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Anesthesiology of dog and cat
Anesthesiology of dog and cat
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Fundamentals of„safe“ anesthesia
1. Venous access
2. Endotracheal intubation
3. Oxygenation
4. Artificial lung ventilation
5. Knowledge and possibility of CPCR
Anesthesiology of dog and cat
Anesthesia of DOG
• Monoanesthesia
– Propofol i.v.
– Inhalation anesthesia (Iso, Sevo, Des)
• Examination
• Painless procedures only
Anesthesiology of dog and cat
• Sedation and premedication
– Dex/medetomidine (+ opioids) i.m., i.v.
– Midazolam (Diazepam) + opioids i.v.
– Acepromazine + opioids i.m., i.v.
– Droperidol + Fentanyl i.m., i.v.
Anesthesia of DOG
Anesthesiology of dog and cat
• Anesthesia induction
– Intravenous
• Propofol, Thiopental, Thiopental, Etomidate, Alfaxalon
• Diazepam/Ketamin
– Intramuscularly
• Ketamin, Zolazepam/Tiletamin, Alfaxalon
– Inhalation (by mask) – Iso, Sevo, Des
Anesthesia of DOG
Anesthesiology of dog and cat
• Maintenance
– Readministration of boluses
• Propofol, Alfaxalon, Ketamin i.v.
• Ketamin, Zolazepam/Tiletamin, Alfaxalon i.m.
– Infusion (CRI – Constant Rate Infusion)
• Propofol, Alfaxalon i.v.
– Inhalation
• O2 + (N2O, Air) + Iso, Sevo, Des
Anesthesia of DOG
Anesthesiology of dog and cat
Anesthesia of CAT
• Monoanesthesia
– Ketamin, Zolazepam/Tiletamine i.m.
– Propofol, Alfaxalon i.v.
– Inhalation anesthesia (Iso, Sevo, Des)
• Examination
• Painless procedures only
Anesthesiology of dog and cat
• Sedation and premedication
– Dex/medetomidine (+ opioids) i.m., i.v.
– Midazolam (Diazepam) + opioids i.m., i.v.
– Zolazepam/Tiletamine i.m.
– (Acepromazine + opioids i.v.)
Anesthesia of CAT
Anesthesiology of dog and cat
• Anesthesia induction
– Intravenously
• Propofol, Ketamin, Alfaxalon
– Intramuscularly
• Ketamin, Zolazepam/Tiletamine, Alfaxalon
– Inhalation (by mask, chamber)
• Iso, Sevo, Des
Anesthesia of CAT
Anesthesiology of dog and cat
• Maintenance
– Bolus readministration, CRI
• Propofo, Ketamin, Alfaxalon i.v.
• Ketamin, Zolazepam/Tiletamin, Alfaxalon i.m.
– Inhalation
• O2 + (N2O, Air) + Iso, Sevo, Des
Anesthesia of CAT
Anesthesiology of dog and cat
Patient with
cardiovasculardisease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Patient with cardiovascular disease
• Reduction of drug absorption after i.m., s.c.
• Reduction of distribution, metabolization, elimination
• Formation of edemas
• Hypoproteinemia
• Faster onset of inhalation anesthetics
• Impairment of ventilation/perfusion – venous admixture
Anesthesiology of dog and cat
Anesthetics
• Influences
– Autonomic functions
– Vascular tone
– Heart rate
– Myocardial contractility
Anesthesiology of dog and cat
HR MAP C.O. SVR
Atropine ↑↑↑ ↑ ↑ 0
Dex/Medetomidine ↓↓↓ ↑/↓ ↓↓ ↑↑/↓
Acepromazine 0 ↓↓ ↓ ↓↓
Diazepam, Midazolam 0 0 0 0
Butorphanol ↓ ↓ 0 0
Buprenorphine ↓ 0 ↓ ↑
Fentanyl ↓↓ ↓ 0 0
Morphine ↓ ↓ 0 0
Methadon ↓↓ 0 0 0
Anesthesiology of dog and cat
HR MAP C.O. SVR
Propofol ↓ ↓↓ ↓ ↓↓
Ketamine, Tiletamine ↑ ↑ ↑ ↑
Etomidate 0 0 0 0
Thiopental ↑↑ ↓ ↓ ↓
Isoflurane ↑↑ ↓↓ ↑ ↓↓
Sevoflurane 0 ↓ 0 ↓
Desflurane ↑ ↓↓ 0 ↓↓
Nitrous oxide ↑ 0 ↑ ↑
Lidocaine Ca ↑ Fe ↓ Ca 0 Fe ↑ Ca 0 Fe ↓ Ca 0 Fe ↑
Anesthesiology of dog and cat
Stabilization before anesthesia
• Current medication
– Furosemide, ACE, Pimobendan, Benazepril, …
• Evacuation (drainage) of effusion
• Left-side insufficiency
– Furosemide 1–2 mg/kg
• DCM, mitral valve degeneration
– Pimobendan 0,1–0,3 mg/kg
• Correction of arrhythmias
Anesthesiology of dog and cat
Goals of anesthesia
• Stable HR
– Catecholamine, vagal tone
– Anesthesia depth, level of analgesia
• Stable MAP
– Fluid therapy
• Sufficient oxygenation
– Hemoglobin, ventilation
– Anemia, normoxia
Anesthesiology of dog and cat
• Preparation of drugs, anesthetics, equipment, …
– Atropine, Epinephrine, Lidocaine
• Continual monitoring
• Pre/oxygenation
• Sedation
– Sufficient reduction of stress
• Adequate analgesia
• Smooth induction
Anesthetic protocol
Anesthesiology of dog and cat
Anesthetic protocol
• Balanced anesthesia
• Constant, adequate depth of anesthesia
• Sufficient analgesia
• Normoxia – oxygenation
• Ventilation – minimal PIP/PEEP
• Adequate monitoring
Anesthesiology of dog and cat
Fluid therapy
• Cardiac patient – increased circulatory volume
• Vasodilatators, diuretics – hypovolemia
• Surgery without fluid loss
– Avoid fluids with increased concentration of Na (0,9% NaCl)
– Ringer lactate 2 ml/kg/h
– Precisely dosed colloids
Anesthesiology of dog and cat
• Intra-cardiac pressures
Cardiologic patient
Anesthesiology of dog and cat
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• L-R PDA – decreasing of C.O. – hypotension – hypertrophy
• R-L PDA – venous admixture – cyanosis
• Anesthesia
– Maintain HR, C.O.
– Maintain PVR, SVR
– Oxygenation
– (Acepromazine 0.002–0,005 mg/kg
– Ligation – Branhams reflex – bradycardia, vasodilatation
Anesthesiology of dog and cat
Aortic stenosis
• Reduction of LV output – hypertrophy
• Decrease of DAP – decrease of coronary perfusion
• Anesthesia
– Normotension, avoid hypertension
– Maintain HR
– Oxygenation
– (Dexmedetomidine 0.001 – 0.002 mg/kg
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Anesthesiology of dog and cat
Stenosis of a. pumonalis
• Insufficiency of v. tricuspidalis – RA hypertrophy –RV hypertrophy
• Anesthesiaa
– Keep venous return, preload
– Maintain contractility – HR
– Maintain PVR (IPPV/PEEP)
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Anesthesiology of dog and cat
Ventricular septal defect
• Larger defects – commonly with AS, PS, PDA
• Smaller defects – without severe abnormalities
• Anesthesia
– Maintain PVR
– Maintain SVR
– Keep L-P shunt
– Oxygenation
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Anesthesiology of dog and cat
Valvular defects
• Bradycardia, hypotension, lung edema
• Accurate dosing of fluids
• Anesthesia
– Reduce bradycardia
– Slight tachycardia
– Maintain C.O.
– Keep (decrease?) SVR, PVR
Anesthesiology of dog and cat
• Emptying of LV reduced
• Myocardial ischemia, arrhythmia
• Anesthesia
– Avoid tachycardia
– Avoid contractility
– Increase preload, SVR
– Ketamine unsuitable
– Dexmedetomidine 0.005–0.007 mg/kg
Hypertrophic cardiomyopathy
Anesthesiology of dog and cat
• Ca – deficit of LV
• (Fe – deficit of RV)
• Decrease SV, Arrhythmias, lung edema
• Anesthesia
– Maintain C.O.
– Reduce arrhythmias
– Oxygenation
– Alpha-2 agonists unsuitable
Dilated cardiomyopathy
Anesthesiology of dog and cat
Cor pulmonale
• Pathology of lungs and RV – affected tricuspid and pulmonary valve
• Anesthesia
– Maintain/decrease lungs PVR
– Iso, Sevo, Des – decrease PVR
– Low PIP/PEEP
– N2O, ketamin, dopamin, hypercapnia
• Increase PVR – unsuitable
Anesthesiology of dog and cat
Systemic hypertension
• Stress – sympatric stimulation – myocardial hypoxia – arrhythmias
• Anestezia
– Stable HR, SV
– Stable MAP
Anesthesiology of dog and cat
Anesthesia of cardiologic patient I.
• (Midazolam 0.25 mg/kg i.v.)
• Fentanyl 0.005–0.01 mg/kg i.v.
• Propofol, Alfaxalon (to the effect)
• O2 – Iso, Sevo, Des
• Fentanyl 0.005–0.02 mg/kg/h i.v.
• (Artificial ventilation?)
• (Analgesia?)
Anesthesiology of dog and cat
• (Midazolam 0.25 mg/kg i.v.)
• Fentanyl 0.005–0.01 mg/kg i.v.
• Propofol, Alfaxalon (to the effect)
• O2 – Iso, Sevo, Des
• Fentanyl 0.005–0.02 mg/kg/h i.v.
• (Artificial ventilation?)
• (Analgesia?)
Anesthesia of cardiologic patient II.
Anesthesiology of dog and cat
• Midazolam 1.2 mg/kg + 0.9 mg/kg/h i.v.
• Sufentanil 0.0038 mg/kg + 0.003 mg/kg/h i.v.
• IPPV/PEEP
Anesthesia of cardiologic patient II.
Anesthesiology of dog and cat
Patient with
respiratorydisease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Respiratory abnormalities
• Hypoxia, hypercapnia – cardiovascular abnormalities – multiorgan effects
• Anesthesia – impairment of
– Mucocilliar function (Atropine)
– Formation of atelectases
– Impairment of ventilation/perfusion – AV shunts(Propofol)
– Respiratory depression
Anesthesiology of dog and cat
Healthy lungs Pathology
FiO2 21 % (0,21) 21 % (0,21)
PaO2 110 mmHg 50 mmHg
PaO2 / FiO2 524 238
PaO2 / FiO2
> 500
(normal)
< 300
(abnormal)
PaO2 / FiO2 ratio
Anesthesiology of dog and cat
A-a gradient
Healthy lung Pathology
FiO2 21 % (0,21) 21 % (0,21)
PaO2 74 mmHg 74 mmHg
PaCO2 58 mmHg 31 mmHg
PAO2 = FiO2 (PB – PH2O) – (PaCO2 / RQ)
PAO2 76,6 mmHg 110,4 mmHg
A-a gradient
= PAO2 – PaO2
2,6 mmHg 36,4 mmHg
A-a gradient < 15 mmHg (normal) > 25 mmHg (abnormal)
PB – barometric pressure (760 mmHg), PH2O – partial pressure of water vapor (50 mmHg), RQ – respiratory quotient (0,8)
Anesthesiology of dog and cat
Bronchial effects
• Bronchodilatation
– Atropine, Ketamin, (Propofol)
– Ketamin/propofol ("Ketofol", 0.5/0.5 doses in one syringe)
• Bronchoconstriction
– Thiopental
• Antitussic effect
– Butorphanol, Codeine
Anesthesiology of dog and cat
Anesthetic technique
• Preoxygenation (3 minutes)
• Induction
– Fast – i.v. + ETR
– Benzodiazepines + opioids
+ Propofol, Alfaxalon
• Adequate ETR
• TIVA
• Precise checking of ventilation (IPPV/PEEP)
Anesthesiology of dog and cat
Monitoring
• SpO2
– More than 95 %
• EtCO2
– 30–45 mmHg (4,0–6,0 kPa)
• Spirometry
– VT 7–15 ml/kg
– MV 100–300 ml/kg/min
Anesthesiology of dog and cat
Bronchoscopy
• Pre/oxygenation
• Feline asthma – Albuterol
• Adapter for bronchoscopy
• Larmasks
Anesthesiology of dog and cat
• Pre/oxygenation
• Albuterol
• Midazolam
Butorphanol
Ketamin – bronchodilation
• Stimulation of pharynx – spasm
– Lidokain local
Feline asthma
Anesthesiology of dog and cat
Contusion, pneumonia, bullae, …
• Pre/oxygenation
• Risk of bleeding, rupture
• Spontaneous breathing
• IPPV/PEEP
– fR 8–10 breaths/min
– PIP ˂ 10 cmH2O
Anesthesiology of dog and cat
Patient withhepaticdisease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Liver
Glucose
Detoxication
Proteins Lipids
CoagulationProduction
regulation
Anesthesiology of dog and cat
Blood plasma protein binding
• High (> 80%)
– Propofol, Diazepam
• Medium (50-80%)
– Thiopental
• Low (< 50 %)
– Ketamine, Morphine
• Change of anesthetic effectiveness
Anesthesiology of dog and cat
Hepatic disease I.
• Drugs with minimal liver metabolisation
– Opioids – Fentanyl derivates
– Inhalation anesthetics – Iso, Sevo, Des
– Short acting anesthetics – Propofol, Etomidate, Alfaxalon
– Atracurium, Remifentanil (Hoffmanns degradation)
– Ester L.A. – Procaine
Anesthesiology of dog and cat
• Unsuitable drugs
– Morphine (↑ of tone of Oddi´s sphincter ↑ histamine,
↓ perfusion)
– Neuroleptics (vasodilation, duration time, seizures?)
– Alpha-2 agonists (vasoconstriction)
– Ketamin (vasoconstriction)
– Thiopental (protein binding)
– Amid L.A. (prolonged metabolisation]
Hepatic disease II.
Anesthesiology of dog and cat
• High risk patients
• Liver hypoplasia
– Hepatoencephalopathy
– Hypoglycemia
– Blood coagulation impaired
– Hypoprotemia
• Surgery
– Serious changes of blood pressure
Portosystemic shunt (PSS) I.
Anesthesiology of dog and cat
50
• Postoperative care
– Normothermia
– Normoglycemia
– Normotension
– Control of seizures
– Normoproteinemia
– Oxygenation
Portosystemic shunt (PSS) II.
Anesthesiology of dog and cat
Liver biopsy
• Sedation, decrease of fR
• Hemostatic examination
• (Vitamin K?)
• Premedication
– Opioids (Fentanyl derivates, Pethidine)
• Anestezia
– Propofol, Alfaxalon
Anesthesiology of dog and cat
Abnormalities of biliary tract
• In small animals rare
• Oddi´s sphincter– increases pressure in biliary tract– Opioids– Morphine – Pethidine, Fentanyl –
Butorphanol – Buprenorphine, Nalbuphine
Anesthesiology of dog and cat
Anesthesia for hepatopathy I.
• Hemostazeology
• Short acting anesthetics
• Hydratation
• Normoglycemia, normoproteinemia
• Normotension
• Eukapnia
• Control of seizure
• Risk of thromboembolia
Anesthesiology of dog and cat
• Premedication
– Opioids (Morphine unsuitable)
– (Atropine?)
• Induction
– Mask? – cooperating patients only
– Propofol, Etomidate, Alfaxalone
• Maintenance
– Iso, Sevo, Des
– (Atracurium?)
Anesthesia for hepatopathy II.
Anesthesiology of dog and cat
Patient with
urologicdiasease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Pathophysiology I.
• Autoregulation of glomerular filtration
– MAP 80–180 mmHg
– Hypovolemia – vasoconstriction
• Fenothiazines
• Up to 50% lower GF
• Correction (> 4 hours)
• Anesthesia
– Autoregulation impaired
Anesthesiology of dog and cat
• Sympaticus – renal vasoconstriction
– Insufficient anesthesia, analgesia, hypoxia, hypercapnia
• Antidiuretic hormone
– Secretion – stress, anesthetics
• Barbiturates, opioids, inhalation anesthetics
– Decreased secretion
• Fenothiazines (+ vasodilation) – diluted urine
Pathophysiology II.
Anesthesiology of dog and cat
Nephrotoxins
• Aminoglycoside antibiotics
• Amphotericin B
• Hemoglobin, bilirubin, myoglobin
• Fluoride ions
• X-ray contrast media
• Oxalates
• Metoxyflurane
• Non-steroidal anti-inflammatory agents
Anesthesiology of dog and cat
Urologic patient I.
• Influence of anesthetic on renal functions
• Influence of renal abnormalities on drug metabolisation
• Regulation of
– Fluid and electrolyte balance
– Acid-base balance
• Excretion of N-metabolites, anesthetics
Anesthesiology of dog and cat
• Without abnormalities
• Abnormalities
– Hyperkalemia, hyperphosphatemia, hypocalcemia, hyponatremia
– Acidosis
– Hypovolemia
• Emergency states
– Urinary tract obstructions
– Urinary bladder rupture
Urologic patient II.
Anesthesiology of dog and cat
Influence of anesthetics
Kidney perfusion GFR
Etomidate +++ +++
Thiopental +++ ++↓
Ketamin ↑↑ ++↓
Iso, Sevo ↓ ↓↓
Anesthesiology of dog and cat
Nephropaties
• Drugs effect prolonged
– With active metabolites
• Morphine, Ketamine, Diazepam
– Primarily excreted by kidneys
• Pankuronium, Ketamine
Anesthesiology of dog and cat
Patient with
neurologicdisease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
• ICP = 0-10 mmHg
CPP = MAP – ICP
• MAP = 70-80 mmHg
• PaCO2 = 35-40 mmHg
• PaO2 = 90-100 mmHg
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Patophysiology
Anesthesiology of dog and cat
Normotension and normocapnia
Seymour Ch, Duke Novakowski T 2007: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia
Anesthesiology of dog and cat
Regulation of ICP
• Patient positioning
• Stabilization of MAP, CVP
• Normocapnia (IPPV), oxygenation
• Sedation
• Lidocaine
• Furosemide
• Mannitol
Anesthesiology of dog and cat
Influence of anesthetics on ICP
Ketamin
N2O
Acepromazine
Opioids
Dex/medetomidine
Benzodiazepines
Isoflurane, Sevoflurane
Propofol, Thiopental
Anesthesiology of dog and cat
Anesthesia
• Sedation and premedication
– Opioids (Morphine?)
– Alpha-2 agonists (Xylazine?), Benzodiazepines
• Induction and maintenance
– Propofol (CRI)
– Iso, Sevo, Des
– Induction by mask – unsuitable (excitation)
Anesthesiology of dog and cat
Analgesia
• Opioids
• Alpha-2 agonists
• NSAIDs, steroids
• Ketamine – low doses, CRI
• Lidocaine – CRI
• Gabapentin (anticonvulsant)
• Amitriptiline (tricyclic antidepressives)
Anesthesiology of dog and cat
Patient with epilepsy
• Acepromazine? (Tobias a kol. 2006)
• Opioids
• Low doses of alpha-2 agonists
• Benzodiazepines (in combination)
• Propofol, Thiopental
• Ketamine unsuitable
Anesthesiology of dog and cat
Patient with
gastrointestinaldisease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Gastrointestinal abnormalities
• Abnormalities
– Electrolyte, acid-base
– Dehydratation, hypovolemia
– Malabsorption, hypoproteinemia
• Emergency cases
– Volvulus, perforation, …
• Pancreas
– Changes of glucose metabolism
Anesthesiology of dog and cat
Pharmacology of anesthetics
• Atropine – ↓ motility, tone, secretion of GIT
• Opioids – obstipation (Morphine), stimulation (Fentanyl)
• Benzodiazepines – minimal influence, stomachic (Diazepam)
• Acepromazine – antiemetic, ↓ secretion of ADH
• Alfa-2 agonists – ↓ motility, GOR, vomitus, ischemia
• Thiopental – ↑ duodenal and jejunal motility
• Propofol, Etomidate – minimal influence
• Nitrous oxide – gas accumulation
Anesthesiology of dog and cat
Abnormalities of oral cavity
• Toot and periodontal disease
• Pathology of salivary glands
• Pathology of pharynx
– ETR intubation
– Nerve blocks
Anesthesiology of dog and cat
Abnormalities of esophagus I.
• Obstruction
– KI drugs inducing vomiting
– Opioids + Propofol, Thiopental, Ketamin, Etomidate, Apfaxalone
– ETR (cuff) necessary
– Ca – striated muscles – PMNBA + UPV
– ? thoracic surgery ?
Anesthesiology of dog and cat
• Megaesophagus
– Risk of aspiration pneumonia
– Vascular ring anomaly
• Esophagitis
– Complication of GOR
• (17% of pacients undergoing G.A.)
• Sucralfate, H-2 blockers, Metoclopramide
• Atropine – relaxation of esophageal sphincter
Abnormalities of esophagus II.
Anesthesiology of dog and cat
Abnormalities of stomach
• GDV
– Shock
– Benzodiazepines + opioids + Propofol, Etomidate, (Ketamin) + Iso, Sevo, Des
– Cardiac arrhythmias – Lidocaine
• Gastroduodenoscopy
– Opioids – ↑ tone of pyloric sphincter
– Acepromazine
Anesthesiology of dog and cat
• Small intestine
– Opioids (increased pyloric tone)
– Acepromazine, Midazolam
– Propofol, Etomidate, Alfaxalon
– Iso, Sevo, Des
• Large intestine
– ? Epidural anesthesia ?
– Rectum – recumbency – UPV
Intestinal abnormalities
Anesthesiology of dog and cat
Visceral analgesia
• Opioids + NSAIDA
– Buprenorphine + Metamizol, Carprofen, Meloxicam
• CRI
– Lidocaine
– Ketamin
– Dex/medetomidine
– Fentanyl, Morphine
Anesthesiology of dog and cat
Patient for
Cesarean section
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Pregnancy
• Decrease of lung capacity, increase consumption of O2
– Risk of atelectases, hypoxia
• Increase of alveolar ventilation
– Risk of inhalation anesthetics overdose
• Sedative effects of progesterone
– Risk of anesthetic overdose
• Distension of abdominal cavity
– Hypoventilation, hypotension
Anesthesiology of dog and cat
Cesarean section
• Influence of female and fetal health status
• Influence of character of CS
• Increased fetal mortality
– Alpha-2 agonists
– Long-acting anesthetics
• Minimal negative effects
– Iso, Sevo, Dex, Propofol, Alfaxalone
Anesthesiology of dog and cat
• Short-acting anesthetics
• Anesthetics with antagonists
• L.A. – EPI
• Oxygen supplementation
• ETR
• Fluid therapy
• ABP monitoring
Anesthesia for CS
Anesthesiology of dog and cat
Anesthetics for CS I.
• Mu-opioids
– Respiratory depression, bradycardia
– Antagonisation
• Phenothiazines
– Prolonged metabolisation
– Vasodilatation
• Benzodiazepines
– Crossing placental barrier
– Depression of neurological functions
Anesthesiology of dog and cat
• Alpha-2 agonists
– Reduction of perfusion of uterus
• Propofol
– Placental barrier crossing restricted
• Barbiturates
– Reduction of newborns vitality
• Ketamin
– Respiratory depression in newborns
Anesthetics for CS II.
Anesthesiology of dog and cat
• Alphaxalone
– CS in cats
– Fast clearance
• Local anesthetic
– Lidocaine
Anesthetics for CS III.
Anesthesiology of dog and cat
• Local anesthesia
– Opioids + Lidocaine EPI
– Infiltrative line block
• General anesthesia
– Inhalation anesthesia (induction by mask)
– Opioids + Etomidate + Isoflurane/Sevoflurane
– Opioids + Propofol, Etomidate + Iso, Sevo, Des
Anesthesia for CS
Anesthesiology of dog and cat
Patient with
ophthalmicdisease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Intraocular pressure
INCREASING
• Increasing of BP
– Coughing, vomiting
• Hypercapnia, hypoxia
• Pressure on eye globe
• Anesthetics
– Atropine, Ketamin
DECREASING
• Decreasing of ABP
• Hypocapnia
• Most of anesthetics
• Osmotic diuretics
• Carboanhydrase inhibitors
Anesthesiology of dog and cat
Anesthesia for ophthalmology I.
• Okulocardial reflex
– Eye – trigeminal nerv – CNS – vagal nerv – heart –bradycardia
• Central eye globe position
– Eye globe surgery
– PNMBA
– Dissociatives
– Retrobulbal block
Anesthesiology of dog and cat
• Lid and conjunctival surgery
– Without limitation
– According health status
• Eye globe surgery
– Without dissociatives
– Muscle relaxation + artificial lung ventilation
Anesthesia for ophthalmology II.
Anesthesiology of dog and cat
Patient with
endocrinedisease
General surgery and anesthesiology
4th study year FVM
Anesthesiology of dog and cat
Stress response
Disease
PyrogensEikosanoids
Tissue damageInfection
HypothermiaAcidosisHypoxia
Hypotension
Immobilization
HYPOTHALAMUS
BRAIN
CORTEX
Nociception
Receptor branch
Anesthesiology of dog and cat
Stress response
Hans Selye
Effector branch
Anesthesiology of dog and cat
Anesthetics
• Alfph-2 agonists
• Etomidate
• Thiopental
– Blockade of stress response in effector branch
– Corticoid supplementation
Anesthesiology of dog and cat
Adrenal gland pathology
• HYPERADRENOCORTICISM– Cushing
• HYPOADRENOCORTICISM– Addison
• FEOCHROMOCYTOMA
Anesthesiology of dog and cat
Increased level of glucocorticoids
• PU/PD, polyphagia
• Muscle weakness
• Abdominal cavity enlargement
• Hypoxemia
• Slow wound healing
• Hypercoagulation
• Lethargy
Hyperadrenocorticism
Anesthesiology of dog and cat
Anesthesia
• Respiratory insufficiency
– Weak abdomen, hepatomegaly
• Complicated venous access
• Hypertension and cardiomyopathy
• Risk of lung embolus
– Preoperative assessment of hemocoagulation
– Heparin, Hydroxyetylstarch
Hyperadrenocorticism
Anesthesiology of dog and cat
Preoxygenation
Premedication
– Diazepam, Midazolam, Acepromazin + Opioids
Induction
– Etomidate, Thiopental, Propofol, Alfaxalon
Maintenance
– Iso, Sevo, Des
– Propofol TIVA
Hyperadrenocorticism
Anesthesiology of dog and cat
Unilateral adrenalectomy
• Glucocorticoids supplementation
Bilateral adrenalectomy
• Glucocorticoids and mineralocorticoids supplementation
Hyperadrenocorticism
Anesthesiology of dog and cat
• Bradycardia
• Dehydration
• Weakness
• Lethargy
• PU/PD
• Weight loss
• …
Hypoadrenocorticism
101
Anesthesiology of dog and cat
Hypoadrenocorticism
Corticoid supplementation
• Small surgical procedures
Pre- and postoperatively
– Hydrocortison 4–5 mg kg-1
– Dexamethasone 0,1–0,2 mg kg-1
– Prednisolon 1–2 mg kg-1
Postoperatively – after complete recovery
– Normal behavior
Anesthesiology of dog and cat
Hypoadrenocorticism
Corticoid supplementation
• Sophisticated surgical procedures
Pre- and postoperatively
Postoperatively – 3 days
– Prednisone 0,5 mg kg-1 BID
– Hydrocortisone 2,5 mg kg-1 BID
– Dexamethasone 0,1 mg kg-1 SID
Postoperatively – since 4th day
– Normal regime
Anesthesiology of dog and cat
Feochromocytoma
• Intermittent episodes
– Weakness
– Hypertension
– Tachycardia
– Heart arrhythmias
• Blood volume reduced
• PU/PD
• Collapse
Anesthesiology of dog and cat
Feochromocytoma
• Risk of catecholamine release – hypertension (in Ho)
– Tricyclic antidepressives (Amitriptyline)
– Droperidol
– Acepromazine
– Naloxone
– Metoclopramid
Anesthesiology of dog and cat
Feochromocytoma
Anesthesia
• High risk cardiologic patient
• Tachyarrhythmia
• Peroperative hypertension – postoperative hypotension
Pre- and postoperative stabilization
• Hypertension
• Tachycardia
Anesthesiology of dog and cat
Feochromocytoma
Preoperative stabilization
• Fenoxybenzamin 0,25 mg kg-1 BID
• Propranolol 0,2-1 mg kg-1 SID
• Atenolol 0,2-1 mg kg-1 BID
Peroperative stabilization
• Fentolamin 0,1 mg kg-1 + 1-2 µg kg-1 min-1
• Esmolol 0,1 mg kg-1 + 50-70 µg kg-1 min-1
• Lidocaine, Amiodarone
Anesthesiology of dog and cat
• DIABETES MELLITUS
• INSULINOM
Abnormalities of homeostasis of glucose
Anesthesiology of dog and cat
Diabetes mellitus
• PU/PD
• Ketoacidosis
• Reduced liver function
• Weight loss
• (brain damage)
• …
Anesthesiology of dog and cat
Diabetic ketoacidosis
• Dehydration
• Hypovolemia
• Metabolic acidosis
• Hyponatremia
• Hypokalemia
• Marked hyperglycemia
• Vomiting
• Anorexia
• CNS depression
Anesthesiology of dog and cat
Diabetes mellitus
Anesthesia
• Maintain glucose levels (slight hyperglycemia)
• Minimel changes in day regime
– Timing, shortening of anesthesia
• Ketoacidosis
– Impaired protein binding
– ↑ sensitivity to anesthetics
• Alfa-2 agonists, Morphine – unsuitable
Anesthesiology of dog and cat
Diabetes mellitus
(Normoglycemia 8–14 mmol l-1)
• Preoperatively
– Glu ˂ 5,5 mmol l-1 2,5–5% glucose
– Glu 5,5–11 mmol l-1 ¼ dose of insulin + 2,5–5% glucose
– Glu ˃ 11 mmol l-1 ½ dose of insulin + fluids
• Peroperatively
– After 30–60 minutes
– Glu ˃ 16 mmol l-1 (longer than 60 minutes) – Insulin
Anesthesiology of dog and cat
Diabetes mellitus
Premedication
– Diazepam, Midazolam + opioids
Induction
– Etomidate, Propofol, Ketamine, Alfaxalon i.v.
Maintenance
– Iso, Sevo, Des
– Propofol, Alfaxalon TIVA
Anesthesiology of dog and cat
Diabetes mellitus
Postoperative care
– Antagonisation
– Monitoring of glycaemia
– Small amount of food immediately, when able to eat
– Standard evening feeding
Anesthesiology of dog and cat
Insulinoma
Adenocarcinoma of beta-cells of Langerhans islets
• Intermittent hypoglycemia
• Ataxia
• Neurologic signs
• Stress intolerance
• Syncopes
• …
Anesthesiology of dog and cat
Insulinom
• Glucose monitoring (15–30 min)
• Postoperative hyperglycemia
– Insulin
• Anesthesia as in diabetic patients
– Glu ˃ 2,2 mmol l-1
– Risk of postoperative pancreatitis
Anesthesiology of dog and cat
Thyroid and parathyroid
• HYPERTHYREOSIS
• HYPOTHYREOSIS
• HYPERPARATHYREOSIS
• HYPOPARATHYREOSIS
Anesthesiology of dog and cat
Hyperthyreosis
• Hypertrophic cardiomyopathy
• Hypertension, tachycardia, arrhythmia
• Hyperthermia
• Restricted hepatic and renal functions
• Weight loss
• Aggressiveness
• PU/PD, polyphagia
Anesthesiology of dog and cat
Anesthesia
• ↑ metabolisation of anesthetics
• ↑ O2, glucose consumption
• ↑ CO2 production
Unsuitable
– Alpha-2 agonists
– Anticholinergics, Ketamine
Hyperthyreosis
Anesthesiology of dog and cat
Hyperthyreosis
Surgery
• Difficultness
• Pain
• Sedation
• Muscle relaxation
DEEP SEDATION
Patient
• Cardiovascular
abnormalities
• Metabolic
abnormalities
MINIMAL SEDATION
Anesthesiology of dog and cat
Hyperthyreosis
• Premedication
– Acepromazine
– Opioids
• Induction
– Induction chamber
– Propofol, Etomidate,
Alfaxalon
– ETR intubation
Anesthesiology of dog and cat
• Maintenance
– 5% glucose
– Iso, Sevo, Des
– Propofol, Alfaxalon TIVA
• Emergency cases
– Propofol, Alfaxalon
– Lidokain, Propanolol, Atenolol, Esmolol
– Hypocalcemia
Hyperthyreosis
Anesthesiology of dog and cat
Hypothyreosis
• Bradycardia
• Hypotension
• Megaesophagus
• Obesity
• Lethargy
• Hypothermia
• Reduced metabolisation
Anesthesiology of dog and cat
Hypothyreosis
Anesthesia
• Carefully negative inotropes
– Acepromazin, Isofluran
• Megaesophagus
– intubation
• Obesity
– Ventilatory support
Anesthesiology of dog and cat
Hypothyreosis
• Premedication
– Diazepam, Midazolam + Opioids
• Induction
– Etomidate, Thiopental, Propofol, Alfaxalon
• Maintenance
– Sevo, Iso, Des
– Propofol, Alfaxalon CRI
Anesthesiology of dog and cat
Hyperparathyreosis
• Monitoring of blood calcium
– Correction of hypercalcemia
– Monitoring of renal functions
• Risk of hypocalcemia after surgery
Anesthesiology of dog and cat
Hypoparathyreosis
• Most often after thyroid and parathyroid surgery
– Monitoring of blood level of Ca
• Calcium gluconate
• (Eclampsia ante-partum)
Anesthesiology of dog and cat
Increased production of estrogens
• Non-regenerative anemia
• Thrombocytopenia
• Febrile
• Immunosuppression
Sertolli cells tumor
Anesthesiology of dog and cat
Diabetes insipidus
Absence of vasopressin (ADH)
• Unlimited access to water
• Exact fluid therapy
• Monitoring of blood Na
– Correction of hypernatremia
– 5% glucose, 0,45% NaCl