IVRA, Veterinary Regional Anesthesia

1. Submitted to:
Dept of VSR
Veterinary College Bidar
Submitted by:
Priyanka V Murthy
MVNK-2118

3. INDICATIONS

4. ANAESTHETIC INDICATION

5. PROS??

6. CONS??

7. Using a standard technique, catheterize a vein in the distal limb using a small‐gauge catheter
Secure the catheter to prevent its dislodgement when the bandage exsanguinates the limb.
The distal extremity must be exsanguinated using a flexible bandage (Esmarch, flexible
self‐adhering bandaging tape). This prevents the injected local anesthetic solution from being
diluted by blood, making it more effective for analgesia.
The tourniquet should then be applied to the limb.
There are two main types of tourniquets: non‐ pneumatic tourniquets that are made of rubber or
elasticized cloth, and pneumatic cuff tourniquets inflated with air.
TECHNIQUE

8. If a pneumatic tourniquet is used, the cuff should be inflated to a pressure 50–100 mmHg
A less expensive alternative for use in small animal patients is to use a sphygmomanometer
and a blood pressure cuff (after the cuff is first tested for leaks). The sphygmomanometer is
used to inflate the blood pressure cuff and to monitor and adjust cuff pressure over time.
In the case of a non‐pneumatic rubber tourniquet, the band should be placed above the elastic
wrap that was used for exsanguination and secured tightly to prevent inadvertent release.
Document the time of tourniquet application in the anesthetic chart. The remaining
procedures (e.g., completion of IVRA, preparation for surgery, surgery) should be completed in
less than 90 min to avoid ischemia of tissues under the tourniquet.

9. Once the tourniquet is in place, the elastic bandage should be carefully removed.
Confirm that the previously identified peripheral pulse is now absent. Never proceed with the block if an
arterial pulse is detected. If arterial blood is allowed to enter the distal limb while venous blood is being
occluded, the limb will become edematous over the course of the procedure.
The local anesthetic solution should be slowly injected over 2–3 min as distally as possible, avoiding high
injection pressures that might increase venous pressure and cause leakage of the local anesthetic under the
tourniquet.
Document the time of local anesthetic injection and continually observe the patient for signs of systemic
toxicity thereafter. Following injection, the catheter can be removed. At the end of the procedure, the
tourniquet is removed slowly while the surgical site is closely evaluated for hemorrhage during initial re-
perfusion

11. IVRA OF TEAT

12. IVRA OF CATTLE LIMB

13. POST SURGERY

15. INDICATIONS

16. painless and not induce fear or apprehension
reliable
rapid
safe and simple to operate
irreversible
inexpensive
as far as possible be aesthetic
be safe for predators/consumers
CRITERIA FOR EVALUATING EUTHANASIA

17. PHYSICAL METHODS
Stunning
Gun shot
Captive bolt
Electrocution
Cervical dislocation
Decapitation
CHEMICAL METHODS
Drug injections
Gas or vapor
inhalation
METHODS OF EUTHANASIA

18. BASIC MECHANISMS OF TERMINATING LIFE
Direct depression of neurons vital for life function
Physical disruption of brain activity &destruction of neurons necessary for life

25. INHALANT AGENTS

26. Carbon dioxide
gasflow of 70% CO2 for atleast 1minute
• Advantages
o Rapid depressant, analgesic and anesthetic effect of CO2
o Readily available and can be purchased in compressed gas cylinders are well established
o Inexpensive, noninflammable, nonexplosive and poses minimal hazard to personnel
o No accumulation of tissue residues in food producing animals

28. Carbon monoxide
o Carbon monoxide is noninflammable and nonexplosive unless concentration exceeds 10 %
o It combines with hemoglobin to form carboxyhemoglobin and blocks uptake of O2 by erythrocytes,
leading to fatal hypoxemia
o Death occurs rapidly if concentrations of 4 to 6% are used

29. INJECTABLE AGENTS
• Most rapid and reliable method
• Most desirable method
• Intravenous administration most effective in well restrained animals
• Intraperitoneal administration is acceptable if IV administration is impractical
• Intracardiac injection is acceptable only in heavily sedated or anesthetized animals

30. Barbituric acid derivatives-
Na Pentobarbital & Thiopental Na
(100mg/kg)
o IV injection is preferred in dogs, cats, other small animals, and horses
o Intraperitoneal injection may be used in situations when an intravenous injection is
distressful or even dangerous
o Intracardiac injection must only be used if the animal is heavily sedated, unconscious, or
anesthetized
o • Depress the central nervous system
o • With an overdose, depression of neurons responsible for vital functions leading to
depression of respiratory center, which is followed by cardiac arrest.
o induce euthanasia smoothly, with minimal discomfort to the animal

32. Tricaine methane sulfonate (MS 222, TMS)
• Euthanasia choice for amphibians and fish
• Concentration ≥ 250 mg/L concentration used for euthanasia
o Fish should be left in this solution for at least 10 minutes following cessation of opercular
movement

33. Potassium chloride in conjunction with prior general
anesthesia
• Unacceptable and condemned when used in conscious animals
• The use of fully saturated solution in anesthetized animals is an acceptable method to produce
cardiac arrest and death
• 1 to 2 mmol/kg IV

36. POST EUTHANASIA INDICATORS OF DEATH

37. EPIDURAL
ANAESTHESIA

38.  Epidural space is that compartment between the
duramater and the bony and ligamentous wall
of the spinal canal
 This space is filled with extradural fat, internal
vertebral plexus of veins and the spinal nerves
 Injection of local anaesthetics will desensitize
the spinal nerves at their origin in vertebral
canal
EPIDURAL SPACE

39.  desensitize tail,vagina,rectum,vulva,anus,caudal prepuce,scrotum and
urethra
 in low dose-1ml/100kg
 it is routinely used in cows, sheep, and goats.
 Indications
• obstetric manipulations
• caudal surgical procedures
• adjunct treatment for rectal tenesmus.
 Needle placement is either at the sacrococcygeal (S5- Col) or more
commonly at the first coccygeal (Col-Co2) interspace.
Caudal epidural/low epidural

40.  The Col-Co 2 interspace is larger and more easily
penetrated than the S5-Col site.
 The S5-Col interspace may be ossified in older cows
and is not so easily detectable in fat cows
 3.75- to 5-cm, 18-gauge needle is used
 Locate Sacro coccygeal joint by moving the tail up
and down, this joint moves very little and located
anterior to the anal folds
 The first intercoccygeal joint is easily located by its
movement, much wider and posterior to anal folds
 Insert the needle exactly at middle of the first
intercoccygeal space at a right angle (aprox.10
degrees to vertical) to the skin surface

41.  Push the needle ventrally through the interarcuate
ligament to the floor of the neural canal, which is
aprox. 2 to 4cm
 Withdraw the needle slightly (about 0.5cm)
into epidural space
 Test by injecting 1 ml of air, no resistance should
be felt

42. ANAESTHETIC EXTENT
the area of anesthesia extends cranially to the middle of the sacrum and
ventrally over the perineum to the inner aspect of the thigh
 Proper techniques should desensitize the pelvic viscera and genitalia,
and paralyze the tail and abolish abdominal contractions.
 locomotor function of the hind legs and uterine motility
remain unaffected.
 Maximal anesthesia may require 10 to 20 min and can be expected to
last 30 min to 2.5 h

43. In sheep and goats
 useful for tail docking in lambs and for intravaginal obstetric
procedures
 Site: Between S4 and Co1 , Co1 and CO 2 and lumbosacral space
(b/w L6 and S1)

44.  Needle used: A 2.5- to 3.75-cm, 18-gauge
needle
 Anesthetic dose: no more than 1 mL of a
2% lidocaine hydrochloride solution per
50 kg of body weight is injected.

45.  This is indicated in cattle and sheep with prolapse of the vagina and/or rectum, which can
provoke severe continuous straining.
 The technique in cattle is simply performed by inserting a fine catheter into the epidural
space through a 7.5-cm, 16- or 17-gauge needle.
 the spinal needle with stylet in place and bevel directed cranially is advanced for 5 to 8 cm
while being directed at approximately 45° to vertical until resistance to needle passage is
abruptly reduced.
 The stylet from the needle is removed, and a test dose of 2 to 3 mL of anesthetic is
injected with almost no resistance, assuring proper placement of the needle in the epidural
space

46.  A30-cm medical-grade vinyl epidural catheter (0.036-cm outside diameter) with
gradual markings is introduced into the canal through the needle and advanced cranially
3 to 4 cm beyond the tip of the needle
 The needle is then withdrawn, leaving the catheter in position.
 The catheter adapter or 23-gauge needle and three-way stopcock are placed on the free
end of the catheter
 The catheter can be sutured to the skin puncture site.
 The sterility of the free end of the catheter is maintained by using protective sterile
gauze
 3 to 5 mL of a 2% lidocaine hydrochloride solution is injected into the catheter at
4- to 6-h intervals or whenever the animal shows signs of straining

47.  It is advocated for all procedures caudal to the diaphragm.
 The anesthetic solution, dosed at 1 mL/4.5 kg b.wt,
 Site: lumbosacral (L6-S1) junction for immature cattle ,sheeps and
goats
 provide analgesia of the the entire inguinal region, the flanks, and the
abdominal wall up to the umbilicus
 Increasing the dose (volume X concentration) increases the area
desensitized

48.  Used in surgical conditions for cesarean section; intra-abdominal,
pelvic, or hind-limb surgery; and udder surgery in small ruminants.
 Site: Lumbosacral intervertebral space
 Needle used: a 6- to 7-cm, 20-gauge spinal needle with a fitted stylet
 Dose:1 mL of a 2% lidocaine hydrochloride solution per 4.5 kg of
body weight

49.  include loss of consciousness, convulsions, respiratory paralysis,
hypotension, and hypothermia after overdose
 Animals with severe hypotension show signs of distress, collapse,
tachycardia or bradycardia, weak pulse, and shallow, rapid respiration

50.  In horses, the spinal cord and its meninges end in the
midsacral region, and only the coccygeal nerves and the
thin phylum terminale remain in the spinal canal.
 Produce regional anesthesia of the anus, perineum,
rectum, vulva, vagina, urethra, and bladder in horses.
 The injection site is the epidural space between the first
and second coccygeal vertebrae.
 The first coccygeal interspace (ColCo2) is identified as
the first obvious midline depression caudal to the
sacrum.

51.  In the standard technique, a 5- to 7.5-cm, 18- gauge spinal needle with
fitted stylet is inserted through the disinfected skin in the center of the
Col-Co 2 joint space
 needle is directed at almost right angles to the general contour of the
croup
 A popping sensation is often detected as the interarcuate ligament is
penetrated
 A mature mare (450 kg) may require a total of 6 to 8 mL of a 2%
lidocaine HC1 solution (0.26 to 0.35 mg/kg) to anesthetize the
anus, perineum, rectum, vulva, vagina, urethra, and bladder.

52.  Continuous caudal epidural anesthesia can be used in horses for
extended surgery in the anal and perineal region, for obstetric
procedures, and for relief of tenesmus
 A10.2-cm, 18- gauge thin-walled Tuohy needle with stylet is
aseptically inserted on the midline into the Col-Co2 interspace
 Acommercially available 91.8- cm, 20-gauge Teflon epidural
catheter with graduated markings and stylet can be introduced into
the needle and advanced cranially 2 to 4 cm beyond the tip of the
needle
 The needle can then be removed from the catheter while the
catheter is left in position
A threeway stopcock and 2.5-cm, 23-gauge needle is placed on the
free end of the catheter for an injection port.

53.  Also known asArthur’s block
 Area blocked: The skin area caudal to the T13 or L1 spinous process
and flank on both sides
 Nerves blocked: T13 and anterior lumbar nerves
 Site: Epidural space between L1 and L2 vertebrae

55.  The site is aseptically prepared
 2 to 4 mL of a 2% lidocaine hydrochloride solution is injected
subcutaneously and adjacent to the interspinous (T13-L1 or L1-L2)
ligaments to minimize pain during the puncture procedure.
 A11.25-cm, 18-gauge spinal needle with stylet is inserted at that site.
 The spinal needle is inserted for a distance of 8 to 12 cm while being
directed ventrally and medially at an angle of 10° to 15° with the
vertical, at which point the needle has reached the epidural space

56.  The needle is properly placed into the epidural space if no blood or CSF
flows from the needle hub or is obtained upon aspiration.
 Asucking sound is heard as air enters the needle immediately after
penetration of the interarcuate ligament.
 Most often, the epidural space is identified by the loss-of resistance method
 An alternative method is hanging-drop method
 Anaesthetic: 8ml of 2% lidocaine in a 500 kg cow
No more than 1ml/50 kg of lidocaine in sheep and goats

57.  This amount of anesthetic is sufficient to desensitize the T13, LI , and
L2 dermatomes within 7 to 20 min with a duration of 45 min to 2 h
 The epidural space at the thoracolumbar (T13-L1) or first lumbar (L1-
L2) intervertebral space in cattle cannot be reached by the spinal needle
if the interarcuate ligament is ossified because of old age (>8 years)
 satisfactory anesthesia and relaxation of the abdominal wall and flank
for operations such as rumenotomy and cesarean section, with the
animal standing

58.  The advantages of segmental dorsolumbar epidural anesthesia as
compared with proximal and distal paravertebral anesthesia
include:
 the use of a single injection of a small quantity of anesthetic
 uniform analgesia and relaxation of the skin, musculature,
and parietal peritoneum
 The disadvantages include:
 difficulty in performing the technique, potential for trauma to the
spinal cord or venous sinuses
 and loss of motor control of the pelvic limbs;

59.  This can be achieved by aseptically placing a catheter into the
epidural space .
A10.2-cm, 18-gauge thin-walled Tuohy needle with stylet is
inserted into the epidural space at the thoracolumbar (T13-L1)
interspace
 commercially available 91.8-cm, 20-gauge Teflon epidural catheter
with graduated markings and stylet is introduced into the needle
and advanced caudally 3 to 5 cm beyond the tip of the needle.
 The needle is removed from the catheter while the catheter is left
in position and sutured to the skin at the site of emergence from the
skin

60.  Injection of apx. 6 mL of a 2% lidocaine hydrochloride solution at the anterior
portion of the lumbar (LI to L2)
 Analgesia lasts 1 h to 1 h 40 min
Advantages
 providing a route for repeated small fractional maintenance doses of local
anesthetic drug,

64. DOG CAT RUMINANTS HORSE
Lignocaine 1ml/5kg(2%) 1ml/4kg(2%) 1ml/100kg(ant.)
1ml/5kg(post.)
8ml/450kg(2%)
Bupivacaine 1ml/5kg(0.5%) 1ml/4kg(0.25%) 0.125mg/kg 0.06mg/kg(0.5%
)
Ropivacaine 5mg/kg(0.5%) 1ml/4kg(0.2%) 0.11mg/kg 8ml/450kg(0.5%
)
Mepivacaine 7mg/kg(2%) _ _ 5ml/450kg(2%)

65. RUMINANTS HORSE DOG CAT
XYLAZINE 0.05mg/kg dil in
5ml NS
0.25mg/kg 0.125mg/kg 0.02-0.2mg/kg
DETOMIDINE 40µg/kg 60µg/kg 10µg/kg -
MEDETOMIDINE 15µg/kg 15µg/kg 15µg/kg 10µg/kg
KETAMINE 0.5-1mg/kg 0.5-1mg/kg in
10ml NS
1-2mg/kg 2.5mg/kg
MORPHINE 0.1mg/kg 0.1mg/kg 0.1mg/kg in 4ml 0.1mg/kg
OXYMORPHONE - - 0.015mg/kg 0.05-0.1mg/kg
BUTARPHANOL - 0.08mg/kg in
20ml NS
0.25mg/kg -
TRAMADOL 2mg/kg 1mg/kg in 20ml
NS
2mg/kg 2mg/kg

66.  William J. Tranquilli John C. Thurmon Kurt A. Grimm, Lumb & Jones'
Veterinary Anesthesia and Analgesia, Fourth Edition,2007
 L.W. Hall, K.W. Clarke , C.M. Trim,Veterinary anaesthesia ,Tenth edition,2001