FECAVA BASIC PRACTICES IN VETERINARY

ANAESTHESIA AND ANALGESIA

1: THE ANAESTHETIC PLAN

The anaesthetic plan covers the whole procedure – from • Check materials and equipment
premedication to recovery. - Fully check the anaesthetic machine; from the oxygen
• It is for use in every patient scheduled for anaesthesia. supply to the endotracheal (ET) tubes.
• It draws attention to particular things that might go - Do you have any leaks? Is the spare oxygen tank full?
wrong for this unique patient. Do you have to correct size of ET tube? Is a smaller one
• It prompts thinking about how to deal with any available if required? Does the light on the laryngoscope
potential problems. work? Do the connectors fit? Is the vaporiser full?
• It will allow early intervention to stop small problems - How will the patient be positioned on the table?
from turning into disasters. Is the surgical/diagnostic kit ready?
• It incorporates a patient risk assessment. - Are the monitors ready, calibrated & working?
https://www.asahq.org/standards-and-guidelines/ - How will the patient’s temperature be monitored
asa-physical-status-classification-system and maintained?
- Is any special equipment required for this patient?
CLINICAL EXAMINATION - Do you have emergency drug doses calculated and
an emergency kit available if required?
BEFORE ANAESTHESIA: https://recoverinitiative.org/cpr-guidelines/current-
• Use a check list - we are only human and we forget recover-guideline/
things.
- Is the environment suitable for induction – is it
https://ava.eu.com/resources/checklists/
sufficiently peaceful?
• Carry out a proper clinical examination - Don’t forget to
take a complete history, especially regarding any previous
anaesthetics and concurrent medications. PREMEDICATION
- Confirm the patient is healthy or identify any SEDATION:
abnormalities that need special attention. - Sedatives calm the patient, smooth induction &
- The cardiovascular (CV) and respiratory systems are the recovery, reduce anxiety and reduce the required
most vital for anaesthesia. dose of induction agent which may reduce undesirable
- Is the animal in pain now or will the pain occur only CV side effects.
post operatively? - Sedation can facilitate easy placement of IV access.
- Decide whether further preanaesthetic investigation - Acepromazine (ACP) is a tranquiliser, it calms without
is necessary. causing heavy sedation, it causes hypotension in a
- Will blood tests make any difference to your hypovolaemic patient and potentially hypothermia.
anaesthetic plan? ACP is non-reversible.
- Consider whether blood tests to provide some - Alpha-2 agonists (medetomidine, dexmedetomidine,
baseline information could be helpful e.g. for ‘healthy’ xylazine) provide profound sedation and have CV side
geriatric patients. effects including bradycardia and decreased cardiac
output. Alpha-2 agonists are reversible.
- Would imaging such as a chest x-ray, ultrasound scan
or echocardiography help? - Consider whether sedation is needed? An opioid
alone may be sufficient in a very painful or
- Has this animal ever had a diagnostic work-up for
compromised patient.
any condition?

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FECAVA BASIC PRACTICES IN VETERINARY
ANAESTHESIA AND ANALGESIA

1: THE ANAESTHETIC PLAN

- Benzodiazepines (midazolam and diazepam) don’t ANAESTHETIC INDUCTION

usually provide sedation, are better used as co-induction
agents (administered concurrently or after the induction INDUCTION AGENTS:
agent where they can have a dose-sparing effect). - Induction is usually performed with injectable agents:
- https://ava.eu.com/resources/dechra-anaesthesia-apps/ IV administration is rapid and allows dosing to effect. IM
has slower onset and the entire calculated dose is given.
- IV access (catheter) is strongly advised for all anaesthetic
ANALGESIA: procedures and essential for long procedures. IV access
- Provides immediate pain relief for the painful animal. allows drug and fluid administration.
- Provides preventive analgesia for post-operative pain - Pre-oxygenation is advised, if well tolerated, prior to
relief and can prevent central sensitisation or ‘wind-up’. induction.
- Opioids provide the best analgesia and enhance - Propofol must be given IV, it commonly causes
sedation. respiratory depression. Usually a smooth, rapid recovery
- Full mu-agonist opioids (methadone and fentanyl) is seen.
provide the most effective analgesia. - Alfaxalone provides rapid induction when administered
- Partial agonists like buprenorphine provide less IV and can sometimes can be given IM (also for
analgesia but may be longer lasting, particularly in cats. sedation) in cats and very small dogs. You may see less
Butorphanol provides even less analgesia but is good at respiratory depression compared to propofol, expect to
enhancing sedation. see tachycardia. Recovery should take place in a calm
environment to ensure it is smooth, otherwise agitation
- NSAIDs are good for elective surgery – especially somatic
and dysphoria can be observed.
pain and are most effective if given before surgery.
- Ketamine can be given by any route, it causes less CV
- NSAIDs have the potential to cause kidney & intestinal
depression and maintains better respiratory drive
damage. Administer NSAIDs post-operatively if you have
(depending on the combination). A good sedative
any concerns regarding cardiac function or hydration
premedication or co-induction (benzodiazepine or
status of the patient or if blood pressure cannot be
alpha-2 agonist) is required to produce surgical depth of
monitored intra-operatively.
anaesthesia with good muscle relaxation.
- Route of injection is important. IM provides reliable
- Monitor CV and respiratory function during induction.
uptake, IV has faster onset, SC has slower onset of action
Pulse oximetry and ECG are particularly advised for high
and effect is less predictable.
risk patients.
- See FECAVA infographic 2 from this series.
- Mask induction is less safe for the patient. It can cause
- https://ava.eu.com/resources/dechra-anaesthesia-apps/ stress and increases risks of volatile anaesthetic
exposure of staff. However in the case of sevoflurane in
cats, induction can be rapid and smooth which is useful
PREMEDICATION:
in some circumstances.
• A combination of sedative & analgesic agents
- Enhances sedation and reduces the required dose of
• Consider a co-induction agent
induction agent.
- Co-induction can provide an anaesthetic-sparing effect.
- Don’t forget about local anaesthetic techniques.
- Opioids & NSAIDs can be used together for
premedication.

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ANAESTHESIA AND ANALGESIA

1: THE ANAESTHETIC PLAN

ANAESTHETIC MAINTENANCE FLUID THERAPY:

- Does this patient need fluid therapy?
 OLATILE ANAESTHESIA:
V
- Advised for any surgery over 30 minutes.
- Use isoflurane or sevoflurane.
- Which type of fluid is required?
- Carried in oxygen or air/oxygen mixture (occasionally
also N2O, but this should not be >66%) - What administration rate will be needed? Is fluid bolus
resuscitation required?
- It is easy to control depth of anaesthesia.
- Initial rates 2-5 ml/kg/hr for cats and 3-6 ml/kg/hr in
- Volatile agents cause CV and respiratory depression,
dogs (https://www.aaha.org/aaha-guidelines/fluid-
particularly hypotension due to generalised vasodilation.
therapy/fluid-therapy-guidelines/). Increase rate if
- Undergo little to no hepatic metabolism.
patient is hypovolaemic or dehydrated.
- Best administered via endotracheal tube to protect
- Respond to changes during anaesthesia
airway.
(e.g. haemorrhage).
- Intubate with care, particularly in cats who are smaller
with unique anatomy predisposing them to laryngeal
damage and laryngospasm. In cats, desensitise BALANCED ANAESTHESIA:
arytenoids with 2% lidocaine. - Aim is for unconsciousness, muscle relaxation and
- An anaesthetic machine is required. analgesia – from the volatile or injectable anaesthetics,
- Oxygen supply, vaporiser, effective scavenging to or a combination of both and extra analgesics.
prevent environmental pollution ensuring staff safety. - Partial IV anaesthesia (PIVA) = balanced anaesthesia
- Use an appropriate breathing circuit. provided by IV & inhaled volatiles together.
- Low dead space and work of breathing for cats & very - IM ‘kitty magic’ protocols provide balanced anaesthesia
small dogs (e.g. non-rebreathing systems) in one injection.
Needs ~500 ml/kg/min fresh gas flow - Consider using antagonists for reversible drugs
- Low flow for larger animals (e.g. rebreathing system) (e.g. alpha-2 agonists).
with less environmental impact. - Remember that if you antagonise opioids (e.g. naloxone)
Needs ~10 ml/kg/min fresh gas flow you will also antagonise the analgesia.

INJECTABLE ANAESTHESIA: LOCAL ANAESTHESIA:

- Any of the IV agents can be used. - Could a suitable local or regional block be used for
- Administer by IV bolus dose top up or infusion (CRI). this patient?
- May still require supplementary oxygen – use pulse - Part of balanced anaesthesia.
oximetry to decide. - Reduces the anaesthetic requirement.
- Injectable-only protocols are often used IM for - Reduces anaesthetic-related mortality.
spay-neuter. Most consist of a single injection for - Contributes to post op analgesia.
premedication, induction and maintenance e.g. - Post op NSAID? Give before return of consciousness if
“kitty magic” protocols. (See infographic 6) deemed unsuitable for pre-operative administration.
- See infographic 5

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FECAVA BASIC PRACTICES IN VETERINARY
ANAESTHESIA AND ANALGESIA

1: THE ANAESTHETIC PLAN

MONITORING ANAESTHETIC RECOVERY AND

- Vital throughout anaesthesia and in recovery.
POSTOPERATIVE PAIN MANAGEMENT
- All anaesthetics depress vital function while producing - Death during recovery is not uncommon, especially
unconsciousness. cats so good monitoring is vital.
- Monitor vital function: Airway, Breathing, Circulation. - Keep under continuous observation until able to sit up
and maintain airway reliably.
- Good monitoring allows a problem to be spotted early,
before it becomes a disaster. - Do not leave until normal reflexes have returned,
temperature > 37°C and they are able to stand,
- Keep a written record – it is a legal document.
drink and eat.
https://ava.eu.com/resources/checklists/
- Prevent hypothermia - it delays anaesthetic recovery.
- Pulse: palpation, pulse oximetry, doppler.
- Have an analgesic plan to manage postoperative pain.
- Respiration: observation, capnography, pulse oximetry.
See infographic 2.
- Body temperature.
- Use a pain scoring tool - better pain management,
- Fluid administration. better outcomes.
- Blood loss. - Plan ‘take home’ medication appropriate
to the patient and the procedure and provide the
owner with detailed administration instructions and
monitoring information.

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to in this publication. Details of this kind must be verified in each case by individual users from up to date published literature. Veterinary surgeons are
reminded to follow all appropriate national legislation and regulations.

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