1. Anesthesia Angst Kelly Lynn Cronin, MBA, BS, PHR, VTS (ECC), RVT
Operations Manager Advanced Animal Hospital Group
Owner/CEO Success Strategies Veterinary Consulting

2. Veterinary Technician Appreciation Week is October 16th-22nd!
We LOVE our technicians!
Veterinary Technician Appreciation Week is October 16th-22nd!

3. What’s Mine is Yours
You are welcome to take pictures, I would be happy to you a copy of the presentation. Share with anyone who needs some anesthesia help.

4. At: http://www.wallpaperden.com/dog-face-3.shtml
First Rule of Anesthesia
For Anesthetics Never Panic
At:

5. Second Rule of Anesthesia Never Let Go of a Closed Pop Off Valve

6. Preparation

7. Safe Anesthesia Starts Before Your Patient Arrives

8. At: http://www.wallpaperden.com/dog-face-3.shtml
Pre-Anesthesia Requirements
General Consent Forms
Discussion of Risks
Physical Examination
Medications & Fluids
Pre-anesthetic tests
Specific Pre-anesthetic Protocols
At:

9. At: http://www.wallpaperden.com/dog-face-3.shtml
Food should be withheld for 12 hours prior to admission in normal cats and dogs over age 4 months.
Why?
Exceptions?
How do we mitigate hypoglycemia in these patients?
How do we test for BG during anesthesia?
Exceptions – young animals, diabetics
6-16 wks food withdrawn for no more than 4 hours
DVM should choose if food is withheld based on length of procedure, insulin should be adjusted, patient monitored hourly and glucose supplementation adjusted accordingly glucose monitoring more often based on initial glucose measurement
J Am Anim Hosp Assoc 2011; 47:---–---. DOI /JAAHA-MS-5846
At:

10. Discuss Anesthesia Concerns with the Owner Discuss the Risks of Anesthesia

11. Premedication Premedication
-Adjust heart rate for anesthetic depression
-Control operative pain
-Multi-modal anesthesia reduce induction meds
-Dry up secretions
-Reduce patient anxiety
-Reduce anesthetist anxiety

12. Blood samples should be drawn prior to premeds if it is not excessively stressful to the patient as premeds may influence the results of certain tests Example – Acepromazine can decrease patient PCV up to 30%
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13. Pre-anesthetic medications should be administered:
-30 to 45 minutes prior if given SQ.
-15 to 20 minutes prior if given IM
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14. A phenothiazine tranquilizer No analgesic properties
Acepromazine
A phenothiazine tranquilizer
No analgesic properties
Addition of an opioid reduces the acepromazine dose and the likelihood of hypotension or excessive sedation
Ace is no longer a concern with seizure patients
-old adage no ace in seizure pets – no longer hold to that
Garner, J., Kirby, R. and Rudloff, E. (2004), THE USE OF ACEPROMAZINE IN DOGS WITH A HISTORY OF SEIZURES. Journal of Veterinary Emergency and Critical Care, 14: S1–S17. doi: /j t x
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15. Atropine /Glycopyrrolate
Heart rate increase
Decrease secretions
Parasympatholytic
Anticholinergic
Difference glycopyrrolate and atropine?
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16. Butorphanol adds a short acting analgesic effect Recommended use
Opioid
Butorphanol adds a short acting analgesic effect
Recommended use
Butorphanol has an antagonistic effect when used with mu agonist opioids such as morphine, hydromorphone, fentanyl, or oxymorphone
More effective for sedation than for analgesia
Antagonist- blocks or dampens a response – so don’t mix or if you do be sure that you give enough time between
Around 2 hours duration of action
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17. Opioids
Many options morphine, hydromorphone, fentanyl, buprenorphine or oxymorphone
Varied duration of action
Effective for sedation and analgesia
Can cause vomiting
Can cause respiratory depression
Vomiting may be useful for patients with no NPO prep
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18. Anesthesia Monitoring and Maintenance

19. Doppler or Oscillometric?
ASA anesthesia guidelines
1. Healthy
2. Mild systemic disease.
3. Severe systemic disease not incapacitating.
4. Incapacitating disease
5. Moribund patient not expected to live
Doppler or Oscillometric?
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20. What constitutes anesthesia ?
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In my mind this means quality sedation fits the description. I also argue that I have in 25 years in vet med had several sedations go very bad. Everything warrants an anesthesia monitoring sheet.
What constitutes anesthesia ?
Anesthesia is a temporary induced state with one or more of analgesia , paralysis , amnesia, and unconsciousness.

21. What warrants intubation? What warrants a catheter?
What warrants an emergency drug sheet?
Any drug with respiratory depression

22. Set Yourself up for Success
-Leak test your machine prior to every use
-Care for ET Tubes correctly
-Check ET tubes prior to use
-Stylets?
-Cuff inflation
- Use the right sized tubes and system for your patient
Dry et tubes inflated to prevent chlorhex crystal formation (rinse well)
Store deflated
Inflate before using
Give a moment or two if using any numbing agent on the laryngeal flaps in cats (use cautiously in short procedures), give care with a stylet, never introduce past the end of the tube
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23. Cautionary Tale

24. Most Dangerous Periods During Anesthesia?
Induction
Recovery
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25. Anesthesia monitoring
Parameter times?
1st route of parameter correction
Time required to change anesthetic depth
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26. Got O2? Discussion re-breather vs. non re-breather
Discussion dead space
Flow rate
Flush Valve
Lung inflation

27. Anesthesia Monitoring
End Tidal CO2
First and best warning
Better at assessing respiratory quality than SPO2
Great warning for faulty equipment
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28. Anesthesia Monitoring
Temperature
Affects everything else
Is affected by everything else
Is all too often ignored
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29. Anesthesia Monitoring
Blood Pressure
A must in small patients and cats
>60 mm Hg MAP
A dry kidney is a dead kidney
Lasting effects
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30. Anesthesia Monitoring
Pulse Oximetry
Gets the most love
Deserves it least
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31. Best Anesthesia Monitoring Device?

32. Anesthetic Agents

33. What is the Correct Setting on an Anesthesia Vaporizer?
For a Million Dollars
What is the Correct Setting on an Anesthesia Vaporizer?

34. Why are fluids so important during anesthesia?
Surgical fluids
Why are fluids so important during anesthesia?
Vasodilation
Surgical Rate

35. There are no safe anesthetic agents, there are no safe anesthetic procedures. There are only safe anesthetists.—Robert Smith, MDa

36. Etomidate Short acting intravenous
Used for conscious sedation if not combined in multi-modal induction
Good for cardiovascular compromise
Rapid onset of action
Head trauma-
Decreases intracranial pressure and maintain a normal arterial pressure
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37. Ketamine Pain Killer Used alone elevates BP (stimulates circulatory)
Antidepressant
Agitation and confusion
Given IV/IM
NMDA receptor antagonist or classified as dissociative
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38. Valium/Midazolam Benzodiazapine
Profoundly potent anxiolytic,  amnesic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative
Given IV/IM (valium stings)/rectal
Rapid onset of action
Flumazenil is the reversal agent
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39. Propofol Given IV Hypnotic/amnestic Rapid onset of action
Causes respiratory depression
Not much analgesic effect
Potential pain on injection
Vasodilation sometimes leads to lower BP
Serial use in cats is contra-indicated due to red blood cell destruction/ 28 is also contra-indicated in cats
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40. Alfaxan Given IV for induction/IM for sedation Rapid onset of action
Rapid elimination
No extra-vascular tissue irritation
Consecutive days use is fine
Less respiratory depression
Not analgesic
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41. Isoflurane Halogenated Ether Inhalation anesthetic
Mechanism of action is not understood 
Analgesic
Muscle relaxant
Potent vasodilator
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42. Reversible Sedatives Dexdomitor -synthetic α2-adrenoreceptor agonist -off label in cats -reversed with antipamezol -peripheral vasoconstriction - bradycardia light,sound and pain reactive -hyperexcited dogs may have reduced effects
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43. Reversible Sedatives Xylazine -Rompun -synthetic α2-adrenoreceptor agonist -makes cats vomit -reversed with yohimbine -sedative -analgesia
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44. Questions? Thank You! Kelly.lynn.cronin@gmail.com