exam 2 Flashcards

Question

Induction of Anesthesia INJECTABLE AGENTS exotics

Answer 1

-ketamine -propofol -alfalaxlone TITRATE TO EFFECT TO AVOID INDUCTION APNEA

Answer 2

* Should only be 2 nd choice to IV induction * Always use with premedication to reduce: - Stress/ struggling -oxygenate if possible -ISO mac 2.5%, induction apnea -Sevo man 3.5 faster, less breath holding.

Answer 3

* Close-fitting: - Reduce environmental contamination - Avoid inhalation of room air * Diaphragm can be adapted using an exam glove * Clear: visual assessment * Low volume: minimize dead space

Answer 4

* Prokinetic effects * Improved food intake and fecal output in rabbits following ovariohysterectomy * Anesthetic sparing (reduces isoflurane MAC) * Analgesic * Anti-inflammatory/anti-endotoxin

Answer 5

-mask -V-gel -intubation (blind, or direct visualization with laryngoscope) -protects airway, allows O2 and positive pressure ventilation.

Answer 6

* 2.0 -3.5mm (un)cuffed ET tube * Ensure rabbit is adequately anesthetized * Pre-oxygenate * Prone to laryngospasm: Use lidocaine (careful toxic dose) * Sternal recumbency with hyper-extended neck - to align the larynx and the trachea with the oropharynx * Continuously monitor heart rate during induction/intubation

Answer 7

* In conscious rabbit – apply local anesthetic cream (EMLA) § Cephalic vein § Lateral saphenous § Marginal auricular vein - Complications: sloughing, chemical phlebitis, mechanical irritation from catheter or bandage - Don’t use central auricular artery § Fluids: 10 mL/kg/h

Answer 8

* Premeasure ETT/atomizer to level of larynx * Sternal recumbency and hyper-extend neck * Insert ET-tube to pre-measured point - Condensation appearing in tube during expiration * Instill lidocaine 2% (neat) via small catheter/atomizer through ET tube * Gently advance ET-tube during inspiration while: - Listening at the connector end of the tube - Watching capnograph

Answer 9

* Difficult placement * Laryngospasm * Trauma to the oropharyngeal soft tissue * Tube dislodgement, occlusion, and kinking * Postintubation oropharyngeal swelling

Answer 10

Anesthetic depth: * Palpebral reflex, eve position: unreliable * Nictitans membrane will move over cornea * Corneal reflex should be maintained Cardiovascular System * Auscultation * Doppler * Pulse oximetry: ear, tongue, digit * ECG * Temperature (Avoid Hypo and Hyperthermia)

Answer 11

-know injury, or procedure before hand so know what drugs/ equipment to bring. top ups, local block, standing sedation ect. -*Only simple procedures of short duration should be attempted in the field.

Answer 12

* IV catheters * Sufficient amount of drugs * Soft ropes with an appropriate halter * Small towels – covering/protecting eyes * OXYGEN supplementation: * Horses are very prone to hypoxemia during GA (V/Q mismatch) E tank with nasal insufflation.

Answer 13

* Dose = 0.01 – 0.05 mg/kg IV/IM * May be useful as a ‘pre-med’ often in combination with other drugs * Can be used alone for non-painful procedures, calm down mare to work with foal * Sufficient time should be allowed for it to work (30 – 40 minutes) * Provides anti-arrhythmic effect * Vasodilation and hypotension does occur (Alpha1 antagonism) * Penile prolapse: * Should be avoided in breeding stallion

Answer 14

-more reliable sedation, analgesia, muscle relaxation and some ataxia. -standing sedation: use low dose. -preanesthetic medication use high dose. -transient bradycardia -xylazine lasts 20 mins, romf lasts 40 mins.

Answer 15

* Butorphanol (0.02 – 0.03 mg/kg IV) * Morphine (0.1 mg/kg) – use a longer lasting alpha2 agonist * Can mix drugs OR give drugs separatel

Answer 16

* Detomidine/Butorphanol/Acepromazine mix is common * Detomidine/Acepromazine is good for mares * Romifidine mixed with acepromazine = precipitation – DO NOT administer

Answer 17

-1.)pre anethetic prep: fast 12 hr, water up to 1 hr before. history, exam. -2.)facilities/enviro -3.) place IV catheter (sometimes) -4.) check halters and ropes -5.) protect facial nerves, eye. remove halter -6.) select site

Answer 18

-administer xylazine (1mg/kg IV) or detamadine (wait a few minutes for peak sedation) can mix diapepam with ketamine. * Diazepam is optional but does ‘smooth’ induction * Butorphanol (0.05 mg/kg IV) can be added * Often wait until horse is induced to minimize the potential for excitement * Consider local anesthetic techniques

Answer 19

* ‘Nose to Knees’ sedation with (aplha 2 or ace) before induction with ketamine * Check heart rate * DO NOT INDUCE WITH KETAMINE IF: * Sedation is poor – top up sedation with alpha2 agonist * HR is extremely low – wait until it comes back up (2 – 3 minutes)

Answer 20

* Ketamine + Xylazine: * Mix 1 / 3 – 1 / 2 the pre-medication and induction doses * This may provide 2 – 3 ‘top – ups’ * Given every 10 – 15 minutes depending on depth of anesthesia *Ketamine is slightly cumulative: * After the third ‘top – up’ the dosing interval should be increased OR subsequent doses decreased

Answer 21

-Indicated when need a little longer duration of anesthetic time * Maximum anesthesia time 90 min * In 1 liter 5% Guaifenesin add: * 500 mg Xylazine * 1000 mg Ketamine * Given at a rate of about 2 mL/kg/hr. -good for 60 min procedures, analgesia, good recovery

Answer 22

* Pulse quality, mucous membrane color, CRT, HR * Respiratory rate and depth * Check eye reflexes: * Palpebral reflex is ‘brisk’ * At a ‘LIGHT’ plane of anesthesia: * Spontaneous blinking * Tearing * Nystagmus * Don’t use corneal reflexes -monitor with portable BP doppler and sphygmomanometer or pulse oximeter.

Answer 23

-dont usually reverse -control recovery -keep safe -avoid noise -keep eyes covered -consider using xylazie if you topped up with ketamine in the last 10 mins and can cause excitable recover. -long procedure place cathitor

Answer 24

* NSAIDs: Used pre-emptively to minimize surgical/inflammatory pain * Opioids - Provide good analgesia and increase sedation -butorphanol 60-90 min -morphine 2-4 hr -buprenorphone 12 hr slower onset 30 mins. * Local Anesthetic Blocks: Can provide a useful part of a balanced analgesia, Intra-testicular for castration

Answer 25

-survival rate of CPA is poo 4-9% 3 catagories of patients -anesthesia and drug related -underlying disease -reversible disease/injury

Answer 26

* For animals > 10kg * Compression over widest part of the thorax * Increases overall intra-thoracic pressure, compresses aorta moving blood out of thorax.

Answer 27

-can put dog in dorsal recumbency and it stays without being held -flat chested dogs -between legs on sternum like human CPA

Answer 28

Use 100% Oxygen! * Use Anesthesia machine or Ambu®-bag * Don’t forget to turn off the vaporizer * Room air 21% O 2/ higher than own breath

Answer 29

* Securing airway for provision of ventilation is critical * Check for any obstruction (blood, fluid) – have suction ready -mask: not ideal, must stop compressions to ventilate, do 30 compressions 2 breaths ratio. -MOUTH TO SNOUT, possible if emergency -Intubation: same as usual but in lateral recumbency, can be performed while doing chest compressions

Answer 30

* Respiratory Rate: 10 breaths per minute * Do NOT go too fast! * Tidal volume 10 mL/kg * Inspiratory time: 1 second * Airway pressure: sufficient to result in a visible chest rise * Airway Pressure (IPPV) 30-40 cmH2O during chest compression * In between chest compressions less than 20 cmH2O.

Answer 31

* Initiate monitoring: ECG, Capnography, Femoral pulse * IV Access * Reversals

Answer 32

* Diagnosis of arrest rhythm * Determine ALS therapy (pharmacologic vs defibrillation) * ECG analysis: never interrupt 2 min cycle of chest compression -no not delay resumption of chest compressions

Answer 33

Non-shockable: * Asystole * Pulseless Electrical Activity (PEA) Shockable: * Pulseless Ventricular Tachycardia * Ventricular Fibrillation (Vfib) - Initial rhythm can change during CPR

Answer 34

* Most common arrest rhythm in dogs and cats * Non-shockable * “Flat line”: indicates no electrical activity in the heart * Treatment: * Continue basic life support: supplements heart action * Drugs: * Recommended Epinephrine +/- vasopressin (every other cycle) * Atropine: (only once, early on

Answer 35

* Common arrest rhythm in veterinary patients - Overdose GA (barbiturates) * Non-shockable * Normal heart rate and rhythm on ECG, but NO myocardial contractility * Heart rate less than 200bpm * Continue basic life support: supplements heart action * Drugs: * Recommended Epinephrine +/- vasopressin (every other cycle)

Answer 36

* Unorganized electrical activity in the heart -> poor myocardial contractions -> loss of cardiac output * Most common initial arrest rhythm in people * Uncommon in cats and dog * Treatment: - Electrical defibrillation - Precordial thump

Answer 37

* Electrical impulse depolarizes myocardial cells “reset button” * Electrical and uncoordinated mechanical activity stops * Allows regular pacemaker cells to regain control -> - Sinus rhythm - Asystole: if SA node doesn’t refire * Start BLS at the same time you charge the defibrillator

Answer 38

* Lubricate paddles with conductive gel * Do not use alcohol – combustible * Place patient in dorsal recumbency * Place paddles on opposite sides of thorax - Over the heart at costo-chondral junction * Check that NO one is in contact with patient or table * Shout ‘CLEAR’ when ready

Answer 39

* Restart chest compressions immediately! (full 2-min cycle) * Desired outcome: * Normal ECG rhythm * Asystole -resume chest compressions for 2 mins before we check ECG -if shockable rhythm persists after the first defibrillation attempt * Double energy dose for next shock * Stay at that dose for subsequent doses * Low dose epinephrine

Answer 40

* Provides information about cardiac output and pulmonary perfusion * Measure of efficacy of chest compressions - EtCO2 < 18 mmHg means poor perfusion (poor cardiac output) * MOST predictive prognostic indicator: * Higher EtCO 2 values (> 15mmHg) during CPR associated with increased rate of return of spontaneous circulation

Answer 41

* Catecholamine with nonspecific α and β adrenergic effects * Alpha mediated vasoconstriction: key for CPR - > increased myocardial/cerebral blood flow * Blood volume - > central circulation * Βeta mediated effects may be harmful: - > increased contractility and HR -> increased myocardial O 2 demand -> myocardial ischemia and arrhythmias * Dose: - Low dose: (0.01 mg/kg) IV - High dose: (0.1mg/kg) NO LONGER RECOMMENDED -repeat every 2-5 mins of arrest -doesnt work in acidodic, hypoxemic or hypothermic patients.

Answer 42

-preffered IV -ntraosseous (IO) * If can’t achieve IV within 2 min. -dont use intracardiac -intratracheal: if other 2 are not possible.

Answer 43

* Only if IV or IO are not possible * Pass a feeding tube or red rubber tube down ET tube to level of carina * Flush the catheter with air and give a few good breaths * Drug dose is doubled! * Epinephrine use “high dose” * Drugs diluted in 0.9% NaCl * Atropine, Epinephrine, Vasopressin, Lidocaine, Naloxone

Answer 44

* Non-catecholamine vasopressor * Acts on V1 receptors of the vascular smooth muscle * Profound peripheral vasoconstriction * More effective in hypoxemic, hypothermic, acidemic environment * Dose: 0.8 IU/kg IV (Double for IT) * As a substitute or in combination with epinephrine every 3-5min

Answer 45

* Most useful in patients that have arrested due to high vagal tone * Vagolytic drug inhibits parasympathetic tone - Increases heart rate - Increase AV nodal conduction * Dose: 0.04 mg/kg IV - As early as possible during CPR - Only once

Answer 46

* Ischemia-reperfusion injury: Sepsis like syndrome * Brain injury: Injury occurs during reperfusion, Mannitol, hypothermia, seizure prophylaxis * Myocardial dysfunction * Something killed you originally! * Persistent precipitating pathology

Answer 47

* Unresponsive * Lack of Spontaneous ventilation * Lack of Heart beat Unresponsive patient (5-10 sec) * STIMULATE – no response – call for help

Answer 48

Complete cessation of effective: VENTILATION and CIRCULATION Definitive clinical signs of CPA: * Loss of consciousness – collapse - unresponsiveness * Respiratory arrest * No heartbeat, no pulse (can take > 30s to identify!) so dont use this, start CPR in unresponsive, apneic patients don't wait and try to find heart beat.

Answer 49

* Delays in initiation of CPR are associated with worse outcome * Benefits of early CPR outweigh risks -call for help -3 minute emergency (brain damage after that) -turn off anesthetic -check airway -early ventilation is most important in dogs and cats -Single rescuer BLS: 30 compressions : 2 breaths

Answer 50

-2 full mins, no pauses -1: chest compressions 100-120/ min -2: ventilation every 6 seconds -pause and check pulse and rythm -3 monitoring -4: IV access -5: reversal

Answer 51

* Rate: 100-120 bpm * Depth: 25% of depth/width of chest * Lock your elbows! (gravity vs muscle strength) * Duration: Rescuer fatigue! - Perform uninterrupted cycles of 2 min * Relaxation => 1:1 compression to relaxation ratio - Allow full chest recoil

Answer 52

-No leaning on the chest because: * Increased intrapleural pressure * Reduced venous return * Suboptimal ventricular filling

Answer 53

* For animals < 10kg or dogs with narrow, keel-chest conformation * Direct compression of the heart (3 rd to 6 th IC space) -> pushes blood out into circulation * Can also cup hand around sternum to squeeze with one hand * Avoid using fingertips (no pinching) A. One-handed thumb-to-fingers B. Circumferential (two hands or two thumbs) C. One-handed palm

Answer 54

1.) OPIODS 2.) NSAIDS 3.) LOCAL ANESTHETIC 4. Decide if administration of α2-agonist would be beneficial 5. Choose analgesic adjuncts (ketamine, lidocaine, gabapentin) if needed 6. Use nonpharmacologic techniques to minimize pain

Answer 55

* Pain * Emergence delirium * Dysphoria * Anxiety

Answer 56

* Anesthesia related behavior * Attributed to residual inhalant anesthesia * Only in immediate recovery period (after extubation) * Self limiting – resolve within several minutes * Sometimes requires sedation

Answer 57

* Reaction to (“overdose” of) opioids, not always some animals just it with opiods * Animals difficult to distract or calm by interaction * Don’t respond to light palpation of painful area * Treatment: - Sedation (low dose acepromazine, dexmedetomidine) - Partial opioid reversal (careful titration) butorphanol or Naloxon (μ antagonist) 2-10μg/kg (IV)

Answer 58

* Animals can be temporarily distracted * Calmed by interaction, will resume behavior when left alone * NO source of pain can be identified! * Animals responsive to TLC, sedation (trazadone, gabapentin) * Limit time in hospital

Answer 59

MU AGONIST OPIOIDS full agonists: hydro, meth, morphine, fetanyl partial:buprenorphone * Analgesia +++ * Sedation +++ * Vomiting ++ * Bradycardia ++ * Respiratory depression ++ REVERSIBLE with NALOXONE: (10-40 μg/kg

Answer 60

-opioid * One dose lasts 1-4 hours * Dose-dependent side effects: * Panting (dogs) * Nausea, vomiting * Dysphoria, hyperthermia? (cats) * Respiratory depression, bradycardia * Urine retention, GI-ileus

Answer 61

* Partial μ-agonist opioid, popular for cats * Preferred route of administration: IV, IM * Avoid OTM (oral transmucosal) and SC * Slow onset time * Duration: 4-6 hours * Rarely causes vomiting or dysphoria * Euphoria in cats * Ideal for mild to moderate pain * Avoid if planning to use a pure μ-agonist in the near future

Answer 62

-opioid * Kappa agonist * (0.2-0.4 mg/kg IV, IM, SC) * Can reverse μ-opioid agonist (dilute, slow to effect) * 30 -90 min duration * Weak analgesic * Mild sedative * Potent antitussive * Does not cause panting in dogs

Answer 63

* Provides consistent levels of analgesia of opioids * Adverse side effects are minimized (compared to intermittent boluses) * Less drug used overall -fetnal strongest analgesia opioid, * Potent analgesic, sedative, respiratory depression

Answer 64

-pH changes effect enzyme function and excitability of nerve and muscle cells -ACIDOSIS: low ph >7.35 -alkalosis: high Ph >7.45

Answer 65

decreased PH= decreased excitability. alters cardiac contractions. -decreased vascular response to catecholamines. -can lead to loss of consiousness.

Answer 66

-increased pH = increased excitability. * Impaired neurological function * Impaired muscular function * Tingling sensations, nervousness, muscle twitches

Answer 67

* Caused by an imbalance in the production and excretion of acids or bases by the KIDNEYS -pH < 7.35, HCO3- < 22 mmol/L * Too much acid build up: * Shock * DKA * Renal Failure * Diarrhea * Diuretics * Lactic Acidosis * Ethylene Glycol Poisoning * Clinical Signs: * Headache, lethargy, nausea, anorexia, vomiting, diarrhea, coma , death

Answer 68

* Caused by an imbalance in the production and excretion of acids or bases by the KIDNEYS -ALKALOSIS = pH > 7.45, HCO3- > 26 mmol/L * Excess loss of acid in the blood: * Excessive vomiting * GI obstruction * Clinical Signs: * Dizziness, lethargy, weakness, muscle twitching, cramps, tetany, coma, death

Answer 69

-caused by lungs or breathing abnormalities -ACIDOSIS = pH < 7.35, PaCO2 > 45 mmHg * Caused by HYPOVENTILATION: * Obstruction of gas exchange * Respiratory depression * Clinical signs: * Dyspnea, respiratory distress, shallow respirations, tachycardia, dysrhythmias, headache, restlessness, confusion

Answer 70

-caused by lungs or breathing abnormalities ALKALOSIS = pH > 7.45, PaCO2 < 35 mmHg * Caused by HYPERVENTILATION: * Pain * Fear * Anxiety * Fever * Clinical signs: * Dyspnea, nausea, vomiting, headaches, restlessness, lethargy, coma

Answer 71

-an immediate response to changes in acid/base balance * ACIDOSIS – compensatory response: * H + moves into the cell while K + moves out of the cell * Results in HYPERKALEMIA

Answer 72

-an immediate response to changes in acid/ base balance * ALKALOSIS – compensatory response: * H + moves out of the cell while K + moves into the cell * Results in HYPOKALEMIA

Answer 73

* Normal by product of cell metabolism = CO 2 * CO2 travels via the blood → lungs * Excessive CO2 combines with H 2O → H 2CO3 -blood ph changes due to how much carbonic acid (H2CO3) is present -lungs change respiration -responds in seconds to minutes

Answer 74

* In the blood – concentrations of the following stimulate the RESPIRATORY RATE: * CO2 * pH * O2 * Central chemoreceptors located on the ventral surface of the medulla respond to changes in pH of the CSF * Peripheral chemoreceptors located in the CAROTID and AORTIC arches

Answer 75

* To maintain blood pH – kidneys retain or excrete bicarbonate (HCO 3-) to compensate * When pH decreases – kidneys retain HCO3- * When pH increases – kidneys excrete HCO3- * RENAL BUFFERING – may take hours to days

Answer 76

-analgesic and anti-inflammatory -side effects with chronic use: gastric and colonic ulcers, renal tubule necrosis -usages: administered pre op anticipating inflammation during surgery. -Phenylbutazone: musculoskeletal pain -Flunixin meglumine (banamine) soft injury, abdominal pain, endotoxemia

Answer 77

* Xylazine * Detomidine * Medetomidine * Dexmedetomidine * Romifidine - Usages: * Pre-medication primarily for sedation * Intra-operatively as a Constant rate infusion for analgesia * Post-operatively for sedation to ensure smooth recoveries from inhalational anesthesia

Answer 78

* Benefits: * Analgesia * Sedation * Anesthetic sparing * Potential negative side effects: * Bradycardia * Vasoconstriction and hypertension * Increased urine output (Hyperglycemic diuresis) * Decreased GI motility * Ataxia

Answer 79

* Used with KETAMINE and GGE (Guaifenesin) in ‘triple drip’ * Total Intravenous Anesthesia (TIVA)

Answer 80

* Used for sedation and analgesia for longer standing procedures, less ataxia than xylazine. * Often combined with an opioid * Administered as an infusion (Variable rate infusion) -want noes to knees sedation so protect neck when in stocks so they dont occlude airway from pressing it on bars

Answer 81

* Used for invasive procedures with inhalational anesthesia (PIVA)

Answer 82

* Used as an induction agent * Used in ‘triple drip’ mixture * Provides great analgesia: * Somatic * NMDA antagonism – good for chronic (‘wind up’) pain * Other beneficial effects: * Local anesthetic effects * Potent anti-inflammatory effects * Anesthetic sparing (↓ MAC by 37%) -can be used at very low doses in conscious horse -risk of excitement which can be controlled with sedatives

Answer 83

1. Morphine (used most in horses) 2. Meperidine 3. Pentazocine 4. Methadone 5. Fentanyl 6. Alfentanil 7. Remifentanil

Answer 84

-Partial Mu agonist: Buprenorphine -Kappa Agonist: Butorphanol (used commonly in horses)

Answer 85

* Primarily used intra-operatively: * Not good sedatives unless combined with an alpha-2 agonist * Appear to be effective in horses in pain OR undergoing invasive procedures: * Good analgesia * Do not reduce isoflurane requirements, not anesthetic sparing in horses and LA due to potential for excitement. -are anethetic sparing in dogs and cats

Answer 86

-Excitement: * Control with sedatives – Acepromazine, Alpha-2 agonists. -to decrease excitement: detamadine aplha 2 first then use butorphenol (opioid) * Decreased GI motility: * Decrease incidence if administered IM, or one bolus, and dont give long term.

Answer 87

* The more severe the pain, the greater the dose of opioid analgesic required, and the lower the risk of excitatory side effects. * In pain free horses – giving appropriate doses of alpha-2 agonists matched for duration of action eliminates the risk of excitation. * In pain free horses – sedation with acepromazine reduces but does not eliminate the risk of excitation -should be given to effect -signs of underdose (pain) -signs of overdosage (excitement) hard to determine difference

Answer 88

* Used at low doses for horses in pain: * 0.05 – 0.1 mg/kg IV or IM (Duration approximately 4 hours) * Side effects when use repeated dosing or high dosages: * Reduced GI motility * Urinary retention * Increased locomotor activity and ataxia -effects: cardio stimulation when used alone. -can make the effects of sedatives worse when used with standing sedation -intra-articular analgesia.

Answer 89

* Constant Rate Infusion (CRI): low dose, Improved recovery characteristics * Higher dosages (0.25 mg/kg): * Used for analgesia * May increase Isoflurane requirements * May result in rough recoveries * Clinical dosages (0.05 – 0.1 mg/kg): * Do not affect recovery quality

Answer 90

* Used with success intra-operatively * Dosage: 3-6 mcg/kg/hr IV * Good recoveries * Some reported hyperthermia * Can only be used as a CRI due to short half life * Take care to ensure analgesia in place before turning off

Answer 91

-partial Mu agonist * Long duration of action – up to 12 hours * Side effects: * Restlessness * Head shaking * Decreased GI motility for up to 4 hours -Sub-lingual administration might prove useful: * Dosage: 6 mcg/kg - Some new evidence that this may provide better post- operative analgesia than butorphanol for minimally invasive procedures

Answer 92

-kappa agonsit opioid -can still produce excitement (delta receptors) but less and less GI ileus than Mu * Often used intra-operatively * Effective for VISCERAL analgesia * Duration of effect: * 45 minutes – 1 hr * Re-dosing is often necessary * not anesthetic sparing * Does provide a more ‘stable’ anesthesia -post op: IM or infusion for several days as anaglesic

Answer 93

* As an infusion intra-operatively - WITHOUT EPINEPHRINE!! * Pharmacological benefits: * Analgesia * Anti-inflammatory * Anti-endotoxemic * Pro-kinetic * Anesthetic sparing -IV low dose * CRI 50 mcg/kg/min IV * Stop infusion at least 30 minutes prior to recovery from general anesthesia – to prevent ATAXIA

Answer 94

-used for anethetic sparing -combinations for multimodel anesthesia * Drugs in which we can use via PIVA and their indications include: 1. Alpha-2 agonists: * Invasive/painful procedures * Orthopedic procedures – musculoskeletal pain and inflammation 2. Lidocaine: * Colic surgeries 3. Opioids: * Orthopedic surgeries 4. Ketamine: * Somatic Analgesia – supplement other drugs

Answer 95

* Good for standing procedures * Require sterile technique for placement * Relatively easy to place in the standing horse – sacrococcygeal (‘caudal epidural’) * Use preservative free drugs * Usually once or twice daily treatment * Administer drugs SLOWLY -can have epideral catheter for long term pain management -ruminants: morphone lasts 10 hr in sacrococcygeal administration

Answer 96

-if you have a large wound you put this at incision site and can add local block for long time pain management * Can provide postoperative analgesia for 2 – 3 days * Preplace during surgery * Commercial kits are available * Use LIDOCAINE infusions – 2 – 5 mL/hr * Use BUPIVICAINE infusions – 2 – 5 mL every 6 – 10 hrs

Answer 97

* Must stop all infusions prior to moving into the recovery box * Give NSAIDs if warranted * Consider local blocks if applicable * Usually sedate with an alpha-2 agonist: * Xylazine: 0.2 – 0.5 mg/kg IV * Romifidine: 10 – 25 mcg/kg IV

Answer 98

* Dose may need to be adjusted if start to see behavioral side effects: * Sedation * Dysphoria * Excessive locomotor activity * Excitement * Can develop intestinal stasis with long term use of opioid -morphine (4-12 hr) or butorphanal (4-6 hr)

Answer 99

* Benefits: * Anesthetic sparing * NMDA antagonist – good for chronic pain * Good for somatic analgesia * Typically use higher dosages than in small animals

Answer 100

* As an infusion intra-operatively - WITHOUT EPINEPHRINE!! * Pharmacological benefits: * Analgesia * Anti-inflammatory * Anti-endotoxemic * Pro-kinetic * Anesthetic sparing * Dosage* (higher than horses and small animals): -stop infusion at least 30 mins before recovery to prevent prolonged recoveries

exam 2 Flashcards

(124 cards)