Anesthesia and Analgesics

Kathy Stollberg-Zagar, BS,CVT, SRS.LATg Research Specialist Principle University Animal Care , University of Arizona
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What is Anesthesia?
The absence of sensation that affects with the whole body or an i l t d part isolated t or region i of f th the b body d Tranquilization and Sedation are frequently used in conjunction with anesthesia
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Types of anesthesia

General

Local

Regional

Topical
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Topical
A technique of applying substances to the skin to "deaden" the area Loss of sensation confined to the skin or mucous surfaces

Local
Local anesthetic (numbing medication) Injected into or around the area on which the surgeon is operating. Awake and alert. Drugs often have the suffix "caine"

Regional
Blocks pain in an area of the body, such an arm or leg. l
Example: p Epidural p anesthesia, , blocks nerve impulses from the lower spinal segments used during childbirth

General Anesthesia
Provides overall insensitivity and unconscious

What is an Anesthetic ?
A drug, g administered for medical or surgical g purposes, that: induces partial or total loss of sensation, provides a state of unconsciousness p provides loss of feeling g or awareness. May be topical, local, regional, or general, depending on the method of administration and area of the body affected

Types of Anesthetics
Neuromuscular blocking agents Sedatives Tranquilizers Barbiturates Dissociative Opiods Halogenated Anesthetics (inhalant)

Neuromuscular Blocking Agent

Block neuromuscular transmission at the neuromuscular junction causing paralysis of the affected skeletal muscles. Can be used as an adjunct to anesthesia t induce to i d paralysis l i f for i intra-abdominal t bd i l and d intra-thoracic surgeries

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Neuromuscular Junction

Global view of a neuromuscular junction:

1. Axon 2 Motor end 2. end-plate plate 3. Muscle fiber 4. Myofibril

Detailed view of a neuromuscular junction:

1. Presynaptic terminal 2. Sarcolemma 3 Synaptic vesicle 3. 4. Nicotinic acetylcholine receptor 5. Mitochondrion

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Tranquilizers
Blocks adrenergic receptors in the sympathetic nervous system Phenothiazine Benzodiazepine p Mild to moderate sedation Reduces anxiety in recovery Acepromazine/Phenothiazine Hypotension Diazapam, Zolapam/Bensodiazepine Bradycardia, Bradycardia apnea apnea, hypotension

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Barbiturates
Rapidly absorbed into the brain More M slowly l l di distributed t ib t d t to muscles l and df fat t Multiple dosed result in prolonged recovery time Thiopental p sodium, ,p pentobarbitol

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Dissociative
act by altering distribution of the neurotransmitter glutamate throughout the brain. brain Glutamate is involved in perception of pain responses to the environment pain, environment, and memory Respiratory R i t d depression, i cardiac di arrhythmias, hyper salivation, vomiting PCP, Ketamine
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Opioid
Stimulate specific Opioid receptors in the brain and spinal cord Receptors produce analgesia analgesia, euphoria and dependence, hypothermia and respiratory depression Morphine, Oxymorphone

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Halogenated Anesthetics
Agents vaporized in oxygen Administered via the breathing system and into the blood stream stream. Increase of inhibitory function and or d decrease of f excitatory it t transmission, t i i at t brain nerve endings. CNS depression, hypothermia, respiratory depression, hypotension Isoflurane, Sevoflurane
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Anesthetic Delivery System

Inhalant Injectable

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Routes of Administration
Intravenous (IV) Intramuscular I t l (IM) Intraperitoneal (IP) Subcutaneous (SQ)

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Accurate Weights
The weight of the animal must be accurately determined when using injectable anesthetic agents

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Injectable Anesthesia
Can be used alone or as an induction agent for inhalation anesthesia

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Advantages of Injectables:
Low cost of drug Minimal special p p post-operative p care Avoidance of undesirable complications Used for Restraint, Sedation or Analgesia

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Disadvantages
Some degree of animal cooperation is necessary Anesthetic period is relatively short Possible tissue damage at injection site Rapid absorption or inadvertent intravascular injection can cause life threatening reactions Metabolized by liver & excreted by kidneys

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Anesthetic Selection
Choosing the best anesthetic agent for the proceedure at hand

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Criteria for Anesthetic Selection

Procedure and duration Compatibility with experimental design Biological characteristics of the . selected species Prior experience with anesthetic in the . Species S i Available equipment equipment, personnel and . facilities
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Inhalation

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Inhalation Anesthesia
Agents administered via the respiratory tract Advantages:
- Can control and regulate depth of anesthesia - Eliminated by exhalation

Disadvantages:
- Need for specialized equipment to deliver anesthesia - Exposure to personnel

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Basic Elements of General Anesthesia

Unconsciousness U i Amnesia Analgesia Muscle relaxation Diminished Di i i h d motor t responses t to stimuli ti li Reversibility y
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How Do We Get There?

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Preanesthetic
1. pertaining to
preanesthesia. 2. an agent that produces preanesthesia. Acepromazine, atropine, diazepam p are examples. p 3. occurring before the administration of an anesthetic th ti

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Commonly Used Preanesthetic

Telazol Ketamine Propofol Isoflurane Rabbit mix
(C bi ti ) (Combination)

Induction
the administration of a drug or combination of drugs at the beginning of an anesthetic that results in a state of general anesthesia. anesthesia

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Types
Injectables Inhalants

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Anesthetic

Stages of Anesthesia in Animals

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Four Stages of General Anesthesia

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Stage I: Onset
Anesthetic administered: Disorientation Di i t ti Panting Normal heart rate Good muscle tone Reflexes present

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Stage 2: Excitment
Loss of consciousness Loss of eyelid reflexes Irregular I l b breathing thi Increased heart rate Good muscle tone Exaggerated reflexes

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Stage 3 Surgical Anesthesia

Loss of eyelid reflexes and most reflexes Depression of vital function Unconsciousness, U i relaxation l ti of f muscles l Diminished gag and blink reflexes Begin surgery preporation

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Stage Four: Danger

Depression of respiration Circulatory failure Start St t emergency Proceedures P d
Establish airway Emergency drugs Chest compressions/cardiac message

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Avoid Anesthesia Risks

Plan in advance to reduce risks if possible Continuous monitoring of patients vital signs before, during and after surgery I Individualize di id li th the anesthetic th ti regime i according to the species

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Step 1: Preparation (premedication)

Given prior to general anesthesia
Why? Wh ?

Tranquilizers: Diazepam/Ace Preanesthetic: Telazol/atropine Analgesics: Butorphanol, Rimadyl

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Step 2: Induction of Anesthesia

Purpose: Place the animal in an unconscious state. (benefits to the animal) Routes: Injectable, Inhalant (face mask)
(One or both)

Endotracheal tube placement

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Step 3: Maintenance of anesthesia

The animal is kept in a surgical plane of anesthesia (not ( t too t light li ht or t too deep) d ) Surgery occurs during this stage Continual monitoring of Vital signs by the anesthetist

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Step 4: Recovery

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Documentation of Surgical Procedure

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Recording Surgical Information

UNIVERSITY ANIMAL CARE University of Arizona, College of Medicine SURGERY RECORD DATE:______________ INVESTIGATOR: ____________________ DEPARTMENT: __________ IACUC PROTOCOL #: _________ PROJECT TITLE:_________________________________________________________________________ TITLE: SURGICAL PROCEDURE:__________________________________________________________________ SPECIES: __________________ BREED: ____________________ SEX: _________ WT: _____________ COLOR:____________ ID # _______________________ PRE-OP CONDITION: Membrane color: _______________________ Temp:_____________ P l Pulse: _____________________ R Respiration: i ti ___________________ PHYSICAL STATUS:_______________________________________________________________________ PREANESTHETIC: Agent: _______________ Dose: _______________ Time: _______________ Surgical Procedure:: INDUCTION: Agent: _______________ Dose: _______________ Time: _______________ ANESTHETIC: Agent: _______________ Dose: _______________ Time: _______________

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Anesthesia Record
Written record of all information
During D i Preparation, P ti Surgery, S &P Post-op t All drugs, g , dosages, g , routes of administation Fluid administration (route, amount, rate) Anesthesia flow percentage Monitoring of Vital signs:
Temperature, Respiration, p Heart rate

Visual Observation
Keep a close eye on the animals vital signs Monitor vital signs every five minutes Notice and report p p problems to the surgeon g when they begin to occur

Anesthesia Monitoring
Heart Rate and Rhythm y Blood pressure Respiratory (Breathing) Rate Body Temperature Oxygen of the tissues (CRT) CO2 & SpO2 Reflexes: Palpebral, Corneal, Toe Pinch
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Recovery Monitoring
Monitor patients vital signs until awake and sternal Patient may vomit or urinate Patient may ma shiver shi er Thrashing/Vocalization g

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Recovery Time
Animals with a large amount of body fat may take longer to recover Injectable anesthesia's have a longer recovery period than inhalation anesthesia

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Post-op Post op Recovery Observations

I Immediate di t Post P t Operative O ti Condition: C diti Membrane Color: _____________________ Temp: ______________________

Pulse: _______________________________ Respiration: __________________

Monitor animal until it is sternal

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Pain Management

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What is Pain?
Pain is a sensation that hurts. It may cause discomfort, distress or agony. It may be steady or throbbing. It may be stabbing, aching, or pinching. Pain can be an unpleasant sensory and emotional experience i associated i t d with ith actual t l or potential t ti l ti tissue damage. .
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Categories of Pain

Acute

Chronic

They both differ greatly. How?

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Acute Pain
Short duration(few days or weeks) Greatest G t t for f the th first fi t 24-72 24 72 h hours Serves as a protective mode

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Chronic Pain
Pain of longer duration (months or years) Does not serve as a protective function

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Types of Pain
Somatic: pain of the body Visceral: originated from organs Neuropathic: damage to the nervous system Deep:
Bones and joints tendons fascia and muscles

Superficial: Pains of the skin and subcutaneous

structure
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Pain Response Factors

Age g Gender Health status Severe Debilitation Individual Variation Species Variation
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Pain Assessment
Difficult to assess in animals Guarding or protecting an affected area (e.g., surgical
incision, implant site)

Vocalization: Squeaking, squealing, crying out, grunting,

growling, hissing, teeth grinding, whimpering or other forms of vocalization

Change in posture or an abnormal posture: Hunching,

huddling, crouching, being stiff or rigid, abdomen tucked, head d down, recumbent b t

Rough looking hair coat due to decreased or lack of

grooming activity

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Assessment cont.
Self-mutilation by licking, biting, scratching Change in personality such as being docile or aggressive, aggressive
anxious, dull, depressed, reclusive

Restlessness: frequent changing of positions such as

repeatedly lying down and getting up or pacing

Decreased activity, reluctance to move or other changes in

locomotion

Isolation from group

Loss

of appetite

Abnormal or increased respiratory pattern

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Pain Behavior
Pain is difficult to assess in animals because of the inability to communicate directly about what the animal is experiencing. Some animals experiencing p g mild to moderate pain might not display any signs of pain (i.e., natural prey response or reluctance to make its vulnerability known).

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Analgesics
Analgesia is the relief of pain.

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Administering Pain Medication

Important during the recovery period Give before &/or during surgery Usually given for several days after surgery Are the meds working? Pain can assumed to
be no longer present if signs disappear after the administration d i i t ti of f analgesics l i

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Guidelines for Analgesic Administration

Analgesics more effective when administered before the surgical incision is made Given in proper doses and according to the drugs time table F Federal d lL Law mandates d t th that t we use th the same guidelines as set for humans
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Selection of Analgesic Drugs

Use care when selecting when choosing the drug: Proper drug for the proper species Appropriate pp p dosage g and schedule for administration S Select l t analgesic l i needed d df for th the t type of f pain
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Dosages
According to animals weight Follow Package insert instructions/warnings Refer to a Formulary for Laboratory Animals

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Types of Analgesics
Non-Opiod:
Acetaminophen, Salicylates, Acetaminophen Salicylates NSAIDs . mild to moderate pain, Antipyretic, anti. inflammatory, anticoagulation - moderate to severe pain

Opioid Agonist
. pain

Mixed Opioid Agonist moderate to severe Opioid Antagonist used to counteract and
p and mixed opioid p agonist g overdoses . reverse opioid
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Non-Opioids p
Acetaminophen:
Tylenol

mild analgesic g , antipyretic py , no effect on platelet p function/bleeding time

Salicylates:

Aspirin, Magnesium salicylate, etc.

mild analgesic, antipyretic, anti-inflammatory, affects platelet function/bleeding time

Nonsteriodial anti-inflammatory drugs (NSAIDs):

Ibuprofen, Naprosyn, Carprofen, Ketoprofen, Flunixin meglumine (Banamine),
Ketorolac ( (Toradol) ) , Etodolac

potent analgesic, antipyretic, anti-inflammatory Effects to consider in some compounds: may affect platelet f function/bleeding i /bl di time, i h hepato- &/or &/ nephrotoxic, h i l less GI ulceration than NSAIDs
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Opioid Agonists
Morphine, Fentanyl, Hydrocodone, Codeine Effect against most visceral and somatic pain Usually used to treat severe pain May M b be used d with i h NSAID NSAIDs Mixed Opioid Agonist: Buprenorphine moderate to sever pain
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Opioid Antagonist
Naloxone naltrexone Naloxone, Prevent the body from responding to opiates and endorphins Weak p partial agonist g effects in compounds that are not pure antagonists
May yp produce some analgesic g effects Usually accompanied by dysphoria

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Neurogenic pain
Pain that arises from damaged nerves or amputation Difficult to Treat Rarely responds to analgesics Anti-depressants more effective (Amitriptyline) Anti-convulsants (Carbamazepine) or Anti-arrhythmics Anti arrhythmics (Lidocaine)
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Routes of Administration
Transdermal Injectable I j t bl Oral

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Transdermal
Fentanyl patches- (analgesic patch)

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Injectable
Butorphanol

Morphine

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Oral
Rimadyl Ibuprofen Ib f Aspirin Morphine

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Sedative
Depresses the central nervous system resulting in:
calmness, relaxation, l ti sleepiness, slowed breathing, and reduction of anxiety.

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Post-op Post op Chart

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Recording Post-op Information

Temperature p Treatments Daily observations Condition of surgical site Physical condition of patient Eating, drinking, defecating, urinating

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