Anesthesia of Dog and Cat

Question 1

Steps of anesthesia

Answer 1

1. pre anesthetic evaluation and patient prep
2. Pre anesthetic medication
3. anesthetic induction
4. maintenance and monitoring
5. recovery

Question 2

Patient assessment

Answer 2

-full exam (age, temperament, breed)

-medical history (past issues, drug responses, anesthetic events, present medications)

-basic hematology (PCV, TP, BUN, Gluc)

Question 3

Diagnostic tests for older/sick patients

Answer 3

-CBC, serum chem, urine

-radiograph thorax (trauma or resp issues)

-ECG, echocardiography (murmurs, arrhythmias)

-delay anesthesia until assessment and stabilization

Question 4

Client communications

Answer 4

-discuss anesthetic risk, expectations

Question 5

Patient prep at home

Answer 5

-anxiety drugs: trazodone or gabapentin

Question 6

Food and water fasting

Answer 6

-allow access to water
-young animals: shorter fasting
>6-16weeks for 4 hrs
>older than 16 weeks: 6-8hrs

Question 7

Anesthetic protocol considerations

Answer 7

-physical exam
-age
-temperament
-surgical procedure
-clinical setting

Question 8

Anesthesia protocol meds

Answer 8

Premed: sedative and opioid

Induction:

Maintenance: inhalant, opioid, local anesthetic

Post op pain med: NSAID, opioid

Question 9

Aim of premed

Answer 9

-sedation and anxiolysis
-allow animal handling
-balanced anesthetic technique (less drugs)
-analgesia
-smooth and quiet recovery

Question 10

Opioids for premed

Answer 10

1. hydromorphone
2. methadone
3. butorphanol
4. buprenorphine

Question 11

Sedatives for premed

Answer 11

1.acepromazine
2.dexmedetomidine
*dont use with anticholinergic
3.midazolam

Question 12

anticholinergics for premed

Answer 12

-atropine
-glycopyrrolate

Question 13

Why not co-administer anticholinegic with dexmedetomidine?

Answer 13

vasoconstriction=dex
anticholinergic=increased HR
**leads to arrythmias

Question 14

Premed protocol options for calm dogs

Answer 14

1.Acepromazin and hydromorphine

OR

2. Dexmedetomidine and hydromorphine

Question 15

Premed protocol for excited, agitated dogs

Answer 15

-acepromazine, dexmedetomidine, hydromorphine

Question 16

Standard Premed for cats

Answer 16

-dexmedetomidine and hydromorphone

Question 17

Heavy sedation for cats

Answer 17

Kitty magic-use ketamine based protocol

Options:

1. Dexmedetomidine, midazolam, butorphanol
2. dexmedetomidine, ketamine, butorphanol
3. alfaxalone, butorphanol, midazolam

Question 18

Induction

Answer 18

-check equipment (breathing system, leak tests, check machine)
-ET tubes ready, lube,
-catheter placement
-monitor HR, RR, pulse quality
-pre-oxygenate
-quiet environment

Question 19

Induction- dog and cat options

Answer 19

1. propofol
2. Diazepam, ketamine
3. alfaxalone
4. mask induction- but not really used anymore. Stressful and waste of drug

Question 20

ABCs of induction

Answer 20

Airway
Breathing
Circulation
Depth and drugs
Equipment
Fluids

Question 21

Airway- Endotracheal intubation

Answer 21

-clean tube/murphy eye
-check cuff for leaks
-have multiple tubes available (laryngoscope, kling, cuff syringe)

Question 22

Measuring ET tube

Answer 22

-incisor teeth to thoracic inlet

Question 23

intubation technique

Answer 23

-laryngealscope in non-dominant hand
-sternal position
-extend head/neck, pull tongue
-inflate cuff
-secure tube

Question 24

Intubation technique of cats

Answer 24

-prone to laryngospasm, so use lidocaine
>lidocaine neat 2%= 2mg per 0.1ml

-typically 3-4 size ET tubes

Question 25

Confirmation of endo tracheal intubation

Answer 25

-direct visualization
-rebreathing bag
-chest excursions
-palpation of one trachea below larynx
-capnograph

GOLD STANDARD: auscultation of both sides of chest during manual ventilation

Question 26

What does airway establishment include?

Answer 26

-intubation
-secure ETT
-inflate cuff
-confirm endotracheal intubation

Question 27

Check depth and drugs

Answer 27

-eye position
-palpebral reflex
-jaw tone

**based on patients depth=turn on vaporizer

Question 28

Equipment

Answer 28

monitor patient and adjust throughout procedure. Do not always need high vaporizer setting

-use doppler

Question 29

Fluids

Answer 29

-used to correct normal ongoing fluid losses
-supports cardiovascular function
-maintains patent IV catheter

Question 30

Fluid rates for cats and dogs

Answer 30

Cats: 3ml/kg/hr

Dogs: 5ml/kg/hr

Question 31

Post op period recovery

Answer 31

-most anesthetic related deaths occurring within first 3 hrs of recovery
-monitor!

Question 32

Extubation

Answer 32

-dont deflate cuff until close to extubation
-don’t untie tube until animal in final recovery spot

Dogs: remove on return of swallowing reflex

Cats: extubated sooner. On return of good palpebral reflex, ear flick reflex

Question 33

Common complications

Answer 33

-emergence delirium- going through stage 2 of anesthesia in reverse order
-dysphoria
-pain
-delayed recovery

Question 34

Optimal recovery time

Answer 34

within 10-30mins of end of anesthesia

Question 35

Supportive care for recovery

Answer 35

-oxygen
-fluids
-heating
-eye ointment

Question 36

Patient comfort during recovery

Answer 36

-environmental stress
-hypothermia
-urinary bladder distension
-pain assessment and adequate pain management