Premed/sedation options in an aggressive poss CRF cat :/

Re: Premed/sedation options in an aggressive poss CRF cat :/

Mark Holmes — Tue, 19 Feb 2013 22:53:07 GMT

Dom/Torb no problems I used DTK in a 16 year old hyperthyroid gd 4 heart murmur just today. No problems at all and never have had. (12 years) I also don't find veins a problem either. I routinely give the K part iv. Central perfusion increases on medetomidine. It has to - if it leaves the periphery where else is it going to go? I used to spend a lot of time calculating the pros and cons of various ga protocols much less worried these days. I have seen many more cats die as consequence of handling than Dom/torb

Re: Premed/sedation options in an aggressive poss CRF cat :/

Clive Ansell — Tue, 19 Feb 2013 19:36:30 GMT

I had one very similar today; aggressive old cat for a blood sample. couldn't get anywhere near the damn thing, so crush cage and 0.1ml each Dom/Torb. Able to get sample and give s/c fluids, no point giving iv as would have needed repeat sedation to get off drip.

I don't know why some folk frown on the use of Domitor and s/c fluids, worked just fine today in a patient that isn't handleable.

Re: Premed/sedation options in an aggressive poss CRF cat :/

Kirsten Simpson — Tue, 19 Feb 2013 16:19:12 GMT

Cheers peeps! Cat was looking better than when I last saw it (gained some weight as eating better due to antirobe). Still v aggressive so went for 0.1ml Dom and 0.1ml torb im. Good sedation but still a bit with it, managed to get bloods easily and place IV in cephalon no prob. Had on fluids at surgical rates and did dental which wasn't too bad! He's up and about and really bright and happy now and has already eaten some food :) all good!

Re: Premed/sedation options in an aggressive poss CRF cat :/

Robin Grimmer — Tue, 19 Feb 2013 13:04:15 GMT

I would avoid Domitor. 0.25mg/kg diazepam and 7.5mg/kg ketamine i/m usually works well enough to enable i/v access.

As you will have to remove the iv catheter before the cat wakes up, you could give some addtional s/c fluids.

Re: Premed/sedation options in an aggressive poss CRF cat :/

Jo Cobbett — Tue, 19 Feb 2013 12:43:21 GMT

[quote user="Gillian Mostyn"]

I doubt you'd have much trouble taking a decent jugular sample - if you drop the head in a skinny cat it usually becomes very obvious.

[/quote]

I agree, with medetomidine sedated cats, I often hold them on their backs with their head over the edge of the table, the vein comes up beautifully.

Re: Premed/sedation options in an aggressive poss CRF cat :/

Gillian Mostyn — Tue, 19 Feb 2013 12:39:26 GMT

I doubt you'd have much trouble taking a decent jugular sample - if you drop the head in a skinny cat it usually becomes very obvious. But I guess I never use anything other than jugular for sampling in cats and most dogs. I use an external lab so need about at least 2ml blood - it would take too long to draw it through a cephalic.

Re: Premed/sedation options in an aggressive poss CRF cat :/

James Laidlaw — Tue, 19 Feb 2013 10:32:16 GMT

Also, making a small incision in the skin and "cutting down" to access a vein in a difficult IV can help too. Just enough of a nick in the skin to avoid having to push the catheter through can be really helpful.

Re: Premed/sedation options in an aggressive poss CRF cat :/

Utlendigur — Tue, 19 Feb 2013 10:20:13 GMT

In old cats that are really extreme to handle I've sometimes used medetomidine - usually at reduced dose - (+ vetergesic or torb) IM, plus ketamine, then reversed the medetomidine as soon as the cat is on iso, so that it's only having 5-10min with the full effect of the medetomidine. Obviously by reversing it you lose the analgesic effect of the medetomidine aswell but with an opioid plus ketamine on board it seems ok. I'd rather do that than struggle with a fragile elderly cat and risk over-restraint or giving too much IV prop because it's thrashing around. Another option with the fluids might be to run in some s/c along with the iv, given that it sounds like it might only get a short period on iv fluids. Good luck - sounds like my old cat (ps buying cake for the nurses also helps otherwise you might not have any help)

Re: Premed/sedation options in an aggressive poss CRF cat :/

Martin Atkinson — Tue, 19 Feb 2013 09:29:31 GMT

I would have no worries with medetomidine in a triple combo, as pointed out, although they can look horribly pale this is superficial and central pressure is maintained, plus of course you can reverse when desired and getting it knocked out with minimal stress and risk of injury to staff for essential dental work outweighs the risks of the sedation. If I could access a vein I'd give IVFT while it was out if there is evidence of renal failure from blood tests but realistically how much are you going to get into the cat for the duration of a dental procedure given you want to wake it up ASAP? So I would also give it a 60-100ml bolus of fluid S/C.

Re: Premed/sedation options in an aggressive poss CRF cat :/

Yantha Smyth — Tue, 19 Feb 2013 08:31:57 GMT

Oh and I just remembered, I think in Australia that Alfaxan is used IM, but it would be off-licence use here...could be a very safe one for nasty cat, but totally useless suggestion for today unless you already stock it!!

Re: Premed/sedation options in an aggressive poss CRF cat :/

Yantha Smyth — Tue, 19 Feb 2013 08:28:36 GMT

Shame you have no midazolam! the problem with diazepam IM is that absorption is unreliable so you can have a poor quality sedation from the ket/diaz combo IM. I generally shy away from using medetomidine in anything other than a fit healthy animal (or pre-PTS!), but I suspect you could get away with a micro dose 0.05-0.1ml if you used that along with ketamine 0.05ml/kg and torb 0.04ml/kg- enough to get an IV and bloods and follow up with propofol to effect for intubation.

Years ago in my first practice ket/val was our routine induction combo, and since ketamine works by any route- for nasty cats that we couldnt get near we would not even try to get out of cage into crush cage etc if that would make them really stressed, and instead squirt the ketamine through the bars of the cage in time with a hiss from the cat! For those doses 0.1ml/kg was used, but by injection 0.05ml/kg was used. With the higher doses the recovery would be prolonged if renal disease.

Good luck!

Re: Premed/sedation options in an aggressive poss CRF cat :/

Louise6732 — Tue, 19 Feb 2013 07:18:49 GMT

I agree that midaz (or diazepam) and ketamine never gives great sedation, especially if given IM. But it is likely to be enough to either get an IV in to give some Propofol, or if you have the option, you can gas the cat down when it's a bit more subdued with midaz/ket.

I agree with David, I find cephallic veins are still visible in the majority of elderly cats that have been sedated with medetomidine, I use medetomidine + butorphanol + ACP to sedate cats before PTS and can always find a vein, it doesn't always raise up but you can see it through the skin!

Good luck, and it sounds like this is the best thing for the cat if it has a sore manky mouth! Too many owners shy away from sorting dental issues when cats are older!

Louise

Re: Premed/sedation options in an aggressive poss CRF cat :/

David Mills — Tue, 19 Feb 2013 00:20:00 GMT

I wouldn't worry too much about using medetomidine in cases like this. It preserves central pressures meaning kidney perfusion is no more affected than with other agents. It will also give excellent sedation. I worry far more about ketamine in stressed cats as high sympathetic tone will cause elevation of HR in combo with ket, and it can be cardiotoxic. There is no evidence that pre-op ivft increases GA safety unless reversing hypovolaemia/dehydration - this does not apply to all CRF cats.

Don't worry about medetomidine collapsing veins - if its an old cat it'll likely have skinny legs so it'll be easy. If the cepahlics aren't much cop the medial saphenous is a great route, and in my experience, always visible even with medetomidine.

If you want him on fluids beforehand then medetomidine to sedate for bloods and ivft then reverse is also acceptable - then you have IV access so can give him something milder like ACP/vet followed by propofol.

For an old cat I'd generally use about 0.15ml dom / 0.2ml torb per 3-4kg depending on how stressed the animal is (SNS activation can counteract alpha 2s). Note this dose level applies to 'normal' medetomidine and dexmedetomidine, whichever you have on the shelf.