Monday, September 12, 2011

605. Anaesthesia - IV - ketamine + diazepam

DRAFT
TO BE REVISED AND MORE DETAILS TO BE CHECKED

METHOD 1
Healthy 10 kg dog
Premedicate with butomide 0.5mg/kg and ACP 0.2-0.4mg/kg IM. Wait 5 minutes.

Ketamine 0.5 ml + diazepam 0.5 ml = 1 ml in one syringe IV
Zoletil 100 top up if not intubated and connected to isoflurane gas. Give 0.05 - 0.1 ml IV via catheter drip set.
No need atropine
This process is claimed to be very safe for dogs and cats




CAT SPAY 4 kg
Ketamine 0.2 ml + diazepam 0.2 ml IV
compared to Ketamine 0.3 ml + xylazine 0.1 ml IM

METHOD 2
XYLAZINE+KETAMINE+ZOLETIL COMBINATION
Most economical for spaying and neutering stray dogs and cats.
No need premedication
Zoletil 100 is fast acting and safe

Zoletil top up by IM in 0.1 ml doses.
Quick surgery is needed. Must completed within 15 minutes if not topping up.

METHOD 3
XYLAZINE+KETAMINE

I use Ketamine 0.4 ml + xylazine 0.1 ml IM and find it most satisfactory and safe in cat spays which normally does not exceed 15 minutes. No need top up.
For cats over 8kg, Ketamine 0.8 ml + xylazine 0.2 ml IM.

METHOD 4
DOMITOR + KETAMINE
Heart rate goes down, very soft and sometimes the dog stops breathing, according to one vet. He said atropine maintains blood pressure. Advantage: Antisedan can reverse and dog wakes up fast and standing (within 5 minutes in my observation of younger dogs, within 15 minutes according to one report). A 12-year-old Alsatian took more than 30 minutes to stand up. (ear irrigation.)

METHOD 5
DOMITOR
Good for short surgical procedures less than 15 minutes. Sedation.
No premed. Antisedan reversal advantage.
According to one vet, the auricle and ventricle do not contract at the same time. Heart rate goes down, very soft and sometimes the dog stops breathing, according to one vet.

METHOD 6
PROPOFOL
10 KG - 5 ml
Give 3 ml first. If not sedated, 1 ml, then 1 ml. Intubate. Isoflurane gas. If moving, Zoletil top up. Quite unreliable analgesia. Will not recommend this method.
Use the small bottle as it cannot be kept long.

METHOD 7
ALPHAXON IV, INTUBATE + ISOFURANE GAS
For Caesarean section. Fast and effective. Does not kill pups.

GUINEA PIG
Domitor + Ketamine 0.25 + 0.15 ml SC. To check on this.
Each vet has his own favourite combination.

ZOLETIL
Said to be very safe.
Needs atropine 0.05 ml/kg before Zoletil







We always pre-med the animals followed by induction. In older or high risk patients use lower ACEPROMAZINE dose or leave out altogether.

MEDETOMIDINE doses recommended are actually lower than those suggested by manufacturer.

*ranges are given here depending to the temperament and amount of pain during the procedure.
WEIGHT OF ANIMAL IMPT!
(Acepromazine ranges 0.02-0.05 mg/kg - if very nervous give high dose. Opiod doses/type based on amount of pain control required - morphine/methadone for painful procedures, butorphanol/buprenorphine for less painful procedures requiring more sedative effects)

Pre-med (usually 45min - 1hr before induction)
DOGS
ROUTE - IM/SC

1. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Morphine 0.2-0.4 mg/kg
Do not use if vomiting, or if mass cell tumour (causes degranulation)

2. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Methadone 0.2-0.4 mg/kg

3. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Butorphanol 0.2-0.4 mg/kg
Sedation w/o analgesia, GOOD for echocardiography/chest rads/U/s

4. Medetomidine 3-5 mcg/kg + butorphanol 0.2-0.4 mg/kg +/- acepromazine 0.02 mg/kg
Reverse with same volume of atipamezole (anti-sedan)

5. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Buprenorphine 0.01-0.015 mg/kg

ROUTE - IV

1. Medetomidine 1 mcg/kg + butorphanol 0.1-0.2 mg/kg

CATS
ROUTE - IM/SC

1. Acepromazine 0.02-0.05 mg/kg + morphine/methadone 0.2-0.3 mg/kg then if not enough + 3-5 mg/kg ketamine

2. Acepromazine 0.02-0.04 mg/kg + Butorphanol 0.2-0.4 mg/kg +/- gas down with sevoflurane OR Alfaxalone/Propofol to effect
GOOD for echocardiography/chest rads/U/s

3.Medetomidine 10-40 mcg/kg + butorphanol 0.1-0.4 mg/kg (or morphine 0.3 mg/kg or buprenorphine 0.01-0.02 mg/kg)

*cats more refractory to medetomidine compared to dogs - may require 10-20 mcg/kg up to 80 mcg/kg (enough for castration)



Induction:
1. Alfaxalone (10mg/ml) -
1mg/kg IV dogs / cat IV (2mg/kg)
stable CV effects (but dose dependent)
fast knockdown, need to intubate quickly, transit to gas
never use halothane
more dysphoric on recovery

2. Valium/Ketamine
1ml/10kg IV of 50:50 volume mix cats and dogs
ketamine makes them tachycardic due to SNS stimulation
avoid in cardiac, renal, CNS disease
ketamine causes excess salivation

3. Propofol (10mg/ml)
2-4 mg/kg IV dogs and cats if has been premeded
6 mg/kg IV dogs and cats if has NOT been premeded
cats need up to 10-12 mg/kg IV
best if high risk patients
use to effect - can top-up if waking up
no excitement
GIVE SLOWLY otherwise too depressant on bp (CAN CAUSE APNOEA IF GIVEN TOO FAST)
watch breathing, is sedative
good for bains/spines, kidney and liver disease
contraindicated in pancreatitis
CVS effects are dose/rate dependant

*ALFAXALONE AND PROPOFOL HAVE TO BE TITRATED TO EFFECT AND GIVEN EXTREMELY SLOWLY TO AVOID POST INDUCTION APNOEA!! WATCH FOR BREATHING AFTER INDUCTION.



Maintenance

1. Inhalants anaesthetic (isoflurane etc to effect)

Hope this helps. As with the other regimes you have below, I can tell you the effect of the drugs but i cant tell you the appropriate dose rates required. Usually the choice of drugs are dependent on the procedure and the amount of sedation and pain management needed. Pre-med gives a smoother induction, easier placement of catheter etc.

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