1 / 25

Veterinary Anesthesia Severna Park Veterinary Hospital Aug. 6, 2014

Veterinary Anesthesia Severna Park Veterinary Hospital Aug. 6, 2014. Rebecca Krimins, DVM, MS Advanced Anesthesia and Pain Management for Animals. Topics. Anesthetic drugs Pre-anesthetic combinations Monitoring a nesthetic depth. Ketamine.

tiger
Télécharger la présentation

Veterinary Anesthesia Severna Park Veterinary Hospital Aug. 6, 2014

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Veterinary AnesthesiaSeverna Park Veterinary HospitalAug. 6, 2014 Rebecca Krimins, DVM, MS Advanced Anesthesia and Pain Management for Animals

  2. Topics • Anesthetic drugs • Pre-anesthetic combinations • Monitoring anesthetic depth

  3. Ketamine • Dissociative: dissociate the thalamocortic and limbic systemscataleptoid state (eyes open, swallow reflex intact) • Muscle rigidity • Decreases cardiac contractility • Increase peripheral vascular resistance decreases cardiac output

  4. Ketamine • NMDA-antagonistic properties (blocks glutamate) • Helpful with superficial pain, not useful for deep or chronic pain (poor visceral analgesia) • Helps prevent sensitization (windup) of nociceptive pathways

  5. Ketamine • Rapid onset (~ 5 minutes) • Moderate DOA (1-2 hours) • Stimulate sympathetic tone increased HR and BP • Induce salivation and airway secretions • Pain upon IM injection (low pH) • Some dogs show emergence delirium (uncoordinated movements of head/neck, voacalizations, salivation, agitation)

  6. Ketamine Pre-anesthetic Dosage • Dogs: 1-3 mg/kg IV, IM, SQ • Cats: 3-10 mg/kg IV, IM, SQ

  7. Ketamine • CRI dosage for intra-op pain: • 0.5 mg/kg IV bolus • 10 ug/kg/min CRI (lower doses for post-op) • Apnea in some (but generally is NOT a respiratory depressant) • Don’t administer with an anticholinergic • Associated with premature ventricular depolarizations

  8. Tiletamine • Dissociative • More potent than ketamine (3X), longer DOA • Produces sedation, immobility, amnesia, analgesia, muscle rigidity • (Zolazepam: similar to diazepam but is water soluble and more potent; can cause prolonged recovery in cats)

  9. Ketamine/valium andTiletamine/zolazepam • Different neuroactive agents usedinduce anesthesia with the goal of achieving the highest quality of anesthesia with minimal side effects • Ketamine/valium • Ketamine 5 mg/kg IV • Diazepam 0.25 mg/kg IV • Tiletamine/zolazepam: (2-8 mg/kg IV, IM) • DOA: 20 min to one hour • Limited shelf-life after reconstitution • Induction: 1-3 mg/kg IV or 6-8 mg/kg IM

  10. Telazol Difference in Dogs vs Cats • Dogs: get a tiletamine hangover • Cats: get a zolazepam hangover

  11. Ket/Val (or Telazol) vsPropofol • Compared to propofol: • Less muscle relaxation • Increased salivation • Increased dysphoria • Good cardiopulmonary support • HR, CO, BP well maintained • Short duration

  12. Propofol • 2,6,-diisopropylphenol • Propofol: soybean oil, glycerol, egg phosphatide • Propoflo-28: benzyl alcohol • White emulsion: shake thoroughly (don’t mix with other drugs) • Metabolized by liver, extrahepatic sites of metabolism

  13. Propofol • Induction dose: 4-8 mg/kg IV • Microdose under GA: 1-2 mg/kg IV • Titrate to effect • Duration of action: 10-20 minutes • Advantages: rapid induction of GA, rapid metabolism, rapid emergence from GA, low incidence of nausea/vomiting

  14. Propofol • Disadvantages • Hypotension and cardiac depression • Respiratory depression • Pain on injection • Heinz body anemia in cats (repeated use)

  15. Dexmedetomidine • α-2 adrenergic agonist • Properties: sedative-hypnotic, analgesic, muscle relaxation • Anxiolysis, calming • Stimulate α2 receptors in braindecreased norepinephrine release • Dose-dependent CV effects: vasoconstrictionhypertensionreflexbradycardia

  16. Dexmedetomidine • Dosage: dependent on patient and procedure • IM: 5 ug/kg • IV: 1-2 ug/kg • Rapid onset (~ 5 minutes) • Moderate duration (~2 hours) • Atipamezole(reversal): • Give same volume as dexmedetomidine IM, SQ, IV

  17. HydromorphoneandMorphine • Pure mu opioids; excellent analgesics • Both drugs can cause excitement when used alone, in young, healthy animals • Both drugs will slow heart rate (increased vagal efferent activity) and cause respiratory depression • Profound sparing effect with induction and maintenance agents

  18. Hydromorphonevs Morphine • Hydromorphone: • SQ route associated with vomiting & panting • Doses > 0.1 mg/kg may produce hyperthermia • DOA: 1-4 hours • Morphine: • Can cause vomiting • Associated with histamine release • Excitement in cats • Metabolites excreted by the kidneys • DOA: 2-4 hours • Pupil size: miosis and mydriasis • Miosis (dogs) • Mydriasis (cats)

  19. Hydromorphone and Morphine • Hydromorphone dosages (SQ, IM, IV) • SQ: 0.1 mg/kg (DOA: 1-4 hours) • IV: 0.05 mg/kg (DOA: 1-2 hours) • Morphine (SQ, IM, IV) • IM: 0.2-0.6 mg/kg • IV: 0.1-0.5 mg/kg • Naloxone (reversal) 1-10 ug/kg IV • Take 1 ml naloxone, dilute with 9ml saline, titrate 1 ml/min to effect

  20. Pre-anesthetic Combinations • Think about: • Procedure: surgical vs diagnostic vs other • Level of pain involved in procedure • Duration of procedure • Patient status • How much time do you have

  21. Pre-anesthetic Combinations • Opioid • +/- benzodiazepine • +/- α2- agonist • +/- phenothiazine • +/- anticholinergic

  22. How to Monitor Anesthetic Depth • No single parameter tells you how light/deep • Gather all information together (patient, normals, disease states, drugs, procedure type and duration) • Must know parameter normals in order to be able to identify abnormals • Temp, pulse, RR, BP • SBP > 140 mmHg = light • SBP < 80 mmHg = deep

  23. How to Monitor Anesthetic Depth • Interact with patient • Every 5 minutes, check palpebral reflex (corneal reflex) and jaw tone; position of eye; check for signs of movement, muscle twitching, neck tone • Maintain body temperature • Vaporizer setting for past 15 minutes = ?

  24. Questions Email: drkrimins@gmail.com Advanced Anesthesia and Pain Management for Animals www.aapma.com

More Related