Veterinary anesthesia

Yasser Haidar Ahmad MD

Anesthesia

Definition
Greek term anaisthaesia meaning
insensibility, used to describe the
loss of sensation to the entire or any
part of the body.
Anesthesia is induced by drugs that
depress the activity of nervous tissue
locally, regionally, or within the
central nervous system

Reasons for Administering Anesthesia

First and foremost, anesthetics

alleviate pain and induce muscle
relaxation, essential for safe surgery.
Other important uses include
restraint, safe transportation of wild
and exotic animals, various diagnostic
and therapeutic procedures,
euthanasia, and the humane
slaughter of food animals.

Effects of anesthetic drugs

1. Analgesia: freedom from or absence of pain
2.Tranquilization: results in behavioral change
wherein anxiety is relieved and the patient
becomes relaxed but remains aware of its
surroundings. In this state, it may appear to be
indifferent to minor pain.
3. Sedation is a state characterized by central
depression accompanied by drowsiness. The
patient is generally unaware of its surroundings
but responsive to painful manipulation

4. Narcosis is a drug-induced state of deep sleep from which

the patient cannot be easily aroused. Narcosis may or may
not be accompanied by analgesia.
5. Hypnosis is a condition of artificially induced sleep, or a
trance resembling sleep, resulting from moderate
depression of the CNS from which the patient is readily
aroused.
6. Local analgesia (anesthesia) is a loss of sensation in
circumscribed body area.
7. Regional analgesia (anesthesia) is insensibility in a
larger,
though limited, body area (e.g., paralumbar nerve
blockade).
8. General anesthesia is drug-induced unconsciousness that
is characterized by controlled but reversible depression of
the CNS and analgesia. In this state, the patient is not
arousable by noxious stimulation. Sensory, motor, and
autonomic reflex functions are attenuated

9. Surgical anesthesia is the state/plane of general

anesthesia that provides unconsciousness, muscular
relaxation, and analgesia sufficient for painless surgery.
10. Balanced anesthesia is induced by multiple drugs.
Drugs are targeted to specifically attenuate individual
components of the anesthetic state; that is,
consciousness, analgesia, muscle relaxation, and
alteration of autonomic reflexes.
11. Dissociative anesthesia is induced by drugs (e.g.,
ketamine) that dissociate the thalamocortic and limbic
systems. This form of anesthesia is characterized by a
cataleptoid state in which the eyes remain open and
swallowing reflexes remain

Types of Anesthesia
1. Inhalation: anesthetic gases or
vapors are inhaled in combination
with oxygen
2. Injectable: IV, IM, SC
3. Oral or rectal: liquid and
suppositories
4. Local: anesthetic drug is applied
topically, injected locally around the
surgical site

pharmacology
Anesthesia is of necessity a reversible process.
Knowledge of the factors underlying production
of anesthesia and those that modify it is
essential.
The dose of anesthetic and the techniques for
its administration are based on the average
normal healthy animal
Variation in response to standard dose result of
factors related to CNS, metabolic activity
existing disease or pathology and the uptake
and distribution of the anesthetic.

Biological variation
Pharmacogenetic differences
Pharmacokinetics
Factors modifying pharmacokinetics
Cellular effects and teratogenicity

Biological variation
Elimination of anesthetics depends on the species and the
metabolic processes within the animal.
Small animals have a higher basal metabolic rate per unit
of surface area than large animals. The smaller the animal
the larger is the dose
Animals with large quantities of fat have low metabolic rate
and require less anesthetic.
Animals in poorer condition requires less anesthetic
In newborns, the basal metabolic rate is low
Response to barbiturates varies in dogs of differing ages.
Very young and adult are most sensitive whereas those of
age range 3 to 12 months are least sensitive
Conflicting evidence regarding sex difference

Pharmacogenetic
differences
Variation in the dose response to drug
because of genetic related factors.
the heritable difference in the ability of
rabbits to hydrolyze atropine and cocaine.
genetic variations in response to
pentobarbital in mice
Some breeds of swine are susceptible to
malignant hyperthermia
Plasma cholinesterase deficiency

Pharmacokinetics
General anesthesia is produced by the action of an
anesthetic on the brain and spinal cord. The agent
must therefore achieve access to the central nervous
tissue
Inhalation anesthetics are eliminated primarily by
exhalation. Thus, providing respiration and circulation
are maintained, inhalants are readily eliminated from
the body
Injectable agents depend on redistribution within the
body, biotransformation in the liver and excretion via
the kidneys
Less control over the elimination process with
injectable anesthetics. for this reason, some consider
them to be more dangerous than inhalant anesthetics

 Anesthetics are commonly administered by

intravenous injection
Intravenous administration bypasses the absorption
phase of the drug with the consequences that onset
and intensity of action are less variable
The body have multiple compartments differentiated
by blood supply and tissue-blood partition coefficient.
After initial IV injection mixing and dilution occur and
initial blood concentration of the drug is established
Binding of drugs to plasma protein, in which form they
cannot readily penetrate cellular membranes, and the
removal of drugs by tissues that store, metabolize, and
excrete them are both important factors that lower the
effective concentration of drugs at their site of action.

 The fraction of bound drug increases with

decreasing drug concentration and vice versa.
The drug is distributed to various tissue according
to their perfusion, their capacity for drug and the
partial pressure gradient between blood and tissue
The vessel rich group of tissues achieves
equilibrium with the blood more quickly than do
other group of tissues
Although fat and muscle have same blood flow, the
higher solubility of anesthetic in fat than in muscle
accounts for the greater time required to achieve
equilibrium for fat than for muscle.

 As the plasma concentration falls anesthetic reenters the

blood from the vessel-rich tissue to be redistributed from
the brain to muscle and fat and lightens anesthesia.
The ultimate effect of any general anesthetic is
contingent to its ability to cross the blood-brain barrier
Limits the penetration of nonlipophilic, ionized, or
protein-bound drugs.
Within moment of tissue uptake and redistribution
elimination of the drug begin. The liver is the primary site
of biotransformation, whereas the kidney is primarily
responsible for excretion
The liver is the primary site of biotransformation and
converts most anestheticcs from lipophilic nonpolar to
polar water-soluble derivatives capable of excretion by
the kidneys

Factors modifying pharmacokinetics

Concentration and rate of injection: the more dilute and
slower injection the less is the effect
Modification of cardiac output, ventilation,
ventilationperfusion ratios, and/or alveolar-capillary
diffusion from any cause will influence both the uptake and
elimination of inhalant drugs, most especially those of
greater solubility.
Variation in distribution of blood to the vessel rich and
vessel poor tissue. In shock, the proportion of the cardiac
output flowing to the brain is increased, and the potential
for redistribution is reduced. dilution of the drug is also
diminished, as is hepatic and renal blood flow .Induction is
thus rapid, the dose required is reduced, and recovery is
delayed.

 Fear, struggling or fever increase CO , decrease circulation

time and prolong the time necessary for equilibration of
inhalant anesthetic concentration between alveoli and
pulmonary capillaries. Muscle and skin blood flow is
increased, induction of inhalant anesthesia is delayed, and
more anesthetic is required. animals showing a period of
excitement during induction of inhalant anesthesia always
require more anesthetic. Preanesthetic sedation is often
advantageous.
a large meal of meat may increase the metabolic rate of
dogs as much as 90% above the basal level. It is usually
12 to 18 h after the last meal before the basal metabolic
rate is attained in carnivorous animals.
Nitrous oxide increases pressure and volume in compliant
spaces.
Drug interaction: antibiotics and muscle relaxant

 Most noninhaled drugs are weak acids (barbiturates) or weak

bases (narcotics, narcotic antagonists, and muscle relaxants).
Once the drug is injected, equilibrium between ionized and
nonionized forms of drug depends on the pH of the blood or
tissues and the dissociation constant (pKa ) of the drug. Plasma
acidosis, for instance, increases intracellular barbiturate but
decreases intracellular narcotic concentration.
Drug availability at the site of action or of elimination is also
modified by the degree of protein binding. Protein binding is
diminished by uremia, hypoproteinemia, dehydration
administration of various drugs can either stimulate or inhibit
hepatic microsomal drug-metabolizing enzymes
Hepatocellular disease causes reduced protein (primarily
albumin) Production and may delay drug biotransformation.
Renal disease
Hyperthyroidism is accompanied by an elevated metabolic rate
and may increase anesthetic requirement, whereas
hypothyroidism is generally accompanied by a lowering of the
metabolic rate and a reduced anesthetic requirement

teratogenicity
First trimester of pregnancy
Exposure of rats to nitrous oxide on
day 9 of gestation has been shown to
cause fetal resorption and skeletal
and soft tissue anomalies
Inhalational anesthetics and chicks

Assessment of Anesthetic
action
General Anesthesia requires:
1. Unconsciousness
2. Insensitivity to pain
3. Muscle relaxation
4. Absence of reflex response
. The degree to which these are required for specific procedures
varies. Anesthetists must therefore select the most suitable drugs
and be able to assess the degree to which the varying effects are
induced.
. Different species has different response to similar anesthetic
dose
. the progressive changes produced by the administration of
anesthetic drugs have been classified into four stages.
Recognizing the signs characteristic of these stages enables
anesthetists to determine whether the required CNS depression
has been achieved or whether it is insufficient or too much.

Stages of General
Anesthesia
Stage 1 or stage of voluntary movement
Last from initial administration to loss of
consciousness
Most variable
Animal may struggle violently and hold their breath
Rapid heartbeat and pupillary dilatation
Salivation is frequent in some species, as are
urination and defecation.
With the approach of stage II, animals become
progressively ataxic, lose their ability to stand, and
assume lateral recumbency.

Stage 2 or stage of delirium or involuntary movements

Loss of all voluntary control marks the change from stage I.
Lasts from loss of consciousness to the onset of regular
pattern of breathing
Patients react to external stimuli by violent reflex
struggling, breath holding, tachypnea, and hyperventilation.
The larynx of cats and pigs is very sensitive at this stage,
and stimulation may cause laryngeal spasms.
Eyelash and palpebral reflexes are prominent. Nystagmus
commonly occurs in horses. Pupils widely dilated
Whine, cry or bellow
Salivation , vomiting or regurgitation in ruminants
In view of the exaggerated reflex responses during this
stage, stimulation of any kind should be avoided

Stage 3 stage of surgical anesthesia

Characterized by unconsciousness with
progressive depression of the reflexes.
Muscular relaxation develops, and ventilation
becomes slow and regular.
Vomiting and swallowing reflexes are lost
In human divided into planes 1 to 4
Light medium and deep
If CNS depression is allowed to increase further,
patients will progress to stage IV

Stage 4
In this stage, the CNS is extremely depressed and respiration cease
Blood pressure is at the shock level, capillary refill of visible mucous
membranes is markedly delayed, and the pupils are widely dilated.
Anal and bladder sphincters relax
Death quickly intervenes unless immediate resuscitative steps are
taken.
If the anesthetic is withdrawn and artificial respiration is initiated
before myocardial collapse, these effects may be overcome and
patients will go through the various stages in reverse.
The stages just described are best seen when inhalant anesthetics
are administered, probably because considerable time is required for
an anesthetic concentration to accrue in the CNS. This allows the
various signs to become apparent.
With some intravenous anesthetics (e.g., dissociatives) or the
concurrent use of preanesthetic sedatives, anesthetic-induced
depression is difficult to assess, and signs of anesthetic depression
are not uniformly apparent.

Signs of anesthesia
1.
2.
3.
4.

Respiration
Circulation
Ocular signs
Pharyngeal and upper airway
reflexes

respiration

Increase during stage 1

Irregular in stage 2 with breath holding
Once again regular in stage 3
surgical manipulation stimulates respiration,
whereas premedication depresses it
During stage III, the intercostal muscles and
the diaphragm weaken progressively.The
depth of respiration declines progressively,
thoracic movement decreases, respiration
becomes largely or entirely abdominal

circulation
Indirect methods of blood pressure monitoring
veterinarians often do not measure pressure, but must
depend on the pulse rate or bleeding at the surgical site,
and on induction of momentary blanching by compressing
an exposed mucous membrane (such as the conjunctiva,
oral mucosa, or tongue) to give some indication of the
circulatory status of patients.
The mucous membranes may show pallor as a result of
hemorrhage or shock and cyanosis caused by hypoxia
In rodent feet and ears are observed
Pulse is strong in stage 1 and 2
Pain stimulation in light stage III may induce tachycardia
Blood pressure decrease and pulse weakens as the
anesthetic depth increase

Ocular signs
include eyeball position and movement, photomotor
reflexes and pupillary size, lacrimation, and palpebral,
corneal, and conjunctival reflexes.
Variable in most species and should never replace
observation of respiratory and circulatory signs.
in horses nystagmus occurs with the onset of stage II and
continues through light surgical anesthesia
The palpebral reflex becomes sluggish in all species when
surgical anesthesia is attained
Lacrimation is a sign of light surgical anesthesia in horses
corneal reflexes is variable, but is usually lost shortly after
the palpebral reflex. In horses, the corneal reflex persists
into deeper anesthesia.

Pharyngeal and upper-airway

reflexes
Suppression of these reflexes is of particular
importance for endotracheal intubation and for
induction of anesthesia in animals, such as
ruminants, with full stomachs.
Coughing and laryngospasm in response to intubation
are lost in light surgical anesthesia
The intensity of these responses varies with the
animal species concerned: especially intense in the
cat, and relatively mild in cattle and horses.
swallowing and vomiting disappear with stage 3 onset
like the laryngeal reflexes, the swallowing reflex
persists into medium anesthesia in cats.

Anesthesia recovery
As anesthetic drugs are eliminated from the CNS, the
degree of anesthesia lightens and reverse progress
through the stages of anesthesia occurs.
Induction techniques are usually selected and performed
to minimize the duration of stage II, in which excitement
and motor activity may occur
During recovery, however, stage II can be prolonged.
Every effort should be made to avoid stimulation of the
animal at this time
Short acting anesthetics and postoperative sedation can
minimize recovery delirium.
effective anesthesia is not only that which just obliterates
a patient's response to painful stimuli without excessive
depression of vital functions, but also that from which
recovery is relatively rapid and uneventful

Preanesthetic evaluation
The purpose of the preanesthetic patient
evaluation is to determine a patient's physical
status: Disease, pain and stress
The goal is to determine any deviations from the
norm that will affect anesthetic uptake, action,
elimination, and safety.
CNS cardiopulmonary, hepatic and renal
Aid to selection of anesthetic technique
the sicker a patient (the poorer the physical
status) is, the greater is the likelihood of adverse
events or death.

Physical status is determined by:

A. History: previous and current health; presenting
complaint, its severity, and its duration;
concurrent symptoms of disease (e.g., diarrhea,
vomitingexposure to drugs; prior anesthetic
history; and recent feeding.. the possibility of a
full or distended stomach or of hepatic or renal
disease, and the prior or concurrent
administration of drugs
B. Inspection: attitude condition stress
C. Palpation, auscultation
D. Laboratory :radiographs Laboratory tests should
be done on the basis of the physical exam and
history

Classification of physical
status
Following examination, the physical status of
the patient should be classified as to its general
state of health according to the American
Society of Anesthesiologists (ASA) classification
and the information recorded
should be done in the owner's presence, if
possible, so that a prognosis can be given
personally. This allows the client to ask
questions and enables the veterinarian to
communicate the risks of anesthesia and allay
any fears regarding management of the patient.

I. Normal healthy: castration

II. Mild systemic disease: fracture
III. Severe systemic disease; fever,
dehydration anemia and cachexia
IV. Systemic disease that is a constant
threat to life: uremia toxemia
V. Not expected to survive 1 day
without operation: extreme shock
and dehydration

Pain
Warms animal of potential tissue damage
Nociception: noxious mechanical, chemical or thermal
transduced into electrical signs by pain receptors,
nociceptors
Transmitted to the spinal cord and projected to the brain
Chronic pain can be responsible for long-term structural
changes within the CNS, leading to the development or
modification of memory patterns that change animal
behavior
visual analogue scale (VAS): A trained observer rates pain
along a 10-cm line from no pain to worst possible pain and,
based on this rating, prescribes appropriate therapy.
initiating therapy before pain is initiated (preemptive
therapy).

Stress
severe or chronic pain is responsible for temporary
periods of dramatic increases in sympathoadrenal
and neuroendocrine activity, which is commonly
referred to as the stress response
Distress, an exaggerated form of stress, is present
when the biological cost of stress negatively affects
the biological functions critical to survival
behavioral changes, including hyperresponsiveness,
hyperarousal, vigilance, and agitation
changes in an animal's behavior may be the most
noninvasive and promising method to monitor the
severity of an animal's pain and associated stress

Patient preparation
it is best to have patients off feed for 12 h previously.
Birds, neonates and mammals may become hypoglycemic within a
few hours of starvation
Induction of anesthesia in animals having a full stomach should be
avoided : Aspiration risk
Distension of the rumen in sheep and larger ruminants has been
shown to impair ventilation, with consequent hypoxemia and
hypercapnia
many older animals suffer from renal disease. water is usually
offered up to the time that preanesthetic agents are administered.
Systemic antibiotics 1 or 2 h before anesthetic induction
Fluid for dehydrated animals
Anemia and hypovolemia should be corrected by administration of
whole blood or blood components and balanced electrolyte
solutions.

 Oxygen administration by nasal catheter or mask if the

patient will accept it : Animals with upper-airway
obstruction by masses or abscesses, pneumothorax,
hemothorax, pyothorax, diaphragmatic hernia, and gastric
or rumen distention are often in a marginal state of
oxygenation
a tracheotomy may be performed under local anesthesia
inotropes, antiarrhythmic drugs, and diuresis should be
made prior to anesthesia for patients with decompensated
heart disease
it is desirable to encourage defecation and/or urination by
giving animals access to a run prior to induction
In cases of hepatic or renal insufficiency the mode of
anesthetic elimination should receive strong
consideration, with inhalation anesthesia preferred.

 During anesthesia, patients should, if possible, be

restrained in a normal physiological position. Complications
include hypoventilation, nerve and/or muscle damage, and
impaired venous return. Horses are especially susceptible to
myopathy and/or neuropathy
a periodic change in position may be beneficial during long
surgical procedures.
In all species, the head should be extended to provide a free
airway and to prevent kinking of the endotracheal tube
In ruminants, it is desirable to have the head tilted down to
enable drainage of saliva
On induction, if active regurgitation begins with large
volumes of ruminal contents flowing into the pharyngeal
cavity, pressure should be applied immediately by
externally grasping the esophagus dorsal to the trachea to
prevent further flow

 an endotracheal tube can be inserted

into the esophagus and the cuff
rapidly inflated, directing the flow
through the tube away from the
laryngeal opening while an
endotracheal tube is properly placed
to protect the airway from
contamination.

Selection of an
Anesthetic
The ideal anesthetic is one that
1. Does not depend on metabolism for its
termination of action and elimination
2. Enables rapid induction, quick alteration in
anesthesia depth, and rapid recovery
3. Does not depress cardiopulmonary function
4. Does not irritate any tissue
5. Is inexpensive, stable, noninflammable, and
nonexplosive
6. Requires no special equipment for administration

No anesthetic drug possesses all of these

qualities. Therefore, selection of an anesthetic
is a compromise based on appraisal of the
situation. Factors to be considered include
1. The patient's species, breed, and age
2. The patient's physical status
3. The time required for the surgical (or other)
procedure, its type and severity, and the
surgeon's skill
4. Familiarity with the proposed anesthetic
technique
5. Equipment and personnel available

 veterinarians will have greatest success with drugs

they have used most frequently and with which they
are most familiar.
short procedures are done with short-acting agents,
such as thiobarbiturates, propofol, alphaxalone-CD,
and etomidate, or with combinations using
dissociative, tranquilizing, and/or opioid drugs. Where
longer anesthesia is required, inhalation or balanced
anesthetic techniques can usually be safely used.
Species differences may prevent the use of some
drugs procaine is frequently lethal for parakeets and,
in high doses, morphine can be excitatory in cats

 Brachycephalic dogs, because of their pendulous soft

palate and restricted respiratory passages, may have
difficulty in breathing even when awake. This is
particularly true in hot, humid weather. During
anesthesia, the degree of airway obstruction is
compounded, and these animals often have severe
respiratory strider unless a patent airway is maintained
via endotracheal intubation.
It is wise to use short-lasting agents that are rapidly
eliminated (e.g., propofol) so that a prolonged recovery
period is avoided and patient control of the airway
recovers rapidly.
the anesthetic protocol should be one that provides
convenience to the surgeon so that the procedure can
be completed efficiently, insures patient comfort, allows
for appropriate monitoring, and can be administered
with confidence by the veterinarian

Record Keeping and

Monitoring
For every mistake that is made for not knowing, a hundred are
made for not looking.
the hazard of death can never be eliminated completely; it can,
however, be minimized, particularly if one is willing to investigate
and to learn from mistakes
items that should be recorded are
1. Species, breed, age, gender, weight, and physical status of the
animal
2. Surgical procedure or other reason for anesthesia
3. Preanesthetic agents given
4. Anesthetic agents used and method of administration
5. Person administering anesthesia (veterinarian, technician,student)
6. Duration of anesthesia
7. Supportive measures
8. Difficulties encountered and methods of correction

 Minimally, the pulse and respiratory

rate should be monitored at 5-min
intervals and charted at 10-min
intervals
The aspects of anesthetic
management that deserve careful
attention include patient circulation,
oxygenation, and ventilation.

Aftercare
In brachycephalic breeds or in animals in which respiratory
function is compromised, an endotracheal tube should remain in
place until upper-airway reflexes and jaw movements return
Care is necessary to assure freedom of the airway from blankets
or paper
Predisposition to postoperative respiratory failure may result from
continuing drug-induced respiratory depression, postextubation
spasm or glottic edema, other respiratory obstructions, diffusion
hypoxia, and persistent hypoventilation and/or atelectasis during
anesthesia
if necessary, supportive respiratory therapy should be initiated.
Under no circumstances should an anesthetized animal be placed
in the same cage with a conscious one. Cannibalism has been
known to occur
It is unwise to send anesthetized animals home