sofficat

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Using iso tanks or using only a mask to knock down a patient for anesthesia seems like it is readily used in many practices. However, it is not as safe as people tend to think it is. Not only is it super stressful for the patient (imagine what they are going through, and the release of all those catecholamines!), but they lose control of their airways for 3-5 min, have an increased risk of aspiration pneumonia and overall using just isoflurane to induce a patient has greater mortality than IV drugs (I can't quote the article, but my anesthesiologist can).
So why is it used so regularly?? What have you been told about it's safety? (I remember many vets telling me they do this because it is safer and better for the patient... yeah right!!). Is there anyone out there that is working for a vet who doesn't like this?
Thanks!
 

eventualeventer

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Besides risk to the patient, as someone who has never seen this (it doesn't happen with horses ;) ), I wonder what the risk is to the people in the area from repeated exposure to volatile anesthetic.
 

cowgirla

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Using iso tanks or using only a mask to knock down a patient for anesthesia seems like it is readily used in many practices. However, it is not as safe as people tend to think it is. Not only is it super stressful for the patient (imagine what they are going through, and the release of all those catecholamines!), but they lose control of their airways for 3-5 min, have an increased risk of aspiration pneumonia and overall using just isoflurane to induce a patient has greater mortality than IV drugs (I can't quote the article, but my anesthesiologist can).
So why is it used so regularly?? What have you been told about it's safety? (I remember many vets telling me they do this because it is safer and better for the patient... yeah right!!). Is there anyone out there that is working for a vet who doesn't like this?
Thanks!

Sometimes, we CANT get a vein on a fractious cat. That's when our tank comes out. Our vets prefer to use IV drugs, followed by a mask if necessary.

Part of the problem, and I openly admit that I really don't know what I'm talking about, so take this with a grain of salt:

Say you have a cat with a problem. Whether it's a heart problem, lung problem, kidney, whatever, and the cat isn't doing well. The last thing you want to do is sedate the cat, but it's a PITA, and you have no choice if you want to get a catheter in and actually do some work up.

So you decide, okay we sedate the cat, because if we don't, he'll die anyway....

Now, how do you sedate that cat? Do you have three people pin him down, giving him a heart attack from the stress of struggling alone while a vet pokes and prods and stabs for a vein? Or do you use the tank where at least he's not physically struggling? (In three years, I have seen ONE cat throw a fit inside the tank, out of probably a hundred. So it definitely seems less phsyically stressful to them)

I don't know what the "ideal" is, or how you really should handle a cat like that, but that's pretty much what my clinic does.
 

cowgirla

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Besides risk to the patient, as someone who has never seen this (it doesn't happen with horses ;) ), I wonder what the risk is to the people in the area from repeated exposure to volatile anesthetic.

We only use our tank next to the door that goes outside. One person takes the cat out, the other runs the tank outside ASAP (a distance of maybe 3 feet)

I haven't had any person get knocked out yet :)

the masks are a pain in the butt. Half the ones we have don't fit right...someone had the brilliant idea of using soda bottles cut up as masks, and unless the dogs nose is the perfect size, they're useless LOL.





ETA: Also, out of curiousity.... we do a great deal of feral cat population control....spay/neuter/vaccinate/release. How exactly are we supposed to sedate them without using a tank? Or are they an exception?
 

Willowhand

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I watched and helped out with numerous surgeries at the clinic I worked for, but I think the most nerve-wracking were always the rabbits. anesthesia + rabbit = nervous Willowhand, regardless of what's being used. Those critters seem as fragile as they are cute.
 

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I've been with one clinic who only knocks them out, but they also cut a lot of corners. The other clinic I worked at uses the drugs. Haven't asked why, but if I'm even back at that second clinic, I'm going to. She's a new vet... just graduated a couple of years ago.
 

Morganator

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In my experience is usually used as a last ditch effort for fractious animals. The problem that I see most often is that there are a number of old school veterinarians out there that either 1) haven't paid attention to advances in anesthesia, or 2) don't care and are going to keep doing what they do.
 

alliecat44

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There are IM sedation protocols that are MUCH safer--for example, torb/midazolam. IM injections are also much easier to give a fractious cat (squeeze cage, pillowcase, etc) than an IV injection.

Many veterinarians were originally taught that masking and/or boxing down is "safer." We have better studies now that show this is not the case, and better drugs and better protocols. There is no control over a patient's airway with a mask or in a chamber. There is tons of personnel exposure to anesthetic gas (even though nobody is "knocked out," it's the repeated exposure that can cause issues down the line). Iso is one of the most potent vasodilators there is, and since it takes so long to become completely anesthetized, you have a prolonged period of hypotension before you get IV access/fluid support. And on and on...

I think many veterinarians still use masking/boxing down because they were taught it was safer a long time ago and either aren't aware of or don't believe all of the studies that have come out in the past 15 years. Newer veterinarians get sucked in because they join practices that "have always done it this way and never had a problem," and so the habit perpetuates.

At least, that's the reason I think a lot of practices still do it. :(
 

cowgirla

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I think many veterinarians still use masking/boxing down because they were taught it was safer a long time ago and either aren't aware of or don't believe all of the studies that have come out in the past 15 years. Newer veterinarians get sucked in because they join practices that "have always done it this way and never had a problem," and so the habit perpetuates.

At least, that's the reason I think a lot of practices still do it. :(

My vets have all been practicing for 20+ years, so that makes sense in my case anyway.
 

Morganator

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ETA: Also, out of curiousity.... we do a great deal of feral cat population control....spay/neuter/vaccinate/release. How exactly are we supposed to sedate them without using a tank? Or are they an exception?
With leather gloves, a towel, and a sick sense of wanting a challenge :eek:
 

lalzi22

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I have to say iso is a gift from the vet gods. To echo the sentiments of cowgirla, having to deal with INSANE feral cats, rabbits who dont want to sit still for a cath, ferrets with NO blood pressure or dogs that could knock me down with their paw- iso makes it safer for us as well as the patient who may hurt themselves from struggling so much. I personally would rather throw a rabbit in with some iso then struggle with them for a cath and have them break their back. I've worked in a hospital for 4 years and have never seen a complication from iso, so for me I dont have a problem with it, but actually love it. Now, if some research comes out to say iso is really harmful and we shouldn't use it, that will suck. But until then, I fully intend on using it in my future, cuz it is a lifesaver.
 

eventualeventer

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We only use our tank next to the door that goes outside. One person takes the cat out, the other runs the tank outside ASAP (a distance of maybe 3 feet)

I haven't had any person get knocked out yet :)

the masks are a pain in the butt. Half the ones we have don't fit right...someone had the brilliant idea of using soda bottles cut up as masks, and unless the dogs nose is the perfect size, they're useless LOL.

ETA: Also, out of curiousity.... we do a great deal of feral cat population control....spay/neuter/vaccinate/release. How exactly are we supposed to sedate them without using a tank? Or are they an exception?
I appreciate that there are times when you have no choice but to use gas induction, I'm just curious about potential risks that would have to be weighed against the benefits in marginal cases. I wasn't thinking of someone getting knocked out, but whether there are risks of neuronal damage, increased cancer risk, etc., from repeatedly being exposed over the long term to levels of anesthetic gases higher than are normally encountered with an animal intubated and hooked up to a proper scavenging or rebreathing circuit. The literature I have found regarding risks to human OR personnel is conflicting, but that is still for situations where the concentration of gas must be much less than when you open a box full of iso.
 

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I've done externships at two exotics only places and they use gas tanks to anesthetize the small mammals and birds (the reptiles & snakes they use propofol). I think it mostly has to do with the stress level and difficulty of placing a catheter in something so small. Also, IV drugs are not as predictable in the exotics stuff.
 

scb44f

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Both of the vets I've shadowed have used the IM drugs, even on feral cats. Neither clinic has a tank so I don't have any experience with those, but it can definitely be done with an injection, cowgirla. Generally, we leave them in the traps, and since they are usually balled up in a corner, it's easy to poke them from there.
 

PrimalMU

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We only use our iso tank with fractious cats (the type of cats that you have to dump into the tank from their carrier, meaning no option for IM). For particularly fragile pets we'll use sevo instead of iso.

I think there's also a convenience factor. How long does it take for IV or IM drugs to wear off in recovery? This is particularly an issue with simple, short procedures (quick cat neuter, or simply a physical exam on a fractious animal). Do we want to wait 45-60 minutes for an animal to recover from a procedure that took 5 minutes to perform?

Of course, in a perfect world we'd always follow medically preferred procedures. However, especially in vet med, there are often times when we must make compromises, be it in terms of cost, time, etc.

So, I guess in short, my feelings are:

Iso tank = good for fractious animals or where compromise is needed
 

eringobraugh

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I've never heard of any vet using iso to sedate a patient. I worked at a small animal practice for 3 years and they ALWAYS used IV drugs first. I also did anesthesia on sheep for 2 years during grad school and we NEVER used iso to sedate, it was against IACUC protocol to do so. We were still using diazepam/ketamine to knock them down then intubated and hooked them up to iso after they were on the table.

Man I learn something new everyday on here!
 

alliecat44

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lalzi: when you learn about anesthesia in veterinary school, you will see how much information there is about how harmful mask/box inductions are. Also, there's a saying in science: the plural of anecdote is not data. ;) Not trying to pick on you, but there are scientific and specific ways we can assess the effects of different anesthetic protocols. You will be exposed to a lot of literature on this--hang in there! :) Just because you don't "see" an adverse event doesn't mean it doesn't happen--or is not subclinical and will cause a patient problems later in life (think decreased bloodflow to the kidneys).

eventualeventer: yes, there are long-term health risks associated with repeated exposure to waste anesthetic gases. As an employer, you could even be sued if you repeatedly put your personnel in this exposure situation if there was a viable alternative and the employee, say, had an abortion--or a child with birth defects. (One recent grad I spoke with is working at rural clinic where they have HOLES poked in the reservoir bags---so that they never have to worry about leaving the pop-off valve closed...so as the veterinarian, he and the technician are CONSTANTLY exposed to waste gases during surgery...so dangerous! There are scary things out there!)

For ferals and exotics--those are different circumstances. However, for most mammals, you can still manage to give them an IM injection of a drug combo that will heavily sedate them enough for IV catheter placement. :)

Ferals are definitely "make sure human safety comes first" territory and some of them ARE genuinely impossible to give an IM injection to, even through the bars of the trap--but I still think these are fewer than some folks think. However, human safety from claws and teeth in a non-vaccinated animal definitely comes first! :)
 

cowgirla

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In cats, has there been any link from IM injections to injection-site sarcomas? Especially in those chronic cats where you have to knock them out on a relatively frequent basis for treatment/workup/etc?

Seems like everything has a downside with cats.
 

alliecat44

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Also something for you guys to start thinking about now: anesthesia DOES NOT equal analgesia.

Isoflurane has NO analgesic properties. The pain is still being transmitted through the nervous system to the brain. There are all sorts of intra-and post-operative issues due to the physiological response to pain if there is no analgesia used in an anesthetic protocol.

Please please remember that certain drugs (iso, ace, valium) cause anesthesia/tranquilization/muscle relaxation but DO NOT DO ANYTHING for pain! And our patients deserve pain control! Please!

Just something to keep in mind.
 

alliecat44

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In cats, has there been any link from IM injections to injection-site sarcomas? Especially in those chronic cats where you have to knock them out on a relatively frequent basis for treatment/workup/etc?

Seems like everything has a downside with cats.
No, except for IM injections of certain vaccines.
 

lalzi22

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allie- no offense taken! I still am a lowly pre-vet, and havent read the literature. I was in no way advocating for iso all the time. We use IM injections most of the time, but we do use iso to knock out some of the more difficult animals and I think it is super helpful.

Also, we only use iso at my exotics clinic just because with IM it can be difficult to wake them up if there is an adverse reaction, so iso works much better. This is what my vet (who was the president of the AAV, so she does have a LOT of experience with birds and exotics), has told me.
 

alliecat44

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lalzi--yup, exotics (especially birds) are a big exception to the rule, especially depending on what you're doing--such as just a brief physical exam instead of an invasive procedure. :)

Many reptiles (such as turtles) will hold their breath and it will be pretty much impossible to mask them down--which is pretty cool from a physiology standpoint, I think. :)

(Anesthesia/analgesia is just a big passion of mine, in case folks couldn't tell. ;) )

Also, you are NOT "a lowly pre-vet"--you ARE a future colleague! :)
 

lalzi22

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cowgirla

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Many reptiles (such as turtles) will hold their breath and it will be pretty much impossible to mask them down--which is pretty cool from a physiology standpoint, I think. :)

Turtles....ugh. Their circulation is so slow it takes forever to do anything to them.
We had a tiny little turtle (maybe 5 inches across the shell) and it took like 20 ccs of "blue juice" before the poor thing's heart stopped.
 

sofficat

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Alliecat :clap::claps::thumbup:
Well, looks I don't have to respond to any of this- you said it all perfectly.
Thank you!
 

sofficat

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I have to say iso is a gift from the vet gods. To echo the sentiments of cowgirla, having to deal with INSANE feral cats, rabbits who dont want to sit still for a cath, ferrets with NO blood pressure or dogs that could knock me down with their paw- iso makes it safer for us as well as the patient who may hurt themselves from struggling so much.
Just to reiterate what Alliecat said- iso is one of the most potent vasodilators- so using this on patients with no blood pressure is not a safe thing to do.
And congrats to be a member of 2014! It's gonna be a fun road!
 

clouds815

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Also something for you guys to start thinking about now: anesthesia DOES NOT equal analgesia.

Isoflurane has NO analgesic properties. The pain is still being transmitted through the nervous system to the brain. There are all sorts of intra-and post-operative issues due to the physiological response to pain if there is no analgesia used in an anesthetic protocol.

Please please remember that certain drugs (iso, ace, valium) cause anesthesia/tranquilization/muscle relaxation but DO NOT DO ANYTHING for pain! And our patients deserve pain control! Please!

Just something to keep in mind.
omg really? did NOT know that!
a clinic i've worked at they use propofol IV & then isofluorane gas during surgery (in dogs). does that mean that while they are being cut open they feel a great deal of pain but just can't do anything about it? thats awful :( i hope i interpreted that wrong
 

alliecat44

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omg really? did NOT know that!
a clinic i've worked at they use propofol IV & then isofluorane gas during surgery (in dogs). does that mean that while they are being cut open they feel a great deal of pain but just can't do anything about it? thats awful :( i hope i interpreted that wrong
Propofol does not have any analgesic properties. Obviously I have no idea if they were using any other drugs that would provide pain relief. It would be a good question to ask (politely, of course). :)
 

david594

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omg really? did NOT know that!
a clinic i've worked at they use propofol IV & then isofluorane gas during surgery (in dogs). does that mean that while they are being cut open they feel a great deal of pain but just can't do anything about it? thats awful :( i hope i interpreted that wrong
No. They aren't aware of whats going on while they are under sufficient anesthesia. On a physiologic level they are experiencing pain, but not actually feeling it. But once they start waking up, they will be feeling a ton of pain(also do some reading on "wind-up pain".
 
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david594

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Is there anyone out there that is working for a vet who doesn't like this?
Thanks!
I work with a vet in the shelter setting who essentially never masks/tanks down patients.

Morphine/ace premed makes pretty much every dog agreeable enough for IV induction. Female cats get the same. Male cats get DTK.
 
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DVMDream

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At the clinics I have worked at we also use a nice concotion of medications before placing them on iso. I love the "kitty magic" combination we have. Kitty will be out in less than five minutes and part of the concoction is reversable so if the kitty is slow waking up we can actually reverse some of the sedative. :) We also do not use iso at all for cat neuters. It is just much safer to give them the kitty magic, do the procedure and then let them wake up. At one clinic they use iso for cat spays but at the other clinic I worked at they did not even use iso for a cat spay just the IM injection (and these vets have been in practice for 30 years). This clinic also did many trap/neuter/release cats and they never iso boxed them down; actually they do not even own an iso box; they use the kitty bag.


The only time we use the iso box is for incredibly fractious cats. These are the cats you can not approach with a 10 foot pole. We have one cat that comes in where you can not do an exam without him being sedated and since we can not even get a hold of him we use the iso box. Dump from carrier straight into box. We have never, ever and I have never seen a dog sedated with only iso. For some reason we can always find a way to give a dog an IM injection, even if it means pinning them behind a door while some pulls a leash between the door and door jam and someone else pokes them in the butt. It is actually really simple and much easier than putting them under by iso only.

For the most part we use a pre-anesthetic to sedate them. Cats get sedated and then are giving a little iso so we are able to get the E.T tube in. Dogs get sedated, then an IV anesthetic and then we put the E.T tube in and start them on low levels of iso. Most patients are never put above a 2.5 on iso.
 

heylodeb

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even though a lot has been said - add my little information in...

At our clinic, we give a pre-anesthetic about 30 minutes before surgery which pretty much leaves them happy go lucky for the propofol in the IV for intubation. About 6 months ago, we stopped using Iso completely and now only use Sevo during surgery. We don't even have a tank. We don't require that owners pay for a post-surgery pain medication (meloxicam) but we highly suggest it. I wish it was mandatory. :(

As for pets that are not able to be handled - we use a cat net. We have a tech who is pretty much a master at it. She gets the cat pinned down as quickly as possible, someone else stabs. :)
 

StartingoverVet

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Interesting and stimulating post.

I shadowed SA clinic for almost 3 years that does a ton of surgeries and gets a large portion of the orthopedic referrals. I would say 3/4 of the patients are just masked down then intubated. Seems that only extremely fearful/aggressive ones are given any drugs first and then masked down.

Of course the doctors there have mostly been around forever so are definitely old school. Going to be hard to convince someone who has done 40-50k surgeries in a long career with an extremely successful record that there is undue risk.

I will tactfully bring up the point and see what the head surgeon says but I am guessing it is going to be something along the lines of "in the right hands there is not an issue, but improperly administered there is more risk." I will report back next week!
 

alliecat44

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This is a great discussion, especially for people who haven't yet had anesthesia classes in veterinary school. I really believe misconceptions regarding anesthetic safety and protocols start with pre-vet experiences, dependng on what type of practices people are exposed to. It can color your perception of your education as well--I've heard it myself from classmates.

Interesting and stimulating post.

I would say 3/4 of the patients are just masked down then intubated. Seems that only extremely fearful/aggressive ones are given any drugs first and then masked down.

Going to be hard to convince someone who has done 40-50k surgeries in a long career with an extremely successful record that there is undue risk.

I will tactfully bring up the point and see what the head surgeon says but I am guessing it is going to be something along the lines of "in the right hands there is not an issue, but improperly administered there is more risk." I will report back next week!
It will certainly be very interesting to hear what they say! :) I'm sure they have their own reasons for their anesthetic protocols (financial, etc...). Just curious--what sort of anesthetic monitoring do they use? (If you don't look, you won't find any problems!) Any pain medication at all?

It's great that you're paying attention to what they're doing! :)

More generally, it's definitely "hard to convince" someone that there's an issue when they haven't perceived a problem--but that's what keeping up with the literature and continuing education is all about.

For example, before we started measuring blood pressure in our patients, we had NO IDEA how incredibly hypotensive our patients can and do get under anesthesia. We thought that the fact they woke up indicated a successful anesthetic episode--but now we know a successful episode is more than just "not dying".

As veterinarians we are scientists, and so need to evaluate the new information/studies/drugs/physiological insights that are coming out all the time. It's our professional responsibility to at least be aware of certain changes in thought, whether or not we choose to adopt them for our practice. It's good to get used to THAT idea now...things change, all the time, and being a professional means you are commiting to a lifetime of learning.

Most of the stuff we're learning now in school will be outdated in 5-10 years. I don't want to be practicing 2011 medicine in 2040--but that's just me. :)

Okay, stepping off my soapbox now!!! Again, apologies--anesthesia/analgesia is just really important to me.
 

sunshinevet

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Also something for you guys to start thinking about now: anesthesia DOES NOT equal analgesia.

Isoflurane has NO analgesic properties. The pain is still being transmitted through the nervous system to the brain. There are all sorts of intra-and post-operative issues due to the physiological response to pain if there is no analgesia used in an anesthetic protocol.

Please please remember that certain drugs (iso, ace, valium) cause anesthesia/tranquilization/muscle relaxation but DO NOT DO ANYTHING for pain! And our patients deserve pain control! Please!

Just something to keep in mind.
+1 Alliecat!!! This seems to be something that not enough vets - both old AND new - think about!

At the clinics I have worked at we also use a nice concotion of medications before placing them on iso. I love the "kitty magic" combination we have. Kitty will be out in less than five minutes and part of the concoction is reversable so if the kitty is slow waking up we can actually reverse some of the sedative. :) We also do not use iso at all for cat neuters. It is just much safer to give them the kitty magic, do the procedure and then let them wake up. At one clinic they use iso for cat spays but at the other clinic I worked at they did not even use iso for a cat spay just the IM injection (and these vets have been in practice for 30 years). This clinic also did many trap/neuter/release cats and they never iso boxed them down; actually they do not even own an iso box; they use the kitty bag.
Haha, is part of the "kitty magic" domitor??? I actually have a bit of a personal vendetta against domitor, as it has massive systemic depression properties. I mean, its good for quick, low risk, procedures on healthy animals... but I'm the kind of person who's like, "if theres another, safer protocol out there... why take the risk?"

Having worked in many, many clinics for over 5 years, ive definately seen some stuff thats made the hairs on the back of my neck stand up... anaesthetic protocols vary so widely from clinic to clinic, and from vet to vet, its crazy. And to put things into perspective, the vet I worked for longest, who has been out for 20+ years, actually uses far safer protocols than the vets I work with who've been out for less than 5. I personally think that it has less to do with the age of the vet and more to do with how they run their business, as to what they value in an anaesthetic.

I agree with a lot of these posts - sometimes, you've just got to box a cat. The "safe" vet I worked for, we used to pin them to pre-med them (usually ace/torb) and then box them to induce, because we hate using ketamine - you can use ket im and then give IV valium to balance it out, but it can be a bit of a rocky road, and it tends to be a rough as guts recovery, so why do that to them if their pre-medded and you can get them down nicely in the box? Its no more dangerous like that than val/ket. We would have an issue boxing without premed though.
I don't understand why you would ever induce a dog with iso??? If you can hold them still enough to mask them, you can hold them still enough to sedate/induce them another way!!! 99% of dogs will take an IV over a mask any day!

Interesting and stimulating post.

I shadowed SA clinic for almost 3 years that does a ton of surgeries and gets a large portion of the orthopedic referrals. I would say 3/4 of the patients are just masked down then intubated. Seems that only extremely fearful/aggressive ones are given any drugs first and then masked down.

Of course the doctors there have mostly been around forever so are definitely old school. Going to be hard to convince someone who has done 40-50k surgeries in a long career with an extremely successful record that there is undue risk.

I will tactfully bring up the point and see what the head surgeon says but I am guessing it is going to be something along the lines of "in the right hands there is not an issue, but improperly administered there is more risk." I will report back next week!
I would have more of an issue of WHERE IS HIS PAIN RELIEF?!?!?!?!?!? I worked for a specialist ortho, and we used to premed with morph/ace, give more morphine peri-op and fentanyl post op. Ortho surgery HURTS!!! I would be pointing that out to him!!!
 

StartingoverVet

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It will certainly be very interesting to hear what they say! :) I'm sure they have their own reasons for their anesthetic protocols (financial, etc...). Just curious--what sort of anesthetic monitoring do they use? (If you don't look, you won't find any problems!) Any pain medication at all?
As for monitoring... pretty basic: heart rate, pulse-ox, respiration rate.

Pain meds administered near the end of surgery for most procedures (except short simple ones like neuter or small growth removal).
 

david594

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Haha, is part of the "kitty magic" domitor??? I actually have a bit of a personal vendetta against domitor, as it has massive systemic depression properties. I mean, its good for quick, low risk, procedures on healthy animals... but I'm the kind of person who's like, "if theres another, safer protocol out there... why take the risk?"
I'm pretty sure all kitty magic combos involve domitor. If you want to feel better about it, just go read about xylazine. I'm a much bigger fan of DTK(domitor, torb, and ketamine) than TKX(telazol, ketamine, and xylazine).

And can we come back to torb for a minute.... But why does this get used so often? I'm lost? As a sole agent for pain? Really? No love for the morphine/ace premed?
 

alliecat44

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As for monitoring... pretty basic: heart rate, pulse-ox, respiration rate.

Pain meds administered near the end of surgery for most procedures (except short simple ones like neuter or small growth removal).
Okay, I'm not going to touch this one.......discretion is the better part of valor...going to bed before my head explodes. :)
 

DVMDream

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Haha, is part of the "kitty magic" domitor??? I actually have a bit of a personal vendetta against domitor, as it has massive systemic depression properties. I mean, its good for quick, low risk, procedures on healthy animals... but I'm the kind of person who's like, "if theres another, safer protocol out there... why take the risk?"
Kitty magic is buprenex, dexdomitor (domitor is long gone from our clinic dexdomitor causes much less systemic depression and the animals wake up much faster from it in my experience), and one other drug that for the life of me I can not remember (I want to say ketamine). They are all very small doses of each of these drugs.

I would have more of an issue of WHERE IS HIS PAIN RELIEF?!?!?!?!?!? I worked for a specialist ortho, and we used to premed with morph/ace, give more morphine peri-op and fentanyl post op. Ortho surgery HURTS!!! I would be pointing that out to him!!!
Whenever we do TPLO surgeries (not at a specialist clinic, we have another vet come in to do these) we always put a fentanyl patch sutured on the dog's back the night before surgery and then they are given morphine before surgery and then either more morphine or hydromorph after surgery. Interesting to see how different every place can be.
 

david594

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Interesting to see how different every place can be.
Domitor is long gone from everywhere. Discontinued at least a year ago.

Is interesting the PC word for scary?
 

DVMDream

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Domitor is long gone from everywhere. Discontinued at least a year ago.

Is interesting the PC word for scary?
Did not know that domitor was removed everywhere. I do know the difference between domitor and dexdomitor; makes sense why domitor has been removed.

And yes interesting is the PC word for scary. :p
 

nyanko

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I am working with a veterinary anesthesia resident on a research project doing electroretinograms on kittens every 2 weeks from age 5 weeks on, and she is actually using atropine as a pre-med and then masking down with iso.

We are monitoring blood pressure and heart rate with a doppler, and also monitoring temperature and respiratory rate.
 

DVMDream

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I am working with a veterinary anesthesia resident on a research project doing electroretinograms on kittens every 2 weeks from age 5 weeks on, and she is actually using atropine as a pre-med and then masking down with iso.

We are monitoring blood pressure and heart rate with a doppler, and also monitoring temperature and respiratory rate.
We use atropine to help with nausea after surgery. Drooly doggies and kitties get atropine.
 

eventualeventer

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Is interesting the PC word for scary?
:laugh:

It is very *cough* interesting to read the different protocols in use in SA, since I have very limited shadowing experience and don't remember exactly what was used for the couple surgeries I watched. I shadowed a very good vet at a practice with wealthy clients, but it doesn't sound like there is as much balanced anesthesia as I expected.

Alliecat, it's interesting that you say that about hypotension. I sneak into the (horse) OR at work whenever it's slow (or I'm done for the day) and there's an interesting case. Every case gets an art line, and almost every case gets put on a dobutamine CRI (in addition to IVF, of course). Many get lidocaine CRI's on the table. They also use a lot of IV drugs (ket/val/torb/ace) to decrease the amount of iso needed.
 

DVMDream

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:laugh:

It is very *cough* interesting to read the different protocols in use in SA, since I have very limited shadowing experience and don't remember exactly what was used for the couple surgeries I watched. I shadowed a very good vet at a practice with wealthy clients, but it doesn't sound like there is as much balanced anesthesia as I expected.

Alliecat, it's interesting that you say that about hypotension. I sneak into the (horse) OR at work whenever it's slow (or I'm done for the day) and there's an interesting case. Every case gets an art line, and almost every case gets put on a dobutamine CRI (in addition to IVF, of course). Many get lidocaine CRI's on the table. They also use a lot of IV drugs (ket/val/torb/ace) to decrease the amount of iso needed.
:laugh: My problem is the opposite. Get the SA stuff, but the above equine stuff has me doing this --->:confused:.

I need to get some equine experience I feel completely lost when people start talking about horses on here.
 

eventualeventer

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Sorry. Art line = arterial line for continuous BP monitoring (and arterial blood gases as needed -- most colic surgeries usually get at least one ABG run partway through). Dobutamine is used to boost BP -- it increases cardiac contractility (the force with which the heart pumps) and causes peripheral blood vessel constriction, counteracting some of the effects of iso. IVF = IV fluids. Torb = butorphanol, which is similar to buprenex (opioid partial agonist).

David, why would you use telazol AND ketamine?
 

Pandacinny

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Ferals are definitely "make sure human safety comes first" territory and some of them ARE genuinely impossible to give an IM injection to, even through the bars of the trap--but I still think these are fewer than some folks think. However, human safety from claws and teeth in a non-vaccinated animal definitely comes first! :)
I agree with you on this being necessary less often than people think. I'm sure there MAY be ferals you need to use a tank to anesthetize, but after years of working as a technician at a spay/neuter clinic, I don't think I ever saw one. We did a LOT of ferals, too, on a regular basis. We were pretty much always able to find a way to get them IM and the really difficult ones were fairly rare - most feral cats are trying to escape, after all, not come at your face. It's the owned cats who seem to really have it out for people. :p

For REALLY fractious cats that couldn't be given an IM injection through a trap/cage, we would use a net to put it over the feral's cage/carrier, then when the cat runs out, you put a big towel over it and the net and step on the handle, leaving the butt uncovered. Then, you give the injection IM. Worked pretty well, didn't seem super stressful (no more than boxing them down or being in the clinic in the first place), and it was usually pretty quick.

Also, using non-fitting and leaking cut soda bottles as masks? Oh geez - that sounds safe...
 

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We do use iso, especially on exotics, however, we are also 1:1 observing with procedures for intubation, degassing, etc.