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Special Considerations For Anesthesia In Ruminants
1.
2. Regurgitation
Aspirationof rumen contents
Bloat, compromises breathing
Inadequate ventilation
Due to drugs relaxing the
pharyngoesophageal and
gastroesophageal sphincters and
suppressing the swallowing reflex.
Anesthesia also decreases gut motility
3. Recommendations
- Withhold feed prior to general anesthesia
- Intubate with a cuffed endotracheal tube
- Assist or control ventilation with 100%
Oxygen
- Maintain in lateral recumbency only when
necessary. Sternal recumbency allows
eructation and facilitates ventilation
4. Potential problems:
- External pressure from improper
positioning or poor perfusion can produce
myopathy
- Neuropathy due to pressure
5. Proper positioning
Padding all pressure points
Lower forelimb stretched forward to avoid
radial nerve paralysis in lateral recumbency
Upper limbs supported at height of proximal
joint in lateral recumbency
Support circulating blood pressure and
volume when necessary ( maint 10ml/kg/hr)
Maintain light anesthesia
6. Potential problems
- Hypotheria
- Immature liver and kidneys
- Hypoglycemia
Recommendations
- Heating pad used with caution
- Dextrose in fluids ( 2.5% dextrose/LRS)
- Avoid xylazine and barbituates
- Recommend isoflurane
- Nursing up to anesthesia and as soon after
as they can swallow
- Diazepam for sedation and premed
7. Potential problems
- Strong laryngeal reflex
- Laryngeal spasm
- Aspiration
Recommendations
- Stiffer clear plastic endotracheal tubes
- Stylets are useful, laryngoscopes
- Full extension of head and neck for full
visualization
8. - Suction saliva if necessary
- Lidocaine sparingly if needed for
laryngospasm
- Intubate and extubate in sternal
recumbency
- Extubate only if swallowing
- Pull endotracheal tube to larynx before
deflating cuff
9. Xylazine
- One tenth of equine dose IV
- Low conc. 20 mg/ml
- Smaller ruminants dilute to 1 mg/ml
- Goats are more sensitive than sheep
- Bulls are more sensitive than cows
- .02-.1 mg/kg IV
- Yohimbine .1 mg/kg, give ½ dose slowly
and repeat if necessary
10. Xylazine/ketamine
- Xylazine .02 -.08 mg/kg IV, wait 5 minutes
and apply casting rope and halter to assist
in to sternal recumbency
- Ketamine- 2-4 mg/kg IV good induction in
healthy animals
11. Xylazine-ketamine-guaifenesin
- 50 mg xylazine
- 500 mg ketamine in 500 ml of 5%
guaifenesin
- .5-1 mg/kg/hour max 1 liter of solution per
hour
12. Considerations of IV maintenance
- Intubation may be necessary to prevent
regurgitation and aspiration
- Drug overdose may cause apnea
- Respiration may need to be assisted
- Limited anesthetic plane
- To be used following xylazine, ketamine
induction if needed
- Used in adults > 300 lbs
13. - Not recommended for juveniles or small
ruminants
- Use only 5% guiafenesin, 10% causes
RBC hemolysis
- IV necessary as guiafenesin is very
irritating if perivascular
14. Sheep and goats
- Withhold food 12-24 hours
- Don’t withhold water, just avoid excessive
intake
Calves, lambs, kids
- Withhold food 2-4 hours
- Don’t prevent water of prevent nursing
- Calves, lambs and kids less than 1 month
of age are monogastric and less prone to
regurgitation
15. Adult cows and bulls
- Withhold food for 36-48 hours
- Withhold water for 13 hours
- Bradicardia may occur due to withholding
food
16. Recommendations
- Individual variation- .5-2% halothane or 1-2%
isoflurane
- Monitor pulse quality, heart rate, respiratory
rate
- Palpebral reflex should be maintained. Bovine
eye rotates ventrally and medially in light
anesthesia
- Ventilation may need assisstance
- Periods of apnea are common
a. Verify anesthesia is not excessive
b. Assist ventilation for gas exchange
17. 1. xylazine/ketamine IM
- Xylazine .08-1 mg/kg wait 10 minutes for
sedation and give ketamine 8-10 mg/kg Im
- Adv:
a. Good induction in healthy adults when IV
access is not possible
b. Longer duration of anesthesia than with
IV inductions to facilitate induction
18. - Disadv
a. hypotension, respiratory depression
b. Sting of IM ketamine
c. Not recommended for >300 lbs due to
volume needed
d. Goats sensitive to xylazine
19. 2. 5% guaifensesin/ketamine IV
- Mix 1 mg of ketamine per 1 ml guaifenesin
solution
- Dose at .5-1 ml/kg
- Wait max 1 minute for effect
- Maintain sternal for intubation
- Adv:
a. No premed necessary
b. Titrate to effect if necessary
20. - disadv:
a. IV catheter necessary due to guaifenesin
b. GG can cause RBC hemolysis
21. 3. Diazepam/ketamine
- Diazepam .1-.2 mg/kg IV wait 5
minutes, ketamine 2.2-4.4 mg/kg IV
- Adv:
a. Good induction for neonates, small
ruminants, and debilitated
b. No cardiovascular depression at these
doses
c. May mask with isoflurane also
22. - disadv:
a. Diazepam may cause
excitement, especially in adults
4. xylazine/ketamine
- Xylazine .08-.1 mg/kg wait for sedation
and place IV catheter, ketamine 2-4 mg/kg
IV
- Adv: good induction in healthy animals
23. 1. Phenylbutazone- PBZ or Bute
- injectable, tablets, oral paste
- NOTE: must be given IV only by injection.
Administered BID. Causes severe tissue
reaction, necrosis if administered
perivascular, intramuscular, subcutaneous
- Comments: used commonly for
musculoskeletal pain at 1-4 mg/lb
- Chronic use and or high dose results in
ulceration of GI tract
24. 2. Flunixin meglumine ( banamine)
- Injectable, oral paste
- Injectable must be given IV or IM.
Administered BID or TID. Potent analgesic
may mask a surgical colic. Binds
endotoxin. Chronic use and or high dose
results in ulceration of GI tract or renal
failure
25. 3. Ketoprofen ( ketofen)
- Injectable, human formulation ( alleve) has
been given orally but not approved route of
administration in animals.
Absorption, excretion data unavailable.
- Given IM SID
26. 4. Diclofenac ( surpass)
- Topical cream to be rubbed over affected
areas
27. 1. Acepromazine
- Injectable, tables
- Tranquilizers, NOTE: do not administer this
medication to an already excited, agitated
animal. It may create hyper exciteability
28. 2. Xlazine ( rompun)
- Injectable
- Potent sedative and analgesic which may
be administered IV or IM
- Ruminants highly sensitive, use 1/10 the
horse dose
- In horses, be aware that no matter how
drunk the horse looks, it is capable of
kicking violently and accurately. Never trust
xylazine behind the navel
29. 3. Butorphanol ( torbugesic)
- Injectable
- Commonly used to manage colic pain.
May be administered IV or IM
4. Detomidine ( dormosedan)
- Injectable
- Commonly used to manage colic pain or
for procedures requiring profound sedation
30. Due to complex bacterial ecosystem in the
ruminant and horses GI tract, there are few
antibiotics which may be safely and or
effectively administered orally.
In production animals always confirm
withdrawal time before administration
31. Glucosamine/chondroitin sulfate (
cosequin)
- Powder
- Often requires 30-60 days administration
before benefits are observed.
- Many cheaper, copycat products are
available over the counter but are less
effective
32. 1. Polyglycosylated aminoglycan ( adequan)
- Injectable IM or intra articulare
- For treatment and or minimization of wear
and tear lesions of articular cartilage
2. Hyaluronic acid ( legend)
- Single dose injectable for intra articular use
33. 3. clenbuterol- ventipulmin
- Oral syrup
- Bronchodilator for COPD, treatment of
lower airway diseases
4. Omeprazole – gastroguard
- Oral paste
- For treatment of equine gastric ulcers, very
expensive
34. 5. Ponazuril- marquis
- Metered dose oral paste, 28 day regimen
- For treatment of EPM, symptoms may
worsen initially as parasites die in CNS
6. Betamethasone and diuretic
- Bolus
- Used to reduce edema
35. Ifit is not labeled for use in production
animals, don’t use it in production animals.
There is more latitude in companion
animals regarding off label use because
the medication should not have the
potential to enter the food chain.
36. Anesthesia- a state characterized by loss of
sensation
- General anesthesia is a loss of sensation
associated with a loss of consciousness
- Regional anesthesia/local anesthesia, loss of
sensation while consciousness is retained
Analgesia- state in which stimuli is not
perceived as pain
Tranquilization/sedation- chemically induced
state of calm
37. Permits surgery to be safely and humanely
performed on the conscious patient
Agents: caine family:
lido, carbo, mepivi, bupivi
Methods of regional anesthesia:
1. Topical
- Lidocaine gel effective only on
mm, disrupted skin
- Proparacaine opthalmic solution
38. 2. Infiltrative “line block”
- Laceration or wound repair
- Dermatologic procedures, skin biopsy
- Castration
- Standing laparatomy
a. Left sided approach- rumenotomy
b. Right sided approach- cesearan section
39. 3. perineural- epineural- anesthetic injected
directly over a nerve, desensitizing distal
areas innervated by that nerve
- Dehorning
- Lameness diagnosis
4. Intra articular- for lameness evaluation
40. 5. Epidural
- Areas desensitized:
anus, perineum, vulva, vagina
- Dystocia correction
- Repair of prolapsed vagina/uterus
- Perineal surgery
- fetotomy
41. General considerations
- Adequate trained staff must be present to restrain
animal during induction and for surgical positioning
- Minimize contamination of surgical site
a. Bathe animal if necessary to remove fecal material
b. Wrap feet
c. Flush/rinse mouth to prevent material being pushed
by endotracheal tube into lungs
d. Clip and initiate surgical scrub on standing animal to
minimize anesthesia time
e. Note: direct relationship between length of
anesthesia and risk of post anesthesia complications
42. Regurgitation and or bloat can be serious
complications of general anesthesia
Elective surgery withhold food for 36-48
hours, withhold water for 12 hours
Emergency surgery use rumen lavage
NOTE: most ruminant surgeries can be
performed with regional anesthesia
Equine: elective surgery, withhold food 12
hours, water 6 hours
43. 1. acepromazine- tranquilizer
2. Xylazine
- Profound sedation- head drop and marked
ataxia, up to 1-2 hours
- Despite ataxia, horses can still viciously
and accurately kick.
- Analgesia up to 30 minutes
- Ruminant dose is 1/10 the equine dose
44. 3. detomidine- similar to xylazine but without
ataxia, useful for standing procedures
4. butorphanol- predominant function is
analgesia
5. diazepam- muscle relaxation, sedation
and decreased anxiety
45. Masking down with inhalation agent
- Patient selection based on size, weight, ability to
tolerate physical restraint
- Risk of injury to patient and or staff during
excitement phase of induction
Injectable induction- loss of consciousness and
muscle relaxation
- thiobarbituates, ultra short acting 5-15 minutes
- Ketamine/tiletamine- dissociative anesthetics
- Guiafenesin- muscle relaxant, used in conjunction
with another induction agent
46. Endotracheal
1. cattle/horses- blind intubation, fully
extend head, align with cervical spine
2. Swine- very difficult, must use
laryngoscope
3. Goats/sheep- virtually never place on gas
anesthesia, value of animal vs. cost of
procedure
47. Isoflurane- about 3.5%
Oxygen delivery- 1 liter/250 lb body
weight, minimum flow 3 liters per minute
Fluids/electrolyte replacement
- Maintenance 3-5 ml/lb/hr
- Replacements
a. Blood loss <40% administer 3 ml
crystalloid solution for each ml blood lost(
in addition to maintenance needs)
b. Blood loss >40% transfusion required
48. Indications
a. PCV <20%, HbB < 5 g/dl
b. Massive >40% total blood volume
hemorrhage
Donor selection
- Cross match with agglutination and lysis
tests, critical when multiple transfusions
are performed
- Universal donor is adult male that has
never received a transfusion
49. Heart rate
- Cattle 60-80 ( < 48 trouble)
- Horses 30-48 ( <28 trouble)
- Swine 60-100 ( < 50 trouble)
Pulse quality/blood pressure assessment
- Direct palpation
- Direct measurement of arterial blood
pressure, cannulation, catheterization
- Mean arterial blood pressure 80-110 mm
Hg ( <60 or > 160 trouble)
50. Respiration rate
- Spontaneous respiration 6-12 breaths per
minute
- Mechanical ventilation
a. Assisted requires spontaneous respiratory
effort
b. Controlled does not require spontaneous
respiratory effort
c. Assisted kicks into controlled when
ventilation level falls below a certain level
51. Capillaryrefill time < 2 seconds
Corneal reflex- not applicable to
swine, horses and ruminants only
a. Hyperractive-
pain, hypotension, hypoxia, ketamine
administration, inadequate plane of
anesthesia
b. Hyporeactive- CNS
depression, excessively deep plane of
anesthesia
NOTE: you can wear out this reflex by
52. Paralysis- from direct pressure to
superficial nerves
a. Facial paralysis- always remove halter
after anesthetic induction
b. Radial nerve paralysis- inability to
advance the limb, positioning of limbs
during lateral recumbency is critical
53. Myositis/rhabdomyolysis
a. Pressure hypotension ( sustain MAP at
<60 mm Hg)
b. Padding inadequate between animal and
surgery table permits crushing of down
muscles by animals body
weight, resulting in localized ischemia
c. Position: down forelimb should be
advanced and up limbs limbs supported
54. Malignant hyperthermia
- Horses and swine
- Monitor body temperature during
anesthesia
- Body temperature > 106
55. Ruminants
- Sternal recumbency
- Extubate only when active swallow reflex
is present
Horses
- Prone to violent recovery, require close
monitoring, possibly physical restraine
- Laryngeal spasm at extubation,
tracheotomy kit should be kept in proximity
of all equine recovery skills
57. Techniques
- Medication option
a. To sedate or not
b. Euthanasia solution +/- succinylcholine
(paralytic agent)
c. Barbituate and phenytoin ( beuthanasia)
d. Vortech CII
e. Sleep away CII
- Captive or live bolt bullet
58. Carcass disposal
- Local regulations/zoning restrictions may
dictate options
- Animal disposal companies
- Burial
- Cremation
- Landfill
- Zoos/wildlife parks will not accept animals
euthanized with barbituates, carcass must
be dressed out