Vet Anesthesia and sedation

Anesthetic and Sedation Drugs

Drug Dose Comments Common adverse effects

Alpha-2 Do not use with atropine as it can

increase work on the heart and
Adrenergic increased risk for arrhythmias;
Bradycardia
Cardiac output reduction
Agonists 5-10 ug/kg reversible with atipamezole. Higher
Hypertension/hypotension
0.2-1 mg/kg doses required in cats than dogs Do
Dexmedetomidine Vasoconstriction
not use with epinephrine.
AV Block
Both can be used for emesis in cats,
Xylazine X is reversed with yohimbine.

Avoid oral use in cats: hepatic

Benzodiazepines failure May cause excitement in Minimal cardiorespiratory
0.1-0.5mg/kg effects; avoid PO use in cats:
dogs; appetite stimulant in cats
Reversible flumazenil rare hepatic tox
Diazepam
Paradoxical excitation in some
Can be given IM for seizures unlike patients (mostly diazepam)
diazepam; Both D and M are Caution midaz/etomidate
Midazolam 0.25mg/kg
anxiolytics reversible with canine glaucoma
flumazenil

Inhalant Contraindications: Predilction for Decreased cardiac output

Anesthetic Dog 1.5-1.8 % malignant hyperthermia in some Decreased myocardial
Induction Agents Cat 1.2 to 2.2 dogs Caution with increased contractility; dose dependant
% intracranial pressure; dose dep resp. respiratory depression,
Isoflurane depression hypotension
Partial mu agonist, K antag often
Opioids More
part rapid induction
of short and recovery
term procedures or Hypothermia/hyperthermia
Minimal sedation, good
0.01-0.03
dog 2.1-2.4% OTM;More easily dosed to effect foruse
Sevoflurane long onset of action; don't Mayanalgesia; rare resp
result in vasodilation,
mg/kg
Cat 2.6-3.4 % geriatrics; can mask induce; requires
within 8 hours of sx if likely planning dose dep.
depression
resp depression
Buprenorphine higher vaporizer settings
to use full mu opiod

Sedatives Doses
kappa are typically
agonist, mumuch
antaglower than
Minimal
Peripheral vasodilation
Burtorphanol 0.02-
0.2-0.4 mg/kg on approvedanalgesia;
label. Can potentiate Sedation, ataxia
causing heat loss and
Acepromazine 0.05mg/kg effectsgoodofsedation;
opiates. Tranquilizer
anti-tussivenot a
hypotension
anxiolytic
Full mu, full kappa agonist;
Most potent opioid, commonly used Dose dependant resp, CNS
Fentanyl 05-10 ug/kg
as a bolus, or CRI; fast onset within and cardio depression
1-2 min, duration 20 min

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 Drug Dose Comments Common adverse effects

Intravenous Often used in combination with

diazepam or dexmedetomidine for
Induction injectable sedation
Caution increased ICP or
intra-ocular pressure,
Agents 2-10mg/kg Inhibits NMDA, which can control
Occasional muscle tremors
pain as well; Also used in CRI's with
/seizures
Ketamine dexmedetomidine. Eyes remain open,
use eye lubricants
Continuous monitoring required,
Respiratory depression,
caution for apnea. Short acting
myoclonus, repeated doses in
hypnotic. Can be used as an
Propofol 2-6 mg/kg cats can cause heinz body
anticonvulsant; Myoclonus can occur
anemia; prolonged recovery
during induction. Best if combined
in sighthounds
with a benzodiazepine
Good choice for pre-existing cardiac
muscle rigidity and
conditions, head trauma or critically
myoclonus. Can be painful IV
Etomidate 0.5-1mg/kg ill patients. Not good choice for
if not diluted. Causes miosis;
Addisonian patients: it suppresses
caution with glaucoma
cortisol
Resp depression/apnea,
Neuroactive steroid affecting Gaba
SQ/IM dosing can cause
Alfaxalone 1-3mg/kg dog receptors Does not provide
hyper-reactivity;
3-5mg/kg cat analgesia; extra label IM use with
SQ/IM dosing harder in larger
short and rapid duration
pets, due to volume needed

Partial mu agonist, K antag often

Opioids part of short term procedures or Minimal sedation, good
0.01-0.03
OTM; long onset of action; don't use analgesia; rare resp
mg/kg
within 8 hours of sx if likely planning depression
Buprenorphine
to use full mu opiod

kappa agonist, mu antag Minimal

Burtorphanol 0.2-0.4 mg/kg analgesia; Sedation, ataxia
good sedation; anti-tussive

Full mu, full kappa agonist;

Most potent opioid, commonly used Dose dependant resp, CNS
Fentanyl 05-10 ug/kg
as a bolus, or CRI; fast onset within and cardio depression
1-2 min, duration 20 min

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 Drug Dose Comments Common adverse effects

hyperthermia in cats,
0.1-0.2 Full mu, full kappa agonist vomiting,
Hydromorphone mg/kg Minmal cardio/resp depression decreased GI motility,
bradycardia
0.2-0.5 mg/kg Histamine release (caution
Full mu, full kappa agonist
Morphine Dog mast cell dz),vomiting,
Minimal cardio/resp depression
0.2mg/kg Cat bradycardia, resp depression

Important drug/fluid doses

Dogs and Cats 0.02 to 0.04 mg/kg IV, IM, SQ
Atropine
Faster onset, shorter duration of action than Glyco

Dogs and Cats 0.010 to 0.015 mg/kg IV, IM, SQ

Glycopyrrolate
Slower onset, lasts longer than atropine

Flumazenil Dogs and Cats 0.01 mg/kg IV; Repeat hourly as needed

Dogs and Cats 0.02-0.1 mg/kg IM or IV; Give 1/4 of the

Naloxone calculated dose every 3-4 minutes until desired effect achieved
Re-dose every 1-3 hours if needed
Dog 2-10 mcg/kg/min
Cat use low end of the range

Sample recipe for 2 mcg/kg/minute dose

Dopamine CRI 1. Add 60 mg of Dobutamine (4.8ml of a 12.5 mg/ml solution)
to a 250 ml bag of 0.9% Saline
This provides a 0.24 mg/ml solution
2. If you give 0.5 ml/kg/hour it will provide 2 mcg/kg/minute

Dog 1-10 mcg/kg/min

Cat use low end of the range

Dobutamine CRI Sample recipe for 0.002 mg/kg/minute dose

1. Add 60 mg of Dopamine (1.5ml of a 40 mg/ml solution)
to a 250 ml bag of 0.9% Saline
2. If you give 0.5 ml/kg/hour it will provide 0.002 mg/kg/minute

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 Anesthetic
Normal vital signs under anesthesia
Temp 97-102 F MM color: pink
Large dog HR 60-160 CRT: 2-3 sec
Interventions small dog HR 70-180
Cat HR 90-200
ET02: 35-45mmHg
BP 100-160mmHg Syst
Resp Rate: 8-20 BPM 80-120 MAP
SP02: >95%

Excessive Anesthetic Depth Too light

Signs: Intervention: Intervention:
Minimal Jaw Tone
Decrease Anesthetic gas flow rate
Central Eye Position
Increase IV fluid rate/provide boluses
Lack of Corneal Reflex Increase gas flow rate
as needed to raise BP
No response to surgical Manually ventilate
Provide additional heat support
stimulus Administer propofol
Consider medications as indicated
Bradycardia 0.5-1mg/kg IV over 15sec
(see below for more details)
Slow Respiratory Rate
Hypotension

Pale mucous Membranes Hypotension

If you notice gum pallor, check: Hypotension: BP < 90mMHG systolic
anesthetic depth MAP < 60mmHg
Signs of circulatory problems: HR (too high or too low) Signs:
BP (low) Increased CRT >2 second
If these signs are normal, collect a PCV/TS Poor pulse quality
Tachycardia or Bradycardia
Bradycardia Cool extremities and Body temperature
Lg Breed dog < 60 Dexmedetomidine Rough estimates of blood pressure:
Sm Breed Dog <70 causes low HR Absence of a peripheral pulse indicates
cat <90 Dogs: 30-60, cats 80-100 systolic pressure < 60mmHg
Interventions Intervention:
1. Administer Atropine 0.02-0.04 mg/kg First decrease the amount of gas if possible
2. Determine possible cause
Try a 10-20 ml/kg crystalloid bolus
most common are drug induced (anesthetic gas,
narcotics). Increase the fluid rate If nothing is
3. Reduce anesthetic gas, may need to reverse A colloid bolus can be given next working to
medications: Naloxone, Flumazenil if there is no adequate response correct the
consider using hypotension, the
Tachycardia: procedure may
Lg breed dog >160 Sm Breed Dog >180 need to be
CAT >200 aborted
Interventions
1. Might be insufficient anesthetic depth: increase gas Hypertension
2. Patient might be painful
3 Check for hypotension causing reflex tachycardia Evaluate anesthetic depth
Administer supplemental analgesia
Consider increasing gas inhalant

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 Monitoring Under
Anesthesia/Sedation

Patient parameters Specific features

Pay attention to pulse quality

Heart rate
Palpation of pulses
Whether there are any dropped beats
Auscultation of heart
when palpating pulses while auscultating
beat with stethoscope,
Prolonged CRT >2-3 seconds suggest poor
doppler or esophageal
Circulation perfusion or dehydration
stethoscope
BP systolic should be 90-140
Assess CRT
Blood lactate should be <2; lactate
measure BP
increased with poor perfusion
Measure blood gases
PaC02 should be 35-45; Low PaC02
happens with acidosis and poor perfusion

Monitor for presence or absence of

respiration
Observe chest wall
Monitor regularity and frequency of
movements
respiration
Observe excursion of re-
Monitor pattern and depth of respiration
breathing reservoir bag
PaC02 and Bicarb decrease with
Auscult lung sounds
Ventilation respiratory alkalosis (hyperventilation)
Observe for fogging of
and both increase with respiratory
endotracheal tube or
acidosis (hypoventilation)
face mask
End -tidal C02 should be 35-45; it rises
Paco2, Bicarbonate
with hypoventilation, increased body
End- tidal C02
temperatureFalls with hyperventilation or
decr body temp

Assess mucous
Pink (adequate oxygenation)
membrane color and
Pale or cyanotic (inadequate oxygenation)
Oxygenation tongue color
Low Sp02 <95%
Monitor Sp02

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 Opioid Selection, Dosing, Analgesia, Adverse Effects
Buprenorphin
e
Opioid 1.8 mg/ml
Fentanyl Buprenorphine Hydromorphone Butorphanol Methadone Morphine
Decreasing simbadol :
50 ug/ml 0.3mg/ml 2 mg/ml 10mg/ml 10mg/ml 10 mg/ml
potency feline
labeled
product

Schedule II III III II IV III II

Dog and cat 1-5 Dog and cat

ug/kg IV 0.01- 0.03 Cat: Dog 0.25-
Dog and cat:
Most commonly mg/kg IM, or IV. 0.24mg/kg 1.0mg/kg IM
0.2-0.4 mg/kg
used as a CRI Commonly used SQ, decrease or slow IV 0.5
IM or IV
Loading dose: in cat OTM at if using Dog 0.1- 0.2 Dog and cat: mg/kg most
Dog and cat
Common Cat 5 ug/kg home: multimodal mg/kg IM or IV 0.2-0.4 common; 0.25
0.4mg/kg
Dose IV;Dog 2-10ug/kg 0.03- analgesia; do Cat 0.1mg/kg IM mg/kg IM or mg/kg
typically
IV 0.05mg/kg BID- not send or IV IV old/compromis
for Sx and
CRI: TID. Dog and home this ed
0.2mg/kg for
Cat 5 ug/kg/hr Cat high dose Cat 0.1- 0.3 IM
sedation
Dog 2-10 0.02mg/kg IV, product or slow IV
ug/kg/hr IM

Analgesia Excellent Moderate Moderate Excellent Mild Excellent Excellent

full mu partial mu partial mu full mu full mu full mu
Kappa agonist,
Agonist full kappa agonist agonist full kappa full kappa full kappa
mu antagonist
agonists Kappa antag Kappa antag agonists agonists agonists
1-5 min IV
1-5 min IV 1-5 min IV
or
Onset <1-2min 20-45 min 1 hour or 1 hour or
10-20 min
10-20 min IM 10-20 min IM
IM
4-8 hours
Dep. on pain, 20-60 min
20-30 24
Duration concentration 2-4 hours (dog) 90 min 2-4 hours 2-4 hours
minutes hours
and dose (cat)

Long duration of action but Good sedation in Good

slow onset of action and alternative
dogs and cats
Less likely to cause to morphine. May cause
minimal to no sedation; particularly
adverse effects Similar effects as NMDA vomiting after
Same set of adverse effects if combined with antagonist.
Comments compared to other as other opioids but much morphine, but no IM injection,
a tranquilizer; Causes
opioids. more mild . Don't use within 8 histamine release. histamine
and Don't use panting,
Commonly used as hours of surgery if planning to At doses release with
Adverse within 8 hours of vocalization,
a bolus or in a CRI use full mu opioid. Partial >0.1mg/kg in vomiting, fast iv injection,
surgery if
effects More potent than reversal with naloxone cats can cause defecation. bronchoconstric
planning to use
any of the other hyperthermia. Greater tion and resp
full mu opioid.
opioids cardiodepres depression.
Little analgesic
sant than
effects. morphine
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 Common Anesthetic
ARrhythmias
2nd degree AV block is when there are p waves and dropped
QRST complexes. This is a common anesthetic arrhythmia and
generally does not require intervention. However, high grade 2nd
degree block (when there are many p waves with dropped QRST
2ND DEGREE AV BLOCK complexes) is more dangerous. This block is more like to lead to 3rd
Drugs that can lead to AV block degree block (complete dissociation between p waves and QRST
slow the HR: Dexmedetomidine, methadone, complexes). A low HR or hypotension warrants treatment.
hydromorphone, fentanyl. Administer atropine

Sinus Tachycardia is a very common rhythm disturbance in

small animals due to stress and excitement. Unrelenting
sinus tachycardia may be due to CHF and high sympathetic
drive. Animals in pain or with fevers may have persistent SINUS TACHYCARDIA
Heart rates with sinus tachycardia are typically
sinus tachycardia. Treat underlying illness.
slower than in SVT. Also, P and T waves are easier
Check for pain, hypoxia, etc.
to distinguish.

An idioventricular rhythm is called an accelerated IV rhythm if

IDIOVENTRICULAR RHYTHM
Notice the ventricular beats are not premature.
Depolarizing at the sinus rate.
the HR is fast. Generally, this rhythm indicates
systemic illness is present such as: GDV, hemangiosarcoma, or
pancreatitis. Often don't have to treat this rhythm. However,
you should monitor the BP, HR, and ECG until the rhythm
converts back. Also keep an eye on oxygenation, lytes,
acid/base, hydration, and lactate levels.

Polymorphic VPC's raise the concern for progression to a

malignant arrhythmia. Treatment is recommended if you see any of
the following:
-Hemodynamic alterations are present:
Hypotension, Tachycardia, Respiratory effort. MULTIFOCAL VPC'S
-Pairs or triplets of VPC's and/or polymorphic VPC's which indicate Irregular rhythm with premature ventricular
an increased risk of progression to ventricular fibrillation. beats. Pairs or triplets of VPC's increase concern
level.

Ventricular tachycardia significantly decreases cardiac output and

contribute to weakness or collapse. Sustained v-tach lasting >30
seconds is an indicator of medium to high risk for sudden death (due
to development of ventricular fibrillation). Treatment with lidocaine if
HR >150-180, hypotensive V-tach indicates either cardiac illness or
V TACH systemic illness. Start with a 2mg/kg iv bolus. If no response within a
minute or two, give a second dose. After that, if there is no
This is an urgent concern! Treat immediately. conversion, switch to another anti-arrhythmic drug like :
procainamide, diltiazem or propranolol.
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 Canine Sedation Choices

PICK ONE ADD AN OPIOID

Non painful patients

YOUNG, HEALTHY or procedures
Light sedation:
Acepromazine (use local block if possible) 0.05-0.1 mg/kg IM or 0.025-0.05 Butorphanol
0.4 mg/kg IM
mg/kg IV Greyhounds, Boxers, Dobermans used lower dose: 0.02 mg/kg or
Maximum is 3 mg IM or 1.5 mg IV for any dog 0.2 mg/kg IV
Painful patients or
OR procedures
Profound sedation (orthopedic radiographs):
Morphine
Dexmedetomidine 10ug/kg IM or 5 ug/kg IV 0.2-0.4 mg/kg IM
Fractious: can increase to 15-20 ug/kg IM or 7-10 ug/kg IV or
And /OR add Ketamine 5 mg/kg IM or 2 mg/kg IV 0.2 mg/kg IV
(Avoid in dogs with mast cell
tumors or allergic disease)
OLDER, HEALTHY OR
Quiet, friendly
Midazolam 0.2 mg/kg IV or IM Hydromorphone
0.1-0.2 mg/kg IM
Excited, painful or
0.1 mg/kg IV
Add Ketamine 5-10 mg/kg IM or 3-5 mg/kg IV
Light sedation for nervous/fractious
Acepromazine 0.05mg/kg IM or 0.02 mg/kg IV
Fractious, healthy
Dexmedetomidine 5-10 ug/kg IM or 2-5 ug/kg IV

ANY DEBILITATED PATIENT

Midazolam 0.2mg/kg IV Reversal of Dexmedetomidine with Antisedan
or IM Within 30 minutes, reverse dexmedetomidine with an equal volume of anti sedan
Avoid Acepromazine Consider reversing with half volume after 30 minutes or in fractious dogs
Avoid
Reversal of Hydromorphone or Morphine with Naloxone
Dexmedetomidine
Complete reversal - 0.01 mg/kg IV
ANY DOG WITH Naloxone: Partial reversal- titrate to effect- 40 ug (0.1ml) IV per large dog , dilute to
A HEART MURMUR 40 ug/ml per dog and titrate for small dogs; OR consider 0.2 mg/kg Butorphanol
instead of Naloxone
No Dexmedetomidine
Low dose Acepromazine Reversal of Midazolam with Flumazenil
if required 0.01-0.2 mg/kg IV - start at lower dose and repeat as needed to reverse sedation

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 Feline Sedation Choices
PICK ONE ADD AN OPIOID

YOUNG, HEALTHY Non painful patients

or procedures
Light sedation:
Acepromazine (use local block if possible) Butorphanol
0.1mg/kg IM or 0.05mg/kg IV 0.4mg/kg IM
or
OR 0.2 mg/kg IV
Profound sedation (orthopedic radiographs):
Dexmedetomidine 10ug/kg IM or 5 ug/kg IV Painful patients or
procedures
Fractious: add Ketamine 5 mg/kg IM or 2mg/kg IV
Morphine
OR use Alfaxalone 1-2mg/kg(~0.5-1ml) and combine 0.2-0.4mg/kg IM
or
Alfaxalone, Ketamine and opioid in one syringe for SC 0.2mg/kg IV
or IM (Avoid in dogs with
mast cell tumors or
OLDER, HEALTHY allergic disease)
Quiet, friendly OR
Midazolam 0.2mg/kg IV or IM
Light sedation for nervous/fractious Hydromorphone
0.1-0.2 mg/kg IM
Acepromazine 0.05mg/kg IM or 0.025 mg/kg IV or
Excited, painful 0.1mg/kg IV
Add Ketamine 3-5 mg/kg IM or 2 mg/kg IV
Fractious, healthy
Alfaxalone 1-2 mg/kg(~0.5-1ml) and combine
Alfaxalone,
Ketamine and opioid in one syringe for SC or IM

ANY DEBILITATED PATIENT ANY CAT WITH A HEART MURMUR

No Ketamine
Avoid Acepromazine Avoid Acepromazine
Avoid Dexmedetomidine Avoid Dexmedetomidine -use a low dose 3-5 ug/kg only if
required
Can use Alfaxalone 1-2mg/kg, Midazolam 0.2 mg/kg; Do not
mix
Alfaxalone and Midazolam in the same syringe. Give Alfax SQ
and Midazolam + opioid IM

Reversal of Dexmedetomidine with Antisedan

Use half volume of antisedan IM ONLY

Reversal of hydromorphone or Morphine with Naloxone

Complete reversal - 0.01 mg/kg IV
Naloxone: Partial reversal- titrate to effect- 0.0001 mg/kg- or titrate to effect, dilute to
40 ug/ml and titrate OR consider 0.2mg/kg Butorphanol instead of Naloxone

Reversal of Midazolam with Flumazenil

0.01-0.2mg/kg IV - start at lower dose and repeat as needed to reverse sedation

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