PART TWO

VETERINARY ANAESTHESI-
OLOGY
 Out line
• Definition of anesthesia
• Types of anesthesia
– Local anesthesia
– Regional anesthesia
– General anesthesia
• Premedication
• Induction
• Maintenance
• Commonly used anesthetic agents
• application anesthesia
 Anesthesia
Anesthesia: is defined as total loss of sensa-
tion in a body part or the whole body, induced
by a drug or drug combination that depresses
activity of nervous tissue peripherally (local
and regional anesthesia) or centrally (general
anesthesia).
 Common terminolgies
• Analgesia- A diminished or abolished per-
ception of pain
• Hypnosis - Drug-induced sleep
• Narcosis - Drug-induced sedation or stupor
• A sedative- is a drug which relieves anxiety
so that it easier (rest or sleep). E.g.xylazine
• A tranquillizer (ataractic)- is a drug with a
predominant action in relieving anxiety with-
out producing undue sedation.
 Cont.

• Local anesthesia: is production of anesthesia in a

limited body area.

• Regional anesthesia: is desensitization of an area by

blocking a nerve or nerves to that particular area.

. General anesthesia: Is a state of unconsciousness

with absence of pain sensation over the entire body of
the animal with muscle relaxation.
 Importance of veterinary anesthesia

A. To alleviate pain and provide muscle relaxation.

B. Technical efficacy (to carry out ligation, suturing, inci-
sion).
C. To restraint (to avoid injury).
D. For safe transportation of wild and exotic animals.
E. Euthanasia-merciful killing by using general anesthetic
agent of increased dose.(dogs and cat)
F. For diagnostic procedures (radiological, ultra sono-
graphic and endoscopic examination).
 Local Anesthesia
• It enables us to carry out operation in standing posi-
tion.
• Techniques are easy and require easily available mate-
rials.
• Clinically useful LA includes:
– Novacain = procain hydrochloride
– Xylocain= lidocain hydrochloride and lignocaine
– Lidocaine 2%= the most frequently used (available
with adrenaline or alone)
 Cont….
Local anaesthetics may be used:-
 To provide total analgesia, allowing surgical
procedures on conscious or sedated animals.

 To control postoperative pain

 Local anaesthetics can cause vasodilation and

increase side effect of their toxicity.
 Methods of Producing local analgesia
1. Topical (surface) analgesia: is applying the
LA directly in to specific body parts. E.g.
• eye (conjunctiva)- Proxymetacaine may be
used on the eye (e.g. to allow removal of a
foreign body)
• onto mucous membranes (larynx, urethra,
nasal passages) - lignocaine gel or spray on
the mucous membranes (e.g. to facilitate en-
dotracheal intubation in (e.g. to facilitate en-
dotracheal intubation in cats).
 Cont………..
• ‘Splash’ blocks- LAs are flooded or dripped onto sur-
gical sites and wounds at the end of a procedure.
• Intrapleural blocks- Intrapleural administration of lo-
cal anaesthetics provides analgesia following median
sternotomy or intercostal thoracotomy. The drug is
generally instilled into the thorax through a thoracic
drain.
• Intra-articular or synovial blocks-LA(or opioids) are
instilled into the affected joint cavity following surgery.
Used commonly in horses to dx lameness
 Cont……….
2.Infiltration analgesia:-The intra dermal or sub der-
mal tissues are infiltrated by injection with a local
anesthetic agent.

 only for minor procedures, and normally sedation

and/or manual restraint are also required.

 Local toxicity may delay tissue healing. How??

 Cont….
 This method of application is common in cat-
tle and sheep and Can be done in 3 ways.
a. Line block e.g. inverted “L” block
b. Ring block
c. Field block
Direct infiltration: A local infiltration is made
over the entire length and depth of tissue that
is to be operated.
 Cont..
Inverted “L” block
• Two lines of infiltration are made
• Is useful method for flank laparatomy in cattle (open-
ing the abdomen via the flunk).

Field block
E.g. Injection at the base of the teat to remove.
 Cont…….
• To remove a digit we can deep the LA at metatarsal
area of the limb in a circular manner and called circu-
lar infiltration.
• Symptoms of toxic dose of LA:
– Depression of CNS
– Bradycardia
– Hypotension
– Convulsion
– Tremor
– Shivering
 Regional Analgesia

• Requires knowledge of topographic anatomy (the

nerve and site of injection).

• Injection is to tissue to surrounding the nerve.

• For producing regional analgesia needles of different

size and gauge is necessary.
 Advantageous over general anaesthesia b/c:-
 relatively simple technique
 general availability
 minimal apparatus, e.g. syringe, needles and
drug
 little risk of toxic side-effects
 safety
 Regional Anesthesia

Local anesthesia Regional anesthesia

Onset of Analgesia 1-5 min 5-20 min

Duration 30 min-1 hour 1-2 hour

Common application of regional analgesia/anaes-
thesia

1.cornual nerve block

2. Para vertebral block
3.retrobulbar block
4. Flank anaesthesia
5. Caudal epidural anesthesia
 1. cornual nerve block in cattle
Indication:
– Dehorning
– Horn injury
Injection site:
– The upper third of the temporal ridge, about 2.5 cm
below the base of the horn.
– The nerve is relatively superficial, about 0.7-1 cm
deep.
Anesthetic:    
– 2% lidocaine 3-5 ml
 Cont……
Onset of analgesia:
– 10-15 minutes
Duration of analgesia:
– approximately one hour
Variability:
– In adult cattle with well developed horns, a
ring block around the base of the horn may
be necessary
 Site for cornual nerve block

.
 Site of cornual block rostral view
note: site of injection and zygomatico-temporal nerve (1) as well as site of
captive bolt on euthanesia (x)
Cont……… lateral view
 Cont.
2. Para vertebral block
• The thirteenth thoracic nerve (T13), the
first, second and third lumbar nerves (L1,
L2 and L3) supply motor and sensory in-
nervations to the skin, fascia, muscle and
peritoneum of the flank.
• Indication–laparatomy, abosopexy, c-section
and rumenotomy
 Cont.
• For practical purposes with flank laparatomy,
blocking of the dorsolateral branch of L3 is not
generally necessarly considered and may be
contraindicated. Because if one has miscounted
the vertebrea, one may actually block L4,
which has nerve fibers which runs to the back
legs.
• Rumenotomy, 13T, L1
• C-section, 13T, L1,L2,L3
 Paravertebral block advantages over
flank infiltration
a. Uniform desensitization of the abdominal wall in-
cluding the peritoneum
b. minimal volume of anesthetic solution is used
c. absence of anaesthetic solution in surgical field
d. rapid onset of action
 3. Retrobulbar nerve block.
Indications
 intra-ocular neoplasia
 severe trauma
•Also called four point block (medial, ventral, lateral
and dorsal canthi)
•Enucleation—removal of an eyeball leaving adipose
tissue and muscle
•Extirpation-removal of everything within the orbit
– slightly curved 8-10 cm gauge needle
– 10ml lidocaine per site
 4. Flank anaesthesia (line block, T block or
inverted L7 pattern)
Indication
-To produce adequate analgesia by infiltration
at or around incision site.
- used following unsuccessful Para vertebral
block.
Advantage- is it’s simplicity.
dis adv- large volume of solution, local edema
and hemorrhage, distortion of tissue layers,
 Cont…….
poor analgesia of peritoneum, poor muscle re-
laxation, increased post-operative swelling and
increased risk of wound infection
Note that- needle is only inserted through skin
twice in entire infiltration.
 Spinal Anelgesia

• This involves injection of local analgesic agent in to

the spinal canal
• The injection can be made;
– Intrathecally ---in to spinal canal (subarachnoid
space)
– Epidural space
Two types of epidural analgesia
A.Caudal epidural analgesia
B.Cranial epidural analgesia
 cont…
 Caudal epidural anesthesia implies that motor control
of the hind legs is not affected.
indication-intra vaginal, intrauterine manipulation and
tail surgery
 Sensory innervations is lost from the anus, vulva, per-
ineum, the caudal aspect of the thighs.

 Tenesmus is relieved and obstetric straining is pre-

vented.
 Site for Epidural Injection

• Lumbosacral space------small animals

• Sacrococcygeal-------sheep and goat
• 1st intercoccygeal space-----cattle and equine
 General Anesthesia

• General Anesthesia encomposes: Analgesia, muscle

relaxation and unconsciousness (narcosis)
– These are known as the ‘Liverpool Triad’.
• This idea has been expanded to add
– Amnesia and suppression of reflexes (motor and
autonomic)
• Therefore, general anaesthesia can be defined as drug-
induced changes in behavior or perception with all the
above components attained
 Signs and stage of general anesthesia
• There are four stages.
Plane 1: is light anesthesia in which the reflexes are
corneal reflex, palpebral reflex, pupillary light reflex
and pedal reflex are still present
• Used for diagnostic procedure and minor operation

Plane 2:medium Anaesthesia. Sign of plane 1 is ab-

sent. Muscles are relaxed and most surgeries can be
conducted except abdominal surgery.
 Cont.
Plane3: deep anesthesia. No corneal and pedal reflex.
•Relaxation of abdominal muscles
•Inter costal muscles are relaxed
•Used in intra-abdominal surgery
•All reflex are absent except pupillary reflex

Plane4: too deep. All muscles including diaphragm and

inter costal muscles are paralyzed.
Pre anaesthetic assessment, selection of anaes-
thesia and patient preparation
 The state of health of the animal
 The complexity of the procedure to be performed.
 The experience of the surgeon (duration of surgical
activity)
 nature of the operation to be performed, i.e site, dura-
tion, route, dose, spp, age of the patient

 With holding of feed and water ---reasons

 Cont………….

– Small animals=to avoid vomition

– Equine= stomach may rapture
– Cattle= tympany—gas accumulation in rumen and
produce pressure on diaphragm

Recommended time for with holding of food and wa-

ter or fasting are summarized as follows.
Recommended time for with holding of food
and water
 Monitoring of anaesthetized animals

1. Assessment of circulation: to ensure blood flow to

tissue is adequate.
Method-HR, palpation of peripheral pulse and ausculta-
tion

2.oxygenation:to ensure adequate oxygen concentration

in the animal’s arterial blood.
Method- observation of visible mucus membrane and
capillary refill time(CRT).
 Cont…..
3. Ventilation: to ensure animal’s ventilation is
adequately maintained.
Method: RR, observation of thoracic wall
movement and auscultation of breathing
sounds.
 Anaesthetic drugs

 They can generally be subdivided into four and used

for:-
 Premedication (sedation)
 induction of general anaesthesia,
 maintenance of general anaesthesia,
 providing analgesia
Importance of Pre Anesthetic medications

 To calm the patient

 To reduce the total dose of anesthetic
 To reduce autonomic side effects
 To relieve pain
 To smooth the recovery period
 To reduce other side effects of Anaesthesia
 Cont….
Drugs Used For Preanesthetic Medication

 Antimuscarinics (anticholinergics, parasympathetic

antagonists; parasympatholytics, )
 Phenothiazines
 alpha-2 adrenoceptor agonist
 benzodiazepines
 opioids
 Antimuscarinics
• They are administered to prevent salivation
and decrease respiratory secretions
• Adverse effects
-Tachycardia
- Cardiac arrhythmias
 Pupillary dilation (mydriasis )
- Confusion and Dry mouth
 Common antimuscarinic agent
 Atropine
Most commonly used one
adminstered through-IV,SC,IM
 Dose-0.02-0.04 mg/kg over dose results nerve
system stimulation and seizures. The use of atropine
is limited in horses(mydriatic effect).
 In cattle it is contraindicated (decreases muscle tone
in the GIT because atropine causes secretions from
salivary and bronchial glands become more viscous
and thick).
 Cont……….
 Glycopyrolate
More potent than atropine sulfate
It is drugs of choice for horse and cat.
.Dose :0.005-0.01mg/kg Iv or IM
.Not cross BBB( no central effect)
 Phenothiazines
 group of drugs that provide tranquillisation, with se-
dation appearing at higher doses.
 The only member of this group in use in veterinary
anaesthesia is acepromazine (ACP).
Used for-
 Tranquillisation and sedation
 Cardiac anti-arrhythmic effects
 Anti-emetic effect
 Smooth muscle spasmolytic
Adverse effect- (Hypotension and Hypothermia)
 Cont……………….
• Dose- dogs is 0.01–0.05 mg/kg, by IM (prefer-
able), SC or IV routes.
Cats - 0.1 mg/kg by IM or SC ( more resistant
as compared in the dog for sedation).

Benzodiazepines
. Although not licensed for use in animals, uesd as vet-
erinary anaesthesia and intensive care.
 Used as-
 - Anti-anxiety effects (anxiolysis)
 Minimal effects on cardiovascular and respiratory
system
 Muscle relaxation
 Anticonvulsant effects
 Appetite stimulation
 sedation
 Dose- diazepam 0.2-0.5 mg/kg IV is used and
for midazolam 0.2 mg/kg IM/IV
 Alpha-2 adrenoceptor agonists
 bind to alpha-2 adrenergic receptors in the central and
peripheral nervous system.
 are potent sedative,premedication, hypnotics and
good analgesia (marked effect on CVS--healthy pa-
tient only).e.g. xylazine 1-3mg/kg
 Side effects- Profound cardiovascular effects, Milder
respiratory effects, Vomiting, Diuresis, Premature par-
turition
 Dose of xylazine in domestic animals

species Dose in mg/kg body

weight of animals
Dog and cat 1-3 (IM)
Horse 1.1 (IV), 3 (IM)
Shoat 0.11-0.22 (IM)
Cattle 0.05-0.3 (IM)
 Opioids
 The opioids are used in isolation for premedication
(usually in high risk’ patients),
 more commonly, they are combined with ACepro-
mazine as part of a neuroleptanalgesic
mixture(Better sedation) i.e. they are synergistic, and
effects on the cardiovascular and respiratory systems
are relatively mild
 Induction of Anaesthesia
 General anaesthesia may be induced by the use of in-
halational agents, or, more commonly, by the use of
injectable drugs.
 Injectable anesthetic drugs
 The thiobarbiturates have been used widely in prac-
tice as routine agents for anesthetic induction.
 Thiopental sodium and thiamylal sodium are com-
monly used 6.6 to 8.8 mg/kg.
 Guafenesin, used alone or in combination with thio-
barbiturates or ketamine, has become a common in-
duction agent.
• Guafensine is muscle relaxant effect and also pro-
vides some degree of analgesia.
 Cont………
 The dose of induction agent required is as much as
the patient needs, and no more’, i.e. anesthetic agents
should be given to effect. Thus, it is not possible to be
completely prescriptive about induction doses.

 - Injectables -by the IV, IM ( ketamine) and Other

routes can be also used
 Other common injectable induction agents

 Propofol
 Ketamine
 Ethomidate
 Methohexiton
 Maintenance of Anaesthesia

 In current veterinary practice, maintenance of general

Anaesthesia is most commonly accomplished by in-
halational agents.

• Inhalation anesthesia is the preferred method of main-

taining general anesthesia in the horse, especially
when procedures involve a total anesthetic time of
longer than an hour.
 Cont……………..
 The combination most commonly used is that of
halothane and oxygen.

 Halothane provides rapid induction and recovery, ad-

equate muscle relaxation, and easy monitoring of
anesthetic depth.
 Common inhalational anesthetics
Diethyl ether
 First anesthetic discovered
 Nontoxic to organs
 Unpleasant smell
 Decreases possibility of action potential by decreas-
ing rate of rise to an end-plate potential
 Cont……
Chloroform CH(Cl)3
 Colorless and odorless
 Hepatotoxin
 Severe CV depressant
– Cardiac arrhythemia
– Blocks flow of K+ out of the cell
 Cont….
 Isoflurane
 enhances inhibitory synapses
– Lets more Cl- into the cell
 Dog: 2.0-2.5% isoflurane concentration (in oxygen)
 Horse: 3.0-5.0% isoflurane concentration (in oxygen)
Can keep it on a low concentration throughout the
procedure
 Cont….
Sevoflurane
 Newer, more expensive than isoflurane
 Dogs: Induce with 7.0% sevoflurane
 Isoflurane is safer because patient does not require as
much anesthesia, can be kept lighter
– Higher cardiovascular stability