Clinical sedation and Premedication Flashcards
When can sedation be used as an alternative to anaesthesia?
In non-invasive or non-painful procedures
What are some reasons to sedate an animal?
- Relieve patient anxiety
- Facilitate patient handling
- Provide analgesia
- Provide muscle relaxation
- To enable procedures or interventions to be carried out
What are some reasons to premedicate an animal?
- Smooth induction, maintenance and recovery of general anaesthesia
- Reduce required dose for induction/maintenance agent
- MAC sparing effect
What are some factors that an ideal sedative/premed would have?
- Safe
- Reliable and predictable effect
- Quick onset with an appropriate duration of action
- Easy to administer
- Minimal side effects
- Provide analgesia
Drugs for food producing animals must have what?
Maximum residue limit
What could be used in equine species pre-appointment to relieve anxiety?
Acepromazine oral gel
Detomodine oromucosal gel
What drugs can be used in dogs and cats pre-appointment to relieve anxiety?
Gabapentin
Trazadone
Give some example of opioid drugs
Butorphanol Buprenorphine Methadone Fentanyl Morphine
In which situations will opioids be adequate on their own?
- Very painful animals e.g. fracture, urinary infection
- Very sick animals
Which system can become depressed after opioid administration?
Respiratory
Which anaesthetic drug is a part of the phenothiazine group?
Acepromazine
What are some downsides of using acepromazine?
- No analgesia
- Onset = 20-40mins (long)
- Not reversible
In which cases would Acepromazine not be suitable?
- Very young (<3 months)
- Hepatic impairment
- Haemorrhage (actual or anticipated)
- Anticipated hypotension during general anaesthesia
- Sepsis
Give some drug examples of Alpha-2 agonists
Xylazine Detomidine Romfidine Medetomidine Dexmedetomidine
What are some side effects of alpha-2 agonists?
- peripheral vasoconstriction, then reflex bradycardia
- reduced cardiac contractility
- increased urine production
What are some of the advantages of alpha-2 agonists?
- Almost immediate onset of action
- Very reliable sedation
- Analgesia
- Reversible
- Large MAC sparing effect
Which drug acts to reverse alpha-2 agonists?
Atipamezole
Benzodiazepines are useful for which types of patient?
Very old
Very young
Very sick
What are the pros and cons or benzodiazepines?
Pros: - Minimal side effects - Relatively fast onset - Reversible Cons: - Unreliable sedation - No analgesia
In which species are benzodiazepines not suitable?
Farm animals
Propofol can only be administered via which route?
IV
Ketamine can be useful as an adjunct in which type of cases?
Cases which need additional analgesia
Aggressive cases to increase sedation reliability
Which 3 drugs can be used in farm animal species?
Butorphanol
Xylazine
Detomidine
Ruminants are particularly sensitive to which alpha-2 agonist? how does this affect the dose?
Xylazine
- Use 1/10th of the dose you would use for a horse
Which drug group provides reliable sedation of horses?
Alpha-2 agonists
Why would acepromazine be added following equine sedation?
To smooth recovery
In which equine cases would you not use acepromazine and why?
Colic because of vasodilation effects
In horses why would you administer an alpha-2 agonist first and then an opioid 5 minutes later?
If not given like this it can cause excitation from the opioid
