clinical induction + maintenance

Options of induction agents

Propofol, alfaxalone, ketamine, inhalation agents, thiopental, GGE, etomidate, potent opioids

Species differences in induction agents - dogs

Variety in shape+size+ temperament

Obesity

Brachiocephalic

Easy IV access

Can induce to effect

Species differences in induction agents - Cats

Smaller body mass

Challenging IV access

Care with repeated propofol

Can induce to effect

Species differences in induction agents - Horses

Variety in shape + size

Flight reaction

Large body mass

Easy IV access

Don’t want to be recumbent

Can’t easily administer to effect

Species differences in induction agents - Farm

Follow food safety legislation

Licensing of injectable induction agents in UK - for cats

propofol, alfaxalone, ketamine

Licensing of injectable induction agents in UK - For dogs

Propofol, alfaxalone, ketamine

Licensing of injectable induction agents in UK - For horses

Ketamine, thiopental

Licensing of injectable induction agents in UK - For LA

Ketamine, thiopental

Licensing of injectable induction agents in UK - What to use in rabbits

Alfaxalone

Licensing of injectable induction agents in UK - What to use in sub human primates

Ketamine

ROA for propofol

IV

ROA for Alfaxalone

IV, IM

ROA for Ketamine

IV, IM, transmucosal

ROA for Thiopental

IV

ROA for Etomidate

IV

Which inj induction agents are IM

Alfaxalone, ketamine

Options of maintenance agents (inj+inh)

Isoflurane, sevoflurane, propofol, alfaxalone, ketamine, thiopental, halothane, desflurane

Maintenance agent licensing - for cats

Isoflurane, sevoflurane, propofol, alfaxalone

Maintenance agent licensing - for Dogs

Isoflurane, sevoflurane, propofol, alfaxalone

Maintenance agent licensing - for Horse

Isoflurane, ketamine

Maintenance agent licensing - for LA

Isoflurane, ketamine

Maintenance agent licensing - for Birds, small mammals, reptiles

Isoflurane

Issues with inh maintenance agents

Equipment, greenhouse gases with high global warming potential

Species differences in maintenance agents - dogs+cats

Dose dependent CV + resp depression + vasodilation, no thermoregulation

Species differences in maintenance agents - Horses

Dose dependent CV + resp depression + vasodilation, no thermoregulation

Worse than SA

Adjuncts to maintenance

Analgesia, temp, monitoring

Adjuncts to maintenance- analgesia provided by

Local blocks, opioids, ketamine, alpha 2 agonists, lidocaine, positioning

MAC def

Min alveolar conc - when 50% of patients don’t respond to noxious stimuli

Importance of protecting the airway as anaesthesia causes

Relaxation of laryngeal + pharyngeal tissues

Removal of swallowing reflex

Resp depression → apnoea

Options of airway management

Face mask, endotracheal tube, laryngeal mask (supraglottic airway device)

Options of airway management- face mask + and -

+variety in shape, size,

- small animals + foals only, doesn’t protect airway, environmental pollution (inhalant anaesthesia), hard to support ventilation

Options of airway management - ET tube types depends on

material, size, cuff, cuff type

Options of airway management- when to use face mask

SA + foal Pre oxygenation

Options of airway management- when to use supraglottic airway devices (LMAs, V gels)

Bronchoscopy, cats, rabbit

Which species often get laryngeal spasm

Pigs, sheep, goats, cats

What to do to reduce laryngeal spasm

Intubeaze- lidocaine spray on larynx (wary of doses)

Methods to achieve airway access in emergency

Urinary catheter (SA), 18G needle into trachea (SA), tracheostomy

What to do in difficult intubation

Bougie (urinary catheter/ stomach tube), stylet, tracheostomy, endoscopic guidance