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Anaesthesia

Aspects of Anaesthesia
by

scott cumming

on 1 March 2016

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Transcript of Anaesthesia

Anaesthesia
Anaesthesia can be done in more ways than one...
What is it?
Why do it?
Loss of feeling or sensation

43 different types of anaesthesia...

Which ones are important to veterinary practice?
Surgery
What is it?

What is it used for?

What are the processes of anaesthesia?

Role of the nurse in an anaesthetic

How to achieve best practice anaesthesia

Alfaxan
Diagnostic Procedures
Seizure Control
Terminology
Anaesthesia
Premedication
Induction
Transition
Maintenance
Recovery
Intramuscular/
Subcutaneous
Injections
Catheterisation

Intravenous injection
Intubation
- always a good idea
Inhalational Anaesthesia

Sometimes injectable
Monitoring
Premedicant
Sedative
Analgesic
Opioid
Induction Agent
Maintenance Agent
Is it any procedure an animal wakes up from?
Smooth Induction

Stable Maintenance

Quiet Clear-headed Recovery
How to achieve a successful Anaesthetic?
Thorough pre-operative examination
Tailored premedication and
anaesthetic dosing
Good anaesthetic monitoring
Adjunctive therapies and support
Quiet & warm recovery area
- but keep looking at the patient!
Routine Anaesthetic?
17 out of every 1000 dogs and 24 out of every 1000 cats
die under anaesthetic....
Pre-Anaesthesia
What is involved in Anaesthesia?
When does the pre-anaesthetic period begin?
What happens on admission?
What are the ("routine") pre-anaesthetic instructions?
Post-Anaesthesia
What happens after the anaesthetic agent is turned off?
Well before any drugs are administered.

Arguably as soon as there is a decision to have an anaesthetic...

..... could be the week before with the old diabetic dog needing a dental, or the HBC needing an emergency splenectomy.....
Fasting? How long? Why?
Water?
What if the patient
doesn't bark or meow?
Talk to the owner:
- Has the animal been fasted if necessary?
- Has the animal been un-necessarily fasted?
- Has the animal been well?
- Does the owner understand what is going to happen?
Pre-operative exam

- Who is responsible?
- What is involved a pre-op exam?
Anything else before drug administration?
Blood collection?
Fluids?
Catheterisation?
The basics
Local Anaesthesia
Infiltration
Regional nerve block
Epidural

Why?
General Anaesthesia

State of unconsciousness together with a loss of sensation over the entire body

How do you achieve general anaesthesia?
What is a premedicant?
Why premedicate?
What is an induction agent?
- a sedative (ACP, medetomidine, xylazine)

- an analgesic (methadone, morphine, buprenorphine, butorphanol)

- atropine?
decrease stress

facilitate handling

pre-emptive pain relief

lower induction agent requirement
Alfaxan
Propofol
Thiopentone
Ketamine
Isoflurane/Sevoflurane
Keep monitoring!
Extubation - Swallowing
Oxygen
Temperature
Environment - warm, quiet
What else?
Thorough Pre-Anaesthetic Evaluation
Procedure
Age
Breed
Sex
Previous Anaesthetic History
Physical Exam
Tailored premedicant and Anaesthetic Dosing
A drug that is given prior to an anesthetic
What is Alfaxan?
An injectable intravenous anaesthetic agent - suitable for both induction and maintenance

Registered for dogs and cats

A steroid compound like progesterone

Acts centrally in the brain and spinal cord to produce anaesthesia
How do we decide what to use?
Induction (with premedication)
- dogs draw up 2mg/kg or 0.2ml/kg
- cats draw up 5mg/kg or 0.5ml/kg

Administer SLOWLY!
- Give 1/4 every 15 seconds

Maintenance
Dogs 6-7 mg/kg/hr
Cats 7-8mg/kg/hr
How does ALFAXAN compare to other anaesthetics?
Alfaxan vs Propofol

Superior safety margin - up to 20mg/kg
Less cardiac depression
Less apnoea and respiratory depression
Non-painful IV administration
Longer storage - 7 days in the fridge
Alfaxan vs Ketamine

Better muscle relaxation
Safer in kidney and liver patients
Can be used in epileptic patients
Better cardiovascular stability - does not
sensitise myocardium
Clear headed recovery
Ketamine is an S8
Alfaxan vs Thiopentone

Better Cardiovascular and respiratory function
No risk of extra-vascular damage
No hangover
Can be used in sighthounds
Safety
Safety margin up to 20mg/kg in dogs and 25mg/kg in cats

Minimal Cardiovascular side effects, at normal doses

No direct effect on the heart muscle

At normal doses no significant effect on cardiac output, blood pressure, SpO2

Clear-headed recoveries

No accumulation
Close anaesthetic monitoring
How is Alfaxan used?
What makes Alfaxan different?
Liver Failure?

Metabolised by the liver, but very severe liver failure required before rate of metabolism is decreased
Renal Failure?
Mostly hepatic metabolism, so Alfaxan clearence wont be delayed
Young animals?

Yes - about the same induction dose rates as for adults.
Anaesthetic of choice for the RSPCA

Think about the effects of premeds
Caesarians?

Yes - steroid anaesthetic and metabolic pathways of foetuses are developed.

No significant difference in puppy survival in a multiclinic trial.
Sight Hounds?

Yes -
no accumulation in the body and rapid metabolism
What is the best premed to use?
All premeds are safe to use with Alfaxan, however benzodiazepenes like Diazepam have been found to not provide enough sedation when used alone
WHAT DOES IT MEAN TO monitor anaesthesia?
Without machines
Anaesthetic Depth
eye position

jaw tone - puppies & kittens?

palpebral reflex

withdrawal reflex
Respiratory rate & depth
Heart Rate & Rhythm
Mucous membrane colour
Capillary refil time
Body Temperature
Blood pressure?
With machines

Electrocardiography (ECG)

Blood pressure

Pulse oximetry

Capnography


Blood gas analysis?
Remember.....

The induction agent is only one component of the anaesthetic process

Other factors such as the effects of premeds, concurrent disease, age and breed all affect anaesthesia as a whole, and may also impact on induction doses
Dr. Scott Cumming BVSc (Hons) MCom

Jurox Companion Animal Product Manager
Preparation is the key!
Safety

Consistency

Minimal Undesirable Effects
Early is better

Look for trends
Respiration
- rate
- depth
Mucous membranes
- colour
-refill time
Heart
- rate and rhythm
Temperature
Blood pressure?
a
s
k
What does the patient tell you & what does it mean?
(And what is your role?)
Why?
The person monitoring can be the difference
Other types of anaesthesia?
Local Anaesthesia

Analgesia

What do you do with all of these numbers?
Why premedicate?
1. Tranquilisation
2. Pre-emptive pain relief
Examples?
Analgesia
- almost always needed in the post op period
- pain is 'plastic'!
- combinations
- top up
- opioids vs NSAIDs vs other
- "It had a premed, we can't give any more"
Induction
Premedication
Maintenance
Recovery
Pre-operative assessment
Full transcript