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Record 6 of 56
title:   anesthesia                                                          ID:  8
author:   many
description:   anesthesia
content:   BERNER-L Digest 1126
Date: Sun, 01 Mar 1998 23:44:19 -0700
From: Angela
To: mzebley@twave.net
Cc: berner-l@prairienet.org
Subject: Re: Anesthesia - long

> Isoflurane is still metabolized by the liver
>and/or kidneys, and so may not be the best choice for a animal with
>severe liver/kidney problems. It may, however, be the best option
>your vet has available.

Actually Isoflurane is 99% eliminated through respiration. Halothane is
20-50% metabloized (liver, kidneys) and 50-80% eliminated through
respiration. Both have only slight analgesia (pain relief), some
depression of respiration, Isoflurane has a slight effect on the heart but
Halothane has a severe depression of the heart. Halothane also causes
cardiac dysrhythmias. There are no reported effects on the liver in either
drug (except Halothane in humans and pigs) and no reported effects on the
kidneys in either drug.

"Of all the volatile anesthetics, isoflurane is considered to have the
fewest adverse effects on the heart and other vital systems."

"Nearly all of the isoflurane administered to a patient is exhaled very
quickly once the vaporizer is turned off. Isoflurane has low fat
solubility, and consequently, there is very little retention of isoflurane
in body fat stores, little hepatic metabolism, and very little renal
excretion of metabolites. For this reason isoflurane is well suited to
animals with liver or kidney disease. Isoflurane is also the preferred
anesthetic for use in neonatal and geriatric animals...."

> Another option I've used is Propofol. This is an injectable
>anesthetic that is used frequently in human medicine. (The
>veterinary label is Rapinovet). It is 99% metabolized in the lungs
>and thus makes an excellent choice for patients with kidney or liver
>problems that make other pre-med and induction agents hazardous.

The way Propofol works is that it is highly lipophilic. "After the
initial bolus of propofol is administered, plasma concentrations decline
rapidly because of redistribution from the brain and other highly perfused
tissues to others which are less well perfused, such as skeletal muscle."
Thus, the drug quickly hides out in highly lipophilic tissues such as fat,
and slowly gets released to be quickly metabolised. Propofol should be
used in short procedures (such as quill removal or cat castration) but it
can be used in longer procedures using a slow drip. (Our pregnant vet
always used this). I totally agree that it is an excellent choice because
the animal is totally recovered 10 minutes after you stop giving it. Thus,
a good choice where it would be risky to keep a dog under for a longer time.

Information is taken from:
Small Animal Anesthesia, by Diane McKelvey and K. Wayne Hollingshead
and
Propofol: A New IV Anesthetic Agent for Use in Cats and Dogs, by Dr. Tanya
Duke

Angela Hoskinson

-----------------------------------------------------------------------

BERNER-L Digest 1191

Subject: New Anesthetics
Date: Sun, 12 Apr 1998 17:03:21 EDT
From: BMDwags
To: berner-l@prairienet.org

Hi Everyone-
Regarding all of the discussion about anesthetizing our dogs for a variety of
reasons...There are several "newer" drugs available besides IV Pentothal and
Isofluorene gas. Some dogs do very well on that combination...some do not.
Sodium Pentothal intravenously is commonly used to induce a dog - to reduce
the excitement stage and then start with the inhalation anesthesia called
Isofluorene gas. Normally this combination is given along with an injection
of Atropine Sulfate to increase the heartrate, and prevent hypersalivating.
There are many post regarding this discussion in the archives... The "newer"
drugs available are fast acting, safe, and the owner can drink a cup of coffee
while the procedure is completed and the dog is reversed and goes home. Ask
your veterinarians about Propofol given intravenously - this last about 10
minutes, but more can be given if needed before they fully awaken. This drug
does not need a reversal because it only lasts a short amount of time.
Another drug is called Domitor which is also given intravenously. This drug
takes about 5-10 minutes to actually take effect, but then you have at least
15-20 minutes to complete the procedure. A reversal, called Antisedan,can be
given in the muscle when the procedure is complete. The dog is standing and
ready to walk out of the office within another 5-10 minutes. An advantage to
letting the dog wake up by himself after having the Domitor is that it has an
analgesic affect...which means if the dog had a painful procedure done, it
acts like a pain-killer. The reversal takes away the analgesic affect...but he
can go home within minutes fully awake. We do lump/cyst removals, abdominal
ultrasounds and x-rays regularly using the above drugs. Just check with your
veterinarians to see if they carry one or more of these anesthetics. Propofol
has also been found to be one of the safest anesthetics to use in sight hounds
(Greyhounds, Afghan Hounds, etc.)
Jennie Lanseigne


BERNER-L Digest 1720

From: "Melissa Zebley, DVM" (mzebley@abts.net)
To: " Bernese Mountain Dog Mailing List" (berner-l@prairienet.org)
Date: Mon, 8 Feb 1999 01:03:59 +0000
Subject: Re: foods and anesthesia

All you old-timers on the list just knew I wouldn't pass this one up,
didn't you? (G) Well, if you're already rolling your eyes and
getting ready to lip sync with me, please scroll down to the bottom,
or go ahead and delete now. ;-p

> >I came across this and am assuming that dogs would be affected in a similar
> way as humans. I know Berners are especially sensitive to anesthesia and I
> thought this important to keep in mind. I quote from Dr. Gott:
Let me state again, this is a myth. Berners as a breed are no more
sensitive to anesthesia than any other dog. I have repeatedly
questioned board certified veterinary anesthesiologists on this topic
and repeatedly been assured of this. This is a myth that is repeated
in EVERY breed circle. The only breeds where it is valid across the
board are sighthounds such as greyhounds, afghans, etc. who all have
a proven sensitivity to certain kinds of anesthesia.
However, any particular dog may have a sensitivity to a particular
anesthetic, just like any person can. Where does this place the
concerned dog owner? Balance the risks vs the benefits. In a young
healthy animal (and I do believe in doing bloodwork to confirm that
"apparently healthy" is truly healthy, and not masking any early
organ problems), the risk is minimal. As an animal gets older, so
does the risk of inapparent organ disease, so the risk, and thus the
need for thorough physical exams and labwork. Even in a young
healthy animal, I would not do repeated frivlous anesthetics, but I
would not be afraid to do needed or helpful procedures. In most
cases, I advise doing all possible procedures at one time so as to
avoid having to put the animal under anesthesia again anytime soon -
such as doing radiographs, ear cleanings, lump removals, etc. while a
dog might be done for a dental cleaning. All contingent, of course,
on the anesthesia proceeding smoothly. Any problems or concerns, we
wake the animal up as quickly as we can, and put off the other
additional procedures until another time, sometimes indefinitely.

OK, now that I have that off my chest - I had not heard of this
before, but it certainly does make sense. And if true in humans, it
certainly could be true in dogs. Fortunately, not too many dogs dine
on tomatoes and eggplant, though potatos might pose a problem - all
you BARFers beware. (G) I will say I advise those of my clients who
homecook, not to serve onions and to limit the amounts of garlic and
potatos. I will now need to remember to add tomatos and eggplant to
my list of foods to be cautious with.

Seriously though, Janet, thanks for pointing this out. And I
apologize for the preachiness and sarcasm in this point (not enough
not to send it, though); I can only blame it on bad timing - hitting
on one of my pet peeves in a week where I've been way overworked and
underslept. I promise to be much nicer next week (got a long
weekend away for Valentine's Day (VBG))

> " As strange as it sounds, certain foods can exert a major influence on
> patients under anesthesia, according to research conducted at the University
> of Chicago Medical Center and reported at the October meeting of the
> American Society of Anesthesiologists. Here's the reason:
> Many foods contain minute amounts of naturally occurring insecticides,
> called solanaceous glycoalkaloids, which inhibit the metabolism of many
> anesthetics and muscle relaxants. SGA's are found primarily in tomatoes,
> eggplants and most notably potatoes. The researchers discovered that the
> consumption of moderate amounts of potatoes days before surgery could result
> in SGA blood levels high enough to prolong the effects of anesthesia. To be
> on the safe side, patients anticipating surgery should restrict their
> consumption of SGA-containing foods for several days before receiving
> anesthesia."

Melissa

PS I did a quick check to see if any of my notes or books at home
had additional info on SGAs. Not much. The only thing I found was
that the toxic principle is called solanine, and is also found in a
plant called Nightshade. Also, sweet potatos, which not everyone
considers a real potato, also contain solanine.
Melissa and Aylen and Tyra (and Sophie, too)
mzebley@abts.net
Granite Falls, NC USA

----------------------------------------------------------------------

BERNER-L Digest 2045

From: "Susan Wilkinson"
To: "Berner-l"
Subject: anesthetics (long)
Date: Tue, 27 Jul 1999 00:27:28 -0400

I'm actually quite hesitant to comment on this subject as in the past some
people have flamed those who share medical info -- no flames please, but I
did want to add my thoughts on the subject of anesthetics. As a foreward --
I am a final year vet student and have spent the better part of 3 summers
working in different vet clinics (each with their own anesthetic protocol)
as well as courses/lectures/labs at school working hands on with the various
anesthetic drugs. In addition, my own menagerie of various critters (from
chinchilla to donkeys) have given me all too frequent hands on experience.
So I do have a little bit of experience to speak from .......

The usual anesthetic experience can be divided into roughly 4 parts: premed,
induction, maintenance, and recovery. Premedication drug(s) is/are
administered to not only calm the animal down prior to surgery but to also
better prepare it for the upcoming surgery by providing preanesthetic pain
control (it's much easier/better to control pain BEFORE it occurs), and
reduce the incidence of undesireable side effects/physical conditions (ie.
cats produce alot of mucous in their airways, therefore it's very common to
include a drug in the premed that reduces these secretions and thus lowers
the risk of the cat developing pneumonia through aspiration of the mucous).
Premed drugs can also ensure a smoother recovery. That being said, as with
all drugs, it is necessary to tailor the premed to the animal and the
animal's condition -- using and not using drugs as the condition warrants,
including choosing to use no premed at all. And remember too, that
sometimes waking up slower is a good thing -- no one wants to see their
animal have a wild and painful recovery where they throw themselves around
in a kennel.

Induction refers to the act of inducing anethetic. This can be achieved
through the use of injectible drugs, such as a barbituate (ie. Thiopental),
non-barbituate that acts similar to one (ie. Propofol), or combination such
as ketamine/valium. The idea here is safely and quickly induce anesthesia
suitable for either performing a short procedure (ie. taking x-rays) or to
allow intubation and maintenace gas anesthesia. Propofol is indeed one of
the newest drugs available and is ultra/ultra short acting -- we like to use
this for really quick procedures where you want to send the animal home very
quickly, for sighthounds (who don't metabolize Thiopental well), or for
older animals or ones that are ill -- this drug wears off REALLY fast, when
you're intubating, you have to be fast. Given at the correct rate of
administration, Propofol gives a lovely smooth induction and recovery. It
can also cause a period of apnea (non-breathing) after administration
(especially if given too fast) so care must be taken to ensure a good airway
is present (pre-oxygenate the animal, intubation ready etc.). For young,
healthy dogs with normal liver function (pre-anesthetic blood testing is
important), Thiopental works very well and safely. I've only seen
Ketamine/Valium used as a short-acting anesthetic for procedures such as cat
neuters (and even cat spays) -- I've never used it myself and personally
prefer to use other protocals with gas maintenance for such procedures. The
big drawback with injectible agents is once they're injected, they're there
to stay until they wear off (are metabolized by the body) -- that's why the
ultra short acting drugs are preferred, any adverse effects they might cause
are transient. Animals can also be "masked down" using gas for induction
which certainly is a viable option although it is more stressful for the
animal for a couple of reasons: the gas smells bad! so they fight the mask;
and they commonly go through an excitement stage that adds to the stress.
The pollution risk from gas leaking around the mask is also a concern for
those humans present. In older/sick animals though, mask induction is a
very viable option. On the plus side, if the animal experiences
difficulties you can turn the gas off, the oxygen flow up, and the animal
breathes out the gas (unlike injectibles that have to be metabolized); also
mask induction is useful for fractious cats that won't let you get IV access
to inject drugs (claws and fangs at the ready!!).

Maintenance anesthesia almost always refers to gaseous agents. The modern
gas anesthetics allow you to make quite rapid changes in the plane of
anesthesia. In modern vet practice 2 agents are commonly used: halothane
and isoflurance. "Iso" is the more recent introduction of the two (1985)
and has less adverse effects than the halothane -- if I'm masking an animal,
I feel safer if it's iso rather than halothane I'm breathing. The two gases
have different vaporization requirements so clinics have to have separate
equipment for each type. Therefore, it is not uncommon for clinics to have
just halothane, just iso, or sometimes both. The clinic I'm at now has both
available -- I really enjopy the luxury of having a choice to fit the
situation (and that choice is still quite often halothane).

All that being said, it's important to remember that the safest anesthesia
is the one the vet and staff are used to using and are comfortable with!!
Also, studies have shown that the most safe anesthetic, is not one
particular drug or combination of drugs, but is the one that is carefully
and constantly monitored. It's also interesting the number of breeders I've
met who are convinced their particular breed (name a breed here) is
sensitive to anesthesia, depends who you speak to. Thus far the only real
sensitivities I've seen have been either individual (ie. Kellu wakes up VERY
fast, Talon much more slowly), or psyiological (health status, age, squished
up noses etc.) and apart from brachyocephalics (pugs, bulldogs, Bostons --
those with the flat faces) and their unique (and troublesome) problems with
their airways, and sighthounds not having very fast liver metabolization of
certain drugs, no real true breed thing.

Just my thoughts on the subject anyway .......

sue -- who still is awed by the responsibility of safe anesthesia but enjoys
the challenge
(Kellu, Talon, and Aeryn)

----------------------------------------------------------------------

BERNER-L Digest 3912

From: Annes4@aol.com
Sent: Saturday, July 20, 2002 1:17 PM
To: LEKesner@aol.com; berner-l@prairienet.org
Subject: Re: The "Z"s are here

In a message dated 07/20/2002 10:00:17 AM Central Daylight Time,
LEKesner@aol.com writes:

<< Propofol and Servo-flo, if I have the drugs right - that second one is
the new one >>

The inhalent anesthetic is "Sevo-flo" or sevofluorane. While still in the
working world, I was in the department that developed both these drugs
(propofal and sevo) for veterinary use. While Isofluorane is an excellent
inhalent anesthtic, Sevo allows an even faster recovery - often less than 5
minutes after extubation and does not seem to have the side effects of
anxiety and thrashing that some other anesthesias do. Hooray for your vet
for using some of the newer, safer drugs. Sevo has been found to be one of
the safest anesthesias for the sight hounds, who do have a real problem as
they metabolize anesthetics differently than most dogs due to having
virtually no body fat, which absorbs some of the drug in other breeds.
Congratulations on the "Z's". Hopefully tonight you can get some of those
other "zzzzzz's".
Anne Copeland, Flash,TDI/CGC (Berner, 8 yrs.) & Gypsy TDI/CGC(Rescue
Cavalier,1 yr.)
NE ILL Annes4@aol.com
BMDCSEW Vice President
Ty's memorial page: http://www.geocities.com/workingyorkie/ty.html
Gypsy's page:http://hometown.aol.com/annes4/Gypsy.html

----------------------------------------------------------------------

BERNER-L Digest 4065

From: owner-berner-l@prairienet.org [mailto:owner-berner-l@prairienet.org] On Behalf Of BMDwags@aol.com
Sent: Friday, October 11, 2002 2:38 PM
To: berner-l@prairienet.org
Subject: Re: Spaying

Hi Everyone-

I think there may be a misunderstanding in regards to the term "excitement
stage". This is a phase of anesthesia induction that ALL animals (including
people) go through. By giving a pre-anesthetic agent, the animal passes
through the stage quickly. Sometimes it is as minor as a little paddling
while the endotracheal tube is being placed, or sometimes it is more severe
and the dog clamps it's teeth shut and thrashes. Regardless whether the
animal actively shows the signs of the excitement stage or not...they all go
through it. It is NOT a controllable behavior...an owner being present does
nothing to aid in the transition. An injectable pre-anesthetic agent such as
Pentothal, Propofol or Ketamine/Valium combination is typically given to
sedate the dog just long enough to safely place the endotracheal tube and
attach the dog to the Isoflurene gas anesthesia machine. In some rare,
special cases, a veterinarian may chose to mask down a patient only using the
Isoflurene gas blowing in the dog's nose and mouth using a cone. It can be
successful, however you are very likely to see the excitement stage in full
force...and the only way to get through it is to wait it out, and patiently
wait for the next plane of anesthesia to take affect. The point regarding
gas anesthesia not having any analgesic effects (pain relief) is true. Some
vets will administer a Torbugesic injection after the surgical
procedure...which will give the animal some pain relief for about 6 more
hours. Some vets prefer to send home Rimadyl for a few days after surgery.
For extremely painful procedures...such as orthopedic surgeries...the vets
may place a Fentanyl Patch on the dog's skin, which will slowly release a
narcotic agent to give pain relief over a 3 day period.

The important thing to remember is that dogs and cats handle pain in a
different way than humans do. They live by survival of the fittest. While
it is kind and humane to help an animal recover after a traumatic
surgery...most animals do extremely well without any pain management drugs.
In fact, some pain relievers can make a dog feel scared and awkward...making
them dangerous to send home because they could fall down stairs, or snap at
the owner by mistake. Cats tend to not do well on many forms of pain
management. Most anti-inflammatories are very dangerous to give cats.

If you notice that your pet has a difficult time recovering from anesthesia,
please inform your veterinarian what the signs were that you observed at
home. They could be completely normal, or they could be indicitive that your
pet had an adverse reaction. It should be indicated on the animal's chart
that there may have been an adverse reaction, and in the future they will try
something different for your pet's anesthetic needs.

Jennie Hoffnagle
Glenmoore, A
date:   30-Sep-2003
spacer_120  

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