Elective Cases

Question 1

What ASA status would an otherwise healthy patient with unilateral cryptorchidism be considered? What pre-op blood work would be recommended?

Answer 1

ASA 1 —> cryptorchid testicle is not affecting the health of the patient

PCV/TS, serum biochemistry

Question 2

What is the recommended IV fluid rate in dogs? What kind is recommended for a healthy dog undergoing a cryptorchid neuter?

Answer 2

5 mL/kg/hr

crystalloids

Question 3

What are important components to IV premeds in a canine elective surgery?

Answer 3

• Maropitant
• Dexmedetomidine
• Hydromorphone

Question 4

What IV induction is recommended for canine elective surgeries? What maintenance is used?

Answer 4

• ketamine: less cardiovascular effects, less propofol needed
• propofol

isoflurane or sevoflurane

Question 5

What analgesia plan is recommended for canine elective surgeries?

Answer 5

• additional 1/2 dose of opioid used in premed (hydromorphone)
• Nocita incisionally
• Bupivacaine or Lidocaine intratesticular block on descended testicles

Question 6

What are 3 important aspects to the post-operative plan in canine elective procedures?

Answer 6

1. Acepromazine (slower onset) or Dexmedetomidine (faster) if needed for dysphoria
2. Hydromorphone based on pain score
3. Carprofen once fully recovered and oral TGH

Question 7

What type of breathing circuit would be recommended for a healthy, 28 kg Golden Retriever undergoing an elective cryptorchid neuter?

Answer 7

rebreathing circuit

Question 8

What are the 6 expected complications associated with a healthy canine elective cryptorchid neuter?

Answer 8

1. hypoventilation - anesthesia-induced, laparoscopy causing insufflation of abdomen
2. hypotension - anesthesia-induced, bradycardia due to anesthetics, especially with Dexmedetomidine and Hydrocodone
3. bradycardia - only treat if BP is low!
4. hypothermia
5. hypoxemia - abdominal distension due to surgery impedes ability to expand lung/chest
6. excitement at recovery - young and active dog, Trazodone + E-collar!

Question 9

How are testicular blocks used in canine and feline patients?

Answer 9

Bupivacaine for longer procedures or Lidocaine for shorter and sooner surgeries pulled up in a 3 cc syringe with a 25g needle

• CANINE = max 0.5 mL per testicle
• FELINE = max 0.25 mL per testicle

Question 10

Where is the testicular block performed?

Answer 10

embed needle in testicular tissue, avoiding pole due to vascularity

• aspirate and, if no blood is present, inject appropriate amount —> testicle should expand, local will travel up the spermatic cord

Question 11

A 6 y/o healthy and slightly obese DSH is presenting for a prophylactic dental. She has never had blood work done. A quick oral exam shows mild tartar.

What ASA status is this patient? What blood work should be done?

Answer 11

ASA 1 - no gingivitis, tartar is not affecting her health

full CBC (PCV/TS) and chemistry - no BW history, obese, possibility of renal disease (middle-aged cat)

Question 12

What fluid rate is recommended for cats? What kind of fluid is used in a healthy feline elective procedure?

Answer 12

3 mL/kg/hr

crystalloids

Question 13

What IV premeds are recommended for a healthy feline elective procedure?

Answer 13

• Maropitant
• Butorphanol - works better in cats, hydromorphone can cause post-op hypertermia
• Midazolam

Question 14

What IV induction is recommended for healthy 6.5 kg feline elective procedures? What maintenance is used? Breathing circuit?

Answer 14

• Ketamine
• Alfaxolone/Propofol

isoflurane or sevoflurane with a pediatric circuit on rebreathing circuit

Question 15

What aspect of anesthesia maintenance is of concern in an obese patient?

Answer 15

may require ventilation —> more challenging to expand thorax = hypoventilation

Question 16

When is an analgesia plan necessary for a routine dental? What medications can be used?

Answer 16

if extractions are required

• dental blocks
• Buprenorphine
• NSAID: no renal disease noted

Question 17

What post-operative plan is recommended in healthy feline elective dentals? What is extractions are required?

Answer 17

Acepromazine +/- Dexmedetomidine for excitement

• Buprenorphine
• Robenacoxib - SQ if not administered during procedure, oral TGH

Question 18

What aren’t mouth gags as commonly used in dental procedures? In cats?

Answer 18

very uncomfortable, soreness

causes decreased cerebral blood flow and patients can wake up blind

Question 19

What are 6 anticipated complications associated with healthy feline dental procedures?

Answer 19

1. hypoventilation - anesthesia-induced, obesity
2. hypotension - anesthesia-induced, especially important due to susceptibility of developing renal disease
3. bradycardia - can be decreased with mixed opioids
4. hypothermia - smaller patients, water used with scaler
5. hypoxemia
6. excitement and hyperthermia at recovery

Question 20

What are the 2 most common causes of excitement and hyperthermia in feline patients following anesthesia? When is it treated?

Answer 20

1. rebound effect due to hypothermia during procedure
2. pure mu agonists, Buprenorphine, Ketamine

use benign neglect unless T > 104, then add more sedation, reverse pure mu agonist with Naloxone or Butorphanol

Question 21

How should dental blocks for procedures be determined? Which local is most commonly used? What should patients go home with?

Answer 21

depending on the region requiring extractions

Bupivacaine - gives time to perform extractions, give 10 mins for onset

NSAIDs +/- Buprenorphine (OTM or Zorbium)

Question 22

Why is it especially important to ensure a feline patient is eating 2-4 hrs post-operatively?

Answer 22

medications to go home are more likely to be PO, can advise owners to give favorite meals to encourage ingestion of medications

Question 23

Why is the timing of the use of NSAIDs controversial?

Answer 23

• pre or intra-op = okay for ASA I and II and higher status if properly hydrated (RBF concerns!)
• post-op = pre-existing hypovolemia, hypotension, surgical risk, coagulopathy

POST-OP - intraoperative hypotension + NSAID use impacts renal function, multimodal approach helps lower dosage —> mostly safe in routine patients

Question 24

How is hypotension, hypothermia, hypoventilation, bradycardia, and hypoxemia troubleshooted in routine cases?

Answer 24

HYPOTENSION - depends on HR - bradycardia should be treated first, fluid bolus

HYPOTHERMIA - want to avoid <97 degrees, warm patient

HYPOVENTILATION - ventilator, assisted breathing

BRADYCARDIA - treat with low BP!

HYPOXEMIA - common during induction

Question 25

What are the 3 most common causes of perioperative hypoxemia?

Answer 25

1. no pre-oxygenation 2. too fast induction agent 3. improper ET tube placement or length

Question 26

How often should patients be monitored? What else is recorded?

Answer 26

every 5 mins - time of surgical incision(s) - dental radiographs - repositioning/moving - support drugs given - anesthesia machine type, ETT size, circuit type, type of IVC and location - quality of sedation and recovery - pain scoring