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Topic included:
Analgesia
Intravenous Anaesthesia
Inhalation Anaesthesia
Local Anaesthesia
To provide immobility of the patient and when required relaxation of the skeletal muscles
To achieve the above without jeopardising the safety of the animal during the operation
Methods of anaesthesia:
1) General anaesthesia - reversible CNS depression which prevent pain sensation and loss of consciousness (usually by administration of narcotic drug all
anaesthetic are narcotic but not all narcotic are anaesthetic drug)
Infiltration and regional block analgesia (injection into the operation site)
Anaesthetic risk:
Class I : normal healthy patient
Class II: Mild systemic disease
Class III: Severe systemic disease which is not incapacitating
Class IV: Severe systemic disease which is constant threat to life
Class V: Moribund patient not expected to survive for 24 hour with or without operation
History
Clinical Examination
i. Concurrent drug therapy:
i. Inspection
Significance of findings
i. Respiratory disease
Restricted airway
iv. Auscultation
Monitoring
i. A, B, C, must be maintained at all times (min heart rate 60/min min respiratory rate 8/min)
ii. Mucous membrane - CRT < 2 sec (pale mucus membrane: anaemia/blood loss/poor perfusion)
iii. Temperature
Anaesthesia
Analgesia
Recognise acute pain: vocalisation & guarding behaviour when moved or touched, aggressive or self- mutilation
Recognise chronic pain: lameness, stiffness or recumbent + mild deviation form normal behaviour patterns
Use of analgesic:
Analgesia + respiratory depression + sedation or excitement + nausea, vomiting & defecation + depression of cough reflex + tolerance & dependence after prolonged use
Side effects of morphine: vomiting, respiratory (panting) & cardiovascular depression & bradycardia & increases intracranial pressure
Morphine is contraindicated in treating pain associated with pancreatitis or biliary obstruction due to spasm produced in gut sphincters
Pethidine has rapid onset but shorter duration when compared to morphine & no vomiting & defecation
NSAID is not for severe pain but effective in chronic pain associated with orthopaedic diseases
Indication of analgesia:
Pre-operative (alleviate pain prior to surgery, enhance sedation & reduce amount of anaesthetic agent used)
Post-operative (esp. opioids for severe pain caused by thoracic, orthopaedic, aural & abdominal surgery)
dog
3 -4 m g /k g IM
2 -3 h o u rs
p a r t ia l o p io id a g o in is t
M o r p h in e
( fo r s e v e r e p a in s )
a s a n a lg e s ia &
p r e m e d ic a t io n
cat
5 m g /k g
2 h o u rs
dog
0 .1 -0 .2 5 m g /k g IM
4 - 5 h o u r s d u r a tio n
b u p r e n o r p h in e
( T e m g e s ic )
0 .0 1 5 m g /k g
4 h o u r s d u r a t io n
cat
0 .1 -0 .2 m g /k g
IM /S C
6 - 8 h o u r s d u r a t io n
b u to rp h a n o l
( T o r b u g e s ic )
0 .2 -0 .8 m g /k g
3 h o u r s d u r a t io n
o p io id a n t a g o n is t
N a lo x o n e
(N a rc a n )
D ip r e n o r p h in e
( S A R e v iv o n )
N S A ID S
M is c e lla n e o u s
p h e n y lb u ta z o n e
k e ta m in e
A s p ir in
M e t h o x y flu r a n e
M e fe n a m ic a c id
(p o n s ta n )
N it r o u s o x id e
F lu n ix in
x y la z in e
P ir o x ic a m
Anaesthesia
Premedication and Sedation
Premedication
Aims:
Others:
Glycopyrrolate
Hyoscine
Sedation
Simple definition:
Tranquilliser - relieves anxiety, tension without drowsiness
Sedative - calms the patient but causes drowsiness
Hypnotic - will induce sleep from which it is possible to
arouse the patient
Markedly reduce dose required for subsequent anaesthetic but delay onset of induction
of IV or inhalation anaesthetic
Vomiting on induction
Inhibit insulin release (causing hyperglyacemia) & decrease in ADH (causing diuresis)
Contraindication:
Dehydated animal
Medetomidine (Domitor )
ACP/ buprenorphine IM
Anaesthesia
Intravenous anaesthesia
Indication:
Simple
Rapid onset
No apparatus needed
No explosion/pollution hazard
Poor analgesia
Slow recovery
Hypothermia is common in
prolonged recovery
Effect or barbiturates:
Cardiac arrhythmia
Hypotension
Classes of drug:
1) Barbiturates
2) Steroids
3) Dissociative agents
4) Propofol
5) Neurolepanaesthetics
Disadvantage
No hormonal effect
Metabolised by liver
Dissociative Agents
Ketamine (duration-30mins)
Onset slow
Metabolized by liver
Rapid onset
Respiratory depression
Neuroleptanaesthetic
Ease of administration
Anaesthesia
Inhalation Anaesthesia
Gas
Diethyl ether (inflammable & explosive in oxygen, decompose by light, air & heat,
muscle relaxation, nausea & vomiting during post-anaesthetic period)
Isoflurane (expensive & least toxic, stabilise cardiac rhythm & dose not sensitise the
to adrenaline, less potent cardiac depressant than halothane, indicated in cardiac
condition, causes respiratory depression)
Semi-close method
Use of anaesthetic machine & an anaesthetic circuit
No CO2 absorption & fresh gas must be used to eliminate the CO2 from
the circuit
4 main types of circuit
Oxygen
good
Semi-closed method
Closed Method
heart
Closed method
Use of anaesthetic machine & an anaesthetic circuit
Incorporated soda lime to absorb the exhaled CO2 thus don't require
high flow rate to remove CO2 (more economical)
Not for animal < 10 kg (resistance to respiration provided by the
soda lime)
Soda lime = 95% CaOH + 5% NaOH + 1% KOH
Economy, less risk of explosion, conserve heat & moisture & less
pollution of atmosphere
e.g.: Circle system
Very economical
To-and-Fro system
Reproductive failure
Liver damage
Kidney damage
Anaesthesia
Anaesthetic circuit (review JAMVA)
Intermittent positive pressure ventilation (IPPV)
Therefore, essential to ensure the blood volume is within normal limits before using IPPV
Local anaesthesia:
Ways to produce local anaesthesia
Surface
Local infiltration
Regional
IV regional
analgesia
limbs
Most local analgesic drugs (except cocaine) cause vasodilation and increase in blood supply, both limits the action of the analgesic & increase systemic
toxicity by increasing the speed of absorption
However, it may also cause ischaemic damage, hair may change colour after intradermal/SC injection
Lignocaine:
Anti-arrhythmic
Anaesthesia
Anaesthesia for Geriatrics and Neonates: (pre-anaesthetic database is important)
Obese
Definition
PathophysioLogical
consideration
Guidelines
Premedication
Induction
Pre-oxygenation is advantageous
Don't use mask induction
Most practical = thiopentone to effect
Rapid intubation & transfer to
inhalation anaesthesia
Geriatrics
10 years dogs, 12 years for cats
Pediatrics
< 12 weeks of age
Maintenance
Recovery
given if needed
Antagonist should be administered if
necessary
Pethidine at 2 - 3 mg/kg IM, 2 - 3 hours
analgesia
Recovery is slower due to decreased renal
& hepatic function & hypothermia
Anaesthesia
Various Stages of Anaesthesia
Stage
Behaviour
Respiration
Cardiovascular
function
Response to
surgery
Depth
Eyeball position
Pupil size
Pupil response
Muscle tone
Reflex response
Disorientated
Normal rate 20
-30 breaths/min,
may be panting
Heart rate
unchanged
Struggle
Not
anaesthetised
Central
Normal
Present
Good
All present
II
Excitement
Struggling
Vocalisation
Paddling
Chewing
Yawning
Regular, may
hold breath or
hyperventilate
Struggle
Not
anaesthetised
Central, may be
nystagmus
May be dilated
Present
Good
Regular rate 12
-20 breaths/min
Strong pulse
rate, heart rate
90 beats/min
May response
with movements
Light
Central or
rotated, may be
nystagmus
Normal
Present
Good
Swallowing
reflex is poor or
absent, others are
present but
diminished
Regular rate
(may be
shallow) 12-16
breaths/min
Moderate
Often rotated
ventrally
Slightly dilated
Sluggish
Relaxed
Patellar, ear
flick, palpebral
& corneal
reflexes may be
present, others
are absent
III
Plane
3
Shallow rate
less than 16
breaths/min
None
Deep
Usually central,
may be rotated
ventrally
Moderately
dilated
Very sluggish
and may be
absent
Greatly reduced
III
Plane
4
Jerky
None
Over-dose
Central
Widely dilated
Unresponsive
Flaccid
No reflex
activity
Apnoea
CVS collapse
None
Dying
Central
Widely dilated
Unresponsive
Flaccid
No reflex
activity
III
Plane
1
III
Plane
2
IV
Anaesthetised
Moribund
Anaesthesia
Common Anaesthesia Procedure
Checklist:
1) Atropine sulphate 0.65 mg/ml 0.05 mg/kg subcutaneous injection
2) ACP 1 mg/ml 0.1 mg/kg subcutaneous injection
3) Syringe 2 or 5ml
4) Needle 23G or 25G (18G = Pink, 21G = Blue, 23G = Green, 25G = Brown, 26G = Orange)
5) Cotton + alcohol
6) Thiopentone 60 mg/ml (6%) 30 mg/kg intravenous infusion (25-30mg/kg)
7) Syringe 5ml
8) Needle 23G or 25G
9) Shaving blade (clipper)
10) Cotton + alcohol
11) Endotracheal tube size
12) Lubricant (KY jelly) on a piece of tissue paper
13) Gauze 15-30cm long to secure the E-T tube
14) Laryngoscope blade size
15) Eye ointment
1)
Oxygen tank & anaesthetic tank with pressure valves to keep at 40-60psi
Flow meter
Vapourizer
Reservoir bag (rebreathing bag - to regulate rate of filling/deflation, used to apply IPPV)
Connecting tubing
Inspiratory/expiratory valves
Endotracheal tube
Induction using inhalation agent:
Induction = from first breath of anaesthetic to Stage III
1)
2)
3)
4)
1)
2)
3)
airway obstruction
thoraxic pain
Solution:
doxapram 1 - 2mg/kg if given injectable anaesthetic agent or 5 - 10mg/kg if given inhalation agent
Pain assessment
Hx
PE
Vocalisation
Response to analgesia
Distress scoring
C/s TPR
Provoked behaviour
Pain management