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Step 4: Anesthetic Protocols

Multimodal Analgesic Drug Considerations for the Four Phases of Anesthesia Preanesthesia: NSAIDs, opioids, alpha-2 agonists, ±maropitant, +/- gabapentin Induction: Sometimes opioids, potentially ketamine (induction dose = loading dose for continuous rate infusion [CRI]) Maintenance: Local/regional blocks, CRI (opioid, lidocaine, ketamine, alpha-2 agonists, combinations), boluses of opioids or alpha-2 agonists Recovery: NSAIDs, boluses of opioids or alpha-2 agonists, continue CRI, ±maropitant, ±gabapentin or other adjunctive drugs

Phase 2: Day of Anesthesia

Follow the links below to fine tune your protocols on the day of anesthesia to improve the anesthesia experience from " doorknob to doorknob. "

Recommended Resources

2011 AAHA Anesthesia Guidelines for Dogs and Cats 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats 2018 AAFP Feline Anesthesia Guidelines 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats 2019 AAHA Dental Care Guidelines for Dogs and Cats 2015 AAHA Canine and Feline Behavior Management Guidelines

Phase 3: Return Home

Once the patient has been discharged, the anesthesia continuum comes full circle. Pet owners can benefit from receiving anesthetic discharge instructions , in addition to a surgical discharge form. This guides postoperative care by the pet owner and alleviates their concerns, addressing possible complications that could be encountered and outlining when the veterinary team should be contacted.

Local Anesthetic Techniques For Castratrations

Feline or canine testicular block INDICATIONS: Feline and canine castrations. INSTRUCTIONS: Choose the desired local anesthetic.* Calculate the low end of the dose of 1 mg/kg (cat)/ 2 mg/kg (dog) of bupivacaine, ropivacaine, or 4 mg/kg (cat), 6 mg/kg (dog) of lidocaine. Complete a rough surgical scrub of the testicles and the incision site (scrotal [cat] or prescrotal [dog]). Insert a 22-gauge needle into the center of the testicle with the tip of the needle pointed toward the spermatic cord. Aspirate and inject ½ of the calculated volume into each testicle or inject until the testicle suddenly feels turgid, whichever occurs first. † The drug migrates up the spermatic cord and provides pain relief from surgical crushing of the cord and associated vessels. To provide pain relief from the incision: Cats: Continue infiltrating as the needle exits the testicular body to block the skin and subcutaneous tissue. Dogs: Inject local anesthetic in skin and subcutaneous tissue at the incision site.

Summary

Anesthesia, which is an integral part of daily care in veterinary hospitals, cannot be defined merely by the time that the patient is unconscious, but rather by a continuum of care that begins at home with the owner and does not end until the patient returns home to the owner for follow-up care. Anesthesia is a multidimensional procedure involving not only the patient’s individual characteristics but also specific and critical equipment, appropriate drugs and drug dosages, diligent physiologic monitoring and support, thorough client communication, and highly trained staff.

Caudal Mandibular Regional Blocks

For additional information on other dental nerve block techniques, see the 2019 AAHA Dental Care Guidelines for Dogs and Cats . Caudal mandibular (inferior alveolar) regional blocks  INDICATIONS: Dental and orofacial surgery on the mandible (i.e., dental extractions, mass removals, fracture repair, etc.) This desensitizes all tissues to midline on the ipsilateral side.  INSTRUCTIONS:  1.  Select and calculate the full dose of a local anesthetic, i.e., lidocaine (cats = 2–4 mg/kg, dogs = 4–6 mg/kg), bupivacaine (cats = 1 mg/kg, dogs = 2 mg/kg), or ropivacaine (cats = 1 mg/kg, dogs = 2 mg/kg).*  2.  Prior to the procedure or extraction is performed, choose intraoral vs. extraoral approach, based on clinical indication, and personal preference. 3. The mandibular foramen or nerve can often be palpated on the lingual side of the mandible, just rostral to the angle of the mandible and just caudal to the last molar in approximately the middle 1/3 rd of the mandible (as measured from dorsal to ventral). NOTE:  The foramen is often difficult to palpate in very small patients like cats and small dogs.

Local Anesthetic Techniques For Ovariohysterectomies

Intraperitoneal lavage technique for dogs and cats INDICATIONS: Feline and canine ovariohysterectomies. (This technique may be more effective than mesovarium block because analgesia will be provided at both the ovarian and uterine surgical sites.) INSTRUCTIONS: Select and calculate the full dose of a local anesthetic, i.e., lidocaine (cats = 2–4 mg/kg, dogs = 4–6 mg/kg), bupivacaine (cats = 1 mg/kg, dogs = 2 mg/kg), or ropivacaine (cats = 1 mg/kg, dogs = 2 mg/kg). If necessary, dilute the drug with saline–the total volume needs to be a minimum of 0.4–0.6 mL/kg to lavage or bathe the entire abdominal cavity. Immediately after making the incision or after completing the abdominal procedure but before closing the incision, “bathe” or “lavage” the peritoneal cavity with the local anesthetic by instilling it into the abdomen through the incision (literally just squirting it in the abdomen).* Close the incision as usual, leaving the local anesthetic in the abdomen.

Step 2: Client Communication/ Education

Once the initial plan is formulated, pertinent information regarding the anesthetic procedure and pet-specific risk factors should be discussed with the pet owner

References

References for the 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats .

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