Anaesthesia

Topic included:

General Principle of Anaesthesia

Preoperative Assessment, Monitoring and Post operative care

Analgesia

Premedication and Sedation

Intravenous Anaesthesia

Inhalation Anaesthesia

Local Anaesthesia

Anaesthesia for Geriatrics and Neonates

General Principle of Anaesthesia
Aim of anaesthesia:

To prevent awareness of pain

To provide immobility of the patient and when required relaxation of the skeletal muscles

To achieve the above without jeopardising the safety of the animal during the operation
Methods of anaesthesia:
1) General anaesthesia - reversible CNS depression which prevent pain sensation and loss of consciousness (usually by administration of narcotic drug all
anaesthetic are narcotic but not all narcotic are anaesthetic drug)

Inhalation - mainly excreted unchanged through lung, very safe

Intravenous - injected into blood stream as bolus or slow infusion

2) Local Analgesia - temporary peripheral blockade of sensory nerves

Topical application (conjunctiva, mucous membrane of nose, penis, vagina, pharynx)

Infiltration and regional block analgesia (injection into the operation site)

Epidural analgesia (injection into lumbosacral space, temporarily paraplegic)

Intravenous regional analgesia (IV injection to site of an arterial tourniquet)

Pre-operative Assessment, Monitoring and Post-operative care
Preoperative

Assessment needed to assure animal is fit for anaesthesia.

Anaesthetic risk:
Class I : normal healthy patient
Class II: Mild systemic disease
Class III: Severe systemic disease which is not incapacitating
Class IV: Severe systemic disease which is constant threat to life
Class V: Moribund patient not expected to survive for 24 hour with or without operation
History
Clinical Examination
i. Concurrent drug therapy:
i. Inspection

Corticosteroids, NSAIDS, antibiotic

Mucous membrane colour

cardiac glycosides, beta blockers may

Dyspnoea indicate respiratory problem

interact with anaesthetic drugs

Obesity, put cardiovascular system under

great stress
ii. Poor exercise tolerance
ii. Palpation

May indicate cardiac or respiratory

disease
iii. Polydipsia, polyuria
iii. Percussion

May indicate renal disease

Over chest wall

High resonance found with pneumothorax

iv. Vomiting and diarrhoea

May be GIT or systemic disease, likely to

have fluid & electrolyte deficit
v. Inappetance

Common with infectious and painful

condition
vi. Time of last meal (fasting depends on
animal i.e. risk of hypoglycaemia in DM &
neonates)

Risk of vomiting during surgery

vii. Breed

Some breed has adverse reaction towards

anaesthesia

Boxer and very large breed are

profoundly affected by relatively small
doses of phenothiazines

Significance of findings
i. Respiratory disease

Restricted airway

Require attention during surgery

Pleural effusion needed to be drained before

surgery
ii. Cardiac disease

Any limits to heart ability to increase cardiac

output under stress is life threatening
iii. Renal disease

Uraemia markedly sensitivity to anaesthesia

and renal excretion is

Must be corrected with fluid therapy

iv. Hypovolaemic and anaemia

Fluid deficit and fluid circulatory deficit needs

to be corrected before surgery
v. Liver disease

Drug metabolism by liver is essential

Rarely a problem if kidney is functioning well

iv. Auscultation

Respiratory and heart for any abnormalities

v. Special tests
Haematology - haemoglobin & leukocyte
Biochemistry - renal, kidney function test
Radiology - respiratory & heart disease

Increase depth of anaesthesia will continue to

depress the vital centres
An animal in surgical plane may response to
any procedure being carried out

Monitoring
i. A, B, C, must be maintained at all times (min heart rate 60/min min respiratory rate 8/min)
ii. Mucous membrane - CRT < 2 sec (pale mucus membrane: anaemia/blood loss/poor perfusion)
iii. Temperature

vi. Drug interactions:

Corticosteroids depress the adrenal cortex.

May need soluble steroids, hydrocortisone or
dexamethasone, IV

NSAIDs (highly protein bound and result in

increase sensitivity to anaesthesia, e.g.
thiopentone)

Antibiotic, cardiac glycoside, anticonvulsive

therapy, and premedication (refer pg. 19)

More fat soluble drugs are taken up more

rapidly by the brain

Post Operative (sternal recumbency with neck extended)

i. Recovery as important as during surgery
ii. ABC, mucous membrane, temperature
iii. Analgesia, given b4 animal gain consciousness

iv. Depth of anaesthesia- surgical plane = stage III plane 2

v. Fluids

iv. General comfort, bedding, food, water

v. TLC

Anaesthesia
Analgesia
Recognise acute pain: vocalisation & guarding behaviour when moved or touched, aggressive or self- mutilation
Recognise chronic pain: lameness, stiffness or recumbent + mild deviation form normal behaviour patterns
Use of analgesic:

Control of acute pain

Control of chronic pain such as skeletal pain

During anaesthesia , decrease amount of anaesthetic used

In a neuroleptanalgesic mixture - to provide sedation and facilitate handling of ferocious animals.

Opioids:

Analgesia + respiratory depression + sedation or excitement + nausea, vomiting & defecation + depression of cough reflex + tolerance & dependence after prolonged use

Part of a neuroleptanalgesic mixture

Side effects of morphine: vomiting, respiratory (panting) & cardiovascular depression & bradycardia & increases intracranial pressure

Morphine is contraindicated in treating pain associated with pancreatitis or biliary obstruction due to spasm produced in gut sphincters

Pethidine has rapid onset but shorter duration when compared to morphine & no vomiting & defecation

NSAID is not for severe pain but effective in chronic pain associated with orthopaedic diseases
Indication of analgesia:

Following trauma (esp. morphine in acute pain)

Pre-operative (alleviate pain prior to surgery, enhance sedation & reduce amount of anaesthetic agent used)

Post-operative (esp. opioids for severe pain caused by thoracic, orthopaedic, aural & abdominal surgery)

Chronic pain (esp. NSAID)

Nursing care (pain relief to enhance well being of the animal)

Type of analgesic:
A n a lg e s ia
O p io id s
o p io id a g o n is t
p e t h id in e
fo r a n a lg e s ia &
p r e m e d ic a t io n

dog
3 -4 m g /k g IM
2 -3 h o u rs

p a r t ia l o p io id a g o in is t
M o r p h in e
( fo r s e v e r e p a in s )
a s a n a lg e s ia &
p r e m e d ic a t io n

cat
5 m g /k g
2 h o u rs

dog
0 .1 -0 .2 5 m g /k g IM
4 - 5 h o u r s d u r a tio n

b u p r e n o r p h in e
( T e m g e s ic )
0 .0 1 5 m g /k g
4 h o u r s d u r a t io n

cat
0 .1 -0 .2 m g /k g
IM /S C
6 - 8 h o u r s d u r a t io n

b u to rp h a n o l
( T o r b u g e s ic )
0 .2 -0 .8 m g /k g
3 h o u r s d u r a t io n

o p io id a n t a g o n is t
N a lo x o n e
(N a rc a n )

D ip r e n o r p h in e
( S A R e v iv o n )

N S A ID S

M is c e lla n e o u s

p h e n y lb u ta z o n e

k e ta m in e

A s p ir in

M e t h o x y flu r a n e

M e fe n a m ic a c id
(p o n s ta n )

N it r o u s o x id e

F lu n ix in

x y la z in e

P ir o x ic a m

Anaesthesia
Premedication and Sedation
Premedication
Aims:

To calm and control the patient

To relieve pre-operative pain

To reduce to total dose of anaesthetic

To reduce unwanted autonomic side effects

(excessive salivation & bradycardia)
Drug used: Sedative type of drug or Analgesics
Parasympathetic antagonists of muscarinic receptors
to reduce salivation and prevent bradycardia,
decreases GIT motility

Atropine sulphate: 0.02 - 0.1mg/kg IM/SC/IV

(contraindicated in pre-existing tachycardia)
(side effects: pupil is widely dilated - mydriasis)

Others:

Glycopyrrolate

Hyoscine

Sedation
Simple definition:
Tranquilliser - relieves anxiety, tension without drowsiness
Sedative - calms the patient but causes drowsiness
Hypnotic - will induce sleep from which it is possible to
arouse the patient

Sedative takes effects if animal are left in dark quite place

Drug used:
i. Phenothiazines - primarily tranquilising agents (e.g. Acepromazine 0.1 mg/kg)
General properties: Tranquilization + Sedation & Anti-emetic + Spasmolytic +
Antihistamine + Hypotension and Adrenergic block + antidysrhythmic
Side effects: effects of adrenergic block (hypotension + excessive vagal tone + bradycardia)
(lowers the epileptic threshold & predispose to convulsions) (effective in nervous & sick
animals but not in vicious animals) (ACP has no analgesic effect)
ii. Butyrophenones (Droperidol, Fluanisone, Azaperone)
iii. Apha-2 adrenoceptor agonists drug and their antagonists
(e.g. Xylazine - Rompun 1 - 3 mg/kg IM/SC)
General properties:

Reduce muscular hypertonicity as in ketamine anaesthesia

Markedly reduce dose required for subsequent anaesthetic but delay onset of induction
of IV or inhalation anaesthetic

Hypotension: superficial veins are difficult to visualize

Skeletal muscle relaxation

Side effects:

Cause bradycardia & hypotension & hypoventilation

Reduce threshold for production of adrenaline to induce cardiac arrhythmias

Vomiting on induction

Slight muscular tremors

Reduce intestinal motility

Inhibit insulin release (causing hyperglyacemia) & decrease in ADH (causing diuresis)
Contraindication:

Dehydated animal

Late term pregnant animal

Other apha-2 adrenoceptor agonists:

Medetomidine (Domitor )

Detomidine (Domosedan ) in horses

Alpha 2 adrenoceptor antagonists

Atipamezole (Antisedan ) for medetomidine & yohimbine (Reversin )

iv. Sedative/Opioid combinations (neuroleptanalgesia):
Phenothiazine combinations:
ACP/omnopon/scopolamine IM
ACP/ pethidine IM

ACP/ buprenorphine IM

Anaesthesia
Intravenous anaesthesia
Indication:

For induction of anaesthesia to be followed by inhalants

As a sole aneasthetic for minor procedure

As supplement to inhalation anaesthesia

To aid in treatment for tetanus and status epilepticus

Advantage of intravenous anaesthesia:

Simple

Rapid onset

Relatively pleasant for animal

No apparatus needed

No explosion/pollution hazard

Non irritant to airway

Barbiturates (only IV)

Thiopentone sodium

12.5mg/kg give to effect

should use as 2.5% for animals < 30

kg & 5% for animals > 30 kg

Highly lipid soluble, weak organic

acid, highly protein bound

Therefore rapid onset of

unconsciousness (20 -30 sec)

Dogs which are thin (greyhound),

emaciated, hypoproteinaemic increase
in sensitivity and delayed in recovery

1/2 calculated dose, then titrate to

effect
Pentobarbitone sodium 6%

25 - 30 mg/kg give to effect

Half the calculated dose & then

titrate to effect

Slower onset, take time to cross the

blood-brain barrier

Respiratory & cardiac depression

prolonged

Poor analgesia

Slow recovery

Hypothermia is common in
prolonged recovery
Effect or barbiturates:

Reduction of respiratory rate

Cardiac arrhythmia

Hypotension

Classes of drug:
1) Barbiturates
2) Steroids
3) Dissociative agents
4) Propofol
5) Neurolepanaesthetics

Disadvantage

Superficial vein may be difficult to find

Animal may struggle

Drug may be irritant if given perivascularly

Once injected cannot be removed

Drug may be cumulative

If animal are not intubated, not ready for respiratory emergency

Possible excitement in recovery

Possible apnoea on injection

Steroids
Alphaxalone/Alphadolone acetate
Saffan- mixture of both steroids

Not licensed to use in dogs

Can be fatal, anaphylactic

For cats: IV & IM

No hormonal effect

Induction same as Thiopentone

Metabolised by liver

30 - 50% protein bound

Wider and safer margin than

barbiturates

Less apnoea at induction

Like all anaesthetic, will cross

placenta

Dissociative Agents
Ketamine (duration-30mins)

Onset slow

Animal appear dissociated from its

environment

Eyes remain open and swallowing

reflex persist

Lacrimation and salivation

Central stimulation of sympathetic

system tachycardia and
hypertension

Respiratory depression initially and

periodic breath holding

Metabolized by liver

Combination with xylazine

Violent recovery if used alone

Hypothermia + corneal drying

Poor muscle relaxation if used alone

Hyper tension (not suitable for

intraocular surgery)
Cat
Ketamine 20 - 25 mg/kg IM
Xylazine 1 mg/kg IM
Ketamine 10 - 15 mg/kg IV
Dogs
Ketamine 10 mg/kg IM 10 mins after
Xylazine 1 - 2 mg/kg
Tiletamine

Propofol (hindered phenol anaesthetic)

Rapinovet (duration - 30 min)

Rapid onset

Highly protein bound

Dose will enhance in

hypoproteinemic state

Hepatic metabolism. T1/2 = 30 mins

Respiratory depression

Rapid & full recovery in 15 - 20 min

For Caesarean section: duration

between induction & foetal delivery
must be less than 10 minutes

Neuroleptanaesthetic

Satisfactory for restraint and minor

procedure

Combination with potent

opioid/narcotic
Advantages:

Ease of administration

Potential for administration of an

antagonist
Disadvantages:

Narcotic component produced marked

respiratory depression and cardiac
impairment

Administration of narcotic antagonist

will also abolish all pain relief

Poor muscle relaxation

Potential for accident to occur

Sensitive to noise and light

May cause defecation and vomition

e.g. S.A. Immobilon (etorphine +
methotrimeprazine)

Anaesthesia
Inhalation Anaesthesia
Gas

Nitrous oxide (not used alone)

Volatile Liquids

Diethyl ether (inflammable & explosive in oxygen, decompose by light, air & heat,
muscle relaxation, nausea & vomiting during post-anaesthetic period)

Halothane (non-inflammable, decompose by light, hypotension due to reduced

myocardial contractility, depressed respiration, may sensitise the heart to
catecholamines, shivering & tremor during recovery)

Methoxyflurane (good analgesia & muscle relaxant, hypotension & respiratory

depression)

Enflurane (less potent than halothane)

Isoflurane (expensive & least toxic, stabilise cardiac rhythm & dose not sensitise the
to adrenaline, less potent cardiac depressant than halothane, indicated in cardiac
condition, causes respiratory depression)
Semi-close method
Use of anaesthetic machine & an anaesthetic circuit
No CO2 absorption & fresh gas must be used to eliminate the CO2 from
the circuit
4 main types of circuit

e.g.: Ayres T-piece

Recommended for animal < 10 kg

Require higher flow rate of fresh gas

Flow rate: 2.5 to 3 x minute volume

Minute volume = tidal volume x respiratory rate (or 300 ml/kg)

Tidal volume : 10 - 15 ml/kg

Respiratory rate = 20 breaths per minute

Others:

Magill circuit (flow rate = minute volume)

Bain Co-axial circuit (flow rate: 2.5 to 3 x minute volume)

Lack system (flow rate = minute volume)

Gases used in association with anaesthesia

Oxygen

CO2 (to increase depth of anaesthesia & speed of

induction, to stimulate the onset of respiration after a
period of IPPV)

good

4 basic technique for administration of Inhalation agents

Open method (placing absorbent material on near the

animal's face, can't control depth of anaesthesia)

Semi-open method (absorbent material in mask)

Semi-closed method

Closed Method
heart

Closed method
Use of anaesthetic machine & an anaesthetic circuit
Incorporated soda lime to absorb the exhaled CO2 thus don't require
high flow rate to remove CO2 (more economical)
Not for animal < 10 kg (resistance to respiration provided by the
soda lime)
Soda lime = 95% CaOH + 5% NaOH + 1% KOH
Economy, less risk of explosion, conserve heat & moisture & less
pollution of atmosphere
e.g.: Circle system

Unidirectional flow of gases by one way valves

When vaporiser inside circuit (VIC), halothane vaporised by patients

respiratory effort. Hence, the deeper the breathing, more halothane is
vaporised

Respiration becomes depressed as anaesthesia deepens and less

halothane is vaporised. (built in safety mechanism)

Very economical

VOC, volatile agent is vaporised by the flow of fresh gas

Known concentration can be delivered and estimated

Other:

To-and-Fro system

A minimal flow rate of 1 litre of oxygen per minute is recommended

Function of endotracheal tube:

Decrease dead space

Allow for a patent airway

Protect patient form aspiration of vomitus

Allow anaesthetist to ventilate the patient

Possible complications of endotracheal tube intubation:

Intubation into bronchus

Pressure necrosis of tracheal mucosa

Spread of infectious disease

Obstruction of the endotracheal tube

Extubate when the animal begin to swallow

Leave endotracheal tube much longer than is should in bradycephalic breed dogs (more likely to vomit after anaesthesia or experience airway obstruction)

Long term hazard of exposure to anaesthetic waste gases:

Reproductive failure

Liver damage

Kidney damage

Nervous system dysfunction

Reduce waste gases by:

Use of cuffed endotracheal tube

Ensuring the anaesthetic machine has been tested for leaks

Use an injectable induction method rather than mask or chamber

Anaesthesia
Anaesthetic circuit (review JAMVA)
Intermittent positive pressure ventilation (IPPV)

Resusitation of apnoeic patients

Used during intrathoracic surgery and when muscle relaxant are used

Physiological changes occurred when IPPV is used:

Intrapleural and intrapulmonary pressure become positive instead of negative

Venous return and cardiac output are reduced

This is compensated by rise in peripheral venous pressure brought about by venoconstriction

Harmful effect can be seen as in hypovolemic shock

Therefore, essential to ensure the blood volume is within normal limits before using IPPV
Local anaesthesia:
Ways to produce local anaesthesia
Surface

Local infiltration

Regional

Mucous membrane, cornea

Directly at surgery site, field blocks

Specific nerve block, spinal/epidural analgesia

(refer pg 80 for epidural analgesia procedure)

IV regional
analgesia
limbs

Use of adrenaline with local anaesthetic:

Most local analgesic drugs (except cocaine) cause vasodilation and increase in blood supply, both limits the action of the analgesic & increase systemic
toxicity by increasing the speed of absorption

Adrenaline which is a vasoconstrictor will counteract this effect of analgesic

However, it may also cause ischaemic damage, hair may change colour after intradermal/SC injection

List of LA (lignocaine + procaine + prilocaine + bupivacaine)

Lignocaine:

Excellent surface analgesia

Minimal tissue irritation & low toxicity

Rapid onset & action for 1 h (1 1/2h with adrenaline)

Anti-arrhythmic

Causes drowsiness & sedation

Local anaesthetic techniques:
1) Inverted "L" block
2) intravenous regional analgesia of the limbs (ischaemic damage from the tourniquet & ischaemic pain & hypotension on removal of the tourniquet)
3) auriculo-palpebral block (no analgesia but paralyses eyelids) (site: upper border of the posterior part of zygomatic arch)
4) epidural analgesia (analgesia of the abdominal, caudal & hindquaters) (site: epidural space of the lumbosacral junction or intercoccygeal junction)
5) paravertebral block

Anaesthesia
Anaesthesia for Geriatrics and Neonates: (pre-anaesthetic database is important)
Obese
Definition
PathophysioLogical
consideration

Guidelines

Premedication

Induction

Respiratory: functional residual

capacity (FRC) due to mediastinal &
diaphragmatic encroachment on the
lung space (reduces tidal volume)
FRC leads to terminal airway
closure in lower most of the lung
leading to increase in airway
resistance
pulmonary compliance due to the
heavy chest wall & restriction in
diaphragmatic movement into
abdomen
respiratory reserve & arterial O2
tension
Increased cardiac workload at rest due
to added weight & arterial hypoxemia
Reduce myocardial contractility due
to fat infiltration
Reduce cardiovascular reserve
Fatty infiltration of liver compromise
hepatic function & drug metabolism
Use mild sedation & local analgesia
Deep Xylazine sedation is not
recommended
Provide respiratory support whenever
necessary (IPPV) during
hypoventilation
Create a venous excess to emergency
All injectable drug dosage is based on
estimated lean body weight
Minimal pre-medication
Atropine 0.02 mg/kg
ACP 0.05 - 0.1 mg/kg
All based on estimated lean body
weight
Avoid xylazine as much as possible

Pre-oxygenation is advantageous
Don't use mask induction
Most practical = thiopentone to effect
Rapid intubation & transfer to
inhalation anaesthesia

Geriatrics
10 years dogs, 12 years for cats

Hepatic insufficiency & reduced ability to

metabolise and excrete drug

Renal reserves commonly decrease, episode

of hypotension would be disastrous

Plasma protein binding of drug can alter

with age drug clearance rate reduces

Age animal normally have some degree of

cardiac diseases (mitral insufficiency &
endocardiosis)

cardiac output & low cardiac reserve

Increase in elestin content in the lung, more

rigid chest wall, reduce compliance, less
effective gas exchange, tendency for airway
closure

Low basal metabolic rate

Increase response to muscle relaxant

(reduce dose to 1/3)

Pediatrics
< 12 weeks of age

Larger surface area to body

weight ratio and high basal
metabolic rate

Lack subcutaneous fat and have

higher obligatory heat loss, poor
thermogenesis & lack capacity to
shiver (very susceptible to
hypothermia under anaesthesia)

Higher percentage of body water

than adult and ratio between
ECF to ICF is greater (prime
candidate for dehydration)

Renal function is not fully

developed

Pulmonary is not fully develop,

fewer alveoli and surfectant
(reduced lung area for gases
exchange & low tidal volume)

Low total circulating blood

volume (any blood lost likely to
lead to hypovolemia)

Period of hypovolemia, hypotension should

be avoided
Reduce dosage to minimise side effects
Drug requires extensive metabolism should
be avoided
If possible, drug with specific antagonist
should be used
Avoid ketamine (excreted via urine)

Use of high doses of phenothiazines should

be avoided (0.03 - 0.05 mg/kg)
Pethidine is the analgesic of choice for
elderly animals, 1mg/kg should combine
with ACP. Avoid xylaxine
Anticholonergic drugs should not be
administered as routine since aged animal
may suffer from tachycardia.
Glycopyrrolate is preferred

Short-acting IV agent : thiopentone,

propofol in cats should be chosen
Pentobarbitone which needs to be
metabolised more should be avoided
Circulation time often slow, drug should be
given slowly
Halothane or isoflurane administered in a
N2O/O2 is preferred
Avoid hypoxia. At least 30-40% of O2
should be used
Keep anaesthesia as light as possible and set
up IV fluid to prevent hypotension
IPPV, analgesic with low dose of halothane
is recommended
Hypothermia must be avoided, especially in
old cats
In heart patient, 0.9% normal saline should
be avoided. Balance polyionic solution
should be used instead
Pulse, respiration, mucous membrane
should be monitored closely
Body temperature should be maintained
Pulse, respiration, mucous membrane
should be monitored closely
IV line should be kept open for drug or
fluid administration
Additional oxygen should be available and

Maintenance

Provide IPPV right from the onset

(large tidal volume 20 mg/kg &
slower rate 8 - 10/min)
Halothane 1.0 - 1.5% (halothane is
absorbed into fat tissue & require long
time for elimination)
"Sigh" the lung to reverse atelectasis
Maintain an inspired O2 concentration
art 33% throughout the anaesthetic

Recovery

Maintain IPPV until the inhalant

anaesthetic is eliminated & the animal
starts to move
"Sigh" the lung to reverse atelectasis
Close monitory of respiration
Avoid sedation

Ideally, animal should be left

with dam until anaesthesia is
induced
Ensure do not become
hypothermic, hypovolemic
Animal should be weighed
accurately
Keep duration if anaesthesia as
short as possible
In animal up to 4 weeks, premedication is not necessary
Pethidine alone is sufficient
If greater degree of sedation
needed, 0.01 - 0.02 mg/kg of
ACP
Avoid forceful physical restraint
(avoid release of large dose of
catecholamines cardiac
arrhythmia)
Induction via inhalation is
preferred
Mask is preferable
Halothane & isoflurane is
preferred
Narcotic pre-medication to
improve analgesia will reduce
tachypnoea
Delivered via apparatus and
must be light. Not to traumatize
the larynx if intubation is done
Maintain IPPV
Tube (< 5 mm) non-cuffed
should be cut to an appropriate
length to avoid dead space
Require higher inhalant
anaesthetic dose of 1.5 - 2.0%
Excess blood loss should be
replaced a volume for volume
basis (maintain IV fluid at 5 10ml/kg/h)
Careful observation
Important to maintain body
temperature
IF recovery delayed, placed
animal in a warm oxygen
enriched atmosphere

Animal is prone to post-operative

atelectasis because of reduced
ambulation & an inefficient cough
mechanism (make animal cough
twice daily in the post-operative
period & force them to expand the
lung)

given if needed
Antagonist should be administered if
necessary
Pethidine at 2 - 3 mg/kg IM, 2 - 3 hours
analgesia
Recovery is slower due to decreased renal
& hepatic function & hypothermia

Give glucose if animal is

hypoglycemic
Pain relief if necessary
(pethidine 1 - 3 mg/kg IM)

Anaesthesia
Various Stages of Anaesthesia
Stage

Behaviour

Respiration

Cardiovascular
function

Response to
surgery

Depth

Eyeball position

Pupil size

Pupil response

Muscle tone

Reflex response

Disorientated

Normal rate 20
-30 breaths/min,
may be panting

Heart rate
unchanged

Struggle

Not
anaesthetised

Central

Normal

Present

Good

All present

II

Excitement
Struggling
Vocalisation
Paddling
Chewing
Yawning

Regular, may
hold breath or
hyperventilate

Heart rate may

increase

Struggle

Not
anaesthetised

Central, may be
nystagmus

May be dilated

Present

Good

All present but

may be
exaggerated

Regular rate 12
-20 breaths/min

Strong pulse
rate, heart rate
90 beats/min

May response
with movements

Light

Central or
rotated, may be
nystagmus

Normal

Present

Good

Swallowing
reflex is poor or
absent, others are
present but
diminished

Regular rate
(may be
shallow) 12-16
breaths/min

Heart rate less

than 90
beats/min

Heart rate and

respiration may
increase

Moderate

Often rotated
ventrally

Slightly dilated

Sluggish

Relaxed

Patellar, ear
flick, palpebral
& corneal
reflexes may be
present, others
are absent

III
Plane
3

Shallow rate
less than 16
breaths/min

Heart rate 60 90 beats/min,

CRT increased
and pulse rate is
weak

None

Deep

Usually central,
may be rotated
ventrally

Moderately
dilated

Very sluggish
and may be
absent

Greatly reduced

All reflexes are

absent

III
Plane
4

Jerky

Heart rate < 60

beats/min,
prolonged CRT
and pale mm

None

Over-dose

Central

Widely dilated

Unresponsive

Flaccid

No reflex
activity

Apnoea

CVS collapse

None

Dying

Central

Widely dilated

Unresponsive

Flaccid

No reflex
activity

III
Plane
1

III
Plane
2

IV

Anaesthetised

Moribund

Anaesthesia
Common Anaesthesia Procedure
Checklist:
1) Atropine sulphate 0.65 mg/ml 0.05 mg/kg subcutaneous injection
2) ACP 1 mg/ml 0.1 mg/kg subcutaneous injection
3) Syringe 2 or 5ml
4) Needle 23G or 25G (18G = Pink, 21G = Blue, 23G = Green, 25G = Brown, 26G = Orange)
5) Cotton + alcohol
6) Thiopentone 60 mg/ml (6%) 30 mg/kg intravenous infusion (25-30mg/kg)
7) Syringe 5ml
8) Needle 23G or 25G
9) Shaving blade (clipper)
10) Cotton + alcohol
11) Endotracheal tube size
12) Lubricant (KY jelly) on a piece of tissue paper
13) Gauze 15-30cm long to secure the E-T tube
14) Laryngoscope blade size
15) Eye ointment
1)

Xylazine 20 mg/ml 0.2 mg/kg to achieve sedation intramuscular injection

To maintain intravenous infusion

1) Indwelling catheter
2) Tape (3x)
3) Saline
4) Extension tube
5) Macrodrip (20 drops/ml) /microdrip (60 drops/ml)
6) Swab
7) Shaver
8) Scissors
9) Needle?
Barbiturate causes splenomegaly
Site for intravenous injection in pig (ear veins)
Tracheal intubation requires Plane 2 anaesthesia to avoid undesired reflexes e.g. laryngeal reflex
Dosage of anaesthetic agent depends on response desired & given until desired effect is obtained
Don't give whole amount in single infusion (may straight go to Stage 4), give 2/3 in a fast rate (to avoid Stage 2), monitor the response & determine the depth of
anaesthesia, infuse slowly until desired plane achieved but don't delay
Make sure anaesthetic agent is injected directly into the vein, slight puncture & leakage may cause irritation to the surrounding tissue (necrosis)
In ruminant GA will cause lateral recumbency (leading to bloat)
Give sedative to calm & depress the animal & inject local anaesthetic agent to the site of surgery to prevent pain stimulus
The anaesthetic machine

Oxygen tank & anaesthetic tank with pressure valves to keep at 40-60psi

Flow meter

Vapourizer

Soda lime canister (absorb CO2)

Reservoir bag (rebreathing bag - to regulate rate of filling/deflation, used to apply IPPV)

Pressure release valve

Connecting tubing

Inspiratory/expiratory valves

Endotracheal tube
Induction using inhalation agent:
Induction = from first breath of anaesthetic to Stage III
1)
2)
3)
4)

slow inducer slow emergence

fast inducer fast emergence
too rapid induction = loss of control over death of anaesthesia
too slow induction = prolonged Stage 2 (danger)

Method to speed up induction

1) expose the animal to higher concentration of gas vapour initially i.e. pushing the anaesthetic
2) induce anaesthesia first with i.v. anaesthetic (thiopentone) & follow by inhalation agent as maintenance
3) premedicate with sedative to depress CNS
Signs of anaesthetic toxicity:
1) shallow & slow respiration
2) dilated pupils as hypoxia develops
3) weak rapid pulse
4) reflexes disappear
5) skin is cold & cynotic
Treatment for toxicity

1)
2)
3)

mechanical obstruction avoided/must be cleared

artificial respiration with 100% oxygen to treat hypoxia
doxapram given to stimulate respiratory centre

Aims of pre-anaesthetic medication:

1) calming effect
2) reduce pain & irritation during GA preparation
3) avoid surgical shock
4) prevent vomiting (emesis) Acepromazine is an anti-emetic drug
5) relaxes muscle
Anaesthetic emergencies
ABC + hypothermia + fluid + correct cardiac rhythm + correct acidosis & cerebral oedema
Causes of apnoea

airway obstruction

resistance to breathing in anaesthesia circuit

central depression (overdoge, hypoxia, hypercapnia)

light anaesthesia (tend to breath holding)

thoraxic pain
Solution:

doxapram 1 - 2mg/kg if given injectable anaesthetic agent or 5 - 10mg/kg if given inhalation agent

stimulate nasal septum with 21 G needle

To correct circulation = cardiac massage

If in shock = give warmed fluid to restore circulation
Bradycardia = atropine
Ventricular asystole = adrenaline
Ventricular fibrillation = lignocaine then massage + adrenaline
Correct acidosis ( sodium bicarbonate)
Correct cerebral oedema (corticosteroid/diuretics)

Pain assessment

Hx

PE

Mental status (dull, depressed, aggressive)

Gait, posture, facial expression

Vocalisation

Response to analgesia
Distress scoring

Appearance (grooming, coat, dischargesm piloerection, huncked up)

Food/water intake, body weight change

C/s TPR

Natural behaviour (mobile, alert, isolated, vocalisation, restless, self-mutilation)

Provoked behaviour
Pain management

Analgesia is most effective if given before pain is experienced

Most effective if given as continuous infusion