CHAPTER 12_ Pi ciples of Anesthesia and Anesthetics 127 EEE ths sage Phines of anestress Sigh: pine iplne SrErmeaunneuaue ed Stage I: Voluntary movement and excitement fom intial adinisvaton Unt ss of eanscousress, Release of epinepnine can ecur dung ‘Stage Ik Deirium and involuntary movernent url he onset of « repulse pater of rectn ng, Relese of einephine can occur during this stage. ‘Stage Ii: Surgical snestnes, Muscle relaxation develops. th stage have been describes 1: has ye moversert reflexes. + Mesium plane Ipline 2: has progressive intercostal paral + Deep slne (ale ai: has caphragmate respration, normal surgical level of medium depth would be stege I plane 2 Deep susie anesthesi would be stage Il plane 3, wih 9 cenerest and alated pus Stage IV: Bxreme corral nervous system depression and a shock state. Death wil ensue unless tne aresthees i vitrawn an 7 EEE Anesthetic Agent/ Class Pe oad Dose Moates tom Trg Grr KE. nveaueton use dntons rir. cneeps,casaheaben,o@ carseat fo anesthe and anaes Glenn fA Lamar A Sra Weta ad, VotenaySnasnesa ard Arage, she, Haran iAWierBiccnwh 2595 228, Onset and Duration of Action Uses/Precautions ‘Antimusearinies Avesine Gheopyrolate Rosi Tranquil Benzodiazepines Diazepern Valse), Sehesule Midsslom verse Schedule N Flumazenil Romanicon) Phenothiszines 0.04 maria IM, 0.02 mak wv (2.01 marks IM, 02-0 meh IM, WN RI-0.1-08 magn 007-0. maikg IM. NV CR 0.-0 magia 0.01-0.02 melee WV Onset of seven 1520ma IM Duration ef seton pert) Onset of seton 20-45 mn IM Duration of action: 2-8 h Onset of action alow at Teest 20 min ator ‘ntemuseubr aomnatiatan Dutton of eeton: 1-8 h (Onset of setion 6-19 min Durston of ation: 1-2 m Onset of setion rape Duration of ations 1h Used to prevent vegatinaiced bradearia and Side effects include © Tachycardia + Decreased respiratory secretin: makes + Bronerodition + Decreased GI matity + Tansint oresyeeria may occur before anichelneric eect + May nerease myocar work ard oxygen + Bradyearaiais more Tkely than wih aheopyrobite + Gauses mydiass + Can couse tachyaehytn as + Less tke to cause tachyeaei than atropine + Does net really e055 the blocatain barr or phoens + More potent than atopine + Used to produce a eating effet © Not etale by themaehes fr sedation oF chemcal restrain mis sedatives) + Donat have analgesie eects + Wide margin of safety + Gan be given IM, IV, PO, ransmucosaly, or + Reversiole + Contains propylene glycol + Gan cause phot: use large ven for CRIs © Paul winen given IM * Increasing the dose doesnot pradce proporianalneeuse sedan + Water soluble + Excelent absorption + Used to reverse benzodiazepine effects + Expensive + isnot schedule erug + Veseaatory © Long aurton of action + Dees not rove anagesie Canineal | Principles ary ‘Anesthetic Agent! Glass GEFs CeIn Dose na) ‘Onset and Duration of Action Uses/Precautions cepramazine (Proree) Opicids ‘Mu Agonists ‘Schedule i! Drugs Merprine ‘Oxymersbone INurrohen* Meperdine (Demerol Valve, Peticine Metnaéone (Delphine, Methadose, Amidon) ydromorphone (Bisuaed Fentanyl Sublinaze) ementanit itive (0.01-0.1 mateg IM, IV Dogs: 02-2 maikg IM, SC C0140. lading ose thes 0.1 meteayn cats 1M 0.05-0.4 maka ops: 0.02-0.2 maikg IM, Nese Cats 0.02-0.17 mak M, 002-005 mgikg 6 Dogs: 1-5 malkg IM, SC Cots: 05-8 mari IM, SC Dogs: 0.2-1.5 maikg IM, IV Cate 01-05 mala IM, ops: 0.05-0.2 males IM, Wisc (CRI 00025-0005 maikg V loading dose, then 0.01-0.04 maka Cots: 0.02-0.2 maikg IM, IV 0.005-0.015 mals IM, Iv, st RI for dogs 5-10 goth 1 Tossing dose, then 0.7 ugha, oF S10 ughkoh Cc forests 2-3 uo WV Toadng dose, then 0.2.04 naikalnin, oF 2-5 uahah bogs C81 0.25-05 pha! in bes been used 0 Conjunction with @ ropotal CAL at 02 makgiin Cats: uaa W: CAL 03-03 nga per minut lone orn eomiination wth ketamine a8 0 male IV followed by 1.8 maiko (Onset of ecto: IM, ‘25-40 min NV, 15 min Duration of etn: dase ‘ependent, 3-8 h Onset of setion IM, Siomn Duration of ston: 3-6 h (Onset of sein: IM, Sion Duration of ston: 1-2 n Onset of set: §10 rin Duration of sevon: 1-2 n Onset of seta So5 mn Duration: 34 h Onset of aeton: 18 min Duration of ston: f= h Onset of seton 10 min Duration of set 1530mn Transsermol pate tre of ‘ug uate to etecive sag cancenvatons is vat, doperang on Shin temperature, ood fw tthe skin, and patch adherence the fins fer 12 hous in fats 1 up to 24 hows in ‘fogs. The uation of effects approxmatey & ays Onset of seton rand Duration of ston: aor, smust be gven as CF, halite mn + Safe give IV; no histamine © Minimal nedenee of vomiting © Poor sedition when given alone + Sefe x give IV; no histamine © Large volumes needed for IM or SC + May cause bradyearia and resoratory depression Do not give mare shan 2 rng ta IMM © Use with caution in boxers nd srimals wth + Do mot use in annals with aypovolemi, hypotension, or shock + May cause callapse winen given inravenously to an extremely excited or sressea animal + Anlduresis is de to release of ADH fwhich ean teas fo urinary retention) + Cause ansigesi,amtiiuress, decreased Gl ratty, ana sedation + May cause respiratory deoresson and bradycardia © Goes analgese Mina ettect on CV parameters + Monitor cas for hyperthermia, most commanly ‘ceurs with hydromorphone + Reverse with naloxone © My need an animuseatine then aiven 9s 3 CRI + May cause emesis + Give W slowly 9 {ean cause histamine classe + Safe te give IV; no histaine release + Wot ecommenced aue to hstmine release © Safe to ave NV: na histanine release + Less tel than morphine ar oxymorphone to cause vomiting + Eminaton is independent of hepa or tera furetion + Brasyearaia may oecur and may reste weatment with an antiuscarine + This 2 potent respiratory depressant and may rnecessiateconvoled vert tonCHAPTER 12_ Pi ciples of Anesthesia and Anesthetics fl TABLE 12.1 ‘Anesthetic Agent! Glass ee oe Dose ‘Onset and Duration of Action Uses/Precautions Mu Antagonist/ Kappa Agonist Butorphanol [Torbugesie Torbuvoh, Schedule Natouphine (Mubsin) 01-038 mag IM, N, $C (CRI 0.1-0.2 mag WV losing dose, then 0.1-0:2 mgikahh 025-2 malig IM, W, SC Partial mu Agonists: Schedule Il Drugs Buprenerarine [Buprenex, Simbsdal Opioid antagonst: INatnone (Mares) opioid aponist and Inhibits rospako of Serotonin ana rorepnephrine Tramadol Schedule IV Dissociatives Ketamine (Ketase, Keaved, Vetalat Scheele I Tietarine (associative! an tolsepamn thenrodarepr, Telezal Sched I .005-0.02 matig IM, 1, SC Cats: 0.24 mala once aay for up to 3 dys, SC (.001-0.08 maria M1 2-10 mati every 12h 4211 maf 1, IM (CRI 0'3 mal WV losing dose then 0.1-05 mglkgh 2-4 maitg IM, IV 2s pat of premed or nduction Diagnostic proceaures Dogs: 86-52 maikg IM Cate: 8.7-11.8 malkg IM. Minor procedures fe. Iheerton repair bogs: 88-13.2 males IM Cats: 108-12.5 maka IM ‘Onset of setion: 67 min Duration of seton 45mo-15h ‘Onset of setion 619 min Duration of scion: 1-2 % Onset of seven 20-20 Duration of ston: 3-8 » Onset of acson | hr Duration of aston 248 h Onset of setion 8 min Duration of seton 20-80 mn Onset of action vale Duration of aston ‘itl, hours Onset of seton 10 min Duration of seton: dove ‘dependent, 20-30 min Onset of seton § min ‘ut ean vary Duration of son: dose ‘depender’, 20-30 min Part reversal of mu agonist tugs © Minmal effects + Mis analgesic + Can be used to poisiy reverse mu opioid ‘oni bt alain kappa ettects + Minit temo sedion use with wanguier ot + Nota senedules erug + tects diet rverse © Goce for moderate pain + Latge satety protle + Adverse side etee's may include hyperaciviy feu im handing, Ssoverction,apration ard late pupils but more coremonly cats become ‘qt cuphore, paring, rubbing and kneading ‘ith thir orepows. + Reverses opioid effects + May cause teenyestea hypertension, pain ane + Ronarcotzation may occur when used to reverse s longseting oid + Mu agonist + Mesabolte mt has ctvity © Cental acing + Naloxone wil only partly antagonize effects of ‘raradol + Unpleasant taste + May see sedaton a higher dase + Can cause excess salvation, 30 it's commonly + May increase heart fate and ICP and 1OP © lnaleliminson inte eat + Well absorbea, but stings on injection © Can couse se rreke setty Im dogs when gen abe, so tis commonly uses with Benzosiazepines + Wil exoss the placerra and lead to depression of rneurologe refenes in cesareandelveres + As oven for ketamine © Profound hypotnerms and prolonged recovery + Mast useful for restraint or very snort proceaures + ocause onset of acton is vaable, observe the patent carefully after admin stration + May cause respratery aepresson © Dorot use n anmals wth panerestie sesse renal petsaogy, af severe estice or pulmonary dysfunction + Dorot use or caesarean section + Dorot use with prenerhiazre-ceriate chugs © Do rot exzees maximum slowable dose for supplementation of increment sedation a ol snesthesi of 264 mglkg IM for dogs and 72 mal kg IM for oats ContinuedAnesthetic Agent/ Glass Barbiturates TrpentalPenotl Scheu Propotal (Divan Soheoule Propotal 28 (PropoFl Soheule N Etomidate (Amida! Sedatives AlpharA Agonists Dexmedetomiine [Dexdomtar Xylene (Rompun Alpha-2 Antagonist Anpumezle(Anvseaan) Tolazotine Yohimoine Reo Dose to eect: 429 moikg 2-8 maiko NV ony CRI .05-04 malkalmin 2-8 maitg IV only (CRI 0.05-04 mglghnin 0.58 malig IV dog dose 1-2 mig IV est dose 2-40 nig IM. ‘eanamucosally CFI ik leading dose, then 05-2 uarkamh 01-1 mag Inv, 008-055 meleg IM, IV, So Equal volume of dexmedsternaine (05-4 mpg VIM, SC 0.05.0.1 maleg slow W, 025-051M.SC os Onset and Duration, of Action Uses/Precautions Onset of stan: fresher acting : 20308 ss Duration of avon: short 115 min, dose ‘dependent Onset of scton raid sing Duration of avon Some Onset of seen tad setng Duration of ston 5 10min Onset of seton rd Duration of seton ingle TV dose 10-20 min Onset of seton 30-20 min Duration of avon: 2h 2 Onset of setion: 10 min Duration of sto 3 20-20m0 : Onset of seton: 10 min Durston of sevens 2-2 n (Onset of seton within § minutes of 1 sominstration Duration of aeton: short may need 10 Be raced Onset of setion within min winen given Durston of aon 12h Can cause CV and respatory depression Can decrease IC? and IOP pressure Evfecis may be polonste oy concurent esis oF poprotenemis Tissue neccoss given pervesculy See caution n txt reguring sighthounds ‘reyrounes,wolthourds, an Afghan hounds May cause respiratory and myocardial depression, pernherl vesolston, and Heine body anemia lth ropeateg use m eas Not an analgesic Use I with eauton inpatients ith volume depletion or CV compromise Can be used in healthy eas 9 single inducvon dose, not as « CA Cumulative tec ete nels atx, ryperesthesa,fescieulatons,ainaness, poression, convulsions, respiratory fale, and Contains propyone alco, may cause homohsis Maintains CV stabity ‘Suppresses aenacortial function for 2-8 h {allowing «single bolus dose ‘Sie effec incl nvolantary muscle ‘movements, hyperionss, and vemors, when ean be mnmizes by gving I Benzodazenine beforehand Datonal side effect ae vomiting and Cause sedation, analgesia, pusce relaxation Poneretie maul nhttion causes hyperayeemis ADH inmition causes auresis Intally causes vesocanstriction an hypertension, ‘allowed by hypotension ‘May cause cariovascla collanse May cause vomiting ardor serepragia Provides good sedation an analgesia ‘Commonly corsined with opioid or Ketrine Use in neatny anmals only: avoid using in very Geta, oa, or young arimals Causes emesis in cats and occasional in dogs Causes bradyearsa Dogs may develo boat rom aerophaga Sie ettecs include tachycardia, systemic and pulmonary hypertension, ana snily IM emission is referred to avoid rapid vesoditon Faiving a reversal pont intravenously must be ‘aver stow to avid susken awakening ond fxetement or potential cade ares becouse ‘he patent may emerence sudaen pain with resukanteatechaline surge Doses higher than 0.1 maka ae recommended tobe gen IM or SC High doses can cause excitement dogsCHAPTER 12 Principles of Anesthesia and Anesthetics CURE Se ee ‘Anesthetic Agent ‘Onset and Duration Irofluene MAC: dog = 4 2icat= 1.62 Sevoflurane futons) Destlurone MAC: dog = 1.2, MAC: dog MAG: dog = 72 Glass Dose cf Action Uses/Precautions Nouroactive Steroid Afasaone (Altec 1-5 maka W Onset of sevion tind + Can cause respiratory and CV depression, rapid Schedule N (CRI 9.07-0.11 maikamin Duration f seion dose cntel ands not anaes ‘dependen, 150 mn Sedation mey be neesed "0 improve recovery + Does not conan preservative one Lsocaine CRI 1-2 maka W loading Onset of aevion rind + Can be use to provide analgesia and decrease dose, then 1-3 makahh Duration of sets aac talus, 10-29 min + Ie antarmytnmic and can scavenge tee oxygen radicals + Not recommenced or use in cats cue to CV depression Inhalants Anesthetic depin can be > Proauce daseionendent CV depression ant Sojsted pil one peripheral vasoateton Cptate ana recovery + Decrease mesabote rate, mean areril locd Pressure, and cerecral prlusion pressure + Roques » specs bested vaporizer due to high vapor pressure | “5 oe pahnon, nynorsk ea wa ove Iniroverous, MAC, minmien sealer cancenaton: SC sbevtaneausW, Benzodiazepines and Benzodiazepine Antagonists ‘Benzodiazepines potentiate the primary inhibitory neurotransmit- ters of the CNS, gamma-aminobutyric acid type A (GABA,) receptors, There ate five main pharmacologic effects: anxiolys sedation, anticonvulsant activity, spinal cord-mediated muscle relaxation, and amnesia. Benzodiazepines undergo hepatic ‘metabolism. Animals receiving benzodiazepines alone become disinhibited; therefore the behavioral response can vary from patient to patient and from species to species. Some animals become quiet and sedate, whereas others can become more vocal, excited, euphoric, dysphoric, and even aggressive, Dysphoria and aggressive behavior limit the use of benzodiazepines, especially ‘when given alone in cats. These unwanted side ellects can persist postoperatively when longer-acting drugs, such as diazepam, are used (sce Table 12.1). Benzodiazepines are usually used in combination with other agents such as opioids, sedatives, or dissociatives; however, they can be used alone in neonatal or extremely ill or depressed animals. Benzodiazepines are a schedule TV agent. They have minimal effect on the cardiovascular and respiratory systems and do not produce analgesia Diazepam (see Table 12.1) is highly lipid soluble and has a prolonged duration of action, Liver metabolism produces active ‘metabolites with prolonged half-lives that undergo renal excretion, Diazepam can cause hypotension if given rapidly intravenously and may be painful on injection; slow administration and dilution, ‘with a crystalloid will decrease these side effects. Diazepam is often given at induction with ketamine, barbiturates, propofol, etomidate, or opioids. Its use in these combinations takes advantage of its sedative and relaxation properties and allows reduced dosing of the other induction medications. ‘Midazolam (see Table 12.1) can be given intravenously and does not create phlebitis or pain on injection. It has a rapid ‘onset of action and rapid metabolism, It is especialy useful as ger marinal Tob nracrnsl pts insu OP, nace prs a premedication when combined with an opioid in pediatric, geriatric, and il animals. Midazolam undergoes hepatic metabo- lism and renal excretion Is useful in combination with ketamine, propofol, etomidate, opioids, or barbiturates for induction. Zolazepamn is combined with tiletamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, and is most useful for restraint or for very short procedures. See precautions in Table 12. Flunazenil is a benzodiazepine antagonist (see ‘ible 12.1). It ‘works well but is expensive. It is not a controlled agent.” Recommendations for Handling Aggressive or Dangerous Dogs Oral medications can be given to aggressive or dangerous dog: when administration of parenteral medications is difficult ox not possible. The goal is to quiet and calm the dog to allow safe handling and for subsequent administration of parental agents. “Medications given orally require a longer onset time to be effective ‘than when given parenterally. When working with aggressive or dangerous dogs itis important to communicate to the owner the potential risks and side effects of drugs used in a patient that has not had a complete physical exam. Additionally, it is imperative that you know the patient's general health status ess handling measures, such as avoiding a busy waiting room, going straight to a quiet exam room, and keeping the dog im a quict environment, are helpful. Tips for administering medications to aggressive or dangerous dogs are provided in Box 12.2. If possible have the owner administer the agent(s) orally into the check pouch or squirt it into the mouth (see Box 12.2). Oral-transmucosal administration avoids the first-pass hepatic effect, and the oral mucoss's rich blood supply allows for therapeutic circulating concentrations to be achieved.” The “chill protocol” developed by Dr. Alicia Karas is useful for anxious pets. The protocol requites that the owner give oral