidine in epidurals: cattle

A
  • Analgesia and sedative effect=dose dependent in intensity and duration of action
35
Q

Specific breed/species considerations

A
  • Bradycephalics and animals with laryngeal paralysis
  • Blocked cats
  • Diabetic implications
  • *UNEXPECTED AROUSAL: do NOT trust it!
36
Q

Bradycephalics and animals with laryngeal paralysis considerations

A
  • Beware of use
  • Pharyngeal and laryngeal MUSCLE RELAXATION may further impair compromised airway
  • *DECREASED ESOPHAGEAL SPINCTER TONE=increased risk of regurgitation
37
Q

Blocked cats considerations

A
  • MUSCLE RELAXATION may aid in passage of urethral catheter
38
Q

Diabetic implications: considerations

A
  • Reduced insulin leads to increased hepatic glycogenolysis and gluconeogenesis causing HYPERGLYCEMIA
  • Clinical relevance: minimal (can manage hyperglycemia and they will be hyperglycemic due to stress)

ANESTHESIA (18 decks)

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