Anaesthesia for Cardiac Compromise

Question 1

What drugs should we use?

Answer 1

• Acepromazine - good for mitral regurgitation (reduces afterload)
• Alpha 2 agonists - used less in cardiac patients (have effect on cardiac output)
• Benzodiazepines - can be used for cardioresp

zen alpha - medetomidine and alpha 2 agonist and antagonist
* should have less effect on cardio

Low dose dexmedetomidine on animals that are anxious

Opioid will cause bradycardia - so use moderate dose and combine with benzodiazepine - fluid load and monitor HR
* butorphanol (good when need sedation)
* buprenorphine
* methadone

Local anaesthesia will help use a lighter plane of anaesthetic
* animal will wake up less stressed

Induction
* propofol - some benzodiazepine to reduce dose
* alfaxalone - less apnea
* ketamine - more common in cat -> increase in HR

Question 2

What should we have ready in case of an emergency?

Answer 2

• Anticholinergics
• Inotropes (e.g. dopamine, dobutamine)
• Vasopressors (e.g. norepinephrine) rather than an inotrope to improve blood pressure causing vasoconstriction, but it might be the case that your animal is inappropriately vasodilated
• Antiarrhythmics (lidocaine, beta blockers)
• IVFT and switch down the volatile!
• Keep the GA short

Question 3

How should we monitor?

Answer 3

• Haematology & biochemistry (beforehand)
• Manual methods (CRT, PR, HR, pulse strength, RR, colour)
• Oesophageal stethoscope
• Pulse oximetry
• Blood pressure (Doppler, Oscillometric, invasive)
• Capnography
• Temperature
• ECG
• Arterial blood gases?