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Anesthesia 2 > Pain management in large animals > Flashcards

Pain management in large animals Flashcards

1
Q

Arguments for use of analgesics in large animal

A

-less pain=better recovery from anesthesia
-help with restlessness
-increase appetite
-increase immune response
-increase wound healing

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2
Q

Arguments against use of analgesics in large animals

A

-allows animal to use the injured area (over use)
-potential side effects (gasto ulcers, constipation, ileus, behavioural alterations)
-marks disease process and worsening
-makes it hard to recognize pain

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3
Q

head Pain behaviour in horses

A

-shake
-snort

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4
Q

Jaw Pain behaviour in horses

A

-drooling
-dropping food
-losing weight

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5
Q

Limb Pain behaviour in horses

A

-stomp
-limp
-refusal to walk
-lying down
-abnormal stance

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6
Q

Abdominal pain behaviour in horses

A

-kick at belly
-flank watch
-roll
-tail swish
-violent behaviour

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7
Q

Pain Face

A

-lowered ears
-contraction of the muscle above eye
-tense stare
-nostril dilated in medio-lateral direction
-edged shape of the muzzle with lips pressed together and flat chin
-tension of facial muscles

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8
Q

Analgesic drugs in horses

A

Pre med/sedation, pre emptive pain management, multi modal

-NSAIDs
-alpha 2 agonists
-ketamine
-opioids
-local anesthetics

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9
Q

Benefits of NSAIDs

A

-analgesics
-anti-inflammatory

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10
Q

Harmful side effects of NSAIDs

A

-gastric and colonic ulceration
-renal tubular necrosis

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11
Q

NSAID uses

A

-administered pre operatively anticipating inflammation that will occur during surgery

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12
Q

Specific NSAID options

A
  1. Phenylbutazone
    -musculo skeletal inflammation and pain
  2. Flunixin meglumine
    -acute soft injury, endotoxemia, abdominal pain
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13
Q

Alpha 2 agonist options

A
  • Xylazine
    -Detomidine
    -MEdetomidine
    -Dexmedetomidine
    -Romifidine
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14
Q

Alpha 2 agonist uses

A
  1. pre med for sedation
  2. intra operatively as CRI for analgesia
  3. Post op for sedation to ensure smooth recoveries from inhalational anesthesia
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15
Q

Benefits of alpha 2 agonists

A

-analgesia
-sedation
-anesthetic sparing

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16
Q

Potential negative side effects of alpha 2 agonists

A

-bradycardia
-vasoconstriction and hypertension
-increased urine output
-decreased GI mortality
-ataxia

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17
Q

Xylazine

A

-used with ketamine and Guaifenesin (GGE) in triple drip
-TIVA

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18
Q

Detomidine

A

-used fo sedation and analgesia for standing procedures
-often combined with opioid
-administered as an infusion (VRI)

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19
Q

Dexmedetomidine

A

-used for invasive procedures with inhalational anesthesia (PIVA)

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20
Q

Ketamine

A

-used as induction agent in triple drip mixture

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21
Q

Benefits of Ketamine

A
  1. Analgesia (somatic, chronic wind up pain)
  2. local anesthetic effects
  3. anesthetic sparing (decrease MAC by 37%)
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22
Q

Ketamine side effects

A

-risk of excitement
*control with sedatives

-only low doses in concious horses

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23
Q

Opioids used in horses

A

Mu agonist: usually morphine

Partial mu: buprenorphine

Kappa: butorphanol

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24
Q

Opioids uses

A
  1. intra-operative sedation only when combined with alpha 2 agonists
    *not anesthetic sparing like in dogs and cats
  2. good analgesia

**ensure isoflurane requirements are maintained

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25
Q

Opioid side effects

A
  1. excitement- control with sedatives (Acepromazine, alpha 2 agonists)
  2. Decreased GI motility- decrease incidence if administered IM or not given long term
26
Q

Opioid dosage guidelines

A

-more severe pain, greater the dose of opioid needed and lower risk of excitatory side effects
-give by effect, not by clock
-signs of underdose (pain) mimic signs of overdose (excitement)

27
Q

Pain free horse opioid dose guidelines for excitement risk

A
  • give appropriate doses of alpha 2 agonists matched for duration of action to reduce excitement risk

-sedation with acepromazine reduces but does not eliminate risk of excitement

28
Q

Morphine dosing/uses

A

-used at low doses for pain
-repeated dosing or high doses may lead to reduced GI mortality, urinary retention and increased locomotor activity and ataxia
-cardiovascular stimulation when used alone

29
Q

Morphine intraoperative CRI use

A

-improved recovery
-no evidence that its use increases the incidence of post anesthetic colic

30
Q

Morphine used at higher doses

A

-used for analgesia
-may increase isoflurane requirements
-may result in rough recoveries

31
Q

Clinical dosages of morphine intraoperatively

A

-no affect on the recovery quality

32
Q

Fentanyl

A

-use is controversial
-various studies/results concerning MAC reduction
-most benefit through transdermal patches

33
Q

Fentanyl patches in horses

A

-peak levels after 12 hrs; location may affect absorption (thorax or groin compared to leg)
-may see excitement (acepromazine or alpha 2 sedation may be needed)
-may need to add NSAID

34
Q

Fentanyl patches in foals

A

-peak plasma levels after 14hrs

35
Q

Remifentanil

A

-used for intra-operative
-good recoveries
-some hyperthermia
-only used CRI due to short half life
-need analgesia before turning off

36
Q

Buprenorphine

A

-duration 12 hrs
-some evidence that its better post operative analgesia than butorphanol for minimally invasive procedures

37
Q

Side effects of buprenorphine

A

-restlessness
-head shaking
-decreased GI mortality for up to 4 hours

38
Q

Butorphanol

A

-can produce excitement
-used intraoperatively
-effective for visceral analgesia
-45mins to 1 hr duration; re dosing often needed
-does not change isoflurane requirements
-provides a more stable anesthesia

39
Q

Post operative use of butorphanol

A

-analgesia is short, may need dose every 3 hrs
-2-3 times daily for several days
-analgesia not consistent as with infusion but there is less risk of impaction

40
Q

Lidocaine

A

-infusion intraoperatively (WITHOUT EPI)
-need to stop at least 30mins prior to recovery from general anesthesia to prevent ataxia

41
Q

Benefits of lidocaine

A

-analgesia
-anti inflammatory
-anti endotoxemic
-pro kinetic
-anesthetic sparing

42
Q

PIVA

A

-combination fo infusions
-used to reduce isoflurane requirements

43
Q

Alpha 2 agonist PIVA use

A

-invasive/painful procedures
-orthopedic procedures= musculoskeletal pain and inflammation

44
Q

Lidocaine PIVA use

A

-for colic surgeries

45
Q

Opioid PIVA use

A

-orthopedic surgeries

46
Q

Ketamine PIVA uses

A

-somatic analgesia= supplement other drugs

47
Q

Other mofes of providing analgesia

A

-epidurals
-epidural catheters
-wound/soaker catheters
-local blocks

48
Q

Epidurals

A

-good for standing procedures
-need sterile technique for placement
-can give in standing horse (sacrococcygeal)
-use preservative free drugs
-usually once or twice daily treatment
-administer slowly!

49
Q

Epidural catheters

A

long term pain management
-require sterile technique for placement and management

50
Q

Wound/soaker catheters

A

-postoperative analgesia for 2-3 days
-preplace during surgery
-commercial kits available
-used with either lidocaine or bupivicaine

51
Q

Local blocks

A
  1. intra operative= anesthetic sparing
  2. Post operative= improved recovery, minimize need for other analgesic agents
52
Q

Considerations for recovery

A

-must stop all infusions prior to moving into the recovery box
-give NSAIDs if needed
-consider local blocks

**usually sedate with alpha 2 agonists: xylazine or romifidine

53
Q

Pain behaviour in ruminants

A

-abnoormal stance and gait
-unusual resting behaviours
-vocalization
-kicking and tail swishing
-subtle indications (teeth grinding, reduced feed intake, absence of rumination)

54
Q

Analgesic drugs for ruminants

A
  1. NSAIDs
  2. Opioids
    3.ketamine
    4.lidocaine
    5.alpha 2 agonists
55
Q

NSAIDs in ruminatns

A

-withdrawal times not well defined for meat or milk
-risk for GI ulcers

56
Q

Opioids in ruminants

A

-morphine
-butorphanol

57
Q

Opioids in ruminants side effects

A

Behavioural side effects
-sedation
-dysphoria
-excessive locomotor activity
-excitement

Intestinal stasis with long term use

58
Q

Epidural opioids in ruminants

A

-morphine
-saccrococcygeal administration

59
Q

Transdermal fentanyl patches in ruminants

A
  1. Goats and sheep: 8-12 hours
  2. Llamas: 12 hours peak levels; 72 hour duration
  3. Pigs: place behind ear or inner thigh
60
Q

Ketamine benefits in ruminants

A

-anesthetic sparing
-NMDA antagonist= chronic pain
-somatic analgesia

61
Q

Ketamine dosing in ruminants

A

-typically need higher doses than used in smaller animals

62
Q

Lidocaine in ruminants

A

Dosage higher than horses
Stop infusion 30mins before recovery
Intra operative infusions

Anesthesia 2 (17 decks)

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