Anesthesia of the sighthound

The sighthounds are an ancient group of dog breeds that have been selectively bred for high-speed pursuit of prey by sight. Probably as a consequence of this selection process, these dogs have a number of idiosyncrasies that can potentially adversely affect their anesthetic management. These include (1) nervous demeanor which can lead to stress-induced clinical complications, such as hyperthermia; (2) lean body conformation with high surface-area-to-volume ratio, which predisposes these dogs to hypothermia during anesthesia; (3) hematological differences such as a higher packed cell volume and lower serum protein compared with other dog breeds which may complicate interpretation of preanesthetic blood work; (4) Impaired biotransformation of drugs by the liver resulting in prolonged recovery from certain intravenous anesthetics, especially thiopental; and increased risks of drug interactions. Safe anesthetic management of sighthounds should include sedative premedication and appropriate use of analgesic drugs to minimize perioperative stress. Thiopental, or any other thiobarbiturate, should not be used in these dogs. Propofol, ketamine/diazepam combination, and methohexital are recommended alternative intravenous anesthetics. Avoid coadministration of agents that inhibit drug biotransformation, such as chloramphenicol. Inhalation anesthesia using isoflurane is the preferred anesthetic maintenance technique. Core body temperature should be monitored closely and techniques to minimize hypothermia should be employed both during anesthesia and into the recovery period.     

AAHA anesthesia guidelines for dogs and cats

Safe and effective anesthesia of dogs and cats rely on preanesthetic patient assessment and preparation. Patients should be premedicated with drugs that provide sedation and analgesia prior to anesthetic induction with drugs that allow endotracheal intubation. Maintenance is typically with a volatile anesthetic such as isoflurane or sevoflurane delivered via an endotracheal tube. In addition, local anesthetic nerve blocks; epidural administration of opioids; and constant rate infusions of lidocaine, ketamine, and opioids are useful to enhance analgesia. Cardiovascular, respiratory, and central nervous system functions are continuously monitored so that anesthetic depth can be modified as needed. Emergency drugs and equipment, as well as an action plan for their use, should be available throughout the perianesthetic period. Additionally, intravenous access and crystalloid or colloids are administered to maintain circulating blood volume. Someone trained in the detection of recovery abnormalities should monitor patients throughout recovery. Postoperatively attention is given to body temperature, level of sedation, and appropriate analgesia.     

Epidural analgesia and anesthesia.

This review describes the beneficial effects of the use of epidural drugs for pre-emptive analgesia, intraoperative analgesia with an inhalant-sparing effect, and prolonged postoperative analgesia. Epidural morphine oxymorphone, or hydromorphone is recommended for use in small animals in combination with a local anesthetic of appropriate duration for procedures involving the hind end, although epidural morphine or hydromorphone may be more appropriate for procedures on the thorax and forelimbs. Side effects are few and can usually be easily managed, with the benefits outweighing any detrimental effects that might occur.     

Balanced anesthetic techniques in dogs and cats

The term "balanced anesthesia" refers to the use of a mixture of drugs, such that the advantages of small amounts of drugs are used without having to contend with the disadvantages of large doses of any one drug. In veterinary practice, inhalant drugs are usually administered alone to maintain anesthesia, and balanced anesthetic techniques are rare. Unfortunately, cardiopulmonary function is reduced in dose-dependent fashion by inhalant drugs and deepening the level of anesthesia in order to modify autonomic responses to noxious stimuli may increase morbidity and mortality. This article justifies the use of balanced anesthetic techniques in veterinary practice and describes the advantages gained by the use of nitrous oxide, continuous opioid infusion, epidural/spinal opioid administration, and transdermal opioid administration. These techniques, described in detail in the article, are easy to learn, relatively inexpensive, may decrease patient morbidity and mortality, and will provide the veterinarian with smoother operating conditions.     

Sedation and anesthesia of pet rabbits

Pet rabbits frequently become stressed when handled and may require sedation or chemical immobilization for procedures such as blood collection, IV catheter placement, radiography, deep ear cleaning, and dentistry. Common surgical procedures requiring general anesthesia include spay, castration, gastrotomy, cystotomy, and orthopedic procedures. Rabbits may be difficult to safely sedate or anesthetize. Individual rabbits may have varying sensitivity to the depressant effects of anesthetics. The apparent sensitivity of the rabbit's respiratory center to anesthetic drugs and the narrow range between anesthetic and toxic doses in this species add to the unpredictable character of rabbit anesthesia. Furthermore, mortality following anesthesia and surgery in sick rabbits is common. Strategically, safe anesthesia of rabbits must include the planning of procedures so that anesthetic time is minimized. Clinicians must be on guard for individual variation in response to drugs. Minimizing the use of cardiovascular depressant agents, use of agents with a high therapeutic index, and careful titration of doses to effect, along with thorough cardiorespiratory monitoring, will permit attainment of appropriate anesthetic depth with the widest margin of safety. This article presents several injectable and inhalant anesthetic protocols that may assist in effective management of many types of rabbit patient.     

Anesthetic management of thoracotomy

Successful anesthesia for thoracic surgery requires an understanding of the clinical disease and the physiologic changes accompanying the disease, as well as anesthetic agents available for use. The authors discuss selection of appropriate anesthetic drugs, perioperative management considerations, pharmacologic support, intraoperative monitoring and postoperative pain management.     

Propofol anesthesia.

Although questions may still remain regarding the use of this unique sedative-hypnotic drug with anesthetic properties in high-risk patients, our studies have provided cardiopulmonary and neurological evidence of the efficacy and safety of propofol when used as an anesthetic under normal and selected impaired conditions in the dog. 1. Propofol can be safely and effectively used for the induction and maintenance of anesthesia in normal healthy dogs. Propofol is also a reliable and safe anesthetic agent when used during induced cardiovascular and pulmonary-impaired conditions without surgery. The propofol requirements to induce the safe and prompt induction of anesthesia prior to inhalant anesthesia with and without surgery have been determined. 2. The favorable recovery profile associated with propofol offers advantages over traditional anesthetics in clinical situations in which rapid recovery is important. Also, propofol compatibility with a large variety of preanesthetics may increase its use as a safe and reliable i.v. anesthetic for the induction and maintenance of general anesthesia and sedation in small animal veterinary practice. Although propofol has proven to be a valuable adjuvant during short ambulatory procedures, its use for the maintenance of general anesthesia has been questioned for surgery lasting more than 1 hour because of increased cost and marginal differences in recovery times compared with those of standard inhalant or balanced anesthetic techniques. When propofol is used for the maintenance of anesthesia in combination with a sedative/analgesic, the quality of anesthesia is improved as well as the ease with which the practitioner can titrate propofol; therefore, practitioners are able to use i.v. anesthetic techniques more effectively in their clinical practices. 3. Propofol can induce significant depression of respiratory function, characterized by a reduction in the rate of respiration. Potent alpha 2 sedative/analgesics (e.g., xylazine, medetomidine) or opioids (e.g., oxymorphone, butorphanol) increase the probability of respiratory depression during anesthesia. Appropriate consideration of dose reduction and speed of administration of propofol reduces the degree of depression. Cardiovascular changes induced by propofol administration consist of a slight decrease in arterial blood pressures (systolic, mean, diastolic) without a compensatory increase in heart rate. Selective premedicants markedly modify this characteristic response. 4. When coupled with subjective responses to painful stimuli, EEG responses during propofol anesthesia provide clear evidence that satisfactory anesthesia has been achieved in experimental dogs. When propofol is used as the only anesthetic agent, a higher dose is required to induce an equipotent level of CNS depression compared with the situation when dogs are premedicated. 5. The propofol induction dose requirement should be appropriately decreased by 20% to 80% when propofol is administered in combination with sedative or analgesic agents as part of a balanced technique as well as in elderly and debilitated patients. As a general recommendation, the dose of propofol should always be carefully titrated against the needs and responses of the individual patient, as there is considerable variability in anesthetic requirements among patients. Because propofol does not have marked analgesic effects and its metabolism is rapid, the use of local anesthetics, nonsteroidal anti-inflammatory agents, and opioids to provide postoperative analgesia improves the quality of recovery after propofol anesthesia. 6. The cardiovascular depressant effects of propofol are well tolerated in healthy animals, but these effects may be more problematic in high-risk patients with intrinsic cardiac disease as well as in those with systemic disease. In hypovolemic patients and those with limited cardiac reserve, even small induction doses of propofol (0.75-1.5 mg/kg i.v.) can produce profound hypotens     

Comparative cardiovascular and pulmonary effects of sedatives and anesthetic agents and anesthetic drug selection for the trauma patient

Objective: To integrate and compare the effects of tranquilizer/sedatives and anesthetic drugs on various parameters of cardiovascular function in normal dogs and in dogs stressed by hypovolemia, anemia, and endotoxemia, and to discuss the relative merits and appropriate precautions of anesthetic drugs with respect to specific patient physiologic complications. Data sources: Personal data and experiences in conjunction with veterinary and human clinical and research studies. Human and veterinary data synthesis: Drugs that produce calming, sedation, muscle relaxation, analgesia, and loss of consciousness have the potential to produce marked cardiorespiratory effects particularly in hemorrhaged, hypovolemic‐traumatized animals. Acute but key cardiovascular components that are affected by sedative and anesthetic drugs include heart rate and rhythm, venous return (preload), systemic vascular resistance (afterload), and myocardial contractile (inotropic) and relaxation (lusitropic) properties. In addition, all sedative and anesthetic drugs alter or depress normal baroreceptor reflex activity, thereby inhibiting or eliminating the animal's normal physiologic response to decreases in arterial blood pressure and predisposing to tissue hypoperfusion, decreased oxygen delivery, and oxygenation. Oxygen delivery needs to be adequate to meet the metabolic (oxygen) requirements of the patient. Decreases in oxygen delivery to tissues increases oxygen extraction, thereby maintaining tissue oxygenation (supply‐independent oxygen consumption phase) until compensatory processes reach their limit and any further decrease in oxygen delivery causes a decrease in oxygen consumption (supply‐dependent oxygen consumption phase). The critical oxygen delivery that defines the transition between these 2 phases is generally higher in the anesthetized state than in the awake state. The effect of anesthetics on critical oxygen delivery at comparable anesthetic dosages is pentobarbital=ketamine>alfentanil>etomidate=propofol>inhalational anesthetics. Anesthetics generally decrease oxygen consumption from the awake, baseline state; exceptions are ketamine and ether. Ketamine, however, increases oxygen delivery and oxygen extraction. Conclusions: The transition from the awake to the anesthetized state is a huge imposition on the physiology of animals and, therefore, should be accomplished with great care and proper vigilance. Rapid, ‘crash’ induction of anesthesia should be avoided in hypotension‐prone animals and slow, prolonged induction should be avoided in animals with respiratory disorders. It is not recommended to implement an unfamiliar protocol in critical patients, even if it might be pharmacologically preferable. Familiarity with an anesthetic drug is a very important reason for its selection.     

Anesthetic considerations for the geriatric patient

The geriatric patient presents an anesthetic challenge due to the physiologic alterations that occur during aging. The geriatric patient usually has an increased number of disease processes and does not possess the functional organ reserve capabilities compared to a younger patient. The geriatric patient seems more susceptible to the cardiopulmonary depressant effects of the preanesthetic and anesthetic agents in common use and, due to decreased hepatic function and other factors, may have a delayed recovery from these drugs. The preanesthetic and anesthetic drugs chosen for a geriatric patient will depend on that particular patient's physiologic status, the procedure to be done, and the experience of the veterinarian. Adequate fluid and monitoring support should always be provided for the geriatric patient.     

Cost comparison of anesthetic regimens in the dog and cat

Comparative costs of anesthetic regimens for the dog and cat were calculated. Various combinations of currently popular sedatives, tranquilizers, and anti-muscarinics (preanesthetic drugs), and anesthetic induction and maintenance drugs were studied. The preanesthetic drug affected overall anesthetic cost through its own cost, its effect on the amount of anesthetic drug necessary for intubation, and its effect on the amount of anesthetic necessary to maintain anesthesia. The combination of acetylpromazine-thiamylal-halothane was the least expensive regimen for both the dog and cat, whereas drug combinations that included isoflurane as the maintenance drug were the most expensive. In the cat, induction of anesthesia by use of N2O, O2, and halothane in a plexiglas chamber was more expensive than by the use of thiamylal.     

Anesthesia and pain control

Successful anesthetic management of the critically ill patient requires familiarity with the pharmacologic properties of a variety of anesthetic drugs. An understanding of the altered physiology present in the critically ill allows an anesthetic regimen to be selected that prevents an anesthetic-induced decompensation. Pain should never go untreated because of a fear of causing excessive physiologic depression. There are numerous options available to control pain. A technique suitable in one instance may be unsuitable in another; for example, an animal that has a significant degree of respiratory compromise may not tolerate the additional respiratory insult associated with narcotic use. A local anesthetic technique may be preferred in this situation. Often a local technique is all that is necessary to control postoperative pain. Furthermore, if pain is controlled for the first 4 to 6 h post-insult, often no further analgesic drugs need to be administered.     

Anesthetic consideration in dogs with traumatic myocarditis

The trauma patient is commonly encountered in veterinary practice. Traumatic myocarditis has often been overlooked due to its delayed onset and preoccupation with other traumatic problems. The traumatic heart is very sensitive and in itself can cause death. Often a trauma patient requires surgery and a proper anesthetic protocol must be used which does not increase the incidence of cardiac arrhythmias. A review of anesthetic management including preanesthetic medications, induction drugs and techniques and maintenance with inhalation anesthesia reveals the need for careful selection of medications. Isoflurane was shown to be beneficial in reducing the incidence of undesirable responses of these patients.     

Regional anesthesia

Organ toxicity from local anesthetic agents is rare. This makes these agents an attractive option in the high-risk patient. Complications associated with local anesthetics are related to overdosage. Overdosage with local anesthetic agents administered epidurally may cause motor paralysis and hind-limb weakness. Systemic signs of local anesthetic overdosage include changes in central nervous system activity (excitement or depression), muscle tremors, and hypotension. Because the dose required to produce these effects in the horse is high (12 mg/kg), this complication is uncommon. Few side effects and low cost justify the use of local anesthetic techniques in equine practice.     

Local and regional anesthesia in cattle.

Although general anesthesia commonly is used in cattle, there are some risks with its use. Local or regional anesthesia is safe and effective and is still the most desirable procedure in many situations. Many surgical procedures can be performed safely and humanely in cattle by using a combination of physical restraint, mild sedation, and local or regional anesthesia. Local anesthetic techniques are usually simple, inexpensive, and provide a reversible loss of sensation to a relatively well-defined area of the body.     

Protocols for anesthesia of cattle.

The article explores the choices and considerations pertinent to the selection of an anesthetic protocol for use in cattle. When the veterinarian is presented with the opportunity to provide anesthesia for surgical or diagnostic procedures, the options include use of local anesthetics, sedative-tranquilizer and analgesic combinations, or general anesthetic techniques. Informed decisions regarding selection of an anesthetic technique or protocol are made possible with understanding of the perianesthetic considerations commonly recognized for cattle.     

VCARS – veterinary computerized anesthetic record system

VCARS, the Veterinary Computerized Anesthetic Record System, has been developed to capture pre-, peri- and post-anesthetic data using Tablet PCs, 802.11b wireless networks, and a web-based database. Patient demographics, anticipated procedures and anesthetist, service information and hematologic and chemistry values are imported from the Veterinary Medical Teaching Hospital patient information system. Using a wireless Tablet PC, pre-anesthetic examination findings are recorded and an anesthetic plan including anesthetic drugs and anesthetic and monitoring equipment is developed. During induction and maintenance of anesthesia, physiologic variables, drug, fluid, anesthetic gas and oxygen administration, laboratory values, patient location, and important events can be charted with the simplicity of a paper anesthetic record. This information can be manipulated for display in a variety of ways depending on the specific needs of the case. Tools for calculating optimal fluid rates and drug dosages are incorporated into the design. The anesthetic records from multiple cases can be viewed simultaneously using a centrally-located monitor. Detailed audit trails ensure data integrity. A high-end search engine will allow rapid and complete retrieval of patient and anesthetic information. Macromedia flash is used to allow temporary disconnection from the wireless network without losing the ability to view, add, or edit data. The initial stages of software development are nearing completion, a wireless network is in place and hardware is being purchased. A pilot study will be conducted using manual entry of physiologic data prior to integration of automatically captured patient physiological variables. It is anticipated that this system will drastically improve the accuracy of data collection and retrieval and will provide important information about anesthetic management allowing improvement in overall patient care.     

Advantages and guidelines for using opioid agonists for induction of anesthesia.

Opioids have a central role in the anesthetic management of small animals, as premedicants, as part of a balanced anesthetic technique, or for the provision of postoperative analgesia. These drugs are safe to use, provide excellent analgesia, and are easily reversible. They cause minimal cardiovascular depression and induce no deleterious renal or hepatic changes. These agents, combined with a sedative, generally provide an ideal anesthetic state.     

Standing sedation and pain management for ophthalmic patients.

Several ocular procedures, including examination, removal of corneal foreign bodies, nictitans surgery, eyelid repair, and tumor excision,can be successfully performed in the appropriately restrained and sedated standing horse. Sedation is best achieved with xylazine,with or without the addition of acepromazine. Additional analgesia can be provided with appropriate local anesthetic blocks.Surgical conditions are greatly improved by using an auriculopalpebral and supraorbital block and topical anesthetics. More elaborate standing sedation involving continuous rate infusions of lidocaine or detomidine combined with butorphanol may facilitate more involved surgery with appropriate support staff and equipment in animals that are at high risk for general anesthesia or when the latter is not an option. Short-term or long-term analgesia is most commonly provided with nonsteroidal anti-inflammatory drugs, but several newer techniques, including lidocaine and butorphanol infusions, may be effective. Topical treatment with opioids to provide analgesia and opioid antagonists to enhance corneal healing is an exciting new development that may revolutionize our approach to corneal ulcer therapy in the future if current research findings are supportive.     

Anesthesia for the acute abdomen patient

Patients with acute abdomen often have marked physiologic and pathologic changes, making anesthesia both challenging and potentially hazardous for the patient. A thorough understanding of the pathophysiologic mechanisms of cardiovascular function under anesthesia and selection of appropriate anesthetic protocols are critical to a successful anesthetic outcome. The goal is to produce anesthesia while minimizing depression of the cardiovascular system. Monitoring and management of acid-base and cardiovascular function serve to ensure appropriate oxygen delivery to the tissues during anesthesia. Postoperative management can significantly influence patient outcome following anesthesic recovery, and must therefore be considered in the anesthetic plan. Finally, pain management in all patients is an important aspect of case management, and should not be overlooked. This article serves to educate the clinician in the above-described areas in regard to the acute abdomen patient.     

Reptile anesthesia.

Successful reptile anesthesia requires patience, planning, and understanding of normal anatomy and physiology in health and disease. Reptiles make good anesthetic patients because of their physiologic resilience. New drugs that are not only safe and efficacious, but also result in relatively short recovery times, have greatly enhanced the design of anesthetic regimens. Further studies are required to quantitatively evaluate the physiologic effects of drugs used and validate available monitoring modalities for use in a wide variety of reptiles.