suitable anaesthesia techniques

Re: suitable anaesthesia techniques

emvn80 — Thu, 04 Feb 2010 15:59:35 GMT

just to add fuel to the debate, I don't believe there is ine 'correct' protocol. There are many drug combinations that are suitble and remember that ketamine and medetom will provide some analgesia, so if an NSAID is used too then analgesia may be adequate (patient should still be assesssed for pain and adding an opioid may be worthwhile), however additional muscle relaxation may also be required.

Ideally whatever the protocol analgesia should be provided preemptively and oxygen available, ideally ET tubes available for intubation and IPPV if nec. In an ideal world each patient would be assessed individually and a plan created to suit that patient and the procedure, cost and experiences of staff.

Ketamine/midazolam is a great induction agent iv in some cases, as is propofol, alfax etc, as is im 'triple combo it all depends on the situation and the familiaraity of the drugs...

remeber the safest drugs are the ones you are familiar with!

Re: suitable anaesthesia techniques

Vicky RVN — Tue, 02 Feb 2010 19:51:30 GMT

[quote user="Claire BearRVN"]

I have to admit I'd be less than impressed if that was my cat. I believe efficiency is key but that's too quick in my opinion

[/quote]

Yeah i thought that too.

We use acp/vet and rimadyl/metacam premed for all cat and dog surgery then induce prop and maintain iso/o2. Occasionally cat castrates are done with triple, if we aren't going to be able to get and iv or if we don't have time to wait for premed to take effect. We have a particularly unfriendly cats protection kitty the other day we struggled to even get triple into!!!

Re: suitable anaesthesia techniques

Claire Cameron — Wed, 27 Jan 2010 12:03:30 GMT

[quote user="SmegSlayer"]Really!? our new grad (qualified july 09 and first job with us Nov 09) is shorter than that now with cat spays. Our fossil vet is less than 10 mins from induction to off gas[/quote]

I have to admit I'd be less than impressed if that was my cat. I believe efficiency is key but that's too quick in my opinion

Re: suitable anaesthesia techniques

Deemus — Wed, 27 Jan 2010 07:24:23 GMT

Yep, the one in question has been qualified for 13 years. Honestly!

Should say that the one who doesn't intubate is off the table in less than ten and gets cranky if he has to close with more than one suture.

Re: suitable anaesthesia techniques

SmegSlayer — Wed, 27 Jan 2010 07:22:53 GMT

we had a vet that if the cat growled or waved its front legs about when we started induction (normally do ACP/Buprenorpnine the Proprofol with o2 and iso) would immediately go to triple combo. Used a mask to admin o2 and was fine.

[quote user="Deemus"]

As a cat spay regularly takes more than 45 mintues(!), we tend not to worry too much about reversing the Domitor within that time limit.

[/quote]

Really!? our new grad (qualified july 09 and first job with us Nov 09) is shorter than that now with cat spays. Our fossil vet is less than 10 mins from induction to off gas

Re: suitable anaesthesia techniques

Deemus — Wed, 27 Jan 2010 07:14:03 GMT

At our place, we use ACP/Carprofen as a premed then induce with Dom/Ket. One vet will intubate and maintain on iso/02. The other won't intubate.

As a cat spay regularly takes more than 45 mintues(!), we tend not to worry too much about reversing the Domitor within that time limit.

Cat casts are done the same way.

Older/dodgy animals are premed with ACP/Buprenorphine then induced with Rapinovet. I hear ya tho, it took me five years to convince the boss that buprenorphine was the way forward. Luckily he's not looked back! Good luck with your lot.

Re: suitable anaesthesia techniques

Kerry Spain — Wed, 27 Jan 2010 00:20:05 GMT

Val & Ket is really good for your cardiac patients with poor circulation/ perfusion, they stay lovely and pink throughout (no cyanosis from medetomidine or apnoea from propofol)

Re: suitable anaesthesia techniques

loobylou — Tue, 26 Jan 2010 22:27:18 GMT

[quote user="debbie anslow"]

ok, thanks, confirmed what I thought. Now I just need to work out how to convince the vets!!

Any opinions on reversing the domitor, I've always been taught that there is no need to leave healthy animals under domitor.

Thanks

[/quote]

If we are using domitor and ketamine we always wait 45 mins after administration to reverse the domitor otherwise the kitties still have the ketamine in their systems and have a bit of a freak out!!

Re: suitable anaesthesia techniques

Saskia Quinn — Tue, 26 Jan 2010 21:30:08 GMT

Adverse effects of ketamine include increased blood pressure, elevated heart rate, respiratory depression, vocalization, erratic and prolonged recovery, spastic jerking movements and muscle tremors. In rare instances, ketamine has been shown to induce seizures. Now this can happen in any patient sedated with ketamine, but in my experience, has only ever been in dogs

Re: suitable anaesthesia techniques

Louise B — Tue, 26 Jan 2010 21:18:57 GMT

[quote user="debbie anslow"]

Hi all,

Just after some opinions please, Does anyone out there have an opinion on whether medetomidine and ketamine a suitable surgical (ovariohysterectomy) anaesthesia?

Also can you let me know what you consider your gold standard to be?

Thanks

[/quote]

The first practice I trained in used ketamine/domitor combo for cat spays. I don't recall any problems with the combination and have used it since in a couple of other practices. Again without problem. They definitely were not waking up mid-op but the vets were quick - no new graduates

Re: suitable anaesthesia techniques

Saskia Quinn — Tue, 26 Jan 2010 21:16:43 GMT

Read my previous reply to Nick, Claire

Re: suitable anaesthesia techniques

Claire Cameron — Tue, 26 Jan 2010 21:14:39 GMT

[quote user="SaskiaVN"]Very many years ago I was taught (& it was drummed into me) NEVER to use Ketamine in dogs as the recovery was awful - and I witnessed first hand, recovery of a dog which had had ketamine and I can tell you, it was not pleasant.[/quote]

I thought Ketamine was ok to give in dogs?

Vetalar may be used in conjunction with xylazine in the cat, dog and horse, in conjunction with medetomidine in the cat and dog and in conjunction with detomidine or romifidine in the horse.

http://www.noahcompendium.co.uk/Pfizer_Limited/Vetalar_V/-39172.html

I've never seen bad response to Ketamine in dogs.

[quote user="SaskiaVN"]

Very many years ago I was taught (& it was drummed into me) NEVER to use Ketamine in dogs as the recovery was awful - and I witnessed first hand, recovery of a dog which had had ketamine and I can tell you, it was not pleasant.

I have known cat spays to have the triple combination of dom/torb/ketamine - it was considered 'brave' to put the ketamine in the same syringe as opposed to waiting till cat sleepy then administer ketamine as it stings like hell! These cats were then intubated. Normal, straightforward no delay surgery - that was all that was needed, but occasionally, maintenance on o2 and isoflurane was required.

Bitch spays were acp/vetergesic, propofol according to weight then maintained on o2 and iso.

Where I am now, cat spay's are given a premed of acp/vetergesic, induced with propofol and maintained on iso. Now, maybe its just me, but is that not an expensive way to perform a cat spay as opposed to the triple combo then intubated? I stand corrected if I am wrong

[/quote]

I personally am not a huge fan of triple, I much prefer acp/vet or dom pre-med with propoclear induction. Just personal preference really.

Re: suitable anaesthesia techniques

Saskia Quinn — Tue, 26 Jan 2010 21:14:37 GMT

[quote user="Nick Shackleton"]

I have seen the use of ketamine in dogs under anaesthesia as analgesia as well as a CRI combined with morphine and given with saline. both giving good analgesic results. And not really seen the responses you are describing.

[/quote]

What I seen Nick was shaking, shivering, disorientated, howling and huddled in a kennel. And, when I say howling - the dog/s were howling sooooo loudly, it could be heard all over the practice - including the waiting room. Now this is going back maybe 15 -17 years......so possibly the make up of the drug has been modified since then. These animals all had adequate pain relief so if definitely wasnt a pain reaction, much as it may sound. But, in that practice, at that time, once we stopped using ketamine in dogs - the side effects were vastly reduced.

Re: suitable anaesthesia techniques

Nick Shackleton — Tue, 26 Jan 2010 21:10:37 GMT

Re: suitable anaesthesia techniques

Saskia Quinn — Tue, 26 Jan 2010 20:44:25 GMT

[quote user="debbie anslow"]

Any opinions on reversing the domitor, I've always been taught that there is no need to leave healthy animals under domitor.

Thanks

[/quote]

We normally reverse domitor with antisedan (atipazamole) for routine surgery - however, on occasions if the animal was given dom/torb, then on isoflurane for any particular reason e.g corrective surgery following x-ray - if the procedure was deemed extremely painful in any way - domitor was NOT reversed, but close monitoring of the patient was necessary until they came around on their own.

Re: suitable anaesthesia techniques

Saskia Quinn — Tue, 26 Jan 2010 20:40:39 GMT

Bitch spays were acp/vetergesic, propofol according to weight then maintained on o2 and iso.

Re: suitable anaesthesia techniques

Claire Cameron — Tue, 26 Jan 2010 19:20:12 GMT

When I worked with dogs one practice pre-med was acp/vet and another practice was dom/torb, both followed by propofol and iso/o2. all intubated

we currently only do cats and standard protocol is routine ops (young, healthy neuters) pre-med dom, induce with propoclear, followed by propoclear and iso/o2. all ops intubated

Re: suitable anaesthesia techniques

Jo RVN — Tue, 26 Jan 2010 19:17:46 GMT

One practice I worked at we used domitor/buprenorphine as the pre-med for bitch spays and dom/ket with cat spays, both followed by IV propafol, and intubated maintained on iso and o2.

Where I am now, standard pre-med is acp/bup followed by propafol and iso/o2. All seem to be fine on this - the only problem i have encountered is it was nicer to have the medetomodine in the cat pre-med as they are easier to handle with it!

Re: suitable anaesthesia techniques

Kerry Spain — Tue, 26 Jan 2010 19:05:57 GMT

We use sedation dose of Medetomidine S/C as premed and I/V Alfaxan with S/C Carprofen for cats - S/C ACP, Butorphanol and Carprofen premed with I/V propofol. (small dogs we use Alfaxan)

Re: suitable anaesthesia techniques

debbie anslow — Tue, 26 Jan 2010 18:32:26 GMT

oh and I agree, it would be WONDERFUL to see patients intubated.

Re: suitable anaesthesia techniques

debbie anslow — Tue, 26 Jan 2010 18:28:24 GMT

ok, thanks, confirmed what I thought. Now I just need to work out how to convince the vets!!

Any opinions on reversing the domitor, I've always been taught that there is no need to leave healthy animals under domitor.

Thanks

Re: suitable anaesthesia techniques

Nick Shackleton — Tue, 26 Jan 2010 17:34:53 GMT

Had a think..............

I would agree with what has been said by previous posters that double combination doesnt provide sufficient anaesthesia to perform cat spay under. Used to perform cat cast under it thou. I reckon triple combination is ok, althou would be nice to have IV access plus intubation. Just in case things go wrong!

Not keen on Pethidine too short acting and vetergesic is too long acting. Personally would go ACP/morphine or ACP/methadone followed by IV propofol or alfaxone. intubate and use O2 and iso/sevo plus nitrous too. then give a NSAIDs. In the kitties wait till in recovery due to possibilities of low BP.

Just so you know also provided Domitor is not reversed it provides some analgesia, but once reversed the analgesic properties are also reversed.

Re: suitable anaesthesia techniques

Nick Shackleton — Tue, 26 Jan 2010 17:25:19 GMT

[quote user="Claire BearRVN"]

[quote user="Bouncyfi"]Not sure about the double, we have used this for dogs but usually just for minor stuff like cut pads, although we have done it once to re-stitch a bitch spay wound. Wouldn't have thought it would have lasted long enough to perform a spay on, or had enough pain relief[/quote]

I second that, does domitor and ketamine cover all aspects of the triad of anaesthesia?

I await Nick's views on this as he is my anaesthesia guru

We currently use domitor pre-med for spays, propoclear induction. isoflo/o2 maint. pre-op onsior for analgesia.

[/quote]

Cheers ClaireBear!!!

will have a think about it!

Re: suitable anaesthesia techniques

Claire Cameron — Tue, 26 Jan 2010 16:18:43 GMT

I second that, does domitor and ketamine cover all aspects of the triad of anaesthesia?

I await Nick's views on this as he is my anaesthesia guru

We currently use domitor pre-med for spays, propoclear induction. isoflo/o2 maint. pre-op onsior for analgesia.

Re: suitable anaesthesia techniques

Fiona Leathers — Tue, 26 Jan 2010 15:59:17 GMT

We use triple combo with cats so they have the added pain killer of buprenorphine, then they are put on sevo & o2 for maintenance. Dogs have acp & buprenorphine or pethidine, then propofol & sevo & o2 for maintenance.

Not sure about the double, we have used this for dogs but usually just for minor stuff like cut pads, although we have done it once to re-stitch a bitch spay wound. Wouldn't have thought it would have lasted long enough to perform a spay on, or had enough pain relief