1. Regurgitation Aspirationof rumen contents Bloat, compromises breathing Inadequate ventilation Due to drugs relaxing thepharyngoesophageal andgastroesophageal sphincters andsuppressing the swallowing reflex.Anesthesia also decreases gut motility

2. Recommendations- Withhold feed prior to general anesthesia- Intubate with a cuffed endotracheal tube- Assist or control ventilation with 100%Oxygen- Maintain in lateral recumbency only whennecessary. Sternal recumbency allowseructation and facilitates ventilation 3. Potential problems:- External pressure from improperpositioning or poor perfusion can producemyopathy- Neuropathy due to pressure 4. Properpositioning Padding all pressure points Lower forelimb stretched forward to avoidradial nerve paralysis in lateral recumbency Upper limbs supported at height of proximaljoint in lateral recumbency Support circulating blood pressure andvolume when necessary ( maint 10ml/kg/hr) Maintain light anesthesia 5. Potential problems- Hypotheria- Immature liver and kidneys- Hypoglycemia Recommendations- Heating pad used with caution- Dextrose in fluids ( 2.5% dextrose/LRS)- Avoid xylazine and barbituates- Recommend isoflurane- Nursing up to anesthesia and as soon afteras they can swallow- Diazepam for sedation and premed 6. Potentialproblems- Strong laryngeal reflex- Laryngeal spasm- Aspiration Recommendations- Stiffer clear plastic endotracheal tubes- Stylets are useful, laryngoscopes- Full extension of head and neck for fullvisualization 7. - Suction saliva if necessary- Lidocaine sparingly if needed forlaryngospasm- Intubate and extubate in sternalrecumbency- Extubate only if swallowing- Pull endotracheal tube to larynx beforedeflating cuff 8. Xylazine- One tenth of equine dose IV- Low conc. 20 mg/ml- Smaller ruminants dilute to 1 mg/ml- Goats are more sensitive than sheep- Bulls are more sensitive than cows- .02-.1 mg/kg IV- Yohimbine .1 mg/kg, give dose slowlyand repeat if necessary 9. Xylazine/ketamine- Xylazine .02 -.08 mg/kg IV, wait 5 minutesand apply casting rope and halter to assistin to sternal recumbency- Ketamine- 2-4 mg/kg IV good induction inhealthy animals 10. Xylazine-ketamine-guaifenesin- 50 mg xylazine- 500 mg ketamine in 500 ml of 5%guaifenesin- .5-1 mg/kg/hour max 1 liter of solution perhour 11. Considerationsof IV maintenance- Intubation may be necessary to preventregurgitation and aspiration- Drug overdose may cause apnea- Respiration may need to be assisted- Limited anesthetic plane- To be used following xylazine, ketamineinduction if needed- Used in adults > 300 lbs 12. - Not recommended for juveniles or smallruminants- Use only 5% guiafenesin, 10% causesRBC hemolysis- IV necessary as guiafenesin is veryirritating if perivascular 13. Sheepand goats- Withhold food 12-24 hours- Dont withhold water, just avoid excessiveintake Calves, lambs, kids- Withhold food 2-4 hours- Dont prevent water of prevent nursing- Calves, lambs and kids less than 1 monthof age are monogastric and less prone toregurgitation 14. Adultcows and bulls- Withhold food for 36-48 hours- Withhold water for 13 hours- Bradicardia may occur due to withholdingfood 15. Recommendations- Individual variation- .5-2% halothane or 1-2%isoflurane- Monitor pulse quality, heart rate, respiratoryrate- Palpebral reflex should be maintained. Bovineeye rotates ventrally and medially in lightanesthesia- Ventilation may need assisstance- Periods of apnea are commona. Verify anesthesia is not excessiveb. Assist ventilation for gas exchange 16. 1. xylazine/ketamine IM- Xylazine .08-1 mg/kg wait 10 minutes forsedation and give ketamine 8-10 mg/kg Im- Adv:a. Good induction in healthy adults when IV access is not possibleb. Longer duration of anesthesia than with IV inductions to facilitate induction 17. - Disadva. hypotension, respiratory depressionb. Sting of IM ketaminec. Not recommended for >300 lbs due to volume neededd. Goats sensitive to xylazine 18. 2. 5% guaifensesin/ketamine IV- Mix 1 mg of ketamine per 1 ml guaifenesinsolution- Dose at .5-1 ml/kg- Wait max 1 minute for effect- Maintain sternal for intubation- Adv:a. No premed necessaryb. Titrate to effect if necessary 19. - disadv:a. IV catheter necessary due to guaifenesinb. GG can cause RBC hemolysis 20. 3. Diazepam/ketamine- Diazepam .1-.2 mg/kg IV wait 5minutes, ketamine 2.2-4.4 mg/kg IV- Adv:a. Good induction for neonates, small ruminants, and debilitatedb. No cardiovascular depression at these dosesc. May mask with isoflurane also 21. - disadv:a. Diazepam may cause excitement, especially in adults4. xylazine/ketamine- Xylazine .08-.1 mg/kg wait for sedationand place IV catheter, ketamine 2-4 mg/kgIV- Adv: good induction in healthy animals 22. 1. Phenylbutazone- PBZ or Bute-injectable, tablets, oral paste-NOTE: must be given IV only by injection. Administered BID. Causes severe tissue reaction, necrosis if administered perivascular, intramuscular, subcutaneous-Comments: used commonly for musculoskeletal pain at 1-4 mg/lb-Chronic use and or high dose results in ulceration of GI tract 23. 2. Flunixin meglumine ( banamine)- Injectable, oral paste- Injectable must be given IV or IM.Administered BID or TID. Potent analgesicmay mask a surgical colic. Bindsendotoxin. Chronic use and or high doseresults in ulceration of GI tract or renalfailure 24. 3. Ketoprofen ( ketofen)- Injectable, human formulation ( alleve) hasbeen given orally but not approved route ofadministration in animals.Absorption, excretion data unavailable.- Given IM SID 25. 4. Diclofenac ( surpass)- Topical cream to be rubbed over affectedareas 26. 1.Acepromazine-Injectable, tables-Tranquilizers, NOTE: do not administer this medication to an already excited, agitated animal. It may create hyper exciteability 27. 2. Xlazine ( rompun)- Injectable- Potent sedative and analgesic which maybe administered IV or IM- Ruminants highly sensitive, use 1/10 thehorse dose- In horses, be aware that no matter howdrunk the horse looks, it is capable ofkicking violently and accurately. Never trustxylazine behind the navel 28. 3. Butorphanol ( torbugesic)- Injectable- Commonly used to manage colic pain.May be administered IV or IM4. Detomidine ( dormosedan)- Injectable- Commonly used to manage colic pain orfor procedures requiring profound sedation 29. Dueto complex bacterial ecosystem in theruminant and horses GI tract, there are fewantibiotics which may be safely and oreffectively administered orally. In production animals always confirmwithdrawal time before administration 30. Glucosamine/chondroitin sulfate (cosequin)- Powder- Often requires 30-60 days administrationbefore benefits are observed.- Many cheaper, copycat products areavailable over the counter but are lesseffective 31. 1. Polyglycosylated aminoglycan ( adequan)- Injectable IM or intra articulare- For treatment and or minimization of wearand tear lesions of articular cartilage2. Hyaluronic acid ( legend)- Single dose injectable for intra articular use 32. 3. clenbuterol- ventipulmin- Oral syrup- Bronchodilator for COPD, treatment oflower airway diseases4. Omeprazole gastroguard- Oral paste- For treatment of equine gastric ulcers, veryexpensive 33. 5. Ponazuril- marquis- Metered dose oral paste, 28 day regimen- For treatment of EPM, symptoms mayworsen initially as parasites die in CNS6. Betamethasone and diuretic- Bolus- Used to reduce edema 34. Ifit is not labeled for use in productionanimals, dont use it in production animals. There is more latitude in companionanimals regarding off label use becausethe medication should not have thepotential to enter the food chain. 35. Anesthesia- a state characterized by loss ofsensation- General anesthesia is a loss of sensationassociated with a loss of consciousness- Regional anesthesia/local anesthesia, loss ofsensation while consciousness is retained Analgesia- state in which stimuli is notperceived as pain Tranquilization/sedation- chemically inducedstate of calm 36. Permitssurgery to be safely and humanelyperformed on the conscious patient Agents: caine family:lido, carbo, mepivi, bupivi Methods of regional anesthesia:1. Topical- Lidocaine gel effective only onmm, disrupted skin- Proparacaine opthalmic solution 37. 2. Infiltrative line block- Laceration or wound repair- Dermatologic procedures, skin biopsy- Castration- Standing laparatomya. Left sided approach- rumenotomyb. Right sided approach- cesearan section 38. 3. perineural- epineural- anesthetic injecteddirectly over a nerve, desensitizing distalareas innervated by that nerve- Dehorning- Lameness diagnosis4. Intra articular- for lameness evaluation 39. 5. Epidural- Areas desensitized:anus, perineum, vulva, vagina- Dystocia correction- Repair of prolapsed vagina/uterus- Perineal surgery- fetotomy 40. General considerations-Adequate trained staff must be present to restrain animal during induction and for surgical positioning-Minimize contamination of surgical sitea.Bathe animal if necessary to remove fecal materialb.Wrap feetc.Flush/rinse mouth to prevent material being pushedby endotracheal tube into lungsd.Clip and initiate surgical scrub on standing animal tominimize anesthesia timee.Note: direct relationship between length ofanesthesia and risk of post anesthesia complications 41. Regurgitation and or bloat can be seriouscomplications of general anesthesia Elective surgery withhold food for 36-48hours, withhold water for 12 hours Emergency surgery use rumen lavage NOTE: most ruminant surgeries can beperformed with regional anesthesiaEquine: elective surgery, withhold food 12hours, water 6 hours 42. 1. acepromazine- tranquilizer2. Xylazine- Profound sedation- head drop and markedataxia, up to 1-2 hours- Despite ataxia, horses can still viciouslyand accurately kick.- Analgesia up to 30 minutes- Ruminant dose is 1/10 the equine dose 43. 3. detomidine- similar to xylazine but withoutataxia, useful for standing procedures4. butorphanol- predominant function isanalgesia5. diazepam- muscle relaxation, sedationand decreased anxiety 44. Masking down with inhalation agent- Patient selection based on size, weight, ability totolerate physical restraint- Risk of injury to patient and or staff duringexcitement phase of induction Injectable induction- loss of consciousness andmuscle relaxation- thiobarbituates, ultra short acting 5-15 minutes- Ketamine/tiletamine- dissociative anesthetics- Guiafenesin- muscle relaxant, used in conjunctionwith another induction agent 45. Endotracheal1. cattle/horses- blind intubation, fully extend head, align with cervical spine2. Swine- very difficult, must use laryngoscope3. Goats/sheep- virtually never place on gas anesthesia, value of animal vs. cost of procedure 46. Isoflurane- about 3.5% Oxygen delivery- 1 liter/250 lb bodyweight, minimum flow 3 liters per minute Fluids/electrolyte replacement- Maintenance 3-5 ml/lb/hr- Replacementsa. Blood loss 40% transfusion required 47. Indicationsa. PCV 40% total blood volume hemorrhage Donor selection- Cross match with agglutination and lysistests, critical when multiple transfusionsare performed- Universal donor is adult male that hasnever received a transfusion 48. Heart rate- Cattle 60-80 ( < 48 trouble)- Horses 30-48 (