Anesthesia For The Pet Practitioner (Banfield, 2003 Edition) PDF

Anesthesia
for the Pet Practitioner

2003 Edition
Will Novak
DVM MBA, Dipl ABVP
THE
PET
HOSPITAL* SINCE
1955
MMI Banfield - Copyright 2003
J
JDedication:
I want to dedicate the 2003 edition of "Anesthesia for the Pet Practitioner" to Professor Lee Tyner
DVM. Dr. Tyner allowed Banfield to sift through the incredible amount of knowledge stored in his
brain. In 1998,1 locked Lee Tyner in a room, and together we created the first draft of the current
Banfield Anesthesia System. While there have been a few updates, additions and revisions to our sys-
tern (utilizing Lee's invaluable input), the core ideas and principles have not changed. In fact, the systern has stood the test of time, day in and day out, making a difference in Pets' lives across the country.
I also need to thank Dr. Robyn Hauser for her valuable input in working to develop Banfield's first
exotic Pet anesthesia protocols. She was able to blend the most current techniques in exotic anesthesia
into a system for Banfield that is very similar to our canine/feline protocols.
I would also like to thank Dr. Karen Faunt for the addition of the CPR protocol, as well as for her daily
efforts in answering our practice doctors' anesthesia questions. Dr. Karen Johnson also needs special
mention for the great editing input she provided during the development of this book.
Additionally, I would be remiss not to thank Helen Schmidling for the incredible effort she has put
forth to blend all the separate pieces of the current system into one professional appearing document
that Banfield can not only be extremely proud of, but which also sets the groundwork for Banfield to
become a leader in small Pet anesthesia systems within our profession.
I cannot forget to thank Dr. Kathy Engler for making me look good by devoting a great deal of effort
and time updating, adding to, and revising the protocols and notes into what you find between these
two covers.
Finally, I acknowledge our Medical Directors in the field who, each day, help to mentor our doctors.
It is my hope that the information contained in this document will help us all to give Pets the same care
we want for ourselves, and treat each Pet like family.
Will Novak, DVM, MBA, Diplomate ABVP

Chief Medical Officer
Banfield, The Pet Hospital
MMI BanfieldCopyright 2003
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Anesthesia for the Pet Practitioner

Will Novak DVM, MBA, DiplABVP
2003 Banfield, The Pet Hospital
LISBN 0-9743262-0-8
Reproduction of the whole or any part of the contents without written permission
of Banfield, The Pet Hospital is prohibited.
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Section 2: The Banfield Protocols

Banfield Anesthesia Protocol
40
Pulmonary Protocol
51
Anesthesia Cycle
41
Renal Protocol
52
Stable Diabetic Protocol
53
42
Orthopedic Protocol
54
Blood Work Evaluation
43
Ear Surgery Protocol
55
Healthy Pet Protocol
44
CNS, Eye Globe Protocol
56
Fractious Pet Protocol
45
Emergency Surgery Protocol
57
Feline Declaw Protocol
46
Anesthesia Monitoring and
Canine/Feline Anesthesia
Physical Examination
Lipemia Protocol
47
Abdominal Protocol
48
CPR Protocol
59
Cardiac Protocol
49
Cardiopulmonary Arrest (1)
60-61
Liver Protocol
50
62
Emergency Protocol
58
Section 3: Fluid Therapy in Pets

Fluid Therapy
64
Colloids
65
Crystalloids
64
Shock
66
Section 4: Anesthetic Considerations for Small Exotic Pets

Introduction
68
Avian Protocol/Flow Chart
80-81
Preanesthetic Evaluation
69
Reptile Protocol/Flow Chart
82-83
Preanesthetic Preparation
70
Ferret Protocol/Flow Chart
84-85
Small Mammals
72
Rabbit Protocol/Flow Chart
86-87
Reptiles/Avians
72
Guinea Pig and Chinchilla
Anesthetic monitoring
75
Protocol/Flow Chart
Induction and maintenance
76
Post-operative care
77
Note on individual protocols
79
88-89
Rat, Mouse, Gerbil, Hamster
Protocol/Flow Chart
90-91
Appendix: Dosage Tables

Acepromazine
94
Ephedrine (AMEP*)
108-109
Butorphanol
95
Lidocaine (AMEP* & CPR**)
110-111
Diazepam
Diphenhydramine
96-97
Epinephrine (AMEP*)
112
98
Dexamethasone (CPR**)
113
99
Atropine (CPR**)
114-115
Propofol
100-101
Epinephrine (CPR**)
116-117
Telazol
102-103
Sodium Bicarbonate (CPR**)
118-119
Ketoprofen
104-105
Morphine
Atropine (*AMEP)
106
Glycopyrrolate (*AMEP)
107
IV
* Anesthesia Monitoring Emergency Protocol

** Cardiopulmonary Resuscitation
MMI BanfieldConfidential Internal Use OnlyRevised 3/10/03
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Table of Contents
Section 1: General Anesthesia

Introduction
Intubation and Airway Management (Cats). . 20
Measuring Quality Anesthesia
Maintenance & Monitoring
Standards and Protocols
Sevoflurane
21
5-9
Oxygen Flow Rates
22
Cholinergic Pathway
Assisted Ventilation
22
Alpha-1 Sympathetic Pathway
Fluid Therapy
22
Monitoring
23
Autonomic Nervous System
Beta-1, -2 Pathways
Alpha-2 Agonist
Anesthesia Monitoring & Emerg. Protocol . . 24
Fractious Pets
Recovery
25
Post-op Pain Management
25
Acepromazine in Fractious Pets
and Epinephrine Reversal
21
Defining Good Perfusion
9
9-10
Injectable Ketoprofen
25
Butorphanol
26
General Information
11
Oral Ketoprofen
Definitions and Requirements
11
Anesthesia Equipment
26
27-38
Tranquilization and Sedation
11
IV Catheter Sizes
27
Immobilization
13
Rebreathing Bag Sizes
27
General Anesthesia
27
14
Endotracheal Tube Selection
Patient Evaluation
15
Breathing Circuit Guidelines
28
Premedications
15
Oxygen Cylinders
28
Acepromazine
15
Soda Lime Canisters
28
Butorphanol
16
Pop-off Valve
30
Diphenhydramine
16
Evacuation System
30
Diazepam
16
Regulator
32
Morphine
17
Manometer
32
Fentanyl Patch
17
Vaporizer
32
Anesthesia Induction
17
Anesthesia Machine
33
Propofol
18
10-second Leak Test
33
Telazol
19
Anesthesia Machine Diagram
Intubation
19
Troubleshooting Guide
34
35-38
III
f?re
Will Novak, DVM, MBA, Dipl ABVP

(Canine/Feline Specialty)
Kansas State University, 1986
ChiefMedical Officer, Banfield, The Pet Hospital

Editor/Contributor
Lee Tyner, DVM

University ofMissouri College of Veterinary Medicine, 1971
Professor ofAnesthesiology,
College of Veterinary Medicine, Mississippi State University
Anesthesia Consultant/Contributor
Kathy Engler, DVM, Dipl ABVP

(Canine/Feline Specialty)
University ofMissouri College of Veterinary Medicine, 1991
QA Medical Advisor, Banfield, The Pet Hospital

Project Manager/Contributor
Karen Faunt, DVM, MS, Dipl ACVIM
(Small Animal Specialty)

Colorado State University, 1994
QA Medical Advisor, Banfield, The Pet Hospital

Medical Consultant/Contributor
Robyn Hauser, DVM

i
Oregon State University, College of Veterinary Medicine, 1994
Protocol Manager/Medical Development

Banfield Medical Quality Assurance
Contributor, Exotic Pet Medicine & Anesthesia
Karen Johnson, DVM

Oregon State University, Washington State College of
'jF-iiiiyil'*
Veterinary Medicine, 1988
Medical Records Review, Banfield, The Pet Hospital

Project Medical Proofreader & Editor
Helen G. Schmidling, BFA

State University of New York, College at Potsdam, 1972
Education Editor, Banfield, The Pet Hospital.

Project Editor & Graphic Designer
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Illustrations
Mortality rate, frequency
Autonomic Nervous System
Alpha-1 sympathetic pathway
Beta-1 pathway
Sevoflurane
Pouring Sevoflurane
Ketoprofen
21
21
25
Butorphanol
Catheters
Re-breathing bags
Endotracheal tubes
26
27
27
27
Fractious Pets
Perfusion
10
Cardiac output
10
Brachycephalic breed
13
Bain's non-rebreathing circuit
28
Evaluate patient
15
Universal F circuit
28
Prepare premedication
15
Acepromazine
15
Soda lime canister

Soda lime sticker
28
30
Sterile empty vial
15
Butorphanol
Diphenhydramine
16
16
Waste gas interface

Evacuation system
30
31
Diazepam
16
Morphine
Fentanyl Patch
17
17
Propofol
18
Telazol
19
Endotracheal tube with stylet
19
Endotracheal tube with syringe
19
Cuff at end of endotracheal tube
19
Lidocaine Viscous
20
Intubating a cat
20
Oxygen regulator
Manometer
Vaporizer
Anesthesia machine
Face masks
Parrot
Lizard
Ferret
Rabbit
Chinchilla
Hamster
32
32
33
33, 34
70
80
82
84
86
88
90
Charts
Autonomic Nervous System (Drugs)
Charts for Exotic Pets:
27
Pre-op Fast & H20 Withholding
Recommended Rebreathing Bag Size
27
Parenteral Access/Injection, Mammals ... 72
Recommended Endotracheal Tube Size
27
Parenteral Access/Injection, Reptiles .... 73
35-38
Intraosseous Catheterization, Reptiles. ... 74
Recommended IV Catheter Size
Troubleshooting Guide
Potassium Supplementation
64
Fluid Type & Rate
65
Analgesic Drug Doses SQ/IM
78
Patient Anesthesia
Monitoring Chart
MMI BanjieldConfidential Internal Use OnlyRevised 3/10/03
71
92
Introduction
Anesthesia in the Pet practice has always been one of the more challenging and complex procedures
that a practitioner performs, and yet, it is done every day with hardly a second thought. Even more
challenging is the wide variation of anesthesia practices used by different doctors. If the question is
asked to the many doctors who join Banfield, "Why is there a wide variety of anesthesia practices/pro
tocols being utilized in general practice today?" one common theme comes to the forefront. Every
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school knows that a wide variety of practice methods currently exists, and as such, they want to expose
students to the many variations of practice. This results in no standards of practice for the general
practitioner regarding anesthesia. Should the veterinary schools be relied upon to set the standards for
general practitioners? The caseloads of most of the veterinary teaching hospitals are referrals, and as
such, does not reflect the typical Pet practice.
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When considering anesthesia training methodology, a deeper question should be asked: "How do you
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determine quality for anesthesia?" The answer starts with outcome analysis, i.e. are the results better
with one method versus another. If practitioners agree that improved case outcomes are a good measure
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of quality for anesthesia, and a standard method of anesthesia results in improved case outcomes, then
anesthesia quality has been improved. Better quality is positive for the profession as a whole.
Banfield's anesthesia standards and protocols are a result of this thinking. The question that I posed in
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1998 was, "Can an anesthesia method be developed that would decrease the mortality rate (as well as
other adverse case outcomes associated with anesthesia) not only for one hospital, but for hundreds of
hospitals?" The challenge forced the question, "Is anesthesia an 'art' or a 'science'?". If it is art, then
the mortality rate is based on luck and experience. If it is science, then many aspects of anesthesia
should be repeatable with standardized methodologies.
Banfield has the luxury of evaluating more than 125,000 general anesthetic cases a year. By utilizing
practice standards and protocols, standardized equipment, and ongoing outcome analysis (the ongoing
outcome analysis is part of the peer review processa concept taken from human medicine), a
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constant process of improvement through learning from ongoing experience occurs. Peer review,
combined with standardized software and equipment, has the benefit of removing many of the
variables seen by the profession, and has resulted in marked improvements for Banfield regarding
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anesthesia case outcomes.
The result of all this has shown that anesthesia is much more of a science than an art form, therefore
forcing practitioners to review their entire approach to anesthesia. Science often requires that old habits
of practice change, even if it doesn't feel right, and forces a paradigm shift. Science may require doc
tors to change, and change is often difficult. This requires practitioners who have a method they would
like to stay with, because of habit or it just "feels right," to justify with a medical reason the superiority
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of the status quo. It is no wonder that many argue against change, but change is upon us.
Section 1:
General Anesthesia
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Outcome analysis over the past years has noted many things:
1. Anesthetic reactions are truly very rare.
2. Lack of proper monitoring results in the appearance that patients are alive one minute and dead the next.
3. Lack of understanding regarding proper drug usage and effects is common.
4. Development of unique protocols (i.e. bypassing standards) increases morbidity rates and mortality rates.
Standards and Protocols
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Anesthesia is often considered to be synonymous with the anesthetic medications used. While the
choice of anesthetic agents is important to case outcome, it is only a small portion of complete and sue-
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cessful anesthesia. It is important not to view anesthesia solely as selecting the right drug, but to look
at how the pharmacology of the anesthetic agents affects patient perfusion while maintaining a "state of
consciousness" that allows a procedure to be performed. To accomplish perfusion-maintenance, other

factors besides pharmacology need to be considered. A total system for anesthesia is necessary which
results in the development of standards and protocols.
When broadening the discussion of what is included in excellent anesthesia, equipment, patient health
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status and evaluation (including blood work), drugs and monitoring must all be considered. If an expe
rienced doctor has the correct drug but the monitoring equipment is not functioning, an adverse anes-
thesia event or a fatal outcome can still result. Perfusion must be maintained during anesthesia, and as
such, patients that are not monitored have higher morbidity and mortality rates.
Secondly, drug selection must be based on a working knowledge of drug interactions and their effects
on perfusion. For example, if a patient is sedated with Acepromazine, will that affect the safety margin
of an alpha-2 agonist? Or, if Ketamine is used for an aggressive cat, should Atropine be given to pre
vent bradycardia? One of the many things that has been learned from outcome analysis is that all drugs
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are not compatible. Their physiological effects need to be understood well enough to be certain of com
patibility. This complex matrix of premeds, induction agents, maintenance agents and emergency drugs
makes well thought out protocols and standards essential.
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Clearly, there is more than one way to practice anesthesia. Doctors in any practice can get similar
results, provided that all components of the total anesthesia system (i.e. equipment, monitoring,
standard medications, etc.) are consistently utilized, and drug selection and dosages are compatible.
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Based upon the previously mentioned studies, and Banfield's ongoing outcome analysis, clearly the vet
erinary profession can improve and obtain better outcomes. The first step in this process is to understand
how drugs affect the autonomic nervous system and in turn affect patient perfusion.
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Measuring Quality Anesthesia
Quality anesthesia can be measured by a number of different methods. The first method chosen by
Banfield was mortality rate. All anesthesia deaths are taken through the peer review process, and many
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of these cases also have necropsy results. This provides consistent data on a large enough sample size
to identify many patterns that affect mortality. The same factors that affect mortality also affect morbidity;
and as such, reducing one will reduce the other.
Research studies regarding anesthesia methodologies and case outcomes in the profession are rare. A
study done with 250 small animal practices in Canada, in which all used isoflurane as the standard,
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showed a mortality rate of approximately 1 death per 1000 anesthesias. It is a reasonable assumption
that in the U.S., the average small animal veterinary practice is no different, although to my knowl
edge, no research studies have surfaced. Some have suggested that the mortality rates for general anes
thesia in rescue shelters, using injectable anesthesia and minimal monitoring, is as high as 1 per 100. A
study by the U.S. Army Veterinary Corps was completed reviewing all deaths and euthanasias of 927
military working dogs from 1993 to 1996, including anesthetic deaths. Anesthetic arrest was noted in
10 of the 927 dogs, or a rate of approximately 1 per 100 patients.
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The goal of our protocols is to be as close to human quality as
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possible (mortality rate of 1 per 10,000). Based on the peer review
12 '
process, we were able to determine that when the protocols are
10 '
followed, the mortality rate is approximately 1 per 10,000. These
findings were based on case reviews during a time period during
which 69,000 procedures were performed. When doctors created
unique protocols, the mortality rate increased by 4 times. At a mor
tality rate of 1 per 10,000 procedures, a doctor averaging 4 general
anesthetic procedures per day, and working 220 day per year, would
have on average one fatal complication every 11.4 years. It clearly is
exciting to have a system that potentially will allow more than 10
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1998
1999
2000
2001
Frequency per 10,000
Banfield Anesthesia Mortality Data
years between fatal events.
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"Infrequent patient deaths" might have been considered successful in the past but can no longer be
labeled as quality anesthesia. Our goal should be for the patient's condition to be equal or better than
the Pet's condition prior to anesthesia. Non-fatal adverse events must be looked at as critically impor
tant when determining quality anesthesia. Poor perfiision doesn't always result in patient death. For
example, we want to avoid behavior changes or cortical blindness as a result of a hypoxic event that
damages brain tissue during anesthesia. While these outcomes are not fatal, they are adverse anesthesia
events, nonetheless. How many Pets are no longer house broken as a result of brain damage from
hypoxia? A great deal of data exists supporting the fact that Pets with behavior problems are more like
ly to be euthanized, thus supporting then need for high quality anesthesia.
Figure 1:
Autonomic Nervous System: Drugs

Eye - contract iris (miosis-miotic)
Heart - A-V Block, decrease
HR and conduction
(+) Bethanechol
(+) Pilocarpine
(+) Medetomidine
(+) Clonidine
(+) Methyldopa
(-) Yohimbine
velocity
Muscarine
(+) Xylazine
Lung - stimulate secretion

GI - acid & fluid secretion,
-) Atropine
Nicotimc
increase motility & tone
-) Glycopyrrolate
Penis - erection
(-) Troplcamide
Glands - secretion
(-) Propantheline
Bromide
(+) Norepinephrine
(+) Epinephrine &
Arterioles - constrict
Dopamine
(+) Neosynephrine
(+) Ephedrine=NE *
(-)
(-)
(-)
(-)
(-)
(coronary, skeletal, cerebral, skin,
and viscera)
Veins - constrict
Penis - ejaculation
Alpha-1 Antagonists
Phenoxybenzamine
Phentolamine
Prazosin
Acepromazine
Liver - glycogenolysis and

gluconeogenesis
Adipocytes - lipolysis
(+) Norepinephrine
(+) Epinephrine
(+) Isoproterenol
(+) Dobutamine &
Dopamine
(-) Beta
Antagonists
(-) Propranolol
(-) Metoprolol
(-) Atenolol
Heart - increase HR, contractility,
(31
automaticity, conduction
velocity
Adipocytes - lipolysis
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(+) Epinephrine
(+) Isoproterenol
(+) Metaproterenol
(+) Albuterol Terbut^line
(-) Propranolol
(-) Hexamethonium
(-) Trimethaphan
Arterioles - dilate
Veins - dilate
Lungs - relax bronchial muscles
Liver - glycogenolysis and

gluconeogenesis
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KEY
Ephedrine causes a release of Norepinephrine
(-) = Inhibition (Antagonist)

(+) = Stimulation (Agonist)
Figure 1:
The Autonomic Nervous System:
Drugs
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Alpha-1 Sympathetic Pathway
o Stimulation of this pathway results in constriction of

arterioles.
o Blocking this pathway results in dilation of the arterioles.

o Example: administering Neo-synephrine (an agonist
that stimulates the pathway) causes blood vessels to
constrict. Additionally, giving Acepromazine (an antag
Blood vessel
onist) blocks the pathway in a dose dependent manner;

thus, blood vessels will not be able to constrict and will
Alpha-1 Sympathetic pathway
be dilated.
o So remember, stimulation of alpha-1 causes constriction

of arterioles. Blocking alpha-1 results in dilation of arterioles.
Beta-1 pathway
o Stimulation of this pathway results in increased heart rate
and contractility resulting in increased cardiac output (CO).

o Dobutamine is an example of a beta-1 specific drug.
o If you need to increase cardiac output, think stimulation of
beta-1.
Beta-2 Pathway
o Stimulation of this pathway results in bronchodilatation and

dilation of the vascular bed within skeletal muscle (in prepa
ration of "fight or flight").

o Example of drug: Albuterol
Beta-1 pathway
Alpha-2 Agonist
o Has good analgesic properties.

o Works on the higher centers in the CNS.
o Will cause bradycardia resulting in decreased COperhaps by as much as 40%.

o Best used as a pre-med analgesic.
o Best used only on healthy patients that can tolerate/compensate for decreased CO
o A common problem is use as an intermediate acting anesthetic without first performing
a complete health evaluation. This can create a higher risk situation, especially in undiagnosed cardiac disease, and as such, alpha-2's are not used in our protocols.
o Example of drug: Xylazine or Medetomidine
MMl BanfieldConfidential Internal Use OnlyRevised 3/10/03
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The Autonomic Nervous System
Review printed chart of the autonomic nervous system (ANS) [Figure 1, Page 6]
The goal of reviewing the autonomic nervous system is to understand how the drugs that we
use during anesthesia affect perfusion. This includes their effect on blood vessels size (i.e.
blood pressure) and cardiac output. Note the following drugs on the ANS sheet:
o Atropine
o Glycopyrrolate
o Acepromazine
o Neo-synephrine
o Ephedrine
o Dobutamine
o Epinephrine
Cholinergic Pathway
o By stimulating the cholinergic pathway, the heart rate slows.
o Many think that by giving an anticholinergic, the heart rate can be increased; it is
important to understand that blocking this pathway (in other words by giving
Glycopyrrolate or Atropine) the heart rate won't increase above the basal rate.
o If heart rate is to be increased above the basal rate, the beta-1 pathway must be
stimulated, as seen with Dobutamine administration.
o Patients with a normal heart rate prior to surgery that are given an anticholinergic will
lose the ability of the heart to slow itself in response to appropriate vagal stimulation.
This may result in a rebound tachycardia.
o If using an alpha-2 adrenergic agent that causes excessive bradycardia, an anticholinergic

may need to be considered to normalize heart rate.
o In our protocols, anticholinergics are used only when the pre-op physical examination
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reveals bradycardia or after bradycardia develops during a procedure.
o Once tachycardia occurs after an anticholinergic is given, it is difficult to slow the heart.
Slowing the heart can be accomplished by fluid loading the patient and stretching the
atrial stretch receptors. These receptors stimulate the vagal pathway and attempt to
override the drugs.
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Understanding cardiac output:
o CO = heart rate x stroke volume (HR x SV)
o SV depends on venous return (pre-load), total peripheral resistance mainly due to
arteriole constriction (afterload) and contractility.

o Thus CO = HR x Contractility x Preload
Afterload
Cardiac output is critical to
perfusion. In tachycardic
patients, an excessively high
heart rate may result in the

stroke volume becoming so
small that no cardiac output

occurs. A cat with a heart rate of
250 beats per minute has literally
no cardiac output. If the vagal
system is blocked and the heart
can't slow itself, a patient may

die from no cardiac output.
It is important to remember that
preload (i.e. venous return) and

afterload (i.e. peripheral
resistance) affect cardiac output.
If a patient is hypertensive
(i.e. the vessels are constricted),
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CO is decreased because the

heart is pumping against the
smaller vessel size.
When considering perfusion,

blood volume is critical to main
taining blood flow. The protocols
include IV fluids to make certain
Good Perfusion
that the blood vessels are full. As
blood vessels are also leaky, oncotic pressure

affects perfusion. If the albumin and total
protein levels are below normal, pulmonary
edema may result during surgery. Patients that
develop pulmonary edema during surgery may
die several hours post-operatively. This is one
of the reasons patients must be monitored for at

least two hours post-operatively.
Cardiac Output
10
Fractious Pet is defined as:
o if it takes more than one petnurse to

restrain;
o if you have to make more than one

attempt at a blood draw or jugular
stick because of patient movement;
o any signs of aggression.

yataa
Acepromazine in Fractious Pets and

Epinephrine Reversal
"Sticking" a fractious dog
o Epinephrine stimulates both alpha and beta receptors
o Epinephrine (a natural catecholamine) can be released by
the body during a stressful (i.e. Fractious Pet) event, or

given in an emergency situation (CPR)
o If an alpha-1 antagonist, such as Acepromazine, is

administered or on-board (i.e. pre-meds), it blocks
vasoconstriction of the arterioles by Epinephrine through its
effect on alpha-1 receptorsthis is a dose-dependent

effect.
The less-than-cordial cat
o Epinephrine is still able to stimulate the beta-receptors,

resulting in increased heart rate and contractility (i.e. less filling
time) [via beta-1], and vasodilatation of the vascular bed in the

skeletal muscle [via beta-2]. This results in pooling of blood in the
vascular beds and inhibits return of blood to the heart.
o This results in acute hypovolemic shock.
o It is, therefore, important to avoid the use of Acepromazine in the

Fractious Pet protocol.
o If Epinephrine reversal is thought to have occurred, shock doses of
This cat isn't smiling
fluids must be given in attempt to volume load the patient.
Defining "Good Perfusion"
Having adequate blood flow and volume to push red blood cells to the lungs, pick up O2,
and deliver it to tissues.
Think of "nice full blood vessels," (i.e. enough blood volume, blood pressure, oncotic
pressure and cardiac output to keep perfusion normal.)
ANESTHESIA MANAGEMENT = PERFUSION MAINTENANCE,
Because drugs used in anesthesia can affect perfusion, one must understand how drugs can
change perfusion during anesthesia.
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For tranquilizing a patient in the hospital:
o Acepromazine (alone)0.025 mg/lb SQ or IM; 1.5 mg maximum dose
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(do not use on an aggressive or fractious Pet)

o Diazepam (alone)0.1 mg/lb IM
o Diphenhydramine (alone)1 mg/lb SQ or IM, 50 mg maximum dose

o Butorphanol0.1-0.2 mg/lb SQ or IM (5 mg maximum dose)
plus one of the three agents above
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For Air Travel:
o Banfield will not give or prescribe Acepromazine or other Phenothiazine-type
"
tranquilizers to Pets traveling by air. Doing so may inadvertently put the Pet's life at risk.
Instead suggest the client give the Pet Diphenhydramine.
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o Phenothiazine derivatives, like Acepromazine, block alpha-1 adrenergic receptors in the

circulatory system, resulting in vasodilation. This may create susceptibility to hypothermia
and an inability to respond to changes in atmospheric pressure and temperature, should a Pet
be in the cargo hold when something goes wrong. It is possible for Pets to die during air
transport as a result of Phenothiazine tranquilization.
o For Pets traveling by air:
Offer Diphenhydramine to the client for the Pet. It will usually cause drowsiness but
without circulatory side effects. Calculate the dose for each Pet1 mg/lb by mouth
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up to a maximum dose of 50 mg. Medication should be given approximately one
hour prior to travel. The dose can be repeated every 6-8 hours as needed.
Recommend acclimating the Pet to the Pet carrier for several days before the flight.
This will decrease the stress that leads to barking, anxiety and hyperexcitability.
Putting a favorite blanket in the carrier and feeding the Pet or offering other treats
^J
while in the carrier helps this process.
Recommend non-stop flights to minimize stress to the Pet. Pets often get cold or hot
while the plane is sitting on the ground.
For Ground Travel:
o Inform owners that oral sedatives have variable effects on Pets, and that they are more
effective when administered before the Pet becomes anxious or excited. Owners will need
to closely monitor their Pet's reaction to the sedative, and consult with the doctor for
dosage adjustments. It is best to start with minimal doses.
*-J
I
o Recommend giving the drug prior to time of travel, in order to evaluate Pet's response.
o Recommend the Pet travel in a Pet carrier whenever possible. Acclimate the Pet to the
carrier as discussed under air travel.
<mJ
o Oral agents that can be prescribed:
12
Diphenhydramine 1 mg/lb PO (maximum dose 50 mg) q 6-8 hrs
Diazepam 0.1-0.2 mg/lb PO q 6-8 hrs
Acepromazine 0.25-1 mg/lb PO q 6-8 hrs (see Phenothiazine notes from above)
"
General Information
The doctor must examine all patients prior to the patient being anesthetized.
When initially following new anesthesia protocols, the medical team should always monitor
and observe the patient, from premed administration through recovery from anesthesia. This
close observation by the doctor and petnurse provides a greater understanding of how each
drug affects the patient. Particularly close observation should occur for the first five anesthetic
procedures in which a new protocol is employed.
miitomZA
All anesthesia protocol information is based on the expectation that anesthetic delivery and
monitoring equipment is in proper working order. It is the responsibility of the attending doctor
to ensure that the equipment is in proper working order.
General anesthesia protocols require a petnurse, from induction through recovery, to monitor
the patient and document/record monitoring parameters.
All drug dosages are subject to patient variation.
Changes in drug dosages should be based first on the health status and second on the tempera
ment of the patient. The doctor is responsible for defining the safe dosage for the individual
patient as long as maximum doses are not exceeded.
Use the lower dose range whenever possible. Minimal dose = minimal risk.
Anesthesia Definitions and Requirements:
The requirements listed under each category are the minimum practice standards. If you feel
additional measures (such as an IV catheter for an immobilized patient) are prudent, please take
LmmI
them.
When using anesthesia agents, charge the appropriate fee.
Tranquilization/Sedation
Definition: The patient can walk.
o Use tranquilization/sedation for blood collection, otoscopic exam, to assist in restraint for
non-painful procedures and to help decrease anxiety.
Requirements:
o Complete and deliberate physical examination.

o Continue monitoring (TPR and pulse quality q 15-60 minutes depending on patient) and
visual observation at all times.
o Depth of tranquilization is such that endotracheal tube placement is not possible.

o Heart monitor (ECG) or pulse oximeter to be used at the doctor's discretion.
o IV catheter to be used at the doctor's discretion (recommended for Pets over five years of
age).
Uj^j
MMI BanjieldCopyright 2003
11
/\rrreffir^
All brachycephalic breeds
Those with excessive pharyngeal folds such as Shar peis
Any Pet with concern for abnormalities of the
pharynx
larynx
trachea
esophagus
o This allows for immediate maintenance of a patent airway with an endotracheal tube
and ventilation support with 100% oxygen. All general anesthesia prerequisites and
monitoring procedures are necessary in these cases.
o The goal of this recommendation is prevention of unnecessary deaths
during immobilization in a high-risk group of patients.

General Anesthesia
Definition: The patient cannot walk, has no gag reflex, is unconscious and has greatly
diminished pain response.
o Used for radiographs requiring special positioning (hips, etc), surgical procedures, invasive
diagnostic procedures and painful procedures. Recommended over immobilization for all
brachycephalic breeds.
Requirements:
o Food and water have been withheld for 2 hours. (No cases of aspiration have occurred
in the practice by using this criterion. Longer periods [i.e. 12 hours] without food can
result in hypoglycemia especially in pediatric patients).
o CBC and profile within 48 hours prior to induction.

o IV catheter.
o Endotracheal tube placement.

o ECG and pulse oximeter.
o Continual monitoring and observation (see Anesthesia Monitoring and Emergency
Protocol algorithm)record in medical record q 5-10 minutes until recovery.
^j
o IV fluid support for procedures longer than 10 minutes.
Use the following for general anesthesia:
o Premedications according to anesthesia algorithms.
o Induction according to anesthesia algorithms.
o Maintain with oxygen and Sevoflurane.
o Supportive care and post op pain management according to anesthesia algorithms.

o Monitoring according to anesthesia flow chart and monitoring algorithms.
14
Immobilization
Definition: The patient cannot walk, the patient is experiencing a non-surgical plane of
anesthesia, the patient can be aroused with minimal effort, and the patient maintains laryngeal
and withdrawal reflexes.
o Use immobilization for procedures that can be completed in < 10 minutes, are not painful,
[_,
and do not require general anesthesia, such as:
Clipping matted hair
Radiographs not requiring special positioning
Pedicure in aggressive patients
Mild ear cleaning
[^
"To enable handling of fractious Pets requiring general anesthesia (see Fractious Pet
Protocol)
o If a Pet is immobilized and the doctor finds the procedure is more extensive than anticipated
and requires general anesthesia, pre-anesthesia blood work, IV catheter, and appropriate
pre-anesthesia medications must be completed prior to induction of general anesthesia.
Requirements:
L.
o Depth of anesthesia is such that endotracheal tube placement is not possible.

(If an endotracheal tube can be placed, the patient is considered to be
experiencing general anesthesia.) Although an endotracheal tube cannot be placed, the

proper endotracheal tube should be readily available.
o Continual monitoring and observation by petnurse and/or doctor of all vital functions
(record pulse, pulse quality, respiration and depth every 5-10 minutes until recovery;
temperature every 15-30 minutes).
Lo Pulse oximetry (since a swallow reflex is still present, the sensor will likely have to be used
use on alternative areas of the bodyi.e. rectum, toe web, vulva, prepuce, ear, lip).
o An IV catheter is required for Propofol, and at the doctor's discretion for Telazol. Direct
venous access for administration of fluids or drugs is highly recommended and decreases
patient risk, especially for those of uncertain health status.
The following agents are used to immobilize patients:
o Telazol 0.5-2 mg/lb IM only (use low doses with debilitated patients) Maximum single
dose is 100 mg.
o Propofol \-A mg/lb IV
Immobilization considerations in brachycephalic breeds:
o Because of the potential for apnea resulting in hypoxemia and/or

hypercarbia in apparently healthy brachycephalic breed dogs
during immobilization with Propofol or Telazol, Banfield recom
mends general anesthesia in all patients with potential for
upper airway or pulmonary compromise. These include:

Bulldog: brachycephalic breed
1$
Butorphanol:
An agonist/antagonist opioid.
Pre-emptive pain management through affects on Kappa and
Also has analgesic actions at the subcortical and spinal
Antagonist to Mu receptors, thus can be used as a reversal agent
Sigma receptors.
levels providing good visceral analgesia.
tlamuuluiyj
for pure opioids whose analgesic action is mediated through Mu

receptors.
Has little to no respiratory depression.
Butorphanol administered SQ in cats is less painful, but may delay
Butorphanol
absorption.
Butorphanol is a mixed agonist/antagonist; therefore, a ceiling is reached on its analgesic

properties (i.e. higher doses do not proportionally equal more pain management). As higher
doses are given, the likelihood of adverse effects developing increases (i.e. aggression, excite
ment, dysphoria). Therefore, to utilize Butorphanol's analgesic properties, but avoid potential
adverse effects, the maximum dose a patient, regardless of size, should receive is 5 mg.
Diphenhydramine:
An HI antihistamine.
Not significantly metabolized by the liver.
Used as the premed (rather than Diazepam or Acepromazine)
when a patient has received or we anticipate will receive a

transfusion to help prevent transfusion reactions.
Used as the sedative (rather than Diazepam or Acepromazine)

when a patient is undergoing surgery for a mast cell tumor.
Diazepam:
A Benzodiazepine.
Produces sedation.
Provides skeletal muscle relaxation.
Anticonvulsantthis is of great benefit in the CNS protocol as it
Diphenhydramine
will help to prevent seizures in higher risk patients such as the

stabilized epileptic requiring a surgical procedure.
Midazolam (a shorter acting, water-based Benzodiazepine) is

substituted for Diazepam when it is unavailablethe dose is
O.lmg/lbSQorlM.
Diazepam
16
Patient Evaluation
Pre-anesthesia blood work (Complete Blood Count with

Differential and Internal Organ Function Screen) performed
within 48 hours prior to anesthetic induction.
See Physical Examination algorithm and Blood Work
Review the patient's medical record completely.
evaluation algorithms.
Confirm that all participating team members are aware of every
Evaluate patient
procedure being performed on the patient.
Premedications
Used to:
o Calm the patient, reduce stress, and improve handling.

o Decrease the dose of induction and maintenance drugs.
o Improve induction and recovery quality.
o Provide analgesia.
o Not for immobilization to draw blood or place a catheter.
Prepare premedications
Acepromazine:
Is a Phenothiazine sedative/tranquilizer.
Protects against some arrhythmias (i.e. VPCs associated with
Epinephrine).
Uiimm
Alpha-1 antagonist
o Results in vasodilatation of arterioles.
o This action is dose-dependent, so low doses results in slight

vasodilation and a large dose can result in hypovolemic shock.
An important point to remember:
Acepromazine
Anything Ace does, fluids can fix.
o Helps counteract the hypertension often seen in "stressed"
patients.
o Acepromazine should be pre-diluted to 1 mg/ml to better allow
proper drug measurement.
o Directions:
Order an 80 ml bottle of sterile water for injection and

30 ml empty sterile vials through the HOEP
EMPTY |:
'VIAL
y~
Draw up 27 ml of sterile water with a sterile syringe and
add it to the empty sterile vial
STERILE^
sterile emP*y viai
Draw up 3 ml of 10 mg/ml Acepromazine and add to the same vialthis will result
in a 1 mg/ml solution
Vial should be labeled appropriately and dated

Because the solution is light-sensitive, the vial should be completely wrapped. If
protected from light, the solution is stable at room temperature.
15
Propofol:
An alkylphenol.
Insoluble in water.
Formulated as an emulsionthe emulsion components
(soybean oil, egg lecithin, glycerol) are a media that

allows bacterial growth; as such, the product has limited
shelf life after opening.
A sedative hypnotic.
Propofol has three main uses: (In the practice you will
Propofol
primarily use it for induction and immobilization. Ifyou
need itfor other uses please contact a Medical Director

or Advisor for further information.)
Uafflaîifej
o Induction Agent
Prior to inhalant
Given following premeds
o Immobilization/Chemical Restraint
Examinations and diagnostic procedures
Radiography and radiology
Intradermal allergy testing
o Anesthetic Maintenance
When intubation is not possible (i.e. tracheoscopy or bronchoscopy)
Status epilepticus that is refractory to Diazepam
Constant rate infusion: (0.1-0.25 mg/lb/min)
Duration: 5-10 minutes (It is redistributed to adipose tissue fairly quickly after injection).
Analgesia: only during unconsciousness.
Side Effects: apnea, cyanosis, hypotension.
Extravasation outside the vein causes no tissue irritation.
Because it contains no preservatives, the use of Propofol is limited to one working day.
Whenever a bottle is opened, it is thrown away at the end of the day. With the potential for
bacterial growth, it cannot be kept overnight. The product is not designed to be refrigerated or
frozen, so this will not help extend the shelf life. Wipe stopper with
alcoholfollow sterile technique when drawing up a dose of this induction agent.
It is recommended to give 1/4-1/3 of the calculated dose as a bolus, assess patient, and give
_J
the rest as needed to allow for intubation.
After induction, keep any remaining Propofol in the syringe for the same patient. If the patient
needs a small dose of agent during the transition from Propofol to Sevo, it will be readily
available.
Wipe stopper with alcohol before subsequent withdrawals.
The average dose of Propofol following premedication is 1-3 mg/lb and 2-4 mg/lb if no pre
medication is administered. (Cats often require closer to 3 mg/lb even with Torb and Ace as
pre-meds).
18
MMI BanfwldCopyright 2003
Morphine:
L
L
A narcotic agonist.
Good analgesic properties.
Classic analgesicagonist of Mu and Kappa opioid receptors.
Some respiratory depression, can cause vomiting and causes
Used in the Orthopedic and Ear protocols.
histamine release if given IV (give IM only).

;
lit
M tlOW M!BAttCfl
hot ros irouau. a
KKUIWCAl UK
Fentanyl Patch:
A Mu opiate agonist.
Good long-term analgesic properties (approximately 2-3 days).
Used in Orthopedic protocol in conjunction with Morphine. The
Morphine
goal is to use opioids for orthopedic surgery, then to transition the

patient from opioids to NSAIDS within 2 days and maintain the
patient on NSAIDs thereafter as needed.
As a trans-dermal delivery system, it takes approximately
12 hours to take effect; and in some patients, it may take

up to 24 hours. The patch is best applied to a shaved area.
Skin inflammation and temperature can affect delivery,
L
L
L
L
L
(i.e. increased warmth results in greater absorption and

likelihood of toxicity).
Fentanyl Patch
Anesthesia Induction
Prior to anesthetizing the patient:
Verify pre-anesthesia blood test results completed within 48 hours prior to induction.
Make sure premeds have had 30 minutes to take effect; if insufficient time is given, a much
higher dose of induction agent will be required.
Induction agents are used to facilitate intubation.
Induction doses are administered carefully to effect.
Induction methods should provide a smooth and calm transition to unconsciousness
One of the two most common timesalong with recoverywhen adverse anesthesia events
occur; it is important to monitor patients carefully during the induction phase to prevent
L
L
Patients ingesting the patch may have Fentanyl toxicity.
occurrence of adverse events.
See individual Anesthesia Protocols for appropriate induction agents.
Mask or Tank induction is highly stressful causing catecholamine release. Tank induction has
special OSHA restrictions so is prohibited at Banfield. Mask induction should only be used
when specifically instructed by the protocol.
L
17
Gently squeeze the balloon to determine if there are any leaks.
Once you have confirmed that there are no leaks, deflate the cuff by reattaching the
syringe and withdrawing the plunger to remove the air from the balloon. The cuff must
be deflated before intubation.

o Once the patient is intubated, inflate the cuff as follows:
Insert the syringe at the end of an air line located at the front end of the
endotracheal tube.
Inject air into the line; the balloon at the other end will inflate. Do not overfill the cuff
as excessive pressure can injure the patient's airway. Pressure check the cuffthe cuff
should hold (not leak air around) at 18-20 cm H2O, and should leak before the pressure
hits 25 cm H2O. A small balloon at the end of the air line, just in front of the syringe,
will also inflate, indicating that the cuff is full and no more air need be injected.
Tips for Intubation and Airway Management in Cats
A cat's larynx is very sensitive to mechanical stimulation, is easily
irritated, and can be damaged if mishandled. Laryngospasm is most

likely to occur if forced intubation is attempted while the cat is too
lightly anesthetized. Mild laryngospasms are bothersome; severe
laryngospasms can kill.
Have the proper equipment ready to intubate BEFORE anesthetic

induction. Have several sized endotracheal (ET) tubes handy. Using
an appropriate stylet in flexible tubes is helpful. Use a laryngoscope if

you are having trouble visualizing the larynx.
Make sure the cat is adequately anesthetized before attempting
intubation. Attempting to intubate a cat in a light anesthetic plane
is likely to cause coughing and laryngospasm. Simply increasing
Lidocaine Viscous
the depth of anesthesia will allow intubation in most cases.

Use topical Lidocaine (viscous) to desensitize the larynx. DO
j
j
NOT use Cetacaine (Benzocaine)it causes methemoglobinemia

in cats! Dip the end of a Q-tip in Lidocaine viscous as it works
faster than the injectable. If the viscous isn't available, place a
few drops of injectable or topical Lidocaine on a Q-tip, gently

swab both arytenoids, wait 60-90 secondsit takes time to
workthen attempt intubation. Avoid using too much
Lidocaineit does absorb systemically.
Extend the cat's neck, pull the tongue forward (gently), and
OPEN the mouth by pulling down on the jaw (not the tongue).
Don't use the tongue as a fulcrum. Place the lubricated (with
sterile K-Y jelly) endotracheal tube just in front of the larynx
Intubating a cat
with the bevel ventral. Without touching the arytenoids, wait for
a breath, then gently insert the tube while rotating the tip.
.j
j
j
Telazol (Zolazepam and Tiletamine):
Similar to Diazepam and Ketamine but with greater synergism
Major uses include:
TTLETAMNEHd
andZOLAZffAiVlHC!
o Immobilizationroutine cases
o Fractious Pet protocol
The acfcfiston of 5 mL sterile wate
o IV induction when lipemia is present
tflji&itt ond 501
o Induction for the Ear protocol if no other health problems
ZolazepamDiazepinone minor tranquilizer.
Tiletaminedissociative similar to Ketamine.
Not first choice with known cardiac disease.
It is the safest drug in our pharmacy for the fractious Pet in the
for injection, USP results m cad

one mL containing 50 mg tile
S7.7mg
Telazol81
TILETAMINE HC1
and ZOLAZEPAM HO
Fort Dodge Animal Health

Foit Dodgo, (mra S0501 USA
Cantoa, Puerto Rtoo'a87
absence of information.
Telazol
Intubation
Choose appropriately sized endotracheal (ET) tube (see table in
During intubation, the petnurse supports the patient in sternal
equipment section, Page 27).
recumbency (on their chest) with head up.
Measure ET tube so that it will reach only to the thoracic inlet.
Mark this location on the tube and tie gauze around it at this spot.
If using a stylet, make sure it does not protrude beyond end of ET
tube. Lubricate tube with KY jelly.
While supporting the patient, the petnurse opens the patient's
Stylet inside ET tube
mouth wide and gently pulls the tongue out. (For cats, at this
time, the doctor will swab the vocal folds with Lidocaine viscous,
which helps relax the folds to allow tube placement.) Using a
laryngoscope to visualize the laryngeal folds, the doctor places
the ET tube into the trachea. (Some state laws will allow the
doctor to train the petnurse to do this.)
Once the tube is in the trachea, secure it around the patient's

upper nose or the back of head, using the gauze strip. A rubber
band may be used for small dogs and cats.
The Cuff:
Endotracheal tube with
syringe
o The cuff is an inflatable balloon-like device on the end of the

ET tube designed to close the air space between the outer
'-r '*" '* '
walls of the tube and the inner walls of the trachea, so that the
patient does not breathe around the tube, receiving an inade

quate or inappropriate amount of oxygen and anesthesia.
o Before using ET tube, check cuff for leaks as follows:
Gently inflate the cuff using a syringe of air inserted at the

end of an air line located at the front end of the ET tube.
Watch the balloon inflate. Do not overinflate the cuff as
overinflation will destroy it.
mm
Cuff at end of ET tube
19
Oxygen Flow Rates During Anesthesia
When using the Unilimb (Universal F circuit) anesthesia tubing (a re-breathing system),
current anesthesia protocols call for oxygen flow rates of 3 L/min during the first 3
minutes of anesthesia with the Sevo level at 3% when Pets are induced with Propofol. This
results in a smooth transition from induction to maintenance anesthesia. This is not done with
Telazol induction.
Following the transition phase, oxygen flow rates are decreased to 1 to 1.5 L/min. In the
majority of patients, higher oxygen flow rates are not necessary to maintain oxygen saturation
>94%. Higher oxygen flow rates vaporize Sevoflurane at a faster rate, thus increasing the cost
of anesthesia.
Assisted Ventilation
When assisted ventilation is necessary, it is important to deliver the correct inspiratory

pressure to avoid adverse pulmonary function or complications:
o
12 to 15 cm H2O for small Pets and Pets with chronic pulmonary disease
o 20 cm H2O for medium to large Pets

o 25 cm H2O may be required for giant Pets
Ventilation should be delivered in a manner similar to normal respiration-avoid holding
inspiratory pressure. The manometer should return to zero between breaths when no pressure
is on the bag.
The pressure relief "pop-off valve should be open when not assisting ventilation, and should
A patient under anesthesia that is breathing spontaneously should be bagged twice per minute,
only be closed enough to reach desired positive pressure during assisted ventilation.
not to exceed the pressure listed above.
Patients that are not breathing spontaneously should have assisted ventilation at 10-12 breaths
per minute, not to exceed the pressure listed above.

Fluid Therapy
For healthy patients, hepatic and renal patients, 2.5% Dextrose/0.45% NaCl may help reduce
recovery time as hypoglycemia may result in prolonged recovery time. Dextrose is required
i
*
for the shiver reflex to occur. A shiver reflex is necessary for patients to warm themselves
during recovery.
The use of fluids containing dextrose is avoided in critical cases (cardiac, pulmonary,
abdominal), as hyperglycemia is related to an increased risk of re-perfusion injury in the
event of cardiac arrest.
0.9% NaCl fluid is also preferred in these cases as it does not contain additives that will
If cardiac arrest occurs in other patients, switch to 0.9% NaCl fluids.
Pulse-ox readings are not affected by the administration of Oxyglobin (Hb-200).
interact with emergency drugs.
22
L-i
Tracheal damage can easily occur if you aren't careful. Mucosal irritation can cause a severe
cough after recovery. Tracheal lacerations can lead to SQ emphysema, pneumomediastinum,
pneumothorax, and death. Most lacerations are caused by inappropriate use of stylets,
L
L
improper lubrication, overinflation of the cuff, or twisting of the ET tube when repositioning
the cat. Never allow stylets to extend beyond the tip of the ET tube.
Listen for leaks before inflating the ET tube; if your ET tube is a tight fit, little to no cuff
inflation is necessary. Using the airway pressure gauge as a guide, only inflate to prevent a
leak to a pressure of approximately 20 cm H20. If you are using ET tubes with low-volume,
high-pressure cuffs, be extremely careful about how much you inflate.
.lîMl
ALWAYS disconnect the ET tube from the breathing system before repositioning the cat.
Twisting of the tube in the airway can cause serious damage.
If a patient laryngospasms, place a large gauge needle into the trachea and administer pure O2
until the swelling decreases.
Anesthesia Maintenance and Monitoring

Sevoflurane:
Sevoflurane is a newer gas anesthetic maintenance agent. It has
similar properties to Isoflurane with some differences. It is a

halongenated hydrocarbon (methyl-ethyl-ether) with a lower
L_
solubility than Isoflurane.
This lower solubility allows for rapid changes in the depth of

anesthesiait is quicker to get into trouble as well as to get out
of trouble.This rapid change in anesthetic depth allows for more
precise control, but it also requires closer monitoring. It is much
easier to have a patient extremely deep within a few minutes.
The vaporizer at maintenance levels will normally be set between
Sevoflurane
2% and 3%. The vaporizer setting and end-tidal Sevoflurane
mmmmi
concentration are slightly different. Patients that are ill or compro
mised will often need a vaporizer setting of less than 2%. The goal
of gas anesthesia maintenance is to have the patient at a plane of
anesthesia that is necessary at any given time. Sevoflurane allows
the patient to be taken deeper during the painful part of a surgical
procedure, and then taken to a lower plane of anesthesia for
closure. The end result is less risk to the patient during anesthesia.
Return to full consciousness is generally rapid. This is especially

important in brachycephalic breeds where airway compromise is
Pour carefully into vaporizer
prevalent.
o With consciousness comes airway protection.

o Brachycephalic breeds that wake up faster experience fewer airway maintenance
difficulties.
Premedications tend to decrease excitement during recovery.
Requires a specific Sevoflurane vaporizer.
Breathing circuits: Use circle or non-rebreathing.
21
dryer. This provides warm air in contact with enough surface area to warm the patient.
Warming the inspired air. This can be accomplished by using a warm water trap added
to the anesthesia machine, or by shining a light bulb on the soda lime canister. Care
must be taken to prevent the temperature of the soda lime from exceeding 100F; place
thermometer strips on the canister in various locations to monitor canister temperature.

Warm water blankets are no better at warming a patient than an insulating pad on the
surgery table. Heating pads and warm water blankets don't have enough surface area
^J
contact to warm the patient; they only slow heat loss.
The Shoreline electric heating pad is not designed for use on the surgery table.
It provides excellent supplemental heat for patients recovering in the kennel.
Anesthetized patients placed on heating pads while on the surgery table may develop
thermal skin burns from the pressure/heat contact.
j
***
^J
Anesthesia Monitoring and Emergency Protocol Algorithm
Review this algorithm, [Page 58] keeping in mind the discussion of the ANS and the necessity
of maintaining perfusion/oxygenation of tissues during general anesthesia.
Should a patient's pulse quality or oxygen saturation diminish, the delivery of oxygen and
fluids must be increased.
Should increased oxygen and fluid administration fail to improve the patient's condition, then
Neo-synephrine, an alpha-1 agonist, is given intranasally. A pure alpha-1 adrenergic agent, it
will vasoconstrict arterioles without affecting cardiac output.
If Neo-synephrine does not result in improved pulse quality and oxygen saturation,
Ephedrine is administered IV. Ephedrine indirectly stimulates both alpha-1 and beta-1
agonist activity (causing vasoconstriction and increased cardiac output) by causing the release
of Norepinephrine. Norepinephrine also effects beta-2 adrenergic receptors, but to a much

lesser degree.
Dobutamine, a pure beta-1 agonist, is given IV as a slow drip to increase cardiac output, if the
previous steps fail to improve pulse quality and oxygen saturation.
Epinephrine is given IV as the last step; it is an agonist to alpha-1 's, beta-1 's and beta-2's.
If monitoring End Tidal CO2 (ET CO2), patients should be maintained between
35-50 mm Hg
o Causes of changes in the exhaled concentrations of carbon dioxide (ET CO2):
Increase (>50 ET CO2) caused by:
24
hypoventilation
endotracheal tube that is too small (i.e. narrowed airway)
malignant hyperthermia
sepsis
rebreathing (CO2 is not being removed by soda lime)
administration of bicarbonate
insufflation of carbon dioxide during laparoscopy
MMI BanfleldCopyright 2003
Monitoring
"Death is a late sign ofpoor perfusion. Patients are not fine one minute and dead
the next."Lee Tyner, DVM
The importance of monitoring patients during anesthesia is to evaluate tissue perfusion.
Anesthetics depress autonomic nervous system function. The autonomic nervous system
Ln.,
maintains and manages perfusion.
Monitor multiple systems for trends (see Anesthesia Monitoring and Emergency Protocol
algorithm). The primary cause for crisis during or after anesthesia is the failure to notice a
problem when it occurs.
y^
Three goals of monitoring:
o Anticipate complications
o Recognize complications
o Correct complications
The patient should be continuously monitored until he can maintain a sternal position (i.e.
TPR, PE and level of consciousness are normal), then should be checked at least every 15-30
minutes until ready for dischargebe sure to record/document monitoring in medical notes.
Anesthetic depth and patient condition are dose dependent. As anesthesia dosage
Anesthetic depth is determined by skeletal muscle tone, selected reflexes (i.e. jaw tone,
increases, depth is enhanced and anesthesia safety margins decrease.

withdrawal), and corneal position (i.e central or ventral). Direct response to surgical
stimulation is the most reliable method of determining depth of anesthesia. If uncertain

about a patient's anesthetic depth, assume they are too deep!
lMi
Hypothermia (body temp below 98F) is common after 30 minutes of surgery. Hypothermia
enhances depression (thus less anesthetic agent is required to maintain appropriate depth of
anesthesia), prolongs recovery, and increases stress.
o Signs include:
*****
1^,
j
cyanosis
arrhythmias
cool extremities
decreased respiratory rate
shivering (Shivering increases oxygen and glucose consumption.)
o For every degree body temperature decreases below 100F, the anesthesia requirements
decrease by approximately 5%. (e.g. vaporizer setting of 2.5, patient temperature drops
from 100F to 98F. Anesthesia requirement decrease is 2F x 5% = 10%. 2.5 vaporizer
results in a vaporizer setting of 2.25.
setting x 10% = 0.25 decrease.) The anesthesia requirement with all else being the same
bssi
o It is best to prevent heat loss with pads, warm IV fluids, using warm surgical scrub and
minimal amount of alcohol during the surgical prep. These methods will NOT increase
Lbody temperature, they will only slow heat loss.

o Warming patients can be accomplished by two methods:
LaHnwJ
Surrounding the patient with warm air. Use a trash bag, cut a hole in the bottom of the
bag for the head to protrude. In the open end of the bag, circulate warm air with a hair
23
j
Butorphanol (Torbugesic) Injectable:
Efficacious for mild to moderate pain
o intermediate duration of action

o well tolerated by cats
o produces less respiratory depression than does Morphine or

Oxymorphone
o no histamine release
Dog 0.2-0.8 mg/kg IM, SQ duration 1-2 hrs
Cat 0.1-0.4 mg/kg IM, SQ duration 1-4 hrs
Time to effect: - 15-30 minutes
Reference: Hellber and Gaynor, Compendium Feb 1998.
J
Butorphanol
Butorphanol/Diphenhydramine Oral D&C:
Diphenhydramine injectable (Benadryl) 12.5 to 25 mg. total dose plus Butorphanol injectable
0.1-0.2 mg/lb. Combination may be administered PO every 4 to 6 hours as needed for pain.
D&C over 1-2 days. Dose frequency may need to be decreased if patient is inactive or
lethargic. If greater sedation is desired, increase Benadryl from 12.5 mg to 25 mg.
Example:
25 lb dog:
Diphenhydramine dose
0 .5-1 mg/lb x 25 lb = 12.5 mg-25 mg
Butorphanol dose
0.1-0.2 mg/lb x 25 lbs = 2.5 mg-5 mg
Conversions:
1 tsp = 5 ml; 6 tsp = 1 oz; 30 ml = 1 oz; 4 oz = 120 ml
Injectable Butorphanol
10 mg/ml
Injectable Diphenhydramine
50 mg/ml
To make a 2-oz. bottle:
J
J
6 ml Butorphanol (60 mg)

+ 6 ml Diphenhydramine (300 mg)
+ 48 ml cherry syrup or Hivite Drops
= 60 ml of 1 mg/ml Butorphanol and 5 mg/ml

Diphenhydramine syrup.
Dosage
Give 0.5-1 tsp (2.5-5 ml) of syrup q 5 hours as needed.
Ketoprofen Oral D&C:
Mix injectable Ketoprofen (100 mg/ml) with cherry syrup or Hivite drops and dose
at 0.45 mg/lb q 24 h PO
For smaller or larger patients, the concentration of syrup can be changed to allow for
easier dosing.
Example:
Ketoprofen dose
J
J
20 lb dog:
20 lb x 0.45 mg/lb = 9 mg Ketoprofen SID
Mix
1 ml Ketoprofen added to 9 ml cherry syrup = 10 mg/ml
Dose
20 lb dog dosed at 0.9 ml of mix q 24 h PO.
J
26
L,
Decrease (<35 ET CO2) caused by:
hyperventilation
hypothermia
low cardiac output
pulmonary embolism
accidental disconnection from the anesthetic machine or ET tube extubation
cardiac arrest
If patient has an ET CO2 <35 mm Hg, the frequency of ventilation should be decreased.
If patient has an ET CO2 >50 mm Hg, the frequency of ventilation should be increased.
Recovery
Fractious or dysphoric dogs can be given 0.025 mg/lb Acepromazine IV slowly (maximum
dose is 1.5 mg) to effect for rough recovery (given only during recovery). This will reduce the
dysphoric effects and rough recovery. This is most commonly seen with Telazol usage in dogs.
Continue monitoring TPR and pulse quality until patient is able to sit sternally and is fully
alert; maintain pulse oximeter on the patient until the patient is fully awake (helps to monitor
the patient's ability to transition back to room air from 100% oxygen)document monitoring in
medical record (See monitoring section.)
Deflate the cuff on the endotracheal tube at the first sign of increased consciousness, and untie
the endotracheal tube from the muzzle.
As the patient recovers, the jaw tension increases, and the patient will begin to swallow. As
the patient begins to swallow or move his own jaw, remove the endotracheal tube.
Once the patient is sternal and normothermic, the Pet may be moved to a kennel.
If recovery appears to be slower than normal, check for hypothermia and hypoglycemia.
Correct if present.
Post-operative Pain Management
["ailiiya
See Healthy Pet Protocol and Orthopedic Protocol algorithms.
Ketoprofen (Ketofen) protocol for pain management:
Anti-inflammatory analgesic
o
mild pain relief
o long duration
o tolerated by dogs and cats
Potent inhibitor of prostaglandin synthesis.

Do not use in the presence of renal disease, liver disease,
hypovolemia or hypotension. Do not use with other NSAIDS
or corticosteroids, or in patients with risk of bleeding.
0.45-0.9 mg/lb IV, IM, SQ, D&C daily first 24-72 hrs
Time to effect: ~ 45 minutes
Ketoprofen
25
j
j
j
Universal F circuit
Bain's non-rebreathing circuit
Breathing Circuit Guidelines:
0-4 lb use Non-rebreathing circuit
< 4-20 lb use Pediatric Unilimb* circuit
> 20 lbs use Adult Unilimb* circuit
*Unilimb= Universal F circuit
Oxygen Cylinders
There are various sizes of oxygen cylinders in our practice. Once
you know how much oxygen each tank holds, you can quickly cal
culate the approximate minutes of oxygen remaining in a partial
tank. A full tank (regardless of size) is pressurized to 2000 PSI.
The small E tanks hold 600 liters of oxygen. If you have no backup
E tanks in your hospital, you should not attempt surgery with

less than 500 PSI remaining in your tank.
The watermelon tanks that fit into the back of the anesthesia cart
hold 1200 liters of oxygen. With 500 PSI, you have 300 liters O2
The large H tanks hold 7000 liters O2 and at 500 PSI ('A left),
1750 liters of oxygen remain. If you are running a flow rate of
Soda Lime Canister
1 L/minute, you have adequate O2 delivery for 1750 minutes (29 hours) of anesthesia time.
Usage Stickers for the Soda Lime Canisters
An important step in anesthesia is to assure all anesthesia equipment is in proper working order
and all of the supplies needed for anesthesia are present and up-to-date. One of the most important
maintenance items on the anesthetic machine is the absorber assembly, which contains the canister
for the chemical absorbent (soda lime), that removes carbon dioxide from the rebreathing circuit.
The canister filled with absorbent is a common area for malfunctions in the circle system, and a
source of resistance during ventilation. It is removed regularly to change the soda lime, and leaks
can result from failure to create a tight seal when replacing the canister. Proper packing of a canis
ter is necessary to prevent flow of gases over a single pathway inside, creating excessive dead
space. Gently shake the canister when filling it with soda lime to prevent loose packing and reduce
channeling. Packing too tightly causes dust formation and increases resistance to ventilation.
It is important to understand the function of the chemical absorbent. Depending on the fresh gas
inflow, all or part of the exhaled CO2 may be absorbed chemically. Chemical absorption of the
28
J
''Wiirtiii
Anesthesia Equipment
Recommended IV Catheter Size:
Pet Weight
Catheter Size
> 35 lbs
18 gauge
20-30 lbs
18-20 gauge
4-20 lbs
22-20 gauge
<4 1bs
24-20 gauge
IV Catheters: 20, 22 and 24 gauge
Anesthetic Re-breathing Bag Size:
Pet Weight
Bag Size
0-10 lbs
1/2 liter bag
10-20 lbs
1 liter bag
21-60 lbs
2 liter bag
61-120 lbs
3 liter bag
121-160 lbs
5 liter bag
Endotracheal Tube Selection:
The tube sizes indicated are approximate. The
Re-breathing bags: 1/2 to 5 liter
largest tube that will fit easily without trauma is

recommended.
W^2;/-J.,?,!-y-.\--; r .
Tubes must be clean and in good condition.
Cuffs should be tested for integrity before use. Do not
After use, tubes should be cleaned in mild detergent
Rinse in dilute solution of surgical disinfectant
spfe
overinflate (in-patient or out).
inside and out.
SbBI
and let air dry.
Lubricate with KY before intubation.
Maximum cuff pressure should be 25 cm H20 dogs
Endotracheal tubes, including one with cuff
and 20 cm H20 cats; air should leak when patient is

"bagged" to this pressure.
ET Tube Size for Dogs
ET Tube Size for Cats
Wt. (kg)
Wt. (lbs)
Tube size (mm)
4.4
2.2
8.8
4.4
11.0
15.4
19.8
12
26.4
14
30.8
20
44.0
10
30
66.0
12
40
88.0
14
MM] BanfieldCopyright 2003
Wt. (kg)
Wt. (lbs)
Tube size (mm)
27
When soda lime
Chan tied:
stickers need to be
replenished, they can
be ordered through
HOEP (PW # 80608).
Initials:
00 00 00 00 op 000
00 00
0000
00 00
1
5-6 hours
11
&
Anesco/Surgivet
JO
Matrix VMS
LEI Medical
8-10 hours
and VASCO
10-12 hours
Check 1 box for every 15 minutes of anesthesia time

Replace soda lime once maximum time is reached
Change soda lime every 30 days, even if the
Bantield
maximum anesthesia time has not been reached.
Soda lime sticker
Pop-Off Valve
Prior to connecting a patient to the anesthesia machine, make sure the pop-off valve is open. If
the valve is closed to assist ventilation, the anesthetist should keep their hand on the valve until it
is reopened to prevent excessive pressure build up that could result in patient death.
Evacuation system
If the active waste gas evacuation (scavenger) system is
out of balance, anesthetic gases will adhere to the first

lawanesthetic gases will follow the path of least resist
ance. If negative pressure is applied to the pop-off valve

on the rebreathing head or the bag bleed valve on the
non-rebreathing system, the patient may not be getting

the proper dose of anesthetic.
Solution: Evacuation system must be hooked up and
adjusted properly.
Waste gas interface
"MlliMiir
One end of 22 mm translucent white corrugated
tubing attaches to the fitting in the ceiling, the other end attaches to the waste gas interface
valve on the machine. Note: do not connect 22 mm tubing from the ceiling directly to pop-off
valve or bag-bleed valve!
One end of the 19 mm evacuation, blue corrugated tubing attaches to either the pop-off valve
on the rebreathing head (or the bag bleed valve on the non-rebreathing system), the other end
attaches to the waste gas interface valve on the machine.
The ceiling adjustment handle must be in the proper position to attain the proper negative
pressure. This is approximately at a 45-degree angle. Newer hospitals will not have an adjustment
handle because the new waste gas interface, as noted in the photo, has an auto-regulation feature.
*U
.J
CO2 enables a lower flow of fresh gas, reduces waste of inhalant anesthetics and oxygen, and
minimizes the cost of anesthesia. Calcium hydroxide is the primary component of soda lime.
During evaluation of a rebreathing system, the anesthetist should confirm that the soda lime is
functional. Fresh granules are soft enough to be easily crushed, while expended granules have
chemically changed to CaCC>3 and are hard. Indicators of pH are added to the absorbents to
reflect color changes as chemical reactions occur. Soda lime changes from white to violet as the
granules are exhausted, but the violet color may revert to white during storage. [Do not wait for
color change to replace absorbent.]
When soda lime granules are exhausted, CO2 is not effectively removed from the rebreathing
system, increasing the potential for hypercapnia. Hypercapnia leads to respiratory acidosis, and
has been associated with increases in vagal tone, slowing of heart rate, development of cardiac
arrhythmias, and even cardiac arrest. Elevated levels of CaCO2 have also produced narcosis in
the dog. Lethal carbon monoxide may also form and be delivered to the patientCO combines
with hemoglobin to form carboxyhemoglobin and blocks the uptake of oxygen by erythrocytes,
leading to fatal hypoxemia. Therefore, soda lime must be changed routinely.
Soda lime should be changed based on anesthesia time. The following are guidelines based on
the type of canister and amount of soda lime each canister holds. Please note that these figures
are general guidelines only. The tidal volume of the patient is the determining factor; i.e. the
larger the patient, the more CO2 is produced and the faster the granules may be exhausted.
The LEI Medical and VASCO (big fat) canisters are 1800-1850cc and hold one full bag
(3 lbs) of soda lime. The absorbent has an expected life of 10-12 hours of anesthesia time
or 4 weeks maximum exposure to room air.
The Matrix VMS canister holds 1500cc and the absorbent lasts for 8-10 hours of anesthesia
time or 4 weeks maximum exposure to room air.
The Anesco/Surgivet (long skinny) canister holds holds 900 cc, sufficient absorbent for
5-6 hours of anesthesia time or 4 weeks maximum exposure to room air.
Remember that soda lime MUST be changed every 30 days, even if the maximum
anesthesia time has not been reached.
Reference: Hartsfield SM. Anesthetic Machines and Breathing Systems. In Lumb and Jones
Veterinaiy Anesthesia, 3rd ed. Baltimore: Williams and Wilkins, 365:1996
In an effort to assure that soda lime is changed in the appropriate time frame, each hospital
receives a roll of 3 x 5 stickers to place on the soda lime canister.
For each hour of anesthesia, a large box is marked off. When the maximum number of anesthesia
hours have been reached:
The sticker is removed
The soda lime is changed
A new sticker is placed on the canister.
zy
Regulator
The oxygen regulator is a medical grade, preset, non-adjustable

regulator designed to reduce oxygen tank pressure from approxi
mately 2100 psi (when full) to approximately 50 psi. The oxygen
regulator can fail resulting in pressure being too high or too low.
A high-pressure failure of the regulator may result in one or more of

the following:
Failure of the oxygen quick disconnects
Failure of the oxygen check valves in dual gas supply
Failure of black tubing
Failure of oxygen flush
Oxygen leak from regulator
Oxygen Regulator
A low-pressure failure of the regulator may result in one or more of the following:
Improper or insufficient oxygen flush
Improper or insufficient oxygen delivered to patient
Failure of oxygen to pass through the regulator
Solution: if any one of the above conditions exists, replace oxygen regulator. Call CTS Facilities
Hotline, 5566 before proceeding.
Manometer
The needle on the manometer gauge should be at zero. The re-zero

screw is located at the 12 o'clock position (top dead center) under
the crystal manometer cover. Remove the cover by turning counter
clockwise. Adjust the screw mechanism until needle is zeroed.

Replace manometer cover.
If the manometer will not re-zero, or if needle will not deflect

proper pressure, it should be replaced.
If the manometer cover is cracked, broken, or missing, it should

be replaced.
Manometer
Vaporizer and Anesthesia Machine Service Schedule
Vaporizer service: Because Sevoflurane is a relatively clean anesthetic, LEI Medical recom
mends that Sevoflurane vaporizers be professionally cleaned and calibrated every three years.
Two years after the initial cleaning and calibration date, LEI Medical will perform the following:
Leak test of the vaporizer
Output test of the vaporizer using Lamtec 605 infrared spectrophotometer or Riken analysis
A written report as to the status of the vaporizer.
Six years after the initial cleaning and calibration date, the vaporizer will be exchanged for a
freshly cleaned and calibrated vaporizer.
32
MMl BanfieldCopyright 2003
frMt-iiJfff'l
If the waste gas interface valve is bypassed, and the negative pressure
from the evacuation system in the ceiling is applied directly to the

anesthesia system's pop-off valve or bag bleed valve, the anesthetic
procedure will be compromised.
All Banfield hospitals should have a scavenger system. This system

has been installed for the safe and complete removal of exhaled
anesthesia gases generated during a surgical procedure. It is utilized
in conjunction with the anesthesia machine. If you have an "F-Air
baiMal
Canister" and not a fan-style system, contact the CTS Facilities Hotline.
The scavenger unit is a UL-approved, custom-made exhaust fan
housed in a 12-inch by 12-inch by 6-inch stainless steel box. This box
Evacuation System
is mounted above the ceiling tile in your hospital. It has been designed
kiajMi
to draw in exhaled anesthesia gases and then expel those gases through a pipe through the roof of
the building, to the outside.
The system itself consists of preset balancing valves (gate valves with a three-quarter-inch copper
or white-painted pipe extending 7-12 inches below it) coming down out of the ceiling in the sur
gery and treatment rooms. The clear plastic tubing that comes with the anesthesia machine con
nects from the anesthesia machine to the end of the balancing valve. The balancing valves are
connected above the ceiling tile in both rooms to a series of horizontal 3-inch copper piping,
which is connected directly to the scavenger unit intake opening. Once the exhaled gases are
drawn up through the balancing valve and piping into the unit, they are then pushed out into a 3-
inch copper pipe leading up through the roof to the outside.

The scavenger unit is commonly located above the ceiling tile, in close proximity to the surgery
room balancing valve (call CTS Facilities Hotline for exact location). The scavenger unit is either
plugged into a 110 electrical outlet or wired directly into an electrical box above the
ceiling tile. This unit is turned on and off by a lighted wall switch commonly located inside or
directly outside the surgery room. (If the switch in your hospital is not a lighted one, please
contact CTS Facilities Hotline for assistance.) All scavenger units are equipped with a fusible
link to prevent motor damage or tripping the electrical circuit.
It is very important to turn off the scavenger unit when not in use. This unit was not designed to
run continuously, and if left on constantly, the life of the unit will be severely compromised.
Older hospitals may have a scavenger unit located below the ceiling tile in the maintenance
room. This unit is turned on and off by means of a toggle switch located on the unit itself.
This unit's piping system above the ceiling is the same as all others.
l:i.'JM^MtJ
Please keep in mind many new team members do not know what a scavenger system is, what it
does and where the on-off switch is located. Use the label printer to make a "Scavenger" label to
place on the on-off switch cover plate for easy recognition.
31
Anesthesia Machine
To Ceiling Exhaust Vent

Ensures correct pressure so that
Flowmeter
used gas will leave the system.
Measures amount
Removes CO2
of oxygen flowing
Soda Lime
Canister
Waste Gas
Interface
(Scavenger)
Adds anesthesia
to oxygen
i*i
''
Expiratory
Inspiratory
Out_
% n^n \M
valve
Pop-off valve can

be closed to stop
gas from leaving
the system.
only
This is done in
conjunction with
squeezing the
rebreathing bag
to fill the Pet's
Manometer
Only flows when oxygen

flush button is pushed. This
delivers pure oxygen to Pet
| ] lungs to assist in
Adjustable component
breathing. The
pop-off valve
must be
reopened after
this procedure.
Oxygen
Inhaled
To Pet
Oxygen with Sevoflurane
L.
"Exhaled
Oxygen with exhaledc=>

Sevoflurane and CO2
L.
L_
L_
L
^
Fill new vaporizers with Sevoflurane and let sit for 24 hours to
"charge" the wick in the vaporizer. After 24 hours, check
Sevoflurane levels in the vaporizer and refill as needed.
L
r
1 'îkmi
Anesthesia Machine service: After two years' use in the hospital,
the entire anesthesia device will be serviced. The service will

include (but not be limited to) the following:
Replace all black tubing
Replace all seals
Replace top canister gasket
Replace bottom canister gasket
Replace dome "O" rings (two each)
Replace downtube "O" ring
Leak test high pressure system
Leak test low pressure system
Inspect pop-off valve pressure
Inspect waste gas interface device
Re-zero manometer
Install mechanical stop oxygen flow control assembly (if not
Vaporizer
Anesthesia Machine
previously upgraded)
Adjust existing mechanical stop oxygen flow control assembly if necessary
Inspect all components for proper fit, alignment, adjustment and operation
Disposable items will not be inspected nor replaced at the two-year service. It is up to the
individual hospitals to ensure that their rebreathing sets, rebreathing bags and non-rebreathing
systems are in proper condition for use.
L
L
10 Second Leak Test
Before each use, check for pressure leaks in the system and make sure the waste gas evacuation
system is working properly.
1. Close the pop-off valve and cover the end of the anesthesia tube with your palm or finger,
or plug.
2. Push the oxygen flush button or turn on the flowmeter until the bag is distended.
3. Turn the oxygen off and watch the manometer. If the manometer reading drops rapidly, if the
bag deflates rapidly, or if you hear a hissing sound, you have a leak.
4. Check hoses, bag, vaporizer inlet and outlet, any mechanical fittings, and the seals of the
canister seals for leaks. When the pressure remains fairly constant, with the oxygen turned off,
the machine can be considered leak-free on the low pressure side.
5. With thumb still over the end of the anesthesia tube, reopen the pop-off valve to usual setting.
6. Squeeze the bag (with your thumb still over the end of the anesthesia tube) to ensure the gases
have an unobstructed path out of the evacuation system.
33
Problem
Too much pres
Diagnosis & Solution
If pop-off valve resistance too high, open the pop-off valve more.
sure in breathing
Check for obstruction in system.
circle, or bag fill
Check O2 flow rate (it may be too high). Normal rate is 1-1.5 L/min.
ing up too much
To maintain proper circuit pressure, close the pop-off valve until bag fills to proper
fullness. Gases follow the path of least resistancethe rebreathing bag will fill
until the tension on the bag is equal to or slightly greater than the resistance on the
pop-off valve. Every pop-off must have resistance to keep the gases within the
breathing circle (they are one-way valves).
Vaporizer not
When vaporizers fail, they usually fail on the low side. It is very rare that vaporizers
working (rare)
fail on the high side, but it can happen. Though it is rare, it is possible that the
vaporizer output is not accurate within acceptable limits. The system is serviced
every 2 years and requires no routine maintenance in between. Before sending

vaporizer in for service, check a number of parameters:
First, check evacuation issues (previous page).

Second, check for leaks in the system. If evacuation issues and leaks are
addressed and those systems are functioning properly, check the following:
o Ensure vaporizer is full of anesthetic.
tvmd$;i,i\
o Ensure manifold inlet and outlet adapters are pressed snugly onto
vaporizer manifold.
o Ensure vaporizer drain is tightened down.
o Ensure vaporizer fill cap is tightened down.
o New vaporizers require 24 hours for the wick in the system to fill.
Refill after the first 24 hours to make sure the system is fully charged.
Is it a leak on the high pressure side? High pressure part of system is from the
oxygen tank to the back of the flowmeter. Test for high pressure leak:
Can you hear it?
Spray Windex on fittingsif it bubbles, you have a leak. Never spray

petroleum products on the oxygen system.
Turn off oxygen flowmeter. Turn on oxygen tank. Watch oxygen tank
pressure gauge on regulator. When needle on gauge is stable, turn off
f'liMii*
oxygen tank. If needle drops, you have a leak (The faster the needle
drops, the bigger the leak). Possible sources of leak:

o Oxygen hose nut not tightSolution: tighten with crescent wrench.
o Oxygen flowmeter flow control assembly stuck in open position. Float

(ball) in flowtube will not go to zero. The float may be stuck in
flowmeter such that it is perceived that oxygen is flowing, when it is

not. Debris in the flowmeter may be causing it to failSolution:
Replace oxygen flow control assembly.
o Oxygen flush seal defective (very rare). Oxygen will leak past oxygen
flush valve and dilute the concentration of anesthetic in the breathing
circleSolution: replace entire oxygen flowmeter and flush assembly

36
Trouble Shooting Guide
Problem
Can't keep patient
1. Check for right bronchus intubation (extremely frequent). Endotracheal tube
downvaporizer
that enters the right bronchus limits anesthesia gas to one lobe of the lung. The
at 4% or higher
vaporizer concentration must be higher to reach the same plane of anesthesia.
and patient is still
Back out the endotracheal tube.
waking up
2. Check for improper evacuation system setup (extremely frequent). The scav
enger system has too much suction and thus pulls anesthesia through the sys
tem. Make sure the scavenger system is connected to the scavenger interface
system. This will look like a black box on the back of the anesthesia machine.
The older style will be the size of a food can that contains a flipper. Make cer
tain the flipper is fully open. Use the scavenger draw meter to test the suction
level of the scavenger fan. This is a small plastic tube with a foam ball inside.
The foam ball will float within the marks if suction is functioning correctly.
Check for leak in system (common).

4. Check to make sure vaporizer is working and it is not empty (uncommon).
Leaks
Windex cleaner can be used to determine leaks on both the high-pressure and low-
pressure side. Small bubbles less than 1 mm in diameter are acceptable. Large
obvious bubbles are not acceptable.
1. High-pressure side leaks may or may not influence anesthesia.
A small to moderate oxygen leak on high pressure will not affect

performance of the vaporizer if oxygen flowmeter is supplied enough
oxygen to read minimum 500 cc per minute flow.
High-pressure leak results in waste of oxygen.
A large leak which precludes proper use of oxygen flowmeter will affect
anesthesia. It does not affect exposure of surgical personnel to inhalant

anesthetic.
2. Low-pressure side leaks usually influence anesthesia.
With positive pressure within the breathing circle (when the patient
surgical personnel.
With negative pressure within the breathing circle (when the patient
inhales), a large enough leak can draw in room air, thus diluting the
concentration of anesthetic within the breathing circle. (Patient's dose of
The larger the leak, the bigger the problem.
exhales), anesthetic gases could come out into the room and expose
anesthetic is reduced and may become "light.")
Oxygen will not
Check to see if oxygen tank is not turned on or is empty.
flow
MMl BanjieldCopyright 2003
35
J
îiî^îw;iij^!i;
Problem
Vaporizer not
o Pop-off valveif pop-off valve has too much resistance, the
working (rare)
rebreathing bag will fill (look balloon-like) and the manometer will
(continued)
read higher than 3-4 cm of water pressureSolution: remove
defective pop-off valve and install new pop-off valve. (This service
is provided at no charge, parts and freight.)
o Pop-off valveif pop-off valve has too little resistanceSolution:

close valve (turn knob clockwise) until bag fills to proper fullness.
o Rebreathing bag (very frequent)inspect rebreathing bag for holes,
cracks and leaks. (Porous tape will not stop a leak in a rebreathing
bag.)Solution: if bag is cracked, has holes or in any fashion lacks
integrity, remove and replace with new rebreathing bag.
o Rebreathing hosesinspect rebreathing hoses for holes, cracks, and
leaks. Windex can be used for this purpose. Look closely at collars,
Y-piece, and where tubing joins collarsSolution: if corrugated tub
ing comes off collars easily, or if collars are missing entirely, discard
tubing, or, if cracks appear at any point on rebreathing hoses, discard
entire set (do not try to replace broken fitting and replace with new).
Oxygen will not
Check non-mechanical stop-flow control (identified by a green plastic knob).
flow or will not
Oxygen flow control assembly (found on earlier models) may be damaged. Over
shut off
tightening of oxygen flow control assembly results in damage to seat (oxygen

can leak past seat so that oxygen flow cannot shut off) or damage to needle valve
(needle valve can break off in seat which prevents flow of oxygenknob and
shaft continue to turn without oxygen flowing).
If oxygen flush does not work, check to ensure that oxygen tank is on
(open tank valve by several turns).
If oxygen flush does not work and oxygen flowmeter does not work and
tank is on, the regulator needs to be replaced or the oxygen tank needs
to be replaced.Solution: try another oxygen tank, if problems persist,
change out regulator.
If non-mechanical stop-flow control is deemed defective, it will

be upgraded to a mechanical stop-flow control.
If mechanical stop oxygen flow control assembly (identified by green decal in

center of silver knob) is leaking (float does not come to rest at zero on the bot
tom of flow tube), the float may be stuck in flowmeter such that it is perceived
that oxygen is flowing, but it is not. There may be debris in the flowmeter,
causing it to failSolution: Remove the old flow control assembly and install
new mechanical stop oxygen flow control assembly.
38
kaasaJ
Problem
(rail system), or replace oxygen flush only in Compact-W.
Vaporizer not
working (rare)
Loose fitting on back of flowmeter (rare)Solution: tighten fitting

with crescent wrench.
(continued)
Faulty check valve in dual gas supply (very rare)Solution: replace

check valve.
Is leak on the low pressure side? Low pressure part of system is from the oxygen
flowmeter control to end of "Y" on rebreathing head or elbow on non-rebreathing

system.
L-
Perform the 10-second leak test. Possible sources of leak:
o Cracked lid in the soda lime canister (rare)remove canister and lid
and inspect lid for cracksSolution: if lid is broken, cracked or

chipped, replace lid assembly.
o Cracked canisterinspect canister for cracks, looking for chips out

of top and bottom rim where canister seats against gaskets (top and
bottom)Solution: if canister is broken, cracked or chipped, replace

canister.
o Crack in black tubing (rare)inspect all black tubing for cracks,
especially where tubing connects to hose barb fittingsSolution: if
cracked tubing is found, replace entire length of tubing between each

hose barb (remove tube, measure length, order appropriate length
and replace), or, if crack is at hose barb fitting, remove hose, snip-off
cracked portion and replace tube on hose barb.
o Gasket (seal) at top and bottom of canister defective (possible)
inspect gaskets, top and bottom, for defects, dents, holes, or carbon
dioxide absorbing material. Gaskets should have a smooth surface
without holes or dents. If carbon dioxide absorbing material in gas

ketSolution: clean off with plain water. If dents or holes or gasket
has imperfections and will not sealSolution: replace it. Order gasket
(with "O" rings) kit. Replace all "O" rings and gaskets.
o Dome "O" ringsinspect "O" rings for cracks, unscrew dome counter
clockwiseSolution: if cracked, worn, or defective, replace "O" ring.
Order gasket kit. Replace all "O" rings and gaskets.
o Inlet and outlet adapters on vaporizer (rare)inspect inlet and outlet

adaptersSolution: push adapters onto vaporizer manifold to ensure
tight seal.
o Common outletinspect for cracksSolution: if cracked, replace.

o Pop-off valveinspect area adjacent to pop-off valve for leaks (rare).
Spray Windex at base of pop-off and block which houses pop-off

Solution: if leak is at base of pop-off, remove valve, use Teflon tape
on threads and reinstall or, if leak is where pop-off valve mounting
block joins to rebreathing head, replace rebreathing head. LEI Medical

will replace rebreathing head block at no charge.
37
Banfield Anesthesia Protocol
J
J
History
J
'
Fractious Pet?
Fractious Pet
Protocol
No,
JL
.J
I
Healthy Pet
Lipemia
Liver
Renal
Cardiac
CNS/Eye Globe
Protocol
Protocol
Protocol
Protocol
Protocol
Protocol
Feline Declaw
Orthopedic
Pulmonary
Ear
Abdominal
Emergency
Stable Diabetic
Protocol
Protocol
Protocol
Protocol
Protocol
Protocol
Protocol
Post-operative
Pain Management
40
I-I
L
r
Section 2:
The Banfield Protocols
L
L
L
L
L
L
L
39
Canine/Feline Anesthesia Physical Examination

Goal: Determine health status prior to induction
Patient
History & Drug Therapy

Bleeding Disorders
S Fractious Pet: Goal is to immobilize, obtain blood sample,
Hyperthermia
place IV catheter, and perform examination/patient evaluation
Anesthesia Problems
Weight
immediately. Immobilizing agent should serve as pre-med or
Shunts
induction agent.
Myopathies
S See Fractious Pet Protocol
Pre-existing Organ
Complete Physical
Compromise
Examination, Internal
Organ Screen, CBC with
Examination - 5 Steps
differential
Capillary Refill Time:
Mucous Membrane
Auscultate Heart:
<2 sec = Normal:
Color:
if normal proceed w/
proceed w/exam
Pink = Normal;
exam
> 2 sec = Abnormal:
proceed w/ exam
(evaluate for shock) if
Abnormal color:
pulse quality normal
evaluate HCT &
proceed
Hgb - if normal
proceed w/ exam
Hypothermia:
Normal Air
Murmur
Present
2.5% dextrose in
with exam
0.45% NaCL IV &
movement, non-
Consider congenital heart
proceed w/exam
problem or physiologic
Ratio < 0.95 = Abnormal:
murmur. Perform
so to Cardiac Protocol
Movement: proceed
Abnormal: (no
Ratio > 0.95 = Normal:
Mature Pets:
compliant, dry/moist
If no improvement,
& look for other
rales) = postpone
anesthesia if possible
exercise tolerance lest *.
proceed to
& make diagnosis.
Flyperthermia:
Physiologic murmur
Cardiac Protocol.
Suspect acquired
to Cardiac Protocol.
WBC count. If
Pulmonary Protocol.
elevated postpone
anesthesia (if
Is Pet Obese?
Finn & steady = proceed
If ejection/systolic
Abnormal = go to Cardiac
murmur present,
consider stenosis.
Obese Pets:
Refer unless
proceed to
emergency.
Abnormal Heart Rate Values (awake Pet)

Small dog < 100, > 140
Medium dog <80, > 140
Large dog <60, > 100

Cat<120,>160
If HR less than above go to Cardiac Protocol. With
possible).
Otherwise, give
IV 0.9% NaCL
and IV Cefazolin
only. Proceed to
appropriate
Pulmonary Protocol
protocol.
For Hyperthermic Giant & other High Risk Breeds: Give

Acepromazine: 0.025 mg/lb (max of 1.5 mg) SQ
Butorphanol: 0.1-0.2 mg/lb (max of 5 mg) SQ
IV LRS
If no temp change, R/O malignant hyperthermia, postpone

If temp normal, go to Healthy Pet Protocol, but use NO additional
0.4 mg).
premeds.
If HR greater than above & no Glycopyrrolate or

Atropine has been given, go to Cardiac Protocol & R/O
anesthesia & recheck in one week.
normal ECG, give Glycopyrrolate 0.005 mg/lb (max of
reasons for tachycardia.
l:MHin
(>103F) Check
Otherwise, see
[Evaluate Pulse Quality:
Protocol
postpone anesthesia
cardiac disease &
should resolve. If not, go
42
(<99F) Give warm
warm Pet.
Evaluate Femoral Pulse
Rate/Heart Rate Ratio:
Temperature
Auscultate Lungs
Hxcrcise tolerance test: Perform liCCi & immediately walk dog vigorously
for 10 min. Recheck ECG. Normal = heart rate increase is less than 25%
of pro-walk IIR and rate returns to normal within 5 min.
laa^,S({i|
Anesthesia Cycle
Discontinue Sevoflurane
Check Anesthesia Equipment *
^^"^
Continue Oxygen for 3-5 Minutes
Fractious Pet? - Telazol Protocol
Evaluate Patient/Cardiovascular System **
Perform PE, Draw Blood, & Place IV Cath
Remove ET Tube When Patient Swallows
Monitor Continuously Until Patient
Select Anesthesia Protocol
Record Anesthesia in Medical Records
Using Anesthesia Stamp***
Select and Administer Premeds *****
Wait 30 minutes for Full Premed Effect
Observe Patient for Minimum of 2 Hours
L
\
Update Soda Lime Hour Usage
L*
Review Blood Test Results **
Sternal and TRPWNL
Review & Document PE Findings **
Phase 4
Phase 3
Phase 1
Phase 2
Perform Surgical Prep and Move Patient
Administer Induction Agent
/
/
Place Endotracheal Tube & Secure
Evaluate and Document Patient
Anesthesia Monitoring Parameters
Attach Patient to Anesthesia Machine
i /
Adjust Anesthesia Based on Patient Needs
Attach ECG Leads, Pulse Ox & Fluids
Evaluate Patient Temp Every 15-30 min ****

--____
All anesthesia equipment should he checked and in working order. Check anesthesia machine for leaks and assure soda lime remaining hour
usage meets or exceeds expected procedure time.
**
Abnormalities should be further evaluated and corrected prior to anesthesia - document in patient file.
**
Indicate rebreathing vs. non-rebreathing system; Initial & maintenance O2flow rate and Sevo %; Pulse Ox readings; ET tube size; Drug doses
and routes; TPR (pre-induction, intra-op, post-op, and pre-release); Fluid type and rate; Anesthesia and recovery time
**
If low, actively warm patient (warm IV fluids, warm inhaled air)
:**
Ifpatient is apparently healthy and may be difficult to handle a second time, healthy Pet pre-meds may be given at the time blood is drawn and
catheter placed; if abnormalities are discovered on blood work, anesthesia should be delayedfor at least 24 hours.
41
j
Healthy Pet Protocol
Premed: Acepromazine 0.025 mg/lb plus Butorphanol 0.1-0.2 mg/lb SQ-Cat/IM-Dog
Healthy Pet
Protocol
Wait 30 minutes
Induction: Propofol to effect 1-4 mg/lb IV
Maintenance: Sevoflurane 1-4% to effect, inhaled

Support: 2.5% Dextrose/0.45% NaCl at 5-10 ml/lb/hr IV
Perform a complete physical examination and pre-anesthetic blood work prior to any pre-anesthetic or anesthetic
drug administration. Fractious patients are the exception and the Fractious Pet Protocol should be followed.
Pre-anesthesia blood work includes a CBC with differential and Internal Organ Function Screen. Perform these
tests within 48 hours of anesthetic induction.
Maximum dose of Acepromazine is 1.5 nig.
Maximum dose of Butorphanol is 5 mg. Additional amounts of Butorphanol at a pre-anesthetic dose may be
given every 1-2 hrs as needed for post surgical pain control.
Premedications administered SQ or IM may need to be diluted before administration to improve drug uptake.
Minimum total volume administered should be 0.5-3 ml depending on patient size. Dilute with sterile water to
final desired volume.
Acepromazine should be prediluted to 1 mg/ml in a separate vial to allow proper dose administration.
Allow 30 minutes for premeds to take effect prior to induction of general anesthesia.
Assess cardiovascular parameters after premeds have taken effect and prior to induction.
If premeds given > 3 hrs prior to induction, repeat premeds at 1/2 dose 30 minutes prior to induction.
Propofol should be administered slowly to effect to minimize adverse cardiovascular effects. Bradycardia may
develop after rapid administration.
The average dose of Propofol following premedication is 1-2 mg/lb for dogs and 2-3 mg/lb for cats.
Due to Propofol's rapid induction and rapid elimination (approx 3-5 minute window of duration) the technique
of "overpressure" is required to assure a smooth transition to Sevoflurane. For "overpressure," Sevoflurane
delivery concentrations should be set at 3% using an oxygen flow rate of 3 L/minute for the first 3 minutes
(3%/3 L/3 min). For this technique to be effective, the respiratory rate must be near normal, or assisted
ventilation is used to assure adequate intake and uptake of the inhalation agent. Following the initial 3 minutes,
the oxygen flow is decreased to 1-1.5 L/min, and Sevoflurane concentration is adjusted "to effect."
If running Sevoflurane at 4% or above, look for system leaks, improper intubation, or inadequate oxygen flow rate.
Antibiotics other than Cefazolin must be administered a minimum of 1 hour prior to anesthesia or following
complete recovery.
It is best to avoid vaccinations in association with general anesthesia. If vaccines must be given, wait until the Pet
has fully recovered for at least 2 hours.
POST OPERATIVE (SOFT TISSUE SURGERY) PAIN MANAGEMENT RECOMMENDATIONS FOR HEALTHY
DOGS AND CATS:
Post-operative Butorphanol at 0.1-0.2 mg/lb IM (max 5 mg per each dose) can be given when Sevoflurane is discontin
ued as long as previous dose was at least 1 hour prior and the Pet's temperature is > 98F.
Post-operative Ketoprofen at 0.9 mg/lb IM (single dose only), can be given when Sevoflurane is discontinued as long as
Pet is well hydrated, has received intra-operative fluids and no risk of significant hemorrhage exists.
Continue Butorphanol at 0.1-0.2 mg/lb IM (max 5 mg per each dose) q 1-2 hours as needed if Ketoprofen alone does
not allow the Pet to be comfortable, NOTE: Dysphoria is common with Butorphanol.
If patient seems excitable or agitated, an additional dose of Acepromazine may be indicated if it has been at least 4
hours since the previous dose and pulse quality and color are good. Then give 1/2 of the premed dose of
Acepromazine.
Do not confuse pain with dysphoria.
44
/ftjiraffi^^

Platelets, Clotting
HCT, Hgb, RBC#
Problems
MCV, MCH,MCHC
WBC Count
pediatric)
ZTZZ
HCT < 25% and/or Hgb < 10,
Platelet < 125,000, VWB + or
postpone or transfuse prior to sx.
other clotting disorderpostpone or transfuse (use FFP
If HCT > 40% (cat) / > 45% (dog * ),
or fresh whole blood) prior to
see Pre-Renal Azotemia protocol.
If above values are abnormal,
WBC < 4000 or > 15,000
review blood smear.
surgery.
If other abnormalities, use

appropriate protocol. Give
Diphenhydramine I mg/lb IM (max
Confirm Pit abnormality/
clotting problem by reviewing
dose 50 mg) 30 minutes prior to
transfusion & DO NOT use

Acepromazine premed. Look for
If neutrophilia with left shift,

postpone surgery & make
blood smear, checking BMBT
diagnosis. Otherwise, see
& ACT.
Abdominal Protocol
L
L
check Pet with pulse ox.

If oxygenation low, check liver
function.
If MCV low, check bile acids.
Postpone surgery if possible.

Select Liver Protocol if PSS.
underlying cause.
(normal will vary adult vs.
BUN/Creatinine
Ca++
ALT/Bilirubin/ALKPhos
Low- go to Liver Protocol.
If elevated, look for renal
If high, evaluate for liver disease. If
High- proceed to next block.
disease or neoplasia
T. bili < 2.0, check bile acids &
(lymphoma, perianal).
evaluate electrolytes. Consider
Give plasma if possible
radiographs & ultrasound.
(administer Diphenhydramine 1 mg/
If low, check albumin &

consider Addison's.
Elevated BUN & Creatinine:

Palpate bladder-
if obstructed do UA by
cystocentesis & go to
Albumin/TP
If TP < 3.5, look for cause.
1b [maximum dose 50 mg] IM prior

to infusion, wait 30 minutes).
If electrolytes abnormal, treat as

cardiac case.
Go to cardiac workup &
If liver dz present, avoid using
perform ECG, if normal
Acepromazine & proceed to Liver
proceed.
Protocol.
Remove Acepromazine from

premed. Go to Healthy Pet
Protocol if no other
abnormalities.
post renal protocol.
BUN elevated & Creatinine

normal: consider GI
K+
bleeding.
Check UA:
ViimzA
High USG:
[> 1.020 (dog) & > 1.030 (cat)]

= rehydrate. Address
underlying cause prior to

proceeding. Consider pre-renal
Glucose
If high or low (suspected

or documented) verify
If< 100, look for cause.
If >200, do serum
sample value.
Start 2.5% Dextrose in
fructosamine test &
0.45% NaCL IV.
postpone anesthesia.
Look for cause (check
urinary tract - i.e. urethral

blockage, ruptured
Go to Healthy Pet
protocol.
Diabetic Protocol or
bladder, renal function).
postpone anesthesia &
azotemia.
Go to Cardiac Protocol
Low USG:
(perform ECG).
If SF test positive, go to
LIPEMIA
stabilize Pet.
[< 1.020 (dog) &< 1.030 (cat)]

= check other UA parameters.
Consider renal disease & go to
Renal Protocol.
* Pets living in higher elevations and

some breeds (greyhounds) may have
See Lipemia Protocol
naturally occurring elevations in HCT.
43
/\nraflllr^
Feline Declaw Protocol

Premed: Acepromazine 0.025 mg/lb plus Butorphanol 0.1 - 0.2 mg/lb SQ or IM
Feline
Declaw
Protocol
Post Surgical Pain Management:
Butorphanol 0.1-0.2 mg/lb
Wait 30 minutes
q 1 -2 hrs as needed

Local Block: see diagram
Ketoprofen 0.9 mg/lb day 1
and 0.45 mg/lb day 2
Support: 2.5% Dextrose/0.45% NaCI at 5-10 ml/lb/hr IV
Butorphanol syrup TGH
Perform a complete physical examination and pre-anesthetic blood work prior to any preanesthetic or anesthetic drug
administration. Fractious patients are the exception and the Fractious Pet Protocol should be followed.
Pre-anesthesia blood work includes a CBC with differential and Internal Organ Function Screen. Perform these tests
within 48 hours of anesthetic induction.
Premedications administered SQ or IM may need to be diluted before administration to improve drug uptake. Minimum
total volume should be 0.5-3 ml depending on patient size. Dilute with sterile water to final desired volume.
Propofol should be administered slowly to effect to minimize adverse cardiovascular effects. Bradycardia may develop
after rapid administration. The average dose of Propofol following premedication is 2-3 mg/lb for cats.
Antibiotics other than Cefazolin must be administered a minimum of 1 hr prior to anesthesia or following complete recovery.
Apply the tourniquet carefully. Improper placement may cause neuropraxia, tissue necrosis, and lameness. The radial
nerve is most often affected, so it is important to place the tourniquet distal to the elbow.
Perform a regional carpal block using 2% Lidocaine. This technique is easy to perform and provides exceptional shortterm analgesia postoperatively.
Calculate Lidocaine dose carefully to avoid toxicity due to overdose:
Maximum Lidocaine dose for a local block is 2 mg/lb
Example: 5 Ib cat x 2 mg/lb =10 mg
Lidocaine is a 2% solution (20 mg/ml)
10 mg/ 20 mg/ml =0.5 ml maximum to be injected into cat

If additional volume is needed, Lidocaine can be volume diluted with sterile saline.
Superficial branches of the radial nerve are blocked by injecting the local anesthetic solution subcutaneously on the
dorsomedial aspect of the carpus just proximal to the joint (see illustration below).
The median nerve and the palmar and dorsal cutaneous branches of the ulnar nerve are blocked by injecting local anesthetic
solution subcutaneously medial and lateral to the carpal pad (see illustration below).
Use a 22- to 25-gauge needle for subcutaneous injection. Avoid intravascular injection.
Lidocaine requires 10-15 minutes to achieve effect and its duration of action is 60-120 minutes.
A second option is to perform a ring block just proximal to the carpus. This may require a larger volume of Lidocaine,
thus volume dilution may be needed. Do not exceed the maximum safe dose of Lidocaine.
Upon completion of surgery, administer Ketoprofen (0.9 mg/lb IM SID) if renal and liver function are within normal limits.
Ketoprofen requires approximately 45 minutes for effect.
The following morning, administer a second dose of Ketoprofen
(0.45 mg/lb IM SID) prior to removal of bandages.
Infusion area
Infusion area
Administer a second dose of Butorphanol 1-2 hours following the
first dose, as Butorphanol's duration of action is only 1 to 2 hours.
j
j
Butorphanol may be repeated every 2 hours if the cat acts painful

and should be given prior to bandage removal.
Send Butorphanol or Ketoprofen syrup home with the patient.
Dorsal and palmar views of the feline front paw
46
Fractious Pet Protocol

Apparently healthy pet:
Telazol 1-2 nm/lb IM
Fractious Pet
Protocol
Avoid Premeds
Obtain blood
Telazol lOOmg/ml
sample
(Max dose 100 mg)
Place IV catheter
Healthy or Illness?
Perform Exam
1
If patient needs general anesthesia:

Give 0.1-0.2 mg/lb
>
Butorphanol SQ/IM
Propofol induction dose
lowered by - 50%
' "i i''
Underlying health
concerns:
Telazol 0.5-1 mg/lbIM
L
L
L
Fractious Pet is defined as:
if it takes more than one petnurse to restrain;
if you have to make more than one attempt at a blood draw or jugular stick because of patient movement;
any signs of aggression.
The use of Telazol IM early in the course of events helps prevent catecholamine release and thus the adverse
physiological events associated with catecholamines.
Telazol should be volume diluted with sterile water to a volume of 0.5-1 ml for improved absorption.
Maximum dose of Telazol is 100 mg per dose; if after 15-20 minutes effects of medication are not adequate for
restraint, the Telazol dose can be repeated up to a total dose of 2 mg/lb.
Most Pets, depending on temperament, will be catatonic in 2-3 minutes.

Drug will provide 8-30 minutes of restraint time.
Telazol will lower Propofol induction dose by approximately 50%.
[Viiiii'W&aJ
Avoid giving premeds with fractious pets; once Telazol has taken effect, give Butorphanol 0.1-0.2 mg/lb SQ/IM.
Maximum dose of Butorphanol is 5 mg; follow up with additional 5 mg every 1-2 hours as needed
Dilute premedications administered SQ or IM to a total volume of 0.5-3 ml depending on the patient's size. Dilute with
sterile water. Volume dilution improves drug uptake.
fei^ttl
Assess cardiovascular parameters after premeds have taken effect and prior to induction. ECG is very helpful.
Assess depth of immobilization; some patients can be intubated without further induction agents.
Propofol should always be administered slowly to effect to minimize adverse cardiovascular effects. Bradycardia
may developespecially after rapid administration.
With Telazol on board, "overpressure" may not be necessaryassess depth of anesthesia prior to utilizing this
technique. (Due to Propofol's rapid induction and rapid elimination (about a 3-5 minute window of duration) the
technique of "overpressure" is required to assure a smooth transition to Sevoflurane. Sevoflurane deliveiy concentra
tions should be set at 3% using an oxygen flow rate of 3 L/min (3%/3 L/3 min). For this technique to be effective, the
respiratory rate must be near normal, or assisted ventilation can be used to assure adequate intake and uptake of the
inhalation agent. Following the initial 3 minutes, the oxygen flow is decreased to 1-1.5 L/minute, and the Sevoflurane
concentration is adjusted "to effect. ")
If running Sevo 4% or above, look for leaks in the system, improper intubation, or inadequate O2 flow rate.
If patient has a rough recovery, use 0.025 mg/lb Acepromazine diluted IV given slowly to effect (Max dose 1.5 mg
Ace)(usually dogs); If unable to access IV, then administer Ace (0.025 mg/lb) IM or Diazepam (0.1 mg/lb) IM.
Lkfajîi
45
Abdominal Protocol
Stabilize Before Surgery
Abdomiiidl
Protocol
Pvometra
IfHCT below 25%
C section
and/or TP below 3.5
Cystitis
L
Check pulse ox now
& ECG
Hot abdomen
Premed: Diazepam 0.1 mg/lb (10 mg maximum) IM** plus

Butorphanol 0.1-0.2 mg/lb (5 mg maximum) SQ-Cat/IM-Dog
transfusion**
Peritonitis
(whole blood, packed
Intussusceptions
RBC's, plasma.
GDV
Oxyglobin)
Stabilize prior to anesthesia:
"Tf'ltllt'H
DO NOT use Acepromazine
give appropriate
Wait 30 minutes
Induction: Propofol to effect 1 - 4 mg/lb IV
Maintenance: Scvoliuranc 1 - 4% to effect, inhaled

Support: NaCI 5-10 ml/lb/hr IV. Do Not use fluid containing Dextrose.
** If a transfusion is given, then Diphenhydramine 1 mg/lb IM
(max dose 50 mg) should be substituted for Diazepam in the premeds
manage shock
manage arrhythmias
provide pain management (Butorphanol 0.1-0.2 mg/lb q 1-4 hr as needed).
If the patient is "shocky," anesthesia is contraindicated. Correct shock prior to induction. In event of an emergency
when correcting shock is not possible, mask induction with Sevoflurane may be indicated. If possible, consult with a
Medical Advisor or Director before proceeding with mask induction. Avoid stress when utilizing mask induction; if
heart rate increases by 25% or more during mask induction, allow patient to relax, then administer appropriate IV
induction agent.
GDV cases require stabilization and decompression prior to general anesthesia. They don't meet the definition of
"emergency" as used in this protocol. Emergencies are surgical cases that require anesthesia within 15 minutes to save
JMflBUMM
the patient's life.
Pre-anesthesia blood work includes a CBC with differential and Internal Organ Function Screen.
Maximum dose of Butorphanol is 5 mg. Additional amounts at a pre-anesthetic dose may be given every 1-2 hrs as
needed for post surgical pain control. DO NOT use Acepromazine.
after rapid administration.
The average dose of Propofol is often less than in healthy Petserror on the side of less is better.
Sevoflurane concentration necessary to keep these patients in a general plane of anesthesia is usually significantly
lower than a healthy Pet.
Due to Propofol's rapid induction and rapid elimination (approx 3-5 minute window of duration) the technique of
"overpressure" is required to assure a smooth transition to Sevoflurane. For "over pressure," Sevoflurane delivery
concentrations should be set at 3% using an oxygen flow rate of 3 L/minutes for the first 3 minutes (3%/3 L/3 min). For
this technique to be effective, the respiratory rate must be near normal, or assisted ventilation is used to assure adequate
intake and uptake of the inhalation agent. Following the initial 3 minutes, the oxygen flow is decreased to 1-1.5 L/min,
and Sevoflurane concentration is adjusted "to effect."

Use saline without dextrose in critical cases (Cardiac/Pulmonary/Abdominal). If cardiac arrest occurs, any drug can be
administered through the existing IV with decreased concern regarding interaction of cardiac drugs with fluid components.
Critically ill patients may be slow to recover from anesthesia. Monitor and document TPR and other vitals frequently
and provide supportive care as necessary.
48
MM BanfieldCopyright 2003
'iiiM1'^
to^tai
Lipemia Protocol
Recheck new blood sample in a few
Lipemia
Protocol
If anesthesia is still required, use appropriate protocol for premeds,

maintenance and support.
hours. If Lipemia persists, evaluate
For induction, use Telazol as follows.
diet, check for I lypothyroidism,
Diabetes Mellitus, Pancreatitis, and

primary Hyperlipidemia.
Induction: Telazol 0.5-1 mg/lb IV slowly to effect

(Telazol should be diluted with sterile water to a volume of 1-3 ml and
given to effect to allow for intubation.)
Perform a complete physical examination and pre-anesthetic blood work prior to any pre-anesthetic or anesthetic drug
Maximum dose of Acepromazine is 1.5 mg.
Maximum dose of Butorphanol is 5 mg. Additional amounts of Butorphanol at a pre-anesthetic dose may be given every
1-2 hrs as needed for post surgical pain control.
total volume administered should be 0.5-3 ml depending on patient size. Dilute with sterile water to final desired volume.
The induction dose of Telazol for healthy lipemic patients is 0.5 to 1 mg/lb. The calculated dose should be drawn
in a syringe and then volume diluted with sterile saline to a volume of 1-3 ml. Telazol should be titrated to effect.
Anesthetic induction with Telazol is used only in healthy patients.
When using a dissociative for induction (Telazol or other dissociatives), do not use the "overpressure" technique.
Begin with oxygen flow rates of 1-1.5 L/minute and a Sevoflurane concentration of 1 to 1.5%. "Overpressure"
may result in excessive anesthetic depth during the initial phase of general anesthesia. This is worsened by rapid
respiratory rates.
It is best to avoid vaccinations in association with general anesthesia. If vaccines must be given, wait until the Pet has
fully recovered for at least 2 hours.
POST OPERATIVE (SOFT TISSUE SURGERY) PAIN MANAGEMENT RECOMMENDATIONS FOR HEALTHY
DOGS AND CATS:
Post-op Butorphanol at 0.1-0.2 mg/lb IM (max 5 mg per each dose) can be given when Sevoflurane is discontinued as
long as previous dose was at least 1 hour prior and the Pet's temperature is > 98F.
Post-operative Ketoprofen at 0.9 mg/lb IM (single dose only), can be given when Sevoflurane is discontinued as long as
not allow the Pet to be comfortable. NOTE: Dysphoria is common with Butorphanol.
Pet is well hydrated, has received intra-operative fluids and no risk of significant hemorrhage exists.
Continue Butorphanol at 0.1-0.2 mg/lb IM (max 5 mg per each dose) q 1-2 hours as needed if Ketoprofen alone does
If patient seems excitable or agitated, an additional dose of Acepromazine may be indicated if it has been at least 4
hours since the previous dose and pulse quality and color are good. Then, give 1/2 of the premed dose of Acepromazine.
L
p^^f
47
te [fee? flto Etefi IRjQSLSSjmai1
Liver Protocol
Premed: Butorphanol 0.1-0.2 mg/lb
If clotting tests are
abnormal, postpone or
transfuse** (FFP,
fresh whole blood).
(max dose 5 mg) SQ-C/IM-D plus

0.1 mg/lb Diazepam** IM (max dose 10 mg)
NO Acepromazine
Wait 30 - 40 minutes

Support: 2.5% dextrose/0.45% NaCl at 5-10 ml/lb/
During recovery,
continue
2.5% Dextrose/0.45%
NaCl at 5 ml/lb/hr. If
recovery greater than
20 minutes, warm
patient & check blood

glucose.
hrlV
Do BMBT (Buccal
Liver
Protocol
Mucosal Bleeding
Time) & ACT
** If a transfusion is given, substitute

Diphcnhydramine (1 mg/lb IM [maximum single
dose 50 mg]) for Diazepam in the premeds.
(Activated Clotting
Time) and clotting
profile prior to any
procedure whenever
possible.
within 48 hours of anesthetic induction. BMBT and ACT should be performed just prior to induction to assess coagulation
the day of surgery.
needed for post surgical pain control. DO NOT use Acepromazine.
j
j
If premeds given > 3 hours prior to induction, repeat premeds at 1/2 dose 30 minutes prior to induction.
The average dose of Propofol is often less than in healthy Petserror on the side of less is better.
Due to Propofol's rapid induction and rapid elimination (approx. 3-5 minute window of duration) the technique of
"over pressure" is required to assure a smooth transition to Sevoflurane. For "overpressure," Sevoflurane delivery concen
trations should be set at 3% using an oxygen flow rate of 3 L/minute for the first 3 minutes (3%/3 L/3 min). For this
technique to be effective, the respiratory rate must be near normal, or assisted ventilation is used to assure adequate
j
50
Cardiac Protocol
I* rented:
2nd degree heart block
Prcmcdication:
If bradycardia
Cilycopyrrolate
Dia/epam 0.1 mg/lb
resolves, 2nd
0.005 mg/lb IM
(10 mg maximum) IM plus
degree heart block
(max dose
Butorphanol 0.1-0.2 mg/lb (5 mg
is vagally
0.4 mg).
maximum) SQ-Cat/IM-Dog.
mediated.
Wait 30 minutes.
Cardiac
"
Protocol
IJ'IX'Ci normal, pulse quality
good and no clinical signs of
cardiac disease are present,
proceed to I lealthy Pel
If still hradycardic,
stop and review
diagnosis.
Perform
Induction: Propoibl to effect 1-4 mg/lb IV
cardiac workup.
Maintenance: Sevoflurane 1-4% to effect,

inhaled
Protocol.
Support: NaCI at 5-10 ml/lb/hr IV
II |-C(i lormal, but there
are
clinic il signs of cardiac
disease, consider furtht:r

e\
aluatio n (chest radiogra phs/
Premedication:
Dia/.epam 0.1 mg/lb
cardi ic ultrasound) o
(10 mg maximum) IM plus
proceed if anesthesia
Butorphanol 0.1-0.2 mg/lb
necessary.
(5 mg maximum)
VPCs gone,
SQ-Cat/IM-Dog.
preoxygenate 3-5
Wait 30 minutes.
minute
avoid stress*
If Ventricular Premature
i.
If VPCs still
Contractions (VPCs), avoid
present, postpone
I Glycopyrrolatc and Atropine
anesthesia if
even if hradycardia exists.
possible. Otherwise,
start lidocaine drip.
'
'" I "
r
lllXXi abnormalities other

than VPC or heart block.
consider significance. Perform

further cardiac evaluation or
proceed if anesthesia
nocessarv.
lidocaine drip (5()m 1/2% Lidocaine to 1 liter saline) give 5-10 ml
Ib/hr until VPC gone then slow to 2 ml/lb/hr and monitor for
bradycardia. If bradycardia develops, slow stop drip and monitor
for VPCs. Lidocaine drip requires a second IV catheter & line.
* Avoid stress means: heart rate does not increase by 25% or more
Patients that are bradycardic after Glycopyrrolate or Atropine may still have a vagal response. Check for increases in ocular
or intracranial pressure or full bladder.
Perform a complete physical examination and pre-anesthetic blood work prior to any pre-anesthetic or anesthetic drug administration.
Fractious patients are the exception and the Fractious Pet Protocol should be followed.
Pre-anesthesia blood work includes a CBC with differential and Internal Organ Function Screen. Perform these tests within 48 hours
of anesthetic induction.
Maximum dose of Butorphanol is 5 mg. Additional amounts of Butorphanol at a pre-anesthetic dose may be given every 1-2 hrs as
needed for post surgical pain control.
Premedications administered SQ or IM may need to be diluted before administration to improve drug uptake. Minimum total volume
administered should be 0.5-3 ml depending on patient size. Dilute with sterile water to final desired volume.
Propofol should be administered slowly to effect to minimize adverse cardiovascular effects. Bradycardia may develop after rapid
administration.
Due to Propofol's rapid induction and rapid elimination (approx 3-5 minute window of duration) the technique of "overpressure" is
required to assure a smooth transition to Sevoflurane. For "overpressure," Sevoflurane delivery concentrations should be set at 3%
using an oxygen flow rate of 3 L/minute for the first 3 minutes (3%/3 L/3 min). For this technique to be effective, the respiratory
rate must be near normal, or assisted ventilation is used to assure adequate intake and uptake of the inhalation agent. Following the
initial 3 minutes, the oxygen flow is decreased to 1-1.5 L/min, and Sevoflurane concentration is adjusted "to effect."
Use saline without Dextrose in critical cases (Cardiac/Pulmonary/Abdominal). If cardiac arrest occurs, any drug can be administered
through the existing IV with decreased concern regarding interaction of cardiac drugs with fluid components.
tiiiUifcaill
49
Renal Protocol
Pre-Renal A/ntemia:
Elevated IICT, BUN
& Creat w/ Urine

specific gravity >
1.020 DoiV 1.030 Cat
Correct dehydration
Recheck HCT & IT
with fluid therapy al
If normal, proceed
5 ml/ib/hr for 1-2 hours
with Healthy Pel
prior to anesthesia.
Protocol.
Renal
Protocjo
Praiieil: Diazepam 0.1 mg/lb 1M (max dose 10 mg) plus
Provide llnid therap) at
Butorphanol 0.1-02 mg/lb (max dose 5 mg) SQ-Cat/1M-Dog
1-5 ml/lh/hr lor 1-2
NO Acepromazine
hours prior to anesthesia.
Wait 30 minutes
Induction: Propolbl to effect 1-4 mg/lb IV

Post Ucnal Azotemia:
{Blocked Urethra)
If unable to gel blood sample, do UA
or place IV catheter, give Telazol 0.5
mg/lb (max dose 100 mg) IM.
If Pet too fractious to allow
placement of IV catheter, ECG,

Stabilize Pet
Check ECG
blood draw, cystocentesis or
Wait 30 minutes,
urethra] catheterization, give the
then place IV
follow ing:
catheter, empty
Start normal saline at 5-10

ml/lb/hr IV and empty
bladder via cvstocentesis.
Attempt to relieve urethra! obstruction.
(Cats: Place 0.1 ml of 2% Lidocaine up

urethra)
bladder, collect
Preuieil: Diazepam 0.1 mg/lb IM
blood sample,
(max dose 10 nig) plus Butorphanol
cheek ECG.
0.1-0.2 mg/lb (max dose 5 nig)

SQ-Cat/IM-Dog
If general anesthesia needed, stabilize Pet first.

Bladder rupture by cystocentesis is rare, while anesthesia death in patients with urethral obstruction is common.
Goal is to lower the potassium level.
The most common ECG abnormalities are due to hyperkalemia (ECG abnormalities: bradycardia, 1st degree
AV block, dropped P waves, spiked T waves) need to be corrected prior to heavy sedation or general anesthesia.
If the patient is "shocky," anesthesia is contraindicated. Correct shock prior to induction. Propofol should be administered
slowly to effect to minimize adverse cardiovascular effects. Bradycardia may develop after rapid administration.
administration.
Maximum dose of Butorphanol is 5 mg. Additional amounts of Butorphanol at a pre-anesthetic dose may be given every
1-2 hrs as needed for post surgical pain control.
Assess depth of immobilization; some patients can be intubated without further induction agents.
These Pets generally require much lower doses of both induction agents and general anesthetics than healthy Pets. Error
on the side of caution.
Sevoflurane concentration necessary to keep these patients in a general plane of anesthesia is usually significantly lower
than a healthy Pet.
52
UfoiMJ
Pulmonary Protocol
Acepromazine 0.025mg/lb plus
Air movement present:
Butorphanol 0.1 mg/lb
If obese with no other
SQ-Cat/IM-Dog
abnormalities, proceed.
Pre-oxygenate 3-5 minutes
If pneumonia or
asthma present, consider
radiographs.
Pneumothorax, or
Pleural Effusion
Consider shock
Pulmonary
dose of
Protocol
corticosleriods
Check pulse ox
present: Drain
Diaphragmatic
chest & stabilize.
Hernia
Local block/
prior to
now
immobilization
anesthesia.
preferred for chest

tube placement.
Premed: see earlier box

Induction: Propofol to effect I - 4
mg/lb IV. Use rapid sequence
induction ** & be prepared to

ventilate.
Maintenance: Sevollurane I - 4%
to effect, inhaled
Support: NaCI at 5-10 ml/lb/hr IV.
Respiratory distress present:
Consider radiographs & thoracocentesis (look for pneumolhorax,
FXG
pleural effusion or diaphragmatic hernia).
If RCG normal, proceed.
If sedation needed for diagnosis, use Acepromazine O.()25mg/lb *
Cardiac Protocol.
(max dose 1.5 mg) plus Butorphanol 0.1 mg/lb (max dose 5 mg)
Manual ventilation may be
required.
If KCG abnormal, see
Resolve l-CG
SQ/IM.
abnormalities, then use
* If high risk avoid Acepromazine - use Diazcpam 0.1 mg/lb 1M
Pulmonary Protocol for
instead (max dose 10 mg). Avoid stress *** & provide 02.
induction and
maintenance.
"Rapid sequence induction" = have all needed supplies available at induction for quick intubation. Any delay in providing
O2 and an open airway increases risk of death.
k Avoid stress means: heart rate does not increase by 25% or more.
If upper airway is blocked, provide O2 through an 18 gauge catheter needle placed into the trachea between the trachea rings.
When ventilating patients with chronic pulmonary disease, be sure to watch the manometer. Pressures should not exceed 12-15 cm
H2O. Higher pressures can cause micro hemorrhage in the alveoli of compromised lung tissue. Such patients may wake up from anesthesia,
only to expire within a few hours of recovery.
Perform a complete physical examination and pre-anesthetic blood work prior to any pre-anesthetic or anesthetic drug administration.
Fractious patients are the exception and the Fractious Pet Protocol should be followed.
Pre-anesthesia blood work includes a CBC with differential and Internal Organ Function Screen. Perform these tests within 48 hours
of anesthetic induction.
Maximum dose of Acepromazine is 1.5 mg. Acepromazine should be prediluted to 1 mg/ml in a separate vial to allow proper dose
administration.
Maximum dose of Butorphanol is 5 mg. Additional amounts of Butorphanol at a pre-anesthetic dose may be given every 1-2 hrs as needed
for post surgical pain control.
Premedications administered SQ or IM may need to be diluted before administration to improve drug uptake. Minimum total volume
administered should be 0.5-3 ml depending on patient size. Dilute with sterile water to final desired volume.
Propofol should be administered slowly "to effect" to minimize adverse cardiovascular effects. Bradycardia may develop after rapid
administration.
Due to Propofol's rapid induction and rapid elimination (approx 3-5 minute window of duration) the technique of "overpressure" is required
to assure a smooth transition to Sevoflurane. For "over pressure," Sevoflurane delivery concentrations should be set at 3% using an oxygen
flow rate of 3 L/minute for the first 3 minutes (3%/3 L/3 min). For this technique to be effective, the respiratory rate must be near normal,
or assisted ventilation is used to assure adequate intake and uptake of the inhalation agent. Following the initial 3 minutes, the oxygen flow is
decreased to 1-1.5 L/min, and Sevoflurane concentration is adjusted "to effect."
Antibiotics other than Cefazolin must be administered a minimum of 1 hour prior to anesthesia or following complete recovery.
Use saline without dextrose in critical cases (Cardiac/Pulmonary/Abdominal). If cardiac arrest occurs, any drug can be administered through
the existing IV with decreased concern regarding interaction of cardiac drugs with fluid components.
Critically ill patients may be slow to recover from anesthesia. Monitor and document TPR and other vitals frequently and provide supportive
care as necessary.
51
J
Orthopedic Protocol
Premcd: Acepromazine 0.025 mg/lb SQ/IM (max
Orthopedic
dose 1.5 mg) plus Morphine: Cat - 0.05-0.15 mg/lb
(max dose 2.5 mg); Dog - 0.2-0.5 mg/lb (max dose
Morphine can be given at premed
5mg) **IMonly
dose q 4-6 hrs ifcardiovascular
Wait 30 minutes
function is normal.
Induction: Propofol to effect 1- 4 mg/lb IV
Protocol
Maintain: Sevollurane to effect 1-4%, inhaled

+/- lipidural * or apply Kentanyl patch ***
Support: 2.5% Dextrose/0.45% NaCI at
Transition to:
Cats: Kcloprofcn 2 - 3 days
Dogs: Ktogesic 5-7 days
Fentanyl Patch Dose:
Pets < 11 lbs:
1/2 of 25 jig patch
11-22 lbs:
25 jig patch
22-44 lbs:
50 ^g patch
44-66 lbs:
100 jig Patch
5-IOml/lb/hrlV
**
Note: Doctor needs to be certified by Medical Director as being able to perform Epidurals.
Note: DO NOT give Morphine IVIV administration may cause histamine release. When using Morphine,
observe for nausea and vomiting, especially at higher doses. Also, observe for bradycardia; if found, treat
with with Glycopyrrolate prior to induction.
k**
Note: Pets with Fentanyl patches should not be sent home with owner. Apply 12 hours prior to anesthesia if
possible. Otherwise, apply as early as possible prior to induction.
Maximum dose of Morphine is 2.5 mg for cats and 5 mg for dogs per administration. Additional amounts of Morphine
at a pre-anesthetic dose may be given every 4-6 hours as needed for post surgical pain control if cardiovascular function
is normal.
Due to Propofol's rapid induction and rapid elimination (approx 3-5 minute window of duration) the technique of "over
pressure" is required to assure a smooth transition to Sevoflurane. For "overpressure," Sevoflurane delivery concentrations
should be set at 3% using an oxygen flow rate of 3 L/minute for the first 3 minutes (3%/3 L/3 min). For this technique
to be effective, the respiratory rate must be near normal, or assisted ventilation is used to assure adequate intake and
uptake of the inhalation agent. Following the initial 3 minutes, the oxygen flow is decreased to 1-1.5 L/min, and
Sevoflurane concentration is adjusted "to effect."
Medications used for Epidural pain control administration: (can use preservative containing products)
1.
Butorphanol : 0.125 mg/lb (max dose 5 mg) qs (bring to) to 1 ml/2.5-5 lb with sterile saline or Lidocaine;
Max volume for infusion is 6 ml; duration 2-4 hours.
2.
Morphine: 0.05 mg/lb qs (bring to) to 1 ml/2.5-5 lb with sterile saline or Lidocaine;
Max volume for infusion is 6 ml; duration ~ 6 hours.
54
Stable Diabetic Protocol

Instead of regular meal & insulin
dose, feed 1/2 meal and administer
Check ECC
Stable
If abnormalities,
Diabetic
use Cardiac-
Protocol
Protocol.
Premed: Acepromazine 0.025 mg/lb plus
1/2 dose insulin 2 hours prior to
Butorphanol 0.1 - 0.2 mg/lb SQ-Cat/IM-Dog
anesthesia. This should be
Induction: Propofol to effect 1 - 4 mg/lb IV
performed as close as possible to the

Pet's regular feeding & insulin
administration time.
Check glucose (N 110-175) just
before anesthesia. If possible, setup
Maintenance: Sevoflurane 1 - 4% to effect,
inhaled
Support: NaCI 5-10 at ml/lb/hr IV
Post Op Care:
Check glucose
every 2-4 hrs until
Pet is awake and
Check Blood Glucose q 30 minutes while
stable.
under general anesthesia.
anesthesia time based on normal

feeding schedule.
Check Blood Glucose q 30 minutes while under general anesthesia. If hypoglycemia develops (BG < 100 g/dl), take
appropriate steps to correct, i.e. start 2.5% Dextrose/0.45% NaCI IV.
Saline is used in diabetic Pets to avoid an increase in glucose. LRS has no advantages in these patients. Diabetics are
also at higher risk for cardiac arrest.
needed for post surgical pain control.
Due to PropofoPs rapid induction and rapid elimination (approx 3-5 minute window of duration) the technique of "over
pressure" is required to assure a smooth transition to Sevoflurane. For "overpressure," Sevoflurane delivery concentra
tions should be set at 3% using an oxygen flow rate of 3 L/minute for the first 3 minutes (3%/3 L/3 min). For this
Antibiotics other than Cefazolin must be administered a minimum of 1 hour prior to anesthesia or following complete
recovery.
53
CNS, Eye Globe Protocol

Premetl: already done

Maintain: Sevoflurane 1-4% to effect, inhaled
Wait 10 minutes.
CNS&
Globe or Eye Injury
Eye/Globe
Head Trauma
O.I mg/lbIM
Protocol
Epileptics
(10 mg maximum)
Diazepam
Administer
ButorphanolO.l-0.2mg/lb
Monitor: Use COn monitor if available. Maintain CO,

between 30-40 mm Hg.
IM
(5 mg maximum).
If CO, is elevated, there is higher seizure risk from

increased intracranial PSI.
If cerebral edema present - maintain CO, between 28-35
mm I Ig to help decrease intracranial pressure.
Acepromazine should be avoided in patients with a history of seizures.

Monitor head trauma patients frequently for changing neurological status.
Tonometry can be used to evaluate for increased intracranial pressure. Increased intraocular pressures can
indicate increased intracranial pressure.
In CNS cases, studies have indicated that use of fluids containing Dextrose decrease the risk of seizures.
Maximum dose of Butorphanol is 5 mg. Additional amounts of Butorphanol at a pre-anesthetic dose may be given
every 1-2 hrs as needed for post surgical pain control.
Maximum dose of Diazepam is 10 mg.
Due to Propofol's rapid induction and rapid elimination (approx 3-5 minute window of duration) the technique of "over
pressure" is required to assure a smooth transition to Sevoflurane. For "over pressure," Sevoflurane delivery concentra
tions should be set at 3% using an oxygen flow rate of 3 L/minute for the first 3 minutes (3%/3 L/3 min). For this
'TJimtfT
recovery.
"i
KrtllBtf1"
56
tlfUHMuJi
Ear Surgery Protocol

Ear Surgery
On,ional:
Apply I'entanyl
Patch 12-24
(Total Ear Ablation,
Lateral Ear Resection,
hours prior to
Bui la Osteotomy)
surgery. **
Premed: Acepromazine 0.025 mg/lb SQ/IM (max dose 1.5 mg)

plus Morphine: Cat - 0.05-0.15 mg/lb (max dose 2.5 mg);
Dog - 0.2-0.5 mg/lb (max dose 5 mg) **IM only
Wait 30 minutes
Induction: Telazol 0.5-1 mg/lb IV to effect (max dose 100 mg)

Maintain: Sevoilurane to effect 1-4%, inhaled
Morphine can be given at premed

dose q 4-6 hrs if cardiovascular
function is normal.
Transition to:
Cats: Ketoprofen 2-3 days

Dogs: Etogesic 5-7 days
Fentanyl Patch Dose:

Pets < 11 lbs:
L
*
1/2 of 25 ng patch
11-22 lbs:
25 jig patch
22-44 lbs:
50 jig patch
44-66 lbs:
100 jig patch
DO NOT give Morphine IVIV administration may cause histamine release. When using morphine, observe for
nausea and vomiting, especially at higher doses. Also, observe for bradycardiaif found, treat with
Glycopyrrolate prior to induction.
KaiM%ifl
** Note: Pets with Fentanyl patches should not be sent home with owner. Apply patch 12 hours prior to anesthesia if
possible. Otherwise, apply as early as possible prior to induction.
Induce healthy Pets for ear surgery with Telazol 0.5-1 mg/lb IV to effect rather than Propofol. This helps avoid
the need for higher doses of Sevoflurane to prevent head movement during surgery. Telazol should be diluted
with sterile water to a volume of 1-3 ml and given to effect to allow for intubation.
Pets must be healthy (other than the chronic ear problems) for this protocol. If there are underlying health concerns
(cardiac, liver, renal or other problems), patient should be stabilized, then appropriate premeds and induction agents used.
Maximum dose of Morphine is 2.5 mg for cats and 5 mg for dogs per administration. Additional amounts of Morphine
at a pre-anesthetic dose may be given every 4-6 hours as needed for post surgical pain control if cardiovascular function
is normal.
L:...ofiaMi
When using a dissociative for induction (Telazol or other dissociatives), do not use the "overpressure" technique.
Begin with oxygen flow rates of 1-1.5 L/minute and a Sevoflurane concentration of 1 to 1.5%. "Overpressure"
may result in excessive anesthetic depth during the initial phase of general anesthesia. This is worsened by rapid
respiratory rates.
If running Sevoflurane at 4% or above, look for system leaks, improper intubation, or inadequate O2 flow rate.
I'jii'lillSKifeJ
recovery.
MMI BcmfieldCopyright 2003
Lsi^Mii
55
Anesthesia Monitoring and Emergency Protocol

Procedures to be used during anesthesia
Monitoring by Surgical Assistant required
(Recordpulse, pulse quality, RR, O 7 saturation, and ECG q 5-10 minutes; record temperature q 10-15 minutes.)
End Tidal CO2
Pulse Quality
Oxygenation
Monitor femoral
Monitor pulse ox
ECG
Monitor
pulse and MM every
and respirations
Monitor ECG and HR continuously.
continuously
3-5 minutes.
continuously.
(pulse ox reading <94)
Lg dog < 60/min

Med dog < 80/min
Bradvcardia:
Saturation
Pulse Quality
2nd heart block or
Decreased
Poor or Diminishing
(optional)
Smdog< 100/min
Increase fluid to
Decrease Sevo
10-40 ml/lb/hr
Start Ventilating
Decrease Sevo
Increase fluid to
Check pulse
Increase 0^ to
2 L/min, check
Decrease Sevo 50%
quality -
MM to verify
ventilate Pet 2x
oxygenation
to clear COO
Increase 07 to
2 L/min
10-40 ml/lb/hr
pulse ox and
cat< 120/min
Increase fluid to
Decrease Sevo
> 50 ventilate patient
10-40 ml/lb/hr
Increase fluid to
< 35 stop
hyperventilation
10-40 ml/lb/hr
If no improvement in 1
min. give Lidocaine bolus
If no improvement within 2 minutes, check ECG.
If bradycardia/2nd heart block or VPC, see
DOG: 1-2 mg/lb IV

CAT: 0.125-0.25 mg/lb IV
appropriate emergency protocol.
AtropineO.Ol mg/lb
Glycopyrrolate 0.005
IV
mg/lb IV or IM
Give slowly over 30

seconds & volume
Given slowly to effect
administer Neo-Synephrine intranasal:

Large dog: 1-4 drops. Small dogs and cats: 1-2
drops. Increase fluids to 10-40 ml/lb/hr.
If positive response and no VPCs, can repeat

dose. If no improvement in pulse quality within 2
minutes, proceed.
Ephedrine 0.5 mg/10 lb
(0.05 to 2.5 mg/lb) IV
ik^~ .'il
dilute if needed.
If ECG normal and pulse quality still decreased,
Start Lidocaine drip for
Slow Lidocaine drip to 2
maintenance at
ml/lb/hr to control VPCs.
5-10 ml/lb/hr until VPCs
Decrease drip rate if
are absent.*
bradycardia develops.
* Lidocaine drip = 1000 ml saline plus 50 ml of 2% Lidocaine.

Lidocaine drip cannot be used for volume loading so a second IV catheter &
line will be needed.
Dilute 0.1 ml Ephedrine in 0.9 ml Saline

to = 5 mg/ml
Give 0.1 ml/10 lb IV slowly
Dose every 15-20 minutes PRN
Limit of three doses.
Tachycardia:
Dobutamine Microdrip:
6.5 lb = 1 drop per 4 sec
12 lb = 1 drop per 2 sec
Lg dog> 120/min
Med dog > 140/min
Sm dog> 140/min
25 lb = 1 drop per sec

If no response, give
Dobutamine 0.5-2.5 ug/lb/minute
as Saline drip. **
Cat> 140/min

If in arrest, use Epinephrine
| (1:10,000) 0.005 mg/lb (1 ml/20 lb)
Without movement:
With movement:
decrease Sevo.
increase Sevoflurane
Increase fluid to
10-40 ml/lb/hr &
Begin CPR
IV or intratracheal.
check pulse quality.
(See CTR protocol)
25 mg in 1 liter of normal Saline via microdrip. 25 mg/ 1000ml = 0.025 mg/ml = 25ug/ml;
25 lb dog @ 1 mg/lb/min = 1 ml/minadminister 1 drop/sec (via microdrip) monitor pulse and ECG.
As pulse increases, decrease Dobutamine. If VPCs and tachycardia develop, decrease Dobutamine
58
m^rf
Watch for VPCs
Emergency Surgery Protocol
Emergency
Surgery
Protocol
Check pulse ox
now
Stabilize & provide pain management such as

Butorphanol 0.1-0.2 mg/lb (max dose 5mg).
If anesthesia is required to save

life in less than 15 minutes,
Next, determine health status- follow exam

flow chart in "Canine/Feline Anesthesia
Protocols & Standards for Physical
estimate protocol category.

Otherwise, complete diagnostics
Examination" exam box.
& use appropriate protocol.
Stabilize prior to anesthesia:
manage shock
manage arrhythmias
provide pain management (Butorphanol 0.1-0.2 mg/lb q 1-4 hr as needed)
True emergencies requiring immediate anesthesia are rare. Most Pets will have a better outcome if stabilized before
anesthesia or surgery. A true emergency requiring immediate surgery would include an airway obstruction or acute lifethreatening hemorrhage. GDV cases require stabilization and decompression prior to general anesthesia. They don't
meet the definition of "emergency" as used in this protocol. Emergencies are surgical cases that require anesthesia
within 15 minutes to save the patient's life.
Perform as complete a physical examination as possible. If the urgency of the situation precludes pre-anesthetic blood
work, run it as the Pet is being examined and anesthetized.
Maximum dose of Butorphanol is 5 mg.
With true emergency anesthesia, premeds, including Butorphanol, may not have had time to take complete effect. Use
the minimum amount of drugs for induction and the lowest Sevoflurane % possible for the situation.
Assess cardiovascular parameters prior to induction.
If the patient is "shocky," anesthesia is contraindicated. Correct shock prior to induction.
In event of an emergency when correcting shock is not possible, mask induction with Sevoflurane may be indicated. If
possible, consult with a Medical Advisor or Director before proceeding with mask induction. Avoid stress when utilizing
mask induction; if heart rate increases by 25% or more during mask induction, allow patient to relax and
administer appropriate IV induction agent.
The average dose of Propofol is often less than in healthy Pets. Error on the side of caution.
Sevoflurane concentration necessary to keep these patients in a general plane of anesthesia is usually significantly
lower than that required by a healthy Pet.
Use saline without Dextrose in critical cases (Cardiac/Pulmonary/Abdominal). If cardiac arrest occurs, any drug can be
administered through the existing IV with decreased concern regarding interaction of cardiac drugs with fluid components.
57
! A
IV Drugs
Ventillation (100% oxygen)

Establish airway (laryngoscope, endotracheal tube, lie in place)
Connect to Anesthesia Machine with O, only
Give 2 long breaths (1.5-2 seconds each)
Continue at 10-20 breaths per minute (2 for every 15 chest
A ways bolus 10-30 ml 0.9% NaCI after each medication & wait 30
seconds to 2 minutes for response, repeat drugs doses as necessary
*Atropinc IV (0.54 mg/ml)

0.01-0.02 mg/lb (0.2-0.4 r il/IO Ib)
compressions)
Dog: 15-20 cm of 11,O
Cat: 12-17 cm of H:O
Chronic lung disease: < 12 cm of 1-1,0
External Chest Compressions
*Epinephrine IV (1:1000 = I mg/ml)
Start with Low Dose and progress to High Dose
Low Dose = 0.005 to 0.01 mg/lb (0.05-0.1 ml/10 Ib)
High Dose - 0.1 mg/lb (1 ml/10 Ib)
*Lidocaine IV (2% solution = 20 mg/ml) Monitor with ECG
< 10 Ib, lateral recumbency
Encircle chest with hands at level of 4th-5th intercostal space
100-120 compressions/minute
Should decrease chest diameter by 25-33%
Start with bolus and if successful convert to CRI
Dog bolus: 1-2 mg/lb (0.5-1 ml/10 Ib)
Cat bolus: 0.125-0.25 mg/lb (0.06-0.125 ml/10 Ib)
Lidocainc CRI: (Lidocaine drip = 1 L saline and 50 ml 2% Lidocaine.)

5-10 ml/lb/hr of above solution until VPCs are absent, slow drip
> 15 Ib, lateral recumbency
(stand with Pel's spine closest to you)
Center over highest portion of chest wall at level of 4th-5th
100-120 compressions/minute
Should decrease chest diameter by 25-33%
to 2 ml/lb/hr to control VPCs, decrease drip rate if bradycardia

develops. Use second IV catheter for administration.
*Dexamcthasonc Sodium Phosphate IV (4 mg/ml)
Intercostal space
2 mg/lb (5 ml/10 Ib)
*Sodium Bicarbonate IV (8.4%, I mEq/ml) Monitor with ECG
Consider after 10-15 minutes of unsuccessful CPR
Consider with known acidosis
(gentle to avoid damage to abdominal organs)
0.2-0.45 mEq/lb (2-4.5 ml/10 Ib) Give slowly over 5 minutes
Counter pressure (sand bag over mid-abdomen)
Repeat every 10-15 minutes of unsuccessful CPR
I lyperventilale post administration for 30 seconds
Augmenting Techniques
Abdominal Compression alternating with chest compressions
Wrapping hind limbs
INTRATRACHEAL DRUGS
Fluids
Place largest catheter possible, central preferred i.e. jugular catheter
0.9% NaCI
Dog:20ml/lb
Cat:IOml/lb
Give as initial bolus then reassess for ongoing rate
Dog: 20-40 ml/lb/hr
Adjust for underlying disease such as congestive heart failure
Cat: 10-20 ml/lb/hr
Atropinc, Epincphrine, Lidocainc

-
Double the IV dose
Administer through a red rubber catheter advanced beyond the end of
Follow with 5-10 ml 0.9% NaCI to Hush drug through red rubber
Hyperventilate after administration for 10 seconds
Establish second IV line)
Cat: 2.5-4.5 ml/lb over first hr in increments of
2.5ml/lb/5-10min
2.5ml/lb/5-10min
Fresh Frozen Plasma:
2.5-4.5 ml/lb at 10 ml/lb/hr
Oxyglobin:
Dog: 4.0-13.5 ml/lb at 4.0 ml/lb/hr or increments of
Monitor (see flow chart)

Support organ systems: Consider all appropriate measures.
Respiratory: supplemental oxygen (nasal or ecollar) Lidocaine,
Cardiac: supplemental oxygen (nasal or ecollar), Furosamide,
Dobutamine, continued fluid therapy
continued positive pressure ventilation with oxygen
Cat: 2.5-7.5 ml/lb at I ml/lb/hr or increments of

2.5ml/lb/5-10min
Assess need for oxygen carrying fluids (I ICT or PCV <25% or
significant hemorrhage. Establish second IV line)

Packed red blood cells: 2.5-4.5ml/lb at 5-10ml/lb/hr
Dog: no need for cross match with first transfusion
Cat: always blood type or cross match
Fresh whole blood: 4.5-10 ml/lb at 5-10 ml/lb/hr, cross match as above
Oxyglobin: (as above)
corticosteroids, Furosamide, Dobutamine
Neurologic: supplemental oxygen (nasal or ecollar) continued

ventilation with oxygen to reduce carbon dioxide levels, Mannitol,
2.5ml/lb/5-10min
Post Resuscitation
Hetastarch:
catheter
adequate crystaloid administration, need for rapid volume expansion.
Dog: 4.5-10 ml/lb over first hr in increments of
endotracheal tube
Assess need for colloids (IP <3.5, Alb. < 1.5, poor pulse quality w/
Renal: continued fluid therapy. If normovolemic and normotensive
and oliguric (less than 0.45 ml of urine/lb/hr produced) consider

Mannitol or Furosamicle with or without a Dobutamine drip-Dogs only
Drugs: Mannitol (0.25-0.5 g/Ib IV over 20 minutes), Furosamide (1-2 mg
Ib IV), Dobutamine (2-10 ug/lb/min IV: 25 mg in I L of 0.9% saline via
microdrip = 25 micrograms/ml. Monitor pulse and ECGas pulse increases
decrease dobutamine. If VPCs or tachycardia develop, decrease drip rate),

Lidocainc CRI. corticosteroids (Dcxamethasone SP 2-5 mg/lb IV or
Methylprcdnisolonc Na Snccinatc 5-15 mg/lb IV), Dopamine (Dogs

only) 0.22-1.4 micrograms/lb/minute (Dopamine 40 mg/ml add 1/2 ml = 20
mg to 1 L 0.9% NaCI = 20 micrograms/ml, microdrip set = 60 drops/ml, 20

Ib dog at I microgram/lb/minute = 20micrograms/minute = 1 drop every 3
INTRACARDIAC DRUGS
NOT APPROPRIATE - DO NOT ADMINISTER
62
seconds), broad spectrum antibiotics. Consider referral for

24-hour care when stable for transport.
L
L
Cardiopulmonary Arrest
VENTRICULAR TACHYCARDIA
LIDOCAINE
EVALUATE FOR RESPONSE,
REASSESS PATIENT
IV FLUIDS
SINUS TACHYCARDIA
ASSESS BLOOD VOLUME
CONTINUE TO VENTILATE

REASSESS PATIENT
NORMAL RATE & RHYTHM
MONITOR, PROVIDE
SUPPORTIVE CARE
REASSESS PATIENT
BRADYCARDIA
L
L
L
L
Sinus
R
Junctional
->
|l_^X
Ventricular
_a
I ' 1
ATROPINE lsl
EPINEPHRINE 2*" IF
NECESSARY
Â-
j_
\f
ASYSTOLE

REASSESS PATIENT
ATROPLNE 1st
EPINEPHRINE 2^" IF NECESSARY
REASSESS PATIENT
EPINEPHRINE lsl
ELECTROMECHANICAL DISSOCIATION
Any and all pulseless rhythms
NECESSARY
Difficult to rule out weak ventricular function

Dog: femoral pulse disappears with a systolic pressure of 60 mm of Hg and heart sounds
DEXAMETHASONE 2M) IF
disappear below a systolic blood pressure of 50 mm of Hg
VENTRICULAR FIBRILLATION
REASSESS PATIENT
EPINEPHRINE 1SI
LIDOCAINE BOLUS 2 IF
NECESSARY

REASSESS PATIENT
NOTE: All ECGs are recorded at 50 mm/sec and 1 cm = lmv
61
NO RESPIRATIONS
NO RESPIRATIONS
PULSE PRESENT
NO PULSE
NO HEARTBEAT
ESTABLISH AIRWAY
ESTABLISH AIRWAY
INTUBATE
INTUBATE
VENTILATE WITH OXYGEN
VENTILATE WITH OXYGEN
(CONNECT TO ANESTHETIC MACHINE
(CONNECT TO ANESTHETIC MACHINE WITH
WITH OXYGEN ONLY)
OXYGEN ONLY)
J
J
CONNECT TO MONITORS
(CONTINUOUS ECG & PULSE OX )
CARDIAC COMPRESSIONS
100-120/MIN
PLACE IV CATHETER
START IV FLUIDS
CONNECT TO MONITORS
DIAGNOSE & TREAT
(CONTINUOUS ECG & PULSE OX )
PLACE IV CATHETER
UNDERLYING DISORDERS
START IV FLUIDS
REASSESS PATIENT
Monitoring includes
Heart rate
Petnurse/Assistant Duties
(Doctor or head petnurse to assign roles)
ECG rhythm
Ventilations
Pulse quality/deficits
Compressions
Capillary refill time
Attach monitors (ECG, pulse ox, etc.)
Respiratory rate (assisted or spontaneous)
Evaluate/monitor patient
Pulse oximetry
Place & maintain IV catheter
Temperature
Administer drugs-record doses, time, Pet response
Blood volume -(PCV/TP, hemorrhage, pulse quality, heart rate)
Supportive care (lube eyes, heating pad, etc.)
Pupillary light response & other cranial nerve reflexes (note any
Gopher
changes & presence or absence of reflexes)
tasinir"1,"!
Level of consciousness
Urine production (place urinary catheter if stable, monitor output)
Blood glucose
J
60
CPR Protocol
"Cardiopulmonary arrest (CPA) is defined as "the abrupt and unexpected cessation of spontaneous and effective ventilation
and circulation." This can be the natural ending of a full life or can result due to trauma or disease states. If CPA is due to
a potentially reversible traumatic or medical condition, then prompt application of sound eardiopulmonarv resusci
tation (CPR) techniques while addressing the underlying cause of the arrest may allow restoration of life signs.
Effective CPR requires a highly trained, efficient and coordinated team, appropriate monitoring devices and medications,
and prompt application of CPR techniques. Even with aggressive and effective CPR, survival rates remain low (less than
10%). Controversy exists as to the best CPR techniques and protocol. Therefore, we have combined recommendations from
many sources to produce a reasonable CPR prg|* ss that will benefit the greatest number of patients and utilizes equipment,
techniques and medications that should be available in all of our hospitals.
The goal of the following CPR protocol is to provide an outline for closed chest CPR in dogs and cats. This protocol is a
template, and to be effective will require training of a team of doctors and petnurses that can work together efficiently.
Recommended team training should include:
1.
2.
All doctors and paraprofessionals must familiarize themselves with the protocol.
Develop a hierarchy of who would be "running the code" according to who is available (the doctor
present will usually be running the code, but a lead petnurse may need to initiate the code).
3.
Have frequent drills with your team to rehearse CPR (consider bringing in a stuffed animal as the dummy). This
should include the leader assigning duties and directing the code.
4.
Rotate teams and individual responsibilities during the code drill so that each team member is comfortable doing
each job during a code.
5.
Determine division of labor during a code by the number of team members available. A person may have more than
one job responsibility. Assigned roles of responsibility include:
i.
Running the code
ii.
Ventilation
iii. Chest compressions (need to rotate the person doing compressions every 3 to 4 minutes to keep
up adequate strength of compressions)
iv. IV catheter placement, fluid and medication administration

v.
Gopher
vi. Monitoring
vii. Recording
This CPR protocol does not replace the Emergency Protocol on the Anesthetic Monitoring Flow chart. The CPR protocol
only applies to anesthetic cases once cardiopulmonary arrest is noted.
MM BanfleldCopyright 2003
59
Fluid Therapy in Pets

There are two major categories of fluids that are administered to Pets: crystalloids and colloids.
A crystalloid is a water-based solution with small molecules that are permeable to capillary mem
branes. The crystalloid solutions currently used in the Banfield practice are:
Lactated Ringer's Solution (LRS)
0.9% Sodium Chloride (0.9%NaCl)
0.45% Sodium Chloride with 2.5% Dextrose (2.5% Dextrose/0.45NaCl)
A colloid fluid is a water-based solution with both small molecules that are permeable to the capillary
membrane and large molecules that cannot cross the capillary membrane. Natural colloids consist of
plasma proteins from donor animals and are administered as fresh-frozen plasma or whole blood.
Synthetic colloids are man-made large molecules dissolved in normal saline. The synthetic
colloid that Banfield currently carries is Hydroxyethyl Starch (otherwise known as Hetastarch).
Crystalloids
Crystalloids are used primarily for interstitial volume replacement and maintenance fluids. In most
clinical situations, rehydration and resuscitation with crystalloids is best accomplished by using an
isotonic, balanced electrolyte solution such as Lactated Ringer's Solution (LRS).
LRS provides electrolytes and buffers in concentrations similar to normal plasma. LRS is called a
replacement fluid. It is important to remember that even though LRS is balanced and contains
potassium typical of normal plasma levels, it will not prevent ongoing potassium loss or correct
hypokalemia. Potassium supplementation is often needed (i.e. severe gastroenteritis, chronic renal
failure). The lactate in LRS is used as a buffer to help prevent or correct acidosis, but it requires
degradation to bicarbonate by the liver. Therefore, it is important that liver function is normal when
administering LRS. It is also important not to administer blood products in the same IV line with LRS
to prevent calcium precipitation with the anticoagulant.
Both 0.9% NaCl and 2.5% Dextrose/0.45NaCl solutions are also isotonic, but they are not "balanced"
since they contain only sodium, chloride and water. They can be used as replacement fluids in select
situations where LRS is not appropriate (hyperkalemia or alkalosis). In many situations, potassium
supplementation may be necessary.
The following reference table is a guide for potassium supplementation.
64
Serum Potassium
Potassium Chloride
Maximum Fluid Infusion Rate
(mmoI/L)
Added to Liter of Fluid
(ml/kg/h)
Below 2.0
80mEq
2.0-2.5
60mEq
2.6-3.0
40mEq
12
3.1-3.5
28mEq
16
Section 3:
Fluid Therapy In Pets
fai
63
o Rectal temperature, heart rate, and respiratory rate should be recorded every 10 minutes
during the first 30 minutes, and every 30 minutes thereafter.
o Monitor also for vomiting, diarrhea, urticaria, hemoglobinuria and hemoglobinemia.

o Any of these symptoms or changes in vital signs can be an indication of a transfusion
reaction. At this point, the transfusion should be stopped until the patient is evaluated
further and treated if necessary.
Synthetic colloids (Hetastarch) can be used to increase central oncotic pressure and avoid the problems
encountered with rapid natural colloid infusion. They can also be used in conjunction with whole blood
or plasma. They are not, however, to be considered a substitute for blood products when albumin, red
blood cells, or coagulation proteins are needed.
Synthetic colloids should be used with caution and at very reduced dosage rates in patients
with congestive heart failure and in those with renal origin oliguria/anuria.
Hetastarch can be used for traumatic or hypovolemic shock. It can be used in combination
with plasma or whole blood for ongoing hemorrhage from traumatic loss, DIC, or a coagulopathy.
-,
^J
Hetastarch has a moderate colloid effect for approximately 24 hours.
Dose: Give IV in increments of 5 ml/kg (2.25 ml/lb), over 5-10 minutes, to effect, up to 40
ml/kg (18 ml/lb) total dose.
fmmJ
Shock
Shock is a multisystemic response to a systemic injury or illness that produces inadequate tissue perfiision and energy production. Causes of shock include severe hypovolemia, trauma, sepsis, heat stroke,
j
****
hypoglycemia, heart failure, malnutrition, or any end stage visceral organ failure.
i
Aggressive volume resuscitation is indicated in the treatment of hypovolemic, traumatic, or septic shock.
Crystalloid fluids such as 0.9% NaCl or LRS should be used initially. Volumes 1 xli to 3 times
the calculated blood volume of the Pet (blood volume of the dog is 80-90 ml/kg; blood volume
of the cat is - 60 ml/kg) may be required to restore cardiovascular values to acceptable levels.
o For dogs, a starting dose is 90 ml/kg (40 ml/lb). Give half of the calculated volume as fast
*J
^J
as possible, then reassess.
o For cats, a starting dose is 40 ml/kg (18 ml/lb). Give half of the calculated volume as fast
as possible, then reassess.
o Two or three large gauge intravenous catheters may be required to achieve these fluid
volume rates.
Synthetic colloids (such as Hetastarch) can be valuable for volume resuscitation. A dose of
10-20 ml/kg for a dog and 5-10 ml/kg for a cat over the first hour of treatment is useful for
reducing calculated fluid volume in the resuscitation protocol.
cell volume (PCV) above 25% and the total plasma protein (TP) concentration above 3.5 g/dl.
Blood products should be run through a separate IV line as previously discussed.
66
Whole blood or plasma should be administered in quantities sufficient to maintain the packed
Oxygen therapy is indicated in all shock categories and may be administered by face mask,
oxygen enclosure, nasal (3-10 L/min), or transtracheally.
^
^
Li
Ssc Sis IRsS I
Selection of the appropriate fluid type and fluid rate for a patient should be based on the needs of the
patient. Fluid rate calculation for a patient is based on maintenance needs plus dehydration deficit plus
ongoing losses.
Maintenance fluid volume for Pet:
2.2ml/kg/hr(l ml/lb/hr)
Dehydration deficit:
% dehydration x B.W. (kg) = L of fluid (then decide correction within
On-going fluid loss:
This usually based on an estimate of fluid loss from vomiting, diarrhea,
12-24 hours to get ml/hr rate)
and urine.
Example:
10 lb Pet with 5% dehydration vomiting 5 x daily (~ 30 ml/vomit)

and urinating ~ 100 ml/day
Maintenance fluid:
10 ml/hr
+ Dehydration deficit:
0.05 x 5 kg = 0.25 L (250 ml); if want to correct dehydration

in 12 hours 250/12 = 20 ml/hr or in 24 hours 250/24 =10 ml/hr
L
L
+ On-going fluid loss:
{(30 ml x 5) + 100 ml} = 250 ml/24 hr = 11 ml/hr
Fluid rate:
41 ml/hr for 12 hrs, then 21 ml/hr next 12 hrs
It is important to evaluate the patient daily to determine if the fluid rate is meeting the patient's needs.
Electrolytes should also be evaluated on a regular basis to ensure imbalance is being corrected.
Colloids
Colloids are primarily intravascular volume replacing fluids. When serum albumin levels are less than
2.0 g/dl, colloids are needed to support oncotic pressure.
Natural colloids contain more than just oncotic proteins.
Fresh whole blood contains red blood cells, coagulation factors, platelets, albumin, fibrinogen,
globulins, white blood cells and antithrombin. A starting dosage is 10-22 ml/kg.
Fresh-frozen plasma (FFP) contains coagulation factors, albumin, fibrinogen, globulins, and
antithrombin. Starting dosage for FFP is 6-10 ml/kg.
Blood products should always be administered warmed (never exceed 37 C) with an in-line
blood filter.
Cross-matching should be performed for animals receiving whole blood products.

In normovolemic patients, the recommended infusion rate for whole blood or plasma products
is 22 ml/kg/day.
In hypovolemic patients, the rate should not exceed 22 ml/kg/hr.

For patients with compromised cardiac function, the rate should not exceed 4 ml/kg/hr.
All transfusions should be completed within 4 hours due to the risk of bacterial growth in
blood maintained at room temperature for a prolonged period of time.
Patients who are receiving transfusions should be monitored during the process to insure early
detection and prompt treatment of a transfusion reaction.
Pulse-ox readings are not affected by the administration of canine blood containing Oxyglobin
(Hb-200).
65
J
Exotic Pet anesthesia is essentially the same as canine and feline anesthesia. However, application
requires modification of equipment and technique due to small patient size, recognition of variable
_J
drug sensitivities, species idiosyncrasies, challenges of restraint, and monitoring limitations. The six
basic steps of anesthesia apply to exotic Pets as well as cats and dogs.
Preanesthetic Evaluation: client education, Pet health status, laboratory information.
Preanesthetic Preparation: fasting, stabilization of systemic status, fluid and oxygen
Monitoring: cardiopulmonary, end-tidal CO2 monitoring, blood pressure (CO2 and BP ideal,
support, equipment and staff training, premedication, venous access if appropriate.
but not currently available at Banfield), pulse oximetry, temperature, plane of anesthesia,
reflexes and hydration status.
^
^
j
*J
Induction: provides a smooth transition into unconsciousness and allows airway to be
established and secured.
Maintenance: temperature maintenance, prevention of hypoglycemia, hypovolemia and

hypothermia.
Postoperative Care: recovery, temperature maintenance, pain control and fluid balance.
UHUmmd
(.J
Proper application of the six steps must address the following issues:
Evaluation of medical history, physical status, and laboratory data.
Stabilization of physiological status before induction of anesthesia.
Minimization of anesthetic time; preparation is key.
Correct anesthetic drug selection and dosage (consider health status, species, age, breed, and
^J
pre-existing conditions and complications).
Maintenance of a patient airway, oxygen support and monitoring.
**'
Monitoring and support of cardiovascular function (fluids and adrenergic drugs).
Monitoring and support of body temperature (use of supplemental heat to reduce heat loss).
Continued monitoring and support until complete recovery.
Analgesic/tranquilizer to decrease pain, stress and excitement during induction/recovery.
Preparation (adequate staff training) for normal and complicated or adverse outcomes.
Special Considerations for Exotic Anesthesia
^J
j
J
j
The small body size of many exotic mammals and avians equates to an increased metabolism rate as
compared to dogs and cats, while reptiles generally have slower metabolism. This variability has a
significant impact on anesthetic considerations. Metabolism levels may increase or decrease drug
requirements or duration of action compared to dogs and cats, increase the risk of hypoglycemia due to
fasting, and increase oxygen requirements. Exotic Pets are extremely sensitive to any period of apnea
or hypoxemia, no matter how short. For example, reptiles may survive an initial hypoxemic anesthesia
episode, only to die a day or weeks later from hypoxic renal damage.
.^J
High body surface area to volume ratio predisposes small Pets to significant body heat loss during
anesthesia. Hypothermia produces prolonged drug metabolism and recovery. Small size makes intuba-
tion, venous access, and anesthetic monitoring difficult and often requires size specific or adapted
equipment. A high level of staff skill is imperative to provide the specialized care needed for successful
^j
exotic care and anesthesia.
68
^^
IRiQSiSBlQlGG3
L*
Section 4:
Anesthetic Considerations
for Small Exotic Pets

j"
Rodents, Rabbits, Ferrets, Guinea Pigs, Chinchillas, Reptiles, Avians
hiLîiM
*****
67
J
Anreflft^
Guidelines for blood sample volumes that can be taken from HEALTHY patients*
(Take smaller amounts from compromised Pets)
Reptiles: Up to 0.5% of body weight. Example: for a 100 gram patient, take 0.5 ml,
Rabbits: Up to 0.5 % of body weight, or 3-5 ml per 1000 grams of body weight.
Ferrets: 4-6 ml per adult ferret, depending on size.
Rodents: 1 ml from Pets weighing more than 100 grams, less from smaller Pets,
Avians: 1 ml per 100 grams body weight.
for a 1000 gram patient, take 3-5 ml.
2-3 ml from larger guinea pigs and chinchillas.
.j
* Adaptedfrom ANTECH Diagnostics sample collection information
Reference laboratories can often supply micro-sized blood collection tubes to facilitate diagnostic
work-ups for small Pets. Check the comments below each Exotic Pet Blood Test listed in the current
reference lab services directory (each hospital should have one). The reference lab information indicates
which collection tubes or containers are best and gives minimum volume amounts for each test. The
most accurate result will be obtained by following these sample container guidelines.
Preanesthetic Preparation
Warm fluids: 2.5% Dextrose in 0.45% NaCl
Supplemental heat source: heating pad at minimum
j
j
The following items will be needed:

Non-rebreathing circuit (at 2-3 L O2 flow)
Insure that the proper supplies and equipment are available.
(with towel between Pet and heat source), incubator best if

available
Pulse Oximeter, ECG, thermometer
Optimal: 24 g, 3/4"IV catheters or 23-20g needles or

bone marrow needles for IO catheters
Appropriately sized face masks or intubation supplies including:
Endotracheal tubes:
Face masks in 2 sizes
o Small face masks
o Large over the needle catheters/red rubber tubes with homemade gas adaptors.
o 2.0 mm and larger endotracheal tubes. Specialty endotracheal tubes also exist.
Mouth gags (to prevent unexpected tube bite-through)
Laryngoscope or otoscope to facilitate intubation.
Lidocaine gel (endotracheal tube lubricant to reduce the

risk of laryngospasm).
Familiarize yourself with pre-anesthetic fasting recommendations. Some exotic Pets should not be
fasted or fasted for only short periods before anesthesia to prevent hypoglycemia.
70
MM1 BanfieldCopyright 2003
L-
Preanesthetic Evaluation
Discuss realistic expectations and potential outcomes with the owner. Provide client education
about after care and present an accurate estimate before the procedure. Include client education about
diagnosis, prognosis and anesthetic risk and recovery. Exotic Pets can respond differently to anesthetic
procedures compared to dogs and cats. Due to small body size and related factors, exotic Pets are more
prone to anesthetic and surgically related complications.
Obtain an accurate body weight, usually in grams. Accurate body weight is imperative for calculat
ing correct drug doses. Obtain a complete history. Determine if the patient can reasonably be handled.
Perform as complete a physical exam as possible to determine if the Pet's status is healthy or compro
mised. Determine "awake" pulse rate, temperature and respiratory rate when possible. Pets that cannot
be examined without chemical restraint should be evaluated based on visual observation and history.
Handle stressed Pets for as short a period of time as possible. In some cases, sedation or anesthesia of
sick Pets to allow evaluation is preferable to the stress induced by struggling and restraint.
Become familiar with common ailments for each species. Evaluate any pre-existing conditions or
clinical signs including anemia, cyanosis, cachexia or obesity, anorexia (fasting), icterus, weakness or
CNS depression, dehydration, ascites, respiratory abnormalities, tissue trauma, and clotting abnormities.
Use appropriate caution in Pets with hepatic, renal, or other compromise. Stabilize systemic status if
possible, including treatment for pain if appropriate.
mmami
Perform pre-anesthetic blood work whenever possible. This includes CBC/differential and chemistry
profile. It may not be possible to obtain adequate blood sample volumes from very small Pets. However,
a sample adequate to perform a PCV/TP and blood glucose is usually obtainable from all but the very
smallest Pets. Consider urinalysis, fecal examination, and other blood tests as appropriate to the case.
The current in-house blood chemistry machine will run chemistries on rabbits, ferrets, many avians,
reptiles, and rodents. Uric acid levels for reptiles and avians will need to be sent out to a reference lab
for most hospitals. The in-house CBC machine will run CBCs on rabbits and ferrets. You will have to
refer to a text for ferret normals. If no rabbit normal card is available for Heska machines, you will
L
L
have to refer to a text for rabbit normals. Call the CTS Facilities Hotline (800-838-6738 ext. 5566) to
obtain a rabbit card for future use. In most cases, CBCs for reptiles and avians will need to be sent to a
reference lab. A manual count can be performed in-house if you have skill in reading avian and reptile
blood smears.
Avoid anesthesia if PCV is less than 20% and/or Total Protein is less than 3 g/dl. For mammals,
Dextrose can be given SQ.
consider the administration of 5% Dextrose in crystalloid fluids if blood glucose is less than 80 mg/dl.
If IV access is not an option, fluids containing 5% Dextrose can be given PO. Fluids containing 2.5%
L
69
.J
J
Small Mammals
Sites For Parenteral Access Or Injection In Small Exotic Mammals:

Adapted from The Veterinary Clinics of North America: Exotic Animal Practice, Vol 4, #/, Jan 2001
Species
Parenteral Access and Injection Sites
Ferret
SQ, IM, 10, IV: cephalic, jugular,
Comments
lateral saphenous, lateral tail
Rabbit
SQ, IM, 10 (trochanteric fossa), IV: marginal ear,
Blood clots quickly, external jugular is
cephalic, lateral saphenous, jugular
primary drainage for head (swelling occurs

if jugular catheter remains in place)
Guinea Pig
Rat&
SQ, IM, 10 (trochanteric fossa), IV: marginal ear,
Self-mutilation can occur with IM injec
medial saphenous, lateral saphenous proximal
tions, vascular access often difficult due to
to hock, dorsal penile, jugular
short, mobile, friable veins
SQ, IM, 10, IV: jugular, lateral tail
Lateral tail veins are difficult to obtain

blood from except by capillary action
Mouse
Gerbil
Hamster
SQ, IM, 10, IV: lateral tail, saphenous, metatarsal
Use 25g needles
SQ, IM, IO (tibial crest), IV: lateral tarsus, cephalic,
IV: access difficult, use 27-30g needles
lingual, dorsal, penile
IM: maximum volume is 0.25 ml
10: use 22g spinal needle

Chinchilla
SQ, IM, 10, IV: femoral, cephalic, lateral saphenous,
IM: use 23g or smaller needles
jugular, auricular, dorsal penile, lateral abdomen, tail
IM: maximum volume 0.3ml.
IV: use 25g or smaller needle
Reptiles/Avians
Reptiles:
Historically, it has been preferable to administer injections into the cranial half of the body of
reptiles to decrease drug passage through the renal portal system. Recent studies indicate it is
unlikely that the injection site actually has significant influence on most drug activity. However,
the coccygeal vein blood of some lizards does appear to enter the renal portal system. Therefore,
renal-toxic drugs or those with a very high first pass renal excretion rate should not be adminis
tered via the coccygeal vein in reptiles.
72
MM! BanfieldCopyright 2003
J
J
Recommended Preoperative Fasting and Water Withholding Times For Exotic Pets
Species
Fasting Time
Water
Ferret
4 hrs
2 hrs
Rabbit
30-60 min.
0-30 min.
Guinea Pig/Chinchilla
4 hrs
2 hrs
Small Rodents
Reptiles
4-6 hrs
0-1 hrs
Smaller Avians
4-6 hrs
0-2 hrs (want empty crop)
Larger Psittacines
8-12 hrs
0-2 hrs (want empty crop)
Allow stressed Pets to calm before anesthesia. Overstimulation and high sympathetic tone can
override sedatives and predispose to vasoconstriction, increased myocardial workload and cardiac
arrhythmias. Some exotic mammals (particularly rabbits and many birds) may benefit from hospitalizaUiMaiJ
tion the night before anesthesia to allow acclimatization to the hospital environment and blood sample
collection for pre-anesthetic testing. This reduces stress in the immediate pre-anesthetic period.
Maintenance of correct body temperature is imperative. Warm SQ, IV, or IO fluids should be
administered before, during and after anesthesia. Provide supplemental heat as needed, especially during
surgery and recoveryuse heating pads, warm air or hot water bottles. Avoid thermal burns
baâl
monitor heat sources closely. Place a dry barrier (towel) between Pets and heating pads to reduce
potential for burns. Use of incubators pre- and post-surgically is ideal.
Prepare to perform anesthesia in a warm immediate environment. Clip hair cautiously from as
small an area as possible and do as much prep as possible prior to induction. Use warm surgical prep
solutions and substitute warm diluted chlorhexidine or saline for scrub rinsesavoid alcohol. Cover as
much of the Pet as possible during surgery to retain body heat. Use clear, adhesive plastic surgery
L.
drapes whenever possible. Use adhesive tape sparingly, as the delicate skin of small Pets tears easily.
Masking, paper or autoclave tape may be better choices.
Fluid support is vital to maintain hydration, blood volume, and fluid balance. Set an intravenous
or intraosseous catheter when possible; IV is preferred. Use a micro-drip fluid administration set.
Whenever possible, a fluid pump should be used to insure accurate delivery rates and volumes.
UiiMmal
71
Sites And Techniques For Intraosseous Catheterization In Reptiles and Avians:

Adapted from: The Veterinary Clinics ofNorth America: Exotic Animal Practice, Vol 4, #1, Jan 2001: Kirks Current
Veterinary Therapy XII, Small Animal Practice, Bonagura, Ed., 1995, W.B. Saunders Therapeutic Avian Techniques, Don
Harris, Atlantic Coast Veterinary Conference 2002 - Program
Species
Intraosseous Site
Lizard
Distal Femur: Flex stifle. Curve in distal femur usually allows catheter to be introduced proximal to the joint.
Proximal tibia: Differentiate from lateral fibula. Pass catheter through tibial crest and advance needle to
medial surface of leg as it is passed into the bone.
Proximal Humerus: Place catheter either into the greater tubercle or slightly medial to it.
Turtle &
Carapace/plastron bridge: Pass needle at an acute angle through the bony bridge between carapace
Tortoise
and plastron. This is difficult to do, and catheter usually enters the coelomic cavity rather than the
Avian
Distal Ulna: Flex carpus. Identify dorsal condyle of distal ulna, insert needle just behind it. Direct needle
intramedullary space.
under dorsal condyle and proximally into ulnar shaft.
Proximal Tibiatarsus: Identify cranial cnemial crest of proximal tibiatarsus between and just distal to the
femoral condyles. Direct needle into the tibial plateau just posterior to cnemial crest and distally into
marrow cavity.
Start fluid administration before anesthesia: (IV, 10, SQ), IV is preferred. Be sure to use warmed
fluids delivered with a micro-drip set.
2.5% dextrose in 0.45% NaCl is recommended for routine perioperative fluid administration.
IV/IO catheter placed:
Begin administration of warm IV/IO fluids at 5-10 ml/kg/hr

before induction of anesthesia when possible. Continue fluids
until recovery is complete.
No IV/IO catheter placed: Begin administration of warm fluids at 5-10 ml/kg/hr SQ.
Administer V4 of the calculated hourly dose every 15 minutes

starting before induction of anesthesia, continuing through recovery.
Measure fluids, control fluid rates, and monitor patients carefully to prevent fluid overload and
pulmonary edema.
Maintenance fluid rate:
1.5-4.0 ml/kg/hr
Anesthesia fluid rate:
5-10 ml/kg/hr
Shock fluid rate:
30-80 ml/kg/hr
Pre-oxygenation before induction is recommended if it can be performed without stress. This is

performed via an oxygen cage/chamber, or induction mask.
Supplemental oxygen should be provided from induction through recovery. Provide supplemental
oxygen even if immobilizing drugs are used alone. It may be necessary to make or obtain special
oxygen delivery equipment, including tiny masks made from syringe cases with a latex glove
diaphragm over the end.
74
l-jy^ I
Sites For Vascular Access/Injection and Intramuscular Injection In Reptiles/Avians:
Adaptedfrom The Veterinary? Climes ofNorth America: Exotic Animal Practice, Vol 4, #/, Jan 2001 Kirks Current
Veterinary Therapy XII, Small Animal Practice, Bonagura, Ed., 1995, W.B. Saunders Manual ofPsittacine Birds,
British Small Animal Veterinary Association, Beynon, Ed., 1996, Iowa State University Press
Reptile
Parenteral Access
Type
and Injection Sites
Snake
Comments
IV: jugular (right),
Right jugular vein is larger than leftincise 4-7 scutes cranial to the heart at
coccygeal, heart,
the junction of the ventral scutes and right lateral body scales. Jugular is
palatine (medium to
identified by blunt dissection just medial to tips of the ribs.
large snakes)
Coccygeal vein is located on ventral midline of tail. Use 22-27g needle,
IM route: paravertebral
hemipenes (males) and anal sacs. Aspirate until blood or bone is encountered.
insert V3 of distance from cloaca to ventral midline of tail to avoid

musculature preferred
If unsuccessful, reposition cranially or caudally. Difficult to use in small

snakes.
HeartUse 25-27g needles in smaller snakes, 22g in very large snakes.

Insert needle at a 45-degree angle to ventricles and aspirate gently.
Palatine vein is located medial to palatine teeth in roof of mouth. Take care
not to injure fingers. Usually accessed while Pet is under anesthesia or a
secure mouth gag is in place.
Lizard
IV: cephalic, ventral
Cephalic vein is located on dorsal (anterior) surface of distal foreleg. A cut
abdominal, jugular,
down incision from the elbow distal and medial over the dorsal forearm allows
coccygeal
visualization of vein.
IM route: proximal
percutaneously or following small skin incision on the midline to visualize
limbs (shoulder to
vessels.
elbow) recommended.
Jugular vein is located on lateral neck, more dorsal than would be expected in
Ventral abdominal vein is located on ventral midline and can be entered
ikimmtM
mammals. Requires a longitudinal incision and blunt dissection to visualize.

Not Recommended:
Coccygeal vein is located on ventral midline of tail. Insert small gauge needle
Distal limb (below
sufficiently caudal to the cloaca to avoid hemipenes (males) and anal sacs.
elbow) IM/SQ
Vessel is entered directly from ventral midline or laterally. Insert needle ventral
injections may cause
to transverse process and advance until vertebral body is contacted. While gently
tissue necrosis.
aspirating, walk needle ventrally around vertebral body until vessel is found.
Turtle &
IV: jugular, dorsal
Jugular vein is located on lateral surface of neck below auricular scale. Some
Tortoise
coccygeal, brachial
Pets may be percutaneously catheterized; others require a longitudinal incision

for visualization.
IM route: proximal
Dorsal Coccygeal vein is located on midline of tail, dorsal to vertebrae. Clean
limbs (shoulder to
injection sites of feces or debris. Insert needle in midline and advance until
elbow) recommended.
bone is contacted. Gentle aspiration allows identification of vessel.
Not Recommended:
Distal limb (below

elbow) IM/SQ
injections may cause
tissue necrosis.
Avian
L-
IV: ulnar (basilic,
Ulnar (basilic, brachial) is located near elbow on ventral aspect of wing. Use
brachial), medial
for birds over 150 grams. Hematoma forms easilyapply pressure for 2-3
metatarsal (caudal
minutes post venipuncture.
tibial), right jugular
Medial Metatarsal is located on medial aspect of proximal metatarsus.

Jugular (right side)extend neck and part or wet feathers to visualize.
IM route: Pectoral
This is the easiest vein to access in small birds.
muscles recommended
73
J
Loss of response to a toe pinch indicates a surgical anesthetic plane has been reached. Blink response
is not a reliable indictor of anesthetic depth in all exotic Pets. Blink response may be impossible
(snakes) or difficult to access in reptiles and very small patients. Rabbits especially may exhibit a
variable blink response, even at deeper planes of anesthesia.
Corneal response varies from species to species. Loss of a previously present corneal response is an
indicator of excessive anesthetic depth; anesthetic concentration should be decreased.
Monitor respiration carefully. Exotic patients are extremely sensitive to even brief periods of apnea
or hypoxemia. Small airways and endotracheal tubes are prone to obstruction with respiratory secre-
tions. Chest wall and rebreathing bag movement as well as condensation and clearing of the face
mask/endotracheal tubing aid in the evaluation of respiratory rate and effort. Increased respiratory
effort or abnormal respiratory sounds (squeaking, wheezing, unexpected silence) are indictors of
impending airway obstruction. Rabbits are especially at risk for respiratory obstruction due to
excess salivation during mask delivery of anesthetic gases.
Maintenance and measurement of body temperature is imperative. Small Pets can lose as much as
10C in 15 minutes.
Anesthetic Induction and Maintenance
The goal of induction is a smooth transition into unconsciousness and to allow placement of a tracheal
tube if possible. Tracheal intubation is optimal. However, it is not routinely recommended in all species
m^
due to the difficulty and potential to inflict life threatening pharyngeal injury in some species (especially
rabbits and rodents).
See individual species protocols for induction medications and doses.
Compromised Pets should receive at least 1/4 of their hourly fluid requirement volume
BEFORE pre-medications are given whenever possible.
DO NOT use Propofol in turtles and tortoises unless you are ready to intubate and assist
ventilation; Propofol can cause prolonged apnea if given to quickly. To prevent apnea, reptiles
in general should be given Propofol very slowly, much more slowly than mammals. See
individual protocols for more information.
DO NOT exceed 5% Sevoflurane for mask induction. Provide oxygen at 3-4 L/minute
initially, then at 2 L/minute for maintenance.
Avoid the stress of struggling. Use a sedative dose of Ketamine or Telazol depending on
species (see individual protocols).
76
Pre-oxygenation is recommended if it can be performed without stress.
"*
f?rr?ff]T^?^
Some surgeons are aided by a brace or support that can be placed over small Pets to allow a place
i^
for the hands to rest while performing surgery. These can be fashioned from PVC pipe cut into various
lengths and placed over part of the Pet.
^^
Premedication is recommended for all patients. It calms, improves handling, reduces the amount of
induction and maintenance agents needed, smoothes recovery, reduces vagal effects, and may prolong
[^
analgesia. Premedication is optimal if it can be performed without causing excess stress. See species
specific recommendations noted in the individual anesthetic protocols that follow.
L*
Special note: If Glycopyrrolate is used as a premedication, Atropine administration for treatment of
bradycardia during anesthesia must be adjusted accordingly. Give 1/4-1/2 the usual Atropine dose in
such cases.
Lsi
When mask anesthetic induction is used, small Pets often hold their breath. Deep, rapid respiration
occurs after "breath holding," leading to rapid uptake and anesthetic overdose. Use low induction con
centrations of inhalant anesthesiado not exceed 5% Sevoflurane. Use small masks. Monitor for apnea.
Anesthetic Monitoring
L
I
Monitoring should be performed continually through induction, anesthesia, and recovery. This includes
anesthetic depth, cardiopulmonary status (ECG, blood pressure, pulse oximetry, end-tidal CO2),
temperature and reflexes.
Routine monitoring methods are useful in larger rabbits, ferrets, guinea pigs, chinchillas, reptiles and
[^
I
L-*
avians. Pulse oximetry, ECG, and blood pressure or end-tidal CO2 monitoring can be used in larger
patients. However, end-tidal CO2 may not be accurate and adds considerable dead space to the breathing circuit if used in Pets under a few kilograms. Pulse oximetry and ECG monitoring can be used on
most patients with some equipment modification. Keep in mind that some monitors cannot read the
rapid heart rate of small mammals, making careful manual monitoring imperative.
l.aI
L
L
L
L
Pulse oximetry probes are useful on ears, tongue, tail, and feet/toes. Rectal pulse oximetry probes are
appropriate for ferrets, rabbits, and larger rodents. Rectal probes can be used in the cloacae of some
avians and reptiles. Oxygen saturation below 94% indicates hypoxia; take immediate steps to correct it.
ECG leads can be attached directly to the skin, to paper clips placed on skin folds, stainless steel
sutures placed in the skin, or small 25 g needles placed just into the skin. However, do not waste anes
thetic time placing sutures, paper clips, or needles if regular ECG leads will work. If the leads are too
tight for delicate skin, loosen them before use. Triangulate the heart for the best reading. Use contact
gel rather than alcohol-based contact solutions.
Manual monitoring techniques are important in exotic Pets. During anesthesia, pulse rate and character
usually decrease by roughly 20%, compared to awake resting rates. If they fall below this range, reduce
the anesthetic concentration being used. Respirations should be slow, regular and stable.
t)llM||gjH(il
75
Monitor respiratory function carefully, as obstruction can easily occur before the patient is fully awake.
For reptiles, it is especially important to minimize orthostatic hypotension by maintaining the Pet in a
natural body plane (usually horizontal and sternal) and by slowly performing changes in body position.
Mammals (except for chinchillas) and avians may benefit from warm ambient or cage temperatures of
20-25C during the first 24 hours post anesthesia. Keep chinchillas below 24C (optimal: 20-22C) as
they easily become overheated. Reptiles benefit from slightly higher ambient temperatures (25-30C
for temperate and aquatic reptiles, 30C for tropical reptiles). Be sure to avoid hyperthermia in all
species. Continue fluid support as drinking may be decreased during this period. Continue to provide
postoperative analgesia.
Monitor and record vitals in the medical record, just as with dogs and cats.
Post-operative pain control
Exotic Pets benefit from analgesics as dogs and cats do. Lethargy, anorexia, and self-mutilation may
occur if post-surgical pain is not controlled. Rabbits are especially reactive to pain; recovery is
improved if analgesia is used for 1-2 days post-surgically. Currently, most anesthesiologists recom
mend pre-emptive analgesia. Analgesia given before the onset of pain or before recovery from anesthe
sia is thought to be most effective.
The duration of action of Butorphanol can vary greatly. Some Pets may need repeat dosing as often as
every 1-2 hours. Monitor all recovering Pets frequently for pain or excess sedation.
Analgesic Drug Doses for Exotic Petsgiven SQ or IM

Pain
Ferret
Rabbit
Management
Mouse
Guinea Pig
Gerbil
Chinchilla
Rat
Reptile
Avian
Hamster
Butorphanol
Ketoprofen
0.1-0.5
0.1-0.5
2.0 mg/kg
2.0mg/kg
2.0 mg/kg
04-1.0
mg/kg
mg/kg
q 2-4 hrs
q 2-4 hrs
q 2-4 hrs
mg/kg
q 2-4 hrs
q 2-4 hrs
SQ
SQ
IM or SQ
IM or SQ
q 24 hrs
SQ
IM
3 mg/kg
5 mg/kg
2.0 mg/kg
2.0 mg/kg
q 24 hrs
q 24 hrs
q 48 hrs
q 24 hrs
IM
SQ or PO
IM or SQ
IM or SQ
78
Minimal injectable volume of Telazol is 0.1 ml. If your patient's needed dose will be a smaller
volume than 0.1 ml, dilute to at least 0.1 ml total volume in sterile water before injection.
Example:
Patient needs 5 mg Telazol. Telazol is 100 mg/ml, so 5 mg would be 0.05ml. Minimal desired
volume is 0.1 ml/dose. (ml/lOOmg x 5mg = 0.05ml)

Draw up 0.1 ml of 100 mg/ml Telazol in a TB syringe and 0.1 ml of sterile water in a separate
TB syringe.
Using a third TB syringe with the capped needle detached and the plunger partially pulled out,
add the Telazol and the sterile water into the third TB syringe through the needle attachment
opening. Replace the capped needle firmly. Mix well by flicking with your finger multiple times.
You now have a diluted Telazol solution of 50 mg/ml (a 1:2 dilution). 5 mg of a 50 mg/ml solu
tion (ml/50 mg x 5 mg) = 0.1ml per dose. Depress the plunger to eject excess air and solution
until you have your desired amount, in this case, 0.1ml.
Tracheal tube sizes of 2.0-3.0 mm are useful in larger Pets (>3 lbs). Smaller Pets may require specialty
tubes available from exotic anesthesia specialty manufacturers (such as Cook's Veterinary Products).
For very small Pets, 18 gauge IV catheters with the needle stylet removed or red rubber feeding tubes
with opened ends and homemade adaptors can sometimes be substituted. Tube ties-ins (gauze strip,
tape) should be attached to these small tubes before intubation.
Maintenance of small mammals is very similar to that of dogs and cats. Protective eye ointment should
be used. Body temperature must be maintained during induction, anesthesia and through recovery.
Perform anesthesia in a warm immediate environment and keep surgical and anesthetic time to a mini
mum. Heat is easily lost through exposed extremities; cover them (see "Preanesthetic Preparation" sec
tion for more details on temperature maintenance).
Prevent hypoglycemia. Warm fluids with 2.5% Dextrose should be given, preferably IV. If this route
is not available, fluid can be given IO or SQ, but absorption time lags for SQ administration.
Minimize blood and body fluid losses and provide maintenance and replacement fluids as needed.
Avoid hypovolemia by administering fluids at a rate of 5-10 ml/kg/h.
Postoperative care
Recover exotic Pets in a warm environmentan incubator is ideal. Dry areas of wet hair or skin to
decrease conductive heat loss. Maintain support of cardiovascular and pulmonary function and monitor
body temperature until the Pet is fully recovered. As with canine and feline patients, this includes
supplemental heat and fluid support until the Pet is able to swallow, sit sternal, and is at normal body
temperature.
MMI BanjieldCopyright 200S
77
Avian Anesthesia Protocol
.J
(See "Anesthetic Considerations for Small Exotic Pets" before proceeding.)
Consider all avians as high-risk patients.
Keep restraint time to a minimum. Stressful restraint and

handling can cause death.
Address life-threatening emergencies immediatelydelay

Parrot
further procedures until Pet is stabilized.
Avians are particularly susceptible to body heat loss. Use a
radiant heat source (heat lamp at safe distance) or elevated ambient temperature (incubator).
Intubation is optimal. Positive pressure ventilation may be needed to prevent hypoxia during
inhalant anesthesia. Use appropriate mouth gag to prevent tube "bite through."
Non-cuffed endotracheal tubes are preferred. The tracheal mucosa is fragile and the complete
tracheal rings of avians do not allow for significant expansion.
hlffirtlff
Do not exceed 5 cm of water pressure during assisted ventilation.
If unable to place endotracheal tube, but intubation is required (such as respiratory compro
mise, surgery that will compromise airway, anesthesia time >30 minutes expected), refer Pet
to a skilled exotic practitioner.
Provide supplemental oxygen throughout induction, anesthesia, and recovery.
J
J
Equipment and Supplies: face mask, non-rebreathing circuit, IV/IO catheter supplies, 2.5% dextrose
in 0.45% NaCl, supplemental heat source, monitoring equipment, intubation supplies if appropriate.
Evaluation: history, physical, laboratory data (including uric acid), health status, determination if
intubation required, client education.
Preanesthetic Preparation: fast appropriately (small birds 4-6 hrs, large birds 8-12 hrs), withhold
water 0-2 hrs, IV/IO catheterization optimal (may need placement after induction), start fluid
support at 5-10 ml/kg/hr (IV preferred).
J
J
Premedication: 30-60 minutes before induction
Healthy Pet: Diazepam 0.2-0.3 mg/kg IM and Butorphanol 0.4-1.0 mg/kg IM
Compromised Pet: Butorphanol 0.4-1.0 mg/kg IM
Induction: pre-oxygenate (before induction) if possible without causing stress, then mask with
Sevoflurane/O2. Intubation is optimal.

Maintenance: Sevoflurane/O2 via mask/endotracheal tube to effect, maintain body temperature,
monitor, provide fluid support and supplemental oxygen.
Recovery: maintain heat and fluid support
Pain Control: Butorphanol 0.4-1.0 mg/kg q 24 hrs IM or Ketoprofen 2.0 mg/kg IM or SQ q 24 hrs.
80
MMJ BanfieldCopyright 2003
\mmsam
Note on Individual Protocols
Each patient should be treated as uniquedifferences between species, breeds, strains, and individuals
exist. This individuality influences what anesthetic drugs choices are appropriate, and whether mask,
tracheal tube, or injectable anesthesia maintenance is best.
Inhalant anesthesia via a tracheal tube is the first choice if reasonably possible. In some species,
intubation is very difficult (guinea pigs/rabbits) or impractical (very small patients). Multiple attempts
at intubation should be avoided as laryngeal edema and subsequent respiratory obstruction can occur.
Mask maintenance is appropriate when a tracheal tube is not in place, but great care must be taken to
decrease the risk of respiratory obstruction. Positioning the patient with head and neck extended,
tongue pulled out, and in sternal recumbency will reduce the potential for obstruction. Supplemental
oxygen should be provided through all stages of induction, anesthesia, and recovery. Pre-oxygenation
is recommended if it can be provided without causing stress.
References
Kirks Current Veterinary Therapy XII, Small Animal Practice, Bonagura, Ed., 1995, W.B. Saunders
Ferrets, Rabbits, and Rodents, Clinical Medicine and Surgery, Hillyer, Queensberry, 1997, W.B.
Saunders
The Veterinary Clinics ofNorth American, Exotic Animal Practice, Analgesia and Anesthesia, Darryl
Heard, Ed., 4:1 January 2001, W.B. Saunders
Lumb & Jones' Veterinary Anesthesia, 3rd Ed., Thurmon, Tranquilli, Benson, Eds., 1996, Williams and
Wilkins
Reptile Medicine and Surgery, Mader, 1996, W.B. Saunders
Clinical Avian Medicine and Surgery, Including Aviculture, Harrison, 1998, W.B. Saunders.
Therapeutic Avian Techniques, Don Harris, Atlantic Coast Veterinary Conference 2002 - Program
Manual ofPsittacine Birds, British Small Animal Veterinary Association, Beynon, Ed., 1996, Iowa
State University Press
British Small Animal Veterinary Association Manual ofExotic Pets, 4th Edition, Meredith and
Redrobe, Eds., British Small Animal Veterinary Association, 2002
J
Reptile Anesthesia Protocol
Intubation is optimal. Positive pressure ventilation may be needed to

prevent hypoxia during inhalant anesthesia and when Propofol is used
k-'.'-..;-^^^^^^Bj
'**" * v
J
in some species.
When intubated, ventilate at 4-6 bpm and do not exceed 10-12 cm of

water pressure.
If unable to place endotracheal tube, but intubation required (such as
respiratory compromise, surgery that will compromise airway, anesthesia time >30 minutes
expected) refer Pet to a skilled exotic practitioner.
May survive an initial hypoxemic anesthesia episode, only to die days/weeks later from
hypoxic renal damage. Proper oxygenation is important.
Perioperative fasting is recommended to reduce visceral volume (improves tidal volume) and
because digestion is impaired during anesthesia and recovery.
IV or 10 fluid administration best, but SQ is better than none. SQ administration may not be
adequate for correction of dehydration or blood loss in the perianesthetic period.
Debilitated, dehydrated, or chilled reptiles have prolonged absorption times for fluids
administered SQ.
Optimal temperatures: temperate and aquatic reptiles: 25-30C, tropical reptiles: 30C.
Equipment and Supplies: face mask/intubation supplies, non-rebreathing circuit, IV/IO catheter
supplies, 2.5% Dextrose in 0.45% NaCl, supplemental heat, monitoring equipment.
Evaluation: history, physical, laboratory data (including uric acid), health status, determination if
intubation required, client education.
Preanesthetic Preparation: fast 4-6 hrs, withhold water 0-1 hr, IV/IO catheterization optimal, start
fluid support at 5-10 ml/kg/hr (IV preferred)
Healthy Pet: Diazepam 2.5 mg/kg IM and Butorphanol 0.4 mg/kg IM
Compromised Pet: Midazolam 1 mg/kg IM
Induction: pre-oxygenate (before induction) if possible without causing stress, then:
Healthy Pet: Propofol IV 3.0-5.0 mg/kg IV to effect. Give slowly in small boluses 2-3
minutes apart (especially in turtle/tortoise) to prevent apnea. If no IV catheter, mask induce

with Sevoflurane/O2 (first choice) or give Ketamine 5-10 mg/kg IM, then mask with
Sevoflurane/O2 to effect.
Compromised Pet: Propofol IV 3.0-5.0 mg/kg IV to effect. Give slowly in small boluses 2-3
minutes apart (especially in turtle/tortoise) to prevent apnea. If no IV catheter, mask induce
with Sevoflurane/O2 (best choice). If struggling or significantly holding breath, give 5 mg/kg
Ketamine IM, then mask with Sevoflurane/O2 to effect. Ketamine can cause prolonged
recovery times in debilitated reptiles.
Maintenance: intubate if appropriate, O2/Sevoflurane via mask/endotracheal tube to effect, maintain

body temperature, monitor, provide fluid support and supplemental oxygen.
Recovery: maintain heat and fluid support.
Pain Control: Ketoprofen 2.0 mg/kg IM or SQ q 48 hrs.

82
Avian Anesthesia Flow Chart

Evaluation:
Fluid Support/Preparation:
Place IV/IO Catheter if Possible- IV preferred
Medical History
Temperament
IV/IO Catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10mL/kg/hr IV/IO, continue
Physical Exam
L,
through recovery.
Gather & Evaluate Lab Data
Determine Health Status:
NO catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10ml_/kg/hr SQ, continue
Healthy or Compromised?
through recovery. Give 1/4 calculated hourly dose every 15 minutes
Determine if IV/IO catheter will be placed

Determine If Pet will be intubated
Intubation optimal
Fast Appropriately
Endotracheal tube placement required for successful anesthesia/procedure? Expect successful
Provide Client Education/Communicate
placement of endotracheal tube upon induction?
Expectations
LCan Intubate or \
Not Required
Requires Intubation,
Needs Intubation, \
but can't do it:
but Can't Do
Consider referral to
skilled exotic
practitioner
Premedicate 30-60 minutes before anesthesia

Healthy Pet:
Diazepam: 0.2-0.3 mg/kg IM
Butorphanol: 0.4-1.0 mg/kg IM
Compromised Pet:
Butorphanol: 0.4-1.0 mg/kg IM
Keep Pet Warm & Monitor
Induction:
Pre-oxygenate if possible without causing stress
Healthy or Compromised: Mask with sevo (2-4%)/O2 and intubate (optimal) or use facemask. O2 at 3-4 L/min
initially, then 2L/min maintenance.
Maintenance:
Mask Induction: Administer sevoflurane (2-4%) & oxygen via mask or endotracheal tube. O2 at 3-4L/minute initially,
then 2 L/min for maintenance. Use minimal concentration of sevoflurane necessary.
Recovery:
Continue to provide warm fluid support through recovery.

Provide Pain Control: Butorphanol 0.4-1.0 mg/kg IM Q 24 hrs
Ketoprofen 2.0 mg/kg IM or SQ Q 24 hrs
MMI BanfieidCopyright 2003
81
Ferret Anesthesia Protocol

Use gauze strips to hold the mouth open, allowing visualization of

the larynx.
Tracheal intubation is optimal and can be attempted in ferrets >4 lbs

body weight with a 2.0-3.0 mm endotracheal tube. Do not try more
than twice. Repeated attempts will cause significant laryngeal edema.
If unable to place endotracheal tube, but intubation required (such as
Ferret
respiratory compromise, surgery that will compromise airway, anesthesia
time >30 minutes expected) refer Pet to skilled exotic practitioner.
Corneal and palpebral reflexes may be lost at a surgical anesthetic plane.
Underlying potential disease states to consider include adrenal tumors, cardiomyopathy,

anemia, hypoglycemia, and endocrinopathies.
Equipment and Supplies: face mask or intubation supplies as appropriate, non-rebreathing circuit,
IV/IO catheter supplies, 2.5% Dextrose in 0.45% NaCl, supplemental heat source, monitoring
equipment.
Evaluation: history, physical, laboratory data, health status, determination if intubation required,
client education.
Preanesthetic Preparation: fast 4 hrs, withhold water 2 hrs, IV/IO catheterization optimal (may need
to be placed after premed or induction), start fluid at 5-10 ml/kg/hr (IV best).
Healthy Pet: Acepromazine 0.1 mg/kg IM and Butorphanol 0.2 mg/kg IM and Glycopyrrolate
Compromised Pet: Diazepam or Midazolam 0.1 mg/kg IM and Butorphanol 0.1-0.2 mg/kg
0.01 mg/kg IM
IM and Glycopyrrolate 0.01 mg/kg IM.

Healthy Pet with IV catheter: Propofol 2.0-8.0 mg/kg IV to effect.
Healthy Pet without IV catheter: Telazol 6 mg/kg IM, wait for effect and mask with
Sevoflurane/O2 if needed. If initial Telazol dose has no effect after 20 minutes, can repeat
V4-V2 dose of Telazol once.
Compromised Pet with IV catheter: Propofol 2.0-8.0 mg/kg IV to effect.
Compromised Pet without IV catheter: Mask with Sevoflurane/O2 to effect. If

struggling, give sedative Telazol dose 1.0 mg/kg IM, wait 20 minutes and mask again. Repeat
Telazol at 1.0 mg/kg dose once if needed.
Maintenance: Sevoflurane/O2 via mask/endotracheal tube to effect, maintain body temperature,

monitor, provide fluid support and supplemental oxygen.
Pain Control: Butorphanol 0.1-0.5 mg/kg q 2-4 hrs IM or SQ.
84
MM! BanfleldCopyright 2003
Reptile Anesthesia Flow Chart

Evaluation:
Place IV/IO Catheter if Possible
Medical History
Temperament
Physical Exam
IV/IO Catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10ml_/kg/hr IV/IO, continue
through recovery.
NO catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10ml_/kg/hr SQ, continue
through recovery. Give 1/4 calculated hourly dose every 15 minutes
Intubation optimal
Fast Appropriately
Endotracheal tube required for successful anesthesia/procedure? Expect successful placement of
endotracheal tube upon induction?
Expectations
L-
but can't do it:
Needs Intubation, \
but Can't Do
skilled exotic
Healthy Pet:
Diazepam 2.5 mg/kg IM
J
Can Intubate or
practitioner
Butorphanol 0.4 mg/kg IM
Not Required
Compromised Pet:
Midazolam 1 mg/kg IM
Yes IV
Catheter
No IV
Catheter
Induction: (No Catheter in Place)
Induction: (IV Catheter in Place)
L-
Pre-oxygenate if possible without causing stress.
Pre-oxygenate if possible without causing

stress.
Induction: Propofol 3.0-5.0 mg/kg IV slowly

to effect. Give SLOWLY in small boluses 2-3
minutes apart to prevent apnea. Monitor for
apnea.
Intubation optimal, otherwise use facemask.

Healthy Pet: Propofol IV 3.0-5.0 mg/kg IV SLOWLY to effect. Give in small boluses 2-3 minutes apart to
prevent apnea. If no IV catheter, mask with sevo (2-4%)/O2 (first choice) or give Ketamine 5-10 mg/kg IM,
then mask with Sevo(1-4%)/O2. O2 at 3-4L/minute initially, then 2 L/min for maintenance.
Compromised Pet: Propofol IV 3.0-5.0 mg/kg IV SLOWLY to effect. Give in small boluses 2-3 minutes
apart to prevent apnea. If no IV catheter, mask with Sevo (2-4%)/O2 (best choice). If struggling or
significantly holding breath, give 5 mg/kg Ketamine IM, then mask with Sevo (1-4%)/O2 if needed. 02 at
3-4L/minute initially, then 2 L/min for maintenance. Ketamine can cause prolonged recovery times in
debilitated reptiles.
Maintenance:
Propofol/Mask Induction: Administer Sevoflurane (2-4%) & oxygen via mask or endotracheal tube. Use minimal concentration of sevoflurane
necessary. If intubated, ventilate at 4-6 bpm & don't exceed 10-12 cm water pressure.
L-y
Ketamine Induction: Provide supplemental O2 via mask or endotracheal tube. Add Sevoflurane at 1-4% as needed to maintain desired
anesthetic plane. Use minimal concentration of Sevoflurane necessary.
If intubated, ventilate at 4-6 bpm & don't exceed 10-12 cm water pressure.
Recovery:

Provide Pain Control: Ketoprofen 2.0 mg/kg IM Q 48 hrs
83
Rabbit Anesthesia Protocol

Difficult to anesthetize as they are easily stressed and can injure them
tynnr^.^ I
selves, often have underlying lung disease, are prone to respiratory

depression, can be difficult to intubate, may have significant anorexia
post surgically, and have great variability in drug response between
breeds and individuals.
Excess salivation is common and can lead to respiratory obstruction. Monitor
Rabbit
respiration carefully.
Intubation not recommend unless surgical procedures may compromise the airway or Pet is
If intubation required (such as respiratory compromise, surgery that will compromise airway,
Palpebral reflex is highly variable. Do not rely on it as an indicator of anesthetic depth.
Ear pinch reflex is lost at a surgical plane of anesthesia.
Provide oxygen throughout induction, anesthesia, and recovery.
Pulse oximetry is critical during maintenance to monitor for hypoxia.
significantly compromised. Repeated attempts at intubation cause significant laryngeal edema.

anesthesia time >30 minutes expected) refer Pet to skilled exotic practitioner.
Equipment and Supplies: face mask, non-rebreathing circuit, 2.5% Dextrose in 0.45% NaCl, IV/IO
catheterization supplies, supplemental heat source, monitoring equipment.
client education.
Preanesthetic Preparation: fast and withhold water 30 minutes-1 hr (be sure mouth is clear of
food/liquid before induction), IV/IO catheterization optimal (may need to be placed after premed
or induction), start fluid 5-10 ml/kg/hr (IV best).
Healthy Pet: Acepromazine 0.2-0.4 mg/kg IM and Butorphanol 0.1-0.2 mg/kg IM
and Glycopyrrolate 0.01-0.1 mg/kg IM.
Compromised Pet: Butorphanol 0.2mg/kg and Glycopyrrolate 0.01-0.1 mg/kg IM.
Healthy Pet: Telazol 5 mg/kg IM, wait for effect, then mask with Sevoflurane/O2 if needed.
If initial Telazol dose has no effect after 20 minutes, can repeat l/4-l/2 dose of Telazol once.
Compromised Pet: Mask with Sevoflurane/O2 to effect. If struggling, give sedative

Telazol dose 1.0 mg/kg IM, wait 20 minutes and mask again. Repeat Telazol at 1.0 mg/kg
dose once if needed.
Maintenance: Sevoflurane/O2 via mask to effect, maintain body temperature, monitor, provide fluid
support and supplemental oxygen.
Pain Control: Butorphanol 0.1-0.5 mg/kg q 2-4 hrs IM or SQ Ketoprofen 3 mg/kg q 24 hrs IM.
86
Lt
Ferret Anesthesia Flow Chart

Evaluation:
Medical History
Li
Place IV/IO catheter if possible- IV preferred
Temperament
Physical Exam
IV/IO Catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10ml_/kg/hr IV/IO,
continue through recovery.

NO catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10mL/kg/hr SQ,
continue through recovery. Give 1/4 calculated hourly dose every 15 minutes
Intubation optimal & can be attempted in Pets > 4 lbs body wt.
Fast Appropriately
Endotracheal tube required for successful anesthesia/procedure?
Provide Client Education &
Expect successful placement of endotracheal tube by second try?
Communicate Expectations
Healthy Pet:
Acepromazine 0.1mg/kg IM
Butorphanol 0.2 mg/kg IM
but can't do it:
Needs Intubation
but Can't Do
Glycopyrrolate 0.01 mg/kg IM
skilled exotic
Compromised Pet:
practitioner
Diazepam OR Midazolam 0.1 mg/kg IM

Butorphanol 0.1-0.2 mg/kg IM
Glycopyrrolate 0.01 mg/kg IM
Yes IV
No IV
Catheter
Catheter
îp '. -
Induction: (IV Catheter in Place)

Induction (healthy or compromised):
Propofol 2.0-8.0 mg/kg IV to effect.
Induction: (No IV Catheter in Place)

Healthy: Telazol 6 mg/kg IM, then mask w/ sevoflurane (1-4%)/O2 if needed. O2 at 3-4 L/min initially,
then 2L/min maintenance. If initial Telazol dose has no effect after 20 minutes,
can repeat 1/4-1/2 dose of Telazol once.
Intubation optimal,
Compromised: Mask w/ sevo (2-4%)/O2. 02 at 3-4 L/min initially, then 2L/min maintenance.
otherwise use facemask.
If struggling can give Telazol 1.0 mg/kg IM, wait 20 min, repeat mask attempt.
Repeat Telazol at 1.0mg/kg dose once if needed
L
Maintenance:
Propofol/Mask Induction: Administer sevoflurane (2-4%) & oxygen via mask or endotracheal tube. O2 at 3-4L/minute initially,
Telazol Induction: Provide supplemental 02 via mask or endotracheal tube at 3-4 L/minute initially,
then 2 L/min for maintenance. Add sevoflurane at 1-4% as needed to maintain desired anesthetic plane.
Use minimal concentration of sevoflurane necessary
Recovery:
Provide Pain Control: Butorphanol 0.1-0.5 mg/kg IM or SQ Q 2-4 hrs
85
<&D^fflb3Efe 2a? ilhs-fflsfil
Guinea Pig and Chinchilla Anesthesia Protocol
Potential for anesthetic complication is high as these Pets: stress easily,

are difficult to intubate, are prone to postoperative complications, and
have differing drug responses per individual.
Intubation not recommended unless surgical procedures may compro
mise the airway or Pet is significantly compromised.
Chinchilla
IV catheter insertion not routinely recommended.
If intubation is required (such as respiratory compromise, surgery that will compromise
Large amounts of thick respiratory secretions are often produced and can lead to respiratory
Anticholinergics are generally used (even for brief immobilization).
Ear pinch and pedal withdrawal reflexes are lost at a surgical plane of anesthesia.
Provide oxygen throughout induction, anesthesia, and recovery.
airway, anesthesia time >30 minutes expected) refer Pet to skilled exotic practitioner.
obstruction.
Equipment and Supplies: face mask, non-rebreathing circuit, 2.5% Dextrose in 0.45% NaCl,
supplemental heat source, monitoring equipment.
client education.
Preanesthetic Prep: Fast 4 hrs and withhold water 2 hrs, start fluid at 5-10 ml/kg/hr (SQ)
Premedication: 30-60 minutes before inductionin healthy Pets, can be diluted in first dose of SQ fluids
Healthy Pet:
Guinea Pig:
Chinchilla:
Acepromazine
0.1 mg/kg SQ
0.05 mg/kg SQ
Butorphanol
0.1 mg/kg SQ
0.1 mg/kg SQ
Atropine
0.05 mg/kg SQ
0.05 mg/kg SQ
Compromised Pet
Guinea Pig:
Chinchilla:
Diazepam
1 mg/kg SQ
1 mg/kg SQ
Butorphanol
0.1 mg/kg SQ
0.1 mg/kg SQ
Atropine
0.05 mg/kg SQ
0.05 mg/kg SQ
Healthy Pet: Telazol 5 mg/kg SQ, wait for effect, then mask with Sevoflurane/O2 if needed.
If initial Telazol dose has no effect after 20 minutes, can repeat l/4-l/2 dose of Telazol once.
Compromised Pet: Mask with Sevoflurane/O2 to effect. If struggling, give sedative
J
J
Telazol dose l.Omg/kg SQ, wait 20 minutes and mask again. Repeat Telazol at 1.0 mg/kg dose
once if needed.
Pain Control: Butorphanol 2.0 mg/kg q 2-A hrs SQ.
l3ttMEia
teaama
>tiryffirei^fljT?ffe
Rabbit Anesthesia Flow Chart

Evaluation:
Medical History
Place IV/IO catheter if possible (IV preferred).
Temperament
IV/IO Catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10ml_/kg/hr IV/IO,
Physical Exam
continue through recovery.
NO catheter in Place: Start warm 2.5%Dextrose in 0.45% NaCI at 5-10ml_/kg/hr SQ,
continue through recovery. Give 1/4 calculated hourly dose every 15 minutes.
Intubation not routinely recommended due to
Intubation not routinely recommended.
difficulty of tube placement.
Exception: pre-existing airway compromise or procedures that require intubation to protect airway
Fast Appropriately
may need referral to a skilled exotic practitioner.
Endotracheal tube required for successful anesthesia/procedure? Rabbits are difficult to intubate.
Expectations
Intubation Not \
Required
Requires Intubation
skilled exotic
Healthy Pet:
practitioner
Acepromazine 0.2-0.4 mg/kg IM

Butorphanol 0.1-0.2 mg/kg IM
Glycopyrrolate 0.01-0.1 mg/kg IM
Compromised Pet:
Butorphanol 0.2mg/kg IM
Glycopyrrolate 0.01-0.1 mg/kg IM
Induction:
Pre-oxygenate if possible without causing stress.
Healthy: Telazol 5 mg/kg IM, then mask w/ sevoflurane (1-4%)/O2 if needed. O2 at 3-4 L/min initially, then 2L/min maintenance. If
initial Telazol dose has no effect after 20 minutes, can repeat 1/4-1/2 dose of Telazol once.
Compromised: Mask w/ sevo (2-4%)/O2. 02 at 3-4 L/min initially, then 2L/min maintenance.
If struggling can give Telazol 1.0 mg/kg IM, wait 20 min, repeat mask attempt. Repeat Telazol at 1.0 mg/kg dose once if needed.
Keep Pet Warm and Monitor
Maintenance:
Mask Induction: Administer sevoflurane (2-4%) & oxygen via facemask. O2 at 3-4L/minute initially,
Telazol Induction: Provide supplemental O2 via facemask at 3-4 L/minute initially, then 2 L/min for maintenance. Add sevoflurane
at 1 -4% as needed to maintain desired anesthetic plane. Use minimal concentration of sevoflurane necessary
Recovery:

Provide Pain Control: Butorphanol 0.1-0.5 mg/kg IM or SQ Q 2-4 hrs

Ketoprofen 3 mg/kg IM Q 24 hrs.
87
Rat, Mouse, Gerbil and Hamster Anesthesia Protocol

Intubation not recommended unless surgical procedures may compromise

the airway or Pet is significantly compromised.
IV catheter insertion not routinely recommended.
If intubation is required (such as respiratory compromise, surgery that
will compromise airway, anesthesia time >30 minutes expected) refer
Hamster
Pet to a skilled exotic practitioner.
Tail and ear pinch, as well as pedal withdrawal reflexes disappear at a surgical anesthetic plane.
Common diseases include respiratory infections (subclinical disease is common) and chronic
otitis media.
Equipment and Supplies: face mask, non-rebreathing circuit, 2.5% dextrose in 0.45% NaCl,
supplemental heat source, monitoring equipment.
client education.
Preanesthetic Prep: DO NOT fast or with hold water, start fluid at 5-10 ml/kg/hr (SQ)
Premedication: 30-60 minutes before inductionin healthy Pets, can be diluted in first dose of SQ fluids
Healthy Pet:
Rat
Mouse
Gerbil
Hamster
Acepromazine
1 mg/kg SQ
1 mg/kg SQ
Do Not Use
1 mg/kg SQ
Butorphanol
1 mg/kg SQ
1 mg/kg SQ
1 mg/kg SQ
1 mg/kg SQ
Diazepam or
1 mg/kg SQ
Midazolam
0.05 mg/kg SQ
0.05mg/kg SQ
0.05 mg/kg SQ
0.05 mg/kg SQ
Pet:
Rat
Mouse
Gerbil
Hamster
Butorphanol
1 mg/kg SQ
1 mg/kg SQ
1 mg/kg SQ
1 mg/kg SQ
Midazolam
1 mg/kg SQ
1 mg/kg SQ
1 mg/kg SQ
1 mg/kg SQ
Atropine
0.05 mg/kg SQ
0.05mg/kg SQ
0.05 mg/kg SQ
0.05 mg/kg SQ
Atropine
Compromised
Diazepam or
Induction: pre-oxygenate (before induction) without stress if possible, then:
Healthy Pet: Telazol 5mg/kg SQ, wait for effect, then mask with Sevoflurane/O2 if needed.
If initial Telazol dose has no effect after 20 minutes, can repeat {/4-l/2 dose of Telazol once SQ.
Compromised Pet: Mask with Sevoflurane/O2. If struggling, give sedative Telazol dose
1.0 mg/kg SQ, wait 20 minutes and mask again. Repeat Telazol dose at 1.0 mg/kg once if
needed.
J
j
j
j
Pain Control: Mouse, Gerbil, Hamster: Butorphanol 2.0 mg/kg q 2-4 hrs SQ.
Rat: Butorphanol 2.0 mg/kg q 2-4 hrs SQ, Ketoprofen 5 mg/kg SQ/PO q 24 hrs.
90
Guinea Pig and Chinchilla Anesthesia Flow Chart

Evaluation:
Medical History
Start warm 2.5%Dextrose in 0.45% NaCI at 5-10ml_/kg/hr SQ, continue through recovery.
Temperament
Give 1/4 calculated hourly dose Q 15 min.
Physical Exam

hiktotmml
Intubation & IV/IO catheterization not routinely recommended.
ception: pre-existing airway compromise or procedures that require intubation to protect airway
may need referral to a skilled exotic practitioner.
Intubation & IV/IO catheterization not routinely

recommended due to small body size.
Is endotracheal tube required for successful anesthesia/procedure?
Fast Appropriately
Endotracheal tube placement is difficult in Guinea Pigs & Chinchillas.

Expectations
I
1. MitaU
Intubation Not \
Required
1
Requires Intubation:
skilled exotic practitioner

Healthy Pet:
Acepromazine
0.1 mg/kgSQ
0.05 mg/kg SQ
Butorphanol
0.1 mg/kgSQ
0.1 mg/kg SQ
Atropine
0.05 mg/kg SQ
0.05 mg/kg SQ
Diazepam
1 mg/kg SQ
1 mg/kg SQ
Butorphanol
0.1 mg/kg SQ
0.1 mg/kg SQ
Atropine
0.05 mg/kg SQ
0.05 mg/kg SQ
Compromised pet:
Chinchilla:
Induction: Pre-oxygenate if possible without causing stress
Healthy: Telazol 5 mg/kg IM, then mask w/ Sevoflurane (1-4%)/O2 if needed. O2 at 3-4 Umin initially, then 2L/min maintenance. If initial
Telazol dose has no effect after 20 minutes, can repeat 1/4-1/2 dose of Telazol once
Compromised: Mask w/ Sevo (2-4%)/O2. O2 at 3-4 L/min initially, then 2L/min maintenance. If struggling can give Telazol 1.0 mg/kg IM, wait
20 min, repeat mask attempt. Repeat Telazol at 1.0 mg/kg dose once if needed.
I
Maintenance:
Mask Induction: Administer Sevo (2-4%) & O2 via facemask. 02 at 3-4L/minute initially,
then 2 L/min for maintenance. Use minimal concentration of Sevo necessary.
Telazol Induction: Provide supplemental O2 via facemask at 3-4 L/minute initially, then 2 L/min for maintenance. Add sevo at 1-4% as
needed to maintain desired anesthetic plane. Use minimal concentration of Sevo necessary
V/MitmuMl
kaaa;i
Recovery:

Provide Pain Control: Butorphanol 2.0 mg/kg SQ Q 2-4 hrs
L-
89
2a? flto Eteft UtosfflBsaia?
Patient Anesthesia Monitoring

Information needs to be transferred into patient's medical notes in PetWare, using the Anesthesia Stamp.
Date:
| Date of Birth: |
Weight:
Pet's Name:
doq
cat
| Procedure(s):
other
circle oni
Temp.
Pulse: |
Resp:
Pre-Meds
Aceprom.(1mg,mI)
0.025 mg/lb x
lbs / 1 mg/ml =
ml.
Rt of admin:
(Warning: max dose is 1.5 ml)
Butorphanol
0.1mqfo0.2mq/lbx
lbs / 10 mq/ml=
ml.
Rt of admin:
(Warning: max dose is 0.5 ml)
SCorIM
circle one
maximum single dose 5 mg
Telazol
0.5mqto2mq/lbx
(for fractious pet)
maximum single dose 100 mg
Other
SCorIM
circle one
maximum single dose 1.5 mg
lbs / 100mq/ml=
ml
Rt. of admin:
(Warning: max dose is 1 ml)
mq/lbx
lbs /
mq/ml =
ml
Rt. of admin:
mg/lb x
lbs
mg/ml =
ml.
Rt. of admin:
IM
name of agent
Other
name of agent
Evaluation after pre-meds prior to induction
Temp:
Pulse rate:
Sedation:
none/mi!d/adeq /excessive
1
Resp:
Pulse quality:
circle one
Induction
Propofol
1 mg/lb or 2 mg/lb or 3 mg/lb or 4 mei/lb x
Ib;i/i0mg/ml=
ml.
(give to effect)
Am't given
ml.
Ib s/i00mg/ml=
ml.
(give to effect)
Am't given
ml.
circle dose used
0.5 to 1 m<3/lb x
Telazol
Fluid type & rate:
rnl/hi
Sternal:
Extubated:
Time Sx Ended:
Time Sx Started:
Trach Tube size:
Catheter size:
Total vol fluid admin:
Induction
5 min
10 min
15 min
20 min
25 min
30 min
35 min
40 min
45 min
50 min
55 min
60 min
65 min
70 min
75 min
80 min
85 min
90 min
95 min
Sevo %
O2 flow (L/min)
Heart Rate
Pulse Ox O2
Respiratory Rate
CRT/memb. Color
Pulse Quality
ECG rhythm
BP
Temperature
Sevo %
O2 flow (L/min)
Heart Rate
Pulse Ox O2
Respiratory Rate
CRT/memb. Color
Pulse Quality
ECG rhythm
BP
Temperature
Antibiotic given
92
Am't given
Time given
Pain Meds Rxed
MM! BanfwldCopyright 2003
liiMMMJ
Rat, Mouse, Hamster, Gerbil Anesthesia Flow Chart

Evaluation:
Medical History
Start warm 2.5%Dextrose in 0.45% NaCI at 5-10mL/kg/hr SQ,
Temperament
continue through recovery. Give 1/4 calculated hourly dose Q 15 min.
Physical Exam
Intubation & IV/IO catheterization not routinely recommended.
Exception: pre-existing airway compromise or procedures that require
Intubation & IV/IO catheterization not routinely
intubation to protect airway may need referral to a skilled exotic

^
practitioner.
recommended due to small body size.

Do not fast or withhold water
Provide Client Education/Communicate Expectations
Is endotracheal tube required for successful anesthesia/procedure?
Requires Intubation:
Not \
Intubation Not
Required
skilled exotic practitioner
Premedicate 30-60 minutes before anesthesia (doses given SQ)
Healthy Pet:
Hamster
Rat
Acepromazine
1mg/kg
1mg/kg
1 mg/kg
NO
Butorphanol
1 mg/kg
1 mg/kg
1 mg/kg
1 mg/kg
0.05mg/kg
0.05mg/kg
0.05mg/kg
0.05mg/kg
Gerbil
Diazepam or Midazolam
Atropine
1 mg/kg
Compromised Pet:
Rat
Mouse
Gerbil
Butorphanol
1 mg/kg
1 mg/kg
1 mg/kg
1 mg/kg
Diazepam or Midazolam
1 mg/kg
1 mg/kg
1 mg/kg
1 mg/kg
Atropine
0.05mg/kg
0.05mg/kg
0.05mg/kg
0.05mg/kg
Induction: Pre-oxygenate if possible without causing stress.
Healthy: Telazol 5 mg/kg IM, then mask w/ sevo (1-4%)/O2 if needed. 02 at 3-4 L/min initially, then 2L/min maintenance. If initial
Telazol dose has no effect after 20 minutes, can repeat 1/4-1/2 dose of Telazol once.
Compromised: Mask w/ sevo (2-4%)/O2. O2 at 3-4 L/min initially, then 2L/min maintenance. If struggling can give Telazol 1.0 mg/
kg SQ, wait 20 min, repeat mask attempt. Repeat Telazol at 1.0 mg/kg dose once if needed.
Maintenance:
Mask Induction: Administer sevoflurane (2-4%) & oxygen via facemask. O2 at 3-4L/minute initially,
Telazol Induction: Provide supplemental O2 via facemask at 3-4 L/minute initially, then 2 L/min for maintenance. Add sevoflurane
at 1-4% as needed to maintain desired anesthetic plane. Use minimal concentration of sevoflurane necessary.
Recovery:

Provide Pain Control:
Mouse. Gerbil. Hamster: Butorphanol 2 mg/kg SQ Q 2-4 hrs
Rat Butorphanol 2 mg/kg SQ Q 2-4 hrs, Ketoprofen 5 mg/kg SQ/PO Q 24 hrs
91
j
Acepromazine 1 mg/ml**
Dose: 0.025 mg/lb for Anesthesia Protocol (Maximum single dose is 1.5 mg)
Petwt.
ml tc
adminis,ter
0.5
0.03
ml
Pet wt.
lbs
31
14.1
0.78
ml
0.9
0.05
ml
32
14.5
0.80
ml
Pet wt.
lbs
Pet wt.
kg
ml to
administer
kg
1.4
0.08
ml
33
15.0
0.83
ml
1.8
0.10
ml
34
15.5
0.85
ml
2.3
0.13
ml
35
15.9
0.88
ml
2.7
0.15
ml
36
16.4
0.90
ml
3.2
0.18
ml
37
16.8
0.93
ml
3.6
0.20
ml
38
17.3
0.95
ml
4.1
0.23
ml
39
17.7
0.98
ml
10
4.5
0.25
ml
40
18.2
1.00
ml
11
5.0
0.28
ml
41
18.6
1.03
ml
12
5.5
0.30
ml
42
19.1
1.05
ml
13
5.9
0.33
ml
43
19.5
1.08
ml
14
6.4
0.35
ml
44
20.0
1.10
ml
15
6.8
0.38
ml
45
20.5
1.13
ml
16
7.3
0.40
ml
46
20.9
1.15
ml
17
7.7
0.43
ml
47
21.4
1.18
ml
18
8.2
0.45
ml
48
21.8
1.20
ml
19
8.6
0.48
ml
49
22.3
1.23
ml
20
9.1
0.50
ml
50
22.7
1.25
ml
21
9.5
0.53
ml
51
23.2
1.28
ml
22
10.0
0.55
ml
52
23.6
1.30
ml
23
10.5
0.58
ml
53
24.1
1.33
ml
24
10.9
0.60
ml
54
24.5
1.35
ml
25
0.63
ml
55
25.0
1.38
ml
26
11.4
11.8
0.65
ml
56
25.5
1.40
ml
27
12.3
0.68
ml
57
25.9
1.43
ml
28
12.7
0.70
ml
58
26.4
1.45
ml
29
13.2
0.73
ml
59
26.8
1.48
ml
30
13.6
0.75
ml
60
27.3
1.50
ml
>27.3
1.50
ml
>60
j
j
Acepromazine
** Acepromazine should be pre-diluted to 1 mg/ml to better allow proper
drug measurement.
Directions:
Order an 80 ml bottle of sterile water for injection and 30 ml empty sterile

vials through the HOER
Draw up 27 ml of sterile water with a sterile syringe and add it to the
empty sterile vial.
Draw up 3 ml of 10 mg/ml Acepromazine and add to the same vialthis

will result in a 1 mg/ml solution.
Vial should be labeled appropriately and dated.
The solution is light-sensitive. Protect it from light by wrapping the vial
completely. If protected from light, the solution is stable at room temperature.
94
Maximum dose of Acepromazine 1 mg/ml is 1.5 ml.
MMl BanjkldCopyright 2003
Section 5:
Appendix
93
Diazepam 5 mg/ml
Dose: 0.1 mg/lb for Anesthesia Protocol (Maximum single dose is 10 mg)
Petwt.
lbs
Petwt.
kg
ml to
administer
0.5
0.02
ml
0.9
0.04
ml
1.4
0.06
ml
1.8
0.08
ml
2.3
0.10
ml
2.7
0.12
ml
3.2
0.14
ml
3.6
0.16
ml
4.1
0.18
ml
10
4.5
0.20
ml
11
5.0
0.22
ml
12
5.5
0.24
ml
13
5.9
0.26
ml
14
6.4
0.28
ml
15
6.8
0.30
ml
16
7.3
0.32
ml
17
7.7
0.34
ml
18
8.2
0.36
ml
19
8.6
0.38
ml
20
9.1
0.40
ml
21
9.5
0.42
ml
22
10.0
0.44
ml
23
10.5
0.46
ml
24
10.9
0.48
ml
25
11.4
0.50
ml
26
11.8
0.52
ml
27
12.3
0.54
ml
28
12.7
0.56
ml
29
13.2
0.58
ml
30
13.6
0.60
ml
31
14.1
0.62
ml
32
14.5
0.64
ml
33
15.0
0.66
ml
34
15.5
0.68
ml
35
15.9
0.70
ml
36
16.4
0.72
ml
37
16.8
0.74
ml
38
17.3
0.76
ml
39
17.7
0.78
ml
40
18.2
0.80
ml
41
18.6
0.82
ml
42
19.1
0.84
ml
43
19.5
0.86
ml
44
20.0
0.88
ml
45
20.5
0.90
ml
46
20.9
0.92
ml
47
21.4
0.94
ml
48
21.8
0.96
ml
49
22.3
0.98
ml
50
22.7
1.00
ml
Diazepam
j
j
96
Butorphanol 10 mg/ml
Dose: 0.1-0.2 mg/lb for Anesthesia Protocol (Maximum single dose is 5 mg)
Pet wt.
lbs
Petwt.
ml to
administer
kg
0.5
0.01
to
0.02
ml
0.9
0.02
to
0.04
ml
1.4
0.03
to
0.06
ml
1.8
0.04
to
0.08
ml
2.3
0.05
to
0.10
ml
2.7
0.06
to
0.12
ml
3.2
0.07
to
0.14
ml
3.6
0.08
to
0.16
ml
4.1
0.09
to
0.18
ml
10
4.5
0.10
to
0.20
ml
11
5.0
0.11
to
0.22
ml
12
5.5
0.12
to
0.24
ml
13
5.9
0.13
to
0.26
ml
14
6.4
0.14
to
0.28
ml
15
6.8
0.15
to
0.30
ml
16
7.3
0.16
to
0.32
ml
17
7.7
0.17
to
0.34
ml
18
8.2
0.18
to
0.36
ml
19
8.6
0.19
to
0.38
ml
20
9.1
0.20
to
0.40
ml
21
9.5
0.21
to
0.42
ml
22
10.0
0.22
to
0.44
ml
23
10.5
0.23
to
0.46
ml
24
10.9
0.24
to
0.48
ml
25
11.4
0.25
to
0.50
ml
26
11.8
0.26
to
0.50
ml
27
12.3
0.27
to
0.50
ml
28
12.7
0.28
to
0.50
ml
29
13.2
0.29
to
0.50
ml
30
13.6
0.30
to
0.50
ml
31
14.1
0.31
to
0.50
ml
32
14.5
0.32
to
0.50
ml
33
15.0
0.33
to
0.50
ml
34
15.5
0.34
to
0.50
ml
35
15.9
0.35
to
0.50
ml
36
16.4
0.36
to
0.50
ml
37
16.8
0.37
to
0.50
ml
38
17.3
0.38
to
0.50
ml
39
17.7
0.39
to
0.50
ml
40
18.2
0.40
to
0.50
ml
41
18.6
0.41
to
0.50
ml
42
19.1
0.42
to
0.50
ml
43
19.5
0.43
to
0.50
ml
44
20.0
0.44
to
0.50
ml
45
20.5
0.45
to
0.50
ml
46
20.9
0.46
to
0.50
ml
47
21.4
0.47
to
0.50
ml
48
21.8
0.48
to
0.50
ml
49
22.3
0.49
to
0.50
ml
50
22.7
0.50
to
0.50
ml
>50
>22.7
0.50
ml
Butorphanol
** Maximum single dose is 0.5 ml
** Butorphanol dose can be repeated as needed every 1-2 hrs for pain management
95
DiPHENHYDRAMINE 50 mg/ml
Dose: 1 mg/lb for Anesthesia Protocol (Maximum single dose is 50 mg)
Petwt.
lbs
kg
ml to
administer
0.5
0.02
ml
0.9
0.04
ml
1.4
0.06
ml
1.8
0.08
ml
2.3
0.10
ml
2.7
0.12
ml
3.2
0.14
ml
3.6
0.16
ml
4.1
0.18
ml
10
4.5
0.20
ml
11
5.0
0.22
ml
12
5.5
0.24
ml
13
5.9
0.26
ml
14
6.4
0.28
ml
15
6.8
0.30
ml
16
7.3
0.32
ml
17
7.7
0.34
ml
18
8.2
0.36
ml
19
8.6
0.38
ml
20
9.1
0.40
ml
21
9.5
0.42
ml
22
10.0
0.44
ml
23
10.5
0.46
ml
24
10.9
0.48
ml
25
11.4
0.50
ml
26
11.8
0.52
ml
27
12.3
0.54
ml
28
12.7
0.56
ml
29
13.2
0.58
ml
30
13.6
0.60
ml
31
14.1
0.62
ml
32
14.5
0.64
ml
33
15.0
0.66
ml
34
15.5
0.68
ml
35
15.9
0.70
ml
36
16.4
0.72
ml
37
16.8
0.74
ml
38
17.3
0.76
ml
39
17.7
0.78
ml
40
18.2
0.80
ml
41
18.6
0.82
ml
42
19.1
0.84
ml
43
19.5
0.86
ml
44
20.0
0.88
ml
45
20.5
0.90
ml
46
20.9
0.92
ml
47
21.4
0.94
ml
48
21.8
0.96
ml
49
22.3
0.98
ml
50
22.7
1.00
ml
>22.7
1.00
ml
>50
98
Pet wt.
Diphenhydramine
J
*"ifiiiiffi-"''- *
J
J
J
J
J
J
J
J
1''teflWi'""T
DlAZEPAM 5 mg/ml (cont.)

Dose: 0.1 mg/lb for Anesthesia Protocol (Maximum single dose is 10 mg)
Pet wt.
lbs
Petwt.
kg
ml to
administer
51
23.2
1.02
ml
52
23.6
1.04
ml
53
24.1
1.06
ml
54
24.5
1.08
ml
55
25.0
1.10
ml
56
25.5
1.12
ml
57
25.9
1.14
ml
58
26.4
1.16
ml
59
26.8
1.18
ml
60
27.3
1.20
ml
61
27.7
1.22
ml
62
28.2
1.24
ml
63
28.6
1.26
ml
64
29.1
1.28
ml
65
29.5
1.30
ml
66
30.0
1.32
ml
67
30.5
1.34
ml
68
30.9
1.36
ml
69
31.4
1.38
ml
70
31.8
1.40
ml
71
32.3
1.42
ml
72
32.7
1.44
ml
73
33.2
1.46
ml
74
33.6
1.48
ml
75
34.1
1.50
ml
76
34.5
1.52
ml
11
35.0
1.54
ml
78
35.5
1.56
ml
79
35.9
1.58
ml
80
36.4
1.60
ml
81
36.8
1.62
ml
82
37.3
1.64
ml
83
37.7
1.66
ml
84
38.2
1.68
ml
85
38.6
1.70
ml
86
39.1
1.72
ml
87
39.5
1.74
ml
88
40.0
1.76
ml
89
40.5
1.78
ml
90
40.9
1.80
ml
91
41.4
1.82
ml
92
41.8
1.84
ml
93
42.3
1.86
ml
94
42.7
1.88
ml
95
43.2
1.90
ml
96
43.6
1.92
ml
97
44.1
1.94
ml
98
44.5
1.96
ml
99
45.0
1.98
ml
100
45.5
2.00
ml
> 100
>45.5
2.00
ml
Diazepam
97
Propofol 10 mg/ml
for Anesthesia Protocol Dose: 1-4 mg/lb
Petwt.
lbs
Petwt.
0.5
0.9
1.4
1.8
2.3
2
3
4
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
2.7
3.2
3.6
4.1
4.5
5.0
5.5
5.9
6.4
6.8
7.3
7.7
8.2
8.6
9.1
9.5
10.0
10.5
10.9
ml @
1 mg/lb
ml @
2 mg/lb
ml @
3 mg/lb
0.10
0.20
0.30
ml
ml
ml
0.20
0.40
0.60
ml
ml
ml
0.30
0.60
0.90
ml
ml
ml
0.80
ml
1.20
ml
1.60
ml
ml
1.00
ml
1.50
ml
2.00
ml
0.60
0.70
0.80
0.90
1.00
1.10
1.20
1.30
1.40
ml
ml
1.20
1.40
ml
ml
1.80
2.10
ml
ml
ml
ml
ml
ml
ml
ml
ml
2.40
ml
2.40
2.80
3.20
2.70
3.00
ml
3.60
ml
4.00
ml
ml
ml
ml
ml
ml
3.30
ml
4.40
ml
ml
ml
4.80
5.20
5.60
6.00
6.40
1.50
ml
ml
1.60
1.80
2.00
2.20
2.40
2.60
2.80
3.00
1.60
ml
3.20
ml
1.70
ml
3.40
ml
ml
6.80
ml
ml
3.60
ml
5.40
ml
7.20
ml
1.90
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
5.70
6.00
ml
2.00
ml
ml
ml
ml
ml
ml
ml
6.30
6.60
6.90
7.20
7.50
7.60
8.00
8.40
8.80
9.20
ml
3.80
4.00
4.20
4.40
4.60
4.80
5.00
ml
5.20
ml
7.80
ml
5.40
ml
8.10
ml
ml
ml
ml
12.7
2.80
ml
5.60
ml
8.40
13.2
ml
5.80
ml
ml
6.00
ml
14.5
15.0
15.5
15.9
2.90
3.00
3.10
3.20
3.30
3.40
3.50
16.4
3.60
16.8
3.70
38
17.3
3.80
39
40
41
42
43
17.7
3.90
4.00
4.10
4.20
4.30
4.40
4.50
4.60
4.70
4.80
8.70
9.00
9.30
9.60
9.90
10.20
10.50
10.80
11.10
11.40
11.70
34
35
36
37
49
18.2
18.6
19.1
19.5
20.0
20.5
20.9
21.4
21.8
22.3
50
22.7
44
45
46
47
48
ml
ml
ml
ml
1.80
ml
29
30
31
32
33
ml
3.60
3.90
4.20
4.50
4.80
5.10
ml
28
13.6
14.1
ml
ml
ml
ml
12.3
11.8
0.40
0.80
1.20
0.40
25
26
27
11.4
ml@
4 mg/lb
0.50
2.10
2.20
2.30
2.40
2.50
2.60
2.70
24
100
kg
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
4.90
ml
ml
5.00
ml
ml
6.20
ml
6.40
6.60
6.80
ml
ml
ml
ml
7.00
7.20
7.40
ml
ml
7.60
ml
7.80
ml
ml
ml
ml
ml
8.00
8.20
8.40
8.60
8.80
9.00
9.20
9.40
9.60
12.00
12.30
9.80
ml
ml
12.60
12.90
13.20
13.50
13.80
14.10
14.40
14.70
10.00
ml
15.00
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
9.60
ml
10.00
10.40
11.20
ml
ml
ml
ml
ml
ml
ml
ml
ml
11.60
12.00
12.40
12.80
13.20
13.60
14.00
14.40
14.80
15.20
15.60
16.00
16.40
16.80
17.20
17.60
18.00
18.40
ml
18.80
ml
ml
ml
ml
ml
ml
Propofol
j
j
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
19.20
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
19.60
ml
ml
20.00
ml
ml
ml
ml
ml
ml
ml
Uboratorfcv Horth <*!'
ml
ml
ml
ml
20 ML SAX
taolilon lor Intravenous Use
ml
10.80
ml
Anesthetic Injection
Morphine 10 mg/ml
For Anesthesia Protocol
L
L
L
L
L
Dose for Doc Si 0.2-0.5 mg/lb
Dose for Cats: 0.05-0.15 mg/lb
Maximum single dose is 5 mg
Maximum Single Dose is 2.5 mg
Petwt.
Pet wt.
ml to
lbs
kg
Petwt.
Pet wt.
ml to
administer
lbs
kg
administer
0.5
0.02
to
0.05
ml
0.5
0.01
to
0.02
ml
0.9
0.04
to
0.10
ml
0.9
0.01
to
0.03
ml
1.4
0.06
to
0.15
ml
1.4
0.02
to
0.05
ml
i .;.
1.8
0.08
to
0.20
ml
1.8
0.02
to
0.06
ml
I:, ?
2.3
0.10
to
0.25
ml
2.3
0.03
to
0.08
ml
2.7
0.12
to
0.30
ml
2.7
0.03
to
0.09
ml
3.2
0.14
to
0.35
ml
3.2
0.04
to
0.11
ml
3.6
0.16
to
0.40
ml
3.6
0.04
to
0.12
ml
4.1
0.18
to
0.45
ml
4.1
0.05
to
0.14
ml
10
4.5
0.20
to
0.50
ml
10
4.5
0.05
to
0.15
ml
11
5.0
0.22
to
0.50
ml
11
5.0
0.06
to
0.17
ml
12
5.5
0.24
to
0.50
ml
12
5.5
0.06
to
0.18
ml
13
5.9
0.26
to
0.50
ml
13
5.9
0.07
to
0.20
ml
14
6.4
0.28
to
0.50
ml
14
6.4
0.07
to
0.21
ml
15
6.8
0.30
to
0.50
ml
15
6.8
0.08
to
0.23
ml
16
7.3
0.32
to
0.50
ml
16
7.3
0.08
to
0.24
ml
17
7.7
0.34
to
0.50
ml
17
7.7
0.09
to
0.25
ml
18
8.2
0.36
to
0.50
ml
18
8.2
0.09
to
0.25
ml
19
8.6
0.38
to
0.50
ml
19
8.6
0.10
to
0.25
ml
20
9.1
0.40
to
0.50
ml
20
9.1
0.20
to
0.25
ml
21
9.5
0.42
to
0.50
ml
21
9.5
0.21
to
0.25
ml
22
10.0
0.44
to
0.50
ml
22
10.0
0.22
to
0.25
ml
23
10.5
0.46
to
0.50
ml
23
10.5
0.23
to
0.25
ml
24
10.9
0.48
to
0.50
ml
24
10.9
0.24
to
0.25
ml
25
11.4
0.50
to
0.50
ml
25
11.4
0.25
to
0.25
ml
0.50
ml
26
11.8
0.26
to
0.25
ml
27
12.3
0.27
to
0.25
ml
28
12.7
0.28
to
0.25
ml
29
13.2
0.29
to
0.25
ml
30
13.6
0.30
to
0.25
ml
>25
>11.4
MORPHINE W1:
SfcfTt INJECTION, US'
I;
?!lii5mg/mL'StS"{
,;;
'w wbcutiou$. otaucsao ic

onuowunuriBOascs
'j
Morphine
klMMl
** Maximum single dose is 0.5 ml
** Morphine dose can be repeated as needed every 4-6 hrs for pain management if cardiovascular system is stable.
LaitttlBl
99
Telazol 100 mg/ml

Dose: 0.5-2 mg/lb for Anesthesia Protocol (Maximum single dose is 100 mg)
Petwt. Pet wt.
lbs
kg
ml @
0.5 mg/lb
ml @
1 mg/lb
ml @
1.5 mg/lb
ml@
2 mg/lb
0.5
0.01
ml
0.01
ml
0.02
ml
0.02
ml
0.9
0.01
ml
0.02
ml
0.03
ml
0.04
ml
1.4
0.02
ml
0.03
ml
0.05
ml
0.06
ml
1.8
0.02
ml
0.04
ml
0.06
ml
0.08
ml
2.3
0.03
ml
0.05
ml
0.08
ml
0.10
ml
2.7
0.03
ml
0.06
ml
0.09
ml
0.12
ml
3.2
0.04
ml
0.07
ml
0.11
ml
0.14
ml
3.6
0.04
ml
0.08
ml
0.12
ml
0.16
ml
4.1
0.05
ml
0.09
ml
0.14
ml
0.18
ml
10
4.5
0.05
ml
0.10
ml
0.15
ml
0.20
ml
11
5.0
0.06
ml
0.11
ml
0.17
ml
0.22
ml
12
5.5
0.06
ml
0.12
ml
0.18
ml
0.24
ml
13
5.9
0.07
ml
0.13
ml
0.20
ml
0.26
ml
14
6.4
0.07
ml
0.14
ml
0.21
ml
0.28
ml
0.15
ml
0.23
ml
0.30
ml
15
6.8
0.08
ml
16
7.3
0.08
ml
0.16
ml
0.24
ml
0.32
ml
17
7.7
0.09
ml
0.17
ml
0.26
ml
0.34
ml
18
8.2
0.09
ml
0.18
ml
0.27
ml
0.36
ml
19
8.6
0.10
ml
0.19
ml
0.29
ml
0.38
ml
20
9.1
0.10
ml
0.20
ml
0.30
ml
0.40
ml
21
9.5
0.11
ml
0.21
ml
0.32
ml
0.42
ml
22
10.0
0.11
ml
0.22
ml
0.33
ml
0.44
ml
23
10.5
0.12
ml
0.23
ml
0.35
ml
0.46
ml
24
10.9
0.12
ml
0.24
ml
0.36
ml
0.48
ml
25
11.4
0.13
ml
0.25
ml
0.38
ml
0.50
ml
26
11.8
0.13
ml
0.26
ml
0.39
ml
0.52
ml
27
12.3
0.14
ml
0.27
ml
0.41
ml
0.54
ml
28
12.7
0.14
ml
0.28
ml
0.42
ml
0.56
ml
29
13.2
0.15
ml
0.29
ml
0.44
ml
0.58
ml
30
13.6
0.15
ml
0.30
ml
0.45
ml
0.60
ml
31
14.1
0.16
ml
0.31
ml
0.47
ml
0.62
ml
32
14.5
0.16
ml
0.32
ml
0.48
ml
0.64
ml
33
15.0
0.17
ml
0.33
ml
0.50
ml
0.66
ml
34
15.5
0.17
ml
0.34
ml
0.51
ml
0.68
ml
35
15.9
0.18
ml
0.35
ml
0.53
ml
0.70
ml
36
16.4
0.18
ml
0.36
ml
0.54
ml
0.72
ml
37
16.8
0.19
ml
0.37
ml
0.56
ml
0.74
ml
38
17.3
0.19
ml
0.38
ml
0.57
ml
0.76
ml
39
17.7
0.20
ml
0.39
ml
0.59
ml
0.78
ml
40
18.2
0.20
ml
0.40
ml
0.60
ml
0.80
ml
41
18.6
0.21
ml
0.41
ml
0.62
ml
0.82
ml
42
19.1
0.21
ml
0.42
ml
0.63
ml
0.84
ml
43
19.5
0.22
ml
0.43
ml
0.65
ml
0.86
ml
44
20.0
0.22
ml
0.44
ml
0.66
ml
0.88
ml
45
20.5
0.23
ml
0.45
ml
0.68
ml
0.90
ml
46
20.9
0.23
ml
0.46
ml
0.69
ml
0.92
ml
47
21.4
0.24
ml
0.47
ml
0.71
ml
0.94
ml
48
21.8
0.24
ml
0.48
ml
0.72
ml
0.96
ml
49
22.3
0.25
ml
0.49
ml
0.74
ml
0.98
ml
50
22.7
0.25
ml
0.50
ml
0.75
ml
1.00
ml
Telazol
J
J
J
J
** Maximum single dose is 1 ml, this can be repeated in 10-15 minutes up to a total dose of 2 mg/lb if adequate
immobilization is not achieved.
102
J
J
Propofol 10 mg/ml (cont.)

for Anesthesia Protocol Dose: 1-4 mg/lb
Petwt.
lbs
51
53
54
ml @
1 mg/lb
ml
5.10
ml @
2 mg/lb
ml
10.20
ml@
3 mg/lb
ml
15.30
ml @
4 mg/lb
ml
20.40
5.20
ml
10.40
ml
15.60
ml
20.80
ml
5.30
ml
10.60
ml
15.90
ml
21.20
ml
24.5
5.40
ml
10.80
ml
16.20
ml
ml
55
25.0
5.50
11.00
ml
25.5
25.9
26.4
5.60
5.70
5.80
5.90
6.00
6.10
6.20
6.30
6.40
6.50
ml
ml
ml
ml
ml
ml
ml
16.50
56
57
58
59
60
61
62
63
64
65
ml
ml
ml
ml
66
67
30.0
16.80
17.10
17.40
17.70
18.00
18.30
18.60
18.90
19.20
19.50
19.80
21.60
22.00
22.40
22.80
23.20
23.60
24.00
24.40
24.80
25.20
25.60
26.00
ml
26.40
ml
20.40
20.70
21.00
21.30
ml
ml
ml
ml
ml
ml
ml
21.60
ml
21.90
22.20
ml
26.80
27.20
27.60
28.00
28.40
28.80
29.20
29.60
30.00
30.40
30.80
31.20
31.60
ml
68
69
70
71
72
73
74
75
26.8
27.3
27.7
28.2
28.6
29.1
29.5
30.5
30.9
31.4
31.8
32.3
32.7
33.2
33.6
34.1
80
81
82
83
34.5
35.0
35.5
35.9
36.4
36.8
37.3
37.7
84
38.2
85
38.6
86
39.1
39.5
40.0
40.5
40.9
41.4
41.8
42.3
42.7
76
77
78
79
87
6.60
6.70
6.80
6.90
7.00
7.10
7.20
7.30
7.40
7.50
7.60
7.70
7.80
7.90
8.00
8.10
8.20
8.30
8.40
8.50
8.60
8.70
43.6
8.80
8.90
9.00
9.10
9.20
9.30
9.40
9.50
9.60
97
44.1
9.70
98
99
100
101
44.5
45.0
45.5
45.9
9.80
9.90
10.00
10.10
88
89
90
91
92
93
94
95
96
kg
23.2
23.6
24.1
52
Petwt.
43.2
MM! Banfield-Copyright 2003
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
11.20
11.40
11.60
11.80
12.00
12.20
12.40
12.60
12.80
13.00
ml
13.20
ml
ml
ml
ml
ml
ml
13.40
13.60
13.80
14.00
14.20
14.40
14.60
14.80
15.00
15.20
15.40
15.60
15.80
16.00
16.20
16.40
16.60
ml
16.80
25.20
ml
ml
25.50
ml
ml
17.00
17.20
ml
ml
ml
25.80
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
17.40
17.60
17.80
18.00
18.20
18.40
18.60
18.80
19.00
19.20
ml
ml
ml
ml
ml
ml
ml
19.40
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
26.10
26.40
26.70
27.00
27.30
27.60
27.90
28.20
28.50
28.80
29.10
ml
38.80
ml
ml
ml
ml
ml
29.40
29.70
30.00
30.30
ml
ml
ml
ml
39.20
39.60
40.00
40.40
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
19.60
19.80
20.00
20.20
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
20.10
22.50
22.80
23.10
23.40
23.70
24.00
24.30
24.60
24.90
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
32.00
32.40
32.80
33.20
33.60
34.00
34.40
34.80
35.20
35.60
36.00
36.40
36.80
37.20
37.60
38.00
38.40
Propofol
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
101
Ketoprofen 100 mg/mlPost-op Analgesia

Dose: 0.9 mg/lb Day 1, then 0.45 mg/lb Days 2-5 for Post-op Analgesia
Petwt.
lbs
Petwt.
104
kg
ml
Days 2-5
ml
Day 1
0.5
0.01
ml
0.00
ml
0.9
0.02
ml
0.01
ml
1.4
0.03
ml
0.01
ml
1.8
0.04
ml
0.02
ml
2.3
0.05
ml
0.02
ml
2.7
0.05
ml
0.03
ml
3.2
0.06
ml
0.03
ml
3.6
0.07
ml
0.04
ml
4.1
0.08
ml
0.04
ml
10
4.5
0.09
ml
0.05
ml
11
5.0
0.10
ml
0.05
ml
12
5.5
0.11
ml
0.05
ml
13
5.9
0.12
ml
0.06
ml
14
6.4
0.13
ml
0.06
ml
15
6.8
0.14
ml
0.07
ml
16
7.3
0.15
ml
0.07
ml
17
7.7
0.15
ml
0.08
ml
18
8.2
0.16
ml
0.08
ml
19
8.6
0.17
ml
0.09
ml
20
9.1
0.18
ml
0.09
ml
21
9.5
0.19
ml
0.10
ml
22
10.0
0.20
ml
0.10
ml
23
10.5
0.21
ml
0.10
ml
24
10.9
0.22
ml
0.11
ml
25
11.4
0.23
ml
0.11
ml
26
11.8
0.24
ml
0.12
ml
27
12.3
0.25
ml
0.12
ml
28
12.7
0.25
ml
0.13
ml
29
13.2
0.26
ml
0.13
ml
30
13.6
0.27
ml
0.14
ml
31
14.1
0.28
ml
0.14
ml
32
14.5
0.29
ml
0.15
ml
33
15.0
0.30
ml
0.15
ml
34
15.5
0.31
ml
0.15
ml
35
15.9
0.32
ml
0.16
ml
36
16.4
0.33
ml
0.16
ml
37
16.8
0.34
ml
0.17
ml
38
17.3
0.35
ml
0.17
ml
39
17.7
0.35
ml
0.18
ml
40
18.2
0.36
ml
0.18
ml
41
18.6
0.37
ml
0.19
ml
42
19.1
0.38
ml
0.19
ml
43
19.5
0.39
ml
0.20
ml
44
20.0
0.40
ml
0.20
ml
45
20.5
0.41
ml
0.20
ml
46
20.9
0.42
ml
0.21
ml
47
21.4
0.43
ml
0.21
ml
48
21.8
0.44
ml
0.22
ml
49
22.3
0.45
ml
0.22
ml
50
22.7
0.45
ml
0.23
ml
J
Ketoprofen
j
j
Telazol 100 mg/ml (cont.)

Dose: 0.5-2 mg/lb for Anesthesia Protocol (Maximum single dose is 100 mg)
Petwt. Petwt.
lbs
kg
ml @
0.5 mg/lb
ml @
1 mg/lb
ml @
1.5 mg/lb
ml @
2 mg/lb
51
23.2
0.26
ml
0.51
ml
0.77
ml
1.00
ml
52
23.6
0.26
ml
0.52
ml
0.78
ml
1.00
ml
53
24.1
0.27
ml
0.53
ml
0.80
ml
1.00
ml
54
24.5
0.27
ml
0.54
ml
0.81
ml
1.00
ml
55
25.0
0.28
ml
0.55
ml
0.83
ml
1.00
ml
56
25.5
0.28
ml
0.56
ml
0.84
ml
1.00
ml
57
25.9
0.29
ml
0.57
ml
0.86
ml
1.00
ml
58
26.4
0.29
ml
0.58
ml
0.87
ml
1.00
ml
59
26.8
0.30
ml
0.59
ml
0.89
ml
1.00
ml
60
27.3
0.30
ml
0.60
ml
0.90
ml
1.00
ml
61
27.7
0.31
ml
0.61
ml
0.92
ml
1.00
ml
62
28.2
0.31
ml
0.62
ml
0.93
ml
1.00
ml
63
28.6
0.32
ml
0.63
ml
0.95
ml
1.00
ml
64
29.1
0.32
ml
0.64
ml
0.96
ml
1.00
ml
65
29.5
0.33
ml
0.65
ml
0.98
ml
1.00
ml
66
30.0
0.33
ml
0.66
ml
0.99
ml
1.00
ml
67
30.5
0.34
ml
0.67
ml
1.00
ml
1.00
ml
68
30.9
0.34
ml
0.68
ml
1.00
ml
1.00
ml
69
31.4
0.35
ml
0.69
ml
1.00
ml
1.00
ml
70
31.8
0.35
ml
0.70
ml
1.00
ml
1.00
ml
71
32.3
0.36
ml
0.71
ml
1.00
ml
1.00
ml
72
32.7
0.36
ml
0.72
ml
1.00
ml
1.00
ml
73
0.37
ml
33.2
0.73
ml
1.00
ml
1.00
ml
74
33.6
0.37
ml
0.74
ml
1.00
ml
1.00
ml
75
34.1
0.38
ml
0.75
ml
1.00
ml
1.00
ml
76
34.5
0.38
ml
0.76
ml
1.00
ml
1.00
ml
11
35.0
0.39
ml
0.77
ml
1.00
ml
1.00
ml
78
35.5
0.39
ml
0.78
ml
1.00
ml
1.00
ml
79
35.9
0.40
ml
0.79
ml
1.00
ml
1.00
ml
80
36.4
0.40
ml
0.80
ml
1.00
ml
1.00
ml
81
36.8
0.41
ml
0.81
ml
1.00
ml
1.00
ml
82
37.3
0.41
ml
0.82
ml
1.00
ml
1.00
ml
83
37.7
0.42
ml
0.83
ml
1.00
ml
1.00
ml
84
38.2
0.42
ml
0.84
ml
1.00
ml
1.00
ml
85
38.6
0.43
ml
0.85
ml
1.00
ml
1.00
ml
86
39.1
0.43
ml
0.86
ml
1.00
ml
1.00
ml
87
39.5
0.44
ml
0.87
ml
1.00
ml
1.00
ml
88
40.0
0.44
ml
0.88
ml
1.00
ml
1.00
ml
89
40.5
0.45
ml
0.89
ml
1.00
ml
1.00
ml
90
40.9
0.45
ml
0.90
ml
1.00
ml
1.00
ml
91
41.4
0.46
ml
0.91
ml
1.00
ml
1.00
ml
92
41.8
0.46
ml
0.92
ml
1.00
ml
1.00
ml
93
42.3
0.47
ml
0.93
ml
1.00
ml
1.00
ml
94
42.7
0.47
ml
0.94
ml
1.00
ml
1.00
ml
95
43.2
0.48
ml
0.95
ml
1.00
ml
1.00
ml
96
43.6
0.48
ml
0.96
ml
1.00
ml
1.00
ml
97
44.1
0.49
ml
0.97
ml
1.00
ml
1.00
ml
98
44.5
0.49
ml
0.98
ml
1.00
ml
1.00
ml
99
45.0
0.50
ml
0.99
ml
1.00
ml
1.00
ml
100
45.5
0.50
ml
1.00
ml
1.00
ml
1.00
ml
101
45.9
0.51
ml
1.00
ml
1.00
ml
1.00
ml
TelazoP
TllETAMlNEHC!
andZOLAZEPAMHCI
Use In Dogs and Oa 'J>
per mL (when raW^

SmL
Telazol
** Maximum single dose is 1 ml, this can be repeated in 10-15 minutes up to a total dose of 2 mg/lb if adequate
immobilization is not achieved.
103
Atropine 0.54 mg/mlamep

Dose: 0.01 mg/lb for Anesthesia Monitoring and Emergency Protocoladminister slowly to effect
Petwt.
lbs
106
Pet wt.
kg
ml to
administer
Pet wt.
lbs
Petwt.
kg
ml to
administer
0.5
0.02
ml
51
23.2
0.94
ml
0.9
0.04
ml
52
23.6
0.96
ml
1.4
0.06
ml
53
24.1
0.98
ml
1.8
0.07
ml
54
24.5
1.00
ml
2.3
0.09
ml
55
25.0
1.02
ml
2.7
0.11
ml
56
25.5
1.04
ml
3.2
0.13
ml
57
25.9
1.06
ml
3.6
0.15
ml
58
26.4
1.07
ml
4.1
0.17
ml
59
26.8
1.09
ml
10
4.5
0.19
ml
60
27.3
1.11
ml
11
5.0
0.20
ml
61
27.7
1.13
ml
12
5.5
0.22
ml
62
28.2
1.15
ml
13
5.9
0.24
ml
63
28.6
1.17
ml
14
6.4
0.26
ml
64
29.1
1.19
ml
15
6.8
0.28
ml
65
29.5
1.20
ml
16
7.3
0.30
ml
66
30.0
1.22
ml
17
7.7
0.31
ml
67
30.5
1.24
ml
18
8.2
0.33
ml
68
30.9
1.26
ml
19
8.6
0.35
ml
69
31.4
1.28
ml
20
9.1
0.37
ml
70
31.8
1.30
ml
21
9.5
0.39
ml
71
32.3
1.31
ml
22
10.0
0.41
ml
72
32.7
1.33
ml
23
10.5
0.43
ml
73
33.2
1.35
ml
24
10.9
0.44
ml
74
33.6
1.37
ml
25
11.4
0.46
ml
75
34.1
1.39
ml
26
11.8
0.48
ml
76
34.5
1.41
ml
27
12.3
0.50
ml
77
35.0
1.43
ml
28
12.7
0.52
ml
78
35.5
1.44
ml
29
13.2
0.54
ml
79
35.9
1.46
ml
30
13.6
0.56
ml
80
36.4
1.48
ml
31
14.1
0.57
ml
81
36.8
1.50
ml
32
14.5
0.59
ml
82
37.3
1.52
ml
33
15.0
0.61
ml
83
37.7
1.54
ml
34
15.5
0.63
ml
84
38.2
1.56
ml .
35
15.9
0.65
ml
85
38.6
1.57
ml
36
16.4
0.67
ml
86
39.1
1.59
ml
37
16.8
0.69
ml
87
39.5
1.61
ml
38
17.3
0.70
ml
88
40.0
1.63
ml
39
17.7
0.72
ml
89
40.5
1.65
ml
40
18.2
0.74
ml
90
40.9
1.67
ml
41
18.6
0.76
ml
91
41.4
1.69
ml
42
19.1
0.78
ml
92
41.8
1.70
ml
43
19.5
0.80
ml
93
42.3
1.72
ml
44
20.0
0.81
ml
94
42.7
1.74
ml
45
20.5
0.83
ml
95
43.2
1.76
ml
46
20.9
0.85
ml
96
43.6
1.78
ml
47
21.4
0.87
ml
97
44.1
1.80
ml
48
21.8
0.89
ml
98
44.5
1.81
ml
49
22.3
0.91
ml
99
45.0
1.83
ml
50
22.7
0.93
ml
100
45.5
1.85
ml
Atropine
Ketoprofen 100 mg/mlIPost-op Analgesia (cont.)

Dose: 0.9 mg/lb Day 1, then 0.45 mg/lb Days 2-5 for Post-op Analgesia
L,
L
L.
liiiiiimtijattJ
iiiilil
Petwt.
lbs
Pet wt.
51
23.2
0.46
ml
0.23
52
23.6
0.47
ml
0.24
ml
53
24.1
0.48
ml
0.24
ml
54
24.5
0.49
ml
0.25
ml
55
25.0
0.50
ml
0.25
ml
56
25.5
0.51
ml
0.25
ml
57
25.9
0.52
ml
0.26
ml
58
26.4
0.53
ml
0.26
ml
59
26.8
0.54
ml
0.27
ml
60
27.3
0.55
ml
0.27
ml
61
27.7
0.55
ml
0.28
ml
62
28.2
0.56
ml
0.28
ml
63
28.6
0.57
ml
0.29
ml
64
29.1
0.58
ml
0.29
ml
65
29.5
0.59
ml
0.30
ml
66
30.0
0.60
ml
0.30
ml
67
30.5
0.61
ml
0.30
ml
68
30.9
0.62
ml
0.31
ml
69
31.4
0.63
ml
0.31
ml
70
31.8
0.64
ml
0.32
ml
71
32.3
0.65
ml
0.32
ml
72
32.7
0.65
ml
0.33
ml
73
33.2
0.66
ml
0.33
ml
74
33.6
0.67
ml
0.34
ml
75
34.1
0.68
ml
0.34
ml
76
34.5
0.69
ml
0.35
ml
11
35.0
0.70
ml
0.35
ml
78
35.5
0.71
ml
0.35
ml
79
35.9
0.72
ml
0.36
ml
80
36.4
0.73
ml
0.36
ml
81
36.8
0.74
ml
0.37
ml
kg
ml
Day 1
ml
Days 2-5
ml
82
37.3
0.75
ml
0.37
ml
83
37.7
0.75
ml
0.38
ml
84
38.2
0.76
ml
0.38
ml
85
38.6
0.77
ml
0.39
ml
86
39.1
0.78
ml
0.39
ml
87
39.5
0.79
ml
0.40
ml
88
40.0
0.80
ml
0.40
ml
89
40.5
0.81
ml
0.40
ml
90
40.9
0.82
ml
0.41
ml
91
41.4
0.83
ml
0.41
ml
92
41.8
0.84
ml
0.42
ml
93
42.3
0.85
ml
0.42
ml
94
42.7
0.85
ml
0.43
ml
95
43.2
0.86
ml
0.43
ml
96
43.6
0.87
ml
0.44
ml
97
44.1
0.88
ml
0.44
ml
98
44.5
0.89
ml
0.45
ml
99
45.0
0.90
ml
0.45
ml
100
45.5
0.91
ml
0.45
ml
MMI BanftelilCopyright 2003
Ketoprofen
105
j
Ephedrine 5 mg/ml**amep
Dose: 0.05 mg/lb for Anesthesia Monitoring and Emergency Protocol. Limit to 3 dosesstart at low end
kg
ml to
administer
0.5
0.01
ml
0.9
0.02
ml
Pet wt.
lbs
1
Petwt.
1.4
0.03
ml
1.8
0.04
ml
2.3
0.05
ml
2.7
0.06
ml
3.2
0.07
ml
3.6
0.08
ml
4.1
0.09
ml
10
4.5
0.10
ml
11
5.0
0.11
ml
12
5.5
0.12
ml
13
5.9
0.13
ml
14
6.4
0.14
ml
15
6.8
0.15
ml
16
7.3
0.16
ml
17
7.7
0.17
ml
18
8.2
0.18
ml
19
8.6
0.19
ml
20
9.1
0.20
ml
21
9.5
0.21
ml
22
10.0
0.22
ml
23
10.5
0.23
ml
24
10.9
0.24
ml
25
11.4
0.25
ml
26
11.8
0.26
ml
27
12.3
0.27
ml
28
12.7
0.28
ml
29
13.2
0.29
ml
30
13.6
0.30
ml
31
14.1
0.31
ml
32
14.5
0.32
ml
33
15.0
0.33
ml
34
15.5
0.34
ml
35
15.9
0.35
ml
36
16.4
0.36
ml
37
16.8
0.37
ml
38
17.3
0.38
ml
39
17.7
0.39
ml
40
18.2
0.40
ml
41
18.6
0.41
ml
42
19.1
0.42
ml
43
19.5
0.43
ml
44
20.0
0.44
ml
45
20.5
0.45
ml
46
20.9
0.46
ml
47
21.4
0.47
ml
48
21.8
0.48
ml
49
22.3
0.49
ml
50
22.7
0.50
ml
Ephedrine
** Stock solution is 50 mg/ml. 0.1 ml Ephedrine is added to 0.9 ml of sterile saline.
108
Glycopyrrolate 0.2 mg/mlamep

Dose: 0.005 mg/lb for Anesthesia Monitoring and Emergency Protocol
Petwt.
lbs
L
Li
l ::*mm>Hi
L
L
Petwt.
kg
ml to
administer
Pet wt.
lbs
Pet wt.
kg
ml to
administer
0.5
0.01
ml
51
23.2
0.58
ml
0.9
0.02
ml
52
23.6
0.59
ml
1.4
0.03
ml
53
24.1
0.60
ml
0.05
ml
54
24.5
0.61
ml
1.8
2.3
0.06
ml
55
25.0
0.63
ml
2.7
0.07
ml
56
25.5
0.64
ml
3.2
0.08
ml
57
25.9
0.65
ml
3.6
0.09
ml
58
26.4
0.66
ml
4.1
0.10
ml
59
26.8
0.67
ml
10
4.5
0.11
ml
60
27.3
0.68
ml
11
5.0
0.13
ml
61
27.7
0.69
ml
12
5.5
0.14
ml
62
28.2
0.70
ml
13
5.9
0.15
ml
63
28.6
0.72
ml
14
6.4
0.16
ml
64
29.1
0.73
ml
15
6.8
0.17
ml
65
29.5
0.74
ml
16
7.3
0.18
ml
66
30.0
0.75
ml
17
7.7
0.19
ml
67
30.5
0.76
ml
18
8.2
0.20
ml
68
30.9
0.77
ml
19
8.6
0.22
ml
69
31.4
0.78
ml
20
9.1
0.23
ml
70
31.8
0.80
ml
21
9.5
0.24
ml
71
32.3
0.81
ml
22
10.0
0.25
ml
72
32.7
0.82
ml
23
10.5
0.26
ml
73
33.2
0.83
ml
24
10.9
0.27
ml
74
33.6
0.84
ml
25
11.4
0.28
ml
75
34.1
0.85
ml
26
11.8
0.30
ml
76
34.5
0.86
ml
27
12.3
0.31
ml
77
35.0
0.88
ml
28
12.7
0.32
ml
78
35.5
0.89
ml
29
13.2
0.33
ml
79
35.9
0.90
ml
30
13.6
0.34
ml
80
36.4
0.91
ml
31
14.1
0.35
ml
81
36.8
0.92
ml
32
14.5
0.36
ml
82
37.3
0.93
ml
33
15.0
0.38
ml
83
37.7
0.94
ml
ml
34
15.5
0.39
ml
84
38.2
0.95
35
15.9
0.40
ml
85
38.6
0.97
ml
36
16.4
0.41
ml
86
39.1
0.98
ml
37
16.8
0.42
ml
87
39.5
0.99
ml
38
17.3
0.43
ml
88
40.0
1.00
ml
39
17.7
0.44
ml
89
40.5
1.01
ml
40
18.2
0.45
ml
90
40.9
1.02
ml
41
18.6
0.47
ml
91
41.4
1.03
ml
42
19.1
0.48
ml
92
41.8
1.05
ml
43
19.5
0.49
ml
93
42.3
1.06
ml
44
20.0
0.50
ml
94
42.7
1.07
ml
45
20.5
0.51
ml
95
43.2
1.08
ml
46
20.9
0.52
ml
96
43.6
1.09
ml
47
21.4
0.53
ml
97
44.1
1.10
ml
48
21.8
0.55
ml
98
44.5
1.11
ml
49
22.3
0.56
ml
99
45.0
1.13
ml
50
22.7
0.57
ml
100
45.5
1.14
ml
Glycopyrrolate
107
Lidocaine 20 mg/ml bolusamep & cpr*

Dose: Dog: 1-2 mg/lb; Cat: 0.125-0.25 mg/lb (administer slowly to effect)
Pet wt.
lbs.
Petwt.
kg
Dose
for Cats
Dose
for Dogs
0.5
0.05
to
0.10
ml
0.01
to
0.01
ml
0.9
0.10
to
0.20
ml
0.01
to
0.03
ml
1.4
0.15
to
0.30
ml
0.02
to
0.04
ml
1.8
0.20
to
0.40
ml
0.03
to
0.05
ml
2.3
0.25
to
0.50
ml
0.03
to
0.06
ml
2.7
0.30
to
0.60
ml
0.04
to
0.08
ml
3.2
0.35
to
0.70
ml
0.04
to
0.09
ml
3.6
0.40
to
0.80
ml
0.05
to
0.10
ml
4.1
0.45
to
0.90
ml
0.06
to
0.11
ml
10
4.5
0.50
to
1.00
ml
0.06
to
0.13
ml
11
5.0
0.55
to
1.10
ml
0.07
to
0.14
ml
12
5.5
0.60
to
1.20
ml
0.08
to
0.15
ml
13
5.9
0.65
to
1.30
ml
0.08
to
0.16
ml
14
6.4
0.70
to
1.40
ml
0.09
to
0.18
ml
15
6.8
0.75
to
1.50
ml
0.09
to
0.19
ml
16
7.3
0.80
to
1.60
ml
0.10
to
0.20
ml
17
7.7
0.85
to
1.70
ml
0.11
to
0.21
ml
18
8.2
0.90
to
1.80
ml
0.11
to
0.23
ml
19
8.6
0.95
to
1.90
ml
0.12
to
0.24
ml
20
9.1
1.00
to
2.00
ml
0.13
to
0.25
ml
21
9.5
1.05
to
2.10
ml
0.13
to
0.26
ml
22
10.0
1.10
to
2.20
ml
0.14
to
0.28
ml
23
10.5
1.15
to
2.30
ml
0.14
to
0.29
ml
24
10.9
1.20
to
2.40
ml
0.15
to
0.30
ml
25
11.4
1.25
to
2.50
ml
0.16
to
0.31
ml
26
11.8
1.30
to
2.60
ml
0.16
to
0.33
ml
27
12.3
1.35
to
2.70
ml
0.17
to
0.34
ml
28
12.7
1.40
to
2.80
ml
0.18
to
0.35
ml
29
13.2
1.45
to
2.90
ml
0.18
to
0.36
ml
30
13.6
1.50
to
3.00
ml
0.19
to
0.38
ml
31
14.1
1.55
to
3.10
ml
32
14.5
1.60
to
3.20
ml
33
15.0
1.65
to
3.30
ml
34
15.5
1.70
to
3.40
ml
35
15.9
1.75
to
3.50
ml
36
16.4
1.80
to
3.60
ml
37
16.8
1.85
to
3.70
ml
38
17.3
1.90
to
3.80
ml
39
17.7
1.95
to
3.90
ml
40
18.2
2.00
to
4.00
ml
41
18.6
2.05
to
4.10
ml
42
19.1
2.10
to
4.20
ml
43
19.5
2.15
to
4.30
ml
44
20.0
2.20
to
4.40
ml
45
20.5
2.25
to
4.50
ml
46
20.9
2.30
to
4.60
ml
47
21.4
2.35
to
4.70
ml
48
21.8
2.40
to
4.80
ml
49
22.3
2.45
to
4.90
ml
50
22.7
2.50
to
5.00
ml
Lidocaine
*Lidocaine dose is the same for both AMEP and CPR charts.
110
Ephedrine 5 mg/ml**amep (cont.)

Dose: 0.05 mg/lb for Anesthesia Monitoring and Emergency Protocol Limit to 3 dosesstart at low end
L-
L
L
Petwt.
lbs
Petwt.
51
23.2
0.51
ml
52
23.6
0.52
ml
53
24.1
0.53
ml
54
24.5
0.54
ml
55
25.0
0.55
ml
56
25.5
0.56
ml
57
25.9
0.57
ml
58
26.4
0.58
ml
59
26.8
0.59
ml
60
27.3
0.60
ml
61
27.7
0.61
ml
62
28.2
0.62
ml
63
28.6
0.63
ml
64
29.1
0.64
ml
65
29.5
0.65
ml
66
30.0
0.66
ml
67
30.5
0.67
ml
68
30.9
0.68
ml
69
31.4
0.69
ml
70
31.8
0.70
ml
71
32.3
0.71
ml
72
32.7
0.72
ml
73
33.2
0.73
ml
74
33.6
0.74
ml
75
34.1
0.75
ml
76
34.5
0.76
ml
77
35.0
0.77
ml
78
35.5
0.78
ml
79
35.9
0.79
ml
80
36.4
0.80
ml
81
36.8
0.81
ml
82
37.3
0.82
ml
83
37.7
0.83
ml
84
38.2
0.84
ml
85
38.6
0.85
ml
86
39.1
0.86
ml
87
39.5
0.87
ml
88
40.0
0.88
ml
89
40.5
0.89
ml
90
40.9
0.90
ml
91
41.4
0.91
ml
92
41.8
0.92
ml
93
42.3
0.93
ml
94
42.7
0.94
ml
95
43.2
0.95
ml
96
43.6
0.96
ml
97
44.1
0.97
ml
98
44.5
0.98
ml
99
45.0
0.99
ml
100
45.5
1.00
ml
kg
ml to
administer
Ephedrine
** Stock solution is 50 mg/ml-0.1 ml Ephedrine is added to 0.9 ml of sterile saline
109
J
EPINEPHRINE
AMEP
1:10,000 for Anesthesia Monitoring and Emergency ProtocolDose: 0.005 mg/lb

Pet wt.
lbs
Pet wt.
kg
0.5
2
3
0.9
5
6
7
1.4
1.8
2.3
2.7
3.2
3.6
9
10
11
4.1
4.5
5.0
5.5
5.9
12
13
14
15
16
17
6.4
6.8
ml to
administer
ml
51
23.2
ml
ml
52
53
23.6
24.1
0.20
ml
54
24.5
2.70
ml
ml
25.0
25.5
ml
55
56
57
2.75
2.80
2.85
ml
ml
ml
0.40
0.45
0.50
0.55
0.60
0.65
0.70
0.75
ml
58
26.4
59
60
61
62
63
64
65
66
26.8
27.3
27.7
28.2
28.6
29.1
29.5
30.0
2.90
2.95
3.00
3.05
3.10
3.15
3.20
3.25
3.30
ml
ml
67
30.5
3.35
ml
ml
ml
68
30.9
3.40
ml
69
31.4
ml
1.00
1.05
1.10
1.15
1.20
1.25
1.30
1.35
1.40
1.45
1.50
1.55
1.60
1.65
1.70
1.75
1.80
1.85
1.90
1.95
ml
ml
ml
ml
ml
ml
ml
70
71
72
73
74
75
76
ml
77
ml
78
ml
79
80
81
82
31.8
32.3
32.7
33.2
33.6
34.1
34.5
35.0
35.5
35.9
36.4
36.8
2.00
2.05
2.10
2.15
2.20
2.30
2.35
ml
ml
ml
ml
ml
ml
ml
ml
97
37.3
37.7
38.2
38.6
39.1
39.5
40.0
40.5
40.9
41.4
41.8
42.3
42.7
43.2
43.6
44.1
3.45
3.50
3.55
3.60
3.65
3.70
3.75
3.80
3.85
3.90
3.95
4.00
4.05
4.10
4.15
4.20
4.25
4.30
4.35
4.40
4.45
4.50
2.40
ml
98
44.5
4.90
2.45
ml
99
45.0
4.95
2.50
ml
100
45.5
5.00
18
8.2
0.90
19
20
21
22
8.6
9.1
9.5
10.0
10.5
10.9
0.95
40
41
42
43
44
45
46
47
48
49
50
14.1
14.5
15.0
15.5
15.9
16.4
16.8
17.3
17.7
18.2
18.6
19.1
19.5
20.0
20.5
20.9
21.4
21.8
22.3
22.7
ml to
administer
2.55
ml
ml
2.60
2.65
ml
0.25
0.30
0.35
0.80
11.4
11.8
12.3
12.7
13.2
13.6
Pet wt.
kg
0.05
0.10
0.15
7.3
7.7
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
Pet wt.
lbs
0.85
2.25
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
83
84
85
86
87
88
89
90
91
92
93
94
95
96
25.9
4.55
4.60
4.65
4.70
4.75
4.80
4.85
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
J
J
** Stock solution is 1:1,000. 0.1 ml Epinephrine is added to 0.9 ml of sterile saline.
112
2def flto IRgfiI
LlDOCAINE 20 mg/ml BOLUSAMEP & CPR* (cont.)

Dose: Dog: 1-2 mg/lb (administer slowly to effect) See previous page for Cat
Petwt.
lbs
Pet wt.
51
23.2
2.55
to
5.10
ml
52
23.6
2.60
to
5.20
ml
53
24.1
2.65
to
5.30
ml
54
24.5
2.70
to
5.40
ml
55
25.0
2.75
to
5.50
ml
56
25.5
2.80
to
5.60
ml
57
25.9
2.85
to
5.70
ml
58
26.4
2.90
to
5.80
ml
59
26.8
2.95
to
5.90
ml
60
27.3
3.00
to
6.00
ml
61
27.7
3.05
to
6.10
ml
62
28.2
3.10
to
6.20
ml
63
28.6
3.15
to
6.30
ml
64
29.1
3.20
to
6.40
ml
65
29.5
3.25
to
6.50
ml
66
30.0
3.30
to
6.60
ml
67
30.5
3.35
to
6.70
ml
68
30.9
3.40
to
6.80
ml
69
31.4
3.45
to
6.90
ml
70
31.8
3.50
to
7.00
ml
71
32.3
3.55
to
7.10
ml
72
32.7
3.60
to
7.20
ml
73
33.2
3.65
to
7.30
ml
74
33.6
3.70
to
7.40
ml
75
34.1
3.75
to
7.50
ml
76
34.5
3.80
to
7.60
ml
77
35.0
3.85
to
7.70
ml
78
35.5
3.90
to
7.80
ml
79
35.9
3.95
to
7.90
ml
80
36.4
4.00
to
8.00
ml
81
36.8
4.05
to
8.10
ml
82
37.3
4.10
to
8.20
ml
83
37.7
4.15
to
8.30
ml
84
38.2
4.20
to
8.40
ml
85
38.6
4.25
to
8.50
ml
86
39.1
4.30
to
8.60
ml
Dose
for Dogs
kg
87
39.5
4.35
to
8.70
ml
88
40.0
4.40
to
8.80
ml
89
40.5
4.45
to
8.90
ml
90
40.9
4.50
to
9.00
ml
91
41.4
4.55
to
9.10
ml
92
41.8
4.60
to
9.20
ml
93
42.3
4.65
to
9.30
ml
94
42.7
4.70
to
9.40
ml
95
43.2
4.75
to
9.50
ml
96
43.6
4.80
to
9.60
ml
97
44.1
4.85
to
9.70
ml
98
44.5
4.90
to
9.80
ml
99
45.0
4.95
to
9.90
ml
100
45.5
5.00
to
10.00
ml
Lidocaine
*Lidocaine dose is the same for both AMEP and CPR charts
111
Atropine 0.54 mg/mlcpr

Dose: 0.01-0.02 mg/lb IV for Cardiopulmonary Resuscitation (CPR)
Petwt.
lbs
114
ml to
administer
Pet wt.
kg
0.5
0.02
to
0.04
ml
0.9
0.04
to
0.07
ml
1.4
0.06
to
0.11
ml
1.8
0.07
to
0.15
ml
2.3
0.09
to
0.19
ml
2.7
0.11
to
0.22
ml
3.2
0.13
to
0.26
ml
3.6
0.15
to
0.30
ml
4.1
0.17
to
0.33
ml
10
4.5
0.19
to
0.37
ml
11
5.0
0.20
to
0.41
ml
12
5.5
0.22
to
0.44
ml
13
5.9
0.24
to
0.48
ml
14
6.4
0.26
to
0.52
ml
15
6.8
0.28
to
0.56
ml
16
7.3
0.30
to
0.59
ml
17
7.7
0.31
to
0.63
ml
18
8.2
0.33
to
0.67
ml
19
8.6
0.35
to
0.70
ml
20
9.1
0.37
to
0.74
ml
21
9.5
0.39
to
0.78
ml
22
10.0
0.41
to
0.81
ml
23
10.5
0.43
to
0.85
ml
24
10.9
0.44
to
0.89
ml
25
11.4
0.46
to
0.93
ml
26
11.8
0.48
to
0.96
ml
27
12.3
0.50
to
1.00
ml
28
12.7
0.52
to
1.04
ml
29
13.2
0.54
to
1.07
ml
30
13.6
0.56
to
1.11
ml
31
14.1
0.57
to
1.15
ml
32
14.5
0.59
to
1.19
ml
33
15.0
0.61
to
1.22
ml
34
15.5
0.63
to
1.26
ml
35
15.9
0.65
to
1.30
ml
36
16.4
0.67
to
1.33
ml
37
16.8
0.69
to
1.37
ml
38
17.3
0.70
to
1.41
ml
39
17.7
0.72
to
1.44
ml
40
18.2
0.74
to
1.48
ml
41
18.6
0.76
to
1.52
ml
42
19.1
0.78
to
1.56
ml
43
19.5
0.80
to
1.59
ml
44
20.0
0.81
to
1.63
ml
45
20.5
0.83
to
1.67
ml
46
20.9
0.85
to
1.70
ml
47
21.4
0.87
to
1.74
ml
48
21.8
0.89
to
1.78
ml
49
22.3
0.91
to
1.81
ml
50
22.7
0.93
to
1.85
ml
.J
Atropine
ln^y^J
Dexamethasone SP 4 mg/mlcpr
Dose: 2 mg/lb IV
Petwt.
lbs
1
2
3
4
5
0.5
0.9
1.4
1.8
ml to
administer
51
52
23.2
1.50
2.00
2.50
ml
ml
53
24.1
54
ml
55
3.00
ml
56
57
3.50
ml
8
9
10
11
3.6
4.1
4.00
4.50
5.00
5.50
6.00
6.50
ml
7.00
5.5
5.9
6.4
kg
ml
3.2
5.0
Petwt.
ml
4.5
Pet wt.
lbs
0.50
1.00
2.3
2.7
13
14
ml
ml
ml
ml
ml
58
59
60
61
62
63
ml
ml
24.5
25.0
26.50
27.00
27.50
ml
25.5
28.00
ml
25.9
26.4
28.50
29.00
29.50
ml
26.8
27.3
27.7
28.2
28.6
ml
ml
64
29.1
7.50
16
65
29.5
8.00
ml
17
30.0
7.7
8.50
ml
18
19
20
21
22
23
66
67
8.2
9.00
9.50
10.00
10.50
11.00
ml
ml
68
69
ml
70
ml
71
ml
72
11.50
ml
33.2
12.00
12.50
13.00
13.50
ml
ml
ml
73
74
75
34.1
76
34.5
ml
77
35.0
14.00
ml
78
14.50
15.00
15.50
16.00
16.50
17.00
17.50
18.00
18.50
19.00
ml
79
80
81
82
83
84
85
86
87
88
35.5
35.9
36.4
24
8.6
9.1
9.5
10.0
10.5
10.9
25
26
11.4
27
12.3
28
12.7
13.2
13.6
14.1
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
11.8
14.5
15.0
15.5
15.9
16.4
16.8
17.3
ml
ml
ml
ml
ml
ml
ml
ml
ml
30.5
30.9
31.4
31.8
32.3
32.7
33.6
36.8
37.3
37.7
38.2
38.6
39.1
39.5
40.0
ml
18.6
19.1
19.5
20.0
20.5
20.9
21.4
21.8
19.50
20.00
20.50
21.00
21.50
22.00
22.50
23.00
ml
ml
ml
ml
91
92
93
94
95
96
23.50
24.00
ml
97
44.1
ml
98
22.3
22.7
24.50
25.00
ml
99
100
17.7
18.2
ml
ml
ml
ml
89
90
ml to
administer
25.50
26.00
23.6
6.8
7.3
15
L-
kg
12
UsiMti
Petwt.
ml
ml
ml
ml
30.00
30.50
31.00
31.50
32.00
32.50
33.00
33.50
ml
ml
ml
ml
ml
34.00
34.50
35.00
35.50
36.00
36.50
37.00
37.50
38.00
38.50
ml
ml
39.00
39.50
40.00
40.50
41.00
41.50
42.00
42.50
43.00
43.50
44.00
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
44.5
44.50
45.00
45.50
46.00
46.50
47.00
47.50
48.00
48.50
49.00
ml
45.0
45.5
49.50
50.00
ml
ml
40.5
40.9
41.4
41.8
42.3
42.7
43.2
43.6
Dexamethasone
ml
ml
ml
ml
ml
ml
ml
ml
ml
ml
113
Epinephrine 1:1,000 = 1 mg/mlcpr
Low Dose: 0.005-0.01 mg/lb IVHigh Dose: 0.1 mg/lb IV for Cardiopulmonary Resuscitation
Petwt.
lbs
Pet wt.
Low Dose IV
kg
ml/lb to administer
High Dose IV
ml/lb to admin.
ml
0.10
0.5
0.01
to
0.01
ml
0.9
0.01
to
0.02
ml
0.20
1.4
0.02
to
0.03
ml
0.30
ml
1.8
0.02
to
0.04
ml
0.40
ml
ml
2.3
0.03
to
0.05
ml
0.50
ml
2.7
0.03
to
0.06
ml
0.60
ml
3.2
0.04
to
0.07
ml
0.70
ml
3.6
0.04
to
0.08
ml
0.80
ml
4.1
0.05
to
0.09
ml
0.90
ml
10
4.5
0.05
to
0.10
ml
1.00
ml
11
5.0
0.06
to
0.11
ml
1.10
ml
12
5.5
0.06
to
0.12
ml
1.20
ml
13
5.9
0.07
to
0.13
ml
1.30
ml
14
6.4
0.07
to
0.14
ml
1.40
ml
15
6.8
0.08
to
0.15
ml
1.50
ml
16
7.3
0.08
to
0.16
ml
1.60
ml
17
7.7
0.09
to
0.17
ml
1.70
ml
18
8.2
0.09
to
0.18
ml
1.80
ml
19
8.6
0.10
to
0.19
ml
1.90
ml
20
9.1
0.10
to
0.20
ml
2.00
ml
21
9.5
0.11
to
0.21
ml
2.10
ml
22
10.0
0.11
to
0.22
ml
2.20
ml
23
10.5
0.12
to
0.23
ml
2.30
ml
24
10.9
0.12
to
0.24
ml
2.40
ml
25
11.4
0.13
to
0.25
ml
2.50
ml
26
11.8
0.13
to
0.26
ml
2.60
ml
27
12.3
0.14
to
0.27
ml
2.70
ml
28
12.7
0.14
to
0.28
ml
2.80
ml
29
13.2
0.15
to
0.29
ml
2.90
ml
30
13.6
0.15
to
0.30
ml
3.00
ml
31
14.1
0.16
to
0.31
ml
3.10
ml
32
14.5
0.16
to
0.32
ml
3.20
ml
33
15.0
0.17
to
0.33
ml
3.30
ml
34
15.5
0.17
to
0.34
ml
3.40
ml
35
15.9
0.18
to
0.35
ml
3.50
ml
36
16.4
0.18
to
0.36
ml
3.60
ml
37
16.8
0.19
to
0.37
ml
3.70
ml
38
17.3
0.19
to
0.38
ml
3.80
ml
39
17.7
0.20
to
0.39
ml
3.90
ml
40
18.2
0.20
to
0.40
ml
4.00
ml
41
18.6
0.21
to
0.41
ml
4.10
ml
42
19.1
0.21
to
0.42
ml
4.20
ml
43
19.5
0.22
to
0.43
ml
4.30
ml
44
20.0
0.22
to
0.44
ml
4.40
ml
45
20.5
0.23
to
0.45
ml
4.50
ml
46
20.9
0.23
to
0.46
ml
4.60
ml
47
21.4
0.24
to
0.47
ml
4.70
ml
49
22.3
0.25
to
0.49
ml
4.90
ml
50
22.7
0.25
to
0.50
ml
5.00
ml
j
Epinephrine
ljpâ,;,a:l
J
'I
''Wtiir'ri'1'
116
MMIBanjieldCopyright 2003
Atropine 0.54 mg/mlcpr (cont.)

Dose: 0.01-0.02 mg/lb IV for Cardiopulmonary Resuscitation (CPR)
Pet wt.
lbs
Petwt.
51
23.2
0.94
to
52
23.6
0.96
to
ml to
administer
kg
1.89
1.93
ml
ml
53
24.1
0.98
to
1.96
ml
54
24.5
1.00
to
2.00
ml
55
25.0
1.02
to
2.04
ml
56
25.5
1.04
to
2.07
ml
57
25.9
1.06
to
2.11
ml
58
26.4
1.07
to
2.15
ml
59
26.8
1.09
to
2.19
ml
60
27.3
1.11
to
2.22
ml
61
27.7
1.13
to
2.26
ml
62
28.2
1.15
to
2.30
ml
63
28.6
1.17
to
2.33
ml
64
29.1
1.19
to
2.37
ml
65
29.5
1.20
to
2.41
ml
66
30.0
1.22
to
2.44
ml
67
30.5
1.24
to
2.48
ml
68
30.9
1.26
to
2.52
ml
69
31.4
1.28
to
2.56
ml
70
31.8
1.30
to
2.59
ml
71
32.3
1.31
to
2.63
ml
72
32.7
1.33
to
2.67
ml
73
33.2
1.35
to
2.70
ml
74
33.6
1.37
to
2.74
ml
75
34.1
1.39
to
2.78
ml
76
34.5
1.41
to
2.81
ml
77
35.0
1.43
to
2.85
ml
78
35.5
1.44
to
2.89
ml
79
35.9
1.46
to
2.93
ml
80
36.4
1.48
to
2.96
ml
81
36.8
1.50
to
3.00
ml
82
37.3
1.52
to
3.04
ml
83
37.7
1.54
to
3.07
ml
84
38.2
1.56
to
3.11
ml
85
38.6
1.57
to
3.15
ml
86
39.1
1.59
to
3.19
ml
87
39.5
1.61
to
3.22
ml
88
40.0
1.63
to
3.26
ml
89
40.5
1.65
to
3.30
ml
90
40.9
1.67
to
3.33
ml
91
41.4
1.69
to
3.37
ml
92
41.8
1.70
to
3.41
ml
93
42.3
1.72
to
3.44
ml
94
42.7
1.74
to
3.48
ml
95
43.2
1.76
to
3.52
ml
96
43.6
1.78
to
3.56
ml
97
44.1
1.80
to
3.59
ml
98
44.5
1.81
to
3.63
ml
99
45.0
1.83
to
3.67
ml
100
45.5
1.85
to
3.70
ml
Atropine
115
Sodium Bicarbonate 8.4%, 1 mEq/mlDose: 0.2-0.45 mEq/lb-Give slowly over 5 minutes
Petwt.
lbs
Petwt.
kg
ml to
administer
0.5
0.20
to
0.45
ml
0.9
0.40
to
0.90
ml
1.4
0.60
to
1.35
ml
1.8
0.80
to
1.80
ml
2.3
1.00
to
2.25
ml
2.7
1.20
to
2.70
ml
3.2
1.40
to
3.15
ml
3.6
1.60
to
3.60
ml
4.1
1.80
to
4.05
ml
10
4.5
2.00
to
4.50
ml
11
5.0
2.20
to
4.95
ml
12
5.5
2.40
to
5.40
ml
13
5.9
2.60
to
5.85
ml
14
6.4
2.80
to
6.30
ml
15
6.8
3.00
to
6.75
ml
16
7.3
3.20
to
7.20
ml
17
7.7
3.40
to
7.65
ml
18
8.2
3.60
to
8.10
ml
19
8.6
3.80
to
8.55
ml
20
9.1
4.00
to
9.00
ml
21
9.5
4.20
to
9.45
ml
22
10.0
4.40
to
9.90
ml
23
10.5
4.60
to
10.35
ml
24
10.9
4.80
to
10.80
ml
25
11.4
5.00
to
11.25
ml
26
11.8
5.20
to
11.70
ml
27
12.3
5.40
to
12.15
ml
28
12.7
5.60
to
12.60
ml
29
13.2
5.80
to
13.05
ml
30
13.6
6.00
to
13.50
ml
31
14.1
6.20
to
13.95
ml
32
14.5
6.40
to
14.40
ml
33
15.0
6.60
to
14.85
ml
34
15.5
6.80
to
15.30
ml
35
15.9
7.00
to
15.75
ml
36
16.4
7.20
to
16.20
ml
37
16.8
7.40
to
16.65
ml
38
17.3
7.60
to
17.10
ml
39
17.7
7.80
to
17.55
ml
40
18.2
8.00
to
18.00
ml
41
18.6
8.20
to
18.45
ml
42
19.1
8.40
to
18.90
ml
43
19.5
8.60
to
19.35
ml
44
20.0
8.80
to
19.80
ml
45
20.5
9.00
to
20.25
ml
46
20.9
9.20
to
20.70
ml
47
21.4
9.40
to
21.15
ml
48
21.8
9.60
to
21.60
ml
49
22.3
9.80
to
22.05
ml
50
22.7
10.00
to
22.50
ml
Sodium Bicarbonate
-J
J
J
J
Epinephrine 1:1,000 = 1 mg/mlcpr (cont.)

Low Dose: 0.005-0.01 mg/lb IVHigh Dose: 0.1 mg/lb IV for Cardiopulmonary Resuscitation
hsUJMmUl
Petwt.
lbs
Pet wt.
51
23.2
0.26
to
0.51
ml
5.10
ml
52
23.6
0.26
to
0.52
ml
5.20
ml
53
24.1
0.27
to
0.53
ml
5.30
ml
54
24.5
0.27
to
0.54
ml
5.40
ml
55
25.0
0.28
to
0.55
ml
5.50
ml
56
25.5
0.28
to
0.56
ml
5.60
ml
57
25.9
0.29
to
0.57
ml
5.70
ml
58
26.4
0.29
to
0.58
ml
5.80
ml
59
26.8
0.30
to
0.59
ml
5.90
ml
60
27.3
0.30
to
0.60
ml
6.00
ml
61
27.7
0.31
to
0.61
ml
6.10
ml
62
28.2
0.31
to
0.62
ml
6.20
ml
63
28.6
0.32
to
0.63
ml
6.30
ml
64
29.1
0.32
to
0.64
ml
6.40
ml
65
29.5
0.33
to
0.65
ml
6.50
ml
66
30.0
0.33
to
0.66
ml
6.60
ml
67
30.5
0.34
to
0.67
ml
6.70
ml
68
30.9
0.34
to
0.68
ml
6.80
ml
69
31.4
0.35
to
0.69
ml
6.90
ml
70
31.8
0.35
to
0.70
ml
7.00
ml
71
32.3
0.36
to
0.71
ml
7.10
ml
72
32.7
0.36
to
0.72
ml
7.20
ml
73
33.2
0.37
to
0.73
ml
7.30
ml
74
33.6
0.37
to
0.74
ml
7.40
ml
75
34.1
0.38
to
0.75
ml
7.50
ml
76
34.5
0.38
to
0.76
ml
7.60
ml
11
35.0
0.39
to
0.77
ml
7.70
ml
78
35.5
0.39
to
0.78
ml
7.80
ml
79
35.9
0.40
to
0.79
ml
7.90
ml
80
36.4
0.40
to
0.80
ml
8.00
ml
81
36.8
0.41
to
0.81
ml
8.10
ml
82
37.3
0.41
to
0.82
ml
8.20
ml
83
37.7
0.42
to
0.83
ml
8.30
ml
84
38.2
0.42
to
0.84
ml
8.40
ml
85
38.6
0.43
to
0.85
ml
8.50
ml
86
39.1
0.43
to
0.86
ml
8.60
ml
87
39.5
0.44
to
0.87
ml
8.70
ml
88
40.0
0.44
to
0.88
ml
8.80
ml
89
40.5
0.45
to
0.89
ml
8.90
ml
90
40.9
0.45
to
0.90
ml
9.00
ml
91
41.4
0.46
to
0.91
ml
9.10
ml
92
41.8
0.46
to
0.92
ml
9.20
ml
93
42.3
0.47
to
0.93
ml
9.30
ml
94
42.7
0.47
to
0.94
ml
9.40
ml
95
43.2
0.48
to
0.95
ml
9.50
ml
96
43.6
0.48
to
0.96
ml
9.60
ml
97
44.1
0.49
to
0.97
ml
9.70
ml
98
44.5
0.49
to
0.98
ml
9.80
ml
99
45.0
0.50
to
0.99
ml
9.90
ml
100
45.5
0.50
to
1.00
ml
10.00
ml
kg
High Dose IV
ml/lb to admin.
Low Dose IV
ml/lb to administer
Epinephrine
117

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Anesthesia

for the Pet Practitioner

MMI Banfield - Copyright 2003

Will Novak, DVM, MBA, Diplomate ABVP

Banfield, The Pet Hospital

MMI BanfieldCopyright 2003

:"', ,-', ;.;'.! .

Anesthesia for the Pet Practitioner

2003 Banfield, The Pet Hospital

Section 2: The Banfield Protocols

Stable Diabetic Protocol

Blood Work Evaluation

Ear Surgery Protocol

Healthy Pet Protocol

CNS, Eye Globe Protocol

Fractious Pet Protocol

Emergency Surgery Protocol

Feline Declaw Protocol

Anesthesia Monitoring and

Cardiopulmonary Arrest (1)

Cardiopulmonary Arrest (2)

Section 3: Fluid Therapy in Pets

Section 4: Anesthetic Considerations for Small Exotic Pets

Avian Protocol/Flow Chart

Reptile Protocol/Flow Chart

Ferret Protocol/Flow Chart

Rabbit Protocol/Flow Chart

Guinea Pig and Chinchilla

Induction and maintenance

Note on individual protocols

Rat, Mouse, Gerbil, Hamster

Appendix: Dosage Tables

Lidocaine (AMEP* & CPR**)

Sodium Bicarbonate (CPR**)

* Anesthesia Monitoring Emergency Protocol

MMI BanfieldConfidential Internal Use OnlyRevised 3/10/03

Section 1: General Anesthesia

Intubation and Airway Management (Cats). . 20

Measuring Quality Anesthesia

Maintenance & Monitoring

Standards and Protocols

Oxygen Flow Rates

Alpha-1 Sympathetic Pathway

Autonomic Nervous System

Anesthesia Monitoring & Emerg. Protocol . . 24

Post-op Pain Management

Acepromazine in Fractious Pets

and Epinephrine Reversal

Defining Good Perfusion

Definitions and Requirements

Tranquilization and Sedation

Rebreathing Bag Sizes

Endotracheal Tube Selection

Breathing Circuit Guidelines

Soda Lime Canisters

10-second Leak Test

Anesthesia Machine Diagram

MMI BanfieldCopyright 2003

Will Novak, DVM, MBA, Dipl ABVP