Anesthetic Regimes

for Large Animals

Group # 2
7th , DVM (FVS, BZU)
ANESTHETIC
REGIMES FOR HORSE
GENERAL CONSIDERATIONS

 Preparing the horse for surgery

 Proper positioning and appropriate padding of the head, shoulder, and hip
 Controlled positive pressure ventilation can be used to maintain normal PaCO₂
 Horses should be closely monitored during the recovery period and, assisted to a
standing position
PRE-ANESTHETIC EVALUATION

 Review history
 Conduct a physical examination
 Conduct a laboratory evaluation
• CBC
• Acid-Base balance (pH, PaO₂, PaCO₂)
PRE-ANESTHETIC MEDICATIONS
1) Xylazine
• Dose: 0.4 to 1.0 mg/kg IV ; 1 to 2 mg/kg IM
• Onset of action: within 2 to 3 minutes after IV and within 10 to 15 minutes after IM
• Duration: 30 minutes after IV and 60 minutes after IM

2) Acepromazine
• Dose: 10 to 40 μg/kg IV ; 20 to 80 μg/kg IM
• Onset of action: within 10 to 20 minutes after IV
• Duration: 2 to 4 hours

3) Chloral Hydrate
• Dose: 20 to 80 mg/kg IV
ANESTHETIC EQUIPMENT
Equipment for producing anesthesia
 IV catheter (10, 12, 14 G)
 Orotracheal tubes
 Pressure bag (for IV fluids/drugs)
 Cotton ropes (restrain)
 Appropriate padding
 Monitoring equipment
o ECG monitor
o Blood pressure monitoring device
o End expired gas monitor

Inhalant Anesthetic Equipment

 anesthetic machine
 pressure monitor
 O2 Fresh gas flow rate (Oxygen: 5 to 10 mL/kg)
 scavenging (waste gas removal) system
INDUCTION

1) Ketamine
o Dose: 1.5 to 2.0 mg/kg IV
o Duration: Short-acting (10 to 15 minutes)

2) Guaifenesin
o Dose: 50 to 100 mg/kg infusion
o Duration: 15 to 25 minutes

3) Telazol (tiletamine/zolazepam)
o Dose: 0.5 to 1.5 mg/kg IV
o Duration: Longer duration of action

4) Isoflurane, sevoflurane:
o 3% to 7% concentration and high O2 flow rate can be used for induction in foals after
placing a nasotracheal tube or mask
OROTRACHEAL INTUBATION
Endotracheal tube and a speculum or mouth gag should be available for intubation

a) Orotracheal intrubation
 Place a speculum between the incisors
 Extend the head and neck
 Advance the tube over the base of the tongue into the pharynx
 Rotate the tube while advancing it into the trachea
 Make sure that the tube is in trachea, not the esophagus
 Connect the endotracheal tube to the anesthetic circuit Y-piece
 Inflate the orotracheal tube cuff (50 to75 ml)

b) Nasal intubation
 Performed in adult horses and foals
 Lubricate the tube and insert into the ventral meatus of the nostril
MAINTAINING ANESTHESIA
 Inhalant anesthesia
 Avoid over extending the limbs or head and neck
• Isoflurane: 1% to 3%
• Sevoflurane: 2% to 5%
 Analgesia
• Morphine: 0.04 to 0.10 mg/kg IM
• Butorphanol: 0.01 to 0.04 mg/kg IV or IM
 Monitoring
 Body temperature
 Monitor all vital signs (i.e., cardiovascular, respiratory) and the depth of anesthesia (i.e., unconsciousness, eye
signs)
 Measure, maintain, and record arterial blood pressure (>60 mm of Hg)
 Administration of fluids
RECOVERY

 Turn off the inhalant before discontinuing O2

 Administer O2 until the horse is swallowing, then extubate
 Oxygen flow rate (15 L/min )
 Make sure the cuff on the endotracheal tube is deflated
 Keep the animal’s head and muzzle tipped down to allow drainage
 Assist the animal to a standing position, if necessary
 Administer sedative (50 to 100 mg Xylazine IV) to adult horses when any of these occur:
 Excessive nystagmus
 Excessive muscle tremors
 Uncoordinated limb movements; paddling
POTENTIAL ANESTHETIC
PROBLEMS
 Hypotension (arterial blood pressure < 60 mm Hg)
 Hypoventilation (PaCO₂ > 55 mm Hg)
 Hypoxemia (PaO₂ less than 60 mm Hg)
 Bradycardia (heart rate < 25 beats/min)
 Nasal congestion and/or upper airway obstruction
 Poor or prolonged recovery
 Excessive muscle weakness during recovery from anesthesia
ANESTHETIC
REGIMES FOR LARGE
RUMINANTS
GENERAL CONSIDERATIONS

o Preparation of ruminants for anesthesia and surgery

 Withhold food for 12 to 18 hours
 Withhold water for 8 to 12 hours

o Orotrachealand rumen tubes should be placed when appropriate

to avoid bloat and aspiration of rumen contents
PREANESTHETIC EVALUATION

Preanesthetic evaluation is similar to horses

 Review history
 Conduct a physical examination
 Conduct a laboratory evaluation
• CBC
PREANESTHETIC MEDICATION
Preanesthetic drugs are used to calm or sedate ruminants or to decrease the dose
of more potent intravenous (IV) or inhalant drugs.
a) Xylazine
Dose: 0.02-0.04 mg/kg IV ; 0.1 to 0.4 mg/kg IM
Ruminants may become recumbent after xylazine even at low doses.
It cause Respiratory & Cardiovascular depression, Rumen atony with bloat, pulmonary edema and
hypoxia
b)Acepromazine
Dose: 40 to 90 μg/kg IM; 10 to 20 μg/kg IV
Onset of action: within 10 to 20 minutes
Duration: 2 to 4 hours
Not frequently used because of prolonged elimination
c) Atropine, glycopyrrolate
Infrequently used, the duration of action of atropine is short
INDUCTION
a) Guaifenesin
 Dose: 50 to 100 mg/kg IV

b) Xylazine-ketamine combination
 Dose: 40 μg/kg xylazine and 2 mg/kg ketamine IV
Onset of Action: 45 to 90 sec for IV ; 10 to 30 min for IM

c) Ketamine-guaifenesin combination (called double drip)

Dose: 500 mg ketamine in 500 mL of 5% guaifenesin ; 1 to 2 mL/kg IV

d) Guaifenesin-ketamine-xylazine combination (called triple drip)

 Dose: 30 to 50 mg xylazine + 500 mg ketamine in 500 mL of 5% guaifenesin; 1 to 2 mL/kg IV
Duration: 60 minutes
Overdose causes apnea and hypotension

e) Using a face mask with an inhalant anesthetic is discouraged in large ruminants because of
the potential for regurgitation.
OROTRACHEAL INTUBATION
Orotracheal intubation should be performed immediately after the induction of anesthesia

Procedure
 A dental speculum or mouth gag can be placed in the mouth.
Method (a)
Insert an arm into the oral cavity of the adult cow, reflect the epiglottis forward manually, and guide
the endotracheal tube into the larynx.
Method (b)
Extend the animal’s head and neck and gently advance the tube into the trachea during inspiration
(blind intubation).

 Intubation may be facilitated by a long-blade laryngoscope and endoscopic light

 Intubation should be performed quickly to avoid regurgitation and aspiration of fluid
 A tracheostomy may be performed if necessary.
MAINTAINING ANESTHESIA
Total IV anesthesia
• Triple drip (guaifenesin-ketamine-xylazine combination)

 Inhalant anesthetic drugs produce general anesthesia effectively, particularly for

prolonged surgical procedures
 Analgesia
• Butorphanol: 0.05 to 0.1 mg/kg IV ; 0.1 mg/kg IM
• Morphine: 0.04 to 0.08 mg/kg IV ; 0.04 to 0.10 mg/kg IM

 Induction is completed with 2% to 4% isoflurane, or 4% to 6% sevoflurane

Monitoring
 Body temperature
 The position of the eyeball provides a useful guide to anesthetic depth
 Monitor all vital signs (i.e., cardiovascular, respiratory) and the depth of anesthesia (i.e., unconsciousness, eye signs)

 Administration of fluids
RECOVERY

 Provide 100% oxygen for 5 to 10 minutes

 Position the animal’s head (nose down) to allow drainage before the
endotracheal tube is pulled
 The orotracheal tube can be removed with the cuff inflated
 Pass a stomach tube if the animal is bloated
 Ruminants may be less likely to regurgitate if placed on their right sides or
in sternal recumbency
COMMON ANESTHETIC PROBLEMS

 Regurgitation, Bloat, Inadequate oxygenation, Respiratory depression and

apnea, Aspiration of rumen contents
 Regurgitation is caused by parasympathetic effects on reticular
contractions and the pharyngo-esophageal and gastro-esophageal
sphincters
• Anesthetic drugs increase the risk of regurgitation:
 Relaxation of the pharyngoesophageal sphincter
 Relaxation of the gastroesophageal sphincter
 Depression of the swallowing reflex
• Recumbency increases the risk of regurgitation by increasing abdominal cavity
pressure