Summary of Anesthesia Presentation (in bold by DNathan


									Summary of Anesthesia Presentation by Dr Riedesel in bold

Anesthetists have two main duties at the Feral Cat Clinics:
            Monitoring/maintaining the anesthetized cat
            Ensuring that medical record is complete

Bring a pen, scissors, a stethoscope and a thermometer.
Be familiar with the FCA medical record (at the end of this document)
Familiarize yourself with the anesthesia machine and circuit and gather supplies prior to
inducing the cat. Check that the alarm is working and iso is filled.... etc.

(Female cats)
         The cats at the Feral Cat Clinics are induced by a mixture of ketamine,
butorphanol and medetomidine. This mixture is prepared by the induction/recovery
team and given by them IM with the assistance of another person restraining the cat.
(match cage label to medical record) Trapped cats are induced inside the trap (do not
open the trap until the cat is completely anesthetized) Caged (ie: “tame”) cats are gently
restrained inside their cage as the shot is given, and the cat is released back in the cage as
the drugs are allowed to take effect.
         Record the time of induction on the anesthesia form. Once the cat is non-
responsive, the induction team will hand over the cat and record. Fill in your name as
anesthetist (one side is an anesthesia form modified from the one used in Junior surgery,
the other is a checklist of prep duties specific to the Feral Cat Clinics and the surgeon’s
report). Look over the anesthesia form to ensure that cage/owner information is filled
out, as well as date, weight, breed and color of cat, drugs used and dosage.... etc.
         Put on the paper collar (check that the cage # and owner are consistent with
information on the cage/trap and anesthesia form) so that we know where the cat belongs
if it happens to get separated from its paperwork. Then take the cat to a prep station.
         Cats are prone to laryngeal spasm, even when deeply anesthetized, so their
arytenoids need to be painted with xylocaine prior to intubation (if unfamiliar with this,
ask for help from a clinician or another student familiar with the technique).
         The cat trachea is very delicate and can easily be damaged, leading to
pneumothorax or subcutaneous emphysema. Palpate to ensure that the end of the
tube can be felt at the thoracic inlet (one lung intubation is much easier to do in a
cat than a dog). Inflate the cuff gently if necessary. Overinflation can cause
pressure necrosis or tear open the trachea. Detach the cat from the anesthetic
circuit -every- time the cat is moved (this even includes just flipping the cat from
sternal to dorsal). Twisting of the endotracheal tube with the cuff inflated can also
easily damage the trachea.
         The mixture of induction drugs provides a much longer/deeper anesthesia that the
thiopentol used on the dogs in Jr. surgery. Start the cats on pure oxygen or 1%
isoflurane. (Increase to 1.5-2% only as necessary... toe pinch just prior to surgery to
test for pain). When masking down a cat (inadequate anesthesia from an
incomplete or non-IM (SQ or fascial plane) injection or young kitten) start with
pure oxygen and increase 0.5% every 30 sec until adequate anesthesia is achieved.
        Oxygen flow of 1L/min is appropriate for most cats. Cats are on a non-
rebreathing circuit put through a pressure alarm. A 1 L bag is used (this means that
if the pop-off valve is closed, the cat can be overinflated in 1 minute or less).
Diligent monitoring of the bag is necessary, even with the alarm. Over inflation of
the cat can cause pneumothorax or cardiac arrest from the increased pressure, both
of which can quickly lead to death.
        A pulse oxymeter and esophageal stethoscope are available for monitoring (no
        Heart rate should be greater than 100 bmp (if bradycardic, tell the
anesthesia technician, who will draw up and administer glycopyrrolate).
        Respiratory rate should be greater than 6 bpm.
        Hypothermia can be a problem, especially with kittens/smaller cats. Make
sure the heating blankets are functional and monitor temperature closely in kittens... even
during surgery if possible. Don’t let the prep team go overboard with the alcohol
during surgical scrub (no need to squeeze out the alcohol onto their abdomen or
soak the fur).
        Fluid rates are the same as Jr Surgery, but due to the smaller size of cats, buritrol
drip sets are used. This allows for more accurate measurement of actual fluids given.
                 10 ml/kg/hr for the first hour         5 ml/kg/hr thereafter
        The buritrol drip size is such that ml/hr equals drops/min.
        Be aware of what the prep team is doing (assist them as necessary but don’t forget
about watching the bag) and place the initials of whoever did the task in the blank as they
are being done. Once all tasks have been done and the cat is surgically prepped, move
the cat into the surgery suite.
        Do not take the cat into the surgery suite until all prep tasks have been performed
and are initialed. (don’t forget to record PCV and TP values)
        Monitor the cat during surgery.
        After surgery, remove the IV catheter while the cat is still on the table and hold
off the site as necessary. Deflate the cuff, turn off the anesthesia machine and detach the
cat from the circuit. The cat can be extubated by the anesthetist once it begins to
swallow. Carry the cat back to the recovery area and place the cat in its cage/trap (double
check with the collar and remove the collar). Notify the recovery personnel of the cat’s
return. Have the surgical clinician in charge sign the completed medical record. Retrieve
your anesthesia machine and fluids from the surgery suite (it is possible a clinician will
have already done this) and get ready to do it all again.

Special notes:
    Be ready for changes in protocol if special situations arise.
    Anesthetists may get to neuter at the end of the clinic, be prepared to neuter as well.
    Males do not get an IV catheter and are not intubated-just masked... Don’t forget to
give SQ fluids... use the 18 ga needles provided.
    Young kittens (2lbs) receive different drugs and will need to be masked to
receive full anesthesia. (This means they also recover very quickly...) They also get
dextrose added to their IV fluids. You will be instructed how to do this if it occurs.

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