Pre-med protocol

RE: Pre-med protocol

steph fursland — Sat, 15 Apr 2017 19:55:03 GMT

re medetomidine in kidney patients - I think if it's mild, stable renal dysfunction you could still get away with medetomidine, but I guess most of my renal patients are cats anyway and diazepam/ket can be used on these.

If you did have a dog with kidney issues who needed sedation, you could see if torb+Acp (+lidocaine if a painful intervention!) was enough, and if not then maybe give a bit of propofol (for instance if wanted to take an X-ray, just to keep it still).

RE: Pre-med protocol

Nicola Smith — Sat, 15 Apr 2017 08:19:12 GMT

We only use med in young cat neuters or aggressive animals. Our routine is acp (we only ever use half dose) with bupe or meth dependant on procedure. We might leave out the acp in very occasional very sick flat animals.

RE: Pre-med protocol

Una Wall — Sat, 15 Apr 2017 08:15:17 GMT

Thanks thats great, bit worried about using medetomidine in renal patients though, we would normally drip them for surgery but still think its contraindicated , think they have trouble excreting it????

RE: Pre-med protocol

WelshyNurse — Fri, 14 Apr 2017 15:28:07 GMT

Pretty much the same, although some of our vets prefer using methadone than others.

RE: Pre-med protocol

steph fursland — Fri, 14 Apr 2017 10:57:11 GMT

For an older dog or cat I tend to use a premed of 0.01-0.02mg/kg ACP and 0.02 mg/kg buprenorphine (or 0.3mg/kg methadone if you anticipate a painful surgery). I am pretty happy with this, patients stay a healthy colour while under GA, and the methadone especially means they don't have to be on too much iso during painful bits.

I sedate most dogs with 0.1ml/10kg of each medetomidine and butorphanol, given intravenously it is an effective sedation and as it is reversible I don't decrease the dose in renal patients. If they are cardiac patients I use twice the dose of butorphanol and 0.01mg/kg ACP (with no Medetomidine)

I sedate old/sick cats with diazepam/ketamine (doses are in the formulary but I tend to mix 0.2ml of each and give to effect slow iv; you can also give this combo im if the cat is fractious). This is a sedation which will allow you to position for X-rays, drain a chest, dematt etc, but the cat will looks at you which can be unnerving ;-)

The only exception is in very hyperthyroid cats I avoid ketamine as it increases myocardial oxygen demand and I use ultra low dose medetomidine instead (if you look in the formulary they quote lower doses than the charts do, so use those!) with butorphanol.