Preanasthetic and sedative protocols..?

RE: Preanasthetic and sedative protocols..?

Catriona MacIntyre — Thu, 05 Nov 2015 18:54:33 GMT

[quote user="Luca Poddighe"]

[quote user="Catriona MacIntyre"] There's a very easy to use mobile phone app for quick dose calculations "Kitten Quad"[/quote]

I assume the doses you get are IM. Am I correct?

[/quote]

Yes Luca

I haven't used it all that often but one of my assistant uses it regularly and we both like it.

The last feral cat colony neutering I did involved 17 cats, the majority of whom were 4 months or less. I used a combination of xylazine and ketamine with good results, but I think I would use this for the tiniest ones now

RE: Preanasthetic and sedative protocols..?

Anthony Dennison — Thu, 05 Nov 2015 11:57:02 GMT

There's a very good article by Jo Murrell in an older issue of In Practice that lists the pro's and con's of all pre-meds, including what to use for different ASA scales.

RE: Preanasthetic and sedative protocols..?

Luca Poddighe — Thu, 05 Nov 2015 11:49:27 GMT

[quote user="Catriona MacIntyre"] There's a very easy to use mobile phone app for quick dose calculations "Kitten Quad"[/quote]

I assume the doses you get are IM. Am I correct?

RE: Preanasthetic and sedative protocols..?

Danny cazabon — Wed, 04 Nov 2015 22:07:54 GMT

Thanks for that, something new to try

RE: Preanasthetic and sedative protocols..?

Catriona MacIntyre — Wed, 04 Nov 2015 15:50:31 GMT

[quote user="Danielle Dillon"]

Whilst on this topic, what protocols do you find safest in compromised patients. Today I used Buprenorphine and diazapam for CHF patient. Any better ideas?

[/quote]

I like combining diazepam or midazolam with ketamine in debilitated cats. Can't remember the dose rate off hand, but it works out something like 0.2ml each.

There is also a protocol I find very good for early neuterings, especially stray kittens. http://www.langfordvets.co.uk/sites/default/files/Neutering%20article%20revised%20300413.pdf

It combines tiny doses of medetomidine, ketamine, midazolam and either buprenorphine or methadone. There's a very easy to use mobile phone app for quick dose calculations "Kitten Quad"

RE: Preanasthetic and sedative protocols..?

Mark Hedberg — Wed, 04 Nov 2015 08:38:42 GMT

[quote user="Seadna "]

I'm sure you remember being a bottom-rung assistant with no pull over drug purchasing

[/quote]

I do indeed and tip my hat, great point :)

RE: Preanasthetic and sedative protocols..?

Braden Collins — Wed, 04 Nov 2015 04:57:21 GMT

My standart protocol is ACP at 0.02-0.05mg/kg plus methadone 0.2-0.4mg/kg IM as a premed. Induction is diazepam/ketamine IV. I loke this combo becasie it can be given as a rapid bolus, maintains BP well, provides good analgesia and as a bonus is cheap.

RE: Preanasthetic and sedative protocols..?

Danny cazabon — Tue, 03 Nov 2015 23:13:57 GMT

Whilst on this topic, what protocols do you find safest in compromised patients. Today I used Buprenorphine and diazapam for CHF patient. Any better ideas?

RE: Preanasthetic and sedative protocols..?

Seadna — Tue, 03 Nov 2015 19:34:04 GMT

Thank you John Flynn, this is just the sort of insight I was hoping for!

RE: Preanasthetic and sedative protocols..?

Mark Hedberg — Tue, 03 Nov 2015 08:40:57 GMT

[quote user="mariette asselbergs"]

I use it for surgery cases in shock (GDV for eample). First midazolam or diazepam iv, followed by ketamine until you can intubate. Means a high dose up to 10 mg/kg, but very safe and keeps cardiac output going. Not for nothing was (is?) this the field anaesthetic for war trauma. I myself have been operated on three times with this combination years back in Mozambique, and it was a perfectly good experience.

[/quote]

I'm going to remember this one!

RE: Preanasthetic and sedative protocols..?

mariette asselbergs — Mon, 02 Nov 2015 22:56:23 GMT

RE: Preanasthetic and sedative protocols..?

John Flynn — Mon, 02 Nov 2015 20:10:43 GMT

[quote user="Seadna "]The bottle of ket (an excellent analgesic I believe) is just sitting there, I would like to know how to use it to the advantage of the bitch on the table.[/quote]

If it was me, then probably just 1mg/kg ketamine intramuscular just after induction (won't sting that way) - should be having its effect by time tugging ovaries - monitor depth of anesthesia more carefully after any change in protocol like this until you get used to it, might need 0.25% less on average bitch spay of isoflurane.

IV is quicker to take effect, bit more predictable, but will also wear off quicker... If doing iv, then you have 2 options:

1) Give an iv dose either pre- or post- induction. Dose suggestion I would give would be a conservative 0.5mg/kg, but if you found this wasn't benefitting you or wanted to try higher, then I think up to 2mg/kg would be fine for the ketamine iv but perhaps best to give it iv first and wait a minute or so for some effect before continuing with propofol induction to effect.

2) Go "ketofol" by mixing your propofol and ketamine together in the same syringe and then injecting iv to effect much the same as you use your propofol to-date. If doing this then traditionally, equal mg/kg doses of both are mixed together (e.g. 2mg/kg propofol and 2mg/kg ketamine in same syringe) and then induce to effect, though there are some suggestions that this ain't the best ratio to consider (e.g. http://docsdrive.com/pdfs/medwelljournals/javaa/2015/119-124.pdf would suggest that a ratio of propofol to ketamine of 4:1 might be preferable). You're likely to waste more ketamine this way, but save on propofol potentially.

RE: Preanasthetic and sedative protocols..?

Seadna — Sat, 31 Oct 2015 19:38:49 GMT

[quote user="Mark Hedberg"]You can get generic medetomidine these days - so it no longer has to cost the earth. Also, pethidine alone isn't really idea in terms of pain control:[/quote]

Thanks for the info but I'm interested in modifying the protocol I have as opposed to changing it outright. I'm sure you remember being a bottom-rung assistant with no pull over drug purchasing The bottle of ket (an excellent analgesic I believe) is just sitting there, I would like to know how to use it to the advantage of the bitch on the table.

RE: Preanasthetic and sedative protocols..?

John Flynn — Thu, 29 Oct 2015 19:29:50 GMT

[quote user="Clive Ansell"]Medetomidine (Domitor) 0.1ml/10kg and Methadone (Comfortan) 0.33/10kg in dogs. I really like it as it seems to provide reliable sedation and is a good pre-med giving smooth and stable anaesthetics with gentle recoveries.[/quote]

I would have thought would have had more post-induction apnoea (a pain for me as I generally have average procedure on spontaneous breathing) and unnervingly low heart rates with a high-dose of medetomidine combined with methadone in a non-painful elective patient such as a neuter?

I probably prefer ACP overall, but do use medetomidine, but typically at lower doses.

On a separate note, I tend to use midazolam as part of "premed" in pretty much any patient. Advantages I imagine:

probable improved amnesia
possible reduction in fear
reduction in other agents with more cardiorespiratory compromising effects
reversible (if required)

RE: Preanasthetic and sedative protocols..?

Glenn Hodgson — Thu, 29 Oct 2015 18:59:45 GMT

0.1ml acp, 0.05ml dormitor, 0.6ml vetergesic... Per 10kg.

Double acp if lively, half if boxer, bulldog.

This serves us well for routines. Tried replacing vetergesic with comfortan and anecdotally not as stable GA s, nurses did not like at all.

RE: Preanasthetic and sedative protocols..?

Clive Ansell — Thu, 29 Oct 2015 16:42:31 GMT

I am having a run in my current locum of using Medetomidine (Domitor) 0.1ml/10kg and Methadone (Comfortan) 0.33/10kg in dogs. I really like it as it seems to provide reliable sedation and is a good pre-med giving smooth and stable anaesthetics with gentle recoveries. I no longer see the need to use Butorphanol or Buphrenorphine really. In addition, if a painful procedure or a patient shows signs of pain post operatively further Methadone can be given.

The RVN's like it too. They report ga's are more stable with less fluctuation in heart and respiratory rates, and that the vapouriser setting is typically 1 to 1.5 less than with previously used Buphrenorphine pre-meds.

RE: Preanasthetic and sedative protocols..?

Mark Hedberg — Thu, 29 Oct 2015 10:23:25 GMT

[quote user="Seadna "]

[quote user="DazMV"]Regarding ketamine, I use ketamine in the vast majority of animals unless theres a contraindication. I use it at 1mg/kg as adjunctive analgesia, and also that same dose intraoperatively in routine OVH if they are panting when tugging on ovarian pedicles[/quote]

Hi Dazmv, I know this is an old thread but I was hoping you (or someone) could let me know if this Ket dosage is IV? I am working in a clinic that uses ACP Pethidine as premed and I'm interested in adding an extra (relatively cheap) analgetic to my routine surgeries.

[/quote]

You can get generic medetomidine these days - so it no longer has to cost the earth. Also, pethidine alone isn't really idea in terms of pain control:

http://veterinaryrecord.bmj.com/content/148/14/441.abstract

[quote]

Abstract

Thirty bitches undergoing routine neutering were used in an assessor-blinded trial of the postoperative analgesic effects of pethidine and carprofen administered either together or singly. The level of analgesia was assessed by visual analogue scale (VAS) scores for pain and sedation and by nociceptive mechanical threshold testing. The two drugs administered together, and carprofen alone, provided good postoperative analgesia as assessed by vAs scoring. Pethidine alone did not provide postoperative analgesia of sufficient duration.[/quote]

RE: Preanasthetic and sedative protocols..?

Seadna — Thu, 29 Oct 2015 10:12:37 GMT

Re: Preanasthetic and sedative protocols..?

Darren Long — Wed, 19 Mar 2014 23:43:16 GMT

Regarding ketamine, I use ketamine in the vast majority of animals unless theres a contraindication. I use it at 1mg/kg as adjunctive analgesia, and also that same dose intraoperatively in routine OVH if they are panting when tugging on ovarian pedicles and it works beautifully. They appear to wake up more smoothly too. Used at 1mg/kg i rarely see excitement in animals i use it in as its subanaesthetic, whilst providing profound analgesia.

For orthopaedic procedures as a premedication we will happily use low dose medetomidine at 0.001-0.002mg/kg or ACP (0.01-0.02mg/kg) with methadone (0.3mg/kg) and ketamine (1mg/kg)

Our routine neuterings most often get low dose acepromazine and methadone or buprenorphine

The last practice i worked in would rarely move away from medetomidine and butorphanol, and now i have access and freedom to use a wide variety of drugs, so I am lucky in that respect. It is certainly true, however that often the safest medications are those that you are most familiar with :)

Re: Preanasthetic and sedative protocols..?

Dan Pan — Wed, 19 Mar 2014 02:50:52 GMT

The good ol' TDK protocol is alright. Although I haven't seen ketamine in my city for awhile because of the drug abuse situation.

Re: Preanasthetic and sedative protocols..?

Mark Holmes — Wed, 12 Mar 2014 06:06:49 GMT

Ketamine is superb just use it iv at lower doses and don't be in a rush to reverse the sedation. I triple the odd dog as well if they are really aggressive. Provided you don't reverse them and wait for the fin to wear off they are fine

Re: Preanasthetic and sedative protocols..?

Moira Hamilton — Tue, 11 Mar 2014 23:48:09 GMT

For dogs I tend to use acp and buprenorphine, tend to go at 0.0125mg/kg and 0.066mg/kg respectively unless completely non painful when drop to 0.033, only very occasionally put acp at 0.025mg/kg. for cats quite often use the same unless is a bit of a scatty cat when use medetomidine and butorphenol at 0.08 and 0.04 respectively, do use this in dogs in emergency situations especially if not starved as it usually acts as an emetic and great for a quick reversal. Don't have access to anything else other than ketamine which I'm not a great fan of especially in cats. But I wholeheartedly agree with using what you're used to rather than experimenting. There are so many protocols out there, it's finding out what suits you best.

Re: Preanasthetic and sedative protocols..?

Rob Loxley — Tue, 11 Mar 2014 20:23:24 GMT

I like ACP, have lots of experience using it and know what to expect. Usually with buprenorphine or methadone, occasionally with butorphanol for sedation (Mike Martin has some good suggestions for sedation for cardiac cases).

However I will often go for other drugs - medetomidine/opiod or dom/torb/ket for cat castrates.

I'd agree the best thing is to have a few options, but to get to know them well

Re: Preanasthetic and sedative protocols..?

Jenny Smith — Tue, 11 Mar 2014 12:03:39 GMT

I hardly get to do 'nice' GAs any more, but for my sick ones I tend to go for a methadone pre-med (usually 0.2mg/kg but varies with pain level/how flat they already are) and then do a midazolam propofol co-induction.

For my few nice ones, usually wound management ones, I tend to go for bupe/meth (depending on how bouncy dog is/how painful I think they are) with medetomidine and then top up with propofol to intubate.

We don't stock ACP in the clinic, and to be honest, I don't really miss it!

Jenny

Re: Preanasthetic and sedative protocols..?

Stigen — Tue, 11 Mar 2014 10:57:44 GMT

Thanks, sounds like some really good protocols to look into. That website is very informative. The formulary is quite short in its description of these protocols, but I found some notes from an Anasthesia course I did at the royal college which are quite helpful.
I want to make sure the animals have sufficient analgesia as well for smaller procedures.