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 A Color Handbook

Small Animal Anesthesia

and Pain Management
SECOND EDITION
 A Color Handbook

Small Animal
Anesthesia and
Pain Management
SECOND EDITION

Edited by Jeff C Ko
DVM, MS, Dip ACVAA
Professor of Anesthesiology
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue University
West Lafayette, Indiana, USA
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742

© 2019 by Taylor & Francis Group, LLC

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Library of Congress Cataloging‑in‑Publication Data

Names: Ko, Jeff C., editor. | Ko, Jeff C. Anesthesia and pain management in
dogs and cats.
Title: Small animal anesthesia and pain management : a color handbook /
editor, Jeff Ko.
Other titles: Anesthesia and pain management in dogs and cats
Description: Second edition. | Boca Raton : CRC Press/Taylor & Francis, 2019.
| Preceded by Anesthesia and pain management in dogs and cats / Jeff C.
Ko. c2013. | Includes bibliographical references and index.
Identifiers: LCCN 2018024366| ISBN 9781138035683 (pbk. : alk. paper) | ISBN
9781138345638 (hardback : alk. paper)
Subjects: LCSH: Veterinary anesthesia--Handbooks, manuals, etc. | MESH:
Anesthesia--veterinary | Analgesia--veterinary | Pain
Management--veterinary | Pets
Classification: LCC SF914 .S634 2018 | NLM SF 914 | DDC 636.089/796--dc23
LC record available at https://lccn.loc.gov/2018024366

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Contents
Preface.......................................xvii
Acknowledgments....................xvii
Contributors...............................xix
Abbreviations.............................xxi
CHAPTER 1
Equipment for inhalant
anesthesia.....................................1
Jeff C Ko
Introduction......................................... 1
Components of the anesthesia machine....1
Flowmeters....................................... 2
Regulators (pressure reducing
valves).......................................... 2
Vaporizers........................................ 4
Gas supply........................................ 6
Scavengers ..................................... 11
Breathing circuits and components..... 12
Rebreathing circuit
(circle breathing system)............. 12
Non-rebreathing circuits................ 19
Modern human anesthesia machines
for veterinary use............................ 22
Selecting a breathing circuit................ 23
Ambu bags......................................... 24
Ventilators.......................................... 24
Oxygen flow rates............................... 25
The oxygen consumption
requirements of the
anesthetized animal................... 25
The amount of oxygen needing
to carry inhalant anesthetic
from the vaporizer to the
patient...................................... 25
Amount of oxygen flow required
to remove the CO2 exhaled by
the anesthetized animal from a
non-rebreathing circuit.............. 25
Changes to the speed of inhalant
anesthetic uptake during the
transition from intravenous
induction to inhalant
maintenance............................... 26
Changes to the speed of chamber
or face mask induction............... 26
Important concept of time
constant for inhalant
anesthetic during chamber
induction................................... 27
Changes to anesthetic depth
during anesthesia maintenance.... 27
Conservation of the patient’s
body temperature and airway
moisture.................................... 27
Reducing the cost of a given
inhalant anesthetic agent............ 27
Global issues, including
pollution control and energy
conservation............................. 28
Endotracheal tubes............................. 28
Types of endotracheal tubes............ 28
Endotracheal tube construction...... 28
Endotracheal tube selection............ 29
Laryngeal mask airway for cats........... 32
Laryngoscopes.................................... 32
Induction chambers and face masks.... 33
Induction chambers ...................... 33
Face masks..................................... 34
Checking the accuracy of the
flowmeter....................................... 35
Checking the anesthesia machine
and breathing circuit for leaks........ 36
Positive-pressure leaks.................... 36
Negative-pressure leaks................... 37
Checking the scavenging system for
leaks and malfunctions................... 39
Monitoring of waste gas and
pollution....................................... 39
Further reading.................................. 40
CHAPTER 2
Perioperative blood work
and urine analysis....................... 41
Jeff C Ko
Introduction....................................... 41
Blood work......................................... 41
vi Contents
Packed cell volume......................... 42
Total protein.................................. 43
Blood glucose................................. 43
Reticulocyte count......................... 44
Mean corpuscular volume............... 44
Mean corpuscular hemoglobin
concentration............................. 44
White blood cells (or leukocytes).... 44
Neutrophils.................................... 44
Lymphocytes.................................. 44
Eosinophils.................................... 45
Platelets and coagulation tests........ 45
Biochemistry profiles.......................... 45
Liver function tests......................... 45
Kidney function tests..................... 46
Pancreatic function tests................. 47
Electrolytes.................................... 47
Urine analysis..................................... 48
Further reading.................................. 49
CHAPTER 3
Preanesthetic medication:
drugs and dosages...................... 51
Jeff C Ko
Introduction....................................... 51
Reasons for preanesthetic medication....52
Preanesthetic medication protocol...... 53
Phenothiazines: acepromazine............ 54
Quick points for consideration........ 54
Preanesthetic medication doses...... 54
Advantages of using acepromazine.....55
Disadvantages of using
acepromazine............................. 55
Butyrophenone: azaperone.................. 55
Quick points for consideration........ 55
Preanesthetic medication doses...... 56
Benzodiazepines: diazepam and
midazolam..................................... 56
Quick points for consideration........ 56
Preanesthetic medication doses...... 56
Differences between diazepam
and midazolam.......................... 57
Advantages of using
benzodiazepines......................... 57
Disadvantages of using
benzodiazepines......................... 57
Alpha-2 adrenergic agonists:
xylazine, romifidine,
medetomidine, and
dexmedetomidine........................... 57
Quick points for consideration........ 57
Preanesthetic medication doses...... 58
Differences between the various
alpha-2 adrenergic agonists......... 58
Advantages of using alpha-2
adrenergic agonists..................... 59
Disadvantages of using alpha-2
adrenergic agonists..................... 60
Dissociatives: ketamine and tiletamine....61
Quick points for consideration........ 61
Preanesthetic medication doses...... 61
Differences between the
dissociatives............................... 61
Advantages of using dissociatives.... 62
Disadvantages of using
dissociatives.............................. 62
Anticholinergics: atropine and
glycopyrrolate................................. 63
Quick points for consideration ....... 63
Preanesthetic medication doses...... 63
Differences between atropine and
glycopyrrolate............................ 63
Advantage of using
anticholinergic agents................. 63
Opioids.............................................. 64
Quick points for considerations...... 64
Preanesthetic medication doses
and properties............................ 64
Differences between the various
opioids....................................... 66
Advantages of using opioids........... 66
Disadvantages of using opioids....... 67
Neuroleptic–analgesic combinations.... 67
Overview........................................ 67
Concepts of using two or more
sedatives together....................... 68
ASA I and II dogs.......................... 70
Sick (ASA III, IV, V, III-E, IV-E,
V-E), pediatric, or geriatric dogs....72
ASA I and II cats............................ 72
Case example...................................... 74
Further reading.................................. 75

CHAPTER 4
Intravenous injection
techniques and intravenous
anesthetic agents........................77
Jeff C Ko
Introduction....................................... 77
Intravenous injection techniques......... 78
Intravenous anesthetic agents......... 78
Induction or short-term restraint.... 78
Arm–brain (cephalic vein to brain)
circulation time............................ 78
Apnea induced by intravenous
anesthetics during induction...... 78
Characteristics of intravenous
anesthetic agents used in dogs
and cats.......................................... 79
Thiopentone (thiopental) sodium.... 81
Propofol......................................... 83
Etomidate...................................... 86
Alfaxalone...................................... 87
Diazepam (midazolam)/ketamine.... 88
Tiletamine/zolazepam........................ 89
Overview........................................ 89
Induction and immobilization........ 90
Further reading.................................. 91
CHAPTER 5
Inhalant anesthetic agents.........93
Jeff C Ko
Introduction....................................... 93
Uptake and distribution of inhalant
anesthetic agents............................ 94
Stage of anesthesia.......................... 95
Anesthetic partial-pressure
gradient: induction phase........... 95
Anesthetic partial-pressure
gradient: recovery phase............. 96
Types of volume barriers................. 97
Minimum alveolar concentration........ 98
Factors that decrease minimum
alveolar concentration values...... 98
Factors that increases minimum
alveolar concentration values...... 98
Factors that do not affect
minimum alveolar
concentration values................... 98
Contents vii
Blood gas solubility............................ 98
Pungency and airway irritation........... 99
Isoflurane, sevoflurane, and
desflurane....................................... 99
Isoflurane....................................... 99
Sevoflurane.................................... 99
Desflurane.................................... 100
Face mask and chamber induction
with overpressurizing techniques... 100
General principles......................... 100
Technique for face mask induction...100
Technique for chamber induction....101
Advantages of using chamber
and face mask induction........... 103
Inconsistencies during anesthesia
maintenance................................. 103
Premature awakening during a
surgical procedure.................... 103
Anesthetic plane becomes too
deep......................................... 103
Recovery from inhalant anesthesia.... 104
Further reading................................ 104
CHAPTER 6
Anesthesia monitoring and
management.............................107
Jeff C Ko
Introduction..................................... 107
Monitoring circulation..................... 108
Subjective assessment of
circulatory function.................. 108
Objective assessment of
circulatory function.................. 109
Monitoring fluid responsiveness
using the plethysmographic
variability index............................ 121
Limitation of using PVI as a
fluid administration guide........ 121
Monitoring oxygenation................... 122
Subjective assessment of
oxygenation............................. 122
Objective assessment of
oxygenation............................. 122
Hemoximetry and pulse oximetry....122
Placement of the pulse oximeter
probe....................................... 123
viii Contents
Factors that influence pulse
oximetry.................................. 123
Normal values for SpO2................ 124
Normal values for PaO2................ 124
Relationship between SpO2
(or SaO2) and PaO2.................. 124
Hypoxemia................................... 125
Monitoring ventilation...................... 127
Subjective assessment of
ventilatory function.................. 127
Objective assessment of
ventilatory function.................. 128
Monitoring other vital parameters.....133
Monitoring body temperature.......133
Monitoring blood glucose levels.... 134
Monitoring blood lactate.................135
Monitoring blood electrolytes,
total protein, and packed
cell volume............................... 136
Monitoring the depth of anesthesia...136
Pain management......................... 137
Neuromuscular monitoring.............. 138
Further reading................................ 140
CHAPTER 7
Fluid therapy............................. 141
Ann B Weil and Jeff C Ko
Introduction..................................... 141
Composition and fluid distribution
within animals ............................ 141
Indications for fluid therapy under
general anesthesia......................... 141
2013 American Animal Hospital
Association/American
Association of Feline Practitioners
Fluid Therapy Guidelines for
Dogs and Cats.............................. 142
Fluid classification............................ 142
Crystalloids.................................. 142
Colloids....................................... 145
Blood products............................. 146
Case examples.................................. 148
Healthy patient undergoing
general anesthesia for elective
procedure................................. 148
Patient with suspected
portosystemic shunt requiring
general anesthesia..................... 148
Patient with hemolytic anemia
to be anesthetized for bone
marrow aspiration.................... 148
Patient with bleeding
abdominal mass presented for
surgery..................................... 148
Patient with ruptured
bladder presenting for bladder
repair....................................... 148
Two- to three-month-old male
puppy presented for laceration
repair....................................... 148
Further reading................................ 148
CHAPTER 8
Blood components and
transfusion therapy..................149
Paula A Johnson and J Catharine
Scott-Moncrieff
Introduction..................................... 149
Blood products................................. 149
Fresh whole blood........................ 149
Packed red blood cells.................. 151
Fresh frozen plasma/frozen
plasma...................................... 152
Cryoprecipitate and
cryoprecipitate-depleted
fresh frozen plasma
(cryosupernatant)..................... 153
Platelet products........................... 154
Albumin products........................ 154
Transfusion monitoring.................... 156
Transfusion reactions.................... 157
Safe transfusion practices.................. 158
Blood typing................................ 158
Cross matching............................ 159
Safe sources of blood products.......... 159
Blood donors............................... 159
Autologous blood transfusion....... 160
Massive transfusions..................... 161
Further reading................................ 162
 Contents ix

CHAPTER 9 CHAPTER 10
Injectable sedative and Anesthetic considerations for
anesthesia–analgesia specific diseases........................185
combinations in dogs Ann B Weil and Jeff C Ko
and cats.................................... 163 Introduction..................................... 185
Jeff C Ko Hepatic dysfunction......................... 185
Introduction..................................... 163 General considerations ................ 185
Dexmedetomidine (and Anesthetic management and
medetomidine)-based protocols.... 164 pharmacologic considerations.... 186
Dexmedetomidine Examples of anesthetic protocols
(or medetomidine)–ketamine for dogs with liver dysfunction....187
combinations........................... 164 Anesthetic protocols for cats with
Dexmedetomidine liver dysfunction...................... 188
(medetomidine)–butorphanol.... 166 Other considerations.................... 188
Dexmedetomidine Cardiac dysfunction.......................... 188
(medetomidine)–butorphanol– General considerations................. 188
midazolam (or diazepam) Hypertrophic cardiomyopathy...... 188
sedative combination................ 167 Dilated cardiomyopathy .............. 189
Dog-specific dexmedetomidine Mitral valve regurgitation
combinations........................... 168 (or insufficiency)...................... 190
Cat-specific combinations............. 172 Tricuspid regurgitation................. 190
Pulmonic stenosis ........................ 190
Alternative injectable anesthetic
Aortic stenosis ............................. 191
combinations and techniques
Patent ductus arteriosus (PDA)..... 191
for giant breed dogs................. 174
Pericardial effusion ...................... 192
Chemical restraint combinations
Protocols to minimize the risk and
for animals with systemic
maximize the chances of a good
illness or geriatric dogs
anesthetic outcome in patients
and cats.................................... 175
with pre-existing cardiac disease....192
Tiletamine/zolazepam-based
Anesthetic management and
protocols...................................... 176
pharmacologic considerations.... 193
Tiletamine/zolazepam– Examples of anesthetic protocols
butorphanol– for dogs with cardiac
dexmedetomidine dysfunction.............................. 194
(medetomidine) ....................... 176 Anesthetic protocols for cats
Tiletamine/zolazepam– with cardiac dysfunction.......... 195
dexmedetomidine (or Respiratory dysfunction.................... 195
medetomidine) combination General considerations................. 195
without opioids........................ 180 Anesthetic management and
Tiletamine/zolazepam– pharmacologic considerations.... 195
opioid combinations Examples of anesthetic protocols
without dexmedetomidine/ for dogs and cats with
medetomidine.......................... 180 respiratory dysfunction
Case examples.................................. 180 (e.g. brachycephalic obstructive
Further reading................................ 183 airway disease)......................... 196
x Contents
Central nervous system dysfunction... 197
General considerations................. 197
Anesthetic management
and pharmacologic
considerations.......................... 198
Examples of anesthetic protocols
for dogs with CNS dysfunction...198
Other considerations.................... 198
Endocrine dysfunction..................... 198
Diabetes mellitus..................................198
General considerations................. 198
Anesthetic management and
pharmacologic considerations.... 199
Hypothyroidism............................... 199
General considerations................. 199
Anesthetic management
and pharmacologic
considerations.......................... 199
Hyperthyroidism.............................. 199
General considerations................. 199
Anesthetic management and
considerations.......................... 200
Examples of anesthetic protocols
for dogs and cats with
endocrine disorders.................. 200
Urinary and renal dysfunction.......... 200
General considerations................. 200
Anesthetic considerations
of hemodialysis and
hemoperfusion cases................ 201
Anesthetic management and
pharmacologic considerations.... 202
Examples of anesthetic
protocols for dogs and cats
with urinary and renal
dysfunction.............................. 202
Gastrointestinal dysfunction............. 203
General considerations................. 203
Anesthetic management and
pharmacologic considerations.... 203
Examples of anesthetic protocols
for dogs with GDV.................. 203
Cesarean section............................... 204
General considerations................. 204
Anesthetic management and
pharmacologic considerations.... 205
Examples of anesthetic
protocols for cesarean section
in dogs..................................... 206
Resuscitation of neonates............. 206
Trauma............................................. 207
General considerations................. 207
Anesthetic management and
pharmacologic considerations.... 208
Examples of anesthetic protocols
for traumatized orthopedic
patients.................................... 209
Further reading................................ 209
CHAPTER 11
Airway management and
ventilation................................. 211
Ann B Weil and Jeff C Ko
Introduction..................................... 211
Managing the difficult airway........... 211
Difficulty in intubation................ 211
Laryngospasm.............................. 211
Airway occlusion and changing
the endotracheal tube............... 212
Oral surgery................................. 213
Perioperative oxygen
administration......................... 214
Extubation................................... 215
Ventilation (assisted or controlled).... 216
Indications for use........................ 216
Types of ventilation...................... 216
Ventilator settings........................ 216
Assessing ventilatory efficiency..... 217
Types of ventilators....................... 217
Further reading................................ 218
CHAPTER 12
Anesthetic considerations
for patients requiring upper
airway surgery and patients
requiring thoracic surgery........ 219
Jennifer C Hess
Introduction..................................... 219
Patient preparation........................... 219
Premedication.................................. 220
Anxiolysis and sedation..................... 220
Medication interactions ............... 221

Monitoring....................................... 221
Induction......................................... 222
Analgesia options............................. 222
Opioid analgesia........................... 224
Postoperative analgesia................. 224
Emergencies..................................... 225
Thoracic surgery............................... 226
Pleural space disease......................... 227
Acid–base abnormalities .............. 229
Further reading................................ 230
CHAPTER 13
Anesthetic considerations
for upper and lower
gastrointestinal endoscopic
procedures.................................231
Ann B Weil
Introduction..................................... 231
General considerations................. 231
Pharyngeal/oral examination............ 232
Upper gastrointestinal endoscopy..... 232
Lower gastrointestinal endoscopy....233
Sample anesthetic protocols.......... 234
Further reading................................ 234
CHAPTER 14
Anesthetic considerations for
minimally invasive surgical
procedures.................................235
Ann B Weil
Laryngoscopy/tracheoscopy............. 235
Rhinoscopy...................................... 237
Laparoscopy..................................... 237
Sample anesthetic protocols.............. 239
Laryngeal examination................. 239
Rhinoscopy.................................. 239
Laparoscopic gastropexy............... 239
Further reading................................ 239
CHAPTER 15
Anesthetic considerations
for neurologic patients.............241
Stefania C Grasso
Introduction..................................... 241
Brain diseases...................................242
General considerations.................242
Contents xi
Anesthetic management and
pharmacologic considerations.... 242
Additional considerations for
patients with head trauma........ 243
Potential complications................. 245
Anesthetic management for
patients with seizures...............246
Anesthetic management for
CSF sampling..........................246
Examples of anesthetic protocols
for dogs and cats...................... 247
Spinal and vertebral diseases............. 247
Anesthetic management for
thoracolumbar and cervical
spinal disease........................... 247
Anesthetic management for
patients with atlantoaxial
instability................................. 248
Examples of anesthetic protocols
for dogs and cats...................... 248
Neuromuscular diseases.................... 248
General considerations................. 248
Anesthetic management and
pharmacologic considerations.... 248
Examples of anesthetic protocols
for dogs and cats...................... 249
Further reading................................ 249
CHAPTER 16
Anesthetic considerations
for ophthalmic surgeries.......... 251
Tokiko Kushiro-Banker
Overview.......................................... 251
General considerations...................... 251
Sedation protocols for ophthalmic
examinations and/or minor
procedures.................................... 252
Sedation protocol examples.......... 252
Sedatives and electroretinography....252
Intraocular pressure.......................... 253
Tear production................................ 253
Airway management......................... 253
Oculocardiac reflex....................... 253
Pain management......................... 253
Globe position.................................. 254
Diabetic patients.......................... 255
xii Contents
Commonly used ophthalmic drugs
and possible systemic adverse
effects.......................................... 256
Examples of anesthetic protocols
for dogs for non-intraocular
procedures............................... 256
Examples of anesthetic protocols
for diabetic dogs for
intraocular surgeries................. 256
Examples of anesthetic protocols
for cats for ophthalmic
procedures............................... 256
Further reading................................ 257
CHAPTER 17
Anesthesia and sedation
for radiography, ultrasound,
CT, and MRI patients................259
Jeff C Ko
Introduction..................................... 259
Clinical considerations for selecting
sedation or general anesthesia for
radiographic-related procedures.... 259
Cases suitable for radiography,
ultrasound, and CT
procedures using sedation........ 260
Safety keys to consider when
using sedation for radiography,
ultrasound, CT, and MRI
procedures............................... 260
Sedative protocols for
radiography, ultrasound,
CT, and MRI procedures......... 261
Further reading................................ 263
CHAPTER 18
Anesthetic considerations for
orthopedic surgical patients....265
Bonnie L Hay Kraus
Introduction..................................... 265
Preoperative evaluation..................... 265
Sedation protocols for radiographic
examination................................. 266
Anesthesia/analgesia protocols
for dogs........................................ 267
Induction..................................... 269
Intraoperative analgesia................ 270
Loco-regional anesthesia/
analgesia.................................. 271
Anesthesia/analgesia protocols
for cats......................................... 274
Intraoperative analgesia,
including NSAIDs................... 275
Monitoring.................................. 275
Complications.................................. 275
Postoperative considerations............. 276
Case examples.................................. 276
Case 1 ......................................... 276
Case 2.......................................... 277
Further reading................................ 278
CHAPTER 19
Anesthetic considerations
for dental and oral–facial
surgeries....................................279
Jeff C Ko
Introduction..................................... 279
Anesthetic considerations for
dental and oral–facial surgical
procedures.................................... 280
Pain management for in-hospital
and as take-home medication........ 283
Recommendations for dental and
oral–facial surgeries...................... 284
Premedication ............................. 284
Intravenous induction.................. 285
Inhalant anesthetics..................... 285
Fluid administration..................... 285
Pain management......................... 285
Further reading................................ 285
CHAPTER 20
Analgesia and sedation of
emergency/intensive care
unit patients..............................287
Elizabeth J Thomovsky and
Aimee C Brooks
Introduction..................................... 287
Basic triage of emergency cases......... 287
Specific emergency/intensive care
unit conditions............................. 290
Skin/integument/
musculoskeletal ....................... 290
Neurologic emergencies................ 292

Respiratory emergencies............... 293
Cardiovascular emergencies.......... 295
Metabolic disorders...................... 297
Renal diseases.............................. 300
Further reading................................ 302
CHAPTER 21
Anesthetic emergencies
and cardiopulmonary
resuscitation..............................305
Ann B Weil and Jeff C Ko
Introduction..................................... 305
Respiratory complications that
result in anesthetic emergencies.... 305
Apnea........................................... 305
Hypoventilation........................... 306
Loss of airway ............................. 306
Hypoxemia................................... 307
Laryngospasm.............................. 307
Cardiovascular complications that
result in anesthetic emergencies.... 308
Bradycardia.................................. 308
Hypotension................................ 308
Hemorrhage................................. 309
Cardiac arrhythmias..................... 309
Other complications that result in
anesthetic emergencies................. 311
Hypothermia................................ 311
Hyperthermia............................... 311
Cardiopulmonary resuscitation......... 312
Identification of arrest via
checking of vital signs.............. 312
Action to be taken........................ 312
Defibrillation ............................... 315
Some considerations regarding
cardiopulmonary resuscitation....315
Further reading................................ 316
CHAPTER 22
Perioperative cardiac
arrhythmias and treatments.... 317
Jeff C Ko
Introduction..................................... 317
Normal cardiac conduction pathways...317
Causes of perioperative cardiac
arrhythmias.................................. 319
Contents xiii
Types of cardiac arrhythmias............. 320
Cardiac arrhythmias due to an
abnormal heart rate.................. 320
Cardiac arrhythmias due to
abnormal rhythms.................... 321
Cardiac arrhythmias due
to impulse conduction
abnormality.............................. 323
Identifying perioperative cardiac
arrhythmias and making decisions
for immediate treatment................. 324
Commonly occurring cardiac
arrhythmias, causes, and
treatment perioperatively.......... 324
Cardiac arrhythmias associated
with cardiac emergency and
arrest....................................... 327
Further reading................................ 328
CHAPTER 23
Local anesthetic agents and
anesthetic techniques...............329
Jeff C Ko and Tomohito Inoue
Introduction..................................... 329
Pharmacodynamics........................... 329
Types of local anesthetic agent...... 329
Mechanism of action.................... 330
Specific actions............................. 330
Factors that determine the
potency, onset, duration, and
toxicity of a local anesthetic
agent........................................ 330
Additives...................................... 331
Toxicity of local anesthetics and
treatments................................ 331
Dental blocks................................... 332
Infraorbital block................................ 333
Indications................................... 333
Area and nerves blocked............... 333
Landmarks................................... 333
Drugs and equipment................... 333
Approach..................................... 334
Mental foramen block.......................... 334
Indications................................... 334
Area and nerves blocked............... 334
Landmarks................................... 334
xiv Contents
Drugs and equipment................... 335
Approach..................................... 335
Brachial plexus block........................ 335
Indications................................... 335
Area and nerves blocked............... 335
Landmarks................................... 335
Drugs and equipment................... 336
Approach..................................... 336
Ring and three-point blocks............. 338
Indications................................... 338
Area and nerves blocked............... 338
Landmarks................................... 338
Drugs and equipment................... 338
Approach..................................... 339
Nerve blocks for thoracic surgeries.... 339
Intercostal nerve block......................... 339
Indications................................... 339
Area and nerves blocked............... 339
Landmarks................................... 340
Drugs and equipment................... 340
Approach..................................... 340
Intrapleural infusion nerve block....... 340
Indications................................... 340
Area and nerves blocked............... 340
Landmarks................................... 340
Drugs and equipment................... 340
Approach..................................... 340
Lumbosacral epidural block.............. 341
Indications................................... 341
Area and nerves blocked............... 341
Landmarks................................... 341
Drugs and equipment................... 341
Approach.....................................342
Epidural catheter placement..............344
Specific nerve blocks......................... 345
Intravenous regional blocks
(Bier block and hindlimb blocks).... 345
Indications................................... 345
Area and nerves blocked............... 345
Landmarks................................... 345
Drugs and equipment................... 345
Approach..................................... 345
Local anesthetic as an adjunct to
general anesthesia for eye surgery.... 346
Indications...................................346
Areas and nerves blocked..............346
Landmarks...................................346
Drugs...........................................346
Lidocaine regional constant rate
infusion........................................ 347
Indications................................... 347
Areas and nerves blocked.............. 348
Landmarks................................... 348
Drugs and equipment................... 348
Approach..................................... 348
Intratesticular and intrauterine
blocks using a local anesthetic...... 350
Intra-articular injection of a local
anesthetic or other medication..... 351
Further reading................................ 351
CHAPTER 24
Acute pain management..........353
Jeff C Ko
Introduction..................................... 353
Principles of acute pain management....353
Mechanisms of pain and
mechanism-based pain
management................................. 354
Origins of somatic and visceral
pain and pain management....... 354
Analgesic therapies for acute pain..... 356
Pre-emptive analgesia................... 356
Intraoperative analgesia................ 357
Postoperative analgesia................. 357
Drugs used in analgesic therapies
for acute pain........................... 357
Pre-emptive/preoperative pain
management................................. 358
Opioids........................................ 358
Alpha-2 agonists........................... 359
Non-steroidal anti-inflammatory
drugs....................................... 359
Local anesthetic agents................. 360
Intraoperative pain management....... 360
Opioids........................................ 360
Alpha-2 agonists........................... 360
Other constant rate infusion
alternatives............................... 361
Local anesthetic blocks during
surgery..................................... 362

Postoperative pain management........ 363
Opioids........................................ 363
Alpha-2 agonists........................... 363
Non-steroidal anti-inflammatory
drugs....................................... 363
Take-home pain medication.............. 363
Buprenorphine............................. 363
Tramadol..................................... 365
Fentanyl patch.............................. 366
Lidocaine patch............................ 366
Similarities and differences
between lidocaine patches and
fentanyl patches........................ 368
NSAIDs....................................... 368
Further reading................................ 369
CHAPTER 25
Photobiomodulation therapy
in pain management.................371
Andrea L Looney
Introduction..................................... 371
Mechanism of action in device
and in vivo............................... 371
Classification of devices................ 372
Precautions with
photobiomodulation therapy.... 373
Laser parameter selection and
treatment techniques................ 373
Conclusion................................... 375
Treatment example........................... 375
Further reading................................ 375
CHAPTER 26
Management of neuropathic
pain in dogs and cats................377
Talisha M Moore and
Stephanie A Thomovsky
Overview of pain.............................. 377
Components of normal pain
perception.................................... 377
Role of the peripheral nervous
system in pain perception......... 377
Role of the central nervous
system in pain perception......... 378
Neuropathic pain.............................. 379
Common medications used for the
treatment of neuropathic pain...... 379
Contents xv
Common medications used for the
treatment of chronic pain............. 380
Alternative therapies used for the
treatment of neuropathic pain...... 382
Case examples.................................. 382
Case 1.......................................... 382
Case 2.......................................... 382
Case 3.......................................... 382
Further reading................................ 383
CHAPTER 27
Oncologic pain management
and radiation therapy...............385
Nicholas J Rancilio and Jeff C Ko
Overview of radiation therapy and
its role in pain management.......... 385
Head to tail approach to painful
tumors and cancer........................ 386
Body systems commonly affected
by oncologic pain..................... 386
Oncologic pain assessment and
management................................. 389
Palliative pain management.......... 389
Oncologic treatment-related
pain management..................... 390
Pharmacologic therapy................. 391
Further reading................................ 391
CHAPTER 28
Chronic pain management for
osteoarthritis in dogs and cats.... 393
Tamara L Grubb
Introduction..................................... 393
Pathology of osteoarthritis............... 393
Pain from osteoarthritis.................... 394
Sources of osteoarthritis pain....... 394
Treatment of osteoarthritis pain....... 394
Pharmacologic and non-
pharmacologic therapy............. 394
Other alternative therapies............ 399
Sample protocols for treating
osteoarthritis pain........................ 399
Mild pain..................................... 399
Moderate pain.............................. 399
Severe pain...................................400
Further reading................................400
xvi Contents
CHAPTER 29
Acupuncture and Chinese
medicine for pain
management in dogs and cats....401
Patrick Roynard, Lauren R Frank,
and Huisheng Xie
Introduction..................................... 401
What is acupuncture?........................ 401
Acupuncture for treating pain...... 402
Common methods of veterinary
acupuncture for pain................ 402
Evidence-based mechanisms of
acupuncture............................. 403
Acupuncture channels/meridians....403
Herbal medicine............................... 406
Top five herbs used in small
animal anesthesia and pain
management............................ 406
Clinical applications of acupuncture
and herbs in pain management..... 407
Neurologic conditions.................. 407
Osteoarthritis and degenerative
joint disease............................. 410
Postoperative pain management.... 410
Palliative care and oncology.......... 411
Conclusion....................................... 411
Further reading................................ 411
CHAPTER 30
Rehabilitation and pain
management for veterinary
patients...................................... 413
Stephanie A Thomovsky
Introduction..................................... 413
Types of patients who benefit from
physical rehabilitation................... 415
Orthopedic patients that may
have one or more of the
following conditions................ 416
Neurologic patients with one
or more of the following
conditions................................ 416
Other types of patients................. 416
Use of physical rehabilitation for
pain control............................. 416
Further reading................................ 417
CHAPTER 31
Anesthesia in shelter medicine
and high-volume/high-quality
spay and neuter programs......... 419
Jeff C Ko and Rebecca A Krimins
Introduction..................................... 419
Preimmobilization and anesthesia
considerations ............................. 421
Anesthetic protocols......................... 423
Tiletamine/zolazepam,
butorphanol,
dexmedetomidine................... 423
Monitoring of anesthesia in shelters,
high-volume/high-quality spay
and neuter clinics, and trap–
neuter–release environments......... 427
Further reading................................ 427
CHAPTER 32
Euthanasia.................................429
Jeff C Ko
Introduction..................................... 429
Principles of euthanasia..................... 429
Euthanasia under general anesthesia.....431
Two-stage euthanasia: anesthesia–
sedation prior to euthanasia ......... 431
Drugs and solutions for euthanasia..... 432
Barbiturate-based solutions.......... 432
Potassium chloride....................... 432
Intravenous access for drug
administration.............................. 432
Avoiding agonal breathing and
muscle spasms.............................. 432
Further reading................................ 433
APPENDIX
Anesthetic dosage
reference ranges.......................435
Index..........................................437
Preface
The first edition of this Small Animal
Anesthesia and Pain Management – A Color
Handbook was published in October 2012.
The book has been a popular anesthesia
textbook among veterinary practitioners,
­ making anesthetic/analgesic decisions for
veterinary nurses/technicians, and students
alike, simply because it contains high-quality
photographs on various anesthesia techniques
and related subjects.
In this second edition, we not only include
the content of the first edition in essence, but
also greatly expand on the anesthetic tech-
niques used in dealing with patients with
various diseases subjected to diagnostic or
surgical procedures. In addition, we have
included new drugs, monitors, anesthetic/
analgesic techniques, and information made
available since the first edition was published.
The goals of this handbook, similar to
those of the first edition, are to provide
the anesthetist with (1) a quick information
Acknowledgments
This book is dedicated to my parents and
family, especially my father who passed away
in 2017. He was unable to read and write
English but worked as hard as he could as
an immigrant citizen to the United States
for 40 years. This book is also dedicated to
my wife and two sons, who provided encour-
agement and support during the writing of
this book. Special thanks also go to all the
contributing authors for unselfishly sharing
their wealth of veterinary experience with
the reader. I would also like to thank Kim
Sederquist, BS, RVT, VTS (Cardiology), who
kindly provided ECG strips for Chapter 22.
xvii
source about anesthetic equipment, moni-
tors, drug dosages, and anesthetic techniques
via high-quality photographs, flow charts,
tables, and illustrations; (2) a resource for
both healthy and various organ-dysfunctional
animals. Each chapter from the first edition
has been updated, and the number of authors
increased from the initial 6 to 17 specialists,
to reflect the wide range of experience and
expertise of practitioners in this field.
Because this book is not intended to be a
comprehensive or theory-based textbook, it
allows the authors to be able to provide com-
plex anesthetic information and techniques in
a very precise and practical way. As the key
author of this book, I hope that the reader
continues to find this color handbook a use-
ful tool when practicing anesthesia and pain
management.
Jeff C Ko
My thanks also to all the readers who bought
the first edition of this book and continue
to provide their support and encouragement.
Special gratitude goes to Alice Oven, Paul
Bennett, and Ruth Maxwell of the Taylor &
Francis Group, who worked tirelessly in edit-
ing and proofreading the manuscript with
great care. Warm acknowledgment also goes
to my DVM students, veterinary technol-
ogy ­ students, graduate students, residents,
and veterinary technicians/nurses who chal-
lenged my thoughts and ideas throughout
the ­w riting of both first and second editions
of the book.
Contributors
Tokiko Kushiro-Banker BVM, MS, PhD,
Dip ACVAA
Clinical Assistant Professor, Veterinary
Anesthesiology
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Aimee C Brooks DVM, MS, Dip ACVECC
Clinical Assistant Professor, Emergency and
Critical Care
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Lauren R Frank DVM, MS, CVA, CVCH, CCRT,
Dip ACVSMR
Physical Rehabilitation and Acupuncture
Service
Long Island Veterinary Specialists
Plainview, New York, USA
Stefania C Grasso DVM, MS, Dip ACVAA
Faculté de Médecine Vétérinaire
Université de Montréal
Montréal, Quebec, Canada
Tamara L Grubb DVM, PhD, Dip ACVAA
Assistant Clinical Professor, Anesthesia
and Analgesia
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Washington
State University
Pullman, Washington, USA
Jennifer C Hess DVM, MS, Dip ACVAA
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Tomohito Inoue DVM
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
xix
Paula A Johnson DVM
Clinical Assistant Professor, Emergency and
Critical Care
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Jeff C Ko DVM, MS, Dip ACVAA
Professor of Anesthesiology
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Rebecca A Krimins DVM, MS
Assistant Professor of Radiology and
Radiological Science
School of Medicine, John Hopkins University
Baltimore, Maryland, USA
Bonnie L Hay Kraus DVM, Dip ACVAA, Dip ACV
Assistant Professor
Iowa State University College of Veterinary
Medicine
Ames, Iowa, USA
Andrea L Looney DVM, Dip ACVAA, CCRP,
Dip ACVSMR
Anesthesiologist, Learning & Development
Team, Specialists
Ethos Veterinary Health
Woburn, Massachusetts, USA
Talisha M Moore DVM, Dip ACVIM (Neurology)
Assistant Clinical Professor, Neurology/
Neurosurgery
Mississippi State University, College of
Veterinary Medicine
Mississippi, USA
Nicholas J Rancilio DVM, MS, Dip ACVR
(Radiation Oncology)
Assistant Professor, Radiation Oncology
Department of Clinical Sciences
College of Veterinary Medicine, Auburn
University
Auburn, Alabama, USA
xx Contributors
Patrick Roynard DVM, Dip ACVIM (Neurology)
Neurology/Neurosurgery Department
Long Island Veterinary Specialists
Plainview, New York, USA
and
Fipapharm
Mont-Saint-Aignan, France
J Catharine Scott-Moncrieff VetMB, MA, MS,
DECVIM (Companion Animal), DSAM,
Dip ACVIM (Small Animal Internal Medicine)
Department Head, Professor, Small Animal
Internal Medicine
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Elizabeth J Thomovsky DVM, MS, Dip ACVECC
Clinical Assistant Professor, Small Animal
Emergency and Critical Care
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Stephanie A Thomovsky DVM, MS, Dip ACVIM
(Neurology), CCRP
Clinical Assistant Professor, Veterinary
Neurology
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Ann B Weil MS, DVM, Dip ACVAA
Clinical Professor
Department of Veterinary Clinical Sciences
College of Veterinary Medicine, Purdue
University
West Lafayette, Indiana, USA
Huisheng Xie DVM, PhD
Clinical Professor – Integrative Medicine
Department of Comparative, Diagnostic and
Population Medicine
University of Florida
Gainesville, Florida, USA
Abbreviations xxi

ABG arterial blood gas Cytoco cytochrome c oxidase

ACD anticoagulant citrate dextrose DBK dexmedetomidine–butorphanol–
ACh acetylcholine ketamine
ACVAA American College of Veterinary DCM dilated cardiomyopathy
Anesthesia and Analgesia DEA dog erythrocyte antigen
AKI acute kidney injury DIC disseminated intravascular
ALP alkaline phosphatase coagulation
ALT alanine aminotransferase DISS diameter index safety system
APL adjustable pressure limiting DK A diabetic ketoacidosis
(valve) EBRT external beam radiation therapy
aPTT activated partial thromboplastin DRT definitive radiation therapy
time ECG electrocardiogram/
ASA American Society of electrocardiography
Anesthesiologists EDTA ethylenediaminetetraacetic acid
AST aspartate aminotransferase EEG electroencephalogram/
ASTM American Society for Testing electroencephalography
and Materials ERG electroretinography
ATP adenosine triphosphate ETCO2 end-tidal carbon dioxide
AV atrioventricular ETT endotracheal tube
AVMA American Veterinary Medical FDA Food and Drug Administration
Association FiO2 inspiratory fraction of oxygen
BBB bundle branch block FLK fentanyl–lidocaine–ketamine
BCS body condition score FFP fresh frozen plasma
BG blood glucose FLK fentanyl–lidocaine–ketamine
BIS bispectral index (monitor) FP frozen plasma
BLK butorphanol–lidocaine–ketamine FROGS Flowmeter, Regulator,
BMBT buccal mucosal bleeding time vapOrizer, Gas supply, Scavenger
BNZ benzodiazepines FSNB femoral/sciatic nerve block
bpm beats per minute GABA gamma-aminobutyric acid
BP blood pressure GDV gastric dilatation/volvulus
BUN blood urea nitrogen GER gastroesophageal reflux
BW body weight GFR glomerular filtration rate
cAMP cyclic adenosine monophosphate GGT gamma glutamyltransferase
CBC complete blood count GI gastrointestinal
CBF cerebral blood flow Gy Gray
CMRO2 cerebral metabolic rate H 2O water
CNS central nervous system HCM hypertrophic cardiomyopathy
CO cardiac output Hct hematocrit
CO2 carbon dioxide HFV high-frequency ventilation
COX cylcooxygenase HLK hydromorphone–lidocaine–
CPDA citrate-phosphate-dextrose- ketamine
adenine HPBCD 2-alpha-hydroxypropyl beta
CPP cerebral perfusion pressure cyclodextrin
CPR cardiopulmonary resuscitation HR heart rate
CRI constant rate infusion IAP intra-abdominal pressure
CRT capillary refill time IC intercostal
CSF cerebrospinal fluid ICP intracranial pressure
CT computed tomography ICU intensive care unit
xxii Abbreviations

ID internal diameter PG propylene glycol

I:E inspiratory to expiratory PI perfusion index
(time ratio) PIP peak inspiratory pressure
IM intramuscular/intramuscularly PISS pin index safety system
IOP intraocular pressure PK/PD pharmacokinetic/dynamic
IPPV intermittent positive-pressure PNST peripheral nerve sheath tumor
ventilation PO per os/orally
IT intratracheal/intratracheally pRBC packed red blood cell
IV intravenous/intravenously PRT palliative radiation therapy
IVDD intervertebral disc disease PSGAG polysulfated glycosaminoglycan
KCl potassium chloride psi pounds per square inch
kPa kilopascals PT prothrombin time
LA local anesthetic PTT partial thromboplastin time
LASER low-level impulse light PVC polyvinyl chloride
amplification by stimulated PVI plethysmographic variability
emission of radiation index
LED light-emitting diode RBC red blood cell
LLLT low-level laser therapy RNA renal nerve activity
LRS lactated Ringer’s solution ROS reactive oxygen species
LS lumbosacral (epidural) RPE re-expansion pulmonary edema
MAC minimum alveolar concentration RR respiratory rate
MAP mean arterial blood pressure RUMM radius/ulna/median/
MCH mean corpuscular hemoglobin musculocutaneous (block)
MCHC mean corpuscular hemoglobin SA sinoatrial
concentration SaO2 hemoglobin oxygen saturation
MCV mean corpuscular volume measured by arterial blood gas
MLK morphine–lidocaine–ketamine analysis
MOA mu opioid agonist SC subcutaneous/subcutaneously
MRI magnetic resonance imaging SG specific gravity
MV minute volume SNS sympathetic nervous system
NAALT North American Association of SpO2 hemoglobin oxygen saturation
Photobiomodulation measured by pulse oximeter
NaCl sodium chloride SSI surgical site infection
NIOSH National Institute of SV stroke volume
Occupational Safety and Health SVR systemic vascular resistance
NMBA neuromuscular blocking agent SVT supraventricular tachycardia
NMDA N-methyl D-aspartate TCM Traditional Chinese Medicine
NO nitric oxide TCVM Traditional Chinese Veterinary
NRS numerical rating scale Medicine
NSAID non-steroidal anti-inflammatory TENS transcutaneous electrical nerve
drug stimulation
OA osteoarthritis THDex Telazol–hydromorphone–
OSHA Occupational Safety and Health Dexdomitor
Administration TIVA total intravenous anesthesia
OTM oral transmucosal/ TKX Telazol–ketamine–xylazine
transmucosally TMDex Telazol–morphine–Dexdomitor
PaCO2 partial pressure of arterial TNDex Telazol–nalbuphine–Dexdomitor
carbon dioxide TOF train-of-four
PaO2 partial pressure of arterial oxygen TP total protein
PBM photobiomodulation TPLO tibial plateau leveling osteotomy
PCV packed cell volume TS total solids
PDA patent ductus arteriosus TSDex Telazol–Simbadol–
PEEP positive end expiratory pressure dexmedetomidine
 Abbreviations xxiii

TTA tibial tuberosity advancement VOC vaporizer-out-of-the-circuit

TTD Telazol–Torbugesic–Domitor VPC ventricular premature
TTDex Telazol–Torbugesic–Dexdomitor contraction
TV tidal volume V/Q ventilation–perfusion
VAS visual analog scale (mismatch)
VIC vaporizer-in-the-circuit WBC white blood cell
CHAPTER 1
Equipment for inhalant
anesthesia
Jeff C Ko
Introduction..........................................1
Components of the anesthesia
machine.............................................1
Breathing circuits and components.....12
Modern human anesthesia
machines for veterinary use.............22
Selecting a breathing circuit ...............23
Ambu bags..........................................24
Ventilators ..........................................24
Oxygen flow rates...............................25
Endotracheal tubes.............................28
Laryngeal mask airway for cats..........32
Introduction
Inhalant anesthetic equipment includes an
anesthesia machine and a breathing circuit
(Figs. 1.1, 1.2). Other important equipment
for inhalant anesthesia includes a reservoir
bag, endotracheal tube, laryngoscope, and
blade, as well as oxygen and other medical
gases. The purpose of the inhalant anesthesia
Components of the anesthesia machine
No matter how simple or complicated an anes-
thesia machine looks, it has five basic compo-
nents (Flowmeter, Regulator, vapOrizer, Gas
1
Laryngoscopes....................................32
Induction chambers and face masks.... 33
Checking the accuracy of the
flowmeter........................................35
Checking the anesthesia machine
and breathing circuit for leaks.........36
Checking the scavenging system
for leaks and malfunctions..............39
Monitoring of waste gas and
pollution..........................................39
Further reading...................................40
machine, together with the breathing circuit,
is to deliver oxygen and inhalant anesthetic
effectively to the animal and to remove car-
bon dioxide (CO2) from the animal’s respi-
ratory system. This chapter describes the
primary components of inhalant anesthetic
equipment and their functions.
supply, Scavenger), which can be remembered
using the acronym FROGS.
2 Chapter 1 Equipment for inhalant anesthesia
FLOWMETERS (FIGS. 1.3, 1.4)
Key points about flowmeters:
• The flowmeter is used to control precisely
the delivery of a specific amount of
medical gas through the vaporizer to the
patient.
• A flowmeter is required for each
medical gas.
• There are two types of flowmeter:
pediatric and adult (Fig. 1.4). A pediatric
flowmeter provides more precise control
of the flow rate and allows the anesthesia
machine to run with a precise, low flow
rate. It is therefore preferred for running a
low-oxygen flow rate.
• The flow rate is determined by observing
the position of the bobbin or float in the
flowmeter. The bobbin or float comes
in various shapes and sizes. Ball-shaped
bobbins are read at the center or widest
diameter of the float (Fig. 1.5). Bobbins
with other shapes are read at the top of
the float (Fig. 1.6).
• Flowmeters are agent specific and color
coded (Fig. 1.3). For example, in the
USA, flowmeters for oxygen are coded
green, while flowmeters for nitrous oxide
are coded blue and medical room air
flowmeters are coded yellow. This may not
be the same in other parts of the world.
1.1
F O
G
S S
Fig. 1.1 An anesthesia machine (portion
outlined with the green color box) with a
rebreathing circuit (portion outlined with the
red color box) and an isoflurane vaporizer-
out-of-the-circuit. The acronym for the five
basic components (FROGS) is marked on the
image. The rebreathing circuit has a pair of
breathing hoses and a CO2 absorbent.
REGULATORS (PRESSURE
REDUCING VALVES)
Key points about regulators:
• The pressure regulator, also called a
pressure reducing valve, is designed
to reduce the high pressure from the
medical gas, which is supplied from a
portable or storage tank (up to 2,200 psi
[15,168.4 kPa] in a size E portable oxygen
tank, Fig. 1.7), to a working pressure
(15–30 psi [103.4–206.8 kPa]) that does
not damage the anesthesia machine or the
patient’s airway.
1.2
F
O
R
G
Fig. 1.2 An anesthesia machine (portion
outlined with the green color box) with a
non-rebreathing circuit (portion outlined with
the red color box). The acronym for the five
basic components (FROGS) is marked. Note
the simple structure of a non-breathing circuit,
which is built to have minimal resistance to
breathing.
 Components of the anesthesia machine 3

1.3 1.5 1.6

Read center of the float Read top of the float
(2 liters per minute) (3 liters per minute)

3 3

2 2
Figs. 1.3, 1.4 Two 1.4
sets of flowmeters
each with a rotameter
and a needle valve at 1 1
the bottom (Fig. 1.3); Figs. 1.5, 1.6 Oxygen enters the rotameter
note the nitrous and passes through a bobbin (float), exiting
oxide (blue color) and at the top of the flowmeter to enter the
oxygen (green color) machine and vaporizer. Ball-shaped bobbins
each has their own set are read at the center or widest diameter of
of flowmeters. Note the bobbin (1.5). Other shapes of bobbins
the metal bar in front are read at the top of the bobbin (1.6). Note
of the rotameters to that the flowmeter is tapered in shape. The
prevent accidental clearance between the bobbin and the wall
adjustment of the of the flowmeter increases from bottom
flowmeters. Pediatric (narrow) to top (wide).
flowmeters (on the
left side, 1.4) are
graduated in milliliters 1.7
from zero to 1,000 ml,
while adult flowmeters
(on the right side, 1.4)
are graduated in liters.

Fig. 1.7 This pressure gauge indicates

a partially full size E oxygen tank of
approximately 1,350 psi (9308 kPa). A full size
E oxygen tank has a pressure of approximately
2,200 psi (15,168.4 kPa). A quick way to
calculate the amount of oxygen (in liters) left
in the size E tank is to multiply the pressure in psi by 0.3. So, in this case there are 405 liters of
oxygen left in the tank. Note the regulator (brass color) located directly below the pressure
gauge. Regulators (and flowmeters) are marked with the corresponding medical gas color.
4 Chapter 1 Equipment for inhalant anesthesia
• The regulator provides a constant flow of
gas irrespective of measured changes at
the source.
• Given that each medical gas requires a
specific regulator, there is one regulator
for each medical gas within the anesthesia
machine.
VAPORIZERS
Key points about vaporizers:
• A vaporizer (Fig. 1.8) is used to add a
specific amount of inhalant anesthetic
agent to the oxygen/gas (nitrous
oxide) mixture in order to anesthetize
the patient. The amount of inhalant
anesthetic is expressed either as a
percentage of the saturate vapor added
to the oxygen/gas flow or as a volume
percentage of the vapor output.
• Because anesthetic gas (isoflurane or
sevoflurane) can vaporize to dangerously
high concentrations (isoflurane to 32%
and sevoflurane to 22% at sea level in
room temperature), a precision vaporizer
is required to control precisely the volume
of inhalant anesthetic delivered to the
patient.
• Vaporizers are largely divided into two
types based on their location in relation to
the breathing circuit. A vaporizer placed
within the anesthetic breathing circuit
(Fig. 1.9) is called a vaporizer-in-the-circuit
1.8
Fig. 1.8 A desflurane vaporizer (left), a Tec 4
isoflurane vaporizer (middle with purple color
label), and a Tec 4 halothane vaporizer (on
the right with the red label). Note the electric
cable and plug on the desflurane vaporizer for
the external heat supply required for proper
vaporization.
(VIC), while a vaporizer placed outside the
breathing circuit is called a vaporizer-out-
of-the-circuit (VOC).
Vaporizers-in-the-circuit
Specific points related to VICs:
• VICs are non-precision vaporizers of
simple construction designed to minimize
resistance to breathing. The VIC is less
commonly used in current anesthesia
practice. However, some practices still
have a VIC system. The advantage of
the VIC is that it can be used with many
different types of anesthetic inhalants,
given that it is not calibrated for a specific
anesthetic gas (hence the term non-
precision vaporizer). The most common
VICs are the Ohio #8 bottle vaporizer
(Fig. 1.10) and Stephen’s Universal
vaporizer (Fig. 1.9); both can be used for
halothane, isoflurane, or sevoflurane.
1.9
Fig. 1.9 A vaporizer-in-the-circuit is usually
a non-precision vaporizer constructed of
glass and without flow or temperature
compensation. A Stephen glass vaporizer with
a Stephen machine is shown. (Image courtesy
M. Iqbal Javaid.)
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FROM THE INNER WORLD ***
 The Voice from the Inner World
Second Honorable Mention in the $500 Prize Cover Contest
Awarded to A. Hyatt Verrill, New York City,
for “A Voice from the Inner World.”

... And it was evident that the others were equally afraid of me ... they
stood regarding me with an odd mixture of wonder and terror on their
 huge faces.

The Voice from the Inner World

by A. Hyatt Verrill
Author of “The Plague of the Living Dead,” “Through the Crater’s Rim,” etc.

The author of this story, well known to our readers, in submitting his prize
story, adopts a treatment entirely different from that of practically all the
rest of the winners. He has submitted a tale so characteristic and so
original that it holds your interest by sheer strength. That there should be a
cannibalistic race of females somewhere in our world is, after all, not
impossible nor improbable. There are still cannibals at large, at the present
writing, and probably will be for many generations to come. While the story
has its gruesome moments, it also contains good science and Mr. Verrill
certainly knows how to treat his subject and get the most from it. As a
“different” sort of story, we highly recommend it to your attention.

On the eighteenth of October, the New York papers reported the

appearance of a remarkable meteor which had been seen in mid-
Pacific, and the far more startling announcement that it was feared
that the amazing celestial visitor had struck and destroyed a
steamship.
“At eleven-fifteen last evening,” read the account in the Herald,
“the Panama-Hawaiian Line steamship Chiriqui reported by radio the
appearance of an immense meteor which suddenly appeared above
the horizon to the southeast, and which increased rapidly in size and
brilliance. Within ten minutes from the time the phenomenon was
first sighted, it appeared as a huge greenish sphere of dazzling
brilliance high in the sky, and heading, apparently, directly for the
Chiriqui. Almost at the same time as reported by the Chiriqui, several
other ships, among them the Miners and Merchants Line Vulcan,
and the Japanese liner Fujiama Maru also reported the meteorite,
although they were more than one thousand miles apart and
equidistant from the position of the Chiriqui.
“In the midst of a sentence describing the appearance of the
rapidly approaching meteor, the Chiriqui’s wireless message came to
an abrupt end, and all attempts to get into further communication
with her operator failed. The other vessels reported that a
scintillating flash, like an explosion, was followed by the meteor’s
disappearance, and it is feared that the immense aerolite may have
struck the Chiriqui, and utterly destroyed her with all on board. As no
S O S has been received, and as the ship’s radio broke off with the
words: ‘It is very close and the sea is as bright as day. Below the
immense mass of green fire are two smaller spheres of intense red.
It is so near we can hear it roaring like a terrific wind. It is headed—’
It is probable that the vessel, if struck, was instantly destroyed. It has
been suggested, however, that it is possible that the meteor or
meteors were accompanied by electrical phenomena which may
have put the Chiriqui’s wireless apparatus out of commission and
that the ship may be safe.”
Later editions of the press announced that no word had been
received from the Chiriqui, that other ships had reported the meteor,
and that two of these had radioed that the aerolite, instead of
exploding, had been seen to continue on its way and gradually
disappear beyond the horizon. These reports somewhat allayed the
fears that the Chiriqui had been struck by the meteor, and prominent
scientists expressed the opinion that the supposed explosion had
been merely an optical illusion caused by its passage through some
dense or cloudy layer of air. They also quoted numerous cases of
immense meteors having been seen by observers over immense
distances, and declared their belief that the aerolite had not reached
the earth, but had merely passed through the outer atmosphere.
When asked regarding the possibility of the meteor having affected
the ship’s wireless apparatus, experts stated that such might have
been the case, although, hitherto, severe electrical disturbances had
never been associated with the passage of meteors. Moreover, they
declared that even if the wireless had been injured, it could have
been repaired in a few hours, and that they could not explain the
continued silence of the Chiriqui. Word also came from Panama that
the naval commandant at Balboa had despatched a destroyer to
search for the Chiriqui, or any survivors of the catastrophe if the ship
had been destroyed.
 A few hours later, despatches were received from various points
in Central and South America, reporting the meteor of the previous
night. All of these agreed that the fiery mass had swept across the
heavens in a wide arc and had vanished in the east beyond the
summits of the Andes.
It was, therefore, fairly certain that the Chiriqui had not been
struck by the meteor, and in a few days the incident was completely
forgotten by the public at large.
But when, ten days later, the warship reported that no sign of the
missing ship could be found, and the officials of the Panama-
Hawaiian Line admitted that the Chiriqui was four days overdue,
interest was again aroused. Then came the startling news, featured
in screaming headlines, that the meteor or its twin had been again
reported by various ships in the Pacific, and that the
U. S. S. McCracken, which had been scouring the seas for traces of
the missing Chiriqui, had sent in a detailed report of the meteor’s
appearance, and that her wireless had gone “dead,” exactly as had
that of the Chiriqui.
And when, after every effort, no communication could be
established with the war vessel, and when two weeks had elapsed
without word from her, it was generally conceded that both ships had
been destroyed by the amazing celestial visitor. For a time the
double catastrophe filled the papers to the exclusion of nearly
everything else, and such everyday features as scandals and murder
trials were crowded to the back pages of the dailies to make room for
long articles on meteors and missing ships and interviews with
scientists. But as no more meteors appeared, and as no more ships
vanished, the subject gradually lost interest and was no longer news.
About three months after the first report of the green meteor
appeared (on January fifteenth, to be exact) I was in Peru, visiting
my daughter, when I received a communication of such an utterly
amazing character that it appeared incredible, and yet was so borne
out by facts and details that it had all the earmarks of truth. So
astounding was this communication that, despite the fact that it will
unquestionably be scoffed at by the public, I feel that it should be
given to the world. As soon as I had received the story I hurried with
it to the American Minister in Lima, and related all that I had heard.
He agreed with me that the authorities at Washington should be
acquainted with the matter at once, and together we devoted many
hours to coding the story which was cabled in the secret cipher of
the State Department. The officials, however, were inclined to regard
the matter as a hoax, and, as far as I am aware, no steps have yet
been taken to follow out the suggestions contained in the
communication which I received, and thus save humanity from a
terrible fate. Personally, I am convinced that the amazing tale which
came to me in such an astounding and unexpected manner is
absolutely true, incredible as it may seem, but whether fact or fiction,
my readers may decide for themselves.
My son-in-law was intensely interested in radio, and devoted all of
his spare time to devising and constructing receiving sets, and in his
home in the delightful residential suburb of Miraflores, were a
number of receiving sets of both conventional and original design.
Having been closely in touch with the subject for several years, I was
deeply interested in Frank’s experiments, and especially in a new
type of hook-up which had given most remarkable results in
selectivity and distance. Practically every broadcasting station in
America, and many in Europe, had been logged by the little set, and
on several occasions faint signals had been heard which, although
recognizable as English, evidently emanated from a most remote
station. These, oddly enough, had come in at the same hour each
night, and each time had continued for exactly the same length of
time.
We were discussing this, and trying to again pick up the
unintelligible and unidentified signals on that memorable January
evening, when, without warning, and as clearly as though sent from
the station at Buenos Ayres, came the most astounding
communication which ever greeted human ears, and which, almost
verbatim, was as follows:1
“LISTEN! For God’s sake, I implore all who may hear my words to
listen! And believe what I say no matter how unbelievable it may
seem, for the fate of thousands of human beings, the fate of the
human race may depend upon you who by chance may hear this
message from another world. My name is James Berry, my home is
Butte, Montana, my profession a mining engineer, and I am speaking
through the short wave transmitter of the steamship Chiriqui on
which I was a passenger when the terrible, the incredible events
occurred which I am about to relate. On the evening of October
sixteenth2 the Chiriqui was steaming across the Pacific in calm
weather when our attention was attracted by what appeared to be an
unusually brilliant meteor of a peculiar greenish color. It first
appeared above the horizon to the southeast, and very rapidly
increased in size and brilliancy. At the time I was particularly struck
by the fact that it left no trail of light or fire behind it, as is usual with
large meteorites, but so rapidly did it approach that I had little time to
wonder at this. Within a few moments from the time that it was first
seen, the immense sphere of green incandescence had grown to the
size of the moon, and the entire sea for miles about our ship was
illuminated by a sickly green light. It appeared to be headed directly
towards our ship, and, standing as I was on the bridge-deck near the
wheel-house, I heard the chief officer cry out: ‘My God, it will strike
us!’ By now the mass of fire had altered in appearance, and a short
distance below the central green mass could be seen two smaller
spheres of blinding red, like huge globes of molten metal. By now,
too, the noise made by the meteor was plainly audible, sounding like
the roar of surf or the sound of a tornado.
“Everyone aboard the ship was panic-stricken; women screamed,
men cursed and shouted, and the crew rushed to man the boats, as
everyone felt that the Chiriqui was doomed. What happened next I
can scarcely describe, so rapidly did the events occur. As the meteor
seemed about to hurl itself upon the ship, there was a blinding flash
of light, a terrific detonation, and I saw men and women falling to the
decks as if struck down by shell fire. The next instant the meteor
vanished completely, and intense blackness followed the blinding
glare. At the same moment, I was aware of a peculiar pungent,
suffocating odor which, perhaps owing to my long experience with
deadly gases in mining work, I at once recognized as some noxious
gas. Almost involuntarily, and dully realizing that by some miracle the
ship had escaped destruction, I dashed below and reached my cabin
almost overcome by the fumes which now penetrated every portion
of the ship. Among my possessions was a new type of gas-mask
which had been especially designed for mine work, and my idea was
to don this, for I felt sure that the meteor had exploded close to the
ship and had released vast quantities of poisonous gases which
might hang about for a long time.
“Although almost overcome by the choking fumes, I managed to
find and put on the apparatus, for one of its greatest advantages was
the rapidity and ease with which it could be adjusted, it having been
designed for emergency use. But before it was fairly in place over
my face, the electric light in my room went out and I was in complete
darkness. Also, the ship seemed strangely still, and as I groped my
way to the stateroom door it suddenly dawned upon me that the
engines had stopped, that there was no longer the whirr of dynamos
from the depths of the hull. Not a light glimmered in the passageway,
and twice, as I felt my way towards the social hall, I stumbled over
the sprawled bodies of men, while in the saloon itself I several times
stepped upon the soft and yielding flesh of passengers who lay
where they had been struck down by the poisonous gas. In all
probability, I thought, I was the sole survivor aboard the ship, unless
some of the firemen and engineers survived, and I wondered how I
would manage to escape, if the vessel should be sighted by some
other ship, or if it should be my gruesome task to search the Chiriqui
from stem to stern, drag the bodies of the dead to the deck and cast
them into the sea, and remain—perhaps for weeks—alone upon the
ship until rescued by some passing vessel. But as I reached the door
and stepped upon the deck all such thoughts were driven from my
brain as I blinked my eyes and stared about in dumfounded
amazement. I had stepped from Stygian darkness into dazzling light.
Blinded for the moment, I closed my eyes, and when I again opened
them I reeled to the rail with a cry of terror. Poised above the ship’s
masts, and so enormous that it appeared to shut out half the sky,
was the stupendous meteor like a gigantic globe of green fire, and
seemingly less than one hundred feet above me. Still nearer, and
hanging but a few yards above the bow and stern of the ship, were
the two smaller spheres of glowing red. Cowering against the rail,
expecting to be shrivelled into a charred cinder at any instant, I
gazed transfixed and paralyzed at the titanic masses of flaming light
above the ship.
 “Then reason came back to me. My only chance to escape was to
leap into the sea, and I half clambered upon the rail prepared to take
the plunge. A scream, like that of a madman, came from my lips.
Below me was no sign of the waves, but a limitless void, while,
immeasurably distant beneath the ship, I could dimly see the crinkled
surface of the sea. The Chiriqui was floating in space!
“It was impossible, absolutely preposterous, and I felt convinced
that I had gone mad, or that the small quantity of gas I had breathed
had affected my brain and had induced the nightmarish vision.
Perhaps, I thought, the meteors above the ship were also visionary,
and I again stared upward. Then, I knew that I was insane. The
spheres of green and red light were rushing upward as I could see
by the brilliant stars studding the sky, and the ship upon which I
stood was following in their wake! Weak, limp as a rag, I slumped to
the deck and lay staring at the great globes above me. But the
insanely impossible events which had crowded upon my
overwrought senses were as nothing to the amazing discovery I now
made.
“As my eyes became accustomed to the glare of the immense
green sphere, I saw that instead of being merely a ball of fire it had
definite form. About its middle extended a broad band from which
slender rods of light extended. Round or ovoid spots seemed placed
in definite order about it, and from the extremities of its axes lines or
cables, clearly outlined by the glare, extended downward to the red
spheres above the ship. By now, I was so firmly convinced that I was
irrational, that these new and absolutely stunning discoveries did not
excite or surprise me in the least, and as if in a particularly vivid
dream, I lay there gazing upward, and dully, half consciously
speculating on what it all meant. Gradually, too, it dawned upon me
that the huge sphere with its encircling band of duller light was
rotating. The circular markings, which I thought were marvelously
like the ports of a ship, were certainly moving from top to bottom of
the sphere, and I could distinctly hear a low, vibrant humming.
“The next second I jerked upright with a start and my scalp
tingled. Reason had suddenly returned to me. The thing was no
meteor, no celestial body, but some marvelous machine, some
devilish invention of man, some gigantic form of airship which—God
only knew why—had by some incredible means captured the
Chiriqui, had lifted the twenty thousand ton ship into the air and was
bearing her off with myself, the only survivor of all the ship’s
company, witnessing the miraculous happening! It was the most
insane thought that had yet entered my brain, but I knew now for a
certainty that I was perfectly sane, and, oddly enough, now that I
was convinced that the catastrophe which had overtaken the Chiriqui
was the devilish work of human beings, I was no longer frightened
and my former nightmarish terror of things unknown, gave place to
the most intense anger and an inexpressible hatred of the fiends
who, without warning or reason, had annihilated hundreds of men
and women by means of this new and irresistible engine of
destruction. But I was helpless. Alone upon the stolen and stricken
ship I could do nothing. By what tremendous force the spherical
airship was moving through space, by what unknown power it was
lifting the ship and carrying it,—slung like the gondola of a Zeppelin
beneath the sphere,—were matters beyond my comprehension.
Calmly, now that I felt assured that I was rational and was the victim
of my fellow men—fiendish as they might be,—I walked aft to where
one red sphere hung a few yards above the ship’s deck.

“There seemed no visible connection between it and the vessel, but I

noticed that everything movable upon the deck, the iron cable, the
wire ropes, the coiled steel lines of the after derrick, all extended
upward from the deck, as rigid as bars of metal, while crackling blue
sparks like electrical discharges scintillated from the ship’s metal
work below the red sphere. Evidently, I decided, the red mass was
actuated by some form of electrical energy or magnetism, and I gave
the area beneath it a wide berth. Retracing my way to the bow of the
ship, I found similar conditions there. As I walked towards the waist
of the ship again I mounted the steps to the bridge, hoping from that
height to get a better view of the monstrous machine holding the
Chiriqui captive. I knew that in the chart-house I would find powerful
glasses with which to study the machine. Upon the bridge the bodies
of the quartermaster, the first officer and an apprentice lay sprawled
grotesquely, and across the chart-house door lay the captain.
Reaching down I lifted him by the shoulders to move him to one side,
and to my amazement I discovered that he was not dead. His heart
beat, his pulse, though slow and faint, was plain, he was breathing
and his face, still ruddy, was that of a sleeping man rather than of a
corpse.
“A wild thought rushed through my brain, and hastily I rushed to
the other bodies. There was no doubt of it. All were alive and merely
unconscious. The gas had struck them down, but had not killed
them, and it came to me as a surprise, though I should long before
have realized it, that the fumes had been purposely discharged by
the beings who had captured the vessel. Possibly, I mentally
decided, they had made a mistake and had failed in their intention to
destroy the persons upon the ship, or again, was it not possible that
they had intentionally rendered the ship’s company unconscious,
and had not intended to destroy their lives? Forgetting my original
purpose in visiting the bridge, I worked feverishly to resuscitate the
captain, but all to no purpose. Many gases, I knew, would render a
man unconscious without actually injuring him, and I was also aware,
that when under the influence of some of these, the victims could not
be revived until the definite period of the gases’ effect had passed.
So, feeling certain that in due time the captain and the others would
come to of their own accord, I entered the chartroom and, securing
the skipper’s binoculars, I again stepped upon the bridge. As I could
not conveniently use the glasses with my gas-mask in place, and as
I felt sure there was no longer any danger from the fumes, I started
to remove the apparatus. But no sooner did a breath of the air enter
my mouth than I hastily readjusted the contrivance, for the gas which
had struck down everyone but myself was as strong as ever. Indeed,
the mere whiff of the fumes made my head reel and swim, and I was
forced to steady myself by grasping the bridge-rail until the dizzy
spell passed.
“Once more myself, I focussed the glasses as best I could upon
the whirling sphere above the ship. But I could make out little more
than by my naked eyes. The band about the center or equator of the
globular thing was, I could now see, divided into segments, each of
which bore a round, slightly convex, eye-like object from the centers
of which extended slender rods which vibrated with incalculable
speed. Indeed, the whole affair reminded me of the glass models of
protozoans which I had seen in the American Museum of Natural
History. These minute marine organisms I knew, moved with great
rapidity by means of vibrating, hair-like appendages or cilia, and I
wondered if the enormous spherical machine at which I was gazing,
might not move through space in a similar manner by means of
vibrating rods moving with such incredible speed that, slender as
they were, they produced enormous propulsive power. Also, I could
now see that the two extremities of the sphere, or as I may better
express it, the axes, were equipped with projecting bosses or shafts
to which the cables supporting the red spheres were attached. And
as I peered through the glasses at the thing, the huge green sphere,
which had been hitherto traveling on an even keel, or, in other words,
with the central band vertical, now shifted its position and one end
swung sharply upward, throwing the band about the centre at an
acute angle. Involuntarily I grasped the rail of the bridge expecting to
be thrown from my feet by the abrupt uptilting of the ship. But to my
utter amazement the Chiriqui remained on an even plane and I then
saw that as the sphere tilted, the cable at the uppermost axis ran
rapidly out so that the two red spheres, which evidently supported
the captive ship, remained, in their original relative horizontal
position. No sign of life was visible upon the machine above me, and
I surmised that whoever might be handling the thing was within the
sphere.
“Wondering how high we had risen above the sea, I stepped to
the starboard end of the bridge and glanced down, and an
involuntary exclamation escaped my lips. Far beneath the ship and
clearly visible through the captain’s glasses was land! I could
distinguish the white line marking surf breaking on a rocky shore,
and ahead I could make out the cloud-topped, serried summits of a
mighty range of mountains. Not until then did I realize the terrific
speed at which the machine and captive vessel were traveling. I had
been subconsciously aware that a gale had been blowing, but I had
not stopped to realize that this was no ordinary wind, but was the
rush of air caused by the rapidity of motion. But as I peered at the
mountains through the binoculars, and saw the distant surface of the
earth whizzing backward far beneath the Chiriqui’s keel, I knew that
we were hurtling onward with the speed of the fastest scout airplane.
 “Even as I gazed, the mountains seemed to rush towards me until,
in a few minutes after I had first seen them, they appeared almost
directly under the ship. Then the gigantic machine above me
suddenly altered its course, it veered sharply to one side and swept
along the range of summits far beneath. For some reason, just why I
cannot explain, I dashed to the binnacle and saw that we were
traveling to the south, and it flashed across my mind, that I had a dim
recollection of noticing, when I first realized the nature of the
machine which had been mistaken for a meteor, that by the stars, we
were moving eastward. In that case, my suddenly alert mind told me,
the land below must be some portion of America, and if so, judging
by the altitude of the mountains, that they must be the Andes. All of
this rushed through my brain instantly, and in the brief lapse of time
in which I sprang to the binnacle and back to my observation point at
the bridge-rail.
“Now, I saw, we were rapidly descending, and focussing my
glasses upon the mountains, I made out an immense conical peak in
the top of which was a gigantic black opening. Without doubt it was
the crater of some stupendous extinct volcano, and, with a shock, I
realized that the machine and the ship were headed directly for the
yawning opening in the crater. The next instant we were dropping
with lightning speed towards it, and so terrified and dumfounded had
I become that I could not move from where I stood. Even before I
could grasp the fact, the Chiriqui was enclosed by towering, rocky
walls, inky blackness surrounded me, there was an upward breath-
taking rush of air, a roar as of a thousand hurricanes. The Chiriqui
rocked and pitched beneath my feet, as if in a heavy sea; I clung
desperately to the bridge-rail for support and I felt sure that the ship
had been dropped into the abysmal crater, that the next instant the
vessel would crash into fragments as it struck bottom, or worse, that
it would sink into the molten incandescent lava which might fill the
depths of the volcano. For what seemed hours, the awful fall
continued, though like as not the terrible suspense lasted for only a
few minutes, and then, without warning, so abruptly that I lost my
balance and was flung to the bridge, the ship ceased falling, an
indescribable blue light succeeded the blackness, and unable to
believe my senses I found the ship floating motionless, still
suspended from the giant mechanism overhead, above a marvelous
landscape.

“On every hand, as far as I could see, stretched jagged rocks,

immense cliffs, stupendous crags and rugged knife-ridged hills of the
most dazzling reds, yellows and purples. Mile-deep canons cut the
forbidding plains, which here and there showed patches of dull
green, and in one spot I saw a stream of emerald-hued water
pouring in a foaming cataract into a fathomless rift in the rock. But I
gave little attention to these sights at the time. My gaze was riveted
upon a strange, weird city which capped the cliffs close to the
waterfall, and almost directly beneath the Chiriqui. Slowly we were
dropping towards it, and I could see that the buildings which at first
sight had appeared of immense height and tower-like form, were in
reality gigantic basaltic columns capped with superimposed edifices
of gleaming yellow.
“The next second the glasses dropped from my shaking,
nerveless hands. Gathered on an open space of greenish plain were
hundreds of human beings! But were they human? In form and
features, as nearly as I could judge at that distance, they were
human, but in color they were scarlet, and surmounting the head and
extending along the arms to the elbows on every individual was a
whitish, membraneous frill, which at first sight, reminded me of an
Indian’s war bonnet. The beings appeared to be of average height,
but as the Chiriqui’s keel touched solid ground and, keeling to one
side, she rested upon one of her bilges, I saw with a shock, that the
scarlet creatures were of gigantic size, fully thirty feet in height, and
that, without exception, all were females! All were stark naked; but
despite the frills upon their heads and shoulders, despite their
bizarre scarlet skins, despite their gigantic proportions, they were
unquestionably human beings, women without doubt, and of the
most perfect proportions, the most graceful forms and the most
regular and even handsome features. Beside the stranded ship, they
loomed as giants; but against the stupendous proportions of their
land and city, they appeared no larger than ordinary mortals. By now
they were streaming from their houses and even in the surprise and
excitement of that moment I noticed that the giant rocky columns
were perforated by windows and doors, and had obviously been
hollowed out to form dwellings. Meantime, too, the huge machine
which had captured the Chiriqui had descended and was lying at
rest, and no longer emitting its green light, upon a cradle erected
near the waterfall, and from openings in its central band several of
the scarlet, giant Amazons were emerging. How long, I wondered,
would I remain undiscovered? How long would it be before one of
the female giants spied me? And then, what would be my fate? Why
had they captured the ship? Where was I? What was this strange
land reached through a crater?
“All these thoughts rushed through my brain as I peered
cautiously down at the giant women who swarmed about the ship.
But I had not long to wait for an answer to my first mental question.
With a sudden spring, one of the women leaped to the Chiriqui’s
anchor, with a second bound she was on the fore deck, and close at
her heels came a score of others. Standing upon the deck with her
head fringed by its erect vibrating membrane level with the boat-
deck, she gazed about for an instant. Then, catching sight of the
form of a sailor sprawled upon the deck, she uttered a shrill, piercing
cry, leaped forward, and, before my unbelieving, horror-stricken
eyes, tore the still living, palpitating body to pieces and ravenously
devoured it.
“Unable to stir through the very repulsiveness of the scene,
realizing that my turn might be next, I gazed fascinated. But the giant
cannibal female was not to feast in peace. As her companions
reached the deck, they rushed upon her and fought viciously for a
portion of the reeking flesh. The struggle of these awful giants, as
smeared with human blood, scratching and clawing, uttering shrill
cries of rage, they rolled and fought on the deck, was indescribably
terrible and disgusting. But it came to an abrupt end. With a bound, a
giantess of giantesses, a powerfully-muscled female, appeared, and
like cowed beasts, the others drew aside, licking their chops, the
membranes on their heads rising and falling in excitement, like the
frills on an iguana lizard, and watching the newly-arrived giantess
with furtive eyes. Evidently she was the leader or chieftainess, and in
curt but strangely shrill and, of course, to me, utterly unintelligible
words, she gave orders to the others. Instantly, the horde of women
began swarming over the ship, searching every nook and corner,
and, wherever they discovered the inert bodies of the ship’s
company, dragged them on deck and piled them in heaps. Shaking
with abject terror, I crouched back of the bridge, and racked my
brains for thought of some safe spot in which to hide. But before I
could make up my mind, one of the terrifying, monstrous females
sprang upon the bridge and rushed towards me. With a maniacal
scream, I turned and fled. Then, before me, blocking my way, there
appeared another of the creatures. And then a most marvelous and
surprising thing happened. Instead of falling upon me as I expected
her to do, the giantess turned, and with a scream that equalled my
own, leaped over the rail and fled to the uttermost extremity of the
deck.
“I forgot my terror in my amazement. Why should this giant,
cannibal woman fear me? Why should she run from me when, a few
moments before, she had been fighting over a meal of an
unconscious sailor? And it was evident that the others were equally
afraid of me, for at her cry, and my appearance, all had rushed as far
from me as possible, and stood regarding me with an odd mixture of
wonder and terror on their huge faces. And then it occurred to me
that their fear was, perhaps, due to my gas-mask, to the apparatus
that transformed me from a human being to a weird-looking monster.
At any rate, I was evidently safe from molestation for the time being,
and thanking my lucky stars that I had on the mask, I descended
from the bridge, the giantesses retreating as I advanced. I entered
the captain’s cabin and locked the door.
“Here I breathed more freely, for even if the women overcame
their fear of me and attempted to capture me, the steel doors and
walls of the cabin would be impregnable defenses. Moreover, upon
the wall above the bunk, was a rifle, in a drawer of the dresser was a
loaded revolver, and a short search revealed a plentiful supply of
cartridges. Yes, if I were attacked, I could give a good account of
myself, and I determined, if worst came to the worst, that I would
blow out my brains rather than fall a victim to the female cannibal
horde.
“Dully, through the thick walls of the cabin, I could hear the sounds
of the women on the deck, but I had no desire to witness what was
going on, and seated upon the captain’s chair, I thought over the
events which had transpired during the past few hours and tried to
find a reasonable solution to the incredible happenings.
“That I was within the earth seemed certain, though utterly
fantastic, but who the giant women were, why they had captured the
Chiriqui or by what unknown, tremendous power their marvelous
airship was operated, were all utterly beyond my comprehension.
But I must hurry on and relate the more important matters, for my
time is limited and the important thing is to let the world know how
the human race may be saved from the terrible fate which has
befallen me and all those upon the Chiriqui, and upon the destroyer
McCracken, for that vessel, too, has fallen a victim to these horrible
cannibalistic giantesses here within the centre of the earth.

“Hunger and thirst drove me at last from my refuge in the captain’s

cabin, and armed with the loaded rifle and revolver, I cautiously
peered out and stepped upon the deck. Only one woman was in
sight, and instantly, at sight of me, she fled away. Not a body of the
hundreds of men and women aboard the ship was visible, and
feeling relieved that I was for a time safe, I stepped to the ship’s rail
and peered over. Scores of the women were carrying the inert forms
of the unconscious men and women towards the nearby city.
Stealthily I hurried below in search of food and drink. Fears assailed
me that the women had, in all probability, preceded me and carried
off everything edible. But I need not have worried about food. I was
yet to learn the horrible truth and the gruesome habits of these red
giantesses. The saloon, the corridors, the staterooms, everything,
had been searched, and every person upon the vessel removed. In
the pantry I found an abundance of food, and quickly satisfied my
hunger and thirst. I pondered on my next move. The skipper’s cabin
seemed my safest refuge. I placed a supply of provisions within it,
and locked myself in the little room again. For several days nothing
of great importance occurred. I say days, but there are no days in
this terrible place. There is no sun, no moon, no stars and no
darkness. The whole place is illuminated by a brilliant, greenish light
that issues from a distant mountain range, and which seems to be of
the same character as that which emanated from the spherical air