Feline Anesthesia

Question 1

Compared to dogs cats are

Answer 1

-more difficult to intubate
-more sensitive to CV depression due to inhalant drugs
-more likely to become hypotensive
-slower to metabolize and eliminate drugs
-More sensitive to NSAIDS and lidocaine adverse effects

Question 2

What is a common disease that cats can get that increase their risk of anesthetic death and how would you be able to test for it

Answer 2

Hypertrophic cardiomyopathy
Detecting a murmur in HCM predisposed cat (reach out to cardiologist before anesthesia) but some of them won’t have a murmur so a point-of-care NT-proBNO SNAP test to screen for heart disease

Question 3

What is the concern of having cats with HCM receiving anesthesia

Answer 3

-Anesthetic related death due to fatal arrhythmias
-post anesthetic related CHF

Question 4

What plays a major role in behavior of cats during the physical exam

Answer 4

Physical restraint technique and premeds

Question 5

What are some at-home premedications for cats

Answer 5

-Gabapentin
-Trazodone

Question 6

What are some pre-meds (in hospital) you can give cats

Answer 6

-Dexmedetomidine - need higher doses than dogs and vomiting is most likely to occur
-Ketamine - very common use
-Benzodiazepines - given in combo with ketamine (w/o combination will cause paradoxical excitement)
-Opioids
*Methadone causes less excitement than morphine
*Fentanyl CRI intro/post operative analgesia
*Buprenorphine for visceral analgesia
(Buprenex - ELDU low dose multiple times, Simbadol - SQ SID, Zorbium - Transdermal lasting 4 days)

Question 7

What pre-med in dogs is not advised to use in cats

Answer 7

Acepromazine
Not as effective and can aggravate side effects

Question 8

What are good chemical restraints in aggressive cats

Answer 8

-Oral transmucosal
*desmedetomidine and Ketamine
Good sedation
-IM
*Alflaxalone/Ketamine (+ alpha2 + opioid) = kitty magic

Question 9

What are some induction agents you can use in cats

Answer 9

IV
-propofol (safe in cats just don’t use repeatedly as it can cause Heinz body anemia)
-Alflaxalone
-Etomidate
-ketamine +/- telazol (dissociative anesthetic)

Question 10

What is the induction anesthetic of choice in a cat with cardiovascular disease

Answer 10

Etomidate

Question 11

When is ketamine contraindicated in cats

Answer 11

Cats with renal disease/dysfunction as it prolongs the duration of action

Question 12

When do you want to avoid Ketamine and telazole in cats

Answer 12

When they have cardiac disease diagnosis or suspect ion as it can precipitate CHF in cats

Question 13

Why is mask induction not recommended in cats

Answer 13

-It can trigger a stress response -> release epi/norepi causing arrhythmias
-high doses can cause hypotension

Question 14

What makes orotracheal intubation in cats difficult and what would would you do to prevent it

Answer 14

Cats are prone to laryngospasm
Give topical lidocaine to prevent the arytenoid cartilage spasm

Question 15

What is the risk of advancing the ET tube too far

Answer 15

Risk of mainstem bronchus intubation and pneumothorax
Can cause treachery damage causing SQ emphysema and pmeumomediastinum

Question 16

What is an alternative to ET intubation in cats

Answer 16

V-gel supraglottic airway device (laryngeal mask airway)

It’s a single use devise that is designed to fit over the larynx and is easier to use by inexperienced personnel

Question 17

What is some maintenance anesthetic in cats

Answer 17

-Inhalant anesthetic- ISO (MAC is higher in cats than dogs)
-Adjunct drugs CRIs
*Opioids
*Ketamine

Question 18

What CRI drug can you use in dogs for maintenance but not for cats

Answer 18

Lidocaine
-cats are more sensitive to CNS toxic effects
-can cause additional cardiovascular depression
-can use as a local block though just at a smaller dose than dogs

Question 19

What are some common complications of anesthesia in cats

Answer 19

-pulmonary edema/ fluid overload
-Hypotension
-Blindness +/- neurological deficits
-neuro deficits secondary to open mouth as spring loaded mouth gags compromise maxillary artery blood flow
-cerebral hypoxia caused by poor perfusion and hypoxemia
-renal and GI effects from NSAIDs
-blood transfusion severe reaction

Question 20

What is the total blood volume of cats

Answer 20

60 ml/kg

Question 21

What should be the intro-op fluid rate in cats

Answer 21

3ml/kg/hr

Question 22

What are some things you can give to cats to reduce/correct hypotension

Answer 22

-give MAC sparing inhalant anesthetic
-use vasopressors/ inotropes
*dopamine is a good first choice and effect drug

Question 23

Why are cats more sensitive to the toxic effects of NSAIDs

Answer 23

-defective hepatic glucuronidation and have altered drug metabolites -> extends drug half life and accumulation-> toxic effect

Question 24

What are the 2 approved NSAIDs in cats

Answer 24

-Robenacoxib (3x SID but has been shown to be safer for longer use due to its short half life in cats)

-Meloxicam (one SQ dose)

Question 25

What do you need to do before give a cat a blood transfusion and why

Answer 25

-You MUST ALWAYS type and cross-match blood before transfusion as cats have naturally occurring antibodies

Question 26

Which blood type in cats are considered universal recipients and why

Answer 26

Type AB blood as they have no autoantibodies for A or B

Question 27

Which combination of blood types from donor to recipients will cause a severe hemolytic reaction and why

Answer 27

A type donor to B type recipient

-A types have low level autoantibody to B but B type has high level autoantibodies for A antigen

Question 28

What are the common breed for blood type A and B

Answer 28

Type A - domestic shorthairs
Type B - Himalayan, Persian, Abyssinian, Scottish fold

Question 29

What are two recently added FDA approved drugs for Cats

Answer 29

-Buprenorphine transdermal solution (Zoribum)
-approved for post op pain, admin in hospital prior to six with proper PPE (dries within 30min) and will last for 4 days - can cause hyperthermia for a few days post-op

-Frunevetmab (Solenisa)
Anti-NGF monoclonal antibody that is used to control pain due to OA given as an SQ monthly injection