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Anesthesiology 398 and 466 > Lecture 9 Anesthesia in Dogs and Cats Part 1 > Flashcards

Lecture 9 Anesthesia in Dogs and Cats Part 1 Flashcards

1
Q

What can be done to Prevention of Peri-anesthetic nausea & vomiting

A
  • Give Maropitant (Cerenia) – Neurokinin-1 antagonist 1.0mg/kg subQ at least one hour before opioid premedication
    • Prevents vomiting & signs of nausea associated with opioid drugs
    • Faster return to feeding PO
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2
Q

What type of drug is Maropitant (Cerenia)

A

•Neurokinin-1 antagonist

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3
Q

Other than preventing vomiting and nausea, what does Maropitant (Cerenia) do?

A

Adjunct analgesia - ↓MAC sevoflurane in dogs & cats

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4
Q
  1. What do opoids do to the body
  2. MAC?
A
  1. Bradycardia, respiratory depression
    • Mild CV effects
  2. ↓ MAC of inhalant
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5
Q

What are some considerations when choosing an opioid?

A
  1. Pre-emptive pain score – None, mild, moderate, severe pain
  2. Duration of action – (Onset of action – buprenorphine)
  3. Ceiling effect?
  4. Does it cause nausea/vomiting?
    • ↑ IOP, ICP, risk for aspiration => brachycephalic, laryngeal hemiplegia, neurologic patients
  5. Route of administration – fentanyl requires IV catheter
  6. MAC sparing
  7. Dog vs cat – mu agonists
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6
Q
  1. What type of drug is butorphanol
  2. Does it cause sedation?
    • if so how long does it last?
  3. Analgesia?
    • if so how long does it last?
A
  1. Kappa agonist-mu antagonist
  2. Mild sedation
    • 1-2 hours,
  3. Mild analgesia
    • ~90min.
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7
Q
  1. Does butorphanol have a ceiling effect?
  2. What type of procedures is it used on?
A
  1. ‘Ceiling effect’
  2. Non- or mildly painful procedures
    • Imaging, minor sx procedure
    • Pre-med to avoid vomiting, full agonist to follow
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8
Q
  1. What type of drug is buprenorphine
  2. Causes sedation?
  3. Analgesia?
A
  1. Partial mu agonist
  2. Little sedation,
  3. mild-moderate analgesia
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9
Q
  1. Can Buprenorphine be easy to reverse?
  2. onset
  3. duration
  4. Does it have a ceiling effect?
A
  1. Very ‘sticky’ to mu receptor
    • difficult to reverse or to follow with mu agonist
  2. Slow onset => 30-45min.
  3. Duration => Dogs: 4-10 hours, Cats: 6-12 hours
  4. ‘Ceiling effect’
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10
Q

What are the full mu agonists

A
  1. Hydromorphone,
  2. Morphine,
  3. Oxymorphone,
  4. Methadone
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11
Q
  1. How much pain do the full mu agonists alieve
  2. Duration of actions for each?
A
  1. Moderate – severe pain
  2. Duration of action:
    • Hydro/oxymorphone: 2-4 hours
    • Morphine, Methadone 4-6 hours
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12
Q

Which full mu agonist is also an NMDA antagonist

A

Methadone

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13
Q

What are the side effects of full mu agonists

A
  1. –Nausea, Vomiting, defecation
  2. –Dysphoria, Panting
  3. –CV effects minimal; bradycardia
  4. –Respiratory depression
  5. –Hyperthermia in cats
  6. –Morphine can cause histamine release if given quickly IV
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14
Q
  1. What type of drug is fentanyl
  2. How much pain does it alleviate?
  3. Duration of action?
  4. What does it to do MAC of ISO?
A
  1. Full mu agonist
  2. Moderate-severe pain
  3. Short acting; 20-30 min.,
    • requires IV catheter/CRI
  4. ↓ MAC of ISO ~65%
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15
Q
  1. What is a side effect that most full mu agonists that fentanyl doesnt have
  2. What are its cardiovascular effects?
  3. Respiratory effects?
A
  1. •No vomiting, no histamine release
  2. •Mild CV effects -> Bradycardia
  3. •Respiratory depression -> Monitor SpO2, IPPV
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16
Q

What 2 drugs can be used as an induction agent IV in critical ill patients

A
  1. Fentanyl
  2. Midazolam
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17
Q

What are the Premedications that are sedatives

A
  1. Acepromazine
  2. Dexmedetomidine/Medetomidine
  3. Midazolam
  4. Diazepam
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18
Q
  1. What type of drug is Acepromazine
  2. Duration of action?
  3. Does it have a reversal agent. If so what?
A
  1. Phenothiazine, alpha-1 antagonist
  2. Long duration of action 4-6 hours (will last thorough recovery)
  3. No reversal agent
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19
Q
  1. Does acepromazine cause sedation?
  2. Analgesia?
A
  1. –Relatively more mild sedation vs dexmedetomidine
  2. –No analgesic effects, synergistic effect with opioids
20
Q
  1. What are the cardiovascular effects of acepromazine?
  2. Which types of animals do you want to give a low dose/ avoid it in?
  3. What conditions do you avoid it in?
A
  1. Vasodilation, hypotension,bradycardia
  2. Lower dose/ avoid IV,
    • geriatric,
    • pediatric,
    • liver dysfunction
  3. Avoid in:
    • hypovolemia,
    • shock,
    • critically ill,
    • liver failure
21
Q
  1. Does Dexmedetomidine cause sedation?
  2. Analgesia?
  3. Onset of action?
  4. Duration of action?
A
  1. Potent sedative
  2. analgesia
  3. Short onset of action (~5-10 minutes)
  4. Short duration of action (may not last throrough recovery)
    • May need sedation for recovery to avoid sudden arousal
22
Q
  1. What are the cardiovascular effects of Dexmedetomidine
  2. What is the reversal agent?
  3. What type of patients do you use it in?
A
  1. 40% ↓ CO, reflex bradycardia due to vasoconstriction
  2. Atipamazole
  3. Reserve for healthy or very painful, fearful, aggressive patient
23
Q
  1. Midazolam is good to use in young, healthy dogs?
  2. Geriatric, critical patients?
  3. What are its cardiovascular effects?
A
  1. Typically NOT good sedative in young, healthy dogs
    • Paradoxical excitement
  2. effective in geriatric, critical patients
  3. Mild cardiovascular effects
24
Q
  1. What are midazolams uses?
  2. Does it cause amnesia?
A
  1. Uses:
    • Induction adjunct => ↓ Propofol induction dose
    • Anti-convulsant => seizure patients
  2. Amnesic
25
Q
  1. What are the 2 anti-cholinergics?
  2. What does it do to vagal effects
  3. Salivary secretions?
A
  1. Atropine and Glycopyrrolate
  2. ↓ vagal effects
  3. ↓ salivary secretions
26
Q
  1. Does atropine cross BBB/placenta?
  2. Onset of action
  3. Duration of action?
A
  1. Crosses BBB/placenta
  2. Onset of action (minutes): 5 IM, 1 IV
  3. DOA: 60-90 minutes
27
Q
  1. Does Glycopyrrolate cross BBB/placenta?
  2. Onset of action
  3. Duration of action?
A
  1. –Does not cross BBB/placenta
  2. –Onset of action: 3 – 5 minutes
  3. –DOA: 2-4 hours
28
Q
  1. Side effects of Anti-cholinergics
  2. What drug and when is it contraindicated?
A
  1. Side effects: sinus tachycardia, 2° A-V block
  2. Do NOT use with Dexmedetomidine if high BP
29
Q

•Should you use an anti-cholinergic in premedication?

A
  1. Easier to prevent bradycardia than to treat it
    • IV anti-cholinergics can cause arrhythmias (see above)
  2. Pediatric patients
    • More dependent on HR for CO
  3. Brachycephalic breeds – high vagal tone with upper airway obstruction
30
Q

Which disease process do you avoid anti-cholinergics in?

A

–Avoid in patients with cardiac disease

31
Q

Give a brief summery of the preanesthetics and what they are based on and indicated/ contraindicated in

A
  1. Opioid Analgesic- Butorphanol, buprenorphine, full mu agonist (or fentanyl IV)
    • Based on pre-emptive pain score, inhalant sparing needs, cost, availability
  2. +/- Sedative – Acepromazine, Dexmedetomidine, Midazolam
    • Based on signalment, temperment, patient physical status, co-morbidities
  3. +/- Anti-cholinergic
    • Indications: Pediatric, brachycephalic
    • Contraindications: cardiac disease
32
Q

What are some reasons why cats are NOT small dogs

A
  1. Restraint/Catitude
  2. Combination vs single drug sedation
  3. Airway issues
    • Laryngospasm
    • Tracheal rupture
  4. Drug Metabolism
  5. Pain Evaluation
33
Q

What are the drug combinations for ‘Kitty Magic’

A
  1. Dexmedetomidine
  2. Opoid
    • Butorphanol
    • Buprenorphine
    • Methadone
    • Hydromorphone
  3. Ketamine or tealazol if need more restraint (evil cat)
    • ↑ restraint (aggressive patients)
    • analgesia
    • total injectable anesthesia

​

34
Q

What are the benefits of using dexmedetomidine in “kitty magic”

A
  1. Provides sedation & analgesia
  2. Quick onset of action (5-10 minutes)
  3. Relatively short duration of action 0.5 – 1.0 hr depending on dose/route
  4. Reversible
35
Q

What are the opioids used in “kitty magic”

A
  1. Butorphanol
  2. Buprenorphine
  3. Methadone
  4. Hydromorphone
36
Q

Benefits of using butorphanol in kitty magic

A
  1. short acting ~90 minutes
  2. ceiling effect’ =>↑ dose, no additional analgesia
  3. Better sedation than Buprenorphine
37
Q

Benefits of using Buprenorphine in kitty magic

A
  1. Slow onset of action => 30-45 minutes**
  2. Duration of action => 6-12 hours in cats
  3. Very ‘sticky’ to mu receptor, difficult to reverse
  4. Moderate analgesia, sedation < butorphanol
38
Q
  1. What are side effects of Buprenorphine
  2. What is another mode of administration other than IV,SQ,IM
  3. Does it cause hyperthermia in cats?
A
  1. Vomiting, dysphoria RARE
  2. Good bioavailability with oral transmucosal dosing
  3. NOT ASSOCIATED with hyperthermia in cats**
39
Q
  1. What are the benefits of using buprenorphine alone with dexmedetomidine
  2. Butorphanol pre-med, give Buprenorphine 1 hour later?
  3. Give both Butorphanol, Buprenorphine with Dexmedetomidine pre-med?
A
  1. Buprenorphine (alone) with Dexmedetomidine
    • Less sedation, delayed onset of analgesia
    • OK if using Ketamine
  2. Butorphanol pre-med, give Buprenorphine 1 hour later
    • Better initial sedation, longer lasting analgesia
  3. Give both Butorphanol, Buprenorphine with Dexmedetomidine pre-med
    • One administration, but larger volume
    • Opioid interference?
      • Mu-antagonist + partial mu agonist
40
Q
  1. What type of drug is Methadone
  2. Mode of administration
A
  1. Mu-agonist, NMDA-receptor antagonist
  2. IM, IV, SC
41
Q
  1. How much pain does Methadone releave
  2. Is there a ceiling effect
  3. Duration of action?
  4. What effect does it have on cats?
A
  1. Moderate to severe pain
  2. No ceiling effect
  3. Duration of action ~4 hours
  4. Euphoria in cats
42
Q
  1. What type of drug is Hydromorphone/Morphine
  2. What happens if you give morphine IV rapidly?
A
  1. mu-agonists
  2. Morphine- histamine release if given rapidly IV
43
Q

Hydromorphone has been with associated with what side effect in cats?

A
  • hyperthermia
    • 75% cats had rectal temp >104, peak temp 108.5
    • Related to severity of intra-op hypothermia
44
Q

When and why would you add ketamine or telazol to kitty magic

A
  1. More profound/reliable restraint, add 2-3 mg/kg
    • if aggressive
  2. ‘Excited’ cats may ‘over-ride’ Dexmedetomidine sedation
    • Additional Dexmeditomidine does NOT ↑ level of sedation
    • Add 2 - 5mg/kg if cat is ‘resistant’
  3. Less ↓ in HR
45
Q

How long does Ketamine (or Telazol) last in cats?

A

30 – 40 minutes

46
Q

Give some ‘Kitty Magic’ Options

A
  1. Dexmedetomidine + Butorphanol
    • Short acting sedation, mild analgesia
    • Give buprenorphine 1 hour after butorphanol for longer, moderate analgesia
    • Still need induction agent
  2. Dexmedetomidine + Ketamine (or Telazol) + Buprenorphine
    • D & K provide initial analgesia before slow onset of analgesia by buprenorphine (~45 minutes)
  3. Dexmedetomidine + Methadone
    • Moderate-severe pain
  4. Add Ketamine or Telazol to any for ↑ restraint or TIA
47
Q
  1. Which ‘kitty magic’ drug causes salivation?
  2. Which ‘kitty magic’ drug decreases salivation?
A
  1. Ketamine based protocols require anti-cholinergic to ↓ salivation
  2. Dexmedetomidine is an antisialogue so anti-cholinergic not needed if given with Ketamine

Anesthesiology 398 and 466 (22 decks)

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