Healthy patient anesthesia Flashcards by Laura Westman

common healthy cat sedation protocol other than kitty magic

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

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

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.

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„Kitty Magic” is a mixture of?

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

This combo allows reduction of all drug volumes.

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

kappa receptor agonist and mu receptor competitive antagonist.

the kappa agonism allows for its sedative qualities.

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What does the “kitten quad” involve?

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.

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local anesthesia of cat larynx: what drug what dosage

lidocaine 1 mg/kg

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

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.

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

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.

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what to remember about ket and prop at induction?

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

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

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

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

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

devon rex
sphynx
maine coon
persians

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devon rex cats are predisposed to what due to what?

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

Are Partially hairless
Due to Crossbreeding and inbreeding.

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What are acute phase complications?
Versus sub-acute?

Acute happen during anesthesia or recovery.

Sub-acute happen 24-48 h after anesthesia.

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

ketamine

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

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Main Coon Breed-associated diseases: (6)

 Hypertrophic cardiomyopathy
 Hip and elbow dysplasia

 Patella luxation
 Spinal muscle atrophy

 Polycystic kidney disease
 Aseptic necrosis of femoral head

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

echocardiogram
proBNP-test

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

Peritoneopericardial diaphragmatic hernia

Persian cat breed associated problems: (3)

 Brachycephalic syndrome
 Polycystic kidney disease
 Hypertrophic cardiomyopathy

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

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

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

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

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

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

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

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

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

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

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

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

What is the MDR-1 gene mutation?

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.

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

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

In Sighthounds, Greyhounds favor alfaxalone or prop?

Alfaxalone (neurosteroid) beneficial over propofol for induction.

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

acepromazine

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

carprofen ketoporfen meloxicam robenacoxib (paracetamol but not an NSAID)

Paracetamol in dogs: Clinical dose

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

Paracetamol in dogs, Contraindicated for patients with (2)

liver disease or dehydrated patients Toxic for cats!

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

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

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

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

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

 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)