Small Animal Anesthesia Rounds

Case 1:
Dear Dr. Read,
I recently saw a cat patient with a bite wound and fever. His weight was close to 8 kg and
he was overweight (BCS 4.5 out of 5). I gave him 0.4mL Dexdomitor IM to take a blood
sample since the cat was angry and agitated. I waited 10 minutes but he did not go down
so I gave 0.2 mL more. The cat was sedated and I took a blood sample but it took him a
long time (more than half an hour) to recover even with giving half of the dose of the
reversal (0.3mL Atipamezole).
Another veterinarian that I work with thinks repeating the injection of some medications
like Dexdomitor or acepromazine is wrong even though the total dose that was given is
still within the published dose range. I think that titrating an overweight cat for sedation
is logical and that the total dose given is the important factor, not how many times it was
given. I understand that sick patients are generally not good candidates for Dexdomitor,
but since you can reverse it, I thought it would be the best option for this patient and that
the administration of some IV fluids would help with his recovery.
I would appreciate it if you would give your opinion regarding titrating or giving more
than one Dexdomitor or Acepromazine injection in any patient (even if the total dose is
still within the therapeutic range). I also wanted to know if lean body should be
considered in overweight cats, and what medication I should have given instead of
Dexdomitor?
!
Case 4:
Hi Dr. Read,
I hope you don't mind me asking some advice about a patient with HCM who
needs a tooth extraction. She has a grade 3/6 murmur and I heard some beat
irregularities during the exam. Her echo indicates mild anatomic changes
and the ECG showed an occasional VPC. This is new for her within the last
year and an echo done several years ago was normal despite a heart murmur
at that time. Current rads show no congestion. She is a 15-year old DLH
with essentially normal blood work.
I'm wondering about drug choices for anesthesia, what to watch for under
g/a and how to treat the problems that may arise. This may be impossible
questions for you to answer but any advice would be appreciated.
Case 5:
Hi Matt.
I have a case for you to consider.
This is an 11-year old miniature poodle with grade 3/4 dental disease. No heart murmur.
The challenge is that this dog has a chronic cough. The cough occurs with excitement,
exercise, or with cold ambient temperatures. They started the dog on theophylline eight
months ago and the dog has been on it ever since. There has been minimal to no
improvement with the theophylline. Further diagnostic tests or therapeutic trials have not
been tried. I think it is a collapsing trachea (+/- chronic bronchitis).
Thoughts?
Case 6:
Hi Matt,
I wanted to ask you about a Cairn Terr/8 yrs/MN coming in for a dental cleaning, with
evaluation of tooth 209.
There is a heart murmur present, grade 2/6 PMI left side. We did a heart radiograph with
the following comments: normal tracheal elevation, normal silhouette. No echo was done
due to financial constraints. Hepatomegaly was noted on the radiograph as well. On
blood work all values were within normal range except for the ALT - 91 (5-60 IU/L). We
followed up with a bile acid stim test, which came back normal. The owners are
concerned with the anesthetic and the heart murmur.
Any suggestions?
Case 7:
Hi Dr. Read,
Question for you:
Pug/11 yrs/MN coming in for extraction of his remaining canine teeth and a retained root.
There was a dental performed at another clinic last year. During this anesthetic (propofol
induction, isoflurane maintenance) the dog had developed and obvious arrhythmia and
bradycardia, and the ECG exhibited what appeared to be 2nd degree heart block. They
gave atropine IV which increased the HR and the rhythm became a normal sinus rhythm
(evidence of 2nd degree heart block vanished from ECG). The recovery was prolonged.
The blood work had values within normal range. Total T4 was normal. The owners are
concerned about this anesthetic and prolonged recovery.
Any suggestions would be welcome.
Case 10:
Hi Matt,
I have a quick question - the practice I'm at will mask dogs down that they consider "high
risk" (so any older animal or ones with heart conditions). I've never seen anyone mask a
dog down and always thought it was supposed to be a risky procedure. What is your
thought on that? They seem pretty cautious about the use of propofol or ket/val.
Thanks.
Case 12:
Hi Matt,
Today we had an 8-year old female dog presented for OHE. She was given hydro as a
premed and masked down with iso. However, she got really cold during surgery so the
surgery was aborted and she was woken up. This dog also went down and woke up very
quickly on the iso (woke up during surgery as well). Her respiratory rate dropped when
the iso was increased but she woke up when the iso was decreased.
Is there a better drug protocol for this dog? Would propofol be appropriate to use in this
case?
Case 13:
Hi Dr. Read,
I hope you don't mind, but I have an anesthetic protocol question for you. We recently
had a 7-year old Scottie present for dental work. Her preanesthetic parameters were
normal, and baseline HR was 120bpm.
We premedicated her with 0.07mg/kg hydromorphone (she is a calm Scottie) and
0.005mg/kg glycopyrrolate (both SQ). After 15 minutes, her HR was 59 bpm, and her BP
was good (systolic over 100). We gave her another 0.005mg/kg glyco SQ and waited.
Her HR went as low as 47 bpm, although her BP was still good (but her HR was well
below our comfort zones). A lead II ECG revealed a sinus bradycardia. We went ahead
and reversed the hydro with naloxone and she quickly became non-sedate and her HR
went up to about 100.
We need to reschedule her dental. Interestingly, 2 years ago she was spayed with the
exact same protocol and same doses and had no issues. Upon reading VIN I see some
comments that in these dogs, BAA might be a better choice. What is your opinion? What
would you suggest for a protocol? Thanks for any help.
Case 16:
Hi Dr. Read,
I have a 13-year old cat with renal disease that requires an anesthetic for a dental
cleaning. Recent blood work indicated the BUN was 19.6 (n: 3.6-10.7) and Creatinine
was 262 (n: 27-186), otherwise everything else was WNL. My understanding is that the
most important thing to consider with the anesthetic is renal perfusion but also using
drugs with limited effect on the kidneys. I was thinking of using hydromorphone with a
small amount of acepromazine (0.01 - 0.03 mg/kg) for sedation, and propofol for
induction. Would this be a good protocol to go with, keeping in mind that I don’t have
access to a variety of drugs (we carry hydromorphone, buprenorphine, midazolam,
acepromazine, propofol, ketamine and diazepam)?
Thanks for your help.
Case #18:
Hello,
I was hoping I could get your advice regarding an anesthetic we will be doing soon. I will
be doing a dental on a 7-year old Beagle to extract a fractured premolar. He is epileptic
and is currently being treated with KBr and is on prednisone due to a history of either
immune-mediated or drug-induced pancytopenia (he is currently stable). He still has
approximately one seizure per week. On his most recent blood work, the only
abnormalities were an ALP of 226 U/L and a total bilirubin of 6.6 umol/L. His CBC was
normal and the KBr levels were within the reported therapeutic range. He had an
abdominal ultrasound done last week that was normal according to the owner (report still
pending).
I've been looking into options for an anesthetic protocol for him. Based on what I have
been reading, it seems I should avoid acepromazine and ketamine for him. I was planning
on giving him hydro 0.05 mg/kg IV for premed, then diazepam 0.1 mg/kg and alfaxalone
IV to effect. We use isoflurane to maintain them. Does this sound like an appropriate plan
to you, or do you have any other suggestions?
Thanks so much for your help.
Case #19:
Hi Dr. Read,
I have a 20 lb. cat coming in for a dental on Thursday. Are there any specific precautions
that I should take with a general anesthetic on an obese cat? We usually
give butorphanol/dexmedetomidine IM for sedation, followed by propofol for induction
and maintenance on isoflurane. I planned on monitoring heart rate and BP with a
Doppler. Any recommendations on whether to dose the pre-anesthetic drugs based on
actual weight vs. estimated lean body weight? Any other tips on trying to avoid
complications would be greatly appreciated.
Thanks.

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