|
K
1)
KETAMINE
a)
Classification
i)
Dissociative injectable anesthetic
agent
b)
General Information
i)
Usually combined with Acepromazine or a Benzodiazepine (Diazepam or
Midazolam) for induction
ii)
Provides analgesia at low doses when used in conjunction with an
opioid agent
c)
Advantages/Recommended use
i)
Routine induction
ii)
Reasonable choice for stable valvular heart disease patients
iii)
Give 5 mg/lb orally for fractious cats
d)
Cautionary Information
i)
Avoid if:
(1)
History of seizures
(2)
Intracranial disease is suspected
(3)
Significant renal disease is present
ii)
Corneal desiccation can occur
(1)
Corneal protection is required
iii)
Initially causes myocardial depression generally followed by
indirect sympathetic stimulation
(1)
Increased heart rate can be detrimental for:
(a)
Hypertrophic cardiomyopathy
(b)
Hyperthyroid patients
(c)
Pheochromocytomas
e)
Dosage Information
i)
Routine induction - Ketamine & Diazepam
(1)
Dog & Cat
(a)
Draw up 1.0 ml of 50/50 mixture per 20lb
(i)
Give ½ initially, then to effect
(ii)
Reduce dose by 30% - 50% if depressed or heavily sedated by
pre-meds
(b)
2 mg/kg (1 mg/lb) lidocaine bolus may be administered to dogs
following initial ketamine/diazepam bolus to reduce total ketamine/diazepam
need
(c)
Keep the unused agent with the patient in the event that the
endotracheal tube is dislodged, the patient suddenly becomes very light,
etc.
(2)
IM/SC use - not recommended as diazepam can be painful and less
predictably absorbed
(a)
Diazepam contains propylene glycol
ii)
Routine induction - Ketamine & Midazolam
(1)
Cats
(a)
Ketamine – 5 to 10 mg/kg (2.5 to 5 mg/lb)
(i)
For younger, fractious cats use 10 mg/kg (5 mg/lb)
(ii)
For quiet, older cats reduce ketamine to 5 to 8 mg/kg (2.5 to 4
mg/lb)
(b)
Midazolam – 0.2 to 0.4 mg/kg (0.1 to 0.2 mg/lb)
(c)
Mix together in same syringe and give IM
(2)
Dogs – the expense of midazolam makes this unattractive for use
in dogs
f)
Cost
i)
Low (for ketamine alone and for ketamine/diazepam combined)
2)
KETOPROFEN
a)
Classification
i)
An NSAID
b)
General Information
i)
Effective anti-inflammatory/analgesic with significant GI side
effects if used long term
c)
Advantages/Recommended use
i)
Long acting analgesic injectable for single
dose post-op use
(1)
Duration of effect is 12 to 18 hours
(2)
Single dose post-op usage has been shown to be free of any
side-effect concerns in normal dogs and cats
d)
Cautionary Information
i)
Avoid long term use
(1)
GI side effects can be substantial
ii)
Avoid use in combination with corticosteroids
(1)
Potentially increased ulcerogenic effect
iii)
Avoid in renal compromised patients
iv)
Avoid in dehydrated or hypotensive patients
e)
Dosage Information
i)
Dogs – 2.0 mg/kg (0.9 mg/lb) SC one time only
ii)
Cats – 2.0 mg/kg (0.9 mg/lb) SC one time only
f)
Cost
i)
Very low
L
1)
LIDOCAINE
a)
Classification
i)
Local anesthetic and anti-arrhythmic agent
b)
General Information
i)
Quick onset
(1)
5 to 10 minutes
ii)
Short duration
(1)
About 1 to 2 hours
(2)
Combine with bupivacaine and either 0.075 mg/kg (0.035 mg/lb)
morphine or 0.003 mg/kg (0.0015 mg/lb) buprenorphine to extend the
analgesic duration of local blocks to approximately 20 hours,
c)
Advantages/Recommended use
i)
Local blocks for:
(1)
Declaws
(2)
Oral surgery
(3)
Dermal growths
(4)
Joint infusion
ii)
Topical anesthesia for:
(1)
Laryngeal desensitization to facilitate intubation
iii)
IV use:
(1)
To deepen anesthetic
plane in dogs after initial induction agents given
(a)
Helps to minimize total induction agent need
(2)
As part of a CRI analgesic strategy
(a)
See CRI section for details
d)
Cautionary Information
i)
Potential CNS toxicity
(1)
Usually manifests as seizure activity if awake, cardiac depression
when anesthetized
e)
Dosage Information
i)
Local blocks
(1)
Dogs and Cats – 1 to 4 mg/kg (0.5 to 2.0 mg/lb)
(2)
For awake patients, mix 0.9 cc Lidocaine, 0.1 cc sodium
bicarbonate, and 2 cc of sterile
water
(a)
Reduced sting
ii)
IV induction enhancement
(1)
Dogs only – 2.0 mg/kg (1.0 mg/kg) IV after initial induction
agent
iii)
Intra-articular
(1)
Generally whatever will fit after joint closure
(a)
Dogs – up to 6.0 mg/kg (3.0 mg/lb)
(i)
Generally 4 to 6 ml total volume
(b)
Cats – up to 4.0 mg/kg (2.0 mg/lb)
iv)
Epidural
(1)
Dogs and Cats – 4.0 mg/kg (2.0 mg/lb)
v)
Other uses
(1)
Intercostal blocks
(2)
Brachial plexus blocks
(3)
Ringblocks
(4)
Dental Blocks
(5)
CRI Infusions (exercise caution in cats)
f)
Cost
i)
Very low |
