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Local Anesthetic Techniques

Local anesthetic drugs block sodium channels and provide complete pain relief from the nerves that are blocked. This fact led to the recommendation “ local anesthetics should be utilized, insofar as possible, with every surgical procedure . "   2 The task force recommends the use of local anesthesia, including these simple techniques for common procedures: Castrations Ovariohysterectomies Perineal procedures (i.e., urinary catheter placement) Dental extractions 

Guidelines Contributors

Task force and contributors to the 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats .

Phase 1: Preanesthesia

An individualized anesthetic plan with specific and sequential steps ensures the continuum of care throughout the entire anesthetic process. A complete anesthetic plan must address all phases of anesthesia, with inclusion of perioperative analgesia throughout each phase. Although each patient should be treated as an individual, having a set of anesthesia plans that are used repeatedly is appropriate.

Drug Combinations

Multimodal anesthesia and analgesia are crucial to providing a balanced anesthetic event. Review, print, and share these tables with your team when considering which medications to include in individual protocols.

Opioid Selection Considerations

There are many factors to consider when choosing an opioid, including the degree of desired analgesia, onset and duration of action, adverse effects, and availability. This table can help you do what you do best—comfort your patients in their time of need.

IM Sedation and Induction Combination for Healthy Dogs and Cats

Sometimes, IM induction protocols are necessary in healthy patients. Making that choice and picking a protocol are some of the many decisions required for a smooth anesthetic event. Review these combinations and consider which might be the most beneficial for each patient.

IV Induction Protocols for Dogs and Cats

Choosing an ideal IV induction protocol is one of the many decisions required for a smooth anesthetic event. Review these combinations and consider which might be the most beneficial for each patient.

Hypoxemia

Hypoxemia (SpO 2 , 95%, severe SpO 2 , 90%) is uncommon when a patient is intubated and breathing 100% oxygen. 44  Observation of mucous  nembrane color is not a sensitive indicator of hypoxemia as cyanosis will likely not occur until hypoxemia is profound. 45 Continuous assessment of oxygenation is best accomplished with pulse oximetry. With low SpO 2 , the anesthetist may be tempted to troubleshoot the pulse oximeter by repositioning the probe, moistening the mucous membranes, or trying a different monitor. These measures may work if the issue is indeed the probe, but prior to troubleshooting the probe, verify that the patient is properly intubated and connected to the oxygen source and that the supply of oxygen is adequate. Hypoventilation can cause hypoxemia, so adequate ventilation should be ensured, as previously described. Insertion of the ETT past the thoracic inlet can cause one-lung intubation with decreased pulmonary surface area for gas exchange. If one-lung intubation is likely, the ETT can be pulled out slightly, with the goal to move the tip of the ETT into the trachea. Hypoxemia can be secondary to atelectasis, in patients with abdominal distention or obesity positioned in dorsal recumbency, or to primary pulmonary (e.g., pneumonia) or pleural (e.g., pleural effusion) disease. If this is expected, manual or mechanical ventilation should be instituted and a positive-end expiratory pressure (PEEP) valve (2.5–5 cm H 2 O) can be added to the expiratory limb of the circuit to open collapsed airways. Decreased oxygen delivery to the tissues from perfusion issues (rather than respiratory issues) can also cause decreased SpO 2 readings. Treat indicators of poor perfusion such as slow capillary refill time, brady- or tachycardia , hypotension , and weak pulses. If no improvement occurs with these treatments, the patient should be positioned in sternal recumbency as soon as possible and recovered from anesthesia with continued oxygen support. 

Special Focus: Staff Education and Safety Training

Staff training is critical for anesthetic safety. Although this is actually the first step in anesthesia, this section has been placed separately in order to emphasize its importance. Providing quality patient care through scientific and knowledge based practice is the mission of veterinary medicine. A cornerstone of the implementation and success of this objective is the veterinary staff, from the veterinarians, technicians, and assistants to the receptionist/office personnel.

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

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