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26 Cards in this Set
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Atropine (Parasympatholytic/vagolytic)
1-1.5 hrs Decreases salivary secretions/combats bradycardia HR increases/bronchodilation Small patients/when ketamine used/increased vagal tone/bradycardia/good for C-sections Short duration/crosses blood-brain and placental barrier/decreases cardiac sphincter tone (+ regurg)/may induce arrhymias/tachycardia/dries up secretions Pneumonia/tachycardia/tachyarrythmias/hyperthyroidism/hypertrophic cardiomyopathy |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Glycopyrrolate (Parasympatholytic/vagolytic)
3-4hrs Decreases salivary secretions/combats bradycardia HR increases/Bronchodilation Small patients/when ketamine used/increased vagal tone/bradycardia/good for C-sections Short duration/crosses blood-brain and placental barrier/decreases cardiac sphincter tone (+ regurg)/may induce arrhymias/tachycardia/dries up secretions/10x more expensive than atropine/slow onset when given IV Pneumonia/tachycardia/tachyarrythmias/hyperthyroidism/hypertrophic cardiomyopathy |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Xylazine (Alpha-2 agonist)
Decrease anxiety/sedates/increases sympathetic tone/increases vagal tone/causes emesis/reversible with yohimbine HR decreases/Cardiac output decreases to as low as 30% of normal/mucous membranes white or blue/Resp no effects Emetic/in healthy animals for short procedures which you want to reverse Severe hypotension/catecholamine induced arrhythmias (SA or AV nodal block/bradycardia)/potentiates effect of thipental (must decrease dose)/Alpha-1 effects outlast alpha-2 effects Hypotensive animals/animals with cardiac dysfunction |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Acepromazine (tranquilizer)
Works on reticular activating system, doesn't cause total CNS depression/patients still react to stimuli/ceiling effect/depresses response of chemoreceptor trigger zone/sedates/can be good anxiolytic/not analgesic HR if energetic will slow as dog calms, in calm dogs will increase/CO no change/SVR alpha antogonist, dogs with sympathetic tone can experience severe hypotention. Resp no effect Young dogs for sedation/smooth recovery esp with ketamine or telazol/can block halothane induced arrhythmias Not analgesic/still respond to stimuli/Alpha-1 blockade - can cause hypotension when theres sympathetic tone (truama/hypovolemia/cardiovascular shock) Truama (avoid for 5days)/seizure patients/myelograms/hypotensive animals/boxers/cardiovascualr disease |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Droperidol (Tranquilizer)
Potent anti-emetic HR if energetic will slow as dog calms, in calm dogs will increase/CO no change/SVR alpha antogonist, dogs with sympathetic tone can experience severe hypotention. Resp no effect (no as severe as ACP) Older, sicker patients/anti-emetic (parvo puppies)/gastroduodenoscopy procedures Not analgesic/not good sedative/can cause alpha adrenergic blockade/blocks dopaminergic receptors Doberman Pinschers (causes extra-pyramdial side effects, head bobbing). Treat with diphenhydramine or other central-acting anticholinergics |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Medetomidine (Alpha-2 agonist)
Decrease anxiety/sedates/increases sympathetic + vagal tone/causes emesis (reversal with Atipamezole) HR decreases, CO severe decrease (as low as 30% of normal). Resp no effect Healthy animals for short procedures which you want to reverse/lower doses as preanaesthetic agent Marked bradycardia + decrease in CO Only use in young and healthy |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Ketamine (Dissociatives)
Low dose sedates/Mild dose restrains/high dose can be used to reach surgical plane of anaesthesia/increased salivation HR increased due to increased sympathetic tone/ventilation decreases a little + pattern changes, periodic apnea Used in cat premed, can be injected "intra animal" oral dose is high due to first pass effect pH very acidic so stings/increases intracranial pressure/increases intraocular pressure/increases salivation/hyperthermia may occur in dogs in recovery Seizure patients/neuro procedures where increased intracranial pressure must be avoided (eg CSF tap)/hypertrophic cardiomyopathy or other cardiomyopathies/glucoma/hyperthyroidism |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Telazol (Tiletamine, a long acting dissociative + Zolazepam, a long acting dissociative)
Same characteristics as ketamine/diazepam but gives more consistent effects + better anaesthesia HR increases due to increased sympathetic tone/ventilation decreases a little + pattern changes/apneustic breathing not usually seen Premed of choice for crazy cats + agressive dogs Increases intracranial +intraocular pressure/increases salivation/recoveries are rough/hyperthermia may occur in recovering dogs Seizure patients/neuro procedures (eg CSF tap)/hypertrophic cardiomyopathy or other cardiomyopathies/glucoma/hyperthyroidism |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Oxymorphone (Opiod)
4-6hrs Some sedation/primarily analgesic against dull pain/very potent agonist, reversible with naloxone Minimal CVS effects/vagotonic, decreases HR use with anticholinergics such as atropine/ventilation decreases (tidal volume + rate) due to decrease in medullary sensitivty to CO2/panting due to reset of thermoregulation Painful surgeries, decrease build up of pain signals so less sore on recovery/Cardiovascular or neuro compromised animals (due to minimal CVS effects) Panting/mild bradycardia/respiratory depressant/increased CSF pressure (decreased sensitivity to CO2 leads to respiratory acidosis, dilation of cerebral vessels, increase in CSF pressure - out on ventilator to avoid)/GI spasms followed by stasis/controlled drug Gastroduodenoscopy - tightens cardiac + pyloric sphincters/hydrocephalus/pulmonary parenchyma disease (resp depression can force ventilator) |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Butorphanol (Opiod)
1-6hrs Agonist/antagonist/analgesia but other opiods better/good sedation/reverse with naloxone Minimal CVS effects/vagotonic, decreases HR use with anticholinergics such as atropine/ventilation decreases (tidal volume + rate) due to decrease in medullary sensitivty to CO2/panting due to reset of thermoregulation Painful surgeries, decrease build up of pain signals so less sore on recovery/Cardiovascular or neuro compromised animals (due to minimal CVS effects) Panting/mild bradycardia/respiratory depressant/increased CSF pressure (decreased sensitivity to CO2 leads to respiratory acidosis, dilation of cerebral vessels, increase in CSF pressure - out on ventilator to avoid)/GI spasms followed by stasis Gastroduodenoscopy - tightens cardiac + pyloric sphincters/hydrocephalus/pulmonary parenchyma disease (resp depression can force ventilator) |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Morphine (Opiod)
4-6hrs Agonist/good analgesia/good sedation(same level as ACP)/reverse with naloxone Minimal CVS effects/vagotonic, decreases HR use with anticholinergics such as atropine/ventilation decreases (tidal volume + rate) due to decrease in medullary sensitivty to CO2/panting due to reset of thermoregulation Painful surgeries, decrease build up of pain signals so less sore on recovery/Cardiovascular or neuro compromised animals (due to minimal CVS effects) Panting/mild bradycardia/respiratory depressant/increased CSF pressure (decreased sensitivity to CO2 leads to respiratory acidosis, dilation of cerebral vessels, increase in CSF pressure - out on ventilator to avoid)/GI spasms followed by stasis/do not give rapidly via IV (histamine release) Gastroduodenoscopy - tightens cardiac + pyloric sphincters/hydrocephalus/pulmonary parenchyma disease (resp depression can force ventilator)/Asthma or limited respiratory reserve/intradermal skin test (histamine release) |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Meperidine (Opiod)
Short acting Agonist/ weak sedative + analgesia not good for post op Minimal CVS effects/vagotonic, decreases HR use with anticholinergics such as atropine/ventilation decreases (tidal volume + rate) due to decrease in medullary sensitivty to CO2/panting due to reset of thermoregulation. Most CVS depressing of opiods, least bradycardia Painful surgeries, decrease build up of pain signals so less sore on recovery/Cardiovascular or neuro compromised animals (due to minimal CVS effects) Panting/respiratory depressant/increased CSF pressure (decreased sensitivity to CO2 leads to respiratory acidosis, dilation of cerebral vessels, increase in CSF pressure - out on ventilator to avoid)/GI spasms followed by stasis/ IV causes hypotension (histamine release) Gastroduodenoscopy - tightens cardiac + pyloric sphincters/hydrocephalus/pulmonary parenchyma disease (resp depression can force ventilator)/Asthma or limited respiratory reserve/intradermal skin test (histamine release) |
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What are the problems of anaesthesia in Young patients?
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Hypothermia
Decreased drug metabolism, may not have fully developed enzyme systems. Avoid thiobarbiturates in animals less than 3months Dehydration Hypoglycemia (occurs mostly in toy breeds less than 12wks) May need to increase dose at animals at 10months as they are at peak anaesthetic requirement |
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What are the problems of anaesthesia in Old patients?
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Lower muscle mass
organ dysfunction (esp kidney, liver + heart) Changes in brain (e.g increased sensitivity to a drug - opiods and diazepam more effective as a premed in older dogs |
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What are the classes of Premed?
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Parasympatholytics
Tranquilizers Opioids Neuroleptanalgesics (e.g. opioid + tranquilizer) Dissociative Alpha-2 agonist |
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What concurrent medication would cause anaesthetic problems?
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Enzyme inducers or inhibitors - e.g. seizure meds induce barbi
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Thiopental (thiobarbiturate)
Very lipid soluable, crosses blood/brain barrier rapidly- rapid induction, usually smooth. Give 1/4 bolus and rest to effect (excitation can occur with relative underdose) Vagolytic - HR increased in healthy animals then levels off, decrease in sick/decreased cardiac contractility/barbiturate apnea Healthy dogs (puppies around 10m may need more)/often given with diazepam/decreases intracranial pressure/anticonvulsant/to anaesthetise animals to check for laryngeal paralysis Cardiovascular depressant/splenic sequestration of RBCs/repeated doses causes longer duration/can cause ventricular bigeminy/sight hounds have long recovery/without premed is excitment phase/perivascular sloughing (not as common with 2%)/cats more difficult to intubate Animals with CVS disease/sight hounds/animals with low PCV that will loose lots of blood in surgery/animals with hepatic insufficiency (esp portocaval shunt) |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Fentanyl (Opioid)
Usually doesn't provide surgical anaesthesia plane. must supplement with inhalants Minimal CVS effects, but HR decreases/premed with parasympatholytic to combat bradycardia/Resp depressant, pre oxygenate for 4mins and ventilate after induction Only used in dogs (and cat that are virtually dead as causes excitement)/older, sick patients - not young and healthy/dogs with CVS disease Must preoxygenate/excitment phase in young healthy dogs Cats/healthy dogs |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Ketamine (Dissociative) - 10min
Usually given with diazepam/high dose needed for surgical plane/increased salivation (use parasympatholytic) HR increases due to increased sympathetic tone/ventilation decreases and pattern changes/periodic apnea Quick knockdowns for short procedures/older patients Increases intracranial pressure/recoveries are rough (acp can slow) Seizure patients/neuro procedures where increased intracranial pressure must be avoided/hypertrophic cardiomyopathy or other cardiomyopathies/hyperthyroidism/renal insufficiency in cats/if CVS is already working hard (eg sepsis, gastric torsion) |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Propofol (Hindered phenol in soybean oil)
2-5min Depressant anaesthetic with rapid onset +smooth rapid recovery Most CVS depressant of all injectables/vasodilator at low dose- arteriolar dilator at high dose/causes myocardial depression/HR does not change/Ventilation = apneusis C-section, crosses placental barrier but short acting/Brain tumours or head truamas - decreases intracranial pressure/quick knockdowns/bronchoscopy/when inhaled agents cant be used (eg malignant hyperthermia)/recovery good with liver + renal disease Cats can only be used in procedures lasts 20-30min or recovery prolonged/expensive soybean oil good for bacterial growth, once opened can only be kept 1 day CVS compromised patients |
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Agent
Duration Action CVS/Resp effects Indications Pro/Cons Contraindications |
Etomidate (Imidazole)
Depressant anaesthetic with rapid onset Little CVS depression/less resp depression than barbiturates and shorter acting Cats with CVS disease (cant use opioids for induction) Potent adrenocorticosupressive agent (glucocorticoids needed for handling stress, should not be used as infusion)/excitatory, high incidence of muscle tremours - often given with diazepam/high osmolality - can cause haemolysis, give with fluids. Amount of haemolysis with infusion is dangerous so dont use as maintenance |
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Purpose of a Premed?
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1) Decrease anxiety and improve handlability
2) Decrease parasympathetic effects such as salivation, bradycardia and vomiting (vomiting not usually a problem as fasted, can induce vomiting with xylazine or morphine 3) Analgesia - helps for placing IV catheter and prevents build up of pain signals during surgery 4) Decrease dosage of other drugs (induction and maintenance agent) 5) Promotes a smooth recovery (important in painful surgeries + where dissociatives are primary induction agent) |
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CONCURRENT MEDS
What problem would Enzyme inducers or inhibitors cause? |
E.g. seizure meds
These will induce barbiturate metabolism. Not that significant as barbiturates only used for a short time and usually titrate to effect |
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CONCURRENT MEDS
What problems would Cardiac Meds cause? |
E.g. vasodilators, digoxin
May predispose the patient to hypotension and arrhythmias |
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CONCURRENT MEDS
What problems would Diuretics cause? |
Changes in electrolytes due to the diuretics plus the anaesthesia may combien to cause hypotension. In addition these animals may be dehydrated
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CONCURRENT MEDS
What problems would nephrotoxic agents cause? |
Methoxyflurane is metabolised to fluoride which is nephrtoxic. the amount that it produces is not damaging unless the animal is also on another nephrotoxic drug such as flunixin or gentamicin, in which case even a normal animal can go into renal failure
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