The specific treatment depends on the cause!

Perivascular injection: e.g., thiopental or phenylbutazone

Treatment:
• dilution with saline (enough to dilute thiopental to less
than 1% in order to prevent tissue necrosis)
• Lidocaine sc (instead of saline to neutralize pH and
decrease vasospasm)
• (Water-soluble steroids)
Bradycardia: Tachycardia:
• Drug-induced increase in vagal tone • Too light anesthesia
(e.g., by opioids)
• Drug-induced
• Too deep anesthesia (overdose of
May lead to arrhythmia
inhalant anesthetics)
Treatment:
• Parasympathetic stimulation
(manipulation of viscera) • Deeper anesthesia
Treatment: • Inotropic agents, fluids (to
correct subsequent hypotension)
• Remove cause
• No ‘real’ treatment for drug-
• Atropine (IV) or glycopyrrolate
induced sinus tachycardia (try
(IV) (or isoproterenol, epinephrine)
beta-adrenergic blockers if
severe sinus bradycardia)
Hypotension:
• Anesthetic overdose
• Hypovolemia

Treatment:
• Lighter anesthestic depth
• Fluid
• Positive inotropes: dopamine, dobutamine, ephedrine

Premature ventricular contractions:

• Can be induced by acidemia, hypoxia, hypercapnia or drugs
thiopental, ketamine, halothane
Treatment: revert metabolic imbalance
Lidocaine I.V. (or procaineamide) used for acute therapy or
beta-adrenergic blockers (Propranolol or esmolol)
 Cardiopulmonary failure
• Characterized by apnea and absence of pulse or heart beat
Action: ABCDE
• Airway establishment
• Breathing (oxygen)
• Cardiac compression-circulation
• Drugs
• ECG
Asystole: may use epinephrine
Ventricular fibrillation: defibrillate with current and may use
lidocaine or sodium bicarbonate if fibrillation persists
Electromechanical dissociation: dopamine and
dexamethasone
• Following resuscitation: inotropic support (dopamine,
etc) to help maintain blood pressure
Example of over-dosage with thiopental
Apnea is the most common side effect
1) Pink mucous membranes, capillary refill time normal,
strong pulse, some jaw tone present: observe animal until
respiration starts or vital signs change
2) Cyanotic mucous membranes: intubate and ventilate (10
breathes/min in dogs) with 100% oxygen; continue until
anesthetic levels lighten if pulse is strong and systolic
arterial pressure is more than 80 mmHg. Then decrease
ventilation to 4 breathes/min to check for respiration start.
3) If situation 2 + weak pulse or arterial pressure: Give a
balanced replacement solution (20 ml/kg over 10-15
minutes); give inotropic drug (e.g., dopamine), especially
if systolic blood pressure is below 60 mmHg.
4) No pulse: start full cardiopulmonary resuscitation.
Difficult to successfully resuscitate in this case.
 Drugs used in anesthetic emergencies
• Atropine: Muscarinic antagonist; good to treat bradycardia
• Glycopyrrolate: Muscarinic antagonist with low CNS effects. Good
vagal blocking action
• Epinephrine: alpha-adrenergic action gives good peripheral and
intrathoracic vessel resistance, increases diastolic pressure (good
myocardial perfusion), useful to treat asystolic arrest. Vital tissues
well irrigated
• Ephedrine: Direct and indirect peripheral sympathomimetic, related
to norepinephrine. Inotropic effect
• Dopamine: direct-acting sympathomimetic
Inotropic effects, but other less desirable effects too
Dobutamine preferred because selective effect on cardiac
contractility
• Sodium bicarbonate: Use is controversial. Try if metabolic acidosis
or resuscitation lasted more than 20 minutes.
• Lidocaine: Na+ channel blocker
Antiarrhythmic action on ventriculum
 Administration

• Via central venous catheter (jugular)

• Endotracheal tube (epinephrine, atropine,

lidocaine) ---rapid absorption in 2-3 mls of saline
followed by 2-3 large breaths with artificial
ventilation

• Intralingual
 CNS STIMULANTS
• Drugs that increase electrical and neurotransmitter activity in the CNS
• Some with specific targets: Apomorphine is specific for the emetic
center
Convulsants and respiratory stimulants:
• Chemically diverse
• Mechanism of action poorly understood
• Limited clinical use in treating acute ventilatory failure (temporary
effect; increased risk of convulsions)
• Have been used following barbiturate poisoning, neonatal asphyxia,
anesthesia-induced respiratory collapse, drowning, heat or lightning
shock
Best therapy remains ventilation!!
DOXAPRAM
• FDA approved in dogs, cats, horses
• Stimulates the medullatory respiratory center and
possibly carotid and aortic chemoreceptors; other
areas of the CNS affected at higher dose
• Used if necessary during anesthesia and post-
anesthetic recovery
• Sublingual, subcutaneous or IV
• Side effects: hypertension, arrhythmias,
hyperventilation, seizures with high doses
• Should not be used as a substitute for aggressive
artificial respiratory support
Psychomotor stimulants:

• Ephedrine: Mild effect, not used anymore as a CNS stimulant

• Methylxanthines: Mild stimulant effects

Caffeine---Not used in veterinary medicine
Theophylline
Not used as a CNS stimulant but rather as a relaxant for
smooth muscles
Prophylaxy of chronic asthma
Bronchodilator when myocardial failure or
pulmonary edema
There are side effects
Other CNS stimulants:
Yohimbine
• Specifically blocks alpha2-adrenergic receptors
(and maybe other non-adrenergic receptors)
• Reverses Xylazine-induced effects
• There are side effects: seizure, etc
4-aminopyridine
• Mechanism of action not well understood
• May reverse ketamine-induced anesthesia in cats
Caution with brachycephalic breeds

• Induce anesthesia rapidly (pre-oxygenate,

use propofol or thiopental, avoid drugs that
induce vomiting reflex)
• Use small size endotracheal tube
• Watch recovery