How do you perform procedures under sedation in SA practice?

Question 1

Difference between sedation and premedication.

Answer 1

Sedation is where the patient is sedated and not under GA i.e. no loss of consciousness.
Premedication is administered prior to administering GA.
Lower doses used for premedication than for sedation.

Question 2

What is sedation?

Answer 2

Falls between completely conscious (fully awake) and completely unconscious (fully anaesthetised).
Allows procedures to take place that may/would not be possible in a fully conscious patient.

Question 3

When is sedation appropriate in SA practice?

Answer 3

• Safe handling of anxious / dangerous / feral animals for procedures that would usually be performed w/o sedation such as blood sampling.
• Non-painful/non-invasive procedures that just require animal to be still e.g. x rays.
• Minor procedures such as wound re-dressing, grass seed removal from ears, de-matting.

Question 4

Is sedation safer than GA in SAs.

Answer 4

Sedation theoretically less extreme procedure than GA.
But…
No control over airway (no ET tube).
Often no option of deepening sedation if inadequate (so may need to progress to full GA anyway).
Staff and patient safety to be considered e.g. staff should not hold down animals for radiography but risk animal falling/jumping off table if only under sedation.

Question 5

How can an IM injection of sedative be given to a feral animal?

Answer 5

Crush cage.

Question 6

Sedation protocols by ASA grade…
1. Grade 1 and 2 dogs and cats.
2. Grade 1 and 2 rabbits.
3. Grade 3 dogs.
4. Grade 3 cats.
5. Grade 3 rabbits.

Answer 6

1. ACP + opioid OR a2 agonist + opioid.
2. ACP + opioid OR a2 agonist + opioid OR fentanyl / fluanisone (Hypnorm) alone or w/ BDZ.
3. ACP + opioid OR BDZ + opioid.
4. BDZ (midazolam) + ketamine.
5. BDZ + opioid.

Question 7

…
Grade 4 and 5 dogs, cats and rabbits.

Answer 7

BDZ + opioid OR BDZ + ketamine OR opioid alone.

Question 8

1. What sedative types could potentially be reversed?
2. What sedative type is usually the most likely to be reversed?
3. What would be used to reverse the fentanyl in Hynorm?

Answer 8

1. a2 agonists, opioids, BZD.
2. a2 agonists.
3. opioid partial agonist (e.g. buprenorphine) / agonist antagonist (e.g. butorphanol) / antagonist (e.g. Naloxone).

Question 9

How do we care for our sedated patients?

Answer 9

• Quiet environment.
• Observed continuously using eyes, ears and nose.
• Think ABC (airway, breathing, circulation).
• Monitor TPR and MMs.
• Pulse oximeter.
• Record obs.

Question 10

What could go wrong with the sedated patient?

Answer 10

• Excitement / excessive sedation.
• Airway obstruction (vomit inhalation, anatomical).
• CVS effects up to and including cardiac arrest.
• Patient cannot compensate for existing condition / hidden condition exposed.
• Something odd develops (e.g. gastric dilation).