Small Animal Anesthesia and Pain Management: A Color Handbook

337 Pages·2012·10.54 MB·English

by  Jeff Ko

A Color Handbook
Anesthesia and
Pain Management
in Dogs and Cats
Jeff C Ko
DVM, MS, DipACVA
Professor of Anesthesiology, Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
Manson Publishing/The Veterinary Press
Disclaimer
The publishers, author and contributors cannot take responsibility for information
provided on dosages and methods of application of drugs mentioned in this publication.
Not all drugs, formulations, and devices are currently available in all countries,
and readers are advised to check local availability and prescribing regimens.
Veterinarians should follow appropriate national legislation and regulations.
Copyright © 2013 Manson Publishing Ltd
ISBN: 978-1-84076-179-5
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Commissioning editor: Jill Northcott
Project manager: Kate Nardoni
Copy editor: Peter Beynon
Design and layout: DiacriTech, Chennai, India
Colour reproduction: Tenon & Polert Colour Scanning Ltd, Hong Kong
Printed by: New Era Printing Co. Ltd, Hong Kong
Contents
Preface . . . . . . . . . . . . . . .10 Changes to the speed of Preanesthetic medication
Acknowledgements . . . . .11 chamber or face mask protocols . . . . . . . . . . . .62
Contributors . . . . . . . . . .11 induction . . . . . . . . .42 Phenothiazines:
Changes of anesthetic acepromazine . . . . . . . .64
Abbreviations . . . . . . . . .12
depth during Quick points for
anesthesia consideration . . . . . .64
CHAPTER I maintenance . . . . . . .42
Preanesthetic medication
Equipment required for Conservation of the doses . . . . . . . . . . . . .64
inhalant anesthesia . . .13 patient’s body
Advantages of using
Jeff C Ko temperature and acepromazine . . . . . .64
airway moisture . . . . .43
Introduction . . . . . . . . . . . .14 Disadvantages of using
Reducing the cost of a
Components of the acepromazine . . . . . .64
given inhalant
anesthetic machine . . . . .15 anesthetic agent . . . . .44 Benzodiazepines: diazepam
Flowmeters . . . . . . . . . .15 and midazolam . . . . . . .66
Global issues, including
Regulators . . . . . . . . . . .16 pollution control Quick points for
Vaporizers . . . . . . . . . . .16 and energy consideration . . . . . .66
Gas supply . . . . . . . . . . .20 conservation . . . . . . .44 Preanesthetic medication
Scavengers . . . . . . . . . . .25 Endotracheal tubes . . . . . . .45 doses . . . . . . . . . . . . .66
Breathing circuits and Types of endotracheal Differences between
components . . . . . . . . . .27 tubes . . . . . . . . . . . . .45 diazepam and
midazolam . . . . . . . .66
Rebreathing circuit (circle Endotracheal tube
breathing system) . . .28 construction . . . . . . .45 Advantages of using
benzodiazepines . . . .66
Non-rebreathing Endotracheal tube
circuits . . . . . . . . . . .34 selection . . . . . . . . . .46 Disadvantages of using
benzodiazepines . . . .66
Selecting a breathing Laryngoscopes . . . . . . . . . .48
Alpha-2 adrenoceptor
circuit . . . . . . . . . . . . . .39 Induction chambers and
agonists:xylazine,
Ambu bags . . . . . . . . . . . . .40 face masks . . . . . . . . . . .49 romifidine,
Ventilators . . . . . . . . . . . . .40 Induction chambers . . . .49 medetomidine, and
Oxygen flow rates . . . . . . . .41 Face masks . . . . . . . . . .50 dexmedetomidine . . . . .68
The oxygen consumption Checking the accuracy of Quick points for
requirements of the flowmeter . . . . . . . . .51 consideration . . . . . .68
the anesthetized Checking the anesthetic Preanesthetic medication
animal . . . . . . . . . . . .41 machine and breathing doses . . . . . . . . . . . . .68
The amount of oxygen circuit for leaks . . . . . . . .52 Differences between the
neededto carry Positive pressure leaks . . .52 various alpha-2
inhalantanesthetic Negative pressure leaks . .54 adrenocepter
from the vaporizer agonists . . . . . . . . . . .68
Checking the scavenging
to the patient . . . . . .41 systemfor leaks and Advantages of using
Amount of oxygen flow malfunctions . . . . . . . . . .56 alpha-2adrenoceptor
required to remove agonists . . . . . . . . . . .70
Monitoring of waste gas
the CO2exhaled by and pollution . . . . . . . . .56 Disadvantages of using
the anesthetized alpha-2 adrenoceptor
animal froma non- Further reading . . . . . . . . . .57 agonists . . . . . . . . . . .70
rebreathing
Dissociatives: ketamine and
circuit . . . . . . . . . . . .41 CHAPTER 2
tiletamine . . . . . . . . . . . .72
Changes to the speed of Preanesthetic medication:
Quick points for
inhalant anesthetic drugs and dosages . . .59
consideration . . . . . .72
uptake during the
transition from Jeff C Ko Preanesthetic medication
intravenous induction Introduction . . . . . . . . . . . .60 doses . . . . . . . . . . . . .72
to inhalant Reasons for preanesthetic Differences between the
maintenance . . . . . . .42 medication . . . . . . . . . . .60 dissociatives . . . . . . . .72
Advantages of using Induction or short-term Further reading . . . . . . . . .103
dissociatives . . . . . . . .74 restraint . . . . . . . . . . .88
Disadvantages of using Arm—Brain (cephalic CHAPTER 4
dissociatives . . . . . . . .74 vein tobrain)
Inhalant anesthetic
Anticholinergics: atropine circulation time . . . . .88 agents . . . . . . . . . . . .105
andglycopyrrolate . . . . .75 Apnea caused by intravenous
JeffC Ko
Quick points for anesthetic agents
consideration . . . . . .75 during induction . . . .89 Introduction . . . . . . . . . . .106
Preanesthetic medication Characteristics of Uptake and distribution of
doses . . . . . . . . . . . . .75 intravenous anesthetic inhalant anesthetic
agents used in dogs agents . . . . . . . . . . . . .108
Differences between
and cats . . . . . . . . . . . . .90 Stages of
atropine and
glycopyrrolate . . . . . .75 Thiopentone (thiopental) anesthesia . . . . . . . .108
sodium . . . . . . . . . . . . . .92 Anesthetic partial
Advantages of using
anticholinergic Overview . . . . . . . . . . . .92 pressure gradient:
induction phase . . . .108
agents . . . . . . . . . . . .75 Induction . . . . . . . . . . . .92
Anesthetic partial
Opioids . . . . . . . . . . . . . . .77 Short-term
pressure gradient:
Quick points for immobilization . . . . .92 recovery phase . . . . .110
consideration . . . . . .77 Other factors to
Types of volume
Preanesthetic medication consider . . . . . . . . . .93 barriers . . . . . . . . . .110
doses and Propofol . . . . . . . . . . . . . . .94
Minimum alveolar
properties . . . . . . . . .77 Overview . . . . . . . . . . . .94 concentration . . . . . . . .112
Differences between the Induction . . . . . . . . . . .94 Factors that decrease
various opioids . . . . .79
Short-term chemical minimum alveolar
Advantages of using restraint . . . . . . . . . . .95 concentration
opioids . . . . . . . . . . .79 Total intravenous values . . . . . . . . . . .112
Disadvantages of using anesthesia . . . . . . . . .95 Factors that increase
opioids . . . . . . . . . . .79 Other factors to minimum alveolar
Neuroleptic–analgesic consider . . . . . . . . . .96 concentration
combinations . . . . . . . . .80 values . . . . . . . . . . .112
Etomidate . . . . . . . . . . . . . .97
Overview . . . . . . . . . . . .80 Factors that do not affect
Overview . . . . . . . . . . . .97
ASA I and II dogs . . . . . .80 minimum alveolar
Induction and concentration
Sick (ASA III, IV, V, maintenance . . . . . . .97 values . . . . . . . . . . .112
III-E, IV-E, V-E),
pediatric, or Other factors to Blood gas solubility . . . . . .113
consider . . . . . . . . . .97
geriatric dogs . . . . . . .81 Pungency and airway
ASA I and II cats . . . . . .81 Alfaxalone . . . . . . . . . . . . .99 irritation . . . . . . . . . . .113
ASA III and IV dogs and Overview . . . . . . . . . . . .99 Isoflurane, sevoflurane,
cats . . . . . . . . . . . . . .83 Induction and and desflurane . . . . . . .114
Case example . . . . . . . . . . . .84 maintenance . . . . . . .99 Isoflurane . . . . . . . . . . .114
Further reading . . . . . . . . . .85 Other factors to Sevoflurane . . . . . . . . .114
consider . . . . . . . . .100
Desflurane . . . . . . . . . .114
Diazepam/ketamine . . . . .100
CHAPTER 3 Face mask and chamber
Overview . . . . . . . . . . .100 induction with
Intravenous injection
Induction and short-term overpressurizing
techniques and
immobilization . . . .100 techniques . . . . . . . . . .116
intravenous anesthetic
agents . . . . . . . . . . . . .87 Other factors to General principles . . . .116
Jeff C Ko consider . . . . . . . . .100 Technique for face mask
Tiletamine/zolazepam . . .101 induction . . . . . . . .116
Introduction . . . . . . . . . . . .88
Overview . . . . . . . . . . .101 Technique for chamber
Intravenous injection
techniques . . . . . . . . . . .88 Induction and induction . . . . . . . .117
immobilization . . . .102 Advantages of using
Intravenous anesthetic
agents . . . . . . . . . . . .88 Other factors to chamber followed
consider . . . . . . . . .102 by face mask
induction . . . . . . . .119
Inconsistencies during Factors that influence Colloids . . . . . . . . . . . .168
anesthesia pulse oximetry . . . . .140 Blood products . . . . . . .168
maintenance . . . . . . . . .119 Normal values for Clinical case examples . . . .171
Premature awakening SpO . . . . . . . . . . .142
2 Healthy patient
duringa surgical Normal values for undergoing general
procedure . . . . . . . .119 PaO2 . . . . . . . . . . . .142 anesthesia for
Anesthetic plane Relationship between elective procedure . .171
becomes too deep . .120 SpO2(or SaO2) Patient with suspected
Recovery from inhalant and PaO2 . . . . . . . .142 portosystemic shunt
anesthesia . . . . . . . . . .121 Hypoxemia . . . . . . . . .142 requiring general
Further reading . . . . . . . . .121 Monitoring ventilation . . .146 anesthesia . . . . . . . .171
Subjective assessment Patient with hemolytic
CHAPTER 5 ofventilatory anemia to be
Anesthesia monitoring function . . . . . . . . .146 anesthetized for
bone marrow
and management . . .123 Objective assessment
aspiration . . . . . . . .171
Jeff C Ko ofventilatory
function . . . . . . . . .146 Patient with bleeding
Introduction . . . . . . . . . . .124 abdominal mass
Managing end-tidal CO . .150
Monitoring circulation . . .125 2 presented for
Subjective assessment Overview . . . . . . . . . . .150 surgery . . . . . . . . . .171
ofcirculatory Interpretation Patient with ruptured
function . . . . . . . . .125 of ETCO2 bladder presenting
Objective assessment concentrations . . . . .150 for bladder repair . . .171
of circulatory Managing abnormal Two to three-month-old
function . . . . . . . . .125 ETCO2 . . . . . . . . . .150 male puppy
Monitoring and Use of multigas (anesthetic presented for
managing blood gas) monitors . . . . . . . .152 laceration repair . . . .171
pressure . . . . . . . . . . . .128 Monitoring and managing Further reading . . . . . . . . .171
Physiology of blood other vital parameters . .154
pressure Body temperature . . . .154 CHAPTER 7
monitoring . . . . . . .128 Bood glucose levels . . .155 Anesthetic emergencies
Non-invasive blood Blood lactate levels . . . .156 and cardiopulmonary
pressure resuscitation . . . . . . .173
Blood electrolytes,
monitoring . . . . . . .130
total protein, and Ann B Weil and Jeff C Ko
Invasive (or direct) packed cell volume . .157 Introduction . . . . . . . . . . .174
arterial blood
pressure Depth of anesthesia . . .157 Respiratory complications
monitoring . . . . . . .134 Proper pain that result in anesthetic
management . . . . . .159 emergencies . . . . . . . . .174
Drug and surgical
effects on blood Neuromuscular blockade Apnea . . . . . . . . . . . . .174
pressure . . . . . . . . . .134 monitoring . . . . . . . . . .160 Hypoventilation . . . . . .175
Interpretation of blood Further reading . . . . . . . . .162 Loss of airway . . . . . . .175
pressure values . . . . .135 Hypoxemia . . . . . . . . .175
Managing blood CHAPTER 6 Laryngospasm . . . . . . .176
pressure . . . . . . . . .135 Fluid therapy . . . . . . .163
Cardiovascular complications
Monitoring oxygenation Ann B Weil that result in anesthetic
andmanagement of Introduction . . . . . . . . . . .164 emergencies . . . . . . . . .177
hypoxemia . . . . . . . . . .140
Composition and fluid Bradycardia . . . . . . . . .177
Subjective assessment
distribution within Hypotension . . . . . . . .178
of oxygenation . . . .140
animals . . . . . . . . . . . .164 Hemorrhage . . . . . . . .178
Objective assessment
of oxygenation . . . .140 Indications for fluid Cardiac arrhythmias . . .179
therapyunder general
Hemoximetry and anesthesia . . . . . . . . . . .164 Other complications that
pulse oximetry . . . . .140 resultin anesthetic
Fluid classification . . . . . . .165 emergencies . . . . . . . . .181
Placement of the pulse
oximeter probe . . . .140 Crystalloids . . . . . . . . .165 Hypothermia . . . . . . . .181
Hyperthermia . . . . . . .181 Dexmedetomidine/ CHAPTER 10
Cardiopulmonary medetomidine-based Anesthetic
resuscitation . . . . . . . . .182 protocols . . . . . . . . . . .200 considerations for
Identification of arrest Dexmedetomidine/ specific diseases . . . .225
viachecking of medetomidine– Ann B Weil and Jeff C Ko
vital signs . . . . . . . .182 ketamine
Introduction . . . . . . . . . .226
combinations . . . . . .201
Action to be taken . . . .182
Hepatic dysfunction . . . . .226
Dexmedetomidine/
Defibrillation . . . . . . . .185
medetomidine– General
Some considerations butorphanol considerations . . . . .226
regarding combinations . . . . . .203 Anesthetic management
cardiopulmonary
Dexmedetomidine/ and pharmacologic
resuscitation . . . . . .186
medetomidine– considerations . . . . .227
Further reading . . . . . . . . .186 butorphanol– Examples of anesthetic
midazolam/ protocols for dogs
CHAPTER 8 diazepam sedative with liver
combinations . . . . . .204 dysfunction . . . . . . .227
Airway management
and ventilation . . . . .187 Dog-specific Anesthetic protocols
dexmedetomidine for cats with liver
Ann B Weil and Jeff C Ko
combinations . . . . . .206 dysfunction . . . . . . .228
Introduction . . . . . . . . . . .188
Cat-specific Other considerations . .228
Managing the difficult combinations . . . . . .210
Cardiac dysfunction . . . . . .228
airway . . . . . . . . . . . . .188
Dexmedetomidine/
General
Difficulty in medetomidine–
considerations . . . . .228
intubation . . . . . . . .188 butorphanol–
Anesthetic management
Laryngospasm . . . . . . .189 ketamine–
and pharmacologic
midazolam/diazepam
Airway occlusion and considerations . . . . .230
combination . . . . . .211
changing the
Examples of anesthetic
endotracheal Alternative injectable
protocols for dogs
tube . . . . . . . . . . . .190 anesthetic
with cardiac
combinations and
Oral surgery . . . . . . . .191 dysfunction . . . . . . .232
techniques for giant
Perioperative oxygen breed dogs . . . . . . .212 Anesthetic protocols for
administration . . . . .192 catswith cardiac
Chemical restraint
Extubation . . . . . . . . . .192 dysfunction . . . . . . .232
combinations for
Ventilation control . . . . . .194 animalswith systemic Respiratory
Indications for use . . . .194 illness or geriatric dysfunction . . . . . . . . .233
Types of ventilation . . .194 dogs and cats . . . . . .213 General
Tiletamine/zolazepam- considerations . . . . .233
Ventilator settings . . . .194
based protocols . . . . . .215 Anesthetic management
Assessing ventilatory
Tiletamine/zolazepam– andpharmacologic
efficiency . . . . . . . . .195
butorphanol– considerations . . . . .233
Types of ventilators . . . . . .195
dexmedetomidine/ Examples of anesthetic
Bellows ventilations . . .195 medetomidine . . . .215 protocols for dogs and
Engler ADS 1000 . . . . .196 Tiletamine/zolazepam– cars with respiratory
Further reading . . . . . . . . .197 dexmedetomidine/ dysfunction . . . . . .234
medetomidine Central nervous system
combination dysfunction . . . . . . . . .235
CHAPTER 9 without opioids . . . .218
General
Injectable sedative and Tiletamine/zolazepam– considerations . . . . .235
anesthesia–analgesia opioid combinations
Anesthetic management
combinations in without
and pharmacologic
dogs and cats . . . . . .199 dexmedetomidine/
considerations . . . . .236
medetomidine . . . . .219
Jeff C Ko Examples of anesthetic
Case examples . . . . . . . . . .220
Introduction . . . . . . . . . . .200 protocols for dogs
Further reading . . . . . . . . .224 with central
neervous system
dysfunction . . . . . . .236
Other Resuscitation of Brachial plexus
considerations . . . . .236 neonates . . . . . . . . .244 blocks . . . . . . . . . . . . .255
Endocrine dysfunction . . . .237 Trauma . . . . . . . . . . . . . . .246 Indications . . . . . . . . . .255
Diabetes mellitus . . . . . .237 General Area and nerves
General considerations . . . . .246 blocked . . . . . . . . . .255
considerations . . . . .237 Anesthetic management Landmarks . . . . . . . . . .255
Anesthetic management and pharmacologic Drugs and equipment . .256
and pharmacologic considerations . . . . .247 Approach . . . . . . . . . .256
considerations . . . . .237 Examples of anesthetic
Ring and point blocks for
Hypothyroidism . . . . . . .237 protocols for felineforelimb declawing
traumatized
General orinterdigital growth
orthopedic
considerations . . . . .237 removal . . . . . . . . . . . .258
patients . . . . . . . . . .248
Hyperthyroidism . . . . . .237 Indications . . . . . . . . . .258
Further reading . . . . . . . . .248
General Area and nerves
considerations . . . . .237 blocked . . . . . . . . . .258
CHAPTER 11
Anesthetic management Landmarks . . . . . . . . . .258
Local anesthetic agents
and pharmacologic Drugs and equipment . .258
and anesthetic
considerations . . . . .238
techniques . . . . . . . .249 Approach . . . . . . . . . .258
Examples of anesthetic
protocols for dogs Jeff C Ko and Tomo Inoue Nerve blocks for thoracic
surgeries . . . . . . . . . . .259
and cats with Introduction . . . . . . . . . .250
endocrine Pharmacology of local Intercostal nerve blocks
disorders . . . . . . . . .238 anesthetic agents . . . . . .250 for thoracotomy . . . . .259
Urinary and renal Types of local Indications . . . . . . . . . .259
dysfunction . . . . . . . . .238 anesthetic agent . . . .250 Area and nerves
General Mechanism of action . .251 blocked . . . . . . . . . .259
considerations . . . . .238 Landmarks . . . . . . . . . .260
Specific actions . . . . . . .251
Anesthetic management Drugs and equipment . .260
Factors that determine
and pharmacologic the potency, onset, Approach . . . . . . . . . .260
considerations . . . . .239
duration, and toxicity Intrapleural infusion
Examples of anesthetic of a local anesthetic nerveblocks for
protocols for dogs and agent . . . . . . . . . . . .251 thoracotomy . . . . . . .260
cats with urinary and
Additives . . . . . . . . . . .251 Indications . . . . . . . . . .260
renal dysfunction . . .240
Toxicity of local Area and nerves
Gastrointestinal
anesthetics and blocked . . . . . . . . . .260
dysfunction . . . . . . . . .241
treatments . . . . . . . .252 Landmarks . . . . . . . . . .260
General
considerations . . . . .241 Dental blocks . . . . . . . . . .252 Drugs and
Infraorbital block . . . . . .252 equipment . . . . . . . .260
Anesthetic management
and pharmacologic Indications . . . . . . . . . .252 Approach . . . . . . . . . .260
considerations . . . . .241 Area and nerves Lumbosacral epidural
Examples of anesthetic blocked . . . . . . . . . .252 blocks . . . . . . . . . . . . .261
protocols for dogs Landmarks . . . . . . . . . .252 Indications . . . . . . . . . .261
with gastric dilatation/ Drugs and Area and nerves
volvulus . . . . . . . . . .241 equipment . . . . . . . .253 blocked . . . . . . . . . .261
Cesarean section . . . . . . . .242 Approach . . . . . . . . . . .254 Landmarks . . . . . . . . . .261
General Mental foramen block . . .254 Drugs and
considerations . . . . .242 Indications . . . . . . . . . .254 equipment . . . . . . . .262
Anesthetic management Area and nerves Approach . . . . . . . . . .262
and pharmacologic
blocks . . . . . . . . . . .254 Epidural catheter
considerations . . . . .243
Landmarks . . . . . . . . . .254 placement . . . . . . . . . . .266
Examples of anesthetic
protocols for Drugs and equipment . .255 Intravenous regional
blocks (Bier blocks) . . .267
cesarean section Approach . . . . . . . . . .255
in dogs . . . . . . . . . .244 Indications . . . . . . . . . .267
Area and nerves Drugs used in CHAPTER 13
blocked . . . . . . . . . .267 analgesic therapies Chronic pain
Landmarks . . . . . . . . . .267 for acute pain . . . . . .280 management for
Drugs and Drugs and dosages for osteoarthritis and
equipment . . . . . . . .267 pre-emptive/ neuropathic pain . . .295
Approach . . . . . . . . . . .267 preoperative pain Amy E Fauber
management . . . . . . . .282
Local anesthesia as an Introduction . . . . . . . . . .296
Opioids . . . . . . . . . . . .282
adjunct to general Classification of pain . . . . .297
anesthesia for eye Alpha-2 adrenoceptor
Physiological pain . . . . .297
surgery . . . . . . . . . . . . .268 agonists . . . . . . . . . .282
Pathologic pain . . . . . .297
Indications . . . . . . . . . .268 Non-steroidal anti-
inflammatory Nociception . . . . . . . . .297
Nerves and areas
drugs . . . . . . . . . . .282 Peripheral
blocked . . . . . . . . . .268
Local anesthetic sensitization . . . . . .297
Landmarks . . . . . . . . . .268
agents . . . . . . . . . . .282 Central sensitization . . .297
Drugs . . . . . . . . . . . . .268
Drugs and dosages for Hyperalgesia . . . . . . . .297
Lidocaine regional intraoperative pain
Allodynia . . . . . . . . . . .297
constant rate management . . . . . . . .284
infusion . . . . . . . . . . . .270 Spinal wind-up . . . . . . .297
Opioids . . . . . . . . . . . .284
Indications . . . . . . . . . .270 Medications used in
Alpha-2 adrenoceptor
themanagement of
Nerves and areas agonists . . . . . . . . . .284
chronicpain . . . . . . . . .298
blocked . . . . . . . . . .270
Other constant rate
Non-steroidal anti-
Landmarks . . . . . . . . . .270 infusion
inflammatory
Drugs and alternatives . . . . . . .284
drugs . . . . . . . . . . .301
equipment . . . . . . . .270 Local anesthetic blocks
Opioids . . . . . . . . . . . .301
Approach . . . . . . . . . . .271 during surgery . . . . .286
NMDA-receptor
Intra-articular injection Drugs and dosages for
antagonists . . . . . . .301
of a local anesthetic . . . .273 postoperative pain
Topical anesthetics . . . .301
Further reading . . . . . . . .273 management . . . . . . . .287
Anticonvulsants . . . . . .301
Opioids . . . . . . . . . . . .287
Tricyclic
Alpha-2 adrenoceptor
CHAPTER 12 antidepressants . . . .301
agonists . . . . . . . . . .287
Acute pain Chondroprotectants . . .301
Non-steroidal anti-
management . . . . . . .275
inflammatory Other drugs that should
Jeff C Ko drugs . . . . . . . . . . .287 be considered . . . . .301
Introduction . . . . . . . . . .276 Take-home pain Alternative therapies . . . . .302
Principles of pain medication . . . . . . . . . .288 Transcutaneous
management . . . . . . . . .276 Buprenorphine . . . . . . .288 electrical
Mechanisms of pain and Tramadol . . . . . . . . . . .288 nervestimulator . . .302
mechanism-based pain Acupuncture . . . . . . . .302
Fentanyl patch . . . . . . .290
management . . . . . . . .277
Physical therapy . . . . . .302
Lidocaine patch . . . . . .290
Origins of somatic and
Low-level laser
visceral pain and pain Similarities and
therapy . . . . . . . . . .302
management . . . . . .277 differences between
lidocaine patches Examples of pain
Analgesic therapies for
and fentanyl management
acute pain . . . . . . . . . . .280
patches . . . . . . . . . .291 protocols . . . . . . . . . . .302
Pre-emptive
NSAIDS . . . . . . . . . . . .292 For mild to moderate
analgesia . . . . . . . . .280
osteoarthritic pain
Further reading . . . . . . . .294
Intraoperative in dogs . . . . . . . . . .302
analgesia . . . . . . . . .280
For severe osteoarthritic
Postoperative pain in dogs . . . . . . .302
analgesia . . . . . . . . .280
For mild to moderate Anesthetic protocols . . . . .316
neuropathic pain Tiletamine/zolazepam
in dogs . . . . . . . . . .302 (Telazol/Zoletil),
For severe neuropathic butorphanol
pain in dogs . . . . . . .302 (Torbugesic),
For mild to moderate dexmedetomidine
osteoarthritis pain (Dexdomitor)
in cats . . . . . . . . . . .302 (TTDex) . . . . . . . . .316
For severe Monitoring of anesthesia
osteoarthritis in shelters, high
pain in cats . . . . . . .302 volume/high quality
spay and neuter clinics,
For neuropathic
and trap–neuter–release
pain in cats . . . . . . .302
environments . . . . . . . .322
Further reading . . . . . . . .303
Further reading . . . . . . . . .322
CHAPTER 14
CHAPTER 16
Cancer pain
Euthanasia . . . . . . . .323
management . . . . . . .305
Jeff C Ko
Michael D Lucroy
Introduction . . . . . . . . . .324
Introduction . . . . . . . . . .306
Principles of euthanasia. . . 324
Prevalence of cancer pain . .306
Euthanasia under
Tumors associated
general anesthesia. . . . . 325
with pain . . . . . . . . . . .306
Two-stage approach to
Physiology of
euthanasia:
cancer pain . . . . . . . . . .306
anesthesia–sedation
Assessing cancer pain . . . . .307 prior to euthanasia. . . . 326
Drugs for cancer pain Drugs and solutions
control . . . . . . . . . . . . .307 used for euthanasia. . . . 327
NSAIDS . . . . . . . . . . . .307 Barbiturate-based
Opioids . . . . . . . . . . . .307 solutions . . . . . . . . .327
Adjuvants . . . . . . . . . . .308 Potassium chloride . . . .327
Other treatments for Intravenous access for
cancer pain . . . . . . . . . .308 drug administration. . . 327
Radiation therapy . . . . .308 Avoiding agonal breathing
Bisphosphonate and muscle spasms . . . . 328
drugs . . . . . . . . . . .308 Further reading. . . . . . . . . 328
Others . . . . . . . . . . . . .308
Case example . . . . . . . . . .310 Appendix
Further reading . . . . . . . .310 Anesthetic dosage reference
ranges . . . . . . . . . . . . .329
CHAPTER 15 Index . . . . . . . . . . . . .330
Anesthesia in shelter
medicine and high
volume/high quality
spay and neuter
programs. . . . . . . . . . 311
Jeff C Ko and Rebecca
A Krimins
Introduction . . . . . . . . . . 312
Preimmobilization
andanesthesia
considerations . . . . . . .314