Quad protocol

RE: Quad protocol

Rob Davis — Tue, 07 May 2019 15:12:07 GMT

[quote user="bob lehner"]Cascade is subject to a fairly close scrutiny by PSS- e.g. checking that veterinary licensed products are used where available, rather than human alternatives; owners give informed consent via Cascade Consent Forms; owners given adequate information about the product/potential side effects etc. - e.g.by use of the BSAVA/BEVA Client Information Sheets for Cascade products and some specific labelling requirements for cascade products.[/quote]

So what about practices using Quad protocol?

RE: Quad protocol

bob lehner — Fri, 03 May 2019 09:35:21 GMT

[quote user="Michael Woodhouse"]

bob lehner do you still inspect for the PSS? How do you handle routine off licence drug use when assessing practices?

[/quote]

Cascade is subject to a fairly close scrutiny by PSS- e.g. checking that veterinary licensed products are used where available, rather than human alternatives; owners give informed consent via Cascade Consent Forms; owners given adequate information about the product/potential side effects etc. - e.g.by use of the BSAVA/BEVA Client Information Sheets for Cascade products and some specific labelling requirements for cascade products.

RE: Quad protocol

Dinu Catilina — Thu, 02 May 2019 23:07:05 GMT

[quote user="David Mills"]We've been recently looking into IM anaesthesia for dogs, does anyone have some tried and tested protocols for these?[/quote]

I used xylazine/ketamine or medetomidine/ketamine in dogs in Romania for everything from spays to fracture repairs. It worked fine but we had no monitoring equipment so no idea on blood pressure, heart rates, etc. I don't remember any issues other that frequent vomiting after xylazine.

RE: Quad protocol

Michael Woodhouse — Thu, 02 May 2019 11:49:37 GMT

bob lehner do you still inspect for the PSS? How do you handle routine off licence drug use when assessing practices?

RE: Quad protocol

Michael Woodhouse — Thu, 02 May 2019 11:47:59 GMT

[quote user="Clive Ansell"]Given there is not a licenced version available, I cannot see an issue using the human generic.[/quote]

Dechra just launched Dormazolam. Only licenced in horses but you'd have to use that rather than the human drug.

[quote user="Clive Ansell"]The biggest stumbling block I find is that many practices seem to get edgy about the use of Midazolam and the cascade, many don't even stock it.[/quote]

Exactly. Remember the cascade isn't for fun we can only use it to prevent unacceptable suffering where a suitable product doesn't exist. We all know that there are many suitable anaesthetic protocols for cats that use UK licenced products. We really don't 'need' midazolam, even though I agree it seems a nice protocol.

I have said many times - we should either do away with the cascade completely and let it be a free for all, or start getting tough on enforcement. The current situation is ridiculous.

RE: Quad protocol

Clive Ansell — Thu, 02 May 2019 10:02:45 GMT

I use the Quad protocol a lot, 2 of my regular practices do lots of CPL early neuters. I've used in in many older stroppy cats for things like dentals or mass removals; where getting an iv access is difficuly because of their temperament. Tend to use Methadone in preference to Buph. No issues whatsoever, and would happily use more often.

The biggest stumbling block I find is that many practices seem to get edgy about the use of Midazolam and the cascade, many don't even stock it. Given there is not a licenced version available, I cannot see an issue using the human generic.

I've used i/m triple in dogs a lot, certainly aggressive dogs.

RE: Quad protocol

David Mills — Thu, 02 May 2019 09:42:36 GMT

[quote user="Jo Murrell"]

I agree that the QUAD was designed for kittens and its a good question about whether to switch to QUAD for all neutering. I think that medetomidine / ketamine and an opioid is good for adult cats and gets away from midazolam being unlicensed - although i would switch your opioid to methadone on med / ket combo as you are likely to get better analgesia compared to butorphanol. We also found that we needed to add in isoflurane to the QUAD for the older population of cats used in our study - whereas with the triple combo you are likely to just need the injectable drugs which is advantageous - although its still good practice to intubate and provide oxygen to cats on the triple combination.

[/quote]

I've used the quad on adults for years, in various hospitals, and it is our current protocol for all cats. For routine procedures, we rarely need iso, I would estimate in 1-2pc of cases, and we're doing around 50 surgeries/investigations a week on cats. I've recently done a leg amp in an adult and not required any iso. For longer procedures, we find iso is required about 45-60 minutes into the procedure, I suspect from the combination beginning to wear off slightly. Even for traumatic surgery, such as fracture repairs, iso requirements are low, about 1pc, and it is not uncommon to only require this after 45mins.

The main issues are with nurses adapting to the different ga conditions (fixed eyes, generally shallow breaths) and avoiding the perpetual temptation to use iso or reverse the medetomidine. Recoveries can occasionally be spacey, but they're generally far more rapid and smooth than propofol.

We've been recently looking into IM anaesthesia for dogs, does anyone have some tried and tested protocols for these?

RE: Quad protocol

paolovet — Wed, 01 May 2019 12:47:45 GMT

We usually use Dex 10-20 mcg/Kg + Ketamine 3 mg/Kg and methadone 0.2-0.3 mg/Kg, obviously we also intubate and supply o2 in mapleson f circuit. iso 1% if surgery needs to be prolonged. Meloxicam 0.2 mg/kg in post op. We use midazolam + btf in premed in cats with restrictive cardiomyopathy. thanks

RE: Quad protocol

Kate Dawes — Wed, 01 May 2019 11:24:11 GMT

Thanks Jo,

We currently use a low dose triple (the iv dose) given i/m, intubate, then top up with iso as necessary.

Current doses are ketamine 2.5mg/kg, medetomidine 40ug/kg and torbugesic 0.1mg/kg.

If we were to replace torbugesic with methadone what dose would you advise?

In general is the BSA dosing used for QUAD advantageous or is the advantage of that less significant in the larger adult cats?

We regularly use midazolam in other sedative regimes where appropriate, so not too worried about the lack of license if we can justify it's use.

Also interested to hear from others if practices are now using the QUAD routinely for all neuters?

Thanks

RE: Quad protocol

Jo Murrell — Wed, 01 May 2019 09:31:00 GMT