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</o:shapelayout></xml><![endif]--></head><body bgcolor="#71AAC3" lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>Subject:</span></b><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> [Safer] Advised Anesthetic Protocols (article)<o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><div><div><div><div><div><div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> Dr. Andrew Jones, DVM </span><span style='font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p></div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>Sent:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> Wednesday, September 02, 2015 10:14 AM</span><span style='font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p></div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>Subject:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> [Safer] Advised Anesthetic Protocols</span><span style='font-family:"Calibri","sans-serif";color:black'><o:p></o:p></span></p></div></div></div></div><div><div><p class=MsoNormal><span style='font-family:"Calibri","sans-serif";color:black'> <o:p></o:p></span></p></div></div><div><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>Is Your Dog or Cat Safe Under Anesthesia?</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>A provocative question?….Yes.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>But important, timely, and one that many pet parents really worry over?</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>Yes again.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>In veterinary college very little time was allocated to anesthesia- there is so much to learn, so little time, and the real training and application of anesthetic and surgery comes after you graduate from veterinary school.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>Then in practice, I found that much of the anesthesia, monitoring, and recovery of your pet after surgery is left to the lay staff.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>Some staff have specific training, ( i.e. Animal Health Techs), while others do not…</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>In most cases, things turn out fine.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>And to be transparent, there have been big advances in veterinary anesthesia knowledge, along with monitoring and the expectations by pet parents that their dogs or cats will be well cared for.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>But..there are BIG variations in veterinary practice.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>What you need to do as a concerned pet parent is ASK specific questions..</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>1.Who performs the anesthesia at the practice?</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>2.NEVER withhold water- if the clinic staff suggest this prior to surgery, go elsewhere.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>3.Food should only be withheld for 12 hours IF your pet is over 4 months of age. For young pets low blood sugar is a big concern, so they should only have food withheld for 4 hours, then offered food after surgery.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>4.Physical Exam- expect that your dog or cat is to be given a pre-surgical physical exam.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>5.What do they use for monitoring. Expect blood pressure to be monitored, and pulse oximeter to be used, and that an anesthesia recording sheet is part of the surgery.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>6.Do they perform a pre-anesthetic checklist? I have a form at the end of this post they can use.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>7.Remember that the MONITORS don’t tell you everything. Your pet needs to be checked for body temperature, that they have adequate blood pressure, that there are no cardiac arrhythmias.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>8.Staying WARM. That the practice uses IV fluid warmers, safe heating pads ( ie those that use warm water, not electric heating pads), warmed up saline if flushing body cavities. It is imperative that your dog or cat’s body temperature is NOT allowed to drop.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>9.Using great pain control during surgery- such as the use of Ketamine in the IV bag, using a narcotic as part of the pre-medication. If adequate pain control is used, then your pet may require a lower concentration of inhalant anesthetic, making the procedure safer.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>10.Pre-oygenate. If your pet is old, has compromised heart, lungs or organs, then by giving them 100% Oygen before they are intubated ensures that they will not go for a period of time without adequate oxygen, making the procedure far safer.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>11.Great monitoring AFTER surgery. The procedure is not finished until your pet can comfortably breath on their own in the recovery cage. As an example laryngospasm is common in cats- they can have difficulty breathing after the endotracheal tube is removed. This can be treated, BUT needs to be monitored for.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>12.Attaching the monitoring equipment to your pet PRIOR to induction of anesthesia. Your pet may have low blood pressure, or be low in oxygen, and knowing this ahead of time allows the practice to delay or adjust the anesthesia.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>13.Choice of anesthesia. ASK what they will use for the first part of anesthesia ( the pre-medication), the induction of anesthesia with the IV injectables, then what type of gas anesthetic is used to maintain anesthesia. Your pet must be on IV fluids.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>An example of a safe protocol for your pet</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>Pre-anesthetic: Hydromorphone and Acepromazine, or Hydropmorphine alone for older/debilitated patients</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>Induction anesthetic: Ketamine/Valium for healthy, uncompromised patients, Propofol or Aflaxan for older, compromised patients. Aflaxan is a ‘new’ injectable anesthesia drug with less chance of your pet not breathing ( apnea), while being given. Regardless, the key is to give lower calculated percent of the drug initially ( ie 25%) to avoid the apnea.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>Maintenance anesthesia: Gas anesthesia with Isoflurane following intubation.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>The following is a pre-anesthetic checklist that your practice should use, courtesy of VASG <a href="http://www.vasg.org">http://www.vasg.org</a></span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>ADMISSION</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>1) It is recommended that a veterinarian or licensed veterinary technician supervise the patient admissions.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) A properly trained nonprofessional can be quite capable of handling this process but we recommend that a licensed professional be available to assist this individual should questions or concerns arise.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>2) The patient’s medical record should be reviewed for completeness.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>3) A pre-surgical review of the patient’s history should be performed prior to admission. An admission checklist or questionnaire can be a valuable tool to insure a thorough assessment of the patient. An example questionnaire is included at the end of this reference.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) Food should be withheld for 12 hours prior to admission in normal cats and dogs over age 4 months.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) For cats and dogs less than 4 months of age, hypoglycemia is a significant concern.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) Withholding food for only 4 hours prior to anesthesia helps to minimize this concern.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(2) Offering food within 2 or 3 hours of recovery is also recommended.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>b) Any medications or supplements given in the prior 7 days should be recorded and reviewed with a doctor.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>c) Any new health concerns should be recorded and reviewed with a doctor.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>d) Any previous anesthetic “problems” should be reviewed with owner, recorded and reviewed with a doctor.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>e) Pets with histories of excessive stress when kenneled, chewing at stitches or bandages, difficulty restricting activity, or difficulty maintaining pet in clean, dry area during recovery should be noted.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>f) Water should not be withheld prior to admission.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>4) Smaller growths should be marked for easy identification.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) The owner should show the admitting staff member where the growths are, and the staff member should mark them with the owner present.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) Hair can be clipped at the site or a marker used to identify the site.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>5) An accurate Estimate and Surgical Release Form should be reviewed with, and signed by, the owner.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) Please be vigilant for owners who may not understand the form or, in fact, may not be able to read the form.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) A resistance to sign the form may be one indication of this.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>PRE-ANESTHETIC ROUTINE</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>1) GENERAL</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) A current weight must be obtained and recorded on the patient’s anesthetic record.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>b) An Emergency Drug Reference Sheet should be immediately accessible for all patients at all times.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) Some computer systems have an emergency drug component built into the software. If so, a customized reference should be produced for, and kept with, each patient. Alternatively, an emergency drug reference should be immediately available in the event it should be needed. The AAHA library has such a reference sheet if you do not have a current one.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>c) An Anesthetic Record should be prepared for each patient. A copy of an example sheet is included at the end of this reference.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>2) PHYSICAL EXAMINATION</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) A pre-anesthetic physical examination should be performed and the information entered into the patient record</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) This examination should be performed by a licensed technician or a staff veterinarian. Each practice should develop their own guidelines as to when the physical examination is to be performed by the doctor and when it can be performed by the technician. Generally speaking, this interval can be longer for younger pets exhibiting no health concerns and it should be shorter when dealing with geriatric and unhealthy patients.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) Some States may require this PE be performed by a DVM and may stipulate the timing of this PE. Be familiar with your State requirements. We cannot detail State to State variation in this reference.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>b) A final categorization of the patient should be made based upon the following guidelines:</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) Excellent – animal with no organic disease or in whom the disease is localized and is causing no systemic disturbance.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) example – healthy 3 year old neuter.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>ii) Good – animal with mild systemic disturbance which may or may not be associated with the planned procedure.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) example – mildly anemic patient, obese patient, geriatric patient.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>iii) Fair – animal with moderate systemic disturbance which may or may not be associated with the planned procedure and which usually interferes with normal activity but is not incapacitating.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) example – mitral valve insufficiency, moderate anemia.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>iv) Poor – animal with extreme systemic disturbances which are incapacitating and are a constant threat to life and seriously interferes with the animal’s normal function.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) examples – uncompensated mitral valve insufficiency, severe pneumothorax.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>v) Critical – animal presenting in a moribund condition, and is not expected to survive 24 hours with or without surgery. This implies that medical treatment cannot improve the animal’s condition and that surgery is required immediately.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) Example – acute, severe intra-abdominal hemorrhage.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>3) PRE-ANESTHETIC MEDICATIONS & FLUIDS</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) Pre-anesthetic medication decisions should be discussed with a staff veterinarian.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) Patients should be provided with an experience that minimizes their stress and anxiety and minimizes their discomfort.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) This not only makes their stay more pleasant; reducing stress and anxiety is an important component in the analgesic process</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>ii) The selection of these medications should be based on the individual needs of the patient as discussed with one of the doctors.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) Species, size, age, attitude, and health status should be factored into this decision.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(2) The safety of our staff and the importance of the planned procedure are also important factors to be considered.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>iii) The timing of the administration of the pre-anesthetic meditation is also an important consideration.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) In general, the pre-anesthetic medications should be administered:</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(a) 30 to 45 minutes prior to the induction of anesthesia if given subcutaneously.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(b) 15 to 20 minutes prior to the induction of anesthesia if given intramuscularly</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(c) It would be ideal to wait until the pre-anesthetic medications have taken effect before placing the patient’s IV catheter.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>b) All syringes must be labeled as to their contents.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) Consider commercial stickers when available.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>ii) Use tape and marker as needed.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>c) It is preferable to have securely placed an intravenous catheter prior to anesthetic induction.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) The catheter should normally remain in place until the animal is recovered to a point that no further need for IV medication or fluid support is anticipated.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>ii) Due to the fractious nature of some patients, it may be necessary to place the catheter immediately after anesthetic induction and remove the catheter prior to full anesthetic recovery in order to protect the safety of the staff.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>iii) In feline patients, the medial femoral vein, just above the tarsus, is an often overlooked site to place a peri-operative catheter.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) This site is not as attractive for day to day IV fluid management.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>d) Pre-anesthetic fluids may be indicated for optimal patient support. The timing and the length of the fluid administration should involve input from a staff veterinarian.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) For general peri-operative fluid support:</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) 5 ml/lb/hr (10 ml/kg/hr) is the suggested starting point.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(2) 10 ml/lb/hr (20 ml/kg/hr) is the upper limit for general fluid support.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(3) the individual needs of the patient may dramatically alter this fluid rate.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(a) A 5 ml/lb (10 ml/kg) bolus can be useful when Bp drops and needs to be addressed more quickly. This may be repeated once.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>ii) IV fluids should be administered through an infusion pump whenever available.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) This is especially important for small patients and cardiac patients for whom fluid overload is a much more likely complication.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(2) If an infusion pump is not available, a micro-dripset should be used when administering fluids to patients under 15 pounds or patients requiring more control over fluid rates.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>iii) Fluid bag and drip set protocol.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>1) Date all fluid bags and drip sets when first put into service.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(2) Switch IV extension sets between patients.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(3) Always cover the drip set end with a new sterile needle.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(4) Discard fluid bags and drip sets over 1 week old.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(a) Immediately discard any fluid bags that contain cloudy fluid or those suspected to be contaminated.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(b) Immediately discard any drip sets suspected to be contaminated.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(5) A high visibility fluorescent orange label must be used to identify any medications added to a fluid bag.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='color:black'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>4) PRE-ANESTHETIC TESTING</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>a) Pre-anesthetic testing is a consideration to allow detection of underlying disorders that may influence the management of the patient or influence the prognosis associated with any given disorder. The decision regarding when to perform preanesthetic tests and which tests to include is a decision that needs to be addressed individually by each practice.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>b) There is considerable debate as to the extent and timing of such testing.</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>c) Blood samples should be drawn prior to premeds if it is not excessively stressful to the patient as premeds may influence the results of certain tests</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>i) Example – Acepromazine can decrease patient PCV up to 30%</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>d) If blood collection is not possible without premeds, or is too stressful, then administer premeds, wait 15 to 20 minutes, then collect samples</span><span style='color:black'><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:13.0pt'><span style='font-size:11.0pt;color:black'>(1) Make sure the laboratory results are labeled so as to indicate that they were collected post-premeds if acepromazine has been used</span><span style='color:black'><o:p></o:p></span></p></div></div></div></div><p class=MsoNormal>-- <br>The Seeing Eye<br>Independence with Dignity since 1929<br><br> <br>If you need to contact one of the list owners for <br>> questions or assistance, please use the following email address: <a href="mailto:seeing-eye+owner@googlegroups.com">seeing-eye+owner@googlegroups.com</a>.<br>--- <br>You received this message because you are subscribed to the Google Groups "Seeing Eye Discussions" group.<br>To unsubscribe from this group and stop receiving emails from it, send an email to <a href="mailto:seeing-eye+unsubscribe@googlegroups.com">seeing-eye+unsubscribe@googlegroups.com</a>.<br>To post to this group, send email to <a href="mailto:seeing-eye@googlegroups.com">seeing-eye@googlegroups.com</a>.<br>To view this discussion on the web visit <a href="https://groups.google.com/d/msgid/seeing-eye/89CB7CD3809A464F9BB565D9D08FC707%40GraceHP?utm_medium=email&utm_source=footer">https://groups.google.com/d/msgid/seeing-eye/89CB7CD3809A464F9BB565D9D08FC707%40GraceHP</a>.<br>For more options, visit <a href="https://groups.google.com/d/optout">https://groups.google.com/d/optout</a>.<o:p></o:p></p></div></body></html>