The use of isoflurane tanks to sedate a patient

[VeganSoprano]

We'll box down the occasional super-fractious cat, usually with sevo. We're a high volume hospital and I see this maybe once a month. It's never the first choice but it can be the least stressful option for the cat and the only practical way for the staff to avoid injury. They're down for 5-10 minutes and we monitor SpO2 at a minimum and are prepared to intubate if needed.

I've never had a feral cat in a trap that I couldn't get an IM injection into. Trap dividers are awesome.

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[ColoGirl]

I'm really glad this topic was brought up! I haven't worked in a clinic in ten years, and when I did about 75% of the patients that needed to be anesthetized were masked with iso. I'm not sure what that same clinic is doing now.

But, more relevant to me....I am anesthetizing hundreds if not thousands of mice for my research. I use iso in a chamber routinely. I guess I just never really dove into the safety etc because the IACUC approved its use and it was used on me when I had knee surgery. It didn't really occur to me that people were moving away from it in practice since it is so widely used in laboratory animals. I am going to read up!

I also use ketamine/xylazine IP for non-surgical procedures when I just need them to lay there super still. I have never had any problems with this procedure in mice, and knock on wood, have never lost one!

 

[alliecat44]

I use iso in a chamber routinely. I guess I just never really dove into the safety etc because the IACUC approved its use and it was used on me when I had knee surgery. It didn't really occur to me that people were moving away from it in practice since it is so widely used in laboratory animals. I am going to read up!

!

Just to clarify--isoflurane is a great maintenance anesthetic and actually quite safe, especially when used as part of a balanced anesthetic protocol with appropriate monitoring and trained staff. For invasive procedures such as spays, it's borderline below the standard of care to use injectable-only anesthesia. I (and others) are referring to the practice of using iso as an induction agent, specifically in an induction tank (although for me, I completely disagree with "masking down" for many of the same reasons).

A balanced anesthetic protocol for an invasive procedure includes premedication (usually some form of sedative/tranquilizer + an opiate to pre-emptively block pain receptors, decreasing pain transmission before the painful stimulus actually occurs). This combination also relaxes the patient to facilitate IV catheter placement. More importantly, using these drugs decreases the amount of induction agent necessary to intubate the patient and the amount of isoflurane they need in order to maintain a surgical plane of anesthesia, increasing patient safety.

Proper anesthetic monitoring includes monitoring perfusion (is the blood getting to where it needs to go at the pressure it needs for oxygen diffusion?)--this information is given to you by blood pressure monitoring and capnography. Monitoring ventilation is also important--is enough bloodflow getting to the lungs and enough gas being diffused to both a) absorb enough oxygen into the bloodstream and b) blow off enough carbon dioxide? That's measured with a capnograph. ECGs are fine but don't tell you anything about cardiac function, just the electrical impulse generated by the heart muscle. Pulse ox measures oxygen saturation, but on 100% oxygen (when a patient is intubated and hooked up to a breathing circuit), it takes a very very long time for the pulse ox to start to go down if an animal is having trouble (you will learn more about this in respiratory physiology and anesthesia).

If posed with the question, "you can only pick two pieces of monitoring equipment on your critical patient--which do you choose?", every criticalist and anesthesiologist I know would choose a Doppler (blood pressure monitor) and a capnograph.

Not going to say more on that subject--it's probably more detail than is appropriate for on here anyway--just want to spark some thought/perhaps some independent research.

Anyways, back to the original question--I have NO problem with isoflurane as a maintenance anesthetic. I DO have a problem with iso used as the sole anesthetic agent. Hope that clarifies my own position.

 

[Bearby]

The clinic I work at currently uses the tank probably once every few months, and only for cats. My parents cat (or my cat depending on who you ask) is ridiculous at the vet. Once upon a time I took him to a vet whose reputation I know now is less than good. He was a sweet kitten but once they did his neuter he turned into a demon lol. He's still a good cat at home, when he wants to be, but there is no way you could do a physical on him let alone try to draw blood for a wellness profile. We've tried just bringing him in with some ace on board and he seemed to be even more aggressive. Then we tried getting him in a bag and using an IM injection for sedation...it worked well, but he had a reaction to it. The only option we have for him is to gas him down. I understand the concern and risks but in this case, the only other alternatives are more dangerous to him or a risk to the people working with him.

 

[dyachei]

someone asked why we don't use ace/morphine as much. I'm pretty sure its because Ace can make some animals aggressive and is highly hypotensive (causes low blood pressure). Also, morphine can be excitatory in cats and causes vomiting (not necessarily the best thing if you are sedated).

 

[Electrophile]

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.

Intubate, intubate, intubate. Always. True story from yours truly. Warning, it's not pretty. About 4-5 weeks ago, I was on an externship where the doctor let me neuter my own dog. I had done a few of them before, but they were on young dogs less than a year of age. He will be 3 next month, so he was certainly on the more adult side of things. Anyways, that clinic does not intubate for dog or cat neuters. They use xylazine/ketamine for induction/maintenance for dog neuters. So my Malinois, who has a very high metabolism as they tend to have, woke up in the middle of me doing his neuter SCREAMING. We did not have him intubated and so the vet tech had to mask him down, which took 2-3 minutes before he was unconscious again. I was nearly finished with the surgery, so the vet tech had turned him down to 0.5% iso. I was starting on the last layer of closure when he woke up AGAIN. Had to go mask him down again while he was screaming and crying tied down to the table so I could finish the last layer. I don't particularly like surgery anyways, so I about never wanted to surgery again ever after that, I was so rattled (even without it being my own dog). So besides the lesson of being cautious if you ever have to do surgery on your own pets, don't rely on kitty magic or other injectables, especially when you're a novice surgeon. INTUBATE, INTUBATE, INTUBATE.

 

[twelvetigers]

That sounds TERRIBLE! I'm sorry you had to experience that.

 

[DVMDream]

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?

Thanks! This helps a lot. I was able to guess on some of them but most of it was way over my head. I think I am going to go search for an equine clinic to shadow at now....

 

[DVMDream]

The clinic I work at currently uses the tank probably once every few months, and only for cats. My parents cat (or my cat depending on who you ask) is ridiculous at the vet. Once upon a time I took him to a vet whose reputation I know now is less than good. He was a sweet kitten but once they did his neuter he turned into a demon lol. He's still a good cat at home, when he wants to be, but there is no way you could do a physical on him let alone try to draw blood for a wellness profile. We've tried just bringing him in with some ace on board and he seemed to be even more aggressive. Then we tried getting him in a bag and using an IM injection for sedation...it worked well, but he had a reaction to it. The only option we have for him is to gas him down. I understand the concern and risks but in this case, the only other alternatives are more dangerous to him or a risk to the people working with him.

In my experience, ace does not work very well in cats for sedation. It is great for dogs but it does not seem to do much of anything (as far as sedation goes) in cats.

Intubate, intubate, intubate. Always. True story from yours truly. Warning, it's not pretty. About 4-5 weeks ago, I was on an externship where the doctor let me neuter my own dog. I had done a few of them before, but they were on young dogs less than a year of age. He will be 3 next month, so he was certainly on the more adult side of things. Anyways, that clinic does not intubate for dog or cat neuters. They use xylazine/ketamine for induction/maintenance for dog neuters. So my Malinois, who has a very high metabolism as they tend to have, woke up in the middle of me doing his neuter SCREAMING. We did not have him intubated and so the vet tech had to mask him down, which took 2-3 minutes before he was unconscious again. I was nearly finished with the surgery, so the vet tech had turned him down to 0.5% iso. I was starting on the last layer of closure when he woke up AGAIN. Had to go mask him down again while he was screaming and crying tied down to the table so I could finish the last layer. I don't particularly like surgery anyways, so I about never wanted to surgery again ever after that, I was so rattled (even without it being my own dog). So besides the lesson of being cautious if you ever have to do surgery on your own pets, don't rely on kitty magic or other injectables, especially when you're a novice surgeon. INTUBATE, INTUBATE, INTUBATE.

Wow. I am so sorry that happened. That is super, super scary. We have not had any cats wake up during the surgery when on only "kitty magic" (buprenex, ketamine, dexdomitor) at the clinic where we us this ONLY cat neuters are done without iso everything else gets iso.

At another clinic I worked at they only used sedation (not sure what it was because the vets always drew up and gave the sedative) but I know it was not the greatest stuff because the cats would kick their back legs sometimes during the neuters. This place also did cat spays without iso. At this place we would easily have 19 surgeries in one morning coming in from the local humane socitey. So it was more like an assembly line operation. These vets have also been doing this since they graduated vet school over 35 years ago and have never lost a cat doing the surgeries that way.

I agree with the always intubate because you do not know what is going to happen. At the first clinic above they used to always use a mask with a low dose of iso for the kitty neuters but since they switched from one pre-anesthetic (did not work very well) to kitty magic they have decided not to use iso for the 2 minute surgery.

 

[ratbandit]

Intubate, intubate, intubate. Always. True story from yours truly. Warning, it's not pretty. About 4-5 weeks ago, I was on an externship where the doctor let me neuter my own dog. I had done a few of them before, but they were on young dogs less than a year of age. He will be 3 next month, so he was certainly on the more adult side of things. Anyways, that clinic does not intubate for dog or cat neuters. They use xylazine/ketamine for induction/maintenance for dog neuters. So my Malinois, who has a very high metabolism as they tend to have, woke up in the middle of me doing his neuter SCREAMING. We did not have him intubated and so the vet tech had to mask him down, which took 2-3 minutes before he was unconscious again. I was nearly finished with the surgery, so the vet tech had turned him down to 0.5% iso. I was starting on the last layer of closure when he woke up AGAIN. Had to go mask him down again while he was screaming and crying tied down to the table so I could finish the last layer. I don't particularly like surgery anyways, so I about never wanted to surgery again ever after that, I was so rattled (even without it being my own dog). So besides the lesson of being cautious if you ever have to do surgery on your own pets, don't rely on kitty magic or other injectables, especially when you're a novice surgeon. INTUBATE, INTUBATE, INTUBATE.

Electrophile - Don't feel too bad it's happened to me too and will probably happen to everyone at some point. At the shelter two dog spays I did woke up and started crying. Luckily both times I was just closing the skin and didn't have the whole abdomen open or anything. They use injectables only and have gas on hand but don’t intubate or put a catheter in anything. The first time there was NO ONE around (I think the vet was somewhere in the building but no one in the clinic area!). I had to fix the tank up and mask the dog down myself and then scrub back in and finish while trying make sure the dog wasn't gonna die under 5% iso! The other time there was an employee walking around who I made come in and hold the mask on while I finished - she was a teenager and was all "Omg is this dog like awake?!" & proceeded to freak out the whole time. Anyways I think I've been traumatized enough to never attempt any more dog spays without intubating and gas. Also –having a surgery assistant – always a good idea! But then again better awake than dead I always say....

 

[DVMDream]

Electrophile - Don't feel too bad it's happened to me too and will probably happen to everyone at some point. At the shelter two dog spays I did woke up and started crying. Luckily both times I was just closing the skin and didn't have the whole abdomen open or anything. They use injectables only and have gas on hand but don’t intubate or put a catheter in anything. The first time there was NO ONE around (I think the vet was somewhere in the building but no one in the clinic area!). I had to fix the tank up and mask the dog down myself and then scrub back in and finish while trying make sure the dog wasn't gonna die under 5% iso! The other time there was an employee walking around who I made come in and hold the mask on while I finished - she was a teenager and was all "Omg is this dog like awake?!" & proceeded to freak out the whole time. Anyways I think I've been traumatized enough to never attempt any more dog spays without intubating and gas. Also –having a surgery assistant – always a good idea! But then again better awake than dead I always say....

Here is a good tip for masks so they do not have to be held on: A large dog muzzle placed over the mask and then snapped behind the dog or cat's head works really, really well. And that had to be really scary especially being all be yourself.

 

[modidl]

I work for a vet who has been in practice over thirty years and almost never uses iso, except for longer surgeries. I think he tends towards IM and IV drugs because he was primarily a large animal vet for the majority of his carrier and is more familiar with them. I think they work really great, and even with large dogs or crazy cats we rarely have a problem. Mostly our problems is if the animal doesn't handle it well and starts to wake up early we have to hurry and drag the iso equipment out and set that all up. But when he goes out of town and we have a fill-in vet she does tend towards iso, because she feels the IM and IV drugs are "old" and "unrealiable" and "unsafe" because if you do have a problem, you can't back them out of the drugs as you can with iso. Personally, i cheer for IV/IM b/c they are a sinch, if you know how to handle a bad dog or cat (really couldn't vouch for rabbits) or even goats, it isn't difficult at all. we rarely have to opt for iso to knock them down (2 or 3times in 2 years)

 

[purplesaurus]

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.

I worked as a vet "nurse" (i.e., not an educated/licensed tech) for several months as a SA clinic. While this was a fantastic opportunity for me, I now feel that I should have been given TONS more training (or just been required to go through a tech program). And none of the nurses I worked with were techs, either. We had one who had many, many years of experience, and she really seemed to know what she was doing. Sadly, she was also the manager, so I didn't get to work or train with her much.

After having worked as a receptionist at clinics that hire licensed techs, I now know that a lot I was told from the other nurses at that clinic was just wrong (and I get the feeling a lot of what I was trained was figured out from anecdotal experience or learned from a vet once and then passed on incorrectly or outdatedly). For example, we always iso-ed our cats in boxes, and I was told this was because that was the ONLY safe method to sedate/anesthetize a cat.

Actually, we had a vet student visit with us for a few days, and I hated her so much! For everything I did, she would tell me why what I was doing was wrong or unsafe, and I had no answers for her for why I was doing it this way (other that "Well, I was told to..."). Now that I'm a little more informed, I can really appreciate her concerns. And it probably was the case that she was learning the most up-to-date info and our practices were out of date.

At first, I felt, "Wow! I know so much!" Now I'm flabbergasted that they let me do so much, independently, with so little knowledge or training. Like I said, great experience for me, but I was not qualified by far!


eta:

Intubate, intubate, intubate. Always. True story from yours truly. Warning, it's not pretty. About 4-5 weeks ago, I was on an externship where the doctor let me neuter my own dog. I had done a few of them before, but they were on young dogs less than a year of age. He will be 3 next month, so he was certainly on the more adult side of things. Anyways, that clinic does not intubate for dog or cat neuters. They use xylazine/ketamine for induction/maintenance for dog neuters. So my Malinois, who has a very high metabolism as they tend to have, woke up in the middle of me doing his neuter SCREAMING. We did not have him intubated and so the vet tech had to mask him down, which took 2-3 minutes before he was unconscious again. I was nearly finished with the surgery, so the vet tech had turned him down to 0.5% iso. I was starting on the last layer of closure when he woke up AGAIN. Had to go mask him down again while he was screaming and crying tied down to the table so I could finish the last layer. I don't particularly like surgery anyways, so I about never wanted to surgery again ever after that, I was so rattled (even without it being my own dog). So besides the lesson of being cautious if you ever have to do surgery on your own pets, don't rely on kitty magic or other injectables, especially when you're a novice surgeon. INTUBATE, INTUBATE, INTUBATE.

That was one very good thing about the SA clinic when I worked as a nurse. Everyone was intubated!

Also, I'm very sorry for your doggy.

eta, one more time:

I'm really glad this topic was brought up! I haven't worked in a clinic in ten years, and when I did about 75% of the patients that needed to be anesthetized were masked with iso. I'm not sure what that same clinic is doing now.

But, more relevant to me....I am anesthetizing hundreds if not thousands of mice for my research. I use iso in a chamber routinely. I guess I just never really dove into the safety etc because the IACUC approved its use and it was used on me when I had knee surgery. It didn't really occur to me that people were moving away from it in practice since it is so widely used in laboratory animals. I am going to read up!

I also use ketamine/xylazine IP for non-surgical procedures when I just need them to lay there super still. I have never had any problems with this procedure in mice, and knock on wood, have never lost one!

Oh man, that's funny. I used to work in research with rats. I am not certain how similar mice are to rats physiologically, but we had a TERRIBLE time with ketamine/xylazine IP. Of course, our problem probably was trying to do surgeries with this combo (we used ketamine/diazepam with no problems, but we had to switch when we couldn't get diazepam anymore). When I left, they were considering switching to iso for reliability and safety.

 

[cowgirla]

I hate using xylazine on small animals.

I dont know the "science" behind it, but I feel like the ones on xylazine have a much harder time waking up, they tend to get cold more easily, and their heart rate slows.
It scares the crap out of me, to be honest. We had one vet who used to knock the cats out with a combo with xylazine, and I hated recovering them, especially afterhours when no one else was around (IE, vet finishes the procedure, and goes home, leaving me to wait around until they are awake)

 

[purplesaurus]

A big issue we had with xylazine was that our rats would not go out easily, and once out, they could wake up very quickly with little forewarning. The overall thing for us, though, was that it was so freaking unpredictable!

 

[Vet Engineer]

I wish someone would tell this to one of the vets with whom I currently work!!! She's old school (graduated in the mid 70's) and she hates all things new. She won't even use chlorhexadine solution! She thinks it's unsafe!

However, she knows everything about cats and she seems to think any unhealthy cat (regardless of temperament) should be boxed down. She also never uses domitor unless it's for something super quick like cutting back a torn toenail.

 

[Electrophile]

Electrophile - Don't feel too bad it's happened to me too and will probably happen to everyone at some point. At the shelter two dog spays I did woke up and started crying. Luckily both times I was just closing the skin and didn't have the whole abdomen open or anything. They use injectables only and have gas on hand but don’t intubate or put a catheter in anything. The first time there was NO ONE around (I think the vet was somewhere in the building but no one in the clinic area!). I had to fix the tank up and mask the dog down myself and then scrub back in and finish while trying make sure the dog wasn't gonna die under 5% iso! The other time there was an employee walking around who I made come in and hold the mask on while I finished - she was a teenager and was all "Omg is this dog like awake?!" & proceeded to freak out the whole time. Anyways I think I've been traumatized enough to never attempt any more dog spays without intubating and gas. Also –having a surgery assistant – always a good idea! But then again better awake than dead I always say....

OMG, that's traumatizing too! At least I had a vet tech in the room with me monitoring who didn't totally freak out so I didn't have to scrub out and the doctor was just down the hall. That's why I would never want to do after hours emergencies all by myself! My dog also thrashed around quite a bit post op in his recovery cage probably due to the ketamine before I gave him some acepromazine, so no more xylazine/ketamine for him again! I'd heard that you have to be cautious with Belgian shepherds like you do with greyhounds because they've got so little body fat. If he needs another surgery, I'll go with propofol!

Then again, we had a HBC border collie get induced with propofol the next day after the trauma so we could surgically reduce both luxated hips and it ended up coding right there after induction, even though it appeared relatively stable. Then to add insult to injury to my own dog, he also developed a big scrotal hematoma, probably from waking up twice and thrashing around. So yeah. Me and small animal surgery/anesthesia apparently are not getting along.

 

[Electrophile]

Oh man, that's funny. I used to work in research with rats. I am not certain how similar mice are to rats physiologically, but we had a TERRIBLE time with ketamine/xylazine IP. Of course, our problem probably was trying to do surgeries with this combo (we used ketamine/diazepam with no problems, but we had to switch when we couldn't get diazepam anymore). When I left, they were considering switching to iso for reliability and safety.

We used acepromazine/xylazine/ketamine SQ on our research mice and usually worked fairly well. I've used it to castrate and ovex rats as well. If we had pregnant females we had to c-section, we'd usually box them down with isoflo though just enough to where they were out enough to inject quickly, because it's difficult to scruff a really pregnant one and not horribly stress them out. I castrated one of my own rats (he was being a royal pain to his cagemate with constant fighting after the patriarch of the cage died, so he got to be neutered to go live with the girls) and boxing him down with isoflo and then the rest of the way with butorphanol did well for him. The key with rodents is to keep them under warming lamps or heating pads, as they lose heat so quickly. Now he gets along with the girls in the girl cage great.

 

[marcwood]

How many of you out there have experience with Sevoflurane?

When I first started at my SA clinic 9 years ago, we primarily used Iso and has Sevo as a back up for patients that did not do well on Iso. Over 6 years ago, we switched to Sevo as a primary gas anesthetic. The difference I've seen is amazing. The depth of anesthesia is easier to control on Sevo and the recovery is a lot more smooth in comparison to Iso.

As far as boxing down, it has been my experience that the most fractious cats do better boxing down with sevo because the gas is not as pungent and they don't seem to try to resist the smell. Also, the excitement phase is very short and hardly noticable most of the time.

I also agree with the other post above regarding intubation. I believe it is essential in any patient that is anesthetised and/or unconscious. I also believe in Pre and/or peri-operative pain management. We're not in the dark ages anymore people...I always imagine myself in the patient's position. I would like to wake up with pain meds on board

Regarding injectable anesthetics, our clinic RARELY uses them. Maybe once or twice a year. We would rather induce with propofol and intubate and maintain on SEVO than leave a patient unconscious on the table with no control over when it will wake up.

 

[scb44f]

How many of you out there have experience with Sevoflurane?

One of the clinics I volunteer at does offer sevo, but at a bit higher cost, which might deter some people, but I see a pretty even split between the two on surgery days.

The other clinic uses only iso, but intubates every patient except for maybe a select few. However, a much higher percentage of their patients have problems breathing (as in someone has to breathe for them at some point during surgery).

I'm not sure the difference between the two clinics, but at the first one, I've never seen a patient who has required a human to breathe for them.

 

[DVMDream]

One of the clinics I volunteer at does offer sevo, but at a bit higher cost, which might deter some people, but I see a pretty even split between the two on surgery days. I do like it, and it seems like patients wake up a bit faster from it, but I haven't done a lot of research on that part... The downside of this clinic is that they primarily use the mask.

The other clinic uses only iso, but intubates every patient except for maybe a select few. However, a much higher percentage of their patients have problems breathing (as in someone has to breathe for them at some point during surgery).

I'm not sure the difference between the two clinics, but at the first one, I've never seen a patient who has required a human to breathe for them.

I have never heard of sevo until now. We only use iso and do not have many problems with breathing in patients. Every once in a great while I will get a dog (usually some medium sized shepherd or lab) that decides to hold its breath and its CO2 goes to 60 and then I have to breathe for it, but usually after 5-6 breaths the dog realizes it does not want to hold its breath anymore and I do not have to do it for the rest of the surgery but it is very rare when that does happen and only seems to occur in the medium-sized breed dogs .

 

[heylodeb]

Like I said in my previous post - our clinic only uses Sevo. I did not work there when they were only using Iso. From comments from the techs and doctors during surgery it seems like they are able to keep the patients "lighter" on the sevo. We also manipulate it a lot during surgery and the results are speedy.

 

[sofficat]

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

Isn't Dormitor medetomidine? Because I believe it's still widely used. Esp Dexmedetomine (Dexdormitor)

 

[sofficat]

Like I said in my previous post - our clinic only uses Sevo. I did not work there when they were only using Iso. From comments from the techs and doctors during surgery it seems like they are able to keep the patients "lighter" on the sevo. We also manipulate it a lot during surgery and the results are speedy.

Interesting because the MAC for sevo is about 2 times higher than iso. So if you maintain good anesthetic depth at 0.75 for iso you'd need 1.5 for sevo. hmmm...

 

[sofficat]

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

How many times does the heart rate shoot through the roof when the dr starts cutting/pulling ligaments/etc? If ANY surgical stimulation causes the patient's vitals to change(incr HR, incr RR) then they do not have proper analgesia.

How often does a heart rate go up and the dr says "turn up the iso" ? This happened ALL the time at the clinics where I work. If the patient is feeling pain (maybe not consciously interpreting it but the brain is perceiving it) then making the patient more unconscious (ie turning up iso) is NOT the answer! Give more pain meds!

 

[Electrophile]

I have never heard of sevo until now.

If you've ever been under gas anesthesia yourself, they probably used sevoflurane as that's what they usually use in humans.

 

[alliecat44]

Isn't Dormitor medetomidine? Because I believe it's still widely used. Esp Dexmedetomine (Dexdormitor)

sofficat, dexmedetomidine (Dexdomitor) is the replacement for medetomidine (Domitor). It has less of the racemic mixture, greatly increasing alpha-2 selectivity. The drug company eventually pulled Domitor from the market after mass production/distribution of Dexdomitor was established, as it's safer.

Sevo's lower solubility is pretty much negated by its higher MAC, making the change in induction time is pretty negligible, in MHO...and as you well know, the data saying that sevo might or might not be more "safe" than isoflurane is questionable at best (lots of threads on the VIN anesthesia boards about this). Most anesthesiologists I know don't think the difference justifies the expense, but folks should look at the science objectively and decide for themselves--again IMHO.

My guess is the differences in anesthetic depth, the perceived need for IPPV, rapidity of induction/recovery observed by these posters are all influenced by premedication/induction protocol, which likely varies highly between each one...which is why I don't think arguing physiological specifics on here is really worth it.

The beauty of controlled studies...!

 

[sofficat]

After having worked as a receptionist at clinics that hire licensed techs, I now know that a lot I was told from the other nurses at that clinic was just wrong (and I get the feeling a lot of what I was trained was figured out from anecdotal experience or learned from a vet once and then passed on incorrectly or outdatedly). For example, we always iso-ed our cats in boxes, and I was told this was because that was the ONLY safe method to sedate/anesthetize a cat.

Actually, we had a vet student visit with us for a few days, and I hated her so much! For everything I did, she would tell me why what I was doing was wrong or unsafe, and I had no answers for her for why I was doing it this way (other that "Well, I was told to..."). Now that I'm a little more informed, I can really appreciate her concerns. And it probably was the case that she was learning the most up-to-date info and our practices were out of date.
.

You'll get that feeling a lot in vet school. "What?! I was told the opposite when I was a tech" "What?! We did that ALL the time!" "What?! We used that stuff everyday!" haha... oh man...

 

[david594]

Isn't Dormitor medetomidine? Because I believe it's still widely used. Esp Dexmedetomine (Dexdormitor)

I was talking specifically about "Domitor"(medetomidine), the pfizer product. They discontinued it after the introduction of Dexdomitor(dex-medetomidine).

 

[DVMDream]

If you've ever been under gas anesthesia yourself, they probably used sevoflurane as that's what they usually use in humans.

Ok. What is the difference between sevo and iso? Does it really make that big of a differnece in safety of use? Like the difference in safety between domitor and dexdomitor.

 

[sunshinevet]

I work for a vet who has been in practice over thirty years and almost never uses iso, except for longer surgeries. I think he tends towards IM and IV drugs because he was primarily a large animal vet for the majority of his carrier and is more familiar with them. I think they work really great, and even with large dogs or crazy cats we rarely have a problem. Mostly our problems is if the animal doesn't handle it well and starts to wake up early we have to hurry and drag the iso equipment out and set that all up. But when he goes out of town and we have a fill-in vet she does tend towards iso, because she feels the IM and IV drugs are "old" and "unrealiable" and "unsafe" because if you do have a problem, you can't back them out of the drugs as you can with iso. Personally, i cheer for IV/IM b/c they are a sinch, if you know how to handle a bad dog or cat (really couldn't vouch for rabbits) or even goats, it isn't difficult at all. we rarely have to opt for iso to knock them down (2 or 3times in 2 years)

Wow... thats actually super dangerous!!! I can't believe there are people out there who still wouldn't maintain on iso - iso is far safer than using enough IV/IM drugs to keep them down! And as I said before, I really don't think age is an excuse - there are plenty of older vets out there who use really safe protocols.

I guess what I find a bit shocking in this whole discussion is the incredible lack of "best practice". So many vets and techs seem to think their protocol is ok just because they haven't lost too many animals on it - but what risk are they putting them through. Intubating animals is one of those things - I would actually refuse to do surgery on an animal that was not intubated - not just for the risk of them waking up, but if they DO crash, its way harder to get a tube in then - you might as well be prepared!
So often we hear about vets wanted to be given the same medical respect as human doctors, but I think that comes with a responsibility and a commitment to always strive to deliver best practice. And I think that involves using the safest anaesthetic protocols, with the greatest scientific and clinical evidence to back them up. Sure, you might get away with some dodgy protocols, but the day will come when an animal will die when it shouldnt, and when the owner starts asking questions like, "were there safer drugs you could have used?" you atleast need to be honest to yourself.

Something I maybe have against the American system, is the amount of experience you guys have to have before going into vet school. Yes, I wish more undergrad students here had experience. But everyone here has their own personal bias toward a protocol - before even recieving any veterinary education! And I think as the new generation of vets, we need to cast those biases aside, and be prepared to deliver best practice to all our patients, based on scientific and clinical trial evidence, instead of perpetuating the cycle of bad practice. Its time veterinary medicine stepped up, and its our responsibility to do it!

 

[alliecat44]

Wow... thats actually super dangerous!!! I can't believe there are people out there who still wouldn't maintain on iso - iso is far safer than using enough IV/IM drugs to keep them down! And as I said before, I really don't think age is an excuse - there are plenty of older vets out there who use really safe protocols.

I guess what I find a bit shocking in this whole discussion is the incredible lack of "best practice". So many vets and techs seem to think their protocol is ok just because they haven't lost too many animals on it - but what risk are they putting them through. Intubating animals is one of those things - I would actually refuse to do surgery on an animal that was not intubated - not just for the risk of them waking up, but if they DO crash, its way harder to get a tube in then - you might as well be prepared!
So often we hear about vets wanted to be given the same medical respect as human doctors, but I think that comes with a responsibility and a commitment to always strive to deliver best practice. And I think that involves using the safest anaesthetic protocols, with the greatest scientific and clinical evidence to back them up. Sure, you might get away with some dodgy protocols, but the day will come when an animal will die when it shouldnt, and when the owner starts asking questions like, "were there safer drugs you could have used?" you atleast need to be honest to yourself.

Something I maybe have against the American system, is the amount of experience you guys have to have before going into vet school. Yes, I wish more undergrad students here had experience. But everyone here has their own personal bias toward a protocol - before even recieving any veterinary education! And I think as the new generation of vets, we need to cast those biases aside, and be prepared to deliver best practice to all our patients, based on scientific and clinical trial evidence, instead of perpetuating the cycle of bad practice. Its time veterinary medicine stepped up, and its our responsibility to do it!

+1,000,000

This kind of stuff drives me absolutely crazy. See my comment about a successful anesthetic episode being MORE than "not dying." People are so biased when they get to veterinary school--and often for many, many wrong reasons (as we see here, and as I hear from classmates all the time). Here's to being the best scientists we can be and to a LIFETIME of learning!

 

[ReadyBeVet]

We only use straight isoflurane with exotics. There is a plastic tub w/lid that we place the rabbit/bird/amphibian inside that connects to the iso. With dogs and cats, we give torb + ace, then telazol as an induction IV. It seems to be very effective. We then will intubate and connect to the Isoflurane to keep the pet maintained during the procedure. I think it works well. We always give torb for pain, too.

 

[DVMDream]

Something I maybe have against the American system, is the amount of experience you guys have to have before going into vet school. Yes, I wish more undergrad students here had experience. But everyone here has their own personal bias toward a protocol - before even recieving any veterinary education! And I think as the new generation of vets, we need to cast those biases aside, and be prepared to deliver best practice to all our patients, based on scientific and clinical trial evidence, instead of perpetuating the cycle of bad practice. Its time veterinary medicine stepped up, and its our responsibility to do it!

I do have lots of clinical SA experience (4,000+ hours) but I am soo glad I have that experience. It has made me realize what I am getting myself into and that I really, really want to do this job and I would recommend to anyone thinking of being a veterinarian to first get experience before doing the pre-reqs so you can be 100% sure that you want to continue into a veterinary career. I do not have any bias towards a specific protocol. I have even asked what the differences are between the various forms of anesthetic (iso vs. sevo) so I might be able to bring it up to the vet I work with. I will also be doing my own research about it as much as I can. Once I get into vet school I will for sure be looking into whatever works best for patient care. If the method I have been used to seeing is not the best then I would have no problem tossing it to the side and doing what is best for my patients. Maybe that is just me but I would much rather look at the scientifc evidence of what has worked best and gives my patients the best care I can give before using the, "well this has worked before with no danger so I am just going to do that."

So overall I definitely agree with your post. We need to give the best medicine available to our patients and not fall into biased opinions of what we have been used to doing or seeing.

 

[BlacKAT33]

We used acepromazine/xylazine/ketamine SQ on our research mice and usually worked fairly well. I've used it to castrate and ovex rats as well. If we had pregnant females we had to c-section, we'd usually box them down with isoflo though just enough to where they were out enough to inject quickly, because it's difficult to scruff a really pregnant one and not horribly stress them out. I castrated one of my own rats (he was being a royal pain to his cagemate with constant fighting after the patriarch of the cage died, so he got to be neutered to go live with the girls) and boxing him down with isoflo and then the rest of the way with butorphanol did well for him. The key with rodents is to keep them under warming lamps or heating pads, as they lose heat so quickly. Now he gets along with the girls in the girl cage great.

We also use xylazine/ketamine on our mice and it works great. Depending on what genotype your mice are you need different amounts. I work in a core facility and we work with all the genotypes made in our department and make note of which amounts work best. You especially need to be careful on obese mice because sometimes you can do IP into a fat pad by accident. I really like xylazine/ketamine (at least for mice), it knocks them out well as long as you wait a proper amount of time (!!! some post docs are too impatient).

We also use iso for our more complicated surgeries. It seems to work well. we first put them in a container with iso and then during the surgery they have a mask...well theres not really a mouse mask but we put a lil tube by their mouth/nose.

i agree with electrophile: with a good heating pad the recovery is nice and smooth

 

[nyanko]

People are so biased when they get to veterinary school--and often for many, many wrong reasons (as we see here, and as I hear from classmates all the time). Here's to being the best scientists we can be and to a LIFETIME of learning!

This is not something exclusive to veterinary school. We as humans are inherently biased in some manner in virtually everything we do.

Furthermore, as a scientist, one of the most important things that I have learned thus far is not to trust everything you read, even if it comes from a peer reviewed source. I'm not saying that is what you are suggesting. However, I'd caution against suggesting a literature search to an audience that doesn't understand the underpinnings of the hypothesis that a particular study eschews. You've got to remember that these "biases" that people come in with are there because somebody with more experience (and a veterinary degree) introduced them.

It's all well and good to want to change the world and revolutionize things - that's what keeps science moving after all. But knowing when, where and how to apply what you learn from any given study or collection thereof is not something that you can do overnight and it seems silly to tell people who don't have the education or background to fully understand the implications of the study (YET!) that it's what they should be doing.

So what are the "right" reasons to be biased?

 

[Electrophile]

We also use iso for our more complicated surgeries. It seems to work well. we first put them in a container with iso and then during the surgery they have a mask...well theres not really a mouse mask but we put a lil tube by their mouth/nose.

i agree with electrophile: with a good heating pad the recovery is nice and smooth

So do you soak gauze with the liquid isoflurane in a 50 mL centrifuge tube and put it over their face? We used to do that, but I figured out a way to breath in much, much less gas and have to fill the tube up less. Take a latex (not nitrile) glove and stretch and rubber band the palm part relatively tight (but not super tight) over the opening of the centrifuge tube. Then take a pin, piece of wire, etc. and poke a little bitty hole in it. Experiment as needed but you want to be able to stick the mouse's mouth/nose in the little tiny hole and stretch it. That way, much less isoflo gets out and you can still loosely put the centrifuge tube cap on if you like as well.

 

[purplesaurus]

Something I maybe have against the American system, is the amount of experience you guys have to have before going into vet school. Yes, I wish more undergrad students here had experience. But everyone here has their own personal bias toward a protocol - before even recieving any veterinary education! And I think as the new generation of vets, we need to cast those biases aside, and be prepared to deliver best practice to all our patients, based on scientific and clinical trial evidence, instead of perpetuating the cycle of bad practice. Its time veterinary medicine stepped up, and its our responsibility to do it!

I agree with you a bit here, but I think this is where a good variety of experience comes in, too. With me personally, I was definitely biased toward one protocol. However, I gained experience (from the "sidelines") watching other protocols, asking about them, etc., which taught me that there are many ways to do things. It also taught me that while a lot of protocols are touted as the best ever, a lot of them seem to come down to what the vet was taught/is comfortable with, i.e., personal opinion.

It also helps that I'm the kind of person who likes to learn new things and new procedures.

 

[alliecat44]

This is not something exclusive to veterinary school. We as humans are inherently biased in some manner in virtually everything we do.

Furthermore, as a scientist, one of the most important things that I have learned thus far is not to trust everything you read, even if it comes from a peer reviewed source. I'm not saying that is what you are suggesting. However, I'd caution against suggesting a literature search to an audience that doesn't understand the underpinnings of the hypothesis that a particular study eschews. You've got to remember that these "biases" that people come in with are there because somebody with more experience (and a veterinary degree) introduced them.

It's all well and good to want to change the world and revolutionize things - that's what keeps science moving after all. But knowing when, where and how to apply what you learn from any given study or collection thereof is not something that you can do overnight and it seems silly to tell people who don't have the education or background to fully understand the implications of the study (YET!) that it's what they should be doing.

So what are the "right" reasons to be biased?

nyanko, I completely agree with you. My suggestions of literature reviews are more to drive home the point that, "this is really complex and there are few easy or straightforward answers to anything"--and that folks will get a LOT more education on these matters (and many others) in veterinary schools. Basically, to add an appreciation for the thought process and evolution of scientific knowledge regarding things such as--in this thread--anesthetic protocols.

I am in no way suggesting changing any protocol based on a single study, or without a critical evaluation of the literature and current understanding of the physiology involved. Also, an analysis of what makes sense for your practice, your finances, and the capabilities of your equipment and staff members influence which changes you choose to implement and when.

What are the right reasons to be biased? When you have scientific rationale (and hopefully evidence-based medicine) to back up the reasons why you're doing things a certain way, and when that rationale is up to date and incorporates recent proven research. As an example, see my comment about measuring blood pressure in our anesthetized animals--we had no idea that mean arterial pressures routinely went below the levels necessary to ensure visceral and cerebral perfusion until we actually did the research and measured blood pressure. Now we know better--we use IV fluids, multiple drugs to create a balanced anesthetic protocol and to maximize perfusion and mean arterial pressure.

Unacceptable reasons to be biased are those based strictly on anecdotal evidence, or because "that's what I was always told." I completely understand that psychological and sociological principles dictate that you are biased towards the belief of someone in authority, especially someone you admire and respect. All I'm saying is find out why they do what they do, and keep an open mind when others present differing viewpoints. Look at the science and weigh the evidence (or lack thereof) along with your own knowledge of pharmacology, physiology, etc etc and decide what makes sense to you.

You're absolutely right that pre-vet students do not have the education--yet--in order to make these decisions. (Hey, we have to pay the big bucks for SOMETHING, right? ) In my perfect world, people (such as DVMDream) would already be used to asking questions and critically evaluating things--and keeping an open mind. Sadly, there are some in veterinary school--particularly when it comes to anesthesia--who have a less open mind than perhaps they should.

For example, I'm referring to students who say to other students, when talking about something *essential* for safety under anesthesia--"oh, you don't really have to do that, they always say you do but 'we' never did and everything was fine." That's bias for the wrong reasons, unless you can back it up.

Hope that helps. Don't want this to devolve into a philosophical conversation, but happy to discuss elsewhere if you'd like! You've raised some excellent points and I really appreciate the clarification.

 

[DVMDream]

This is not something exclusive to veterinary school. We as humans are inherently biased in some manner in virtually everything we do.

Furthermore, as a scientist, one of the most important things that I have learned thus far is not to trust everything you read, even if it comes from a peer reviewed source. I'm not saying that is what you are suggesting. However, I'd caution against suggesting a literature search to an audience that doesn't understand the underpinnings of the hypothesis that a particular study eschews. You've got to remember that these "biases" that people come in with are there because somebody with more experience (and a veterinary degree) introduced them.

It's all well and good to want to change the world and revolutionize things - that's what keeps science moving after all. But knowing when, where and how to apply what you learn from any given study or collection thereof is not something that you can do overnight and it seems silly to tell people who don't have the education or background to fully understand the implications of the study (YET!) that it's what they should be doing.

So what are the "right" reasons to be biased?

nyanko, I completely agree with you. My suggestions of literature reviews are more to drive home the point that, "this is really complex and there are few easy or straightforward answers to anything"--and that folks will get a LOT more education on these matters (and many others) in veterinary schools. Basically, to add an appreciation for the thought process and evolution of scientific knowledge regarding things such as--in this thread--anesthetic protocols.

I am in no way suggesting changing any protocol based on a single study, or without a critical evaluation of the literature and current understanding of the physiology involved. Also, an analysis of what makes sense for your practice, your finances, and the capabilities of your equipment and staff members influence which changes you choose to implement and when.

What are the right reasons to be biased? When you have scientific rationale (and hopefully evidence-based medicine) to back up the reasons why you're doing things a certain way, and when that rationale is up to date and incorporates recent proven research. As an example, see my comment about measuring blood pressure in our anesthetized animals--we had no idea that mean arterial pressures routinely went below the levels necessary to ensure visceral and cerebral perfusion until we actually did the research and measured blood pressure. Now we know better--we use IV fluids, multiple drugs to create a balanced anesthetic protocol and to maximize perfusion and mean arterial pressure.

Unacceptable reasons to be biased are those based strictly on anecdotal evidence, or because "that's what I was always told." I completely understand that psychological and sociological principles dictate that you are biased towards the belief of someone in authority, especially someone you admire and respect. All I'm saying is find out why they do what they do, and keep an open mind when others present differing viewpoints. Look at the science and weigh the evidence (or lack thereof) along with your own knowledge of pharmacology, physiology, etc etc and decide what makes sense to you.

You're absolutely right that pre-vet students do not have the education--yet--in order to make these decisions. (Hey, we have to pay the big bucks for SOMETHING, right? ) In my perfect world, people (such as DVMDream) would already be used to asking questions and critically evaluating things--and keeping an open mind. Sadly, there are some in veterinary school--particularly when it comes to anesthesia--who have a less open mind than perhaps they should.

For example, I'm referring to students who say to other students, when talking about something *essential* for safety under anesthesia--"oh, you don't really have to do that, they always say you do but 'we' never did and everything was fine." That's bias for the wrong reasons, unless you can back it up.

Hope that helps. Don't want this to devolve into a philosophical conversation, but happy to discuss elsewhere if you'd like! You've raised some excellent points and I really appreciate the clarification.

I have to agree with both of these posts. You definitely can not believe everything you read, but you can not fall back on previous biases if the science does not back up those methods. There is definitely a delicate balance that has to be worked out between using what is learned in veterinary school, the research you read (the stuff that is actually backed up with clinical trials and all of that jazz), and the previous methods you have seen work. For me, I love learning anything new especially if it can have a better outcome for the patients I will be dealing with. There can never be too many questions to ask and curiosity is what has lead to the advancements we have seen in the veterinary field as well as the medical field. I personally like to ask why and know the reasons behind why a procedure is done a specific way/this drug is being used vs. that drug. As a vet assistant I have to be able to explain to clients why we are using specific drugs or doing specific treatments, and if I ask why and learn myself I am much better at explaining those things to the clients I am helping. I am actually sure the vets I work with are probably sick of my asking why this antibiotic vs. that one? Or why not do this instead of that? But I am learning what I need to know so I can better explain those exact same questions to the client when they ask. Especially, with the "Isn't there a cheaper antibiotic; why do we have to use that one?" "Do we really have to run x test; can't we just do the treatment for x disease instead of running the test?"

 

[Kaydalia]

Alrighty.. there's a lot of protocol sharing going on, so guess I'll chime in..

The SA practice I work at premeds most surgeries with ket/dexdom/torb IM. If that doesn't put them out enough for intubation, we may supplement with 2-3 minutes of masked iso or sevo, but this is only necessary maybe 20% of the time (if that). Virtually all patients are maintained on iso after intubation (the only patients not intubated are feline neuters or super fast laceration repairs... stuff that lasts less than a literal 5 minutes). All intubated patients get an IV cath and fluids... all are monitored with ECG, pulse ox, and blood pressure (doppler or my precious little PetMAP). HR, BP, CRT, RR, and %O2 readings are taken every 5 mins (max, often quicker); pulse strength and temperature is monitored every 10-15 mins.
Canine neuters, declaws, and dental extractions all receive local blocks (bupivicaine/lidocaine). All patients receive additional pain meds before waking up (spays/neuters often get injectable rimadyl and morphine; others may get buprenorphine, injectable metacam, hydromorph... depends on doc/procedure/patient). Although declaws used to get a fentanyl patch, we recently started controlling their pain with buprenorphine or metacam (and it's working out quite well). Fentanyl is still used for ortho or other major surgeries (ie amputation). Can I also give a shout out for epidurals? We don't have a lot of opportunities to use them... but I saw my first employed before a TPLO procedure (visiting surgeon performed)... Best recovery *ever*. They'll be part of future procedures when possible.
Our protocols do vary if need be... we also use IV propofol, ket/val, and other combos for induction when our standard setup is not ideal for the patient/procedure.

We carry Sevo, and used to offer at client/doctor discretion, but noticed little-to-no difference in our patients when it was used, so it's not as common these days (save for the 3 minute intubation encouragement).
Our gas down box is pulled out maybe once a year... for an uncontrollably fractious cat, or the random exotic that comes in. I've seen maybe 2 gas downs of dogs without premeds and I honestly cannot remember why it went that way... but I trust there was a good reason (since it's rare, they don't employ it lightly).

In 6 years, I cannot recall one animal crashing under anesthesia (we had one post-op fatality, probably due to a pulmonary embolism). Granted, there's a fair amount of luck in that but I'd like to credit our protocol/monitoring techniques just a little. Both the doctors and tech staff constantly improve our protocols and it's that continuous self-evaluation gives me confidence in our choices... even if I don't always understand the science behind them... yet.

 

[DVMDream]

Alrighty.. there's a lot of protocol sharing going on, so guess I'll chime in..

The SA practice I work at premeds most surgeries with ket/dexdom/torb IM. If that doesn't put them out enough for intubation, we may supplement with 2-3 minutes of masked iso or sevo, but this is only necessary maybe 20% of the time (if that). Virtually all patients are maintained on iso after intubation (the only patients not intubated are feline neuters or super fast laceration repairs... stuff that lasts less than a literal 5 minutes). All intubated patients get an IV cath and fluids... all are monitored with ECG, pulse ox, and blood pressure (doppler or my precious little PetMAP). HR, BP, CRT, RR, and %O2 readings are taken every 5 mins (max, often quicker); pulse strength and temperature is monitored every 10-15 mins.
Canine neuters, declaws, and dental extractions all receive local blocks (bupivicaine/lidocaine). All patients receive additional pain meds before waking up (spays/neuters often get injectable rimadyl and morphine; others may get buprenorphine, injectable metacam, hydromorph... depends on doc/procedure/patient). Although declaws used to get a fentanyl patch, we recently started controlling their pain with buprenorphine or metacam (and it's working out quite well). Fentanyl is still used for ortho or other major surgeries (ie amputation). Can I also give a shout out for epidurals? We don't have a lot of opportunities to use them... but I saw my first employed before a TPLO procedure (visiting surgeon performed)... Best recovery *ever*. They'll be part of future procedures when possible.
Our protocols do vary if need be... we also use IV propofol, ket/val, and other combos for induction when our standard setup is not ideal for the patient/procedure.

We carry Sevo, and used to offer at client/doctor discretion, but noticed little-to-no difference in our patients when it was used, so it's not as common these days (save for the 3 minute intubation encouragement).
Our gas down box is pulled out maybe once a year... for an uncontrollably fractious cat, or the random exotic that comes in. I've seen maybe 2 gas downs of dogs without premeds and I honestly cannot remember why it went that way... but I trust there was a good reason (since it's rare, they don't employ it lightly).

In 6 years, I cannot recall one animal crashing under anesthesia (we had one post-op fatality, probably due to a pulmonary embolism). Granted, there's a fair amount of luck in that but I'd like to credit our protocol/monitoring techniques just a little. Both the doctors and tech staff constantly improve our protocols and it's that continuous self-evaluation gives me confidence in our choices... even if I don't always understand the science behind them... yet.

I have to say your monitoring systems and pain control systems are very, very similar to ours. The only difference is that we give local blocks to everything. Spays get a local block around the incision site after surgery. And the types of pain meds we give upon waking up. We usually use buprenex for cats and then hydromorph for dogs. We also send home tramadol for dogs for pain at home (depends on procedure done) and then buprenex for cats (given on the mucous membranes, also depends on the procedure). We have severely cut our use of metacam. It used to be the only thing we gave cats for pain control at home but we have seen that buprenex works much better. We used to use metacam like candy but it gets used maybe once or twice a month now.

Now in almost 5 years I have seen one animal start to decline under anesthesia. I was during an emergency c-section in which the puppies were completely green and one was already in rigor mortis inside the womb. We got her stabilized and she survived the surgery but the puppies had been gone for quite some time already.

I do wish that we did IV cath and fluids for all patients but we only require it in dogs over 7 years at 5 years we start requiring pre-op bloodwork. It is our way of keeping surgeries affordable for people of all incomes. We do highly recommend it to clients though, but it is their decision whether or not they have the money to spend on it. We do a lot of surgeries for the maricopa big fix program. Basically it is a program for people on lower incomes and we do not get much $ for these spays/neuters. Somewhere around $50 for a 100-pound dog spay there is no way we could afford to do these spays/neuters if we were automatically requiring IV cath/fluids with every surgery and we would lose a lot of clients if we started to increase our surgery prices to cover automatic use of an IV cath/fluids. Basically, we give them an estimate with all of the surgery options and the client gets to choose if they can afford IV cath/fluids, bloodwork, pain meds (we comp. a pain injection after surgery if they decline this and use local pain block no matter what they choose here), e-collar, laser, etc. While it would be nice to require everything we just realize that not all people can afford that.

However, if we notice the slightest decline in any patient on the table (only happened once to me during that c-section) that patient gets and IV cath/fluids whether the owner agrees or not.

 

[Kaydalia]

We have severely cut our use of metacam. It used to be the only thing we gave cats for pain control at home but we have seen that buprenex works much better. We used to use metacam like candy but it gets used maybe once or twice a month now.

This is really interesting, because we prefer and buprenorphine and have only recently been using metacam... because we've been told that buprenorphine is backordered! We can't get it! I'm not involved in inventory, but the only reason we started carrying injectable metacam about 2 months ago (I think) was because buprenorphine was unavailable... I'm jealous of your supply because I think it would be the preferred medication if we had it. (Note: I'm purposefully saying buprenorphine because we switched from buprenex to a generic supply a while back so I don't know what the backorder applies to.)

Spays/neuters usually go home with rimadyl, but there's some doctor variation for other surgeries. We don't like sending buprenorphine home because of the controlled-drug issue.. so metacam has long been the standard take-home oral med for declaws or other kitty stuff.

I should clarify that I meant "crashed" as in CPR-requiring distress, or death. We've had to bag some patients (usually in relation to propofol), have changed our fluid/gas rates to help raise low BPs, and once in a great while need some additional drug help (ie atropine).

Yea - I definitely sympathize in the cost area... we are certainly not the cheapest facility around, but we serve a more affluent clientele and that's our niche. Our docs work with our financially limits clients, but for some reason we never take fluids out of the equation... I'm not really sure why that's not a comprising factor, I'll have to ask. As far as screening, we offer/recommend pre-op IDEXX for all patients, but mandate pre-op CBC/Chem for patients 8 or older.

BTW - Totally jealous of your emergency C-section experience. It's the one surgery I've been dying to see for *years* but just never have! Okay that and an open chest... that would be cool.

 

[DVMDream]

This is really interesting, because we prefer and buprenorphine and have only recently been using metacam... because we've been told that buprenorphine is backordered! We can't get it! I'm not involved in inventory, but the only reason we started carrying injectable metacam about 2 months ago (I think) was because buprenorphine was unavailable... I'm jealous of your supply because I think it would be the preferred medication if we had it. (Note: I'm purposefully saying buprenorphine because we switched from buprenex to a generic supply a while back so I don't know what the backorder applies to.)

Spays/neuters usually go home with rimadyl, but there's some doctor variation for other surgeries. We don't like sending buprenorphine home because of the controlled-drug issue.. so metacam has long been the standard take-home oral med for declaws or other kitty stuff.

I should clarify that I meant "crashed" as in CPR-requiring distress, or death. We've had to bag some patients (usually in relation to propofol), have changed our fluid/gas rates to help raise low BPs, and once in a great while need some additional drug help (ie atropine).

Yea - I definitely sympathize in the cost area... we are certainly not the cheapest facility around, but we serve a more affluent clientele and that's our niche. Our docs work with our financially limits clients, but for some reason we never take fluids out of the equation... I'm not really sure why that's not a comprising factor, I'll have to ask. As far as screening, we offer/recommend pre-op IDEXX for all patients, but mandate pre-op CBC/Chem for patients 8 or older.

BTW - Totally jealous of your emergency C-section experience. It's the one surgery I've been dying to see for *years* but just never have! Okay that and an open chest... that would be cool.

I actually have not been in the clinic since late August so it is possible that the buprenex/buprenorphine is on back-order. I work at the clinic seasonally. So I will have to find out. But that really sucks if it is on back-order because we use it as a pre-anesthetic. We have clients fill out information sheets when sending home controlled drugs so there is not problem with the controlled-drug issue. Basically, requires a date-of-birth, signature and driver's license number. It is really simple to fill out and only takes about 5 minutes. We just include it into the appointment we set up to go over post-op instructions. We do not use rimadyl very often either. We tend to use deramaxx instead but tramadol is definitely the pain medication of choice for dogs after spays/neuters because of its realtive saftey when compared to the NSAID's. We start requiring pre-op blood work before surgeries at 5 years. It is just the simple pre-anesthetic profile that IDEXX gives in those little slides. It gives basic liver and kidney values. We also do a PCV and TP with a refractometer.

The emergency c-section was actually the first c-section I have ever been a part of and just happened this past summer. I was scared ****less because I had never actually seen one and know I was actually apart of one. Thank goodness I was able to keep calm when she started to go downhill. I just kept breathing for her while another tech placed an IV cath and started fluids. She had basically stopped breathing and her BP dropped really fast. Absoltuely scary but I was so glad I got to be a part of it. I really wish I could see a non-emergency c-section (like maybe a scheduled bulldog one) so I could actually get to witness live puppies and the recovery period afterwards with the mom and puppies. I would say seeing the chest cavity open would also be really cool. Ok 2 cool surgeries I have seen: Removal of a massive infected uterus in a pot-bellied pig...not even kidding this uterus was bigger than my head. Second one was the removal of a massive mammary tumor. The vet had basically the end of the rib cage all the way down to this dog's pelvis opened. The tumor was so large he had to remove all of that tissue. The coolest part was watching him suture that up....it came together beautifully. The dog did have a lot of staples in her I forget the exact number but it was easily over 30. I love surgery. Thinking about maybe specializing in surgery.

 

[Shanomong]

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[ATX00]

I see a lot of you saying that you use Torb for analgesia, and I was always told that Torb is no good for analgesia. Was I misinformed?

At the feline clinic where I worked, we typically pre'd with buprenex/torb, induced with propofol, and maintained with Iso. We almost never used Metacam.

And Buprenex is backordered where I am, too.

 

[VeganSoprano]

We had buprenorphine backordered for about 2 weeks but it's been back for about a month now. This is great since we go through it like nobody's business.

 

[BlacKAT33]

So do you soak gauze with the liquid isoflurane in a 50 mL centrifuge tube and put it over their face? We used to do that, but I figured out a way to breath in much, much less gas and have to fill the tube up less. Take a latex (not nitrile) glove and stretch and rubber band the palm part relatively tight (but not super tight) over the opening of the centrifuge tube. Then take a pin, piece of wire, etc. and poke a little bitty hole in it. Experiment as needed but you want to be able to stick the mouse's mouth/nose in the little tiny hole and stretch it. That way, much less isoflo gets out and you can still loosely put the centrifuge tube cap on if you like as well.

We only do the soaked gauze for an emergency like if our iso system isn't set up. Otherwise we unhook part of the tubing and place it by their nose, we have a lil fan vent under the microscope and another part of the tubing goes out through our fume hood. But really...we could still use your latex glove idea and put it on the tube that goes to the mouse. I think thats a great idea. Unfortunately my coworker who does the surgery is extremely stubborn and probably won't want to do it...but i'll let him know and at least I know for myself in the future! thanks

EDIT: its so funny we're talkin about this because today is the major surgery (its been a longgg time since we last did it) so i went to look at the iso set up, and he did put this material over the tube with a rubber band and a lil hole for their nose!! haha what a coincidence. guess its a good thing tho now i dont have to convince him about doin it

 

[Vet Engineer]

We had buprenorphine backordered for about 2 weeks but it's been back for about a month now. This is great since we go through it like nobody's business.

Bup just went on backorder for a second time where I work! Although there were some discussions about ordering from a different supplier because they had it even though ours didn't.

 

[Hoxydude]

My vet sedates all of our patients before putting the mask on. It prevents them from getting stressed out too much, and as soon as theyre out we tube them. Ive never had a cat/dog that had breathing problems as they were going down. Seems to work fine like that.

I dont know too much about this kind of stuff, but just thought i'd add my experience to the list