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Old 09-04-2007, 08:05 PM   #1
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Default Pre anesthetic anesthetic (injectable?)

Everyone, please give me your opinions/suggestions. Ellie went to the vet tonight for some hearing issues and I talked to the vet about doing a BAT. She agreed and we will do that on Sunday. Anyway, the vet really wants Ellie to be spayed because of the risk of a pyometra. This risk is increased for Ellie because her heat cycle doesn't happen as often as it should. That means her hormones are already messed up. Her vet said it is also harder to treat pyo in a small dog because the pus-filled uterus can spill into the abdomen during the surgery. It is hard to get a swollen uterus out of such a small thing. My question is: what do all of your vets use for PRE Isoflourine/Sevoflourine? Her vet uses Iso but what do your vets use to intubate before it can be given? She had a dental here 7 months ago and all went well. They used Iso but they also injected something before. I am not sure what that something is but I hope it wasn't a barbituate. How many vets just mask down with Iso before intubation? I don't think they will do that. Sorry I'm a bit rambly. I am just so nervous and I don't know what to do.
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Old 09-05-2007, 06:53 AM   #2
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Quote:
Originally Posted by Ellie May View Post
My question is: what do all of your vets use for PRE Isoflourine/Sevoflourine? Her vet uses Iso but what do your vets use to intubate before it can be given? She had a dental here 7 months ago and all went well. They used Iso but they also injected something before. I am not sure what that something is but I hope it wasn't a barbituate. How many vets just mask down with Iso before intubation?
VERY good questions! And I'd like to know as well bc Marcel gets neutered this month - and I've gone over anesthesia w/ the vet office - but did not ask if they ISO, then intubate. OR, if they want to intubate FIRST - what the heck are they using for sedation???

Anyone?
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Old 09-05-2007, 07:01 AM   #3
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http://www.abtc.org/health_ed/Health-anesthesia.htm

You could try this link. It might help you. Just wondering what everybody's vets do.

It looks like vets either use a combo of Atropine and ACE or Valium (not good for liver problems) and Ketamine. I would prefer that they would mask down with Iso but I know that that isn't gonna happen.
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Old 09-05-2007, 08:47 AM   #4
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Hmmmmm.... forget the masking down idea. I just found this article.

"Masking Down" a Safer Way to Anesthetize? Guess Again

It's no secret that most pet owners fear having their pets anesthetized for any reason, from a simple dental cleaning to life-saving surgery. And it would make perfect sense that we might think that the fewer drugs, the better in any anesthesia procedure. More drugs would mean more risk. It seems logical.

However logical it might seem, however, it's not true, and owners who refuse to use multi-drug anesthesia protocols, or veterinarians who opt not to use them, are doing a grave and potentially life-threatening disservice to those animals.

I'm referring here to the practice known as "masking down" or "gassing down" a pet, where the anesthesia gas, usually isoflurane, is given via face mask to get the cat or dog anesthetized enough to be intubated and then given a maintenance dose of the gas. This procedure was once believed to be easier on the pet, especially older or medically fragile pets, but nothing could be further from the truth.

There are a number of risks associated with "masking down" a pet, all of which are substantially reduced if a protocol of injectable induction agents is used instead.

First, you have to use a LOT higher dose to induce with gas than to maintain anesthesia, which increases the risk. We think we are using "less drug" this way, but we end up using a LOT more.

Second, the gas anesthetics are very potent vasodilators (they dilate the blood vessels), which means that they can send blood pressure plummeting, more so with the high doses needed to induce with it. This is very dangerous for any dog or cat, but much more so for pets with kidney or heart problems - the very pets some veterinarians reserve this procedure for! You also get more severe cardiovascular depression, with its obvious risks.

Furthermore, when you gas induce, you have no control over stage 2 anesthesia, which is the stage of involuntary excitement. You HAVE TO go through stage 2 to get to full surgical anesthesia (stage 3), but with gas inductions it lasts much longer. Stage 2 anesthesia is accompanied by catechol release, which is very hard on the heart; this effect is dose dependent, so again, the increased dosage substantially increases the risk. Arrythmias in particular are more likely to occur, risky for all pets but especially for senior pets or those with heart disease.

When you use gas to "mask down" the animal instead of inducing with injectable drugs, you have no way to get rapid control of the airway during the procedure. This increases risk, once more. In fact, the delay in getting control of the airway could be the difference between the animal surviving an adverse reaction, and being killed by it.

From the vet/staff's points of view, gas inductions expose THEM to waste gases and are hazardous. Improper venting and disposal of waste gases is a huge workplace safety issue for veterinary staff and not something that should be taken lightly.

Please do not use a vet who wants to mask down your pet, nor try to convince your vet to do it instead of using injectable induction. It is outdated, it's unsafe, it's bad for the pet AND the vet staff, and it's bad medicine.

Want more information and evidence?

"Induction of Anesthesia" by Peter W. Hellyer, DVM, MS, Diplomate, American Academy of Veterinary Anesthesiologists, Colorado State University

"Paradoxically, mask or box induction is frequently reserved for sick and compromised animals, the group that is least likely to tolerate the high concentrations of inhalant anesthetic required to induce anesthesia. .... Mask or box induction should be reserved for animals that cannot be approached otherwise (e.g., vicious cat), or that no acceptable injectable technique is available (e.g., birds, pocket pets, etc.). Mask or box induction is frequently stressful for the animal as demonstrated by a wide variety of excitatory reactions. Premedicating the animal prior to induction of anesthesia helps to decrease or eliminate the excitatory phase. Induction of anesthesia with just an inhalant usually requires fairly high doses, particularly if the animal needs to be deep enough for endotracheal intubation or surgery. Those high doses of inhalant anesthesia are deleterious to the cardiopulmonary systems, resulting in marked hypotension and hypoventilation. If no additional anesthetic drugs are used, depth of anesthesia may change markedly in response to changes in surgical stimulation or decreasing vaporizer setting. Mask or box induction increases the amount of waste gas pollution that employees are exposed to and may increase environmental pollution to unacceptable levels."

Veterinary Anesthesia Support Group
"Induction Protocols"
http://www.vasg.org/s_thru_u.htm

"Mask inductions are not recommended for most patient groups

Cautionary information

(a) Increased patient stress
(i) Increased arrhythmic risk

(b) Unnecessary staff exposure to anesthetic agents

(c) Time required for complete induction of anesthesia is longer than compared to IV agents.

(d) Prolonged period of unsecured airway with an increased risk of airway
compromise or obstruction

(e) High concentrations of inhalant agents are required to achieve mask induction. Higher doses produce more cardiovascular and respiratory depression than seen with comparable doses of IV induction agents.
(i) During intubation removal of the mask results in cessation of drug administration of the drug and recovery from anesthesia begins as the drug is eliminated.
(ii) Once intubated higher concentrations of inhalant are required compared to use of IV induction drugs.

(f) Contraindicated in brachycephalic patients"
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Old 09-05-2007, 09:03 AM   #5
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So I guess a pre-ISO injectable is the way to go??
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Old 09-05-2007, 09:09 AM   #6
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They are always calmed down before intubation . Without doing it , it would be impossible to intubate a dog , a cat or even a person .
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Old 09-05-2007, 09:12 AM   #7
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I am really not sure. I guess that is the only way to go if you don't mask them down. I think the concerning thing is what drug are they using pre Iso. What is the safest for Yorkies? I wish I had all the answers.
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Old 01-19-2009, 02:32 PM   #8
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I was just going through old threads and thought I'd bump this up to see if anyone has come upon the right answer yet.

For the record, Ellie was masked down last time.
It is supposed to be better for her liver (I think Dr. Tobias agrees).
I'm just not sure why there is a debate and I wish there was one good answer.
The decision on Ellie will be left up to her vet but this makes things very confusing. Some specialists say mask down and some say don't and it isn't a little issue either.
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Old 01-19-2009, 02:37 PM   #9
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Propoful is the best one I know of. I did tons of research on this before Feather had her spay surgery. Hope I spelled it right
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Old 01-19-2009, 02:42 PM   #10
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A vet on the Maltese forum I belong to wrote this for us to pin:

Anesthesia

there are different phases of anesthesia. there is a premedication, and induction medication, and a maintenance gas used for the whole procedure.

premeds goals are to relax the pet with a tranquilizer and begin pain control before the procedure is even started. they also reduce the amount of induction medications needed which may be harsher for your pet. there are a vast number of types of premeds so i will not go into detail.

induction medications allow your pet to completely relax and allow the veterinarian to intubate your pet. common medications are Ketamine/valium combination and propofol. ket/val should not be used in animals with kidney or heart problems and in animals prone to having seizures. propofol should not be used in animals with trouble breathing unless there are far worse risks with other medications.

maintenance gas anesthesia may be either isoflurane or sevoflurane. both are very safe. it was once thought that sevo was a superior gas but now it is known to be equally as safe as isoflurane. iso is cheaper and far more common. there are other gases out there but these are the two that can be trusted. my personal preference is isoflurane b/c sevo can lower the pets temperature during recovery from anesthesia and can be dangerous if the patient isnt watched carefully. but with proper care both are a good choice.
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Old 01-19-2009, 02:45 PM   #11
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Also I would make sure there is someone other then the vet monitiring ekg, pulse oximetry, apnea monitor, pain control and warming device such as a bair hugger. I paid lots of extra money for both her surgeries but it was worth it to me to be as safe as possible
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Old 01-19-2009, 06:52 PM   #12
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I know this is an older thread, but good for everyone.

I know my small animal vet tranqs them lightly, and then masks them with sevo. They have a great monitoring system complete with a warming jacket and warm water bed under the table to prevent temp drops. The great thing about the sevo and even iso I believe is they are awake within seconds of taking off the mask. They recover quicker from the anesthesia.

There are debates about it, but there are debates about everything in the veterinary field I guess I know the sevo is much easier on them internally, and mine (and most small animal vets around here) won't cut any small dogs or cats any other way.

Great thread Crystal.
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Old 01-19-2009, 07:56 PM   #13
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It just gets sooooo confusing because while sevo is said to be the safest (especially for the hear), aren't there less blood sugar issues with Iso or a lower seizure rate? Isn't it best for liver issues?

I know premedication is usually done with an injectable (subq or IV) but there are reports of being masked down with Iso for liver compromised dogs being better.

Now there are references to Iso being just as safe and way more common than Sevo. So who can you believe? I just give this one to the vet and she can do whatever she wants but it is frustrating.

Jeanietoo, I think a tech monitors during anesthesia. Preop blood work is done. An IV is placed. Surgery is done on a heated surface, pulse oximetry is used, etc. Not sure Ellie has ever had an EKG though. Although I bet the vet does heart monitoring continually during surgery. She doesn't cut corners at all.
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Old 01-19-2009, 08:39 PM   #14
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Quote:
Originally Posted by Ellie May View Post
It just gets sooooo confusing because while sevo is said to be the safest (especially for the hear), aren't there less blood sugar issues with Iso or a lower seizure rate? Isn't it best for liver issues?

I know premedication is usually done with an injectable (subq or IV) but there are reports of being masked down with Iso for liver compromised dogs being better.

Now there are references to Iso being just as safe and way more common than Sevo. So who can you believe? I just give this one to the vet and she can do whatever she wants but it is frustrating.

Jeanietoo, I think a tech monitors during anesthesia. Preop blood work is done. An IV is placed. Surgery is done on a heated surface, pulse oximetry is used, etc. Not sure Ellie has ever had an EKG though. Although I bet the vet does heart monitoring continually during surgery. She doesn't cut corners at all.
It's really hard and frustrating to even think about.

According to hubby- sevo is a cousin to iso. It is a newer dirivative of iso and supposed to be "the thing" to use now days. It is supposed to be easier on the body (at least that's how the drug companies market it to vets and there is a lot of research done on it) and it is true that masking them down is much easier on the liver. I guess the risk of intubation troubles is much less than the harm the pre-anesthetic can do to the liver. They have special cat boxes they use to mask ferral cats and unruly dogs, but the vets and techs have to be extremely careful upon opening the box because of the sevo inside.

I think you know and trust your vet like I do so I do just that- leave it up to them. I guess if I didn't have that type of relationship and I had an extremely liver-compromised dog I would really insist that they mask them down.

I copied this info from a pharmacology drug book. Granted this is from a human pharmacology drug book but it is a good review of the drug:

Sevoflurane is an ether inhalation general anaesthetic agent with lower solubility in blood than isoflurane or halothane but not desflurane. The low solubility and the absence of pungency facilitate rapid mask induction; the low blood solubility also expedites "wash-out' and therefore recovery from anaesthesia. Sevoflurane produces dose-dependent CNS, cardiovascular and respiratory depressant effects that generally parallel those of isoflurane. Sevoflurane is degraded by carbon dioxide absorbents to nephrontoxic (in rats) haloalkenes, although renal toxicity has not been observed in humans. Compared with other inhalation anaesthetics, negligible quantities of carbon monoxide are generated from degradation of sevoflurane by carbon dioxide absorbents. Sevoflurane has negligible airway irritant effects, which facilitates a "smooth' induction, even in comparison with halothane in paediatric patients, and makes sevoflurane especially amenable to rapid induction of anaesthesia in adults and children. Emergence, orientation an postoperative cognitive and psychomotor function recovery of paediatric outpatients is singnificantly more rapid from sevoflurane than from halothane anaesthesia. In adult inpatients and outpatients, emergence and orientation are significantly faster after sevoflurane than after isoflurane but not desflurane anaesthesia. Other recovery parameters (e.g. times to sitting, ambulation) occur at similar times after either sevoflurane or desflurane anaesthesia. Recovery of psychomotor function occurs at generally similar times after sevoflurane, isoflurane or desflurane. Compared with propofol, sevoflurane facilitates more predictable extubation times and significantly better postoperative modified Aldrete scores in outpatients, although cognitive and psychomotor recovery occurs at similar times for both agents. As a supplement to opioid anaesthesia during coronary bypass graft surgery or in those at risk for myocardial ischaemia, sevoflurane is comparable to isoflurane. Limited data suggest that it is also as useful as isoflurane for the maintenance of anaesthesia during neurosurgical or obstetric procedures. Sevoflurane is well tolerated by adult and paediatric patients during induction of anaesthesia, with a low incidence of mild airway complications (breath-holding, coughing, excitement and laryngospasm). During rapid induction, it is particularly better tolerated than isoflurane or halothane. Sevoflurane has a lower potential for hepatic injury than halothane. Unlike methoxyflurane, sevoflurane undergoes minimal intrarenal defluorination, which may account for the lack of fluoride ion-induced nephrotoxicity in humans, despite elevated plasma fluoride levels after its use. In summary, sevoflurane provides for a rapid and smooth induction of, and recovery from, anaesthesia. These features combined with its favourable cardiovascular profile should make sevoflurane the agent of choice for inhalation induction in adult and paediatric anaesthesia. Although further clinical evaluation will define the role of this agent relative to that of propofol and desflurane, sevoflurane should also prove to be a valuable alternative anaesthetic agent for adults in both outpatient and inpatient surgery.

There are some great peer-reviewed articles about sevo/iso at this link here:

PubMed Home

I am sure you know about PubMed but if not it's a wonderful source of peer-reviewed information for both veterinary and human medicine. You can't access the complete study but the overviews are fantastic and easy to follow.
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Old 01-20-2009, 07:24 AM   #15
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Amanda, does hubby want to become a member of YT???
We really need a vet here.

I thought masking was beter but then I read the articles I posted above and surgeons are saying no. Too high of a dose is required. Then you hear about the lower seizure rate (maybe not true) with Iso and think that that is better for the liver. In fact, I think Dr. Tobias uses Iso.

For Ellie, it is in the vet's hands. Whatever she wants to do because whatever it is is working and considered good by the "experts".

You wouldn't happen to know if dentals are ever done under sedation and local anes. rather than general, would you? I don't want to do anes. free because they just aren't as thorough but I wonder if a combination of sedation and nerve blocks could be used for a simple cleaning?

I do occasionally look at DVM Newsmagazine online. They give you whole articles for free.
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