Healthy patient anesthesia

Question 1

common healthy cat sedation protocol other than kitty magic

Answer 1

ket + dex
or butorfanol + dex (opioid + sedative)

Question 2

what dosage ket + medetomidine
and ket + dex are used in healthy cats?

Answer 2

ketamine 5 mg/kg and medetomidine 0,05
mg/kg

(or dexmedetomidine 0.008 - 0.02 mg/kg)

can be mixed in one syringe or given separately.

Has fast onset of action ca 5-10 min and gives ca 50min anesthesia.

Question 3

„Kitty Magic” is a mixture of?

Answer 3

ketamine (100 mg/ml)
dexmedetomidine (0,5 mg/ml) and
butorphanol (10 mg/ml)

This combo allows reduction of all drug volumes.

Question 4

Butorphanol is a synthetic opioid that is classified as a (what does it agonize or antagonize)

Answer 4

kappa receptor agonist and mu receptor competitive antagonist.

the kappa agonism allows for its sedative qualities.

Question 5

What does the “kitten quad” involve?

Answer 5

Combination designed for early castrations (4 months).

Equal volumes of:
Medetomidine 1mg/ml,
Ketamine 100mg/ml,
Midazolam 5mg/ml and
Buprenorphine 0.3mg/ml.

Can mix in same syringe and give at same time.

Question 6

local anesthesia of cat larynx: what drug what dosage

Answer 6

lidocaine 1 mg/kg

Question 7

If using an opioid and dexmed. for a cat patient up to ASA III: at what doses?

Answer 7

Methadone 0,2 – 0,3 mg/kg i.m.
+
dexmedetomidine 0,005 – 0,02 mg/kg i.m.

(+ ketamine at 0,5 – 1 mg/kg i.v. at induction)

This protocol strongly recommended in cases of not standard procedures (unknown duration), ASA III cats.

Question 8

If using an opioid and ace for a cat patient up to ASA III: at what doses?

Answer 8

Methadone 0,2 – 0,3 mg/kg i.m.
+
acepromazine 0,02 – 0,05 mg/kg i.m.

(+ ketamine at 0,5 – 1 mg/kg i.v. at induction)

This protocol strongly recommended in cases of not standard procedures (unknown duration), ASA III cats.

Question 9

what to remember about ket and prop at induction?

Answer 9

wait 1 min between administration of ketamine to beginning administration of propofol titration

Question 10

What premeds would you use in the case of an ASA III - V cat with an existing iv catheter and at what dosages?

Answer 10

Methadone 0,2 mg/kg i.v.
+
midazolam 0,2 mg/kg i.v.

OR

Methadone 0,2 mg/kgi.v.
+
acepromazine 0,01 – 0,02 mg/kg i.v.

Question 11

which cat breeds may benefit from a unique anesthetic protocol? (4)

Answer 11

devon rex
sphynx
maine coon
persians

Question 12

devon rex cats are predisposed to what due to what?

Answer 12

Genetic problems:
 Hypertrophic cardiomyopathy, HCM
 Patella luxation
 Hip dysplasia
 Myopathy / spasticity

Are Partially hairless
Due to Crossbreeding and inbreeding.

Question 13

What are acute phase complications?
Versus sub-acute?

Answer 13

Acute happen during anesthesia or recovery.

Sub-acute happen 24-48 h after anesthesia.

Question 14

In regard to the data on devon rex & sphynx cats, it seems that the most severe incidents and complications happen with anesthetic
protocols including..?

Answer 14

ketamine

However, There is no evidence based information that Devon Rex and Sphynx are more sensitive to anesthetic agents than other cat breeds.

Question 15

Main Coon Breed-associated diseases: (6)

Answer 15

 Hypertrophic cardiomyopathy
 Hip and elbow dysplasia

 Patella luxation
 Spinal muscle atrophy

 Polycystic kidney disease
 Aseptic necrosis of femoral head

Question 16

A pre-anesthetic work-up for a maine coon
should include what extras? (2)

Answer 16

echocardiogram
proBNP-test

Question 17

congenital defect, PPDH, sometimes seen in maine coons stands for

Answer 17

Peritoneopericardial diaphragmatic hernia

Question 18

Persian cat breed associated problems: (3)

Answer 18

 Brachycephalic syndrome
 Polycystic kidney disease
 Hypertrophic cardiomyopathy

Question 19

What 3 factors should one take into account when anesthetizing Sighthounds: (3)

Answer 19

 Low body-fat ratio
 Atypical liver enzymatic activity
 Prolonged recoveries after barbiturates

Question 20

Methadone should be given in lowest dose as possible because it possesses one of the highest

Answer 20

CO (cardiac output) depression adverse affects among the opioids.

Question 21

canine protocol (ASA I-II):
Methadone + dexmedetomidine i.m. at what dosages?

Answer 21

Methadone 0,2 – 0,5 mg/kg i.m.
+
dexmedetomidine 0,005 – 0,02 mg/kg i.m.

Question 22

canine protocol (ASA III -V): Methadone + midazalom i.v. at what dosages?

Answer 22

Methadone 0,2 mg/kg i.v.
+
midazolam 0,2 – 0,3 mg/kg i.v.

Question 23

canine protocol (ASA III -V): Methadone + acepromazine i.v. at what dosages?

Answer 23

Methadone 0,2 – 0,3 mg/kg i.v.
+
acepromazine 0,005 - 0,01 mg/kg i.v.

Question 24

What can you administer at induction with the goal of reducing propofol volume?

Answer 24

midazolam 0.2 mg/kg i.v. and
ketamine 1 mg/kg i.v. both or just the ket.

ie. good for quick induction of brachys to avoid apnea or prolonged apnea

Question 25

What is the MDR-1 gene mutation?

Answer 25

certain breeds carry the multidrug resistance-1 gene mutation which causes the to experience higher penetration of certain drugs through hematoencephalic-
barrier.

they are more sensitive to certain drugs.

Use acepromazine and butorphanol only in lowest dose ranges or try to avoid at all.

Question 26

What 2 anesthetic drugs should you use with caution in potential MDR-1 cases?

Answer 26

Use acepromazine and butorphanol only in lowest dose ranges or try to avoid at all.

Question 27

In Sighthounds, Greyhounds favor alfaxalone or prop?

Answer 27

Alfaxalone (neurosteroid) beneficial over
propofol for induction.

Question 28

In Sighthounds, Greyhounds, Avoid of using longterm acting sedatives with no
antagonization properties such as?

Answer 28

acepromazine

Question 29

Perioperatively used NSAIDs in dogs and cats (4+1)

Answer 29

carprofen
ketoporfen
meloxicam
robenacoxib
(paracetamol but not an NSAID)

Question 30

Paracetamol in dogs: Clinical dose

Answer 30

10– 15 mg/kg IV preoperatively and
then every 8 h

Question 31

Paracetamol in dogs, Contraindicated for patients with (2)

Answer 31

liver disease or dehydrated patients

Toxic for cats!

Question 32

Good choice for basic surgical protocol ASA I OVH 9m/o dog.

Answer 32

Premedication:
 Dexmedetomidine 0.008 mg/kg i.m.
 Methadone 0.25 mg/kg i.m.

The methadone is preemptive analgesia for the known painful surgical procedure ahead.

Induction:
 Ketamine 2 mg/kg i.v.
(to keep the SNS stimulated)
 Propofol 3 – 4 mg/kg i.v.

 Paracetamol 10 mg/kg i.v. and maropitant in order to smooth recovery. (para for postoperative and visceral pain)

Intra-op:
 Fentanyl boluses if needed 2 mcg/kg i.v.
Post-op:
 Buprenorphine 0.02 mg/kg,
meloxicam 0.2. mg/kg

Question 33

Good choice for basic surgical protocol ASA I aggressive OVH 1.5 y/o cat.

Answer 33

Kitty magic:
 Dexmedetomidine 0.01 mg/kg i.m.
 Butorphanol 0.2 mg/kg i.m.
 Ketamine 2 mg/kg i.m.

Induction:
 Propofol 2 - 3 mg-kg i.v.

Intra-op:
 Fentanyl bolus if needed 2 mcg/kg i.v.

Post-op:
 Buprenorphine 15 mch/kg,
meloxicam 0.2 mg/kg sc

Question 34

Good choice for basic surgical protocol ASA III total mastectomy + OVH 8 y/o dog.

Answer 34

 Dexmedetomidine 0.006 mg/kg i.m.
(low dose because of dog age)
 Methadone 0.2 mg/kg i.m.
(preempting painful procedure)
 Midazolam 0.2 mg/kg i.m.
(to compensate the low dose of dex)

 Propofol 2 – 3 mg/kg i.v.
 Paracetamol 10 mg/kg i.v.

Intra-op:
 FLK CRI

Post-op:
 Meloxicam 0.2 mg/kg,
methadone 0.2 mg/kg q 4 h (in hospital, bupe not quite enough for this pain)